Birth: Medical Event or Natural Process?

Imagine if you will, a woman who has just discovered she’s pregnant. If she lives in the United States, one of her first thoughts will likely be that she has to make an appointment with her obstetrician.

From that first appointment the woman usually acquiesces to test after prenatal test throughout the pregnancy. She will likely accept a plethora of interventions throughout her labor and birth that in many cases are, at the very least, uncomfortable or stressful (or both), and in some cases painful. She may be facing a fear of the unknown with courage henceforth unknown to her. She does so for the sake of her baby. She sacrifices privacy, and in some cases dignity, because she believes it will keep her child safe and herself healthy.

What if the vast majority of women and babies are delivered safely because birth is a reasonably safe, healthy, physiological function of the mammalian body? In other words, what if the end result could be the same in a way that focused on the joy and wonder of the process of procreation…not on every possible thing that could, but is not likely to, go wrong?

In the U.S. today, most people assume that medically managing birth makes it safer. It is widely accepted that the interventions in pregnancy and birth serve a purpose…in effect, that they are safe and effective. Does the evidence support these beliefs?

To assess whether birth is safer medically managed as opposed to expectantly managed, I believe we must first examine how obstetricians became the primary caregiver for birthing women. As an experienced childbirth educator, I’ve discussed this with parents, and without exception, the belief has been that birth originally shifted from a midwife monitored event at home to a medically managed hospital occurrence due to safety reasons. That is an erroneous assumption.

According to The Official Plan to Eliminate the Midwife: 1900-1930 (Gibson, n.d.), at the time that birth moved to the hospital, there was little doubt that midwifery was the safer option. Through early professional journals such as Transactions for the Study and Prevention of Infant Mortality (1910 – 1915) we have a unique glimpse into history. She quotes Dr. Ira Wile as saying in 1911, "In NYC, the reported cases of death from puerperal sepsis occur more frequently in the practice of physicians than from the work of the midwives’"(as cited in Gibson, 2006, Part I), and she attributes the following to a Dr. Levy in 1917, "Of the babies attended by midwives, 25.1 per 1000 ... died before the age of one month; of those attended by physicians, 38.2 per 1000 .... died before the age of one month; and of those delivered in hospitals, 57.3 per 1000 died before the age of one month. These figures certainly refute the, which Gibson obtained through Stanford University Medical Library, charge of higher mortality among the infants whose mothers are attended by midwives, and instead present the unexpected problem of explaining the fact that the maternal and infant mortality for the cases attended by midwives is lower than those attended by physicians and hospitals" (ibid.). This, despite the fact that 80 years prior, Dr. Ignaz Philipp Semmelweis had admonished physicians for not washing their hands before attending women after handling cadavers, which he suspected was one reason for their high rate of childbed fever, and subsequently higher mortality rate (CDC, 2001). He was ridiculed.

Midwives would have had no idea their vocation was systematically being eliminated to provide “clinical material”…pregnant women…to obstetricians (as cited in Gibson, 2006, Part II). Even if they had known they couldn’t have done a thing about it. Women didn’t have the right to vote.

Since that time, there has never been a definitive study showing medically managed birth with obstetricians to be safer than expectantly managed birth with trained midwives, though there have been those that have tried (Pang, 2002). The conclusions and methodologies, however, have been called into question (MacCorkle, 2003; Vedham, 2003; Citizens for Midwifery, 2002; Gibson, 2006; Strong, 2000, pp. 222-223). In fact, Jock Doubleday (Doubleday, 2005) has been offering progressively larger amounts of money, with $50,000 being the last offered in December of 2005, for anyone who can provide such a study. The reward has stood unclaimed since he first offered it in 1998.

