>
Dear friends,
        I am posting this to LactNet, after having sent it by private e-mail
to someone asking my professional opinion about the Ezzos.  Enjoy.


>>
>>I guess I have two questions for you.  First of all, have you ever heard
>>of the Ezzos and if so are you aware of any credible independent analyses of
>>their techniques.
>
>I have heard of the Ezzo.  They are infamous/notorious.  Their "programs"
have reportedly led to several infant deaths due to dehydration/starvation,
as well as to many babies with slow weight gain, and mothers losing their
milk supply and therefore having to resort to bottles and infant formula.
They have been condemned by several Christian groups.

>Basically, I have three problems with the Ezzo's program.  One is
philosophical/cultural one is physiological, and the third is historical.
>1) Philosophical/cultural: The underlying assumption of the Ezzo program is
that children are manipulative little demons, an emotional and physical
burden on parents, and must be forced into rigid routines for the
convenience of the parents.  I once wrote that it would be nice if they only
had to be changed once a day, just like it would be nice if the dogs only
had to fed once a week (being sarcastic).  I think this is a terrible
approach to having/raising children.  In my humble opinion, once you have a
child you do not become "A couple who happens to have a child/children."
You become "A family."  And that changes everything, as well it should.
Children should be a joy, they should be loved, their needs should be met,
they should be respected, etc. etc. etc.  Did not Jesus say "Suffer (allow)
the little children to come to me"?
>2) Physiological: Regardless of one's parenting philosophy, their are
limits to human physiological adaptation in terms of producing milk (on the
mother's part) and growth and health (on the child's half).  It is POSSIBLE
for some women to produce sufficient milk when nursing on a three hour
schedule.  However, many many women will not.  Breast milk production is a
DEMAND-driven system.  When the baby latches on to nurse the physical
stimulation of the nipples triggers her pituitary to release oxytocin and
prolactin.  Prolactin is the hormone which tells the breasts to make more
milk.  Prolactin has a very short half-life in the bloodstream, about 30
minutes.  Thus, if the baby is nursing frequently (several times an hour is
the "plan by design" whether you think that is God or evolution) then the
prolactin levels are continuously elevated and mom makes lots of milk.
That's why it is possible for women to nurse twins and even triplets.  If
the baby nurses infrequently, then blood levels of prolactin fall very low
between nursings, and the mother doesn't produce much milk.  Also, frequent
nursing raises the fat content of the milk, as well as the quantity
produced.  So frequent nursing results in lots of high-fat milk, which is
just what the baby needs to grow properly.  If allowed to nurse on demand,
children will regulate their frequency of nursing to get exactly the
quantity and quality of milk they personally need.  Infrequent nursing
results not only in low quantity, but also in low fat milk.  [It's like the
difference between a quart of whole milk and a pint of skim milk -- babies
need the former, in this analogy, but nursing on a three-hour schedule
provides only the latter.]
>        Now, women vary with respect to how much prolactin they release
with each stimulus, and how much milk their breasts make in response to a
given amount of prolactin.  So yes, some women CAN make plenty of milk with
only three-hour nursing intervals (it will still be the low-fat variety).
But, as I said before and can't say too many times, most women will not
produce sufficient milk of sufficiently high fat content, while nursing on a
three-hour schedule.  This leads to fussy behavior in the child, who is
chronically hungry, and can lead to poor growth (mom will be told she
"Doesn't have" or "Can't make" or "Isn't making" enough milk or that "Her
milk isn't good enough" and baby needs a supplemental bottle of formula,
which cuts down even more on the stimulus to the breasts, so she makes even
less, and soon the baby is totally bottle-fed).  In extreme cases, where a
physician is not monitoring the baby's progress, this can lead to growth
retardation, dehydration, and even death.  Especially when parents are
hoping to have a quiet placid baby -- which is exactly how dehydrated, about
to die, babies act -- quiet and placid, sleepy and lethargic.  Thus, while
it might be convenient for moms to only nurse once in every three hours, it
is unphysiological and will usually result in inadequate milk production and
poor growth in the baby.
