Find Your Folks

When Ruby was a toddler I took her to an indoor gym class, to keep her moving in the cold winter. While she was climbing all over the equipment, another girl her age could neither climb up the very small ladder, nor slide down on her own. Her mother never let go of her hand, "helping" her all the time. The mother asked me why Ruby was so capable. My answer was, simple. Practice; allowing her to try.

This mother needed permission to let go. Seeing Ruby on the slide gave her more confidence to let her child try.

There is a notion I remember hearing when my kids were still too young for it to apply, that parents should look to local custom to help determine when to grant freedoms to their kids. That is, if the neighborhood kids are riding their bikes on their own at nine, then you know it's fine to let your kids do the same. Or, if most kids walk to middle school on their own, let you can feel comfortable letting your kids do it, too. The local custom part is important, as it acknowledges that what is normal in suburban New Jersey may be very different from the streets of Manhattan.

There's a community spirit to this reasoning, that puts the onus on making these leaps of faith--after all, letting our kids out of our sight can be seen as such a leap--on the shoulders of many families. The community spirit encourages families to trust each other, and to watch out for each other.

Parents using each other as guide-posts is a great way to work together to raise our children. But it can be hard to do this when there is little trust among parents, or when parents fear that only they can ensure the safety of their kids.

Once, years ago, my family was walking on the sidewalk with another family in a moderately busy area (not in NYC). The other family's child, age 4, rushed ahead with my kids, ages 4 and 6, who were playing, running, etc. My girls were used to walking behind us, in front of us, around us. Josh and I were watching them, but we did not insist that they hold our hands, except for crossing streets. The other family had different rules. The parents became furious with their child for running ahead and "not staying with them" -- i.e. doing exactly what we allowed ours to do all the time. I said "It's okay, we're watching them." But the parents shrugged us off, and punished their child anyway. They clearly didn't trust us, or our norms.

Without doubt, there are children who require special limits because of their own limitations. Know thy child, above all else. But this child seemed normal to me, capable and responsive. The parents' fear, and their need for obedience, were very different from our parental ethos.

Now that Bella and Ruby are walking to school on their own, I feel the tug of the variety of opinion on children's freedom. Some parents of similar-aged children bristle ("not my kid"). A few give their children more freedom than we do. There's no consensus.

So what gives? Aren't we parents supposed to be looking towards each other for guidance?

 I wonder if this is a New York City dilemma. After all, NYC is not a neighborhood in the traditional sense, in that it's so big and diverse. So, like in all other social spheres in this city, we need to go searching for our "neighbors"--the folks whose ways speak to us--and elect them as our community. I reckon this applies elsewhere, too.

When I need to, I find my free-range parenting friends to buck me up and give me support. One friend in particular, who has a slightly older child, tells me how it's done. She told me what to say to Bella before she took the subway by herself the first time, and how to prepare her for the what-ifs. She also told me that Bella could do it, just like her daughter had. And sure enough, Bella can. We all need friends like this! Parenting need not involve reinventing the wheel in each family. Wherever you are, find your folks.

Mom Guilt: Sunburn Déjà Vu

An early sunburn memory: it was one of those first beautiful hot and sunny weekends of pre-summer, in late May or early June. I was eight or nine, and spent the day at the home of a friend, whose family had a pool. We were wet and active all day: on the swing set, in the water, running around the yard; we had a ball. I had no idea that I was burnt until nighttime, when it hurt to peel off my swimsuit. In the days that followed my back and shoulders ached and stung, and I had hot and cold flashes. I remember my teacher spraying Solarcaine on my back at school, sent in with a note by my mother. The teacher sprayed it on my friend, too. I had red hair, and she was blond. We had both been scorched.

This was not the first or last time I would get sunburned as a kid. It was a regular enough occurrence. Yes, there was sunscreen back then. But it was not used as universally as it is now. We brought it to the beach and other height-of-summer activities. But we certainly did not apply it every time we went outside in the spring and summer, as my kids and their peers are used to doing.

I went on to get sunburned many more times before I really learned my lesson. Some of the worst included my first time skiing in Colorado, age 14 (blisters all over my face), a day at the beach in Tel Aviv, age 17 (same, plus burns over my arms, legs, and chest), and a few times in Costa Rica in my twenties, when I simply failed to reapply sunblock often enough for the equatorial sun. (Despite all this, I have been lucky thus far: the dermatologist says my skin is healthy).

Maybe we parents have learned our lesson from the burns of our youth. We hope, armed with both knowledge and fear, that our kids won't get scorched, and they won't get melanoma. We buy sunblock in bulk, we slather it on our kids, and our kids (amazingly) submit to being slathered and re-slathered. (It definitely was not cool to put on sunblock back in my day. Shhh. Don't tell the kids. The stigma seems to have disappeared.) And it seems to work.

In fact, up until recently my red-headed 10-year-old had rarely had so much as pink summer skin, let alone a real sunburn (with the exception of one day last summer in day camp, when I suspect she didn't adequately reapply after swimming).

That was, until last Sunday, when she went bike riding with her sister and dad. When they left our apartment, it was chilly out and she was wearing a sweatshirt over a tank top with crossed straps in the back. It was still only April; we just recently stopped wearing our down coats. I wasn't in sunblock mode, yet! (I, and not their dad, mind you, as sunblock falls squarely in my domain of things-that-must-be-remembered. Alas.) They biked around the southern tip of Manhattan, and played in the Imagination Playground on the way. They had a great time. And when they got home, late in the day, this is what Bella's back looked like:

As I gently rubbed aloe vera into her red skin that evening, I empathized with my mother. She, too, did what she could to soothe me after my sunburn all those years ago. But neither of us could wish the burn away.

