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.

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.

Parents: A Warmer Environment Helps the Stress

One reader, Theresa, said that she sincerely wished she'd known more about alternative birthing options before having her daughter. Her hospital experience was OK, she tells TheDoctor, but a birthing center or other environment that offered more personalized care would have made the process much more enjoyable in retrospect.

In the same vein, Rebecca says that she was so terrified of the process, a birthing center could have made all the difference -- if she'd only known that they existed. "In retrospect," she says, "I would have used one. But knowing myself, because I was so scared of the birth process in general and its potential complications, I would have 100 percent chosen one offered by a hospital. A home birth was the only other option I knew of, and I wouldn't have felt comfortable on that end of the spectrum."

Doctors: Have the Best of Both Worlds

Dr. McAllister agrees that she would also want the peace of mind that comes with giving birth in a hospital. "Although I would have loved to have delivered my babies at home, I have to admit that it still makes me a little nervous. Having witnessed dozens of hospital deliveries in which either the mom or the newborn required emergency care, I wanted to have immediate access to the highly skilled physicians, nurses, and other trained professionals that could provide that lifesaving care if my baby needed it."

This is another decision that's very much a matter of personal choice -- and comfort level. In many cases, alternative options can work out problem-free. 

"The vast majority of pregnancies are uneventful, and mom and baby do just fine," says McAllister. "Women have been delivering babies forever, and our bodies know just what to do!" If you are interested in other, less conventional options (and there are several), they may be worth looking into, by talking to doctors and friends, researching options on the Internet, and the best method -- touring the hospital or birthing center and talking to the staff yourself.

Zeroing in on the Best Information

Given the almost comical amount of information out there on pregnancy, childbirth, and babyhood, finding the right sources can be challenging. Books, websites, and television shows can be informative, but they can also overwhelm. For a life event that is already stress-inducing by its very nature, it's important to find clear, research-based information that serves to educate, not to scare.

It may be tempting to just put off informing yourself, or to make a quick decision, but as the comments here suggest, the decisions you make regarding the birth and early care of your baby have a way of staying with you. They are life decisions, and you will be happier if you do your homework. Even if you end up deciding to do something differently the next time around, knowing why you made the choice you did is bound to produce more peace of mind.

Parents: Stay Away From Anxiety-Producing Information

One reader, Heather, told us that she wished she had laid off the advice books about the birth process during pregnancy, and spent her time on reading up about the baby's needs. She says, "especially towards the end of the pregnancy, I spent a ton of time reading books about childbirth in the hopes that somehow I would learn what it would feel like and get a sense of what my experience would be like, which of course is impossible from books. It did nothing to quell my anxiety."

Another mother, Sandy, said that she wished she hadn't taken the hospital tour before going there in earnest to have the baby, because it only served to scare her. The equipment, the sterility of the place, and the sounds from the birthing rooms were not what this mother needed to experience prior to "D-day" itself. These parents agree that though it's good to be prepared in some ways, there's a fine line between awareness and anxiety.

Doctors: Look for Cited, Expert-Written Sources

McAllister underlines that education is good, but it's all about where you get your information. "As the old saying goes, knowledge is power. The more moms-to-be know about pregnancy and delivery, the better decisions they'll make. I think the question is not so much whether new moms should educate themselves, rather it's how they choose to educate themselves." She recommends staying away from "scary reality shows and books that focus on all the things that can go wrong during pregnancy and delivery.... Worry and emotional stress isn't good for anyone, especially moms-to-be and their unborn babies."

It is important to pay attention to where the information comes from. That means the information you use has to have references or clearly state the source of the facts and figures mentioned in it so you can determine how valid the information is. Check who authored the health information you're using.

Go to trusted sources like the National Institutes of Health (NIH), CDC, the American Academy of Family Physicians, and the American Academy of Pediatrics. These are all excellent sources for information on pregnancy, childbirth, and baby's health and behavior, says McAllister. Try to stay away from sites that have no author listed or no biographical information, or which don't give references -- cite journal articles, reputable websites. or books -- for their information. Pay attention to who is behind any websites you use. Avoid sites sponsored by commercial enterprises that would appear to have a vested interest (such as a baby formula manufacturer) in the information.

Remember that the process of having a baby is not a one-size-fits-all situation -- so it is helpful to seek out multiple takes on any issue and choose the one that fits you and your baby best. "Often, there's more than one way to do things right, and there's more than one good answer to any problem," McAllister tells us. "The more you read and understand the facts, the better prepared you'll be to make the decisions that are best for you and your baby."

Be Prepared ... To Be Anxious -- And Trust Your Baby

It's important to keep in mind that women have been having babies for millennia, and in many ways, the female is well prepared for it, in body and mind. The idea behind educating yourself before having a baby is the same as it is for buying a car -- so you can make a better informed decision you are more likely to be happy with.

Yes, there is a lot of information out there, and it can easily have the unwanted effect of making one feel as if she doesn't know what she's doing, or is ill-prepared. As Sarah told us, "I wish I knew to trust my instincts. I wish I knew all babies are not the same. Just because a book (or the Internet) says a baby does X, doesn't mean your baby will. I was concerned if the book said babies drink 16 oz of milk and mine was drinking 'only' 13 oz., etc. I called La Leche for advice so many times, I finally could diagnose myself just by listing the answers to questions I knew 'the experts' would ask. After about a year, I realized I was doing it correctly!"

Polin agrees that keeping it simple and using your intuition is the way to go: "You don't have to be perfect," he says. "When I was growing up, mothers just did what they thought was best, and the kids turned out OK. Maybe we should do more of that these days."

It's true that the days and weeks before and after a baby is born can be overwhelming, draining, and full of questions. But relaxing into it as much as possible can help it along. Like anything else that is new and challenging, having a baby is bound to make you a little anxious. So be prepared for that.

Sarah adds, "My biggest thing is I wish I knew the baby is the true expert  -- only he or she knows what he or she wants, and it may be different (more or less, earlier or later...) than other babies; and that's OK." The process can be overwhelming, but it can also be wonderful -- though it's easier said than done, worrying and comparing yourself to others less helps highlight the joys, so that the hardships can fade away.

Image: REUTERS/David Mdzinarishvili.


This article originally appeared on TheDoctorWillSeeYouNow.com.

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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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