>        The Ezzo's approach also assumes that babies nurse only for
nutrition, but this is not true.  They are also getting immunological
factors in the milk that help them cope with infections and diseases they
have been exposed to, and they are regulating their temperature, heart rate,
and blood pressure through nursing also.  There is no way to tell "why" the
baby wants to nurse -- you have to trust God that when the baby says it
wants to nurse by crying, rooting, being fussy, that it *knows* what it is
doing.  This may not be convenient for the parents.  If you want
convenience, get a doll.  Not to mention that when babies cry very hard for
very long, they can suffer from skyrocketing blood pressure, intracranial
bleeds and persistence of the fetal patterns of circulation of the blood
through the heart which can keep the postnatal circulation of the blood from
being established correctly and can lead to brain damage (see the work of
Gene Cranston Anderson on why it is dangerous to let a baby cry).  Babies
also nurse for the comfort of being near mom, smelling, tasting, hearing,
feeling her, and in my humble opinion these emotional needs are legitimate
and should be met if you want healthy happy children later down the road.
>3)  Historical:  I have to try not to laugh about this aspect of the Ezzo's
approach, because it is just plain incorrect.  The concept of scheduling
infant feeding began early in this century with "scientific" approaches to
mothering and the desire to raise children who could cope with factory work
(I kid you not).  For an excellent analysis of this, I refer you to Anne
Millard's "The Place of the Clock in Pediatric Advice," and Rima Apple's
book on the history of mothers and medicine in the West.  Anthropological
studies of breastfeeding frequency in "traditional cultures" shows that
mothers may feed children earlier than they are indicating a want/need,
because mom has something else to do, or they may try to placate the baby by
tying them on their backs when they have something they have to finish (in
other words, not everyone drops what they are doing to nurse the baby truly
"on demand" in every culture), but that no one outside of
industrialized/Western cultures nurses children on a schedule.  People
simply have no access to clocks, pay no attention to how long it has been
since the child last nursed, etc.  Kids are carried with the mother as she
does her work, and her nursed very very frequently.  My own research in Mali
(West Africa) shows that women nurse their children while doing their work,
and children are thought to have the absolute right to be nursed whenever
they need/want.  It is certainly true that Mary, and other women of ancient
Israel, and around the world today, work very very hard and have lots of
physical labor that they must accomplish each day.  NONE OF THEM nurse
according to a schedule, however, nor do they do much of anything else
according to a schedule except perhaps prepare meals.  They incorporate
frequent and irregular nursing into their lives without missing a beat.
Short of having a time machine to go back and watch, I think we can safely
assume that Jesus was nursed several times an hour, around the clock, slept
with his mother, was carried on her back, and nursed until he was 3 to 4
years of age, or older.
>
>Like you said, you aren't about to start transporting your children by
donkey (glad to see you have a sense of humor), and neither am I suggesting
that all women should nurse their babies several times an hour around the
clock until they are 3 or 4 years of age.  But let's not distort the
historical record, and let's try to keep in mind that if you want to
breastfeed your baby, you have to follow certain biological rules in order
to maintain your milk supply enough to support healthy growth in your baby.
It would be very convenient if humans were like seals, who could nurse their
babies for only a few days and triple their birth weight, and then wean
them.  But humans are not seals.  They are primates, and like other primates
they have very dependent young, who grow very slowly, and who are designed
by evolution/God to expect frequent breastfeeding for several years.  When
you go against the design and don't "follow the instructions" being provided
by the infant, then you have to expect problems.  If you don't mind taking
the consequences on behalf of your child (poor growth, crying, health
problems) then go right ahead, but do it with your eyes wide open about what
caused these problems.
>
>Other than the health problems caused to the infants, and the whole
philosophy of viewing children as inconveniences, I think the saddest part
of the Ezzo's program is that it sets so many young women up for failure.
They will try to follow the "rules" set by the curriculum, their babies will
be unhappy and not grow properly, their doctors will tell them they "don't
have enough milk" and must supplement with formula, and they will feel like
failures for not having been able to do this most basic act of nurturing.
This shatters their confidence in their bodies and their parenting
instincts, makes them feel like a failure, and discourages them from trying
breastfeeding again.  It also makes their experience as parents very
unpleasant, with an unhappy, fussy baby who is screaming "I'm hungry" and
the parents are telling him/her "You're not hungry."  This is not a good
basis for a lifelong connection with one's children.
>
>Breastfeeding should be a wonderful connection between mother and child
that fosters better health in both and leads to a close emotional bond,
giving the child the best start possible in life.  When people conspire to
sabotage this process, while claiming to support it (!), you have to wonder
what their underlying motive is.
>
>
>Katherine A. Dettwyler, Ph.D.
>Associate Professor of Anthropology
>Texas A&M University
>College Station, TX 77843-4352
>(409) 845-5256/(409) 778-4513
>FAX (409) 845-4070
>e-mail: [log in to unmask]
>
>Mother of three breastfed children, all nursed on demand.