“Empower a woman having a baby and you’ve empowered her for the rest of her life,” says midwife Lisa Sherwood. With 35 years of experience as a labor and delivery nurse and 17 years as a midwife, she’s seen just about everything and understands the value of knowledge, preparation and flexibility. As a provider at Orange Coast Women’s Medical Group, she encourages parents to research their options and choose health care providers who will support them on their journey. The choices parents face while pregnant and raising a child can be overwhelming, and the decision process is often complicated by the views and opinions of others.
“We’ve polarized everything,” says Staci Berrey, registered doula and founder of Labor of Love Birth Services. “But in the end, everybody just wants to feel human.”
To that end, pediatrician Jonathan Auth of Seaview Pediatrics in Irvine advises new parents to “take each day at a time and try to break down parenting into the skills that are most appropriate at that moment.”
Here’s a roundup of the difficult decisions faced by new parents and some input from local experts:
Home or hospital?
A home birth offers intimacy, environmental control and freedom of labor position. However, medical intervention is limited to what the midwife or nurse practitioner can provide. This absence of medical technology means the price tag of a home birth is often less than a hospital birth, but it’s a good idea to check with your insurance to see what expenses will and won’t be covered.
A home birth is not recommended for anyone with a chronic medical condition such as diabetes or seizure disorder. Mothers who’ve had a C-section, any current pregnancy complications or a history of early or late labor are also cautioned against a home birth. If a mother is giving birth to multiple infants or babies not in the correct birthing position, a hospital is a better setting.
Planning is a necessity if you decide you want to give birth at home. It’s important to partner with a trained health care provider who has a relationship with a nearby hospital or clinic. You’ll also need to create a detailed birth plan that includes hospital transfer in the event of an emergency.
Those wanting the coziness of a home birth with slightly more support might consider a birth center. Often the center will be in or adjacent to a hospital. A labor in a birth center may be allowed to progress with minimal interruptions. There will be no routine IVs, no inductions and no fetal monitoring unless warranted.
“The majority of births are hospital births,” Berrey says. The advantages of a hospital are the availability of full medical support, including an operating room in the event of a C-section, on-site pediatricians, medical techs and advanced pain-relief options. Many hospitals offer private rooms, birthing tubs and other amenities, so it’s a good idea to tour several hospitals and meet with a variety of doctors before deciding.
“Hospitals can feel automated,” Sherwood says, but it is very possible to create a more personal experience.
Berrey agrees. “First, you need to go in with your eyes wide open,” she says. “Know what happens during labor so you can prepare and ask for what you need.”
Berrey recommends asking about protocol for routine episiotomies, induction and use of stirrups. She emphasizes the importance of finding a doctor you “connect with on a gut level,” and encourages parents to think of childbirth not as just a “medical event,” but “a physiological shift.”
While the majority of women will choose an OB-GYN to deliver their baby, in recent years, the number of certified midwives working in hospitals has risen. Statistics published in 2013 by the American College of Nurse-Midwives place this number as 8.2 percent of total U.S. births. Like doctors, midwives are trained health care providers and are licensed and regulated by the state. A midwife provides a more relational experience, often giving counsel on nutrition, emotional health and other issues before and after the birth. The desire to labor without pain medication or other medical assistance often informs the choice to work with a midwife in the hospital.
Sherwood says, “You can start slow and low-tech and add as you go along.” This makes the midwife an ideal option for a low-risk pregnancy.
What parents should know about vaccinations
Many parenting decisions are very personal, but the subject of vaccination is also informed by state and local legislation, public school regulations and community opinion.
The Centers for Disease Control and Prevention recommends 28 doses of 10 vaccines for children before their seventh birthday. There is no federal mandate for vaccination, but all states require vaccination for public school entrance. Rubella, diphtheria, smallpox, polio and whooping cough have been nearly eradicated in this country through adherence to strict vaccination policies.
This said, there is a contingency of parents who choose not to vaccinate based upon religious belief, personal belief or medical concern. Many of these concerns stem from a perceived link between vaccines and autism based upon a 1999 study published in the English medical journal Lancet. The journal has since retracted the study.
A second study done in 2004 comparing 1,294 children with autism spectrum disorder with 4,469 children without autism found no link between vaccines and autism.
