Making the best choices

Families - February 6th, 1998
tokyoweekender_Diane Wiltshire

by Diane Wiltshire

Few experiences affect the life of a couple as pro­foundly as the birth of a baby. Nine months after that moment of conception, a baby emerges and nothing is ever the same again. As a recent quote in the UK Tatler stated, “The decision to have a child is to accept that your heart will forever walk about outside your body.”

I have never met a parent who didn’t want to do what was best for his baby, from planning the birth through the child-rearing years. Unfortunately, with the confusing plethora of information available, it is sometimes difficult to make informed choices that are genuinely in the baby’s best interest. Especially for parents residing overseas, there can be the added dif­ficulty of obtaining up-to-date information.

To get off on the right foot here in Tokyo, the first phone call any potential parent should make is to the Tokyo Childbirth Education Association. Run by cer­tified childbirth educator Elena de Karplus, TCEA of­fers classes in everything the expectant parent needs to know about giving birth in Japan.

Childbirth Preparation, Choosing a Place of Birth and Pregnancy Exercise are all part of the TCEA pro­gram for the foreign community. In spite of Elena’s trans­fer back to the States last year, she still carries on the work of this fine organization. As director and teacher, she commutes from New York to Tokyo on a regular basis; her next round of classes begins in early February.

Elena is also editor of the TCEA monthly newslet­ter, The Tokyo Stork, which carries the latest child­birth information and editorials, plus announcements and classified ads. And don’t miss her new website at where you can order from a wide selection of birth and parenting books, check out the class schedules and be entertained as well as informed by various articles she has compiled.

Elena can be contacted directly by email at or by telephone in New York at (914) 725-0151. The fax and telephone number of the Tokyo TCEA office is 5760-3764.

If you are expecting a baby, you will be faced with many important decisions as the due date nears.

Wherever you choose to have your baby, whether it be a large hospital or small clinic, it is important to work with a doctor of midwife who shares your views on the birth and care of the baby afterward. Some hospitals are more flexible than others on rooming in with the baby, or whether they will subject the mother to interventions during labor which are often unnecessary, such as episotomies or electronic fetal moni­toring. Other issues to consider are how the clinic or hospital would respond to a situation requiring treat­ment for the baby, such as the onset of jaundice.

For example, when my first child suffered from jaundice just after he was born, the clinic recommended that he be placed in an incubator under ultraviolet lights for three days. This was quite traumatic for our baby and resulted in difficulties with breast feeding. By the time my second child was born, I had studied enough about jaundice to insist upon frequent nursings and exposure to indirect sunlight instead of the incu­bator. I also brought in my own pediatrician who backed up this decision. The level of jaundice with my second child dropped dramatically in half the time due to a different, yet equally effective, treatment.

All parents have strong instincts to protect and nurture their babies, and it is important to check with your heart as well as your mind when making deci­sions about childbirth and infant care in any country. Try not to be intimidated by doctors or hospital poli­cies if they don’t agree with your own. If you disagree with your clinic routinely whisking new babies away for a 24-hour observation period, or offering glucose water between feedings, you should communicate re­spectfully yet clearly that you don’t want that to happen. Remember: it’s your baby!

One of the first issues I faced as a mother of a son was whether or not to circumcise my newborn baby. Historically, the majority of baby boys in the U.S. have been circumcised and many American parents have automatically continued this practice with their sons.

I decided to find out more about his procedure before making a decision, especially as it is not a com­mon practice in Japan. What I found out appalled me. Most distressing was the fact that a majority of cir­cumcisions are performed without anesthesia. When I read accounts of the actual surgery, where the baby is helplessly strapped down and cut, I couldn’t imagine subjecting my child to such pain.

In checking out the pros and cons of circumcision, I discovered the truth about several medical miscon­ceptions. Circumcision is claimed to prevent penile cancer, but actually this cancer is very rare and strikes one in 100,000, usually elderly men. Breast cancer strikes one in nine women, yet we don’t routinely remove breast tissue to prevent this disease!

Another misconception is that circumcision pre­vents urinary tract infections, a problem that affects fewer than 1.5 percent of males. Females get urinary tract infections more often than men and are simply treated with antibiotics. Uncircumcised men have been blamed for a higher incidence on cervical cancer in women, but the incidence of this cancer is about the same in the U.S. as it is in Japan, Scandinavia and other countries where circumcision is not routinely performed. It seems extreme that many babies are still being subjected to this painful rite as a preventive treatment for rare diseases when good hygiene is a much less violent alternative.

