Just the Facts, Ma’am: The Minefield of Parenting Choices

While pondering this newsletter’s theme, “Choices in Parenting”, I have been realizing what a political minefield this topic can be. Obviously, choices can be weighty and political in themselves (just bring up the issue of circumcision at a dinner party to experience a truly volatile topic), but the very concept of ‘choice’ itself can be problematic.

It sets us up to expect a duality, two or more equally weighted options with comparable lists of pros and cons. Sometimes this is accurate: diapering choices, brands of baby carriers, prenatal vitamins vs whole food diet… But sometimes there is enough evidence that one so-called choice is more physiologically appropriate or biologically normal than its counterpart.

For example, consider cord cutting. There is now enough solid evidence to confirm that allowing the umbilical cord the extra few minutes to transfer the baby’s blood back into baby before severing it, is healthy for the baby. Or more accurately, it comprises a biological norm, a neutral standard of birth health, that we risk compromising if we interfere by cutting it too soon. In other words, cutting the umbilical cord prematurely may be a ‘choice’, but it is not a neutral choice. It is not an evenly balanced “either/or” on par with waiting until the blood transfer is complete. Rather it is a decision between allowing a naturally salubrious function to occur, versus interfering and thereby causing likely harm.

Although we no longer position the timing of cutting the umbilical cord as a choice, we commit a similar over-simplification when we present certain other parenting decisions as if they were ‘choices’ of relatively equal consequence. There are many examples, but I will offer only one: breastfeeding versus bottle-feeding. Without delving into the multitude of known reasons why species-specific milk is healthiest—we know all this, no need to dwell in this limited space—I will simply note that mammals are hard-wired to lactate upon giving birth, and that this milk is meant to be consumed by the infant(s). This is a biological fact. All mammals drink their mothers’ milk. In the animal world, in our evolutionary programming, there is no “feeding choice”. There is a physiological neutral—or normal—and then there is a deviation known only to humans and only to recent history, which is artificial feeding. I think everyone agrees artificial feeding is a wonderful, life-saving, enhancing invention sometimes, such as when a mother cannot breastfeed, or when a baby cannot take human milk, or when the birth-mother is absent, or for many other specific reasons. But none of these are a “choice”. There is no situation in which artificial feeding and lactation are of equal value to the baby, since mother’s milk contributes to the completion of so many developing parts of the baby’s many systems in ways that synthetic milk, or other species’ milk, simply cannot.

It is not my goal to denigrate anyone for whatever method they use to feed their baby, but rather to point out that by positing these two methods of feeding as if they were equally weighted, with equivalent considerations on either side of a balanced scale, we are doing a disservice to babies, mothers, and indeed to the debate itself. This is not a choice anymore than real-teeth versus false-teeth is a choice. Rather, false milk is miraculous and essential in situations when real milk is not available, just as we appreciate false teeth when the need arises, but would rarely choose them over the real thing otherwise. This is how mother’s milk is for babies.

Perhaps we hesitate to frame the discussion this way for fear of inducing guilt in new mothers. While I agree that intentionally contriving to provoke guilt is a nasty and unfair way to convince anyone of anything, I think this concern sells mothers short. Deliberately misrepresenting relevant information in order to tiptoe around delicate feelings is an insult to anyone’s intelligence. Mothers need to know all the facts to make a real decision. Facts do not cause guilt. On the other hand, looking back with regret because one wishes one made different decisions? Or that one knew then what one knows now? Guilty feelings abound! To minimize potential guilt, I think we would do better to present all the facts as such, and trust that everyone can embrace their own choices, for their own reasons.

We tread dangerously close to harmful misinformation when we treat such consequential issues as if they were just parenting choices akin to choosing a stroller, and as if the reasons for and against were of similar value. Rather, we need to present biological norms as such, and deviations just as any other medical interventions: essential in the absence of the real thing, but not in the baby’s interests under typical circumstances. Human birth results in lactation. Babies expect to be nourished as mammals. When that’s not possible, formula is the necessary intervention. One is part of the reproductive process; the other is a prosthetic. There is no guilt in needing a prosthetic, but neither is there any incentive to use one if you have your own biological limbs.

If this particular choice were always presented this way, perhaps we would tend to question other mothers’ motives less. For example, mothers can have their own reasons for not breastfeeding, related to their own health, their own history, their own life situation, or something that is entirely their own business. It would be nice if mothers didn’t feel they needed to explain or justify their choices, if we all could feel confident that mammalian feeding norms and needs are well-known, and any decisions a mother makes are educated ones—that they have already taken everything I wrote above into account. They have made a choice based on all the pros and cons. Given the exact same information, different people come to different decisions for a variety of reasons. We have to all feel free to come to our own conclusions, trusting that when they differ it is not simply for lack of information or support.

But sometimes this lovely trust in other mothers’ judgment gets derailed by a pervasive sense that everyone “ought” to be making the same decisions on certain topics. Consider the issue of vaccinations. I have witnessed families that choose to decline or defer infant vaccinations treated with open derision, suspicion, and scorn. I have heard them accused of being irresponsible, stupid and uneducated, and of posing a threat to the health of the larger community. This kind of bullying can apply to any contentious parenting issue (circumcision, homebirth, bed-sharing etc), but I will redirect us back to the example of breastfeeding.

Mothers can choose not to breastfeed, or to make any parenting choices that are against the current grain. But they can do so better if they are privy to all the facts. Facts do not judge. But we do. And we are guilty of judging if we dilute vital information as we present it to parents, because we are depriving them of the ability to make fully informed parenting decisions. We are judging them incapable of ‘handling the truth’. We commit this error every time we try to squeeze complicated parenting issues into two sets of equal choices. Breast vs bottle. Solitary vs shared sleep. Vitamin K shot vs not… Few parenting issues truly break down into tidy columns of pros and cons. Most issues are much more complex than that, with many secondary considerations, and personal influences. For example, in all this discussion of choice, I haven’t even broached the fact that many women want to breastfeed, long to breastfeed, try so very hard to breastfeed, but it just doesn’t work out. There can be many, many layers to any parenting “choice”. There can be many influences including cultural, religious, reasons pertaining to the mother’s own childhood, health reasons, situational or circumstantial reasons, economic, social influence, previous experience….in fact an unlimited number of factors contributing to any choice.

But the one thing that should not affect her choice, is bad information. We owe it to all the families we encounter to make sure we don’t fudge the facts in a misguided effort to lessen potential guilt, or in a pedantic attempt to tidy-up the presentation. We don’t need to pretend that these major issues can be squeezed into pretty either/or boxes.

And then, if the information has been clearly and realistically presented, parents have to be able to make their own decisions even if those decisions are at odds with current trends, social norms, or even standard medical advice. We can best support parents in making choices that are right for them by giving them the straight up facts, with no ideology, and no judgment. Just the facts, ma’am, nothing but the facts. Followed, of course, by trust in their competence as decision-makers, no matter what decisions they have made.