In this chapter, Ezzo explains the way he sees different parenting philosophies - namely Attachment Parenting vs. his own Parent-Directed Feeding Method- affect the success of breastfeeding.
Lie #15; Page 63, Babywise
"Quite possibly the decision to quit breastfeeding actually is a disturbing necessity for distraught and fatigued moms unable to cope with endless demands created by a faulty parenting philosophy".
Quite possibly the faulty philosophy is one in which the clock, rather than compassion, determines a parent's response to her baby!
It was during the days of strict scheduling set up by doctors in the 40's that breastfeeding rates declined, but Ezzo promotes this same philosophy. "Distraught and fatigued" moms are unable to cope with listening to a baby cry when you can't do anything about it. With the PDF schedule, nursing freely is not an option. I say "nursing" as opposed to 'breastfeeding' because 'nursing' also means caregiving. And nursing a baby soothes the mother as much as it soothes a baby because it produces calming hormones such as Prolactin, Oxytocin and CCK in both. It wasn't until there was an alternative to the breast, that the we used the word breastfeeding to differentiate from the more popular alternative.
Possible Lie # 16; Page 63
And while the national average was 21.6% of mothers breast-feeding into the fifth month, a full 70% of PDF mothers continued into the fifth and sixth month. On the average, PDF moms breast-feed 33.2 weeks.
Ezzo makes it appear that PDF is more likely to lead to longer breastfeeding by comparing the national average (no references are given), to his own survey of PDF mothers. In online parenting forums for PDF parents, former Babywise parents, and lactation consultants, there appears to be few PDF mothers who are able to maintain an adequate milk supply beyond 4-5 months. He also fails to mention that the AP mothers he so strongly criticizes, have a 98% breastfeeding rate at one year of age.
Frequent lactation in the early weeks optimizes production for the long term. In “Counseling the Nursing Mother,” under the heading “Adequate Milk Supply” it says:
When a baby nurses frequently, there is greater nipple stimulation and consequently greater milk production. Mothers need to know that suckling makes milk. Specifically, then, what can a mother do to ensure that she has a sufficient supply of breast milk for her baby? She can nurse her baby frequently, offering both breasts at a feeding and keeping her baby on each breast long enough to empty it and assure that more milk will be produced. She can avoid missed feedings, especially in the early months when she is still establishing her milk supply.
Under the heading “Frequency of Nursings” the same book states:
During the first month, nursing frequency for a healthy fully developed baby may range from 8-14 feedings daily, with most babies requiring 10 or 12. …A mother should not be alarmed, however, if her baby wants to nurse as often as every hour or hour and a half during the day or several times during the night. Every baby’s needs are different and the mother should remain flexible to meet her own baby’s requirements.
Ezzo’s minimum spacing on the PDF routine is 2½ hours between feedings, which only allows for a maximum of 9 feedings a day. On page 118 he provides a sample schedule you can personalize. “This work sheet is based on eight feedings in a 24-hour period,” he says, “and is a guide for your first six to eight weeks.
Lie #17; Page 64
The routine for these [PDF] moms provides greater understanding of their babies’ needs and helps them connect with their baby sooner.
It is not a routine that helps you connect with another human being, it is communication. The mother who pays attention to her baby’s nonverbal communication is the one who connects sooner, not the mother who is paying attention to the time on the clock!
Lie # 18; Page 64
Responding promptly to a newborn’s hunger cues is also a central part of Parent directed Feeding.
Lie # 19; Page 65
Demand feedings more standard, moderate approach… instructs parents to feed their babies every two to three hours based on the baby’s hunger cues … PDF parents will feed their babies on a flexible routine every two to three hours based on the same cues. In terms of nutrition and response, both methods are the same…
These statements attempt to prove that Ezzo’s PDF method is responsive to baby’s cues and offers frequent feeds to the baby, similar to Demand-Feeding. Unfortunately however, this is not the case. The PDF method does not allow feeding routinely every 2 hours, nor does it allow opportunity for mothers to recognize many of the baby’s hunger cues. (See my HUNGER CUES post.)
Possible Lie # 20; page 65
Weak and sickly babies may not have the energy to cry let alone signal a need for food. That is why exclusive cue-response feeding can lead to infant dehydration, low weight gain, and frustration and fatigue for both mother and baby.
This is more of a misleading comment than a lie, in order to scare mothers away from response-feeding. There have been cases where sickly babies have been underfed because they have not demanded to nurse often enough, which is why the AAP statement says “In the early weeks after birth, nondemanding babies should be aroused to feed if 4 hours have elapsed since the last nursing.”