I never blamed my mom for my sunburn, and I still don't. She wasn't even there that day at my friend's house. So, why, then, do I feel so guilty about Bella's burn? Because I should have known. (Says the voice in my head.) I should have protected her. Even though I, too, wasn't even with Bella on her bike ride, I still feel the burden of having failed to protect her from that all-too-familiar sun.

It takes constant vigilance to protect our kids from from every possible wrong that can come to them, and from repeating our own mistakes. We live in a safety-obsessed world, where helmets and pads and sunblock have become de-rigeur. Mostly, this is a good thing, as who can argue with protecting kids from head injuries and sunburns? The problem is that when the expectation becomes perfection, we're all doomed to fail. Or, even worse, we fail to try. We keep kids in instead of letting them outside, lest they get hurt. If we worry too much, it takes away our ability to live.

The truth is, we can't protect our kids from everything. Bad things happen. Life happens. So it always was, and so it will be. Bella still had a great time being active and outside on Sunday. Her skin is fine now (aloe vera works wonders), and the incident served as a reminder to get that sunblock down off the top shelf.

Here's to summer.

When There's Such a Thing as Too Much Medicine

This past weekend's New York Times magazine cover story, "Our Feel-Good War on Breast Cancer," explains how a very well-meaning campaign to save women's lives has terrified women and resulted in unnecessary medical interventions, without actually saving lives.

It was impossible to read the story without feeling strong emotions. We all know someone who is a breast cancer survivor, and we are of course grateful that those friends or family members (or ourselves) are well. But what does it mean to be a survivor of a disease that may not have needed treatment all all? What if the treatment is permanently damaging, but does not change the overall outcome? The idea of watching and waiting doesn't sit comfortably with many of us patients. We want doctors to heal, and to act. But what if, sometimes, there's nothing at all to be done? What if the research supports watching and waiting?

Yet who among them would dare do things differently? Which of them would have skipped that fateful mammogram? As Robert Aronowitz, the medical historian, told me: “When you’ve oversold both the fear of cancer and the effectiveness of our prevention and treatment, even people harmed by the system will uphold it, saying, ‘It’s the only ritual we have, the only thing we can do to prevent ourselves from getting cancer.’ ” (Peggy Orenstein in New York Times Magazine, 4/28/13)

All this made me think about the over-medicalization of birth. Replace the words cancer with "birth" and "prevention and treatment" with "caesarean", and you have yet another area where women's bodies and selves are often being harmed under the guise of being saved.

There are many reasons why 1 in 3 births in the US are by cesarean, but an important one is that women are oversold the fear of birth. Because birth most often takes place in the hospital, where people usually go to have pain-free operations under sedation, people (both men and women) often believe that women should be passive and calm when they give birth. When if fact, birth is not designed to be a passive experience. To give birth, women need first and foremost to be empowered. They need to be reminded that their bodies are designed to give birth, and be given the freedom to follow the signs that there own bodies are giving them in labor--to move around, to stay upright,  to have privacy, to vocalize, and/or to do whatever they need or want to do (with whomever they need or want present to help them).

But instead, women are sold fear. When I was pregnant with my first daughter, I told one doctor that I wanted to have a normal (intervention-free) birth, and she responded by saying, "Don't set yourself up for disappointment." Not one word of encouragement. Birth is not easy, but it's a lot harder when everyone around you tells you you can't do it. (This is why I hired a doula: I needed to have someone in the room who knew what normal birth looked like, and who believed in me.)

Many women who have unnecessary caesarean births are told by their doctors that the surgery was life-saving. But what they aren't told is that it is the cascade of interventions that have become standard in hospitals that often leads to the moment of distress: making women lie on their backs in bed attached to an IV, preventing them from eating and drinking, attaching them to continuous fetal monitors, giving them medicines that prevent them from moving around and actively using their own bodies to move the baby down through the pelvis--all of these interventions work against a woman's ability to give birth normally. These interventions often cause labor to stall, or make a woman's efforts at pushing less effective, or cause the baby's heartbeat to drop, all of which can lead to the fearful all-too-common moment when the doctor announces that this just can't go on any longer--the baby must be taken out now.

Just like women are "oversold both the fear of cancer and the effectiveness of our prevention and treatment", women are also oversold the fear of birth and the effectiveness of the cascade of medical interventions that supposedly make birth safer. But surgical birth is not safer, and it is not without consequences, both physical and psychological. 

One thing I know, as a health care consumer who has given birth three times in this country, is that trying to have a normal birth in a hospital is an uphill battle. (The exception was my second birth, which was midwife-attended in an in-hospital birthing center.) I also know that birth can be beautiful, empowering, fear-free and peaceful.

The result of all this, for both birthing women and for women considering mammography and/or cancer treatment, is a confounding quagmire wherein doctors are trying to treat and satisfy patients while protecting themselves from those same patients--who have the right to pursue justice in the courts if they don't like the outcome of their birth/ illness. One thing patients forget (encouraged by a litigious environment) is that life is not without inherent risks; doctors may do their best, and a certain percentage of the time, things will not go right. In court, a doctor can defend herself better if she did something, than if she did nothing. Even if nothing would most likely in most cases, based on research evidence, be better and safer. 

I do believe that doctors want to do right by their patients--that they want to protect women and give them what they want. But I also think that the system sometimes acts against what is actually in women's best interests. Doctors too often worry about worst-case scenarios, so they treat every patient as a potential disaster. This attitude may protect a small percentage of women, but it has the potential to harm many more.