Concern over the mercury-based preservative Thimerosal also colors perception of vaccines; however, this substance is absent in all post-2001 childhood vaccines.
Speaking to a hesitancy to vaccinate, pediatrician Auth says, “I think many parents are fearful based on misinformation and what they’ve heard through friends or social media. Fear can sometimes be an irrational emotion and hard to simply overcome despite the reassurance that science provides.”
Public concern following a 2015 measles outbreak at Disneyland spurred Gov. Jerry Brown to sign SB277. As of July 2016, this law eliminates a parent’s right to exempt their children attending public and private schools from getting vaccines based upon their personal or religious beliefs.
Auth supports vaccination “for the safety of all of our patients and community but particularly those too young to benefit from vaccines or those with underlying medical conditions which would prevent or otherwise impair the effectiveness of vaccines.”
Pediatricians recommend that parents be open about their family medical history and the current health of the child. With good record-keeping, it’s possible to be aware of weakened immune systems, a history of allergies or other reactions, chronic medical conditions and illness. All of these factors should be considered before deciding to vaccinate. In most cases, the side effects of vaccinations are limited to pain at the site of injection, mild rash, mild fever or temporary swelling. Despite concerns, or perhaps because of school regulation, the latest statistics released by the California Department of Public Health show an increase of 2.5 percentage points in vaccinations statewide.
“Most parents need some reassurance,” Auth says. “They need their concerns to be heard.”
Tara Haelle, co-author with Emily Willingham, Ph.D., of the book “The Informed Parent: A Science-Based Resource for Your Child’s First Four Years,” (TarcherPerigee, 2016) encouraged this kind of mindful exchange in her 2015 TEDx Oslo Talk: “When we come across someone who fears vaccines we won’t get very far by laughing, mocking, accusing, but we might get somewhere, bit by bit, with thoughtful communication, and some empathy and compassion.”
Circumcision
Religion, culture, identity, ethics and health are all factors in the decision to circumcise. Courtney (who asked that we not use her last name) explains, “I didn’t have a super strong opinion either way and told my husband I would be fine with whatever he wanted. I felt like it was important that the dad have a big say in it. I was pretty sure he’d go with circumcising because he’s circumcised and Jewish, but he surprised me by really considering not circumcising. We both understood it was not necessary, but ultimately went with it because we wanted our son to look like his dad.”
Despite the American Academy of Pediatrics’ opinion in 2012 that the health benefits of circumcision outweigh the risks, the number of circumcisions (according to CDC statistics) has dropped in the United States, with Western states falling to approximately 4 out of 10 male infants circumcised. Although the AAP and the CDC recommendations seem to hinge on clinical research that links circumcision to a decreased risk for urinary tract infections, penile cancer and sexually transmitted diseases, the actual rates of these conditions are quite small. “In the end,” Auth says, “parental choice plays a far greater role than medical decision-making in the vast majority of circumcisions.”
Breast or bottle?
At the beginning of your baby’s life, the only feeding choices are breast or bottle. The AAP and the World Health Organization agree that an exclusively breast milk diet for the first six months, followed by continued breast-feeding with the addition of foods through the first year, is best.
Breast milk has been found to reduce instances of clinical asthma, atopic dermatitis and eczema. Breastfeeding can also help the mother by burning calories, which can speed the process of losing baby weight. And breast milk is free, available and efficient.
“More and more hospitals are moving toward baby-friendly protocols,” Auth explains, “which default to breast-feeding and do not provide for formula except in medically indicated scenarios.”
Breast-feeding is what Auth calls a “learned behavior,” and he encourages his patients to refrain from bottle feeding until breast-feeding is well established. “This can take two to three weeks,” he says.
Berrey bears witness to the challenges of breast-feeding in her doula practice. She recently opened a gathering space in Orange called The Village, which offers mother support groups, breast-feeding meet-and-greets and Baby & Me Yoga.
“It’s so important to connect,” she says. “Pregnancy and motherhood can be a lonely journey. We need to meet other moms and share our stories.”