Part of the problem is that new mothers may not realize that the nursing cue is not crying, as Ezzo suggests, but mouthing, rooting, increased restlessness, etc., as stated by the AAP.
Ezzo’s statement that “the baby may not have energy to cry, let alone signal a need for food,” shows that he doesn't understand or agree with the AAP that crying is a late signal of hunger.
Lie # 21 Page 66
Babies provide parents two sets of response cues—those that are immediate need… and those that represent a parenting style.
In this paragraph Ezzo says that some nighttime cues are legitimate “need for food” cues, but if a baby continues to nurse during the night at three months, it’s the result of poor parenting. “A baby nursing for comfort so many times during the night is a cue that your parenting style during the day may be causing too much discomfort.” It is unclear what exactly parents do to cause discomfort, but it is implied that nursing on demand is the problem. He says that when babies sleep through the night on his program, “This is a healthy response signaling that their tummies are content and their hearts are secure in mom and dad’s parenting.” It is also unclear how babies are more secure in their parents by not being fed during the night.
“Parents must learn how to distinguish between immediate need cues and parenting style cues. Both are important. One is for short-term benefit and one is for long-term goal.”
AP parents would agree with that. Getting your baby to sleep through the night by eight weeks is a short-term goal. The long-term goal is a relationship with your child based on communication, love, and security, which is more important than achieving uninterrupted sleep if it means someone gets hurt in the process.
Since no further instruction is given regarding the “parenting-style cues,” the reader will assume that hunger cues occurring outside of feeding times must be indicative of poor parenting.
Milk Production, page 67:
The following excerpts indicate a very poor understanding of the mechanics of lactation.
Certainly a mother who takes her baby to breast seven times a day will produce more milk than the one who offers only two feedings. However, there are limits. A mother who takes her baby to her breast twelve, fifteen, or twenty times a day will not necessarily produce any more milk than the mom who takes her baby to breast eight or nine times a day.
It’s true that the mother may be able to produce enough milk nursing eight or nine times a day. Many women do. But just as many women need to nurse much more often to produce the same amount of milk. Lactating women can have a 300% difference in the amount of milk they store in the breast. This doesn’t mean they were unable to produce sufficient milk, only that they needed to nurse more frequently – fill their tanks more often, so to speak - than their larger-capacity sisters. This is not a supply problem - unless she is trying to follow the Babywise schedule. Tall or short, black or white, blonde or redhead, women are different but they are all capable of nursing their babies, provided they nurse as much as they need to. The baby is the best guide as to how often this needs to be.
The problem isn’t the amount of milk overall, but the quality of the milk taken in by baby. First, babies on a routine of fewer feedings will take in more calories at each of those set feedings than babies who feed ad lib. The difference here is qualitative feeding, as with a baby on a routine; versus quantitative feeding, meaning more feedings at lesser quality.
Here Ezzo implies that the quality of breastmilk is improved by withholding it until 3 hours have passed. Most nutritionists will tell their clients that snacking is a healthy practice as long as the food is nutritious – referring to adults who are no longer growing! Babies are growing at a rapid rate and like teenagers, often need extra snacks when going through a growth spurt.
With qualitative feeding, you eliminate the need for continual snacking. Many feedings become exactly that. Baby feels like a little something to tide her over. No meal is desired. Such snack feeding provides baby only a partial meal consisting of the lower-calorie foremilk and not the higher-calorie hindmilk essential for growth. Mom thinks she’s doing more for baby through endless breast availability. In actuality, she’s delivering less than her best. Baby often quits suckling before optimum nourishment is offered. How disheartening for both.
Baby may indeed need more than a little something to tide her over. She may be thirsty, and the lower-calorie foremilk is exactly what she needs. This is not a “partial meal” but an important way of meeting the baby’s fluid requirements as well as assuring an ample milk supply. The mother is not "delivering less than her best;" she is delivering exactly what her baby needs. If the baby quits suckling it’s because he or she doesn’t need any hindmilk at that time.
Too many snack feedings, with two little time in between, may reduce proper stimulation.
The best way to insure an ample milk supply is by more frequent nursing. The breasts produce milk in response to nipple stimulation, which has nothing to do with a time lapse between feedings. Women can nurse twins or triplets because there is two or three times as much suckling at the breast.
If “too little time” between feedings can “reduce proper stimulation” it makes no sense that he tells mothers to add an extra feeding when the supply is low, on page 102.