When We Know Better, We Do Better

I just learned this quote from Maya Angelou today, and thinking about it, among other things going on around me, prompts this post. It's also an apt title.

It's hard, sometimes, not to feel guilty about past choices we've made. To give an example totally removed from pregnancy, childbirth, or breastfeeding, I do transcriptions for a periodontist, among other people. He'll often mention in his letters that 20 years ago, or when his patient was younger, they had a particular dental therapy performed that we would never do today, as now we know it causes problems decades down the line; problems that my client, of course, tries to fix for the patient. To bring the point closer to this blog, doctors used to recommend that women smoke during pregnancy in order to reduce the size of their babies for easier delivery. We used to routinely give antibiotics for every ailment. We used to fire-proof using asbestos. Now we know better. Now we no longer do those things. "When we know better, we do better."

It's hard not to feel guilty for making choices in the past that we now know may have negatively affected our health or the health of our children, even if we didn't know better. This is especially true in childbirth and breastfeeding. Many, many babies in the 20th century never received a drop of breastmilk, because doctors and mothers were convinced that formula, because it was "scientific," surely had to be better than paltry breastmilk. Breastfeeding was for poor women who couldn't afford better, as was giving birth at home instead of at a hospital. Should our grandmothers feel guilty if they did not breastfeed our mothers? Should our mothers feel guilty if they did not breastfeed us?

Maybe "guilty" isn't the right word. Maybe a little guilt is all right, since guilt about a past error can be impetus not to repeat that error. But it should not be a stigma. I didn't "know better" when my first son was born. I followed the advice of the people I trusted - nurses and doctors. Maybe "we" as a society "knew better," but I didn't, so I didn't do the best thing I could. I did feel guilty about it for a long time. How could I have deprived my son and myself of something so precious?

But now I know better, so I do better. I did better, and will do more in the future.

My grandmother was 20 years old when my mother was born, back in 1953. My mother was born seven weeks premature. At that time, premature babies were routinely placed in pure-oxygen environments, as it was believed to help them breathe. It was found that this environment was not, in fact, healthy at all, and caused blindness and other problems for many preemies of the time. Thankfully, my mother was not given this particular treatment. When we know better, we do better. My grandmother wanted to breastfeed her daughter. She had no idea how, had no support from hospital staff, but she felt that it would be best for her baby. The doctors at the time said that surely what a preemie needed was specially developed formula, that breastfeeding her 4lbs-something baby could only be detrimental, and how could she be so crazy as to want to do that. So, bowing to the pressure of the wisdom of the 1950s, my grandmother acquiesced and gave her first daughter formula. My mother is a healthy grandmother herself, now. We don't know if she suffered ill effects from her precarious early days on this Earth. But we do know now that those doctors were wrong. A study released just two days ago by Johns Hopkins reconfirmed that the absolute best food for a premature infant is, shockingly, breastmilk, at least in the goal of preventing potentially fatal necrotizing enterocolitis (NEC).

When my mother's younger sister was born full term, 18 months later, my grandmother again wanted to breastfeed. Though my aunt was full term, she was quite small, barely 5 pounds, and, again, the hospital would not "let" my grandmother breastfeed her own daughter because of her size. She needed to put on weight, you see, and formula was the best thing for that!

Finally, 4.5 years after that, my mother's younger brother was born. I don't know if my grandmother even bothered to ask if she could breastfeed, or tried to breastfeed, after not being allowed to with her first two babies. My uncle, unfortunately, unlike his sisters, is not as healthy as they are. He has Crohn's disease. My grandfather told me that when my uncle was a baby, they tried formula after formula, but all of them caused him distress. My grandfather was a pharmacist, and "the Enfamil guy" promised to hook my grandparents up with the best of the best formula to be had in 1959. Still, this didn't work for my uncle, and he ended up being fed pure cow's milk before he was a year old, as that seemed to be the food he tolerated best. He is suffering from quite a few health problems now, most as a result of the Crohn's disease. I can't help but wonder, if he had been born in 2009 and "allowed" to breastfeed, would he suffer from such severe intestinal problems 40 years down the road? It will be interesting to one day see a study on whether breastfeeding in infancy reduces the risk of developing Crohn's or colitis in adulthood. (This is all speculation, of course!)

Should my grandmother feel guilty about not breastfeeding her daughters and son? Should she in some way feel that she "caused" her children's health problems, especially her son's? For that matter, should she feel guilty for smoking through all of her pregnancies (probably causing her babies to be premature and low-birth-weight, as we now know)? I'm not sure, frankly. I don't see what good it would do to feel guilty. She may have regrets. She may wonder, as I do, how things would have been different. But we can only move forward. We can only say, "Well, now we know that breastmilk is the best food for preemies. Now we know that breastmilk helps prevent intestinal diseases in babies. Now we know smoking during pregnancy can be harmful to the baby." We know better, so we do better.

And when we know better, we can educate the next generation. We can support them in making the best decision with the best information they have at hand. My grandmother fully supported her daughters in their desire to breastfeed their respective children. And she and my mother and aunt fully supported me in my desire to breastfeed my children. And I can send that information on forward to my future daughters or daughters-in-law (G-d willing!).

A friend of mine, in discussing our birth experiences, said that she does regret that she never got the home birth, all natural, water birth experience as she had planned. Instead, she ended up with four c-sections, although not by her initial choice. But, one day, when her daughters or daughters-in-law come to her and say that they want to have natural home waterbirths, of course she will be supportive of that, and will be by their sides if they want her there, and will weep with joy when her grandchildren are born the way their mother's want them to, the way, probably, nature intended.  We can regret. We can feel guilt. But we can use that regret and guilt to make the future better than our past.

Of course there's no sense in wallowing in what may have been. We can't change it. We simply can't. But we can start right now with doing better.