The Examined Life


| by Peggy O’Mara, Editor and Publisher

“The unexamined life is not worth living.” This saying of the Greek philosopher Socrates inspires me to lead an examined life as a parent. Socrates observed the world around him in order to learn, through thought and discussion, how to make it a better place. He was found guilty of corrupting the minds of the youth of Athens, whom he encouraged to challenge the accepted beliefs of the time and to think for themselves.

Do parents today think for themselves? We are called “helicopter parents”—hovering, overly attached—if we set healthy boundaries and limits on our children’s experience, and yet only a minority of parents do so. In the latest report from the Kaiser Family Foundation, more than 2,000 children aged 8 to 18 were asked whether or not they were subject to any rules regarding media use. Only 26 percent reported having some rules that were regularly enforced.

As parents who try to bring consciousness to family life, we are in a minority. As readers of this magazine, we are also in a minority. Eighty-four percent of us have a college degree, and 32 percent have a graduate degree. In contrast, just 27 percent of the 
US population has graduated from college.

Forty-six percent of our readers had a midwife present at their children’s birth, which is five times the national average of 8 percent; and 30 percent gave birth at home, 30 times the national average of 1 percent. And when it comes to breastfeeding, we’re off the charts: 96 percent of Mothering subscribers breastfeed; of those, 41 percent nurse for one to two years, and 32 percent for three to four years. Nationally, only 22.7 percent of babies are still breastfeeding at one year.

In short, Mothering readers are definitely part of a culture distinct from the dominant one in the US, and, as such, we should take the recommendations of that culture with a grain of salt. Like Socrates, we may appear to be heretical for questioning the dominant parenting practices of our times, for challenging authority, for making individual and sometimes controversial decisions regarding the welfare of our families—but sometimes we must.

Soon after my first baby was born, in 1974, my husband designed and built a small, wooden addition to attach to our bed so that our baby could sleep beside us and we could have more room. This practical solution helped facilitate breastfeeding, and we liked keeping our baby close all through the night.

In those days, my husband and I said that we had a family bed, a term coined by Tine Thevenin in her classic book, The Family Bed. This practice was not particularly controversial at the time, as it was of interest only to the minority of women, 32.2 percent, who were then breastfeeding. For us, it was simply a good idea that helped us to be more successful at nursing; we talked with one another about how to make the family bed more comfortable, but seldom questioned its safety.

Today the family bed has become controversial, its vocabulary complicated and clinical. There is no longer talk of the family bed, but only of cosleeping and bedsharing, two terms that, not long ago, were used interchangeably. This fall you may see press releases from the Juvenile Products Manufacturing Association (JPMA) designating September as Baby Safety Month, and exhorting parents to put their babies to sleep only in cribs approved by the Consumer Product Safety Commission (CPSC). Further, the JPMA, along with the CPSC, will caution you against putting your baby to sleep in an adult bed.

I imagine that, if I were a new parent today, I would be frightened by these messages, but my own experience tells me that bedsharing with my baby is perfectly safe. Nor am I convinced by a trade organization that represents crib manufacturers or a government agency that regulates those cribs. These entities are experts on products, and can understandably recommend only something that is a product; they are not experts on sleep, and certainly not on cosleeping or bedsharing.

For an expert on cosleeping, I always turn to James McKenna, PhD, Edmund P. Joyce Chair in Anthropology at the University of Notre Dame, and director of the Mother-Baby Behavioral Sleep Laboratory, where he and his team observe mothers and babies bedsharing. According to McKenna and fellow researcher Thomas McDade, “mother-infant co-sleeping represents the most biologically appropriate sleeping arrangement for humans and is both ancient and ubiquitous simply because breast feeding is not possible, nor easily managed, without it.”

McKenna and McDade also shed light on some of the myths involving cosleeping: “Most USA and other western infants die from [Sudden Infant Death Syndrome] or from fatal accidents during solitary sleep outside the supervision of a committed adult. Moreover, the overwhelming number of suspected accidental overlays or fatal accidents occur not within breast feeding–bed sharing communities but in urban poverty, where multiple independent SIDS risk ‘factors’ converge and bottle feeding rather than breast feeding predominates.”

