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It's None of Their Business
by Peggy O'Mara
On September 29, 1999 the Consumer Product Safety Commission (CPSC) issued a recommendation against co-sleeping. The CPSC cited research that indicates an increased risk for SIDS, for suffocation and for strangulation associated with cosleeping. This research, published by D.A. Drago and A.L. Dannenberg in Pediatrics (103:5:e59,1999), has been sharply criticized in a follow-up letter to that journal by James J. McKenna, PhD, director of the Mother-Baby Behavioral Sleep Laboratory at the University of Notre Dame and Lawrence M. Gartner, MD, co-author of the American Academy of Pediatrics (AAP) 1997 statement on breastfeeding.

On September 30, 1999, La Leche League International, the worlds foremost authority on breastfeeding, issued a statement citing studies that show that "cosleeping with a breastfeeding infant promotes bonding, regulates the mother and baby sleep patterns, and helps the mother become more responsive to her baby's cues."

And in an opinion piece in the New York Times on October 1, 1999, Penelope Leach, London psychologist and author of Your Baby and Child, says, "Three other studies, in the United States, New Zealand and Britain reported no direct risks to babies from sleeping in parents' beds".

Unfortunately, the American Academy of Pediatrics (AAP) is publishing a new book in December, Guide to Your Child's Sleep, that extols the dangers of the family bed. Fortunately, I know better, but I grieve for the new parents who will be sorely confused by this nonsense.

Over the years, I've observed a progression in the life cycle of new ideas. They are first ignored, then ridiculed, next attacked and, finally, assimilated. This process of social change can take decades. Does the fact that the AAP finds it necessary to attack the family bed mean that it is being taken seriously by our culture? Does the advice in their book indicate that pediatricians, unfamiliar with the family bed themselves, don't know how to advise the parents who have legitimate questions about it? Could it possibly mean that the AAP is afraid of some future liability should they appear to condone the family bed in the present? Or, does it simply mean that now we will have something new to lie to our doctors about?

The family bed is not a medical issue. It is a personal, social, and familial issue. It is a "mother management" issue. It is nobody's business but our own. I suppose that someone can dredge up obscure research showing that some drunk or drugged parents have actually rolled over and squished their infants while sleeping with them. I, for one, am tired of recommendations based on the worst case scenario.

I will not have my perfectly innocent, healthy maternal instincts co-opted by medical associations who focus on deviations at the expense of normalcy. And, I refuse to base my parenting philosophy on fear.

I am not a doctor. I am, however, the mother of four contented family bed veterans. I have also been the editor and publisher of a magazine for parents for 20 years. Never once have I heard a story of any real parent who slept with a child, rolled over and hurt that child. Nor have I heard of any child being emotionally hurt by sleeping in the family bed.

What I have heard, however, are the moans of parents whose awareness is so heightened by the presence of their baby in the bed that they cannot sleep. I have heard from parents who don't know how to manage the family bed when their baby squirms, kicks and moves about. I have heard the frustrations of parents who wonder how to keep their sexual relationship alive with a family bed. And, I have heard from parents who fear they will never get their child out of their bed once they have experienced nighttime nurturing. All of these situations have creative solutions that experienced family bed parents can share with new parents.

I'm practical enough, however, to want to know more than anecdotes. I want to know more about what other countries do, what other generations in our own country have done. That's why I was glad to find the book The Family Bed when I was a new parent 25 years ago. And, more recently, Meredith Small's book, Our Babies, Ourselves, reminds us that, "In almost all cultures around the globe, babies sleep with an adult." Small says that it is only in industrialized Western countries such as the US, Canada, and some countries in Europe that sleep has become a private affair. In fact, the US is unique from the rest of humanity in the way we treat our children during sleep.

In her book, Small notes one study of 186 non-industrial societies that shows that in 67 percent of these cultures, children sleep in the company of others. And in none of these 186 cultures do babies sleep in a separate place before they are at least one year old. In another study of 172 societies, all infants in all cultures do some cosleeping at night. As Small says, "The US consistently stands out as the only society in which babies are routinely placed in their own beds and in their own rooms."

In officially being cautious and fearful about the family bed, the AAP not only ignores the practices of hundreds of other societies in the world but also the research of other scientists. The research of James McKenna, PhD, for example, shows a synchronicity between the breathing of the mother and the newborn suggesting that, for some babies, especially for those at risk for SIDS, cosleeping may be life saving.

When did we agree to let medical authorities into our bedrooms? What gives medical associations the right to terrorize us with so-called "recommendations" that only undermine our authority as parents? Why are we parents so often made to feel that our doctors are our adversaries rather than our advocates? Such "universal recommendations" that take neither individual circumstances nor personal preferences into account are a one-size-fits-all pediatrics- insulting at best and hurtful at worst.

However, as parents, we do want the leadership of the AAP regarding medical matters. Just what is its track record in this regard? Let's take, as examples, the association's recommendations regarding breastfeeding, circumcision, and vaccinations. In 1997, the AAP came out with an historic statement in support of breastfeeding, which encouraged women to breastfeed their babies for at least one year and advised physicians to become educated about and supportive of breastfeeding. I know that the authors of this statement worked for years to reach consensus among the academy, and while I applaud the AAP for this statement, it was hardly new information. La Leche League has been saying the same thing for over forty years. The World Health Organization (WHO) goes further than the AAP by recommending breastfeeding for at least two years. And, a study of women in the US who allow their children to wean themselves showed the average age of weaning to be between two and a half and three years of age.

