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The Biggest Decisions New Parents Face

I don't know about you, but pregnancy only intensified my usual indecisiveness. Should I cut my hair short to stay cool  -- or would that make my face look fatter? Pick maternity jeans with stretch panels or drawstrings? I changed my mind five times about my firstborn's birth announcements. And don't even ask me about the trials of choosing a name.

Then there were the really big decisions after the baby came, regarding things I'd never had to consider before in my life. How would I feed her? Where would she sleep? I now know that what's "right" often boils down to what's right for you. The best way to navigate decision making:

  • Gather facts.
  • Ask moms who've been there.
  • Filter what you learn through your own situation.
  • Then trust your instincts.

To get you started on the biggies:

Contributing editor Paula Spencer is a mom of four and the author of the Parenting Guide to Pregnancy and Childbirth.

Breast or Bottle?

Should I breastfeed or use formula?

The facts: While many moms-to-be assume the answer should be based on convenience, in fact it's an important health issue. You've heard it before: Medical evidence tilts strongly in favor of breast milk for newborns. The colostrum secreted by the breasts before the milk comes in helps the digestive system mature and provides immunity against infection. Breast milk itself has unique health-protective properties: Babies who are nursed have fewer ear infections, stomach bugs, and allergies and less risk of chronic disease, such as diabetes. Breastfeeding also benefits brain development, says Joan Meek, M.D., editor-in-chief of the American Academy of Pediatrics (AAP)'s New Mother's Guide to Breastfeeding.

Nursing's good for moms too. It speeds the shrinking of the uterus back to its normal size by increasing levels of the hormone oxytocin. It may also reduce the risk of ovarian and breast cancer.

Some moms prefer formula, since it allows you to be less physically tethered to the baby and others can share feeding responsibility. On the other hand, anyone can feed an infant a bottle of expressed milk. Working mothers face added challenges in balancing breastfeeding with a job, although lightweight portable pumps and storage packs have made this easier if you're able to pump at your workplace.

The bottom line: Give it a try. It can be tough at first  -- it's uncomfortable, exhausting, and time-consuming  -- but the benefits really are worth it. And once you've got the hang of it (it'll probably take some practice), you still have the option of also using formula if you need to. Many moms combine breast- and bottle-feeding. "Any breastfeeding is better than none," says Dr. Meek. Take it one day at a time.

Feeding Schedules

Should I feed my baby on demand or put him on a schedule?

The facts: A newborn or very young baby should be fed on cue, say experts  -- in other words, anytime he seems hungry (by making movements with his mouth, bringing his hands to his face, or turning toward anything that touches his mouth). For most infants, this will be as often as every two to three hours, for a total of 8 to 12 feedings a day. A breastfed baby may eat even more often, since breast milk is easy to digest and clears the stomach more quickly than formula. And during growth spurts, a baby may "cluster feed" every hour or so.

The promise of a convenient schedule comes from an alternative approach known as "parent-directed feedings" (PDF). Popularized by a minister named Gary Ezzo, who doesn't have a medical degree, the PDF system recommends timed intervals over reading hunger cues.

To feed an infant by the clock is dangerous, says Dr. Meek. Going too long between meals puts him at risk of dehydration and insufficient nutrition. By the time a baby's crying from hunger, he's already given many other cues. "By then, it's often difficult to get the baby calm enough to eat," she says. Plus, breasts need frequent stimulation and emptying to continue to produce adequate amounts of milk.

If you want one, a more regulated schedule can work for infants after 4 to 6 months because most will eventually fall into one on their own.

The bottom line: No contest. Watch your baby rather than the clock in the first few months. "Your job is to know your child, not to make him fit your expectations," says Harvey Karp, M.D., author of The Happiest Baby on the Block.

Sleeping Arrangements

Where should the baby sleep?

The facts: You can have her sleep with you in your bed or alone in her own bed  -- a standard crib, cradle, Moses basket, or bassinet. Either option's fine, but safety considerations vary.

A traditional crib that conforms to U.S. Consumer Product Safety Commission standards has proven to be the safest. Other baby beds may be safe, but a lot depends on the model. Look for a "JPMA (Juvenile Product Manufacturers Association) certified" sticker. On the downside, a standard crib can be a challenge to assemble, and once it's up, you won't want to move it. Portable cribs resemble regular-size ones but fold for storage and are slender enough to roll through doorways.

Cradles, Moses baskets, and bassinets are cute early alternatives and are easy to keep in a parents' room, but babies outgrow all of them after just two to four months. Play yards aren't recommended for use as baby beds  -- and because they're so low to the ground, they're murder on a parent's back.

Sleeping in your bed (co-sleeping) is an option that breastfeeding mothers, especially, may find convenient in the early weeks. According to the first long-term study of the practice, at the University of California, Los Angeles, there are neither significant benefits from nor disadvantages to the family bed before age 6. A 5-month-old who sleeps with her parents isn't more likely to have sleep problems later, says lead researcher Paul Okami, Ph.D. Nor is she likely to have gained any of the special advantages often connected to co-sleeping, such as more emotional or behavioral maturity or creativity.

