Preparing For Baby - Part One

Today's expectant parents have many options. Because of the wide variety of life-styles and parenting styles, they need them.

Choosing Dr. Right For Your Baby
There are three qualities a parent looks for in choosing a doctor for their baby. The doctor must be able, affable, and available. These three "A's" of doctor choosing haven't changed for a long time. Besides hospitals, other physicians, and medical societies, the best references are given by parents themselves. If you are expecting your first baby or are new to a community, ask friends and neighbors about the qualifications of several doctors and interview them prenatally. Here's how to get the most out of your prenatal interview with the doctor:

* Take a written list of your most important concerns and parenting issues to determine whether your needs are in harmony with your doctor's philosophies.

* If you have a special needs, such as "I want to continue breastfeeding even though I'm returning to work," ask if the doctor can help you with this.

* Avoid negatives openers. Nothing is more nonproductive than opening the interview with an "I don't want" list --for example, "I don't want my baby to have any bottles in the hospital." It is more productive to ask, "What is your policy about giving bottles to breastfeeding babies in the hospital?" Remember, your urpose for the interview is to determine if you and the prospective pediatrician are on the same wavelength. Negative openers close your mind to the possibility that you may learn something from the doctor's response.

* Keep your interview brief and to the point. Most doctors do not charge for prenatal interviews, and five minutes is usually enough to make a doctor assessment. If you honestly feel you need more time, offer to make a regular appointment so you can pay for the time. Rambling about future behavior worries or trying to cover the whole field of pediatrics, from bed-wetting to vitamins, is not the purpose of your visit.

* Are you and the doctor of a similar mindset? For example, if you are committed to breastfeeding and your doctor is a charter member of the bottle feeding set, he or she may be Dr. Wrong for you.

* Ask about the availability of special services in your doctor's practice. For example, if you are planning to breastfeed, does your docotor employ the services of a lactation consultant, and how does he or she use the consultant?

* Browse around the office. Either before or after your time with the doctor, here are some observations to consider as you make your reconnaissance. Sit in the waiting room awhile and observe the spirit of the office. Is there a child-considered atmosphere, orderly but friendly and flexible? Is there child-considered furniture that is practical and safe? Is the staff approachable over what may seem to you the silliest of questions?

* Observe the provision for separating sick, possibly contagious children from those who are well. Separate "sick" and "well" waiting rooms, a favorite question on printed sheets handed out at childbirth classes, are impractical. Nobody wants to use the sick waiting room. A more practical method of separating sick and well patients is to immediately shuttle potentially contagious children into an examining room, leaving the waiting room for children who are there for checkups and children who are not contagious.

* Ask the staff for other information: insurance plans, office hours, medical fees, hospital affiliations, availability and coverage when off call, and credentials of the medical training, Ask how emergencies are handled, how the office handles phone calls, approximate waiting time, and who does what in the office when you have a question.

Choosing Dr. Right -- either a family practitioner or pediatrician -- is an investment. Your baby's doctor becomes like another member of the family, an Uncle Bill or Aunt Jane, who, as your child grows, also grows in the knowledge of your child and your family. This is the doctor who examines your newborn fresh after delivery, gets you through those early feeding problems, turns off the runny nose, eases the pain of the middle-of-the-night ear infection, counsels the bed wetter, helps with school problems, and clears the teenage acne. Choose this long-term partner wisely.

Choosing Whether to Breastfeed or Bottlefeed
Perhaps you have already decided on how you want to feed your baby. But, if you are still not sure about feeding, consider the following decision-helping tips:

* Remember this is a very personal decision involving individual preferences and life-styles. Don't be discouraged by well-meaning friends who confess, "Breastfeeding didn't work for me." In most of these cases it didn't work because they breastfed in a non-supportive atmosphere and without early professional help.

* Attend a series of La Leche Leqgue meetings before the birth of your baby. Ask other breastfeeding mothers what breastfeeding has done for them and their baby. Breastfeeding is a life-style, not just a way of feeding. Surround yourself with like-minded, supportive mothers. Many women are intellectually convinced that breastfeeding is best but are not prepared for the energy commitments of this style of feeding, and there is where the need for support comes in.

* See my article, "Breastfeeding: Why and How," and my article to come, "Bottlefeeding with Safety and Love," to learn not only why your milk is best for your baby, but also what's in it for you.

* If you are still undecided by birth time, give breastfeeding a thirty-day trial, using all the right-start tips also discussed in my article, "Breastfeeding: Why and How." It is easy to go from breast to bottle, but the reverse is very difficult. Many breastfeeding mothers find that after they get over the hump of the first few weeks of learning latch-on and establish a routine, they settle down into a comfortable and lasting breastfeeding relationship. If after the trial period you do not joyfully anticipate most feedings, or if you feel pressured to breastfeed but really do not wish to, consider an alternative method of feeding or a combination. It's important to feed your baby in a way that works for both of you.

