Katie Allison Granju

The midwife of modern midwifery

From her Tennessee commune, Ina May Gaskin almost single-handedly inspired the rebirth of midwifery in the United States.

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With her long, graying hair, often in braids, and her flashback
’60s clothes, Ina May Gaskin isn’t as glamorous as many other pregnancy and
childbirth “experts” seen frequently on television and in the glossy
parenting magazines. Instead, Gaskin looks like what she is: a
hard-working, grandmotherly ex-hippie who still lives on the Farm, the
legendary Tennessee commune that she and several hundred others founded in
1971. Yet despite her relative personal anonymity, Gaskin’s influence on
U.S. birthing culture has been profound. She’s widely credited with
having created the modern home-birth
movement, as well as with
almost single-handedly inspiring the renaissance of midwifery
in
the United States. And her 1976 book, “Spiritual Midwifery,” a smallish trade
paperback with a psychedelic cover design reminiscent of the Indian-print
curtains on a ’73 VW bus, is in its third printing, with more than a
half-million copies sold.

“Ina May’s contribution to the culture of childbirth in the U.S. has been
enormous,” says Robbie Davis-Floyd, Ph.D., a research fellow in the
department of anthropology at the University of Texas and author of “Birth
as an American Rite of Passage.” “I have known for years that she is the
most famous midwife in North America; now I can say without hesitation that
she is also the most famous midwife in the world.”

Although this sort of professional recognition from academics, physicians
and researchers has become routine for Ina May Gaskin, it is somewhat
unusual, considering that this “most famous midwife in the world” has neither
a Ph.D. nor any formal medical training. Instead, Ina May Gaskin’s road to
prominence has been decidedly nontraditional.

The woman called “the mother of authentic midwifery” by Midwifery
Today
editor Jan Tritten began life 59
years ago in Marshalltown,
Iowa, as Ina May Middleton, the daughter of what she describes as a “stable,
Midwestern, Protestant family.” She grew up a tomboy, wrestling with her
brother, delivering newspapers and reading voraciously. Although Gaskin
claims she never imagined she’d one day become a
midwife — planning instead to become an engineer — she does remember
checking out of the local library the early natural-childbirth classic
“Childbirth Without Fear,” by Grantly Dick-Read. Gaskin concedes that this
was an unusual reading selection for a 16-year-old Iowan in 1956.

“Birth just always fascinated me,” explains Gaskin. “As a teenager, I could
always tell you every detail of the birth stories in the historical romances I read.”

An excellent student, Gaskin graduated from high school in Marshalltown in
1958 and decided to turn her academic aspirations to English after being
denied a scholarship to study any of the “men’s subjects” she was
interested in. Married at 19, Gaskin attended
community college before transferring to the University of Iowa, where she
earned her English degree. After graduation, she joined the Peace Corps with
her husband and lived in Malaysia teaching English, later returning to the
Midwest to obtain her master’s in English from Northern Illinois
University in 1967.

While she was a graduate student, Gaskin gave birth to her first baby in a
hospital with an obstetrician in attendance. Despite her confidence that
she could have the natural, unmedicated birth she wanted within the
strictures of the medicalized childbirth system, her experience wasn’t a
pleasant one. “During birth at the hospital, I was left alone and treated
like I had done
something nasty. Then I was approached by a gang of masked attendants who
came in the room and treated me like a ritual victim. They used forceps, and
then I wasn’t allowed to see my baby for 18 hours,” remembers Gaskin.

Not long after becoming a mother, and radicalized by her own childbirth
experience, 27-year-old Gaskin and her husband and daughter packed
up and left for California — the epicenter of the cultural universe in the
late 1960s — to, as Gaskin succinctly puts it, “become hippies.”

There Gaskin’s transformation from mother to mother of midwifery commenced in
earnest. She began attending a lecture series given by
the man she would later marry, San Francisco counterculture guru Stephen
Gaskin, in which he spoke to groups of up to 2,000 young hippies on
everything from religion to politics to sex. At these classes, Ina May Gaskin
was exposed for the first time to a variety of women relating tales of their
own unmedicated, outside-the-hospital births, an experience she found so
affecting that to this day she remembers virtually every detail of the
stories she heard a generation ago. For the first time, recalls Gaskin, she
understood how beautiful a birth could be, given the right setting and
support.

In 1970, a pregnant Ina May (who by this time was involved in what she describes as a “group family situation” with her husband and Stephen
Gaskin and his then-wife) set off with
approximately 250 other followers of Stephen Gaskin on what came to be known
as “the Caravan” — a five-month-long speaking tour across the United States.
Traveling in colorful converted school buses, the group
stopped in towns, cities and on college campuses so that Stephen Gaskin
could lecture. One evening, while the buses were parked
at Northwestern University, a pregnant woman from among the Caravan group
went into labor. The sojourners had no money to pay doctors, and according to
Ina May, their beliefs didn’t allow them to accept welfare. Thus, with no
physician in attendance, and with the woman’s own husband catching the baby, she easily gave birth to a healthy boy. This turned out to be the
first of 11 babies born on the buses during the Caravan.

“When each birth took place,” writes Gaskin in “Spiritual Midwifery,” “we all
parked in a sort of protective formation around the bus in which the birth
would take place, and everyone waited for the baby’s first cry.”

By the third birth within the group, Ina May Gaskin had emerged as a
natural at attending births. Mothers began to request her presence during
their labors and
deliveries. She knew she was feeling a calling to become a
midwife. But Gaskin still had had no medical training, until a Rhode Island
obstetrician, having read in the local newspaper about the visiting hippies’
bus births, took the trouble to visit the Caravan and offer
her and a few other women some training in the essentials of midwifery.

“He gave [us] a hands-on seminar on how to recognize any complications we
were likely to encounter, and what to do if we did, demonstrating how to
stimulate a baby to breathe, what to do if the umbilical cord was wrapped
tightly around the baby’s neck, what to do if the mother hemorrhaged. He
taught us sterile technique and provided us with some necessary medications
and instruments, my first obstetrics textbook and gave us instructions on how
to provide good prenatal care,” remembers Gaskin.