Childbirth is safer than it was 100 years ago (Johanson, Newburn, & Macfarlane, 2002). Undoubtedly, it is safer to give birth in the U.S. than it is in many places throughout the world. However, to assume that if obstetricians now attend birth, then improved outcomes must be due to that development alone is a fallacy that does not take into account improved nutrition, sanitation, disease control, birth control or any number of other variables. It is a spurious correlation. There are many contributing factors to improved health and well-being in the childbearing year (Wagner, 1994). In fact, countries that enjoy the modern advancements mentioned above in addition to midwifery care have the best outcomes in the world (Strong, 2000), and “…there is never a doctor in the room” (Wagner, 1994, pp.124). Where exactly does modern obstetrical management place the U.S. in comparison to the rest of the world? There are 42 countries with lower infant mortality rates (Central Intelligence Agency, 2006) and 29 countries where fewer mothers die (World Health Organization, 2004, pp.23).

While this may be surprising to some, certainly, it is not to suggest that the practice of obstetrics is unnecessary. We need surgeons and experts in pathology for a small number of cases that might be deemed high risk, such as mothers who have pre-existing medical conditions or mothers with addictions. The evidence suggests that number should be a very small percentage (Johnson & Daviss, 2005; Declercq, Skala, Corry, Applebaum, & Risher, 2002).

In essence, the system under which the U.S. currently operates might be like hiring a cardiologist as a personal trainer. Could heart attack deaths be reduced by having surgeons immediately available in the event that a normal, but strenuous, activity turned tragic? It’s very likely. However, would a game of tennis be imminently more difficult, if not impossible, if mobility were restricted by an assortment of electrodes and devices strapped to the player to assess every biological function and make the job of the cardiologist easier?

If this seems like an absurd analogy, consider this: the image that most of us have of birth is of a woman in bed, usually on her back, pushing out her baby, possibly with her feet in stirrups, or her legs being pulled toward her ears by herself, her partner or a nurse. Now, look at the following two pictures. The picture on top is the reproductive anatomy of an upright female. The picture on bottom has been turned as if the model were on her back.

Free clip art from http://www.arthursclipart.com/medical/reprobw.htm

The path the baby follows is called the ‘curve of Caras’. It becomes apparent in the second picture that, on the back, the mother would be pushing her baby uphill. Why? Is there some physiological reason that mothers are expected to lay on their backs? No. The reason mothers are restrained to bed is so that the monitors can be hooked up and so that the doctor can sit comfortably at the end of the bed.

Women are told throughout pregnancy to avoid laying on their backs because oxygenation to the uterus can be impeded by the weight of the baby resting on the vena cava (major blood vessel). Does the position suddenly become safe in labor? No. This position is detrimental to babies, and it creates pain for the mother because the weight of the baby rests on her tailbone (Lamaze, 2005). The position also makes the pelvic outlet considerably smaller by resting the mother’s weight on the tailbone, this flexing it inward. It makes the final stage of labor much harder than it needs to be. It almost guarantees the perineum (area between the vagina and anus) will tear (Walsworth & French, 1998). Therefore, episiotomies are done to prevent tears. This means healthy perineal tissue is cut to prevent tears that would be unlikely to occur if the mother were not in a position that creates conditions for tears. Does it work? Think about it. If you try to rip a piece of whole fabric, it remains strong. If you first cut the fabric a tiny bit, it rips easily. The same is true of the human flesh. Fourth degree lacerations (where the perineum rips through to the rectum) happen almost exclusively with episiotomies (Goer, 1995).

All of this so the baby could be continuously monitored, and for the convenience of the provider, without any regard for how it impedes the process of birth, the danger it introduces into the process, or the comfort of the mother. It is not supported by evidence as safe, is not backed by common sense or evidence as effective for, well, anything. Yet it is a nearly universal intervention.

At this point, it might be argued that by constantly monitoring the baby, we can avert a terrible tragedy by knowing moment by moment what the state of the baby is. Except that what the evidence says is that the routine use of continuous electronic fetal monitoring does nothing but increase the rate of surgical birth without any improvement in outcomes (Goer, 1995; Wagner, 1994).

The act of giving birth becomes more difficult, and in some cases impossible, due to the assortment of wires and devices meant to assess every biological function.