Circumcised or Intact?
Isn't it amazing that no part of an infant's body has stirred so much international debate as this tiny half inch of skin. Whole cultures and religious groups circumcise as a ritual and as a right; national organizations, come together to protect the foreskin -- and they have appropriate protective titles: Intact, No Circ, and Peaceful Beginnings. Some parents definitely want their son circumcised for religious or cultural reasons, or they just prefer circumcision. Some fathers feel, "I want my son to have a maintenance-free penis." Others are adamant, nearly militant, about leaving the penis intact. Some agonize about this decision, feeling, "I'm going to great lengths to bring my baby into the work as gently as possible. Circumcision just doesn't seem to fit the scene." If you are undecided about your son's foreskin, read on.

Circumcision was once considered routine procedure for most newborn males in the United States, but, as with most routine procedures, many parents question if circumcision is really necessary for their babies. The following are the most common questions asked about circumcision. The answers are intended to help you make an informed choice.

How is circumcision performed?
The baby is placed on a restraining board, and his hands and feet are secured by straps. A local anesthetic is usually injected into the foreskin of the penis. The tight adhesions between the foreskin and the glans (or head) of the penis are separated with a medical instrument. The foreskin is held in place by metal clamps while a vertical cut is made into the foreskin to about one-third of its length. A metal or plastic bell is placed over the head of the penis to protect the glans, and the forekskin is pullled up over the bell and circumferentially cut. Between one-third and one-half of the skin of the penis (which is what the forekskin is) is removed. A protective lubricant is put on to cover the incision area for a few days. The healing of the circumcised area takes approximately one week, during which time you can expect the circumcision, like most cuts, to go through the usual stages of healing.

Is circumcision a safe procedure?
Circumcision is usually a very safe surgical procedure. There are rarely any complications. As with any surgical procedure, however, there are occasional problems such as bleeding, infection, or injury to the penis. If there is a family history of bleeding tendencies or one of your previous newborns bled a lot during circumcision, be sure to inform your doctor of this fact.

Does it hurt?
Yes, it hurts. The skin of the penis of a newborn baby has pain receptors completely sensitive to clamping and cutting. The myth that newborns do not feel pain came from the observation that newborns sometimes withdraw into a deep sleep toward the end of the operation. This does not mean that they do not feel pain. Falling into a deep sleep is a retreat mechanism, a withdrawal reaction as a consequence of overwhelming pain. Not only does circumcision cause pain in the penis, the rest of the newborn's overall physiology is upset. During unanesthetized circumcision, stress hormones rise, the heart rate speeds, and valuable blood oxygen diminishes. Sick babies and premature babies should never subjected to this shock.

A local anesthetic can and should always be used. Painless circumcision should be a birthright. Local anesthesia should be used. It is a safe procedure and it works. Sometimes the anesthetic will not remove all the pain, but it certainly helps. Within a few hours, after the anesthetic wears off, some babies exhibit no discomfort; others will fuss for the next twenty-four hours. The most common and effective method is called a dorsal penile nerve block, in which a few drops of Xylocaine (similar to the anesthetic your dentist uses) is injected into the nerves in the skin on each side of the base of the penis.

Does circumcision make the penis easier to keep clean?
Making hygiene easier is often a reason given for performing circumcision. In the adolescent and adult male the glands of the foreskin secrete a fluid called smegma. These secretions may accumulate beneath the foreskin. Sometimes, though rarealy, the penis becomes infected. Removing the foreskin removes the secretions, makes the care of the penis easier, and lessens the risk of infection. With normal bathing, however, an intact foreskin is quite easy to care for.

What happens if the foreskin is left intact?
Leaving the foreskin intact protects the penis from irritation caused by rubbing on wet and soiled diapers. At birth it is impossible to make a judgment about how tight the foreskin will remain, since almost all boys have tight foreskins for the first year. In about 50 percent of boys the foreskin loosens from the head of the penis and retracts completely by two years. By three years of age, 90 percent of intact boys have fully retractable foreskins. Once the foreskin retracts easily, it becomes a part of normal male hygiene to pull back the foreskin and cleanse beneath it during a bath. While it is true that infections from the secretions beneath the foreskin can more often be a problem in intact males, simple hygiene can prevent this problem.

If the foreskin doesn't retract naturally, will the boy need a circumcision later on?
Circumcision is very rarely necessary for medical reasons, but occasionally the foreskin does not retract, becomes tight and infected, and obstructs the flow of urine. This unusual condition, called phimosis, requires circumcision. If circumcision for phimosis is necessary later on in childhood or adulthood, anesthesia is given, and the boy is involved in the decision.