With this rudimentary start to her education as a midwife, Ina May Gaskin was
present for each of the next births that took place on the Caravan. Sadly,
the 10th birth — that of her own child — ended with the death of her
two-months-premature son, born on a bus in Grand Platte, Neb. At only 3 pounds,
the baby lived a mere 12 hours and died in Gaskin’s arms. Her
grief over her loss only strengthened her resolve to continue helping other
women to achieve empowering births with healthy babies.

Shortly after the Caravan returned to San Francisco, the group of 250
Gaskin-ites decided to establish a commune in
the rolling farmland of middle Tennessee. Named the Farm, the commune
flourished during the ’70s and early ’80s, eventually reaching a
population peak of 1,500 in 1980. Since the early ’80s the Farm population
has held steady at more than 200 residents.

With a thriving community of men and women of childbearing age living on the
Farm, pregnancy and childbirth became common occurrences. Soon after the
commune’s founding, and with the support of a sympathetic local
doctor, Ina May and several other women established an on-site
midwifery clinic to which Farm residents could come for prenatal and
childbirth care. Births took place wherever the mother wished to be — usually
in her home. Women from outside the community were also able to hire the
Farm’s midwives as birth attendants at a cost of less than half that for OB
care. Today, the majority of the 100 births a year the Farm midwives handle
are of women living outside the community.

With the publication of “Spiritual Midwifery,” in 1976,
Ina May Gaskin’s work on the Farm began to receive wider notice. A
mix of first-person homebirth stories, black-and-white birth
photography and information on caring for women in pregnancy and
childbirth, the book laid out Gaskin’s philosophy that birth is a spiritual
event akin to making love, and that women could take back the power to
give birth
without excessive and unnecessary medical intervention. These were
revolutionary ideas at a time when the ancient profession of direct-entry or
“lay” midwifery — in which midwives receive the majority of their training
through apprenticeship with other skilled midwives rather than in medical
or nursing school — had all but died out in the United States under intense
pressure from physicians’ groups such as the American Medical Association and
the American College of Obstetricians and Gynecologists.

Gaskin’s book introduced an entire generation of young women to the
possibility of homebirth and midwifery. Passed from
mother to daughter and from friend to friend, the book’s impact stretched far
beyond its actual sales figures. Many of today’s midwives and midwifery
advocates report having discovered their career calling in the pages of
“Spiritual Midwifery.”

Susan Hodges, the president of Citizens for Midwifery, says of Gaskin’s
book: “I first heard of Ina May Gaskin when my Bradley Method childbirth
educator loaned me her copy of ‘Spiritual Midwifery’ when I was pregnant
the first time. This book had an enormous impact on me and changed the way
I thought about childbirth.”

Karen Lupa, who went on to become a certified nurse-midwife, remembers, “I
was first exposed to ‘Spiritual Midwifery’ while riding on a train in the
’70s. A fellow passenger had a torn-up copy that I got to read various
pages of … enough to see that it was way different from what I learned in
nursing school. It seems like ‘Spiritual Midwifery’ has been such a
milestone in the natural birth movement that it couldn’t have quite
happened without it.”

As women read and talked about “Spiritual Midwifery,” demand for midwifery
care began to grow, and by the early 1980s, despite the fact that the
practice was illegal in many states, the number of
midwives in this country was again slowly on the rise. Awareness of midwifery
in the United States has been increasing ever since: The American College of
Nurse-Midwives
reports that while only 6.14 percent of
this country’s total
births are attended by midwives, preference for in-hospital,
midwife-attended births in the United States grew from about 20,000 in 1975
to almost 239,090 in 1996. Currently, approximately 30,000 women each year
give birth in planned homebirths, and there are now approximately 10,000
midwives, both direct-entry and nurse-midwives, practicing in this country —
still
many fewer per capita than in other Western nations.

In addition to her writing, Ina May Gaskin’s renown has spread through her
clinical midwifery skills, developed entirely through independent study and
apprenticeship with other midwives around the world. The statistics for
Gaskin’s midwifery practice, which has delivered more than 2,300 babies,
tell the tale. In contrast to the national Cesarean
rate of over 22 percent, the Farm’s midwives have a rate of only 1.8
percent. And in 1992, a peer-reviewed study of the work of the Farm
midwives in the Journal of the American Public Health Association compared
over 1,700 planned, direct-entry, midwife-assisted home births with
approximately 14,000 statistically matched hospital births. Only 2
percent of the women who gave birth at home experienced such interventions
as forceps, vacuum extractors or C-sections, while 26 percent of those
giving birth in the hospital encountered these outcomes.

Additionally, Gaskin is now credited with the development and growing use of
the Gaskin Maneuver,
a revolutionary approach to dealing with the life-threatening obstetrical complication known as “shoulder dystocia,”
in which a baby’s shoulders become stuck in a laboring woman’s birth canal.
In collaboration with Dr. Joe Bruner, a professor at Vanderbilt University
College of Medicine, the Gaskin Maneuver has now been written up in the May
1998 issue of the Journal of Reproductive Medicine, as well as presented at
medical conferences. This marks an extraordinary achievement for a
direct-entry midwife.

According to Robbie Davis-Floyd, Gaskin’s ability to bring together the
sometimes hostile opposing camps from the worlds of medicine and midwifery
has been perhaps her greatest achievement. Ina May is “warm, funny,
good-hearted, brilliant, politically savvy and
aware — a postmodern hippie who holds a very strong space for her alternative
knowledge system yet moves with fluidity and ease in the professional,
political and medical realms,” notes Davis-Floyd.

As one of the founders and the current president of MANA — the Midwives’
Alliance of North America — Gaskin has been at the
forefront of legalizing
and
credentialing direct-entry midwifery while maintaining a “separate but equal”
status with certified nurse-midwives. She has been instrumental in the
development of the rigorous Certified Professional Midwife (CPM)
certification process, which is rapidly gaining momentum within the midwifery
community. And Gaskin also
acts as publisher of Birth Gazette, a respected quarterly magazine for
midwives and others, and conducts training for other midwives both at the
Farm and around the world. Lastly, she has just written a book, tentatively titled “Ina May’s New Birth Book: Breaking the Spell of Fear,”
which has attracted interest from several major publishers.
Currently, however, she says that her favorite activity is spending time with
her newly born grandaughter, born at home on the Farm with Gaskin and the
baby’s other grandmother — also a Farm midwife — in attendance.