I thought carefully about risk factors when, in the 1970s and ’80s, I chose to birth three of my babies at home. Two of these homebirths were attended by a doctor, and the third by a midwife. I live in New Mexico, where midwives now attend 32 percent of births, and where one in every ten births takes place at home.

Homebirth, however, remains outside the experience of most US physicians, so it is no surprise that, in 2008, the American Congress of Obstetricians and Gynecologists (ACOG) reiterated its long-standing opposition to homebirth. While ACOG pays lip service to informed consent for pregnant women in its “Statement on Home Births,” the organization “does not support programs that advocate for, or individuals who provide, home births.” In addition, ACOG supports care only by nurse-midwives, not licensed midwives, even though states such as New Mexico have safely and 
successfully licensed midwives for 30 years.

ACOG’s “Statement on Home Births” is also disrespectful of birthing moms because it suggests that mothers make childbirth decisions “dictated or influenced by what’s fashionable, trendy, or the latest cause célèbre.” Further, the statement suggests that mothers would be selfish to “place the process of giving birth over the goal of having a healthy baby.”

This suggestion—that homebirth is a selfish choice—is further reinforced by a study published online in June by the American Journal of Obstetrics & Gynecology, “Maternal and Newborn Outcomes in Planned Home Birth vs. Planned Hospital Births: A Metaanalysis,” which concludes: “Less medical intervention during planned home birth is associated 
with a tripling of the neonatal mortality rate.”

A metaanalysis is a study that looks at many other studies; this one looked at studies as far back as 1950, something the American College of Nurse Midwives (ACNM) questions: “[W]e are puzzled by the authors’ inclusion of older studies and studies that have been discredited because they did not sufficiently distinguish between planned and unplanned home births—a critical factor in predicting outcomes. Also troubling is that several recent credible studies of home birth were excluded for no apparent reason.” The ACNM goes on to say, “Of the largest studies included in this metaanalysis, only three . . . clearly distinguish between planned and unplanned home births. These three studies—which comprise 93% of the women included in the metaanalysis—found no significant differences in perinatal outcomes.” Citing the international body of evidence that has found no significant difference in infant mortality between planned home and planned hospital births, the ACNM cautions “against over-interpretation of these findings.”

It’s important to note that the publication of the study cited above coincided with efforts in New York and Massachusetts to pass legislation granting autonomous practice to all licensed midwives working in all settings. While it’s common for one profession to challenge a competing profession, it’s up to us to differentiate between objective scientific fact and public relations.

While ACOG has remained firm in its opposition to homebirth, how do we respond when another influential organization, the American Academy of Pediatrics (AAP), appears to change theirs?

In 1971, 1975, and 1983, in updated editions of its policy statements on circumcision, the AAP concluded that there are no medical indications for routine circumcisions of newborn males. In 1989, the revised AAP statement concluded that circumcision has “potential medical benefits and advantages as well as disadvantages and risks.” In 2005, the AAP reiterated their 1989 position, saying that “Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision.” Further, they remanded the decision to the parents: “In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child’s current well-being, parents should determine what is in the best interest of the child.”

With my own sons, both born before 1983, it was easy for me to make a decision. The AAP told me that circumcision was not medically necessary, and neither my husband nor any of his brothers had been circumcised.

Coming to a decision may not be as easy for parents today, who may have heard about recent studies suggesting that circumcision protects against AIDS. They may not know that the methodology of these studies has been questioned, or that circumcision has never been shown to protect against sexually transmitted diseases.

Despite the apparent ambivalence of their statements, the AAP does not recommend circumcision. In fact, no national or international medical association recommends routine infant circumcision. The US is alone in the world in circumcising the majority of baby boys: 56 percent in 2008.

These three examples of important parenting decisions—infant sleep, place of birth, and circumcision—require us to do more than follow the leaders. Even when we are confused by contradictory opinions and vested interests, we must remember that the responsibility lies with us. When it comes to making decisions that may impact our child’s entire life, we can’t afford to rely on changing customs, or be distracted by political rhetoric.

We are left, then, with just a few constants: our observations of our child, our trust in ourselves, consultations with experts, the scientific evidence, and our own common sense. These things are enough. And it helps if we’re already comfortable with being part of a minority.

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