Each obstetrical intervention was created for a specific medical indication for which, when used appropriately for that indication, it is effective. Unfortunately, instead of being used selectively in exclusively pathological (abnormal) situations, many interventions are used routinely within a healthy population, in part due to the litigious environment in which physicians must operate (Carpenter, 2004).

The following graph (Wildner, 2006) illustrates some of these. It shows the percentage of women who will experience the selected interventions under different caregivers, with no substantial difference in outcomes.

If we can obtain virtually the same results without performing them, why are they being done? How many of these common procedures proven safe and are they effective?

Two interventions deserve special consideration. These are procedures deemed ‘elective’, which is a bit misleading, because a woman may ‘elect’ to have them, but should she ‘elect’ to refuse them, they may be performed under court order (Irwin & Jordon, 1987).

These two procedures, induction of labor and cesarean section, while they are extremely important life-saving measures when used for medical indication, are perfect examples of obstetrical technology gone awry when used for convenience.

The World Health Organization suggests that induction is medically indicated no more than 10% of the time (as cited by The Coalition for Improving Maternity Services, 2003). Yet, according to the Listening to Mothers survey, (Declercq, et al, 2002) 55% of mothers were induced, even though there is acknowledgement that induction increases risk (Baxley, 2003; Rubin, 2006) and the chemical agents, such as Cytotec, used for elective induction are not approved by the FDA for such use (Haire, 2001; Physician’s Desk Reference, 2003). In fact, not only is Cytotec not approved for elective induction, it carries a serious warning not to use it for induction at all (U.S. Food and Drug Administration, 2005), which does not seem much of a deterrent to the American College of Obstetricians and Gynecologists (ACOG) or the American Academy of Family Physicians who “…supports the safety and effectiveness of vaginal misoprostol (Cytotec) for cervical ripening and labor induction” (Weaver, 2006) contrary to the scientific evidence.

The Centers for Disease Control, (CDC, 1993) and the World Heath Organization, (as cited by The International Cesarean Awareness Network, 2004) recommend rates of surgical birth not to exceed 12-15%. The U.S. is currently at 29.1% (Dress, 2005), meaning at least half of these surgeries are medically unjustified. Obstetricians contend (Rubins, 2003) that the increase is due to ‘maternal request’ surgeries, to avoid such things as urinary incontinence later in life, or sometimes due to fear of pain, supposedly the case with Britney Spears. Yet, vaginal birth is not a factor in urinary incontinence (Albers, 2003; ACOG, 2005), despite what some doctors may suggest (Healy, 2006). If women are requesting surgery over natural birth, which some sources doubt (Lamaze International, 2006), then one would wonder if they are being apprised of the significant risks (Thornton, 2006). Risks that are perhaps worth taking if the life of mother or baby are compromised…but not worth introducing where none previously existed.

People often say that in the end, all that really matters is that the mother and baby are okay. Is that really all that matters? What if the mother and baby could have been safe without adding insult to injury?

While some authors merely tell women they should expect care with no basis in science (Murkoff, Eisenberg, & Hathaway, 2002) others defend over-treating in order “To be sure that not even one baby will be harmed during delivery” (Tuteur, 1994; Part III-Common Obstetrical Practices). Is that a realistic goal? Is it being realized? Not as evidence by the many people who have studied obstetrical management versus midwifery attended pregnancy and birth for the last 25 years or so (CIMS, 2003; Johnson & Daviss, 2005; Enkin, Marc, Keirse, Renfrew, & Neilson, 1995; Gibson, 2003; Goer, 1995, 2002; Wagner, 1994, 2003; Stewart, 1981; Keefe, 2001; Tillett, 2005). If success is measured by results, the U.S. obstetrical system could do better. In those 25 years, infant mortality has actually worsened, (Kristof, N., 2006) and maternal mortality has remained unchanged (CDC 1998; CDC, 2003).