Gaskin says that if people take one message from her life’s work it should be
that birth is normal. “As a culture we really have to figure out how we got
so afraid of birth and why, of all places in the world, we got rid of
midwives here.”

In defense of parenthood

A controversial and deeply flawed new book, 'The Nurture Assumption,' argues that no matter how you parent, junior might still become the next Charles Manson.

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In a recent New Yorker article, Judith Rich Harris, author of “The Nurture Assumption,” the most widely publicized book on issues of human development since “The Bell Curve,” is quoted as saying that one of her primary reasons for writing the book was to alleviate parental guilt.

“A lot of people who should be contributing children to our society, who could be contributing very useful and fine children, are reluctant to do it or are waiting very long to have children because they feel it requires such a huge commitment,” explains Harris. “If they knew that it was OK to have a child and let it be reared by a nanny or put it in a day-care center or even to send it to a boarding school, maybe they would believe that it would be OK to have a kid.”

“Great,” remarked a friend and fellow mother of three after reading Harris’ comments. “Just what we need: more parents with less commitment.”

Believe it or not, that’s precisely what America needs, according to Harris and the Alice-in-Wonderland premise she sets forth in “The Nurture Assumption.” In the New Yorker piece, as well as in recent articles in Time and Newsweek, among others, Harris and her supporters argue passionately that today’s parents are being asked to commit just too damn much time and attention to nurturing our kids — an essentially useless endeavor — because we have been sold “a bill of goods” that children are impacted in any meaningful way by our parenting. Our naive belief that parenting matters is what Harris has dubbed “the nurture assumption.” Harris says she wants to release parents from the bondage of a supposedly widespread “cultural myth”: the idea that, through our child-rearing practices, “We can make our children turn out any way we want.” After all, “Children are not empty canvases on which parents can paint their dreams,” chides Harris in the chapter of her book titled “What Parents Can Do.” The author further advises that we poor misguided souls currently in the parenting trenches should “give it up” because her own review of the scientific literature (from the fields of child development, psychology, anthropology and even primatology) has revealed startling new evidence that “parenting matters zilch.” As for those of us adults who believe that our own parents’ actions strongly influenced the people we have become, well, according to Harris and her assembled evidence, we are simply deluding ourselves.

While reading Harris’ book, one cannot help but be impressed with her ability to weave together and render readable a vast array of seemingly random data in an attempt to support her bizarre and utterly counterintuitive ideas. However, the reader is also left with the strong impression that, despite the fact that she has clearly crafted a book she believes to be for and about everyday families, Judith Rich Harris must not have spent much time hanging around with any real, live parents if she thinks that we are all so arrogant as to assume that we have the power to personally script our children’s tomorrows. In fact, Harris’ work can sound quite scintillating and paradigm-busting until you realize that few, if any, parents actually hold the views against which the author argues so eloquently.

In her eagerness to demolish what she defines as the nurture assumption, Harris is tilting at windmills. I mean, come on! How many of you mamas out there actually base your day-to-day parenting decisions on the belief that you have the omniscient ability to sculpt every detail of your personal version of procreative perfection? I know that I don’t. As the mother of three little people, each as fundamentally different from one another (and from me) as can be, it became painfully obvious to me some time back that, in many ways, I am just along for the ride. Actually, in discussions in recent days with a wide range of parents, including everyone from a Jewish lesbian mother from Brooklyn to a married evangelical Christian father in the Bible Belt, I have been unable to find one person who assumes that the way in which he nurtures his offspring can guarantee any particular outcome. Perhaps somewhere between Freud and the advent of behavioral genetics there were a few parents out there who genuinely believed that they alone held the key to every aspect of their children’s fate, but not today.

We now know (and Harris acknowledges) that a large part, maybe even the largest part, of who any child will become is inborn. So if parents accept that giving birth to and parenting a genetically unique individual presents perhaps the greatest act of blind faith in all of human relationships, why do we continue to do it? Why, knowing as we do that no matter how hard we try, we still might end up with a member of Heaven’s Gate or even a Mark David Chapman, do we keep trying? Why, ultimately, does parenting matter? And why is Judith Rich Harris so dead wrong in her analysis concluding that it does not?

- – - – - – - – - -

First, it’s a leap from Harris’ central point that parents cannot be assured of any specific results to the idea that parenting has little to no effect on a child’s life. Actually, Harris is vague in her definition of just what it is that our parenting doesn’t affect. Throughout the book, she variously refers to our inability to impact children’s “character,” “temperament,” “personality,” “development,” “behavior” or simply how they “turn out.” Of course, all of these aspects of humanity are distinct from one another and each is uniquely susceptible to various influences. Harris uses her own two adult daughters as an illustration of her case against parental impact by noting that, despite the fact that she believes she parented the girls in similar ways, her biological daughter was friendly, cooperative and well-behaved as a child and teenager, while her adopted daughter was a hellion. See, crows a triumphant Harris, parenting doesn’t matter! The problem with Harris’ highly personal example is that today, both daughters are well-adjusted, productive members of society with whom Harris enjoys a good relationship. Harris may not have been able to influence her daughters’ temperaments, but it appears that her steady, loving parenting did, in fact, likely play a role in how they “turned out.”

But while no one would argue with Harris’ claim that a particular parenting style cannot assure a particular positive outcome, most people do believe, or in too many cases, know through personal experience, that certain failures or abuses on the part of a parent can cause a wide variety of painful responses in children and the adults they eventually become. Harris, however, breezily dismisses this critical point from her polemic. In fact, she virtually scoffs at the belief that even “super-bad” parents — which at one point she defines as those who would “abuse their kids so severely that they end up in the hospital, or who leave them unattended in cold apartments stinking with unchanged diapers and rotted food” — might saddle their children with permanent scars. It is here and in other similar spots in her book that Harris’ views become most surreal and disturbing. In essence, she is saying to the many walking wounded survivors of bad parenting among us that “studies now prove that what happened to you didn’t really matter.”

To take Harris’ logic to its extreme, one could point out that any number of young Holocaust survivors “turned out” just fine in terms of becoming productive, gainfully employed, law-abiding adults. However, to extrapolate from that data that their early experiences were essentially meaningless is both cruel and unwise. In the case of my own children, one of the three is clearly possessed of a natural resilience and toughness that would undoubtedly serve her exceptionally well were she ever faced with suffering or adversity. However, that doesn’t lessen my responsibility as her mother to protect her from facing those things whenever possible.

