Dr Spocks Baby and Child Care: A Handbook for Parents of Developing Children from Birth Through Adolescence

Book by Benjamin Spock Steven Parker

Section I: Your Child, Age by Age

Before Your Child Is Born

Babies Develop; Parents, Too

Fetal development. When you think of all the incredible changes that go into turning a fertilized egg into a newborn baby, how can you not feel awe? By the time most women realize they're pregnant, about five weeks after their last menstrual period, the embryo is already pretty complex. Shaped like a disk, it has an inner layer of cells that will go on to become most of the internal organs, a middle layer of cells that will form muscles and bones, and an outer layer that will become the skin and the neurons of the brain and spinal cord. By eight weeks after conception (about ten weeks after the last menstrual period), all of the major organs have begun to form and the fetus is beginning to take on a human look. But it is still only two inches long and weighs about a third of an ounce.

Four or five months into the pregnancy -- just about half way -- marks a turning point. This is the time of quickening, when you first feel your baby moving. If an ultrasound hasn't been done, those little kicks and nudges may be the first palpable proof that there really is a baby in there -- a thrilling moment!

Moving into the third trimester, after about twenty-seven weeks, the name of the game becomes growth, growth, and more growth. The baby's length doubles, the weight triples.

The brain grows even more quickly than that. At the same time, new behaviors appear. By twenty-nine weeks of gestation, a baby will startle in response to a sudden loud noise. But if the noise repeats every twenty seconds or so, the baby soon ignores it. This behavior, called habituation, is evidence of the emergence of memory.

If a pleasant sound is repeated -- say the sound of your voice reading poetry -- your unborn fetus is likely to remember this, too. After birth, babies choose to listen to their mother's voice over that of a stranger. If you have a favorite piece of music that you play over and over during the third trimester, chances are your baby will love it too, both before birth and after. Without a doubt, learning starts before birth. But that doesn't mean that you need to break out the flash cards along with the maternity clothes. Nobody has ever shown that special teaching adds anything to fetal learning. Instead, it's the natural stimuli -- the sound of your voice, and the rhythms of your body -- that are most nurturing to development.

Classic Spock

There's nothing in the world more fascinating than watching a child grow and develop. At first you think of it as just a matter of growing bigger. Then, as the infant begins to do things, you may think of it as "learning tricks." But it's really more complicated and full of meaning than that.

In some ways, the development of each child retraces the whole history of the human race, physically and spiritually, step by step. Babies start off in the womb as a single tiny cell, just the way the first living thing appeared in the ocean. Weeks later, as they lie in the warm amniotic fluid, they have gills like fish and tails like amphibians. Toward the end of the first year of life, when they learn to clamber to their feet, they're celebrating that period millions of years ago when our ancestors got up off all fours and learned to use their fingers with skill and delicacy.

Mixed feelings about pregnancy. We have an ideal about motherhood that says that every woman is overjoyed when she finds that she is going to have a baby. She spends the pregnancy dreaming happy thoughts about the baby. When it arrives, she slips into the maternal role with ease and delight. Love is instantaneous, bonding like glue.

This is all true to a degree -- more in one case, less in another. But it is also, of course, only one side of the picture. We now know what wise women have known all along -- that there are normal negative feelings connected with a pregnancy, too, especially the first one.

To some degree, the first pregnancy spells the end of carefree, irresponsible youth. Clothes that were loose become tight, and clothes that were tight become unwearable. Athletic women find that their bodies don't move as they once did, a temporary effect but very real. A woman realizes that after the baby comes there will be new limitations on her social life and other outside pleasures. The family budget has to be spread thinner, and her partner's attention (and her own) will soon be focused in a new direction.

Feelings are different in every pregnancy. After you have had one or two, the changes due to the arrival of one more child do not look so drastic. But a mother's spirit may rebel at times during any pregnancy. There may be obvious reasons why one pregnancy is more strained: perhaps it came unexpectedly soon, one of the parents is having tensions at work, there is serious illness on either side of the family, or there is disharmony between mother and father. Or there may be no apparent explanation.

