Bringing Home Baby: Doctors and Parents on Making Big Decisions

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What would new mothers do differently if given the opportunity for a do-over? Reconsidering circumcision and breastfeeding top the list.

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That parenthood is stressful is no surprise. Potty training, hospital visits, struggles in school, driver's licenses, and first dates are just a few of the adventures that parents have to shoulder as their kids grow up.

Some of the earliest decisions can be among the most challenging. The choices that parents have to make leading up to and just after the birth of their children can have long-term implications. Should you to opt for a C-section, breastfeed, circumcise? These are some of the questions that parents face in the days leading up to and just after the birth of a child. Of course, the state of mind parents are in just before and after the birth of their child may not be the best for making these important decisions, some of which can affect a child for years to come.

The months and weeks prior to parenthood -- especially of a first child -- are filled with uncertainly and conflicting information. Baby books can be hard to digest for many reasons, not the least of which is they can offer contradictory theories and advice about parenting.

We wondered how parents feel when they look back and recall those early life decisions that they made for their children and themselves. What do they wish they'd done differently? We talked to several readers who volunteered their experiences, and to two knowledgeable doctors -- a pediatrician and a family physician -- who offered their advice on how to make the toughest decisions. Richard Polin, M.D., is director of the Division of Neonatology at New York-Presbyterian Morgan Stanley Children's Hospital. Rallie McAllister, M.D., M.P.H. is a family physician in Lexington, Kentucky, and coauthor of The Mommy MD Guide to Pregnancy and Birth and The Mommy M.D. Guide to Your Baby's First Year.

Circumcision Rates Decline -- Should You Skip It?

According to a new study by the CDC, circumcision rates are down in hospitals by 4-7 percent in the last 10 years. (1) Why is this? The previous ten years had been marked by a significant increase in circumcisions, so that rates are now declining is a fairly new trend. There are mixed opinions of circumcision: on one hand, it's been shown to decrease the risk of spreading certain STDs like HIV and HPV, while on the other it causes pain and stress for the tiny patient (and parents). Some groups across the country, such as the Whole Baby Revolution, are advocating banning circumcision in their areas, which underlines its changing status.

Parents: Opting to Avoid Pain

Circumcision is a choice parents of boys have to make. Often someone appears at the door of your room and asks if you want your baby circumcised, and if the answer is yes, the baby's foreskin is cut out of sight and (perhaps) out of mind. Some parents view it as a health issue; others see it as a religious or cultural obligation; and still others think, "How will my son feel if his penis looks different from other kids' in gym class?"

So how do parents feel about the practice when and if they have time to think about it? One mother we talked to, Francis*, told us, "I really wish I didn't circumcise my son -- I was in the room when they did it, and afterwards couldn't even believe I had considered it."

Another mother, Melissa, had attended a bris, the Jewish circumcision ritual, a year before her own son was born. She had heard the newborn cry in pain, so she told her husband (who is Jewish) that if he wanted their son circumcised, it would be up to him to secure a mohle and hold their son for the procedure. When the time actually came, her husband couldn't bring himself to go through with it, so their tiny son was off the hook. Since the procedure can be stressful for a newborn, it's understandable that parents would wish to avoid it altogether.

Doctors: Circumcision Is a Cultural, Not Medical, Decision

Dr. Polin underlines that while there's some evidence that circumcision cuts down on conditions like HIV and urinary tract infections, the American Academy of Pediatrics (AAP) does not recommend circumcision. (2) In the end, he says, it really is just a cultural and religious practice, not a medical one: "over time, that message is getting through. It's simply not mandatory."

McAllister agrees that "the declining circumcision rates are a reflection of the increasing availability of information about this surgery. When parents have more knowledge and a greater understanding about the immediate and future impacts of circumcision, they're better able to make a conscious, educated choice about whether they want their baby to be circumcised."

She adds that people should read up and talk to friends about the decision, even though it can be a tricky conversation if you're shy. "If the baby's father is circumcised, it might be helpful to have a conversation with an adult man who wasn't circumcised, to get another perspective. This might sound like a questionable topic for discussion, but it's similar to asking a woman about her experience breastfeeding or having a Cesarean section.... After parents have fully educated themselves and given very careful consideration to their options, I encourage them to do what they feel is best for their child."

The bottom line is that circumcision is a personal decision, not a medical requirement. There may not be enough good evidence to warrant the practice for health reasons alone. On the other hand, if your cultural, religious, or personal beliefs encourage it, there is little evidence that it does a child any long-term harm. Researching it though books, Internet, friends, and, of course, your doctor, is always the best tack to take.

To Breastfeed or Not to Breastfeed?

Another issue that parents face upon the birth of their child is whether or not to breastfeed. Breastfeeding is a topic of fervent debate, and, fortunately, increasing research. Less fortunately, despite growing evidence that breastfeeding is linked to multiple benefits, from fewer infections (3) to better cognitive skills (4) (along with the Surgeon General's recent "Call to Action to Support Breastfeeding"), a recent CDC study suggests that hospitals may not be educating new parents adequately. (5)

In almost 80 percent of hospitals surveyed, newborns were being given formula when they did not need it medically, which makes getting started breastfeeding more difficult. Only 4 percent of hospitals provide the full gamut of lactation support services available, and just 14 percent have a written policy on breastfeeding education.


*Names have been changed.

(1) CDC: Trends in In-Hospital Newborn Male Circumcision -- United States, 1999--2010. Morbidity and Mortality Weekly Report 60(34): 1167-1168. Web link: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6034a4.htm?s_cid=mm6034a4_w; accessed: 9/23/2011.

(2) American Academy of Pediatrics circumcision statement: http://aappolicy.aappublications.org/cgi/content/full/pediatrics;103/3/686. Accessed: 9/23/2011.

(3) Duijts L, Jaddoe VWV, Hofman A, Moll HA. 2010. Prolonged and exclusive breastfeeding reduces the risk of infectious diseases in infancy. Pediatrics 126(1): 18-25.

(4) Quigley MA, Hockley C, Carson C, Kelly Y, Renfrew MJ, Sacker A. 2011. Breastfeeding is associated with improved child cognitive development: A population-based cohort study. In press.

(5) CDC Vital Signs report: http://www.cdc.gov/vitalsigns/breastfeeding/#LatestFindings. 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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