The idea of parental responsibility is a concept generally lacking from “The Nurture Assumption.” Harris writes that, since our parenting can’t be expected to aid in our children’s long-term development, we should treat our children “just as well as we would treat our own husband or wife,” and that we should “love our children because they are lovable.”

The problem with the child/spouse analogy is that children are not the same as adults. They are smaller, weaker and both cognitively and emotionally less developed than their parents. As anthropologist Meredith Small, author of “Our Babies/Ourselves,” mentioned to me in a conversation regarding Harris’ ideas, human children are not truly biologically independent for a number of years. In other words, children are in need of protection and, yes, guidance, from their parents and the other adults in their lives, and we have a responsibility to provide it to them. And if we base our parenting decisions and commitment solely on our children’s “lovableness,” rather than on this responsibility, we risk failing them based on external and often random factors. No one, not even one’s own cherished child, seems lovable or appealing all the time. Most mothers and fathers I know will tell you that it is at those inevitable times when they are challenged to rise above the unpleasantness of the moment and still continue to meet their responsibility toward their children that they gain the most from their roles as parents. This is when parenting becomes the maturing, ennobling experience that matters to parents and that, in the end, enriches us all.

But perhaps the most unsettling aspect of “The Nurture Assumption” has been the huge and mostly positive response the book has received in the media. Why is it that when book after book is released each year with indisputable evidence concerning the children in our midst who are without adequate food, shelter, health care and, yes, nurturing, the book that essentially lets adults off the hook for our failings is the one that makes the cover of Newsweek? Parenting does matter. Ask any child, parent, teacher, psychiatrist, emergency room physician, social worker or prison warden and she will tell you the same thing. If we accept Harris’ assertion that the care and guidance we offer to the youngest and most vulnerable members of society doesn’t matter in the long run, we are left with the question of what, ultimately, does?

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Getting wise to 'Babywise'

Do parents who buy the controversial baby-care book "On Becoming Babywise" know about its conservative Christian agenda?

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Lori Rivas finds it painful to think back to the first few months after
her 2-year-old son Daniel’s birth. Rivas, a 29-year-old stay-at-home
mother from Santa Clarita, Calif., remembers days and nights of
struggling to ignore her baby’s crying, of feeling guilty when she
longed to rock him to sleep in her arms but believed that she should
not. Worst of all, Rivas recalls the day of Daniel’s two week checkup,
when the previously healthy infant was discovered to be more than one
pound below his birth weight and so dehydrated that he was unable to
produce tears.

“I felt that I was failing as a parent,” says Rivas.

Rivas and her 38-year-old husband, Theo, a customer service
representative, were not only worried about their son — they were
confused. After all, they were conscientiously following the highly
detailed dictates of one of today’s most popular child-care guides, a
book that glowingly described itself in its own introduction as “an
infant management program” that has “worked for thousands of parents
and, when faithfully applied, will work wonderfully for you!” In a
soothing, authoritative tone, the guide further assured Lori and Theo
that, if they adhered to the book’s recommendations, their baby would
sleep through the night by approximately 8 weeks of age, cry less
than other babies and even have a reduced risk of Attention Deficit Hyperactivity Disorder and learning
disabilities down the road.

This was enough to convince these eager first-time parents. They wanted
the best for baby Daniel.

“We went by the book,” explains Lori Rivas.

“The book” is called “On Becoming “Babywise,” from a
Christian publishing house, Multnomah/Questar. This slim paperback
and its companion volume, “Babywise II,” for parents of
“pretoddlers” ages 5 to 15
months, have sold at least a quarter million copies over the past
several years, consistently placing in the top 10 most
requested parenting titles on both mainstream and Christian booksellers’
lists. The author behind “Babywise I” and “II” is Gary
Ezzo, an enigmatic, 50-something, evangelical Christian minister.
Ezzo, along with several close family members, heads up Growing
Families International,
a huge, for-profit
“parenting ministry” based in Simi Valley, Calif. GFI has
stated that its goals as an organization are “to capture the hearts
and minds of the next generation,” because “it takes two generations
to affect change (sic). We gave the last over to the ideological
humanists; they have our tax dollar and the public classroom to bring
about their agenda. We cannot collectively capture the
minds of the next generation without educating the minds of today’s
parents.” Ezzo’s personal parenting philosophy can be summed up in
his public statement: “Raising good children is not a matter of
chance but a matter of rightly applying God’s principles in parenting.”

GFI’s ever-expanding product line of conservative Christian parenting
materials is reportedly now used by at least 70,000 parents
in 6,000 churches across the country each week. “Babywise” and “Babywise II”
are the ostensibly secular versions of GFI’s original and still
widely used Christian child-care guides. Dr. Robert Bucknam, a young
Denver-area pediatrician, is listed as co-author of the “Babywise” books,
while Ezzo and his wife, Anne Marie, are named as the sole authors
of their religious counterparts. The bestselling “Babywise”
books, generally
available in the family and parenting aisles of major bookstores, are
fundamentally the same guides as the Ezzos’ Christian versions, but with a crucial difference: All biblical and theological references have been removed. GFI refers to the
“Babywise” books as “outreach materials” and describes them in its
catalog as “the ideal gift for your expectant friends,” and as
offering “many of the same biblical principles as (other GFI child-care
guides).” The catalog goes on to suggest that “Babywise I” and “II” are
“ideally written for the Christian obstetrician, pediatrician or
health-care provider to distribute to their patients.” Although GFI
makes no attempt to obfuscate its own agenda as an activist evangelical
Christian organization in its other, openly religious materials, parents
who buy or are given the seemingly mainstream “Babywise” books have no way
of knowing that the books’ advice is based largely on GFI’s own unique
biblical interpretations. Neither are most “Babywise” readers likely aware
that the child-care guide that now sits on their bookshelf next to their
well-thumbed Spock or “What to Expect the First Year” is designed to
“capture the minds” of their children.

