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A closer look at key issues new parents face

Published on: May 01, 2005

New
parenthood is like no other time. It's exhilarating, intriguing,
life-affirming... but, let's face it, often stressful. Niggling
decisions about cribs, diapers, breast pumps, etc., can devour parents'
attention while critical questions about maternal and infant health may
go unanswered.

Here are boiled-down
facts regarding four important health issues: breastfeeding, cesarean
section, circumcision and vaccination, with an extensive list of
resources so that parents can do additional research on each topic, if
desired.

Breastfeeding -- Why Choose It?


Breast milk:

  • Provides the most complete and balanced nutrition for baby, custom-manufactured.

  • Is more easily digested than formula.

  • Passes antibodies to the baby.

  • Results in milder-smelling stools than formula.


Other benefits of breastfeeding:


  • Helps shrink mother's uterus after giving birth.

  • Facilitates bonding between mother and baby.

  • Relaxes mother and baby.

  • Is cost-efficient.

  • Requires no extraneous packaging or pre-heating.

  • Delays the return of mother's menstrual cycle.

  • Improves mother's digestion, resulting in wholesome milk, whatever the diet.

  • Uses calories (up to 500 per day), potentially helping mother to lose weight.

  • Reduces mother's chance of developing breast and ovarian cancers.

  • Lessens the severity of respiratory infections in baby.

  • Lends to healthy jaw, teeth and speech development in baby.

  • Helps shield baby from sudden infant death syndrome (SIDS).

  • Helps prevent diabetes, obesity, allergies, asthma and childhood cancer.


Why Not?


  • May cause mother to feel anxious about public feeding.

  • Requires pumping for any bottle-feeding of breast milk.

  • Can contribute to decreased sex drive.

  • May involve a learning curve, like any new skill. (Books and lactation
    consultants can help with this.)

  • Some mothers can't breastfeed, due to medical conditions such as
    insufficient milk production (rare) or babies' intolerance to breast
    milk (also rare).


Alternatives:


  • Formula feeding (cow's milk-, soy-, or protein hydrolysate-based, or
    home-made, although some practitioners advise against the last, as it
    is difficult to create formula that meets all of a baby's nutritional
    needs).

  • Donated breast milk from breastfeeding centers or other mothers.

  • Supplemental nursing system (SNS): a container holding supplemental
    liquid and a tube connecting the container to the mother's nipple. The
    baby suckles the breast and tube together, conferring the bonding
    benefits of breastfeeding.

Cesarean section
-- Why Choose It?


Medical reasons:


  • Prolapsed cord (the cord precedes the baby during birth).

  • Placenta abruptio (the placenta separates before the birth).

  • Placenta previa (the placenta partially or completely covers the cervix).

  • Fetal malpresentation (transverse lie, breech or asynclitic position).

  • Cephalopelvic disproportion (the fetus's head is too large to fit through the pelvis).

  • Maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc.).

  • Birth complications (fetal distress, maternal exhaustion,
    non-progressing labor, excessive bleeding).

  • Delivery of multiples.

  • Repeat cesarean or other previous uterine surgery.


Other reasons:*


  • To avert the anticipated pain of vaginal birth.

  • To control the timing of the birth: Convenient and cost-effective for
    parents living in rural areas; also a bonus for parents wanting to
    dictate birth dates, family visits, professional leaves of absence and
    other matters of planning.

  • To get around the emotional and educational preparation commonly undertaken for vaginal childbirth.

  • To reduce the risk of pelvic incontinence.


* In the U.S., a doctor is not obligated to perform a c-section upon
request, without medical reason. However, many doctors are performing
elective c-sections. A study by HealthGrades, a medical consulting firm
in Colorado, showed that 63,000 American women opted for c-sections
without pressing medical reasons in 2001.


Why Not?


Potential risks to mother:


  • Increased incidence of death after surgery, as compared to vaginal birth.

  • Infection, such as uterine, bladder or kidney.

  • Increased blood loss: about twice as much is lost, as compared to vaginal birth.

  • Decreased bowel function that can last for several days.

  • Unexpected reactions to anesthesia or medications, i.e. blood pressure
    dropping, respiratory complications.

  • Longer hospital stay and recovery time, as compared to vaginal birth.

  • Additional surgeries such as hysterectomy or bladder repair.

  • Keloid scarring (an overgrowth of scar tissue at the surgical site).

  • Possible difficulties conceiving future pregnancies.

  • Possible complications during future pregnancies.

  • Increased incidence of uterine rupture during future pregnancies and births.


Potential risks to baby:


  • Premature birth, for example, if the mother's due date was miscalculated.

