How to Make the Toughest New-Parent Decisions

Since British researcher Andrew Wakefield published a study in 1998 that claimed there was a link between the MMR vaccine and autism, parents have been taking a closer look at immunization. Wakefield's findings were declared fraudulent and the report was retracted in 2010, and Wakefield's medical license was revoked, but some parents are still skeptical. They worry that the current vaccine schedule — about 20 shots by age 2 — is too much, too soon. Medical professionals strongly disagree, however, and point to increasing outbreaks of once rare, easily preventable, and potentially fatal diseases like measles, mumps, and whooping cough as a much greater risk to children and society.

What the science says Both the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) insist that the benefits of vaccinating on schedule heavily outweigh the risks. "There's a lot of bad information out there," notes Paul Offit, M.D., chief of infectious diseases at The Children's Hospital of Philadelphia. "Fears that vaccines can cause things like autism, attention deficit disorder, asthma, and allergies are completely unfounded." Dr. Offit says that vaccines are the safest thing we put into our body, thanks to the sheer amount of testing they undergo.

As for the "too much, too soon argument," Dr. Offit explains that vaccines pose less of a threat to a newborn than encountering someone with a simple cold, which is a far greater burden to a baby's immune system than the inactivated viruses in vaccines. Delaying or giving vaccines on a spread-out schedule offers no benefits and boosts the time your infant is susceptible to disease. The most common side effects — slight fever and soreness at the injection site — are worth it. More serious side effects that make news, like seizures, are so rare that they're impossible for the CDC to assess statistically.

In the early 1980s, an estimated two thirds of newborn boys had the foreskin on their penis removed before leaving the hospital. By 2010, that number had dropped to about 58 percent, according to the CDC. "Demographically, our nation is changing to include cultures that have not traditionally circumcised, and modern parents are more likely to question any type of medical procedure," says Doug Diekema, M.D., a pediatrician at Seattle Children's Hospital and member of the AAP's task force on newborn circumcision. They want to know if the health benefits of circumcision are worth it.

What the science says The CDC's draft of its first guidelines states that the benefits of circumcision clearly outweigh the risks, though it's still a parent's decision. Boys who are circumcised are slightly less likely to contract urinary tract infections, which can be serious in a baby. Circumcised adult males have lower rates of HIV and herpes and are less likely to transmit the human papillomavirus (HPV) to female partners, research shows. Problems occur less than 1 percent of the time, and most are minor. And there's no need to fear any pain; it can and should be controlled with medication, says Dr. Diekema.

The benefit of not removing your son's foreskin is that you leave the decision up to him when he's old enough to weigh the pros and cons himself. People passionately opposed to circumcision ("intactivists") claim that men with foreskin have more pleasure during sex, but no research has proven this. Uncircumcised boys will have some risk of infections or a foreskin that doesn't retract properly. In such cases the procedure may need to be performed on a teen or an adult, which is more complicated.

While the AAP maintains that circumcision has health benefits, it states that parents "should make their own decision based on religious, ethical, and cultural beliefs."

"If your care provider is strongly for or against circumcision, then find a different physician," says Dr. Diekema. "You need someone neutral to help you make the best decision for your child."

New moms are bombarded with the "breast is best" message, which can make those who can't or don't want to nurse feel guilt-ridden and defensive. "Lactivists," vocal advocates of breastfeeding, have been known to pressure — online or in public — moms who use formula. There are many good reasons for breastfeeding, but moms often struggle to keep nursing for the full year that the AAP recommends. Everything from pain to supply problems to the challenges of pumping at work can make it difficult. Most women start out nursing — 75 percent — but by 6 months, only 44 percent still do so.

What the science says Research shows that babies who are exclusively breastfed do have fewer illnesses, as well as a lower risk of sudden infant death syndrome and obesity. These benefits translate into fewer medical expenses and sick days down the road. What breastfeeding doesn't offer is guarantees: Nursing doesn't mean your child won't fight the battle of the bulge in adulthood; he'll just be less likely to. Are breastfed babies smarter? Research shows infants who were breastfed for a full year do score about four points higher on IQ tests than their formula-fed counterparts, but mothers who nurse tend to be better educated so you can't give all the credit to the milk.

As for women's health, nursing mothers may have a 20 percent lower chance of developing breast and ovarian cancer during their lifetime and may drop their baby weight faster. How you feel about nursing matters too: If you enjoy it, so will your baby. But if nursing's stressful and making you resentful, your baby will pick up on those negative vibes. If you decide to supplement breast milk with formula or to quit nursing altogether, be assured that today's infant formulas are safe and will allow your baby to grow and thrive, says San Francisco pediatrician Valerie Flaherman, M.D., author of a new report in the Journal of the America Medical Association on the public-health and social aspects of breastfeeding. "Breastfeeding has important health benefits for mothers and babies, but don't believe anyone who says breastfeeding is a panacea for childhood illness," says Dr. Flaherman. "Although breast milk does provide optimal infant nutrition, plenty of formula-fed babies stay healthy, and some breastfed babies can still become sick. There are many important factors in maintaining infant health," Dr. Flaherman adds.

