Melissa Bartick, MD has a forthcoming paper in the journal Pediatrics entitled Trends in Breastfeeding Interventions, Skin-to-Skin Care, and Sudden Infant Death in the First 6 Days after Birth. She claims her data show that the Baby Friendly Hospital Initiative cannot possibly be blamed for sudden unexpected infant deaths (SUID) due to smothering during skin-to-skin care (SCC) because death rates dropped as the proportion of Baby Friendly Hospitals increased.
Dividing one unreliable number by another unreliable number cannot yield a reliable result.
In Massachusetts, births in Baby-Friendly facilities rose from 2.8% to 13.9% and skin-to-skin care rose from 50% to 97.8%. SUID prevalence decreased from 2010-2016 compared with 2004-2009: OR 0.32 (95% CI 0.13, 0.82).
There’s just one problem. The data show nothing of the kind because the data have been noted to be unreliable.
A chart from the paper makes it clear:
How did Dr. Bartick “calculate” that the Massachusetts SUID prevalence decreased over time? She divided one unreliable number (it is literally listed as unreliable) by another unreliable number and expects us to believe that the resulting number is magically reliable. Seriously?
This is just the most egregious misrepresentation in a paper full of them. For example, Dr. Bartick appears to be responding to the paper Trends in the Incidence of Sudden Unexpected Infant Death in the Newborn: 1995-2014 (her first reference).
That paper found:
Death records for 1995-2014 indicate that, although SUID rates in the postneonatal period have declined subsequent to the 1992 American Academy of Pediatrics sleep position policy change, newborn SUIDs have failed to decrease, and the percentage of SUIDs attributed to unsafe sleep conditions has increased significantly in both periods; 29.2% of the neonatal cases occurred within the first 6 days of life.
It’s central claim is that while SUID from 6 days of age to one year of age has decreased dramatically, SUID from birth to 6 days has not decreased and has come to represent an ever larger proportion of total SUID deaths.
So why does she restrict her paper to 2004 and after? Compare the graph she supplies of sudden deaths by year, to the one in the earlier paper and you can see why.
Her graph:
The graph from the earlier paper:
The blue line shows the prevalence of sudden unexpected infant deaths in the neonatal period. The orange line shows SUID in the postneonatal period. It’s pretty hard to argue, as Bartick is trying to do, that as the Baby Friendly Hospital Initiative in general and skin-to-skin care in particular has become more widespread, early SUID deaths have decreased.
Dr. Bartick’s use of make-believe math is the sign of a far deeper problem than math illiteracy.
Why is she resisting the existing scientific evidence in this area as well as — not coincidentally — resisting the scientific evidence that bed-sharing is deadly? Sadly, she and her lactation colleagues appear to be more interested in protecting professionalized breastfeeding support and its attendant practices than in protecting babies.
It is a fundamental violation of medical ethics to protect a process instead of protecting patients. Nonetheless, contemporary lactation professionals view their mission as protecting, promoting and supporting breastfeeding. Their ethical obligation — in contrast — is to protect babies, promoting safe infant feeding, and support mothers.
By pledging their allegiance to the process of breastfeeding instead of babies and mothers, lactation professionals are making a terrible mistake. It’s all the more mystifying when you consider that skin-to-skin care has little to nothing to do with breastfeeding itself. SSC is a method to protect premature babies in low resource settings where there is no access to temperature controlled incubators. To my knowledge, there has never been any evidence that term babies need or particularly benefit from it. Yet lactation professionals are so rigid in their thinking that they feel compelled to mindlessly defend anything that touches upon breastfeeding.
They’re hardly the first medical professionals to make a mistake by refusing to recognize the harm they cause. Most famously, in the 1840’s Semmelweis proposed hand washing to reduce puerperal sepsis and his colleagues not merely ignored him, they got angry at him.
…[D]octors were offended by the implication that they were dirty and needed to wash more, or that doctors could be somehow at fault for their patients’ demise…
Lactation professionals, like Dr. Semmelweis’ colleagues are offended by the implication that THEY could be harming babies in their aggressive efforts to protect, promote and support breastfeeding.
Semmelweis’ colleagues managed to convince themselves for several more decades that puerperal sepsis had nothing to do with them, while women died because they didn’t wash their hands. It wasn’t until the 1880’s that everyone was forced to admit that hand washing protected patients because doctors could and did carry harmful bacteria.
Unfortunately, Dr. Bartick and her colleagues are responding to the burgeoning scientific literature detailing the harms of aggressive breastfeeding promotion just as Semmelweis’ colleagues responded to his discovery. They are desperately trying to protect their egos rather than their patients.