While this may seem an indictment of an entire system it truly isn’t. It is a call for reformation. Obstetrics have at their disposal the most advanced technology in the world. However, when you have a hammer, everything looks like a nail. By transferring care of healthy women and babies to midwives, only the actual ‘nails’ reach the ‘hammers’ through a referral from midwives, guardians of normalcy. Obstetricians are then able to use their considerable skills to benefit the women who really need their help. Under this new paradigm that views birth as a natural process, health care costs would be reduced, (Druley, 1998) maternal satisfaction would increase, (Villagran, L., 2006) outcomes would improve and obstetricians would get the recognition and respect they deserve for doing the job they were trained to do. Everyone wins.

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Dilbert and Hypnosis

I just Googled 'hypnosis' (don't ask me why, I just randomly Google stuff sometimes to see what's out there) and came upon one of the best descriptions of hypnosis I've seen yet on The Dilbert Blog. Go figure.
Not only did Scott Adams do a fine job of explaining hypnosis, but he started off by mentioning that his mother used hypnosis for birth and felt no discomfort!
Then, about 2/3 of the way down, Dudeman posted about how his wife 3rd birth, which should have been more difficult as a posterior presentation, was so quick and easy they almost didn't make it to the hospital. About 3/4 of the way down, a post under Brain Blank, written by his wife, tells of a birth using HypnoBirthing(R) that was also pain-free. Cool!

Speaking of circumcision...

It seems the day before I posted my thoughts on the similarities between male and female circumcision, Yahoo News ran a story on forced adult circumcision between warring tribes in Africa.

It is tragic, to say the least. Why on earth do people have to make such a big deal out of altering the genitalia we are born with? The parts we have are there for a reason! We may not always understand the reason, but often we discover we've been removing parts that people can actually use as in the case of the appendix.

In any case, how did it come to pass that circumcision is so important to one people that they would forcefully impose it on another? Just weird, IMHO.

A New Perspective

Why is it that no matter what I’m doing, my head always relates everything to birthing? I’d stop it if I could. Thoughts come unbidden and take on a life of their own.

I’m currently taking a sociology class. Naturally, the assigned reading sets the wheels in motion. This time, it may actually make sense that I’d wonder about what makes people tick, because apparently, that’s what sociology is. It looks for patterns in behavior and tries to determine the societal impact on our decision-making, which is what I’ve been trying to do willy-nilly for years.

So, I’m going to try to apply the ‘sociological perspective’ to something that was in the news recently. Oddly, not birth this particular time. Many ideas are circulating as I read, but this piece relates to a topical subject.

Time ran an article online (January 4, 2008) titled An End to Female Genital Cutting? The article says that there may soon be a law banning Female Genital Mutilation (FGM). The author, Nicholas Birch/Arbil, then goes on to briefly explain the ‘who, what, where, when, how’ of FGM.

He tells us that about 90% of girls have this procedure done, that sometimes the reason for going it is based on a religious teaching, but that there are also societal beliefs that play into the continuation of the practice. One mother explains that doing the circumcision when a girl is a baby, as she did with her own daughter, is best because then the child is too young to understand.

So, these are my thoughts on the subject:

In the U.S., infant male circumcision is considered by many to be a parenting decision; a cultural norm. Female circumcision is considered a barbaric human rights issue. I propose that the only difference is that it is the values and beliefs of the cultures that support each procedure see themselves as right. Believe it or not, infant male circumcision isn't the universally accepted procedure we tend to think it is. Worldwide, only about 30% of men are circumcised, according to the World Health Organization. To others, what we do to baby boys is just as abhorrent as FGM is to us.

The two procedures are really not as dissimilar as one might think. Both remove a part of the reproductive anatomy of a child who is too young to give informed consent. In both cases, the parts removed reduce sexual sensation and to one extent or another impair normal physiological function. The parts remove existed for physiological purpose, but were removed due to ignorance of these functions, or due to aesthetics and/or collective cultural or religious beliefs. Both are painful. In neither case is anesthetic usually used. What makes it objectionable in one case should argue against the practice in both cases. However, infant male circumcision is still one of the most common surgeries in the U.S. (Stang & Snellman, 1998).