- – - – - – - – - -

Without any major promotion other than word of mouth, the explosive
popularity of
“Babywise” has quietly turned GFI into a publishing industry
phenomenon. However, as more parents like Lori and Theo Rivas speak out
about their negative experiences with the advice contained in the books,
“Babywise I” and “II” have also become the most controversial American
child-care guides in 20 years or more. In response to the books’
radical departure from current pediatric and psychiatric advice, scores
of concerned medical, lactation science and child development experts
are speaking out against what they see as potentially dangerous child-care guidance, being offered up with little in the way of credible supporting
research.

In 1997, approximately 100 health-care
providers, including nationally known experts and 20 fellows of the
American Academy of Pediatrics, sent a “letter of concern” to the
AAP regarding Ezzo’s child-care advice. In February, the Wall Street Journal reported on the growing controversy, and
in April, the AAP’s own District IV Chapter Convention passed a
resolution calling on the AAP to investigate “Babywise” and its effects on
infant health. In the same month’s issue of the AAP News, Dr. Matt
Aney, a California pediatrician, wrote an editorial in which he
discussed having personally reviewed dozens of medical records of infants with health problems ranging from low weight gain to dehydration to symptoms of depression that developed after parents had followed the feeding
advice contained in “Babywise.” The nation’s largest professional
organization for lactation professionals, the International Lactation
Consultant Association, has become so alarmed by growing numbers
of parents using Ezzo’s “infant management program” with poor results
that, at its recent international conference in July, the group offered a
presentation to a standing-room-only audience on how to deal with “rigid
approaches to care giving” in the clients that they see. In the past,
“Babywise” co-author Robert Bucknam has suggested that criticism of
GFI’s child-care programs is based on prejudice against Christians. However, a highly placed source within the AAP says that the
fact that the controversial “Babywise” books are produced by a large
Christian organization has actually prevented the AAP from taking an
even stronger public position against the popular books.

The great controversy stems in large part from the fact that the
“Babywise” approach represents a harsh throwback to decades-old and
widely discredited child-care manuals in which mothers were advised to
watch the clock rather than their babies’ signals in determining when
breast or bottle should be offered. Today, in response to extensive
research into infant nutrition and growth, experts strongly advise
against “scheduling” and in favor of feeding, preferably breast-feeding,
according to a baby’s cues. In recent months, the American Academy of
Pediatrics issued a “Media Alert” in which the organization emphatically
“reaffirms its stance that the best feeding schedules for babies are the
ones babies design themselves.” The alert went on to say that
“scheduled feedings designed by parents may put
babies at risk for poor weight gain and dehydration.”

“Parents shouldn’t try to put their healthy infants on feeding
schedules,” says Susan Baker, M.D., chairwoman of the Committee on Nutrition
for the AAP and an associate professor at the Medical University of
South Carolina. “Babies’ feeding needs are extremely variable. You
should nurse your baby when she’s hungry or shows signs of being hungry,
no matter when she last ate.”

Ezzo disagrees. With a self-coined term, “Parent Directed
Feeding (PDF),” Ezzo continues to advocate feeding-by-the-clock,
suggesting, among many other things, that infants breast-fed in the
manner advocated by Dr. Baker are “confused,” “uncomfortable” and
insecure.” Further, Ezzo recommends that night feeds should generally be
phased out by approximately 8 weeks of age, as infants of this age
should be sleeping seven or more hours at a stretch if his program has
been implemented properly. Ezzo writes that “Between seven and nine
weeks, parents [who have followed "Babywise" recommendations from birth]
can expect [baby's] nighttime sleep cycles to be a continuous 7-8 hours.
After three months of age, that time is extended to 9-11 hours each night.
This nighttime sleep is in addition to … regular nap times during the
day. This means bliss for everyone. Mother. Baby. Father. Siblings.
Perhaps even the family pet.”

Not true, says Dr. Richard Ferber, director of Boston’s Center for
Pediatric Sleep Disorders at Children’s Hospital and the author of the
bestselling “Solve Your Child’s Sleep Problems” (Simon and Schuster).
“Parents shouldn’t expect babies to sleep that long that early,
although a very few will on their own and in that case, you may
sometimes need to actually wake them to feed them,” says Ferber. “There
is no good evidence that babies that young can go that long without a
feeding.”

According to Ferber, any ill-informed child-care advice that suggests
that very young infants should be sleeping through the night has the
potential to leave new parents frustrated as they wonder what’s “wrong”
with their own baby.

Medical textbook co-author Kathleen Auerbach, Ph.D., a nationally known
International Board Certified Lactation Consultant (IBCLC), concurs.
“This is completely out of keeping with how infants sleep and eat. An 8-week-old infant gets approximately 30 percent of all food volume in the hours
between midnight and 8 a.m. To deny babies fully one-third of their total food
volume by 2 months of age is asking for trouble,” says Auerbach.

Although Ezzo’s PDF is not recognized (or even mentioned) in any recent
peer-reviewed medical literature, “Babywise” boldly informs new parents that “PDF is a
new and major paradigm shift for the [lactation science] industry and
not all [lactation] consultants have a working
understanding of routine breast-feeding dynamics.” In fact, leading
lactation
consultants say that it is Ezzo, Bucknam and their supporters who lack
a basic understanding of lactation science. Among other things, “Babywise” states that feeding a baby too frequently can actually
decrease breast milk
production and even “compromise a child’s health.” According to
Kathleen Huggins, R.N., M.S., and an International Board Certified
Lactation Consultant, as well as author of “The Nursing Mother’s
Companion” and
“The Nursing Mother’s Guide to Weaning” (Harvard Common Press), this
information is simply wrong.

“The more often a woman feeds her baby, the more milk she will make. The
less often she feeds her baby, the less milk she will make. This is an
established aspect of human physiology,” says Huggins, who has herself
worked with several families who saw their infants lose or fail to gain
weight after following the feeding advice in “Babywise,” including one
pair of newborn twins who were diagnosed with “failure to thrive.” Huggins
says that she was able to convince the babies’ mother to respond to
their cues and feed them more frequently, leading to a quick recovery. “Some women may be able to maintain a good milk supply with a feeding schedule, but many, many will not, particularly after the first few months,” adds Huggins.