Under certain conditions, though, co-sleeping can increase the risk of SIDS. Ideally, your mattress must be firm (no water beds), with no soft covers under the infant or near her face. Beware of gaps between the mattress and the headboard or between the bed and the wall. And never share the bed with your baby if you've been drinking heavily or taking drugs that make you overly sleepy, or if you're obese.

The bottom line: As long as it's safe for your baby, have her sleep where you feel most at ease.

Crying It Out

Should I let my new baby cry it out or rock him to sleep?

The facts: "A lot of parents have the right idea with the wrong timing," says Dr. Karp. "We should want our kids to learn to put themselves to sleep, but not in the first six months. It's like table manners. We want kids to have them, but a newborn isn't ready to use a fork."

Rocking an infant to sleep is a natural  -- and commendable  -- impulse, Dr. Karp says. In fact, you can trigger what he calls "the calming reflex" by using rocking with other techniques that replicate the soothing conditions of the womb: swaddling, shushing, placing the baby on his side while you rock him, and allowing him to suck.

By 3 months, babies have matured enough to be gradually weaned off these techniques. "If a baby between two and three months old falls asleep while sucking, don't worry. But gently jostle him partly awake so that he can put himself back to sleep," Dr. Karp says. By 6 months, a baby can usually go down after a simple bedtime routine.

The process of letting your baby "cry it out," or cry himself to sleep, is sometimes called "progressive waiting," or "Ferberizing," after Richard Ferber, M.D., the director of the Center for Pediatric Sleep at Children's Hospital in Boston. But Dr. Ferber says this method should only be applied in certain cases, and for babies over 6 months.

The bottom line: You can't spoil a newborn. Give in to your natural impulse to soothe  -- at least for the first few months.

Diapers: Cloth or Disposable?

Should I use cloth or disposable diapers?

The facts: As far as your baby's health goes, it doesn't matter which type you choose. Although cloth was once linked to fewer diaper rashes, recent improvements in the ability of disposable diapers to wick away moisture means that this concern has pretty much become outdated. (There's one exception: Studies have found that disposables reduce the incidence of infection in group settings; some daycare centers won't allow cloth diapers.)

That leaves other considerations to weigh, beginning with comfort. Disposables are cut to fit a baby's bottom like a glove, but the newest cloth varieties are styled as much as possible for comfort and ease of use  -- with fitted shapes (no more awkward triangular folds), Velcro closures (no more scary pins), stylish covers, and removable linings for soilings.

What about the environment? Disposables consume resources when they're manufactured, then mound in landfills after they're used (they're up to 40 percent biodegradable). Laundering cloth diapers consumes energy and water but leaves only dirty water  -- which your city must clean  -- behind.

Expense is another factor. A study in the journal Pediatric Nursing found that the costs of disposable diapers and commercially laundered cloth diapers were comparable. But if you plan to clean your own, that would be the cheapest option.

The bottom line: It's a wash. Weigh your needs and your time against which resources you're most concerned about. Whichever way you go, you can rest assured that your baby will be comfy and dry in her diaper.

To Pacify or Not

Should I give my baby a pacifier?

The facts: Sure, if she likes it. Some parents have been concerned that babies who suck on pacifiers will have a problem with nipple confusion, but a study in 1999 didn't find any connection. To be safe, wait until your infant has been breastfeeding for at least two weeks before introducing a pacifier. Others worry that if they start their baby on a pacifier now, they'll never get her to give it up.

Dental trouble is another concern, but according to the American Academy of Pediatric Dentistry, sucking on a pacifier (or a thumb) doesn't seem to cause problems until permanent front teeth come in. New research shows that taking away a pacifier earlier might help you wean her of it. Dr. Karp says you can begin that as early as 4 to 5 months, though it's fine to wait a couple of years.

The bottom line: It's no big deal. Just be prepared to ditch the pacifier at the optimal time  -- if you don't, it will only get harder as your child grows older.

Circumcising Your Little Guy

Should I circumcise my baby boy?

The facts: There's no medical reason to remove an infant's foreskin. In fact, there are some compelling reasons to consider passing on this procedure, including pain, infection, and the preservation of sensitivity in the penis. Even so, the United States has a high snip rate and is the only country in the Western Hemisphere that routinely circumcises for reasons other than religion. These include family tradition or so that a son will "look like Dad" (or the other boys in the locker room).

Experts haven't agreed on whether pain from the operation lasts for a few hours or a few days afterward. However, there are various types of anesthetic available, including topical creams and injections. But any surgery carries some risks: Complications, such as bleeding or infection, occur in 1 per 200 to 500 cases.

The bottom line: Circumcision is a surgical procedure born of tradition rather than medical merit. If those traditions mean a lot to you, go for it. If they don't, you and your doctor might think twice.

Remember: All of these challenges are good training for the next 18 years or so. "As your baby gets bigger, so do the decisions you'll face," Dr. Karp says. "It never stops."

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