Whether due to lack of support or other difficulties, many mothers find that the challenges of breast-feeding outweigh the benefits. Working mothers may find it hard to pump milk and arrange for storage. Some mothers may find breast-feeding painful or difficult. Others may be uncomfortable nursing in public. Statistics seem to shore up these very real challenges. According to the most recent CDC survey on breast-feeding rates, 92.8 percent of Californians have breast-fed at some point, but the numbers drop to 63.1 percent at 6 months and 38.4 at 12 months.
Greg, a new Southern California father, describes how he and his wife were able to find a solution after a rocky start with breast-feeding.
“We were determined to breast-feed, but our first weekend out of the hospital was difficult physically for my wife and son, and emotionally difficult for all of us. Because of these issues, our new little guy lost quite a bit of weight. First thing on Monday we made an appointment with a lactation consultant and our pediatrician. They both recommended a supplemental nursing system. It fit right on top of our bottles and worked great. Most important, it allowed my wonderful, recovering wife to supplement her direct feeding if the latch just wasn’t happening and helped me feel more of a connection to my son.”
Breast-feeding support and assistance can be found through your pediatrician, doula, midwife or social groups. For those unable to produce milk, there may be opportunities to use donor milk and a supplemental nursing system. For information about donor milk and other resources, check out the Orange County Breastfeeding Coalition at ocbreastfeedingcoalition.org.
Family bed or crib?
Sleep may be elusive for new parents, but there are still choices to be made about where your newborn should sleep. Many families decide to share a family bed when their infant is young, meaning they co-sleep with their baby in the bed, a practice that can be dangerous, especially if you or your spouse is a particularly heavy sleeper. Another popular option is attaching a co-sleeper to your bed so that the baby has his or her own space but is still very close to the mother. Finally, many parents use a crib in their room or in a separate nursery.
In October, the American Academy of Pediatrics released new “Recommendations for a Safe Infant Sleeping Environment,” in which it acknowledged that many parents wind up sleeping with their babies even if they aren’t committed co-sleepers. The recommendation places a value on breast-feeding and skin-to-skin contact, while encouraging parents to take safety precautions.
“We know now, more than ever, that the baby sleep environment plays the largest role in risk to the baby for sudden infant death, most of which is due to suffocation,” Auth says. “Our role as pediatricians is to make sure parents are aware of the science and are educated on the best way to reduce risk.”
Whether co-sleeping is pre-meditated or the result of parental exhaustion, the authors of “The Informed Parent,” Haelle and Willingham, recommend “making bed sharing as low risk as possible – recognizing that you cannot remove risk entirely.” They suggest that parents move the bed away from the wall and other furniture and put the baby to sleep on her back without pillows, blankets or comforters near her or covering her head. Also, parents should understand that smoking, alcohol and illicit drugs increase the risk of danger to their infant.
Sleep training
You might know where your baby is going to sleep, but how will you ensure that he or she will fall asleep? Enter “sleep training,” or “crying it out.” The latter term, Haell and Willingham note, “brings on images of a lonely abandoned infant wailing away in the crib to a background noise or the clink of highball glasses and party noise.”
In reality, sleep training is more about establishing a sleep routine. In “The Informed Parent,” Haell and Willingham’s research suggests that kids need “response to emotional needs – those with emotional response from the mother have less sleep disruption.”
With dozens of books outlining a wide spectrum of approaches to sleep training, the only thing experts agree on is that every child is an individual. Creating a routine based upon your child’s sleep personality may be the most successful strategy. Try for a regular bedtime and stick with the same routine of bath, book and lullaby, then bed. The development of key calming phrases can also be useful. With some practice, your child will relate these calming words with sleep. Listen to your child, learn to identify their signals of distress and offer comfort when it’s needed.
Susan, a mom of three, tells me that she and her wife worked out a hybrid plan that included a little bit of crying and a lot of comfort. “There’s going to be some treacherous nights,” she says. “One night you’ll be on board and your partner won’t and then it’ll flip. But eventually, it works out.”
No matter what you decide, Auth says, “As new parents it’s definitely important to remember to take time for yourselves too, both as individuals and as a couple. Adjusting to the erratic sleep schedules of infants is a particularly challenging aspect of parenting. Take time to sleep when you can and really rely on each other and on family and friends.”
