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Case Studies of Moms who had problems using Babywise
or Preparation for Parenting: Page One

Note: This page is a work in progress. I am working to transfer notes to my computer.

An Overview of Breastfeeding Failure or
Inadequate Infant Weight Gain Associated with
Preparation for Parenting or Babywise Based on Case Studies

Abbreviations Used In This Overview
GFI ~Growing Families International
BW ~On Becoming Babywise
PFP ~Preparation for Parenting
CM ~Contact Mom
CIO ~cry it out
bwt ~birth weight
dcw ~discharge weight
pp ~post-partum
wrt ~with regard to
rev ~revised
hcp ~health care practicioner

Parameters of this Overview

1. To preserve the privacy of individuals, all moms are numbered, and any other names have been removed and replaced by a descriptive such as babyname, doctorname, husbandname, etc.
2. Moms who read Babywise are differentiated from moms who took the PFP class. Version of BW or PFP used by mom is noted when available.
3. All contacts took place between August 1, 1999 and August 1, 2000 (shortly after that time I resigned as a contact mom). I did not begin tracking mom/baby pairs until I began to be concerned with the pattern I saw developing in the calls I received. I conservatively estimate that I worked with at least ten similar situations between January 1999 when I first became a contact mom and August 1, 1999 when I began taking copious notes.
4. Before the crash of my AOL software, I had saved (by a conservative estimate) at least two dozen similar interactions with moms by e-mail (referrals from the GFI e-mail CM help or referrals from other moms who had corresponded with my by e-mail). When my software crashed I lost all saved e-mail correspondence.
5. I did not include in this overview referral calls where mom was responding appropriately and it was evident that there were physiological issues such as latch correction needed, likelihood of needed thrush treatment, or simple encouragement calls for breastfeeding. The contacts listed in this overview are specifically addressing the concern of breastfeeding failure or inadequate weight gain in infants (logged approx. 50 GFI referral calls between 8/01/99 and 8/01/00).

Informational and Assessment Questions
Used To Evaluate the Mom/Baby Pair

(Rather than list separately all questions asked each mom, I will include these questions at the top so it can be assumed that each mom with whom I had personal phone interaction recorded in this overview was asked at least these questions. Any additional information sought will be included for that particular mom)
1. Name, date of call, phone number
2. BW or PFP (and edition)
3. Baby name, date of birth, birth weight, discharge weight, weight at all recorded weight checks (recorded as: lbs/oz)
4. Typical or exact pattern of preceding days (depended on mom’s notes or lack thereof) including: exact timing and number of feedings, time at breast, both amount and composition of urine and stool output, did baby self-initiate feeds or did mom wake to feed, mom pumping vs. feeding at breast, mom or baby ending time at breast
5. Typical or exact amount of time baby spent crying and when it took place: before sleep, before feedings, after feedings
6. Typical or exact response of mom to baby’s crying
7. Behavior at the breast including: did mom feel letdown, audible swallowing by baby, observable open/pause/suck type of swallow, rhythmic swallowing pattern by baby, any clicking sounds or dimpling of cheeks when baby nurses, is mom using a nipple shield, has latch ever been evaluated/observed by lactation professional, have mom describe position of baby’s mouth on breast, baby tugging at breast, baby showing frustration at breast, baby clamping down on breast, baby tongue thrusting, observable vacuum created
8. Early breastfeeding experience right after birth through the first week including: bottles, jaundice, hypoglycemia, pacifiers
9. Did mom believe milk had “come in” after baby’s birth? If so, what day. Asked mom to describe whether engorged, hard/full feeling, dripping, spraying, leaking
10. Physiological issues for mom including: hemorrhaging after birth, color, smell and flow of lochia, any marked difference in size of breasts, flat or inverted nipples, history of injury or surgery involving breasts, thyroid problems, physical exhaustion, dieting
11. Other medical issues including: smoking, alcohol or drug consumption, prescription or non medications during pregnancy or after/currently (including corticosteriods such as with pre-term labor/infant, hormonal birth control, etc.)
12. Emotional/mental issues for mom: stressful family situation, PPD, support or lack from spouse and/or extended family, doubts and fears about breastfeeding, maternal expectations and goals about breastfeeding and infant behavior
13. Physiological issues for baby: cleft palate and/or lip, any medical diagnosis of concern, jaundice, sensitivity to bovine milk proteins, excessive spitting up or reflux symptoms, observable feeding cues identified/able by mom, excessive gassiness
Note: The signs for low milk supply and/or a slowdown or decrease in weight gain don't happen overnight. Urination, along with milk supply was gradually decreasing, happening so slowly that it wasn't immediately obvious to these mothers.