Most parents who choose circumcision for their newborn sons do so not for health or religious rea­sons, but because they want their son to look like the father or like other circumcised boys. There is no evi­dence that a child has ever suffered psychological harm by such a difference. If circumcision is desired or needed for religious reasons, the surgery is much less traumatic when performed upon an older child or adult, since the foreskin and glands separate naturally later on and don’t need to be torn apart. Also, anesthe­sia can be given, a benefit either not available or advisable for tiny infants.

For more information on this subject, I would sug­gest reading an excellent book by Ann Briggs entitled Circumcision: What Every Parent Should Know. This book can be ordered from Birth and Parenting Publi­cations, P.O. Box 134, North Garden, VA, 22959, USA.

You may also want to contact the National Organi­zation of Circumcision Information Research Centers (NOCIRC) at P.O. Box 2572, San Anselmo, CA 94979, USA, Tel. (415) 488-9883. NOCIRC is a clearing house for reading material and the latest research on circumcision. If you have access to the Internet, I encourage you to study the various websites on circumcision. One of the most informative is the Doctors Opposing Circumcision Home Page.

Another issue which requires proper infor­mation, emotional support and commitment is the decision to breast feed your baby. By now, most people have heard of the many benefits of breast feeding, yet unfortunately more and more mothers do not succeed. In the U.S., the ratio of moth­ers who breast feed is steadily declining after reach­ing an all-time high of 60 percent in the 1980s. In Japan, although 95 percent of the mothers are nurs­ing their babies upon leaving the hospital, many turn to formula after the first few weeks, concerned that they can’t produce enough milk. In addition, west­ern influence has made formula feeding trendy, and western hospital practices such as separating mother and baby after the birth make successful breast feed­ing difficult.

It is only in the last two decades that techniques have made it possible for scientists to study the complex properties in breast milk, and some of the most impressive research shows how breast milk affects the infant’s brain. According to numerous studies, children who are breast-fed (for months, not days) are more likely to score higher on tests, read sooner and have fewer learning disabilities than formula-fed babies.

The results from a recent study of children in New Zealand from birth to age 18 (just published in the January ’98 issue of Pediatrics) found the following: “Increased duration of breast feeding was associated with consistent increases in childhood cognitive out­comes from ages 8 to 18. Breast-fed children had higher scores on cognitive ability tests, performed better on standardized tests of reading, math and scholastic abil­ity,” etc., etc.

Scientists have finally come up with an explanation why breast-fed babies may be more intelligent. A prop­erty present in breast milk, taurine, is responsible for stimulating development of the brain cells. Because an infant’s brain cells reproduce at a phenomenal rate during the first nine months of life, a rate never to be repeated again in the child’s life time, breast milk provides the optimum nutrition, far beyond what for­mula can offer.

When made aware of these incredible benefits, most parents would like to offer their baby brain food, but there are even more important reasons to breast feed. Studies show that allergies are less common in exclu­sively breast-fed children: they also have a lower inci­dence of gastrointestinal and respiratory diseases, sometimes as much as 30-to-40 percent!

These health benefits are not to be taken lightly; there is nothing as terrifying or exhausting for parents as a sick baby. The antibodies passed on from nursing mother to infant offer a powerful protection against most illnesses.

If most educated couples are committing to breast feeding their baby for obvious reasons, then why do so many fail? Accurate information plus emotional support are crucial if a woman is to succeed. It would be a good idea to contact a breast-feeding support group such as La Leche League International. This non-profit organization working with women in 46 countries, has more than 25 groups in Japan, many of them English-speaking. For a wealth of information, visit their web site at or write to the LLL headquarters to locate the group nearest you. Their address is 1400 N. Meacham Road, Box 4079, Schaumberg, IL, 60168-4075, USA, or you can call them at (847) 519-7730 to request a catalog of reading material and videos. The LLL fax number is (847) 519-0035. TCEA would also be able to provide the telephone number of a LLL group in your area.

If you have any special concerns about nursing, or if you just want the latest information on any aspect of breast feeding, you may want to contact the CBI, or Center for Breastfeeding Information, which was es­tablished nine years ago by LLL. A $25 subscription fee will give you access to more than 12.,000 articles from professional journals in a range of 200 breast­feeding categories. CBI has a computerized database complete with bibliographies, and all the information is updated monthly. CBI can be contacted through the LLL numbers listed above.

I hope I’ve not overwhelmed you pregnant readers with the thought of making so many decisions before your child is even born! There is no doubt that having a baby will bring the greatest joys and challenges you have ever known, but being as well-informed as pos­sible will make life ever so much easier for everyone.

Babies are babies for a very short time, and being able to look back on this precious time with no regrets, knowing you’ve done your best, is truly worth the extra effort.