A mother who really wants another child may yet be disturbed by sudden doubts about whether she will have the time, the energy, and the unlimited reserves of love that will be called for in taking care of another child. Or the inner doubts may start with the father, who feels neglected as his wife becomes more and more preoccupied with the children. In either case, one spouse's disquiet soon has the other one feeling dispirited, also. Each parent may have less to give the other as the pregnancy progresses and concerns persist.

I don't want to make these reactions sound inevitable. I only want to reassure you that they do occur in the very best of parents, that they are usually part of the normal mixed feelings during pregnancy, and that in the great majority of cases they are temporary. In some ways, it may be easier to work through these feelings early, before the baby arrives. Parents who have had no negative feelings during pregnancy may have to face them for the first time after their babies are born, at a point when their emotional reserves are fully taken up by baby care.

Father's feelings during pregnancy. A man may react to his wife's pregnancy with various feelings: protectiveness of his wife, increased joy in the marriage, pride in his virility (one thing men always worry about to some degree), anticipatory enjoyment of the child. A certain amount of worry -- "Will I be able to be a good father to this baby?" -- is very common, especially in men who remember their own childhoods as having been difficult.

There can also be, way underneath, a feeling of being left out, just as small children may feel rejected when they find their mother is pregnant. This feeling may be expressed as crankiness toward his wife, wanting to spend more evenings with his men friends, or flirtatiousness with other women. These reactions are normal, but they are no help to his partner, who craves extra support at the start of this unfamiliar stage of her life. Fathers who can talk about their feelings often find that the negative emotions (fear, jealousy) shift aside, allowing the positive ones (excitement, connection) to come forward.

The supportive father in pregnancy and birth. The expectations for fathers have changed in recent decades. In the past, a father wouldn't have dreamed of reading a book on child care. Now, it almost goes without saying that fathers take some responsibility for child rearing (although in reality, women still do most of the work). Fathers also take a more active role before the baby is born. A father may go to prenatal doctor visits and attend childbirth classes with his wife. He may be an active participant in labor and the first parent to hold the baby. If the mother is unwell or the baby has special problems, the father may be the parent most actively involved with the baby in the early hours after birth. He no longer has to be the lonely, excluded onlooker.

Love for the baby may come only gradually. Many parents who are pleased and proud to be pregnant still find it hard to feel a personal love for a baby they've never held. Love is elusive and means different things to different people. Many parents begin to feel affection when they watch the first ultrasound that shows a beating heart. For others, it's feeling the baby move for the first time that makes them realize that there is a real baby developing, and affection begins to grow. For other parents, it's not really until they are well into the care of their baby. There is no "normal" time to fall in love with your baby. You shouldn't feel guilty if your feelings of love and attachment aren't as strong as you think they should be. Love may come early. It may come late. But 999 times out of a thousand, it comes when it needs to.

Even when feelings during pregnancy are primarily positive and the expectation is all that could be desired, there may be a letdown when the baby actually arrives, especially for first-time parents. They expect to recognize the baby immediately as their own flesh and blood, to respond to the infant with an overwhelming rush of maternal and paternal feelings, and to bond like epoxy, never to feel anything but love again. But in many cases this doesn't happen on the first day or even the first week. Completely normal negative feelings often pop up. A good and loving parent may suddenly think that having a baby was a terrible mistake -- and feel instantly guilty for having felt that way! The bonding process is often a gradual one that isn't complete until parents have recovered somewhat from the physical and emotional strains of labor and delivery. How long that takes varies from parent to parent. There is no deadline.

Most of us have been taught that it's not fair to hope that the baby will be a girl or a boy, in case it turns out to be the opposite. I wouldn't take this seriously. It's hard to imagine and love a future baby without picturing it as one sex or the other; that's one of the early steps of the prenatal attachment process. Most expectant parents do have a preference for one or the other during pregnancy, even though they are quite ready to love a baby who turns out to be the opposite. So enjoy your imaginary baby, and don't feel guilty if you learn from a prenatal ultrasound or at birth that the baby is not the sex you had envisioned.

