Bringing Home Baby: Doctors and Parents on Making Big Decisions

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Parents: Lack of Help Can Lead to Giving Up

Rebecca, another mother who spoke to TheDoctor, said that the fact that there was so little lactation advice given in the hospital made the whole process feel overwhelming and isolating. The lactation nurse did not make an appearance until her son was a day old, and she was not aware of the fact that she could ask for one earlier. Her son had problems latching on, due to a slight "tether tongue," where the baby's tongue doesn't have the full range of motion to do the suckling reflex.

She ultimately stopped trying when her son was a few weeks old and switched exclusively to formula, which also has its benefits: Rebecca says its convenience and the fact that her husband could feed just as easily as she could with formula, with no pumping required, was quite a nice benefit. On the other hand, she was always slightly sad that she didn't experience more of the mother-child bonding that comes with breastfeeding, and looks back on those early days of frustration with an inkling of regret.

New mothers are often emotionally quite delicate, not to mention exhausted. So the problems that can come up when learning to breastfeed (it is a skill that needs to be learned by mothers and babies) can feel overwhelming. Some babies have trouble latching on to the breast, mothers may find positioning their baby on one side or the other, awkward. All of these difficulties are easily overcome with a little help and practice, but too often, women don't receive the instruction they need to move the process along.

Doctors: Educate Women Early

Dr. Polin has a firm opinion that there's really no excuse for the hospitals that leave new mothers to fend for themselves on the breastfeeding front. "Our department always encourages mothers to breast feed," he says, "especially in the NICU [Neonatal Intensive Care Unit]." He adds. "Most hospitals offer lactation consultants. Every mother should meet with one. A good lactation consultant can make all the difference." If your hospital doesn't provide one for you right away and you have questions about breastfeeding, it's crucial ask for one. A little help can make all the difference.

Dr. McAllister makes the point that the timing of breastfeeding education may be the root of the problem. "[Breastfeeding] education needs to start early in a woman's pregnancy," she says. "It's often too little, too late to see a lactation consultant the day after the delivery. I hear over and over from other mothers -- even those who are physicians -- that they didn't feel that they had enough education about the 'how to' of nursing prior to giving birth."

Talk to your doctor or nurse while you are pregnant, and bring it up in your childbirth class if it isn't mentioned. Of course, much of the learning process clearly has to do with the practice itself, which has to come after the birth of the baby, but there is still something to be said for absorbing as much as you can beforehand so you'll be familiar with all the issues involved.

For some women and some babies, however, breastfeeding remains impractical or impossible. There is no evidence that formula-fed babies have any significant health or developmental problems in the long run. As Polin says, "if you don't have breast milk it's fine. There should be no sense of guilt." So if breastfeeding doesn't work for you -- as it doesn't for many women, for various reasons -- don't fret: your baby will turn out just fine.

C-Sections or Vaginal Delivery: Should It Be a Choice?

C-section rates have reached an all time high in this country. (6) Some of the reasons for this, according to a Healthgrades study, include the convenience (for doctors and parents) of choosing a delivery date and time; a lack of awareness of the complications associated with it; the rise in multiple births, which could require it; an increase in age-related risk factors in the mother; and a rising willingness of doctors to perform the surgery.

What's particularly apparent is that more women are opting for scheduled C-sections, both for reasons of convenience and perhaps for physical or aesthetic reasons. But the surgery has its risks, including a longer recovery period for the mother and potential health risks to the baby -- therefore, C-sections should not be viewed as a simpler alternative to the old-fashioned method.

Parents: Expect a Long Recovery -- No Matter How You Give Birth

One of our readers, Rebecca, offered that although her C-section was necessary and unexpected, the recovery was long, painful, and exhausting. She says that very early into her recovery she tried to take on more than she should have, which lead to prolonged bleeding and a prescription for additional bed rest, not to mention the tears of pain that were produced from the simple act of rising from her bed.

Had she just taken time to allow her body to recover slowly and steadily, she says, the recovery would have been a lot faster than it was when she tried to speed it up. "It took weeks for me to be able to move normally and get back to all my regular daily activities. Picking up the baby without a lot of pain took a number of weeks, too." It's important to remember that C-sections are major surgeries and hard on the body in multiple ways. Allowing your body the time it needs to heal is ultimately the fastest way to recovery.

That said, there's an intense recovery involved with vaginal delivery as well. Sandy tells us that she wished someone had told her about the time that it takes to recover physically from childbirth. The stitches after a vaginal delivery, she said, were exponentially more painful than she'd anticipated, and it took her a very long time to feel normal again. Melissa, echoing Rebecca's experience but without the C-section, said, "It felt so great to feel lighter [after giving birth]; I was so excited to be a mom, that I did too much too soon and had extra heavy bleeding." Giving birth is a natural event, but it's a radical one. Treat yourself accordingly.

Doctors: Planned C-Sections Pose Risks to Mother and Child

Beyond the seriousness of surgery for the mother, Polin tells us that what most people are unaware of are the risks to the child. "The NIH has done maternal-fetal network studies on the C-section issue," he tells us. "There's a great concern that premature babies -- even slightly premature, as with a planned C-section -- are at higher risk. This is because of C-section demand. These babies can have a lot of problems."

Even having a child a week before their natural due date can be hard on their little bodies developmentally. According to Polin, the risks to the infant that can come from planned C-sections include "respiratory disease, mortality, and neurodevelopmental handicaps." He also points out that the March of Dimes has launched a campaign to reduce unnecessary "late pre-term" C-sections (those done before week 39), because of the associated risks.

Of course, it's clear that when C-sections are required, they can be life-saving, for both mother and child. But planned C-sections, particularly early ones, come with real concerns that should not be taken lightly. It is critically important to learn about all the issues associated with C-sections and vaginal births for your particular situation before making a decision.

Where to Give Birth: Options Beyond the Labor and Delivery Ward

Though the use of alternative locales and methods of giving birth seems to be on the rise, many women may still not be aware that there are other places to give birth besides hospital delivery rooms and that people other than doctors and nurses can assist in the delivery. Midwives are trained individuals who can do certain medical procedures, lab tests, and assist with the birth and the newborn. Doulas are not health professionals, but offer other types of services including emotional support for the parents leading up and after the birth of the child.

Birthing centers have a homier feel, some offering Jacuzzis, comfortable furniture, hardwood floors, rugs, and tasteful decoration. And while they typically don't have doctors on staff, they offer nurses or midwives, who can handle a range of complications. According to the American Association of Birth Centers, more widespread use of birthing centers would save the country millions of dollars in healthcare costs per year, not to mention cutting down significantly on the number of C-sections. (7)

Since most birthing centers foster "natural" births, many don't offer epidurals, drugs to induce labor, or C-sections. For women who are concerned about this, some hospitals actually have their own birthing centers, which can put a mother's mind at ease: The latest technology, doctors and specialists, and equipment can be only an elevator ride away should the need arise.


(6) HealthGrades Obstetrics and Gynecology in American Hospitals report: http://www.healthgrades.com/content/ratings_and_awards_2011_Obstetrics_and_Gynecology_Report.aspx. Accessed 9/23/2011.

(7) American Association for Birth Centers Fact Sheet: http://www.birthcenters.org/news/press-kit/bc-fact-sheet.php. Accessed: 9/23/2011.

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Alice G. Walton, PhD, is a health journalist and an editor at The Doctor Will See You Now.

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