In the case of breastfeeding, the AAP has not been a leader, but a follower. In recent years, the AAP has also been a follower, as well, in regards to its contradictory statements on circumcision. Instead of taking the role of leadership that medical associations around the world have taken, the AAP chose vacillation. In 1971, the AAP first publicly opposed circumcision, a procedure performed almost universally in the US at that time. In 1975, the AAP reinforced this position, issuing a statement that "there is no absolute medical indication for routine circumcision of the newborn." And in 1983, both the AAP and the American College of Obstetrics and Gynecology reiterated their opposition to circumcision, and circumcision rates dropped from over 90 percent to just over 50 percent.

However, in 1989, the AAP did an about face, issuing a statement that "newborn circumcision has potential medical benefits and advantages as well as disadvantages and risks." And, to add to the confusion, in 1999, the AAP said, "the benefits [of circumcision] are not significant enough for the AAP to recommend circumcision as a routine procedure." However, they did not actually recommend against it. They left it up to the parents.

The physicians of other countries, however, have been more straightforward in condemning circumcision. The medical associations of Canada, Australia, and Great Britain all have strongly worded position statements opposing circumcision. The Australian College of Pediatrics, for example, says, "Neonatal male circumcision has no medical indication. It is a traumatic procedure performed without anesthesia...."

More recently, the vacillation of the AAP has had tragic effects. In November, 1998, the AAP recommended that RotaShield, the vaccine for Rotavirus, a common childhood virus causing diarrhea and other problems, be given to infants at two, four, and six months of age, with doses no less than three weeks apart. This three-dose series cost parents $240. The vaccine was first recommended by the Centers for Disease Control and Prevention's (CDC) Advisory Committee on Immunization Practices (ACIP).

Less than a year after this vaccine was recommended by the AAP, and after approximately 1.5 million doses were administered to infants, they changed their minds. On July 15, 1999, the CDC postponed the use of RotaShield because of 15 reported cases of bowel obstruction allegedly associated with the vaccine. The AAP followed suit. What makes this "postponement" of the rotavirus vaccine all the more ominous is that a statistically significant rate of bowel obstruction was reported in the vaccine trials that occurred before it was licensed for use. Despite these complications in prelicensure trials, RotaShield was approved and recommended, and neither parents nor physicians were warned to watch for symptoms of bowel obstruction. As a result, some eight infants have required surgery because of a recommended vaccine for an illness that is highly treatable with rehydration therapy in the US and which does not cause widespread death among US children.

Clearly, the AAP is not an infallible organization. While the organization has issued some important statements on the effects of television and violence on children, it has also been dead wrong a number of times. And, it has let us down. Where we expect the organization to be proactive, it has been reactive. Medical recommendations regarding pregnancy, childbirth, and parenthood, for example, are notoriously rift with fears of liability and the concerns for special interest groups. Following standard medical procedures often contradicts even the most current medical research.

Pregnant women are told not to gain too much weight even though low-birth weight is the number one cause of infant mortality in the US. Women are often left alone during labor even though continuous emotional and physical support by another woman has been shown to reduce cesarean births by 50 percent, the labor length by 25 percent, and drug use and other interventions by 20 to 40 percent. Women often take drugs during labor even though studies show that drug use by the mother during labor imprints the baby for drug use and addiction as an adult.

As if this isn't discouraging and contradictory enough, since 1991, the AAP and CDC have recommended the hepatitis B vaccine for all infants at birth. Hepatitis B, however, is most often a sexually transmitted disease and there are five times more reactions to the vaccine as there are incidences of the disease. The AAP and the CDC no longer recommend this vaccine for non-risk infants at birth. They changed their minds this past summer after congressional hearings on the complications of the hepatitis B vaccine.

How could we have been so naive? We expected the medical establishment to lead the way, to be aware of the latest research, to be broad-based. Gosh, we even expected them to inspire us, to support the validity of our own experience. Instead, what they do is to systematically break down our parental instincts so that we no longer know what we know and must rely on experts for the rest of our lives. Maybe that's why they call it the establishment.

So I say to the AAP, "Mind your own business." I want your courageous leadership concerning medical matters, but not your interference regarding personal matters. The unique dyad that I have with my child is incredibly and inherently wise. I may not know you, my doctor, in twenty years, but I will know my child. Only my child and I will have to live with the decisions that I make. Do not make them for me. Do not imply that you know better than I do what is best for my child. Do not give me a one-size-fits-all prescription for my totally authentic and original child.

How long I nurse my baby, whether or not I share my bed with my child, or how many times I have sex with my husband is no business of yours. Please, dear doctors, find us a cure for autism; acknowledge our legitimate questions about vaccinations; give us something other than drugs for our "hyperactive" children; explain to us why there's an increase in chronic disease among youth; support our efforts to raise our children in a clean environment free of pesticides and genetically engineered food.

But do not tell us what to do in our own bedrooms. It's hard enough to figure this parenting thing out. Please, doctors, help us. Don't scare us. Please, doctors, do no harm.

Editorial, Mothering, No. 97, November/December 1999, Pages 6-10.
Reprinted with permission.
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