Katherine Dettwyler, Ph.D., an associate professor of anthropology at Texas A&M University and one of the world’s foremost authorities on biocultural perspectives on infant feeding, says that human infants were designed to eat frequently and at their own pace, which may vary markedly from baby to baby.
“The composition of human milk is similar to that of other primates, with low fat and protein levels typical of a continuous contact species,” explains Dettwyler. “Babies are designed to be fed very frequently for the first few months of life … To cloak ‘convenience for parents’ in the guise of a rigid feeding schedule being ‘best for the baby’ is really misleading.”

Dr. Carl Hays, a Burlington, Iowa, obstetrician and a member of
what GFI calls its “medical advisory board,” concedes that PDF does not
have
widespread medical support, but says that he promotes it anyway.
“Too-frequent feeding doesn’t allow the breast to refill. Although it is
true that this is not what the research currently says, nothing is
carved in stone. I think you are going to see some interesting studies
on this very soon,” he says. He declined to predict where or when
these studies would be published.

- – - – - – - – - -

Although it is the feeding recommendations in “Babywise” that have
received the most negative attention, much of the other child-care
advice in the books is similarly diametrically opposed to modern
pediatric and psychological practice. For example, babies who resist the
prescribed napping and bedtime components of the “Babywise” regimen are
left to wail alone in their cribs for up to an hour at a stretch in
order to
“train” them. Play time is highly structured, with ever-increasing portions of a baby’s day spent in solitary “roomtime” or
“playpen time.” According to Ezzo, skills such as “creativity,” “mental
focusing” and a “sustained attention span” may be “seriously delayed if
your child misses out on structured playpen time.”

“Once parents have their infant’s eating and sleeping patterns under
control, it’s time to do the same with waketime activities,” writes Ezzo. “Playpens are necessary to help parents optimize
a child’s development.”

After babies reach only 6 months of age, parents are
instructed to begin punitive disciplinary measures such as “squeezing or
swatting” of the child’s hands or “isolation” in the crib for
“rebellious” infractions including “foolishness,” “malicious defiance”
or even playing with food on the highchair tray. Ezzo explains to
parents that the use of “pain” and “discomfort” can be essential
disciplinary tools. After age
2 and a half, children who have a toileting accident are required to
clean themselves up.

Despite the plethora of respected research
demonstrating the critical importance
of early parent-child attachment, “Babywise” breezily dismisses this
concept as little more than self-indulgent psychobabble. Thus, parents
are told that they can actually harm a child by too much rocking or
holding and that they should, at all costs, avoid “emotionalism” in
responding to a baby’s cries lest parents be held “in bondage” to the
child.

“Of course you can harm a baby by picking him or her up too much,”
asserts Ezzo.

As radical as these recommendations sound, they are actually considerably toned down from those made in earlier editions, in obvious response to
many specific complaints by medical professionals. The 1993 and 1995
editions of “Babywise,” which are still available in many bookstores, contain dozens of even more bizarre medical
claims. Examples include Ezzo’s contention that
placing an infant to sleep on his stomach is not a risk factor for
Sudden Infant Death Syndrome and his assertion that mothers who feed their infants more frequently than recommended by the “Babywise” schedule — renamed a “flexible routine” in the newest edition — will be plagued by “an
abnormal hormonal condition” leading to post-partum depression. Although
some of Ezzo’s more controversial claims have now been slightly
modified, GFI has never publicly retracted earlier misstatements; instead, the most current
Babywise speaks of “exciting new information” that has motivated the
revisions.

One of Ezzo’s fallacies still in circulation is
his dangerously inaccurate description of how a new parent should
assess a baby’s nutritional intake. Earlier editions of “Babywise” advised
parents to count wet, but not dirty diapers, a seemingly minor but
serious omission, according to certified lactation consultant Jan
Barger, the
current editor of “Clinical Issues in Lactation.”

“Previous editions of ‘Babywise’ didn’t give parents good information on
how to judge adequate caloric intake in their infants. This, combined
with the book’s recommendation for less than optimal numbers of
feedings, could have been the cause of many of the cases we have seen of
‘Babywise’ babies with poor weight gain and a diagnosis of failure to
thrive,” says Barger, who has served as president of ILCA and
as a member of the examining board for lactation consultants’
professional certification.

One notable development found in the newest version of “Babywise” is
Ezzo’s attempt to shore up his advice with supporting documentation.
Incredibly, the 1998 edition actually cites the work of Ezzo critics
Kathleen Huggins and Kathleen Auerbach as being supportive of Parent
Directed Feeding. The book also relies heavily on GFI’s own
self-conducted, never-before-published studies. Although the
phraseology Ezzo uses to describe GFI’s “survey” of more than 500
infants leaves an impression of rigorous medical research, no actual
peer review process, as defined by the scientific community, was
employed. Instead, according to GFI spokesman Mark Severance, the
35 members of GFI’s self-selected “medical advisory board” were
sent copies of the newest edition of “Babywise” and asked to offer a
critique. Reportedly, when asked, at least one advisory board member has
been quoted as saying that she never even read the book, while another
has stated that he looked at it, but offered no input. In the past, Ezzo
has written that GFI has “hundreds of pediatricians” providing the
organization with “expert medical advice.” However, GFI has never been
able to produce such a list.

Upon learning how she has been cited in the latest edition of “Babywise,”
Auerbach says that her research has been presented to “Babywise”
readers inaccurately and out of context. “There is no such thing as an ‘average’ baby, nor is there such a
thing as an ‘average routine’ that will work for everyone,” says
Auerbach. “I have seen too many families who tried [PDF] and found
that it did nothing but cause heartache for the parents and a baby who
not only failed to thrive, but shut down psychologically.”
Auerbach recalls one infant in particular who, after two months on
the “Babywise” program, was not only underweight but listless and
unwilling to make eye contact with his mother.

- – - – - – - – - -

Amy Scott, a mother, writer and sociologist who has observed extensively
on the GFI Internet message boards in order to gain greater insight into how and
why parents are using Ezzo’s programs, says that it is clear that the
“Babywise” approach is indeed popular with busy modern parents who wish to
train babies to conveniently adapt to their lives rather than vice
versa. However, she believes that there is more to the books’ appeal.

“After reading what these parents have to say, I am left with a
disturbing and more complex picture,” says Scott. “Many of these mothers
are working very hard at being good parents. The problem is this:
through simple bad luck or through their religious institution, they have
been offered a seemingly rational plan for child-care that is full of
misinformation, denial and disguised child-hate.”

