Wednesday, March 14, 2012

Attachment - Overrated?

Its an observation, an anecdote, but something I've been thinking about for some time.  Maybe all this emphasis on bonding and attachment to your baby is... way overrated.  On one of my anti-crunch groups someone recently was pointing out how you can bond over a bottle of formula too, as if that squashes an anti-formula argument.  Well, yes, I'm sure that's true, but it just demonstrates what a big deal we make over bonding.  Every one takes it as a matter of fact that of course bonding is crucial, and how crucial cannot be overstated.  Sure its important, but HOW important is it really?  I think it IS overstated, and overrated.

I have a friend who didn't read much of anything during pregnancy, didn't have her heart too set on any particular parenting method, didn't have a birth plan - she watched me drive myself crazy and wisely opted not to do that to herself.  Wouldn't you know it, SHE was the one who got the vaginal birth, who is still breastfeeding at 10 months and for whom co-sleeping just worked in a natural no drama kind of way.  She and I have the kind of relationship where we can give each other crap about these things and laugh it all off and learn from each other.  She's great.  She works from home and is bonded very securely to that child.  But she is SO intensely bonded that when she comes to visit, she can't leave the room or Baby Jenny (I'll call her) has an absolute total meltdown.  Just the sight of her mother walking away from her is enough.  Poor Jenny just screams for 2 solid minutes while my friend pees.  She can't even leave her with her mom or sister at home because of this extreme attachment, and it is really wearing on her.  She recently had what she describes as 3 or 4 days of sheer hell trying to get her to sleep in her own crib at night.  Ironically, she is now DEVOURING "Babywise" in an effort to find some sanity and balance in life.

Similar situation with a 6 month old who has just started coming to my son's home daycare a few days a week. For 6 months, she has only been with Mommy, and after seeing her with Mommy, you can see what a cutie and a delight she is, but at daycare, when Mommy leaves, she cries nearly constantly.  And if a stranger enters the room and she sees or hears them, she starts up again if she had settled.  Doesn't matter if you sing to her, rock her, hold her, talk to her, show her a toy, there is no soothing her.  This child is in extreme anxiety and its sad to see.

I have other crunchy friends who have never ever left their kids, not even with their father, and because of their extreme attachment, they can't now.  It would cause the child extreme distress, and probably the mother as well.  Doesn't seem very healthy to me.  So then should Mommy never leave?

I can hear the answer now.  No, of course she should always be there for her child.  Parenting is hard and if you don't want the job, don't have kids.  This is what you signed up for.  Its YOUR job to raise your kids, no one else's.

A lovely platitude, but is it realistic?  Is it fair?  Will that really work for YOU?  In many cultures the women of childbearing age have STUFF TO DO and its the grandmothers or older siblings who take over childcare while they are out at the market or whatnot.  I don't know where we got this idea that mothers absolutely have to do all the childcare, and that a good mother will not outsource this or get any help from anyone else.

I don't see these parent-child relationships as very functional, for mom or baby, really.  At least not at a level I could function well at.  I initially felt horrified that I turned out to be the type of mother who dropped her kid in daycare at 7 weeks, and nearly dry-eyed, went back to work, when I could have stayed home a little longer.  But Parker didn't cry when I left him there, and he still doesn't cry when its time for me to leave him.  He's already too busy eating his yogurt or playing and exploring.  I think he actually looks forward to the change in scenery.  But he's still bonded to me.  He somehow knows when its time for me to pick him up and starts looking expectantly at the door, and when he sees me, I get a huge smile.

Parker is so secure and confident, and that actually comes from a healthy place of DE-tachment, rather than hyper attachment.  The AP theory is the opposite though.  From AP you come to think that security and confidence come from a solid foundation of attachment with the parents, and from that security, they blossom into confident little explorers of the world.  But comparing my little guy to AP kids, that's very falsifiable.  Sure, every kid is different, but those kids are stressed and lost without mommy around.  They have no coping skills.  These babies I know are young enough, they will learn and adjust, but it has been no picnic for mom to reclaim her life just a little bit.  And I'm sorry, but I think its reasonable for moms to have a bit of a life.  It's no sin.  If you want to be a complete martyr, go for it, but that doesn't mean every mommy has to as well.  There are many ways to raise kids, and right now, compared with what I see around me, mine is very emotionally healthy, even if I do work.  Maybe even because I work.

I think I've ended up making all the right mistakes, in spite of myself.  And with my next little one, coming this summer, I won't hesitate to hand him off to Grandma as I did with Parker and enjoy a manicure.  And I won't hesitate to send him to daycare as well at 7 weeks, just like I did with his brother.  I won't however, feel any guilt or regret about it though.  I want him to be as calm and assured as his brother that yes, mommy is coming back, so let's go play and have fun.

Wednesday, March 7, 2012

Circumcision: Yes or No ...or Wait?

So you’re going to circumcise your son and that’s final.  I get it.  Nothing I can say will change your mind.  I won’t even try.  He is your son.

Could I at least get you to consider waiting?

So many times this is viewed as a yes/no at-the-hospital decision, when actually it can also be a not-just-yet decision.  It can be done at any time, really.  Maybe you just want to get it over with, but really this shouldn’t be about your convenience, but his health.  If its healthier and safer to wait, why wouldn’t you?  I can give you so many reasons why the longer you wait to have it done, the better it is for him.  