  • Breathing problems such as transient tachypnea (abnormally fast breathing).

  • Low Apgar scores related to the anesthesia, fetal distress.

  • Fetal injury, such as cuts from the uterine incision (rare).

  • Difficulty breastfeeding due to the effects of sedative medications and
    anesthesia to both mom and baby, as well as difficulty finding
    comfortable positions for nursing.

Circumcision
-- Why Choose It?


  • Religious or cultural tradition.

  • To promote conformity with peers, father.

  • Belief that circumcision improves the appearance, health and hygiene of the penis.


Why Not?


  • Painful procedure.

  • Potential complications.

  • Produces no significant health benefits.

  • Prevents no diseases.

  • Incurs permanent desensitization.

  • Not advocated by the American Academy of Pediatrics (AAP), the American
    Medical Association, the American Cancer Society, the Pediatric
    Urologists Association, and many other medical societies in the U.S.,
    Canada and throughout Europe.

  • Infant's intact penis requires no extra care. Just leave it alone, doctors advise.

  • Requires little extra care throughout life.

  • There is a growing prevalence of uncircumcised boys (35 percent of
    newborns nationwide, 66 percent in Western states).

  • Growing understanding of the evolved immunological and sexual functions of the foreskin.
  • Desire to "let son choose for himself."


Vaccination
-- Why Choose It?


  • To protect a child from serious and/or life-threatening childhood
    diseases including measles, mumps, rubella (German measles), varicella
    (chickenpox), hepatitis B, diphtheria, tetanus, pertussis (whooping
    cough), Haemophilus influenzae type b (Hib), polio, influenza (flu) and
    pneumococcal disease via a standardized vaccination schedule put out by
    the Centers for Disease Control and Prevention (CDC). The schedule is
    viewable at: www.cdc.gov/nip/recs/child- schedule.htm.

  • To eradicate childhood diseases and promote "the better good."
    Morbidity rates due to whooping cough, diphtheria, tetanus, measles,
    mumps and rubella are down 95 percent. Smallpox and polio are gone from
    this hemisphere. (Health officials warn that diseases that are "nearly"
    eradicated can re-emerge.)

  • To comply with state laws requiring children to be immunized before
    enrolling in public or private school. (Washington state does offer
    exemptions for philosophical or religious reasons.)

  • According to statistics, vaccines are generally safer than contracting
    the diseases they protect against.

  • Common childhood vaccines (except flu) no longer contain more than
    trace amounts of Thimerosal, a preservative shown to harm the brains of
    developing fetuses and young children, according to CDC.

  • High-quality medical practitioners will agree to discuss the medical
    appropriateness as well as known benefits and risks of every vaccine
    before administering.


Why Not?


  • To prevent common mild reactions such as redness or tenderness at the injection site and fever
    .

  • To prevent allergic reactions to vaccine additives, which include
    aluminum, formaldehyde, monosodium glutamate (MSG), antibiotics,
    Thimerosal and others. For more information on additives, visit: www.cdc.gov/nip/vacsafe/concerns/gen/additives.htm
    .
  • To
    avoid the risk of severe, rare reactions, including death. Other rare
    reactions include thrombocytopenia (low platelet count) due to the
    measles-mumps-rubella (MMR) vaccine and febrile seizures following MMR
    and diphtheria-tetanus-pertussis (DTP) vaccines. Find out more about
    reactions at: www.cdc.gov/nip/vacsafe/concerns/side-effects.htm.

  • To take the time necessary to learn about the benefit-risk ratio of
    each vaccine, for an individual child and for society. Concerns may
    include perceptions that routine and multiple vaccinations can overload
    a child's system with antigens, that MMR vaccine is linked to autism
    and that hepatitis B vaccine is linked to SIDS. (According to CDC,
    these fears are unsubstantiated.)

  • A child has medical conditions that contraindicate against
    vaccinations, for example: previous severe reactions to certain
    vaccines; leukemia, lymphoma, other types of cancers or AIDS; severe
    illness including fever.

  • A family has religious or philosophical beliefs that conflict with the
    idea of vaccinating. For example, parents may believe a child can fight
    illness adequately through excellent nutrition, hygiene and emotional
    well-being. Washington and 11 other states allow religious and
    philosophical exemptions from childhood vaccination requirements.


For a straightforward explanation of the safety of skipping the most
common and mandatory vaccinations, check out The New Basics: A-to-Z Baby and Child Care for the Modern Parent, by Michel Cohen, M.D.

Natasha Petroff is a Puget Sound-based writer and mother.


Resources


Breastfeeding:

Cesarean Section:


Circumcision:


Vaccination:

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