Where FGM is practiced, in Africa and the Middle and Far East, defenders insist that Westerners just don’t understand. Women will not be marriageable if they are not circumcised, as they will be unclean and no husband will want a wife that looks different from the cultural norm. They are indignant that arrogant Americans would try to stop something that is required of them in accordance with their understanding of their religious practices (World Health Organization, 2000).

When routine infant male circumcision discussion occurs between parents in the States, the debate is often heated. Defenders of the practice, usually parents who have circumcised or plan to, accuse anyone who opposes circumcision to be unfairly biased. The same people who might consider FGM barbaric consider the same procedure on a baby boy a ‘parenting option.’ Yet the most common reasons for choosing circumcision for a baby boy are essentially the same:

· I want my son to look like his father

· I think uncircumcised penises are ugly

· It’s cleaner

· It doesn’t hurt; babies can’t feel pain. Even if they did feel pain they won’t remember a ‘little snip’

· Religious reasons (oddly enough, often by Christian, not Jewish, parents)

Are not the first two simply variations on the argument for conformity with the cultural norm? The circumcised penis as ‘normal’ is so ingrained in our society that many anatomy textbooks don’t even show natural penises; they show circumcised ones as ‘normal.’

Even the attempt to control sexuality is common to both. At one point, circumcision was medically recommended to prevent male masturbation. The reasoning was that it desensitized the penis. Common sense tells us this would be so, as is illustrated by the explanation of the anatomy and function of the foreskin on a page at the NOHARMM site and a very scientific and informative video here.

Here is a slide show on the progression of the medicalization of circumcision:

Circumcision does not prevent masturbation. Men are men. Does it reduce sensation? One study released in April of 2007 says yes. This study says no. However, in evaluating the veracity of the studies, it would be prudent to look at what the anatomy and physiology of the foreskin actually is, as in the above videos, and then use some common sense. From there, I'd take into consideration what men who have been circumcised later in life have said. Many lament the loss of sensitivity after losing the foreskin. From that perspective, I'd wonder if there was some conflict of interest in promoting a non-medically indicated, routine procedure for infant males.

Even so, this is not justification for what amounts to baby’s first plastic surgery. We don’t reconstruct a baby’s nose if it doesn’t look like his father’s. If his father has an accident that results in amputation of a finger, we don’t remove the baby’s finger so they match. Surely, more people are likely to see his nose or hands than his penis.

According to the American Academy of Pediatrics, routine circumcision has no medical justification, although at one time it was recommended, as was female circumcision, and for the same reasons (Rathmann, 1959). A natural penis is no harder to clean than the female labia (Fleiss, 1997). To suggest that boys cannot be taught personal hygiene of the body they were born with is, in my opinion, insulting.

The argument that amazes me the most though, is that babies cannot feel pain, or that if they do, they don’t remember it so it doesn’t matter. For those that insist it doesn’t hurt, I offer a video that is available elsewhere on the internet (Intact, n.d.). Unfortunately, even though its one of the best out there, that one is a Quicktime video, which not all systems will play and I can't embed it. Therefore, I include two others below. This first one is the 'little snip' version (the procedure is done with a blade) and the one that follows is done with a 'bell clamp'.

Some say, “I don’t think I could stand to watch that.” It is too painful for them, as adults, to watch, but not too painful for their son to experience when he’s just hours old? If babies do feel pain but can’t remember, are other sources of unnecessary pain acceptable? I would argue that lit cigarette butts to the feet of a newborn certainly are painful. While the incident may not consciously be remembered it is still a repugnant and vile abuse.

I've also seen discussion boards where people insist that because one study suggested that circumcision reduces the incidence of AIDS, that is justification for routine infant male circumcision in the U.S.

First of all, it was one study. As mentioned, studies have said the same type of thing before for both male and female circumcision, and have later been proven incorrect. However, let's suppose for a moment that this study is solid. How is it we can then apply a study about sexually active adult men in a country (Africa) where AIDS is epidemic, to newborn babies in another country? Do we understand exactly why it might lower the risk of AIDS? Are there less drastic means of getting the same results? There are just too many questions to ask before using this study to justify a routine practice.