So at least don’t do it in the first few days of his life.  His little body is so new and fragile, and his penis is so tiny (no offense)  ;)  It is extraordinarily easy to take too much or too little skin when its that small and we’re talking millimeters.  It is so important to get this right, yet this is the most difficult time in his life for that to happen.  Also, breastfeeding is not well established yet.  On the chance that it really does interfere, it is worth it to wait.  You’ll kick yourself later if breastfeeding doesn’t work out.  Won’t you always wonder if there was something you could have done differently to help breastfeeding go more smoothly?  This is one thing.  Many mothers report that their sons will not make eye contact or breastfeed after the pain of their circumcisions, and that they view it as a betrayal by their mother to allow this painful thing to happen to them.  I don’t know if that’s really true or not, but could you wait just a little bit after that crucial initial bonding time and he’s feeding and gaining weight?  

Also, since he’s so tiny, another major risk of this delicate surgery is hemorrhage.  It is so easy to nick that teeny tiny artery.  It doesn’t take but half a shot glass worth of blood loss (2.3 ounces) for your baby to bleed to death at this stage, and it happens fast.  Just one ounce of blood loss puts them into shock.  If you think I’m exaggerating the dangers of the surgery at this age, I’m really not.  About the same number of boys die at this age from circumcision, it is estimated, than from SIDS, and you’d do anything to reduce his risk of SIDS, yes?   And trust me, this is not the way you want to find out if your son is a hemophiliac.

Also, babies do feel pain, the foreskin has some 20,000 nerve endings (NSFW), it is not just dead skin, and he is too small for an effective anesthetic to be safe.  The pain is extreme, I’m sorry to say.  You’ve maybe heard stories of babies sleeping through the procedure, but I assure you, many babies react to this extreme pain by going into shock.  They are completely restrained and no one is reacting to their screams, so this is one way that some of them cope.  If you wait, he can at least get effective, safe anesthesia. There is nothing wrong with just waiting.  You’ll be taking him to well baby checkups all the time anyway.  It’s simply one more appointment, its not a big deal.

As far as UTI’s go, his absolute risk is only about 1% or less and UTIs are readily treated with antibiotics.  Don’t forcibly retract and his UTI risk is even lower, more on that next.  The serious complication rate of circumcision, however, is about 4% and those can be much more complicated to fix if they can be fixed at all.  Adhesions after circumcision are painful to resolve and breathtakingly common. There are more men out there than you realize who have simply learned to live with a botched circumcision. (Link NSFW)

Speaking of infection, could you wait until he is out of diapers?  If we are talking about cleanliness, how clean is it to have an open wound exposed to urine and feces in a diaper all day?  His risk of infection and things like meatitis will go way down if you just wait until he is potty trained, and intact care for the baby is so easy!  All you have to do is clean it like you would a finger, and for God’s sake don’t let anyone forcibly retract his foreskin before it separates on its own.  It protects the head of the penis in the diaper and is fused to it with the same biological mechanism that attaches your fingernails to your fingers.  You don’t need to rip the baby’s nails off to clean his fingers.  Ripping the foreskin away is just as painful and just as sensible, and causes its own complications.  If any doctor advises you to, direct them to the AAP on the subject.  (They say no)  It probably won’t retract on its own until age 5 or even 10, and that’s really not a problem healthwise, so just leave it alone and be patient. 

Which brings me to waiting until his foreskin is fully retractable on its own.  A good deal of the trauma and infection risk from the procedure is from ripping the foreskin away before it is cut off, exposing the raw, bleeding, very tender skin on the head of the penis.  If you wait until the retraction process has worked itself out naturally, you’ve cut the pain and the healing process in half making for a much easier recovery. In the mean time, hygiene for the naturally retractable, intact penis is trivial - pull it back, rinse, replace. That's it. Most young boys are more than happy to play with their penis a bit in the shower, so in reality, that's not a huge deal. And with proper care (no premature forced retraction), YOU will likely never even have to do it for him.

So if you’ve waited this long, your son is now able to understand your reasons and communicate with you about his feelings.  Why not talk it out with him and see if he wants to keep waiting?

Actually, since it is classified as an elective cosmetic procedure (non-therapeutic) with only shaky evidence of any statistically significant benefit, and he is still a minor, why not wait until he is 18 or older and can go ahead and give his own consent?  It really comes down to preference and it is his penis, after all, and he’ll soon be a man, legally and sexually.   Who knows at the time of his birth what his future peers will have in their drawers, or what his girlfriends will prefer?  By the time he’s older, you might have a better idea about what he is facing socially.  The truth is the rates of circumcisions ARE dropping.  Maybe he’s totally fine with staying as he is.  Wouldn’t it be nice to give him the choice his father didn’t have?  His father is totally happy with his penis, yes, but really, by definition, he doesn’t know what he’s missing, so how does he really know which is better for his son?  What if a foreskin is actually a good thing to have?  What if? (Video in link NSFW)

Or maybe, after some reflection, he really wants it done.  He sees some benefits and wants to look like his dad and whatnot.  No problem.  He’s not in diapers, he CAN have all the safe pain relief he needs, both during and after the procedure, he’s at much lower risk for bleeding to death and his body is so much better at fighting off infection.  Perhaps most importantly, he is fully developed and the object they are operating on is much much larger and easier to work on than when he was a newborn baby, thus the chances of getting just the right amount of the right skin are so much better.

Best of all, you are completely absolved of any possible feelings of guilt or regret, because this difficult decision was not your decision at all, but his own.  

There are so many reasons I won’t circumcise my baby son, but your mind is also made up - I respect that.  But I hope you can see that the worst possible time to do it is immediately after he’s born, and actually, the longer you wait, the better.  So please, just consider waiting.  That’s all.

P.S. And you don't even have to be annoying like me about it either. If someone asks "Did you have him circumcised?" You can simply say "Not yet." And leave it at that.