Home births rose 59 percent between 2004 and 2012, spurred mostly by women who want to avoid a medical delivery that may include interventions like forceps or a cesarean section. Despite the spike, delivering at home still accounts for fewer than 2 percent of all births, and the trend is mostly among non-Hispanic Caucasian women, according to the CDC.

What the science says You are taking a risk, plain and simple. One study, by researchers at New York-Presbyterian/Weill Cornell Medical Center, found that babies born at home are roughly ten times as likely to be stillborn and almost four times as likely to have neonatal seizures or serious neurologic dysfunction as babies born in hospitals. "The research suggests that there is an increased risk of death, albeit small, when delivering at home," notes Jeffrey Ecker, M.D., an ob-gyn at Massachusetts General Hospital, in Boston. "Giving birth is a natural and healthy process and not something to fear, but problems do come up."

Dr. Ecker encourages parents-to-be to ask themselves this question before they make a decision about where their baby will be born: "What am I seeking in a home birth, and is there a way to get that in a hospital or a birthing center?" If your answer is to avoid unnecessary medical procedures, find an obstetrician or a certified professional midwife you trust who will do everything in her power to avoid such intervention in a hospital. If you want to be surrounded by family and friends, choose a facility that will allow them to be there during the birth.

If home is the only place for you, then both the American Congress of Obstetricians and Gynecologists (ACOG) and the AAP recommend using a midwife who has been approved by the American Midwifery Certification Board, is affiliated with a doctor who can deliver you at a hospital if an emergency comes up, and has a trained partner who can focus solely on the care (and, if necessary, resuscitation) of the baby. Be sure to discuss beforehand the midwife's background in dealing with delivery complications. And there is no system in place to rate midwives' records, so always do your due diligence by checking references.

In a poll American Baby conducted last year with Safe Kids Worldwide, 65 percent of the 4,500 new moms surveyed said they had slept in bed with their infant. Sharing a bed with your baby (and older children) is a major component of the child-rearing philosophy known as "attachment parenting." Followers of this parenting method believe babies who sleep with them cry less, bond more securely, and grow up more confident. However, most major health and safety groups, including the AAP and the National Institute of Child Health and Human Development's Safe to Sleep campaign, recommend keeping a baby in a separate sleep area in the same room as the parents instead of bedsharing, due to its serious risks.

What the science says The dangers of sleeping in the same bed with your infant are widely known. Baby could become trapped between the bed and the wall or beneath a pillow, or be entangled in the blankets. And yes, you could roll over on your baby. Research shows that infants who sleep with an adult are up to four times as likely to die from sudden infant death syndrome (SIDS) in the first three months as those who snooze in a safe crib environment, according to one of the largest analyses to date on bedsharing and SIDS. Another new report in the journal Pediatrics also found that bedsharing was the top risk factor for sleep-related deaths, including SIDS and suffocation, in infants younger than 3 months.

In response to these risks, the proponents of sleeping together usually encourage parents to take preventive measures to do it "safely," such as sleeping without heavy bed linens, and sleeping separately if you have been drinking alcohol, have taken medicine, or are exhausted. Any of these situations can make you less aware of your surroundings and more likely to accidentally harm Baby.

But those measures are still not considered adequate by safe-sleep experts. "Unfortunately, there is just not enough evidence to recommend bedsharing under any circumstance. We don't know of any way to make it safe, and you may be putting your baby at a higher risk of sleep-related death no matter what precautions you take," says Linda Fu, M.D., a pediatrician at Children's National Health System, in Washington, D.C., who studies the safety of bedsharing.

On the other hand, sharing a room with your baby, who sleeps nearby in a bassinet or a crib, has been proven to help reduce the risk of SIDS, probably because parents are close and able to respond to their child's needs more quickly, and it can help facilitate breastfeeding, notes Dr. Fu.

The risk of SIDS diminishes significantly after the first year, but there's new evidence that bedsharing isn't great for toddlers either. A just-released, large-scale European study of 56,000 mothers who reported on their children's sleep habits found that 18-month-olds who shared a bed with their parents had a significantly higher incidence of waking at night and shorter sleep cycles.

Bottom line for bedsharing and for the rest of these much-discussed topics: When a decision about your baby's health or well-being worries you, or you read something that scares you, talk to your pediatrician. There may be all kinds of information at our fingertips now, but an old-fashioned heart-to-heart with an expert is still the best way to solve 21st-century parenting dilemmas.

Inaccurate information can appear on the most professional-looking websites. For science-based, unbiased info, look for the urls .gov and .edu. The urls .com, .org, and .net can be credible — or not. For example, The National Vaccine Information Center, at NVIC.org, appears official but is actually operated by an independent group that has been criticized for providing biased info. Reliable websites will update articles at least every two years, and if a story is missing a date, that's a red flag. Besides AmericanBaby.com and Parents.com, turn to these six sites for accurate health and safety information.

Originally published in the February 2015 issue of American Baby magazine.

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