Mom #1
(phone referral from GFI)
-PFP (6th ed. church class)
-Baby girl 2 mo. old. bwt: 7/3, dcw: 6/15, 2wk: 7/7, 4 wk: 7/12, 2mo: 8/7
-Description: Baby willing to be at breast. At time of this call, mom was feeding 3 oz. of formula per feeding (per hcp orders) in a supplementer at the breast (per LC suggestion). Process: feed baby at each breast until baby no longer satisfied, and then use supplementer with formula. Total time at breast averaged 60 min. Baby feeding q 3 hrs; baby initiating feedings. Mom did not pump post-feed because of time at breast.
-History: Baby diagnosed at 2 wks. with thrush. Baby treated but not mom because hcp said mom was asymptomatic. Mom began treatment at 3 wks. pp. Behavior at the breast was difficult between 12 days and 15 days pp. Baby would latch on and off and fuss at the breast, but improved within 24 hours of treating thrush. Mom believed milk came in at 3 days pp, with typical hard, full feeling. No other issues of concern for baby and mom besides the thrush. Mom often had to initiate feedings, but if baby woke before three hours from start of last feeding she would use pacifier to hold baby off for feeding per instruction from PFP class leader (mom stated this was the first class for church to use 6th ed. and class leader said that her babies did fine with three hours between feeds). Mom stated that even though the video stated she should not be legalistic, she was afraid to feed sooner too often because she didn’t want to fall into the “trap” of demand feeding. Slow weight gain between wk. 2 and 4 was attributed to fussy behavior at breast with thrush. Mom stated that she believed she missed a growth spurt sometime around 6 wk but did not realize it until 2 mo check when she saw baby’s weight. Between 4 wk and 2 mo check she called a CM (referred by GFI) with complaints of “poor napping” (baby waking at 45 min into nap). CM told mom it was the “45 minute monster” and to continue being consistent with baby. CM recommended that mom vacuum or work outside so as to not hear the crying. At 2 mo check, hcp was alarmed at the continued slow down in baby’s growth and told mom to supplement with formula. Mom saw LC in town, because she didn’t want to stop breastfeeding. Mom stated LC took a history and came to conclusion that although thrush was a complicating factor, responsive nursing after thrush behavior discontinued and through the growth spurt or two mom believed she missed would have “covered” any temporary drop in milk supply. Mom reported concern that LC was not understanding her desire to parent biblically, so discontinued discussion, took the supplementer and left. Mom called me after she had been supplementing for a week because she wanted to know if it was possible to regain supply. By this time Mom reported grief that she had been allowing her baby to go hungry.
-Advice given: First, ascertained mom’s goals wrt breastfeeding. Mom wanted to try to rebuild milk supply. Then told mom to go back to LC and share compeletly with her the plan we were working on because she needed a local support for regular weight checks who was also knowledgeable and supportive of breastfeeding. Told mom to decrease supplement by 1/2 oz. per feeding beginning next day. The goal was to have baby wake up and be willing to nurse sooner than three hours (explained to mom how formula sat in stomach longer, etc.) If baby still wanted to go 2.5-3 hour a feed, then to drop an additional 1/2 oz. so that baby would be willing to feed at least every two hours. Instructed mom to chart time and amount of supplement at every feeding, plus all wet diapers and stools. Mom was to take baby for weight check every three days. As long as baby was tolerating plan and mom’s milk supply was increasing (as evidenced by weight checks), every three days, mom would decrease supplement by 1/2 oz. until no longer supplementing baby. In addition, mom was to bring baby into her room and nurse during the night any time the baby woke or stirred. Mom called to update me on how things were going every three days. As I had predicted, LC in town was very supportive of our plan, and gave mom encouragement. I also mentioned to mom that some moms liked to consider use of herbals to help milk supply. Told her that it would have to be her choice, and suggested she do some reading on the subject and consult a certified herbalist. Mom decided to use More Milk according to herblist’s instructions. Within 23 days, mom had discontinued use of supplement and baby was growing on breastmilk alone. Mom made decision to continue with frequent feeds until solids were begun, deciding to nurse before and after naps or when baby indicated a desire to nurse.
-Follow up: Same mom called me when this baby was 15 mo. old because she had given birth to a new baby boy. Mom wanted to discuss thrush treatment because baby was dx with thrush at 10 days pp. Mom stated that she was not “following PFP with this baby.” She stated that she found the sleep/feed/wake pattern helpful but if her baby seemed to desire to nurse at other times, she did so. Mom reported less stress and worry since she wasn’t trying to “do things right by PFP.”