How do we care for the foreskin if left intact?
Above all, do not forcibly retract the foreskin, but allow it to retract naturally over a number of years. Retracting the foreskin before it is time loosens the protective seal between the foreskin and glans and increases the chance of infection. If you choose to leave your baby's foreskin intact, follow these suggestions for its care. In most babies the foreskin is tightly adhered to the underlying head of the penis during the first year. As your baby begins having normal erections, the foreskin gradually loosens itself, but many not fully retract until the second or third year. Leave the foreskin alone until it retracts easily, which occurs between six months and three years. The age at which the foreskin begins to retract varies considerably from baby to baby. Respect this difference and do not allow anyone to prematurely break the seal between the foreskin and the head of the penis, which may llow secretions to accumulate geneath the foreski and cause infection. As the foreskin naturally retracts (usually around the third year) gently clean out the secretions that may have accumulated between the foreskin and the glans of the penis. This should be done as part of the child's normal bath routine. Usually by three years of age, when more foreskins are fully retracted, your child can be taught to clean beneath his foreskin as part of his normal bath routine.

If he isn't circumcised, won't he feel different from his friends?
You cannot predict how different your son will feel if he is circumcised or intact. Boys generally have a wider acceptance of these individual differences than adults do. Locker-room comparisons are a bit of a myth. It is difficult to know whether the majority of the boys will be circumcised or intact in the future. The number of circumcisions has been steadily declining in recent years as more parents begin to question routine circumcision. In the western United States around 63 percent of the infant males are being left intact, up from 50 percent in the early 1980's.

My husband is circumcised. Shouldn't my son be the same as his father?
Some fathers have strong feelings that if they are circumcised, their sons should be, and this feeling is only natural. But the "like father, like son" complex alone is not a good reason to choose circumcision, as few fathers and sons compare foreskins. It will be many years before the boy looks like the father anyway. Even some of these fathers (usually because of pressure from their wives) are beginning to question the necessity of routine circumcision.

We have a son who is already circumcised. Should brothers be the same?
Since little boys do sometimes compare the styles of their penis, many parents feel that sameness is important among brothers. Just as you lean a lot from your first birth and may choose a different style for the next, not every male in the family must be circumcised. If you choose to leave your next child intact, your problem will most likely be not in explaining to your intact child why he is intact by rather in explaining to your circumcised child why his foreskin is missing.

Does circumcision prevent any disease?
Circumcision does not prevent cancer of the penis, which is a very rare disease anyway and occurs more frequently in males who do not practice proper hygiene. Cervical cancer, which is not prevented by circumcision, is not more common in sexual partners of intact males who practice proper hygiene. Circumcision also does not prevent sexually transmitted diseases.

The decision is yours. As you can see from the previous discussion, there is no compelling reason for circumcision. If you are looking to your doctor to be your son's foreskin attorney, you may still be left undecided. In 1999 the American Academy of Pediatrics issued the opinion that current data are "not sufficient to recommend routine circumcision," adding "circumcision is not essential to the child's well-being."

Cord Blood Stem Cell Banking
When a baby is born, stem cells can be collected from the umbilical cord. Stem cells are immature white blood cells that are abundant within the bloodstream of a fetus and newborn. As a baby gets older, these stem cells mature and differentiate into a variety of while blood cell types, which protect the body from infection. Here are some questions you may have about stem cell banking.

What is the purpose of banking, or storing, stem cells?
If a person is diagnosed with leukemia or one of a variety of other cancers of the bloodstream, chemotherapy or radiation is used to kill the cancerous blood cells. Unfortunately this treatment also kills most of the normal blood cells in the bloodstream and bone marrow, leaving the person extremely vulnerable to infection until the bone marrow regenerates enough white blood cells. Certain people in this situation receive a bone marrow transplant, which is an infusion of a large supply of stem cells from a donor. These cells repopulate the bone marrow. Complications can arise if the donated stem cells are not a perfect match with the patient's own immune system and therefore are rejected. Cord blood stem cell banking provides a perfectly matched supply of stem cells that won't be rejected. They can also be used by another family member whose immune system matches.

How are the stem cells collected?
The long portion of umbilical cord that is still attached to the placenta inside the uterus contains a large amount of the baby's blood that was circulating through the umbilical cord and placenta at the time the cord was cut. The labor attendant drains this blood out of the cord (thus the term "cord blood") by either squeezing the blood into a tube or using a needle to withdraw the blood into a syringe. It is painless and only takes five extra minutes. The blood is not taken from the mom or the baby. If it is not collected for banking, it is thrown away.

How are stem cell stored?
The cells are filtered out of the whole cord blood and frozen in liquid nitrogen or by another deep-freeze method.

Are there any drawbacks to this procedure?
The only negative aspect is what it does to your bank account. At this writing, cord blood stem cell banking costs approximately $1,500. There is also a yearly storage fee of around $150. You can find advertisements in pregnancy and childbirth magazines for various cord blood stem cell banks. It's necessary to make arrangements for collecting the blood sample well in advance of your due date.

Note: There is no right or wrong decision about whether or not you should store your baby's cord blood stem cells. The hope is that you will never need the stem cells. Leukemia and other blood cancers are extremely rate. Out of tens of thousands of units of stem cells that have been stored, only a few dozen have been used by donors so far. On the other hand, if the cost is not a hardship, then you may want to consider it. Other medical conditions may be treated with stem cells in the future.

There will be more articles on infants, breast or bottle feeding and other related topics to follow. So please keep an eye our for more of my articles.