Cultural acceptance doesn’t make circumcision hurt any less, and it doesn’t restore the functionality of the organ. I've heard fathers dismiss information about the importance of the foreskin in sexuality, saying that since they were circumcised and they are able to have enjoyable sex, the information is obviously wrong. However, women who undergo FGM still function. They still have sex. They still have babies. Depending on the degree of mutilation, they may still even enjoy sex with a loving partner. To suggest that it's exactly the same as it might have been otherwise is simply illogical. Likewise with males who have been circumcised as infants. How would they know what they've lost if they've never had it? Just because they can still function in a way that is acceptable to them (because it's all they've ever known) doesn't mean it's the same. Groups like NOHARMM, INTACT, NOCIRC have many men who made the decision to get circumcised later in life with the understanding that it wouldn't make a difference in their sex life, only to discover it did in ways they couldn't imagine.

The inconsistency in attitudes is simply not justified. Either it’s an abuse of little girls and boys, or it’s a simple parenting option for both.

Fleiss, P.(1997). The case against circumcision. Mothering, 85(Winter). Retrieved February 2, 2007.

Intact. Circumcision Video. Retrieved February 2, 2007.

Rathmann, W. (1959, September). Female circumcision: Indications and a new technique. GP(XX) 3, 115-120. Retrieved February 2, 2007.

Stang, H., Snellman, L. (1998, June 6). Circumcision practice patterns in the United States.

Pediatrics (101)6. Retrieved February 2, 2007 .

World Health Organization, (2000, June). Fact sheet N°241. Female genital mutilation. Retrieved February 2, 2007.

Plastic Baby Bottles

This week, Newsweek ran an article titled The Baby Bottle Blues.
In it, the author discussed mounting concern over hormone-like compounds (BPA) that might leach into formula or breastmilk contained inside plastic bottles. Also explored was the environmental impact of glass and plastic options for bottles. No mention was made about the hormones in cow's milk formula, or the estrogen precursors in soy formula. Neither did the article go into any detail about the environmental impact of formula production, packaging, distribution and disposal.

Breastfeeding is free. The only energy it takes to distribute is the burning of maternal calories (bonus!). It's always warm, the packaging is attractive, can't be misplaced or dropped and needs no sterilization.

There were several posts pointing this out, no doubt initiated by the quote by one woman interviewed for the article, Stefania Geraci, who started using glass bottles because, "If there's an alternative that might be safer, then you use the alternative," she says. "I liked the idea of a more natural product."

Using this logic, if there were a safer, more natural product than glass bottles, she'd use it. Obviously, there is no safer or natural way to feed a baby than the way Nature intended. Not coincidently, that safe and natural way is also not just more affordable, it's better for the environment too.

The posters who dared to point out this inconsistency got jumped by a lot of very defensive women. Even a succinct, seemingly innocuous (and true) comment like, "Seems like another reason why breast is best!" set off an avalanche of anger. Most of these were women who said they couldn't breastfeed for a variety of reasons, ranging from physical (I didn't make enough milk-women who felt they had no choice but to bottle feed due to circumstance, more on that below) to fiscal (some of us have to work, you know-women who felt they were forced to bottle feed due to outside influences ). Some even said that because small amounts of contaminants have been found in breastmilk, it's dangerous to nurse. Of course any contaminants women are exposed to, so are cows and soybean plants. However, neither cows milk nor soybean juice, even with fortification of 40 other ingredients, have the other 300 ingredients, including interferon, white blood cells, antibacterial and antiviral agents that human mother's milk has. I don't to completely understand why women wouldn't want to understand their options and what the probable ramifications might be!