Mom #2
(phone referral from GFI)
-BW (rev)
-Baby boy 4 mo. old. bwt: 8/11, dcw: 8/9, 2wk: 9/0, 4 wk: 9/15, 2 mo: 11/14, 4 mo: 12/5
-Description: Baby willing to nurse, and vigorous at breast. Baby feeding q 4hrs at mom’s initiation. Mom was no longer charting urination and stooling at this time (said she discontinued that at 8 weeks)
-History: Mom reported baby crying mid-nap, and resumed night waking one week before 4 mo. well baby check. Mom spoke with a CM and was told that some babies just take longer to adjust to “good naps” and she should remain consistent in her effort to train baby to take a “full nap.” No other complicating physical factors for mom or baby. Mom and hcp alarmed at 4 mo. wbc when it was realized that only 7 ounces had been gained in 2 months. While not on the high end of weight gain, weight gain had been adequate first two months.
-Advice: Mom was supplementing after feeds with formula (2 oz.) per hcp instructions. Mom and I discussed her goals with regard to breastfeeding and she stated a strong desire to continue breastfeeding, dropping supplement if possible. We started her on a plan of dropping one half ounce of formula every three days to stimulate a growth spurt pattern in baby’s behavior. Mom also pumped with a double pump after each feeding at the breast (averaging q 2 hrs.) for 10-15 minutes. During this time, mom checked with me every three days, charted both urination and stooling, and had baby weight checked every three days at hcp’s office. Within 15 days, mom was breastfeeding exclusively and baby was thriving. Mom nursed before and after naps to make her routine easier to predict. She found she preferred this to “worrying” about times between feeding intervals or nursing at a specific time based on the clock.

Mom #3
(phone referral from GFI)
-BW (95 ed.)
-Baby girl 3.5 mo. old. bwt: 7/14, dcw: 7/16, 2wk: 8/12, 4 wk: 9/10, 2 mo: 11/4, 4 mo: 11/8
-Description: Baby nursing q four hours after naps, 4 feedings daily. Mom reported that for about a month prior to the 4 mo. wbc, the baby began waking 30-45 min. early from naps, but mom let baby stay in crib until naptime was over. Baby nursed at breast an average of 10 minutes per side, with self-initiated unlatching. Mom reported that just before the 4 mo. wbc that wet diapers seemed to be decreasing and smelled stronger, but mom was not charting output at this time.
-History: Until 4 mo. wbc, there were no concerns with this baby’s growth or mom’s milk supply. Although mom had c-section, milk came in at 3 days pp and there were no latch or other nursing problems. Mom sought help from CM online about sleeping problem and was advised to “stick to her guns” to train her baby that mom was in charge of the end of naptime. Baby cried from waking until feeding time.
-Advice: Mom was “stressed” and “grieving” that she didn’t realize her baby was not being fed adequately and was doubting her ability to ascertain her baby’s needs. While mom wanted to continue breastfeeding, she reported fearing that she would never be able to tell if her baby was really getting enough. Mom decided to wean completely to formula.

