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A closer look at key issues new parents face

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).


  • 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.



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