Look, in 1999, in the United States, approximately 28,000 babies died. Almost one third of those deaths, over 9,000, might have been prevented if those babies were breastfed (Palmer, 2003).
According to Economic Research Service, hired by the U.S. Department of Agriculture, a minimum of 3.6 billion in health care dollars could be saved each year if 75% of women breastfed their babies at birth, with 50% still breastfeeding 5-6 months, which was the suggested goal of the Surgeon General in 1990 (Weimer, 2001). Some of those medical costs relate to babies who don’t die, but suffer from other illnesses linked with formula feeding, such as allergies (Green, 2001), obesity (Sears, 2004), diabetes (Mercola, 2000). (The last two of these are currently deemed epidemics.) As of the compilation of the 2004 data, we haven’t come close to that objective (Centers for Disease Control and Prevention, 2004). If we had, not only would we have saved babies and health care dollars, but since it is estimated that 25,000 cases of breast cancers could be prevented annually worldwide by breastfeeding (Falco, 2002), the lives of perhaps thousands of American women could have been saved as well.

Unaware of these sobering facts, some women choose not to breastfeed. However, a large number of new mothers will try to breastfeed. They often become discouraged and give up after meeting with pain, frustration and even societal disapproval-being kicked off airplanes and out of stores-for simply trying to feed their babies when they are hungry (Associated Press, 2006). They might assume they are just one of those women who “can’t” breastfeed. They are unaware that breastfeeding problems are not often encountered, but are frequently created. Current birthing practices (Kroeger & Smith, 2004), common parenting practices, an absence of role models, and lack of adequate support all contribute to the problems women face.

We are mammals, so named for the mammary glands that feed our offspring. If the physical act of lactation is so flawed, how do other mammals live without formula? It is a fairly recent invention. Surely, the human species wouldn’t have survived without it if 70% of us were actually physically incapable of successful lactation. There is no doubt that formula filled a need for abandoned or orphaned babies; it allowed them to survive. Nevertheless, no species thrives on the milk of another. In the case of humans, mothers are admonished to avoid milk of other animals, like cows, for the first year of life. Considering cows milk is made for baby cows, born with several stomachs and weighing at least 100 pounds at birth, that makes sense. What is ironic is that most formula is made from cow’s milk.

Nature's design is for survival. There is no flaw in the human design. There is no need to succeed because there is a 'good enough' replacement (for many of the retorts were of the 'My mother gave me formula and I'm not dead' sort). We've lost sight that formula is not 'just another way to feed a baby'. It is an inferior replacement for a substance so valuable it kills cancer cells in the laboratory and is used to bathe donated organs for the protective qualities it provides.

In any case, focusing on the benefits of breastfeeding did not seem to substantially increase breastfeeding rates, so the U.S. government launched a controversial 2 million dollar campaign illustrating the inherent risk in formula feeding (Vargas, 2006). Some people said that the ad might make women who chose not to breastfeed feel guilty. Isn’t that the point? If we hadn’t exposed the dangers of smoking and drinking in pregnancy, societal attitudes would still deem those acceptable. In my opinion, to optimize breastfeeding rates, we have got to be honest so that societal norms change.

Requiring a prescription for formula would also make it clear that it is not a natural food source. In fact, according to the National Institutes for Health (MedlinePlus, 2002), formula should, “only be used under medical supervision.” Does that sound like food? Currently, to get breast milk from a bank, a prescription is required, but formula is not only sold over the counter, it is given as a free sample by the very doctors women trust to provide information on infant feeding. What kind of message does that send?

To put the importance of this subject into perspective, remember those 9,000 children who die unnecessarily each year because they didn’t receive their mother’s milk? Consider that 100 children per year died from Chicken Pox and 500 per year due to Measles before compulsory vaccination programs (Centers for Disease Control). We mandate vaccination, but we hesitate to offend when it comes to breastfeeding.

Obviously we cannot force women to breastfeed. Therefore, in order to optimize breastfeeding rates, we must provide education, support and positive reinforcement for women who do choose to breastfeed. We have got to stop perpetuation of the formula company rhetoric that while “breastfeeding is best,” formula is just as good. We have got to re-frame the breastfeeding experience as a continuation of the childbearing year. Provided with what they need to succeed, I believe that women will provide the very best for their babies. Many are already trying and are, sadly, convinced they have failed, when in reality many factors have conspired to fail them.