Mom #4
(phone referral from GFI)
-BW (rev.)
-Baby girl 2 mo. old. bwt: 6/2, dcw: 6/0, 2wk: 6/4, 4 wk: 7/1, 2 mo: 7/14
-Description: Baby nursing q 3 hrs after naps approx. 10 min. per breast. All feedings initiated by mom. Mom reported frustration that her baby was not sleeping through the night yet, and still unable to go longer than 3 hours during the day between feedings. Urination was on the low end of normal—6 wet diapers daily, and baby was stooling large copious amount every 3 or 4 days. Mom reported having a difficult time listening to baby cry, so she used a pacifier to hold baby off for feedings.
-History: During first 2 weeks, mom had problems with baby latching correctly (dx by hcp with short frenulum which was clipped at 2 weeks). Weight gain picked up between 2 and 4 weeks into normal range. Both mom and hcp were perplexed with drop off in weight gain pattern between 4 wks and 2 mo. Mom reported audible swallowing at breast, visit with LC at hcp’s office confirming good latch and swallowing. Baby appeared frustrated at end of feedings, but mom thought baby had more sucking needs than time at breast met, and offered pacifier after feeds for non-nutritive sucking. Mom was afraid to nurse beyond the time that she did because she reported concern for demand behaviors and comfort nursing. Mom did not discuss use of BW with either hcp or LC quoting concern stated in BW and from her CM at her church. No other physiological concerns for mom or baby.
-Advice: Talked with mom about the possibility of a growth spurt being missed at 6 wks. Mom reported confusion wrt understanding what a growth spurt was, how could she know how long to change from her schedule, etc. Mom reported fear that her baby wouldn’t learn how to sleep through the night if she fed sooner than 3 hours on a regular basis. I explained the physiological effects of a growth spurt, and the necessity of being flexible with feeding times when breastfeeding. Mom agreed to try nursing responsively for a few days to see if that would help things improve. I told mom to expect a day or two of intervals closer to two hours or less, and to feel free to adjust her expections wrt to sleep training during the time she was working to build her supply to the necessary level. I assured her that if her baby developed a sleep problem by nursing her baby more often, including before sleep and during the night that she could worry about that later once her baby was growing well. After a week, baby was back to her former nursing habits, nursing every 2.5 to 3 hours at her own initiation this time, and feeding once during the night. Mom reported that she was less stressed than trying to follow the sample schedule she had written in her BW book. Baby had gained 12 ounces in that week and was back on track with good weight gain.
-Follow up: This mom called me at her baby’s 4 mo. wbc to report that her baby weighed 12 lbs, and that baby had begun sleeping 8 hours at night by 14 weeks. We discussed the importance of not allowing her baby to go longer than 8-10 hours at night without nursing, and gave her ideas of how to manage that by waking her baby for one last nursing before mom went to bed for the night. Mom reported that a mixture of responsive nursing and some parent directed feeding (like the bedtime feeding) worked much better for her than trying to schedule feedings. Mom reported that she was confused by some of the messages in BW and she did not intend to recommend it to others.

Mom #5
(Current Contact Mom with GFI)
-Most current edition of PFP when baby was born
-This case is in narrative form with personal details removed, as written by the mother

-My third child was our first Prep-from-birth baby. From her 2 month to 3 month check-up, she lost weight. I mentioned it to my husband because even I thought that probably didn't seem right. He doesn't remember me saying specifically that babyname had lost weight. Anyway, one night at a Bible study we went to, he overheard me talking to a Pediatrician who attended about babyname's weight loss. Doctorname was concerned and now, so was husbandname :) By her 4 month check up, she had lost a bit more and continued to for several weeks. You already know what the cause milk supply had dried up and I didn't know it. Finally another pediatrician suggested gently that I supplement after I nursed her and after 30 minutes of nursing, babyname drank 8 oz.

I am embarrassed to say it happened again with babyname, our 4th child although she didn't lose weight she hardly gained any by her 4 month appt.. I remember thinking "boy, she doesn't poop often" And I was a CONTACT MOM!!! I weaned her at the end of 4 months. I now know that when I drop the 5th feed, my milk supply disappears.

I think Prep/BW does not do a good enough job talking about the deviations from the norm. The message is "do it just like this and your baby will fall in to place with no problems!!" I am living proof that is not true and while the CM-calls I have had are not lactation problems, there are plenty of babies that don't "do" Prep in any way that resembles the book. (Especially boy babies once they seem to hit about 9 weeks....and have you ever had calls from moms whose babies do not nap? I have. Plenty.)

I also wholeheartedly agree with there not being any clear cut message about this is a ROUTINE not a by-the-clock, military schedule. I was guilty of that with babyname and I feel bad about it still, 5 years later.

I used to feel that it was unthinking parents (and I included myself in that group) who did this to their babies, but I no longer think so....While I was unthinking, the book makes it seem so cut and dry: a+b get C! I just love your line in your email to me: being a thinking, assessing parent is THE principle, not blind response. I think Prep/BW somehow encourages blind response.

Read more case studies on Page Two and Page Threeof this overview.


Affect of Maternal Diet Before the Baby is Born Benefits of Breastfeeding Birth Choices
Breast Compression Breastfeeding After Breast Surgeries Establishing A Routine
Flat and Inverted Nipples Formula Use Healthy Growth Indicators Jaundice Milk Supply
Plugged Ducts and Mastitis Pumping Sleepy Baby Sore Nipples
Storage Guidelines Things People Say Thrush Weaning

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This page and contents Copyright © 2002 Laurie Moody