For the past two days I’ve been engaged in a discussion in a private Facebook group about the injuries and deaths caused by lactation consultants who lie. As anticipated, I was met with a wall of denial from lactation professionals. During the course of the discussion I presented more than a dozen scientific citations and those disagreeing with me presented zero, yet that didn’t move the lactation professionals even a tiny bit. Neither did the reports of infant injuries and deaths including the heartbreaking and entirely preventable death of Baby Landon Johnson.
[pullquote align=”right” cite=”” link=”” color=”” class=”” size=””]Making breastfeeding readmissions never events will reduce the epidemic of babies injured by relentless promotion of exclusive breastfeeding. It will save babies and it will save money — the ultimate win-win.[/pullquote]
As I noted earlier this week — lactivists lie first and foremost to themselves and each other — claiming that insufficient breastmilk is rare when it is common. The purported justification is that women are “designed” to breastfeed. It’s like insisting that nearsightedness is rare because eyes are designed to see.
The wall of denial illustrates the primary problem with lactation consultants; they aren’t real medical professionals. When a patient dies from a hospital error — and, make no mistake, infant injuries and deaths from exclusive breastfeeding are hospital errors — real medical professionals ask, “how can we avoid this happening to anyone else?” Lactation consultants, in contrast, ask, “how can we avoid blame?”
Therefore, the best way to protect babies from lactation consultants who lie is to force hospitals to monitor them. The best way to do that is to designate breastfeeding readmissions as “never events.”
What are “never events”?
According to the Agency for Healthcare Research and Quality (AHRQ):
The term “Never Event” was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF), in reference to particularly shocking medical errors (such as wrong-site surgery) that should never occur. Over time, the list has been expanded to signify adverse events that are unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability), and usually preventable…
For example, the “death or serious injury of a neonate associated with labor or delivery in a low-risk pregnancy” is a never event.
Hospitals should do everything in their power to prevent never events, since the whole point is that they should never happen. As a result:
Because Never Events are devastating and preventable, health care organizations are under increasing pressure to eliminate them completely. The Centers for Medicare and Medicaid Services (CMS) announced in August 2007 that Medicare would no longer pay for additional costs associated with many preventable errors, including those considered Never Events. Since then, many states and private insurers have adopted similar policies…
In other words, when a hospital presides over a never event, they will not be reimbursed for the treatment required as a result. That’s a tremendous impetus for hospitals to do everything in their power to prevent never events. Most importantly, it an unbiased, independent method of holding hospital employees to account even when hospitals themselves would prefer not to do so.
There are currently 29 designated never events. We should add a thirtieth: death or serious injury of a neonate associated with exclusive breastfeeding in a low-risk pregnancy that occurs within the first two weeks after birth.
If hospitals had to bear the cost of readmissions for dehydration, hypoglycemia and starvation, it wouldn’t merely break a hole in lactation consultants’ wall of denial about the high incidence of insufficient breastmilk; it would obliterate it.
How common are such readmissions?
According to this 2013 paper in the journal Pediatric Emergency Care:
In the neonatal period, dehydration … is one of the most common causes of re- hospitalization. According to the serum osmolality, dehydration is classified into 3 forms as hypernatremic, normonatremic, and hyponatremic dehydration. Hypernatremic type is a potentially lethal form because it adversely affects central nervous system, leading to devastating consequences such as intracranial hemor- rhage, thrombosis, and even death. Recently, along with many other etiologies, early discharge and failure of breast-feeding are increasingly documented as major causes of hypernatremic dehydration.
High serum sodium (Na) concentration, which is associated with diminished fluid or excessive Na intake, or excessive fluid loss, is usually caused by inadequate breast-milk feeding in otherwise healthy newborns…
How common is readmission for neonatal dehydration?
During the study period, 4280 neonates were admitted to NICU. Among them, 97 had HD. Sixteen patients were ex- cluded from the study. Prevalence of HD was 1.8% (81/4280). All the patients were fed with breast milk. Fifty-nine patients were born in our hospital; 51 patients were discharged from the hospital within the first 48 hours of life.
And that’s just readmissions for dehydration. When you add hypoglycemia and injuries that result from infants falling from or smothering in mothers’ hospital beds the numbers would be considerably higher.
The cost to the hospital if insurance companies refused to pay for these readmissions would be enormous. As a result, we could expect to see hospitals’ risk management departments undertake thorough education on monitoring of its lactation consultants.
At the moment, lactation consultants have no accountability when babies are injured or die as a result of their lies and their relentless promotion of exclusive breastfeeding and near pathological resistance to the benefits of formula supplementation. That would change quite dramatically and it would no longer be possible for them to continue lying to themselves, each other and vulnerable new mothers.
If we take lactation consultants at their word, they should be delighted to accept accountability. According to them, neonatal injuries and deaths as a result of exclusive breastfeeding are vanishingly rare and are prevented when lactation consultants assiduously weigh and monitor newborns and offer timely formula supplementation.
If they’re wrong, it’s going to cost hospitals a fortune. As a result lactation consultants will no longer be free to ignore scientific evidence in favor of ideology. Moreover, they will start telling mothers the truth about the fact that insufficient breastmilk is common, particularly during the first few days after birth. They will teach mothers to look for and respond to the signs of dehydration instead of falsely reassuring them that these warning signs are no reason to be concerned.
Most importantly, making breastfeeding readmissions never events will reduce the epidemic of babies injured and even killed by overzealous encouragement of breastfeeding.
It will save babies and it will save money — the ultimate win-win.