When we get pregnant, most of us know there is an expectation, an agreement with our unborn baby, to the father of the unborn baby, and even with society, that we will eat the best food we can and avoid things that would be toxic to our babies in order that our child will be as healthy as possible. It's an inconvenience to change dietary patterns and sacrifice vices for 9 months, but it's just part of being pregnant. If formula weren't so readily available and socially acceptable, despite the obvious and considerable detriments to its use, we might see breastfeeding the same way.

I am unabashedly a breastfeeding advocate, not because I care to infringe on the rights of any woman in anyway, but because of the serious societal ramifications of making a choice in infant feeding that affect so many. In fact, I see this as a feminist issue.

Breastfeeding is good for our bodies, good for our babies, fiscally responsible and an asset to society. Why aren't women fighting for the right to nurse in public and at work? Why aren't they fighting for maternity leave packages that support mothers? Why are they instead defending the right to work harder, pay more and deal with the stress of sick kids? I would suggest reading Milk, Money, and Madness: The Culture and Politics of Breastfeeding for an interesting perspective.

I'm on several mothering boards, and anguished mothers write in every single day with the same problems: My child is overweight, what can I do? My child has life-threatening allergies, what can I do? My child is diabetic, what can I do? I have missed so much work because my kid is sick all of the time, what can I do? My baby has severe excema, what can I do? My baby has had recurrent ear infections and my doctor wants to put tubes in, what should I do? Many of these mothers, desperate for sleep and torn apart by the suffering of their children, begin these queries with 'I've switched formula several times and nothing is working'. Yet, these are these are often the same mothers who didn't want to hear about the risks of formula feeding, when we know that many, if not most, of these problems could have been avoided all together with breastfeeding.

I just find it interesting that the solution to toxins in bottles is to develop different bottles; not to avoid the bottles.

Associated Press, (2006). Woman kicked off plane for breastfeeding baby. Retrieved February 9, 2007, from http://www.msnbc.msn.com/id/15720339/

Centers for Disease Control: Department of Health and Human Services, (2004). Breastfeeding Practices — Results from the 2004 National Immunization Survey. Retrieved February 8, 2007, from http://www.cdc.gov/breastfeeding/data/NIS_data/data_2004.html

Centers for Disease Control, (n.d.). Chicken Pox: What you need to know. Retrieved February 9, 2007, from http://www.cdc.gov/nip/publications/VIS/vis-varicella.pdf

Falco, M., (2002 July 18). Study: Breast-feeding lowers cancer risk. CNN Medical Unit. Retrieved February 9, 2007, from http://archives.cnn.com/2002/HEALTH/conditions/07/18/breast.feeding.cancer/index.html

Green, A., (2001). Can formula actually cause allergies? Retrieved February 9, 2007, from http://www.drgreene.org/body.cfm?id=21&action=detail&ref=81

Kroeger, M., Smith, L., (2004). Impact of birthing practices on breastfeeding: Protecting the mother and baby continuum. Sudbury, Massachusetts. Jones and Bartlett.

MedlinePlus, (2002). Infant formulas (Systemic). Retrieved February 9, 2007, from http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202678.html

Mercola, J., (2000). Infant formula increase diabetes risk. Retrieved February 9, 2007

Palmer, L., (2003, December). A Natural Family Online special report: The deadly influence of formula in America. Retrieved February 9, 2007, from http://www.naturalfamilyonline.com/articles/312-formula-report-2.htm

Sears, W., (2004). Childhood obesity: Corn syrup in formula. Retrieved February 9, 2007, from http://parenting.aol.com/parenting/onlyonaol/baby/article/0,19840,670926,00.html

Weimer, J., (2001, May-August). The economic benefits of breastfeeding. Food Review, 24(2). http://www.mercola.com/2000/jul/30/formula_diabetes.htm

Vargas, E., (2006, July 13). Is the breast best? Retrieved February 9, 2007, from http://abcnews.go.com/2020/story?id=2188066&page=1