Scott notes that, depending on a child’s individual temperament, Ezzo’s
recommendations appear to either work brilliantly — meaning that the
child
essentially gives up and stops protesting completely — or leave parents
incredibly frustrated as to why, no matter how many times they “swat”
the baby, she still won’t use good “highchair manners.”

Author and lactation consultant Huggins agrees, observing that
parents who read “Babywise” may believe that they are experiencing success
with the program when in fact, the opposite is true. “What Ezzo is saying ‘works’ in that many babies do eventually stop
crying as they become resigned to taking only small amounts of milk. In
that way, you could say it works,” says Huggins.

In interview after interview with families who are using “Babywise,”
parents spoke of their sincere desire to produce “obedient,”
“respectful”
children. Rarely did these parents mention a hope to produce emotionally
healthy
adults. Overwhelmingly, “Babywise” parents accepted without question the
conventional wisdom that “kids today” are out of control. Faced with the
onslaught of media images of rampaging middle-schoolers and wilding
teens, these parents believe that by cracking down on what Ezzo
defines as infant rebellion now, they will prevent problems later.

“I have no intention of raising an out-of-control child, ” says Franklin
Stout, a 32-year-old father of two who is implementing “Babywise” methods
with his young children. “My wife and I like having a guide to help
us know how to respond to our sons’ different behaviors. We believe that
firm discipline in the first year or two will save us all a lot of grief
later.”

Several parents spoke of their belief that, after reading the books,
they are
convinced that any other child-rearing philosophy might eventually
produce some type of obnoxious felon. Some of them may have gotten this idea from a statement made by “Babywise” co-author Bucknam, who in 1997 told the Denver Post: “As they [babies not fed on a schedule] get older, every whine is an opportunity to feed. They become more demanding. They become brats.”

“I believe that never teaching a young child to delay gratification sets the stage for immoral behavior as an adult,” says Karen (who declined to give her last name in her response to an Internet survey), a mother of four who says that she has found Ezzo’s teachings to be a “blessing” in her home.

“Telling parents that there is one simple way to get kids to behave is,
well, let’s just put it like this: This type of parenting is part of
this whole swing to the right all over the country,” says pediatrician and Harvard professor T. Berry Brazelton,
known to millions of American parents and grandparents as the author of
“Touchpoints” (Addison-Wesley) and numerous other bestselling books on
parenting and child development. “I feel bad for young parents who are being told that if they follow
this program or that program, they won’t have problems. You have to look
below the surface to
see what’s going on with each individual family.”

After reviewing “Babywise,” noted social historian Stephanie Coontz, author of
“The Way We Never Were: American Families and the Nostalgia Trap” and
“The Way We Really Are: Coming to Terms With America’s Changing Families”
(Basic Books), says that she is able to understand how some parents are
drawn to Ezzo’s advice. “The way this book has been hyped speaks to real dilemmas faced by
parents today,” says Coontz. “Unfortunately, this book may give the
wrong answers. The book provides solutions to real problems that are at
least as bad as the real problems themselves.”

- – - – - – - – - -

Although “Babywise I” and “II” contain little in the way of credible
supporting scientific research, the religious versions of GFI’s child-care guides use the Bible in order to explain Ezzo’s rigid
recommendations. Additionally, some of the health-care providers
(many of whom are not even pediatricians) who have been willing to
offer their
public support for “Babywise” attribute at least part of their acclaim for
the program to their own spiritual beliefs and the books’ religious
underpinnings. Ezzo writes that “in Biblical times, a new mother
did not lounge around in a bathrobe for
weeks on end attempting to establish a bond with her child,” and he uses
the Christian crucifixion as justification for letting infants cry it
out, writing: “Praise God that the Father did not intervene when His Son
cried out on the cross.” Ezzo explains his support for allowing babies
to cry for long stretches by noting that “God is not sitting on His
throne waiting to jump at our every cry, trying to prove he loves us.”

But not every Christian group agrees with Ezzo’s belief that there is anything “Christian” about his harsh child-rearing dictates. The California mega-church from which
Ezzo launched GFI — the Grace Community Church in Sun Valley, which has a 10,000-member evangelical Christian congregation — has now publicly withdrawn support for his programs,
citing issues of integrity and theology. Many congregations around the
country are reporting painful schisms
as Ezzo proponents attempt to force their courses and materials onto
parents in the church.

Additionally, the most recent issue of the
magazine of the Christian Research Institute, a fundamentalist
“cult-watch” organization, features a lengthy and meticulously
documented cover story titled “More Than Just a Parenting Ministry?”
alleging that GFI
has consistently exhibited “cultic tendencies,” including authoritarianism,
isolationism, physical and emotional endangerment and hardball tactics
used against naysayers. As one example, GFI parenting classes disallow
any debate concerning the course materials. Some parents who have
taken the courses say that they were instructed by GFI representatives
not to discuss what they learned in class with anyone who has not
themselves completed GFI parenting training. GFI’s Web site message
boards are similarly intolerant of any disagreement. Those who are not
deemed to be “like-minded” have had their Web access permanently blocked
from what GFI calls its Internet “Family Room.” (In my own case, after I requested an interview with the Ezzos and
registered to log on to the forum in order to research this article,
GFI’s Web site forum administrator informed me via e-mail that she had
“checked me out” at the request of Anne Marie Ezzo. She wrote that she
had made the determination from information found on my family’s personal
home page that I am “not in agreement with [GFI's] beliefs and so I
have denied you access.” This is despite the fact that I had never
posted or attempted to post to GFI’s message boards. The forum
administrator further cited privacy concerns. Not surprisingly, I was also denied an interview with the Ezzos.)

Dr. Barbara Francis, a well-known Christian licensed marriage and family therapist has written
of her own reservations regarding GFI’s encouragement of secrecy among
supporters. She notes in a recent article for a professional journal
that at least one GFI publication she has reviewed advised parents to
avoid spanking their children in public, to be careful about neighbors
hearing their children’s cries in apartment buildings and “to instruct
one’s children not to tell anyone — even the child’s other parent in a
divorce situation — about occurring chastisement (GFI’s euphemism for
corporal punishment), due to potential ‘misunderstandings.’”