Prenatal Care

Get good prenatal care. Of all the things parents do to help their babies grow up healthy, going for prenatal checkups is one of the most important. As soon as pregnancy becomes a possibility, even before you know that you're pregnant, you should start taking a multivitamin containing folate to lower the risk of spinal cord malformations that can develop in the very first weeks of pregnancy, even before you miss your period. You may want to arrange a preconception visit if you have questions: about fertility, the special health risks of pregnancy, or the risks of genetic disorders, for example.r

Prenatal visits are a time for mothers and fathers to become partners in their baby's health and a time for you to think about the kind of delivery you want. Simple steps -- taking prenatal vitamins, avoiding cigarettes and alcohol, and getting your blood pressure checked -- can make a huge difference in your baby's health, and your own. Routine tests can uncover problems, such as infections, which can be treated before they affect your baby. Even if you're nearing the end of your pregnancy, if you haven't had a prenatal visit yet, it's not too late for your baby and you to benefit.

The usual schedule of prenatal visits is once a month for the first seven months, once every other week in the eighth month, and weekly after that. The visits are an opportunity for you to get advice about common issues, such as morning sickness, weight gain, and exercise. They also are the best way to be reassured that your pregnancy is going along well and that any infections or other serious conditions will be detected early and treated. Prenatal ultrasound is now routine in many places. Even a grainy, black-and-white ultrasound image can make the baby seem much more real, especially to fathers. And you'll have the option of finding out your baby's sex.

Choosing prenatal care. In many communities, women can choose from various providers of prenatal care, including obstetricians, family physicians, nurse midwives, certified midwives (who aren't nurses), and lay midwives. One consideration is the type of delivery you want. Obstetricians nearly always deliver in hospitals; lay midwives tend to specialize in home births. Another consideration is whether you like and trust your doctor or midwife. Does the professional listen to you and give you clear information? Is the person you see for prenatal visits the same person who will do your delivery? If not, do you trust that the other professionals in the group will also provide you with good medical care? Will the hospital and the obstetrics group accept your medical insurance?

Delivery

What kind of delivery do you want? Parenting is about choices, and one of the first you will be asked to make is the kind of childbirth you'd prefer. In the old days, there wasn't a lot of choice. Mind-numbing anesthesia was common; you might get to see your baby for a few minutes when you awoke. Breast-feeding was out of the question for any self-respecting mother. And because doctors were so worried about the transmission of infection, the baby would spend the next week in the nursery, carefully ministered to by well-scrubbed nurses in antiseptic white gowns and hats while the mother lay flat on her back and recovered.

We've come a long way since those days, and now the choices are many. Natural childbirth or an epidural? Support during labor by a husband or partner, by a trained professional (a doula), or by a family member and a doula? Children in the delivery room? Lying down or squatting? Home or hospital? Doctor or midwife? Rooming in or having the newborn spend more time in the hospital nursery? Visiting nurse or lactation consultant at home or both?

No one approach suits every woman, and no method is clearly superior for the baby. As you make your choices, it's wise to consider what you want -- your ideal delivery -- while remaining flexible in case of unforeseen events. Childbirth is safer now than ever before, but it is still unpredictable. Plan to ask a lot of questions and do some more reading. Dr. Spock's Pregnancy Guide, by the obstetrician Marjorie Greenfield (Pocket Books, 2003), is a good source of reliable information that covers all the most important issues and is easy to read.

Doulas. "Doula" is a Greek word that means "woman's helper." Doulas are women who are trained to provide continuous support to women in labor. Some doulas also help out after the baby is born. During labor and delivery the doula guides the mother in positioning, movements, and other activities that can reduce discomfort and provides back rubs and other comforting physical contact. Perhaps most importantly, a doula who has been through many deliveries is often able to reassure a laboring woman when things really are okay, even though the woman may be feeling panicky or overwhelmed. It helps that doulas provide continuous support, staying alongside the laboring woman from start to finish.

A doula can be good for the mother and the father. It's the rare father who can soothe a laboring woman's pain and anxiety as well as a trained doula, especially when the father is anxious himself. By taking over these tasks, the doula frees up the father to be with his partner in a loving way, rather than as a coach. Most fathers feel sup...