Dissenting Christians who have attempted to establish a dialogue with
Gary Ezzo have sometimes found themselves on the receiving end of
patronizing vitriol. Often, Ezzo declines to correspond with “outsiders”
about his views. However, in one Internet chat exchange with Christian
mothers who sought clarification of GFI parenting advice, Ezzo
wrote that participating in the discussion was like “being in the
henhouse at egg-laying time.” Ezzo went on to write that, “ladies, I do
have other more important activities to fill up my day, than the go
nowhere debates with emotionally charged demand feeding mothers talking
about demand feeding practices.”

Outspoken critics of GFI report being investigated, publicly
misrepresented and even harassed by the organization. Steve Rein, an
assistant professor at a Virginia university, maintains a Web site
critiquing GFI materials
and an e-mail discussion list for Christian parents, many of whom hold
negative views of Ezzo’s parenting philosophy. He says that GFI has
unsuccessfully pressed for criminal prosecution of his activities and
subsequently threatened civil action against his employer and him. He
also says that GFI consistently monitors his listserv.

“I think that Gary Ezzo really has a sense that they are engaged in some
kind of holy war. Sure, he’s making money, probably a lot of it, but I
think there’s more to it,” says Rein, who has had to hire an attorney
to deal with GFI.

After a May 1996 report on religious parenting programs sponsored by
the Orange County [California] Child Abuse Prevention
Council concluded that GFI’s materials contained many
disturbing elements that had the potential to lead to child abuse, the
council received such a deluge of time-consuming phone calls from GFI
supporters that it was forced to ask that its report no longer be made
public so that its office could get its work done. While the current
director of the council says that she has no reason to believe that the
phone calls were orchestrated in any way, she says that they were
certainly “overwhelming.”

Gary Ezzo and Robert Bucknam have in the past responded to families who
report experiencing problems with their child-care guidance by
suggesting that the parents in question should have used the ideas in
“Babywise” more flexibly and with a dose of common sense. Although the
books do sprinkle warnings against “legalism” and in favor of “context”
throughout their pages, the overall message remains one of rigid,
uncompromising parental authoritarianism toward even the tiniest
newborn. GFI’s message boards provide insight into how
parents, particularly religious users of Ezzo’s programs, are applying
his ideas to real-life situations in their own homes. In recent months, one anxious mother
posted to the boards of allowing her young infant to cry for so long
over the course of several weeks that
the baby lost his voice and had blood in his throat (GFI quickly removed
this mother’s post from public view). In another
instance, a parent wrote of her frustration with having to spank her
unruly toddler (with a flexible instrument, as Ezzo recommends for
babies after the second year) so often that welts appeared. Yet another
father spoke of leaving his 13-month-old in isolation in her crib off and on for
up to four hours in response to her stubborn refusal to use baby sign
language to communicate that she was “all done” with her meal. In the
case of each of these alarming tales, GFI “contact moms,” volunteer
laywomen
designated by the organization to offer support to other parents in the
appropriate use of their programs, actually suggested a stricter
adherence to the program and more structure for the children (although
it was noted that hitting a child as per Ezzo’s instructions should
inflict pain without leaving visible marks).

“Parenting like this shows very little respect for children,” says
pediatrician Brazelton. “It’s very adultamorphic and not sensitive to the baby.
Although parents should gently set limits, punitive discipline for very
young children and babies is repressive and can quash exploration and
excitement in the first two years of life. It will be interesting to see
some follow up on these kids in later years. I suspect that they’ll have
a lot of inner rebellion.”

Don and Jeanne Elium, family therapists and authors of the
books “Raising a Son,” “Raising a Daughter” and the new “Raising a
Family: Living on Planet Parenthood” (Celestial Arts), concur with
Brazelton that the discipline practices promoted by Ezzo are
neither age-appropriate nor effective in the long run.

“All isolating a baby or young toddler teaches them is that the world is
not a safe place to be in,” says Don Elium. “Let a baby be a baby so that
she can be an adult when it’s time to be an adult.”

“Leaving a baby alone to cry in order to punish or to train them to
sleep can create a sense of rage that comes from abandonment and
hopelessness,” agrees Jeanne Elium. “These children will probably pay an
expensive price in therapy later.”

Babywise supporter Dr. Carl Hays vehemently disagrees.
“If you are sure that a baby has been fed and changed and isn’t in
distress, there is no harm in leaving them alone to cry,” explains Hays.
“If you respond too quickly, these babies become trained to expect every
need to be gratified. This can, of course, lead to problems for kids
down the road.” When asked to elaborate on what these problems might be,
Hays suggests contacting GFI headquarters for answers.

Despite all the controversy and the existence of a number of Web sites
devoted to discouraging the use of the “Babywise” program, the books
continue to fly off the shelves and pass from parent to parent, leaving
observers frustrated.

Dr. William Sears, a practicing pediatrician and clinical assistant
professor of pediatrics at
the University of Southern California School of Medicine, as well as the
bestselling author of more than 20 child-care titles including “The
Baby Book,”
has been one of the most vocal critics of “Babywise.” Sears is the leading
medical
advocate of an increasingly popular style of nurturing called attachment
parenting, which represents the antithesis of Ezzo’s recommendations. Ezzo takes a dim and even hostile view of attachment parenting,
having referred to it as “neoprimitivistic” and redolent of “third world
maternal disorder.” However, after Theo and Lori Rivas abandoned the
“Babywise” approach in favor of the hands-on, relaxed parenting style
advocated by Sears, they saw both Daniel and his 3-month-old brother, Michael, thrive. Lori holds and breast-feeds the boys
frequently.

“People began calling me about the stuff in this book several years ago,
but I basically ignored it, thinking that it was so far out that it
would just die out. I wish that more of us had spoken out earlier,”
says Sears, who has in the past referred to “Babywise” as “probably
the
most dangerous program of teaching about babies and children that I
have seen in my
25 years of being a pediatrician.

“A new mother is vulnerable and a new father often wants his wife back
to himself after only a few weeks. This program preys on this and promises
parents that they can train a baby to sleep when parents want to sleep,
fit in to the parents’ established lifestyle and not be a bother. I think
that the widespread acceptance of this program represents a sad
commentary on the wisdom and discernment of today’s parents.”

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