Good Enough Mum

The MMR Decision, Part 2 - Singles Not Fabulous

I'm always pleased and flattered to stumble across links back to my own posts (assuming the context isn't "For an example of an atrociously poor piece of writing, click...").  This (the main part of the sentence, not the parenthetical bit) happened to me last night while blog browsing - I found my way to a post about the MMR which linked back (favourably) to the one I'd written on the subject.  This reminded me that I'd never written the follow-up posts I promised at the time, dealing with the 'Yes, but...'s that I can see cropping up in some people's minds in response.  Since this fitted in fairly neatly with my by now depressingly familiar need to find something quick and easy to blog about before the end of the month comes around and leaves me with the dreaded Permanent Gap In The Archives, I'm going to write the first of the promised posts - the explanation of why I didn't opt for separate vaccines instead of the three-in-one.

For those who didn't read or can't remember the previous post and can't be bothered to go read it now, it was about the reasons why I felt the MMR to be far safer than leaving my children at risk of catching the diseases against which it immunises.  The flaw that some people may have spotted in that logic is that those aren't the only two options.  One alternative that many parents opt for is to give the three immunisations as separate jabs rather than as a three-in-one combination, seeing this as a compromise solution that protects their children while avoiding the scaaaaary MMR.

While I think singles jabs are far better than leaving children unimmunised, I have to say that I couldn't see any point to them.  The reason usually given for choosing singles jabs (other than the fact that they haven't hit the headlines in the same way as the MMR has, which does not actually strike me as the best basis on which to make decisions about safety) is that giving the vaccines one at a time avoids overloading the immune system.  This argument makes absolutely no sense whatsoever to me.  We are swimming in germs every second of every day.  The microbes we're exposed to in nature don't form an orderly queue and politely wait their turn to infect us.  If we didn't have the capacity to fight off multiple germs in one go, we would have died out millions of years ago.  True, most of the millions of germs we have to deal with every day are stopped at a much earlier stage by the immune protection granted by our skin and by antibodies in the openings to our respiratory and gastro-intestinal tract - only a tiny proportion of them ever gain entry to the body, and injecting viruses directly into the body bypasses the first line of immune defence.  But the defences provided by the skin aren't perfect, and it's hardly uncommon for germs to get through.  I have a very hard time indeed believing that our bodies aren't perfectly capable of fighting off a paltry three viruses (and bear in mind that we're talking about severely weakened viruses, not the full-strength ones) without any undue difficulty.  I just don't see any reason to assume that immunising against one virus at a time would be any less likely to cause complications than immunising against three in one go.

(I heard about some interesting calculations based, if I remember correctly - which I may not, but it was something like this - the amount of antibody needed to combat a microbe, the number of antibodies that each white cell can produce, and the number of white blood cells in the body, that culminated in working out that the human body can under normal circumstances protect against a staggering ten thousand germs in one go.  This is, of course, theoretical, and I suspect it's probably a major overestimate - it seemed to be based solely on antibody production levels without taking into account that there may be other necessary parts of the immune response that may limit the rate of production of immunity.  However, even if that estimate's out by a factor of a thousand, it would still leave us more than capable of simultaneously whipping up an appropriate level of antibodies to measles, mumps, rubella, and a few common colds and infected ingrowing nails into the bargain.)

Anyway, I could, on the other hand, see a number of reasons for preferring the MMR:

1. The extra research that had been done into the safety of MMR.  Ironically, as a result of the scares there's actually been a lot more research done into MMR than into singles.

2. The extra four needles that my children wouldn't need to have stuck into them if I went for the combined vaccine.

3. The occasional horror story that I'd heard about private clinics not operating according to correct procedure, and giving children vaccine that had been contaminated by bacteria.  (I know, I know... being scared away by occasional horror stories isn't a great reason to make a decision, and is in fact a huge part of why we have an MMR crisis in the first place.  It just seemed to me at the time that going privately might mean I'd end up with who knew what quack clinic, whereas, if I went for the MMR, I'd know that the people giving the immunisation knew what they were doing and were working to standard procedures.  That belief may be unfair.)

4. The need for greater organisation on my part.  I'd need to remember to book all six of the appointments (an initial vaccine and a booster for each of the three) for both children, as opposed to simply turning up on a date sent to me.  Realistically, I knew there was a major risk I wouldn't get it done.

5. Actually, there wasn't a number 5 on my original mental list, because it was so obvious to me that I wasn't going to go for singles that I didn't even get as far as thinking about cost.  However, a quick bit of Googling just now clarified for me that going for the singles option would cost me the best part of £700.  Since I live in the UK, we could get the MMR done without paying a penny.

If someone said to parents "Here's a treatment that we think should reduce the risk of your child ever becoming autistic.  It will cost you upwards of £600, it will involve sticking several needles into your child, and we have no evidence at all that it actually does anything to reduce the risk," then I doubt they'd get very many people accepting.  That's essentially what choosing singles instead of the MMR seems to me to be.  So, again, I found that one a no-brainer.

The MMR Decision And Death Rays From Mars

The recent furore about Wakefield's original paper on MMR reminded me that one of the numerous posts I never got round to writing was the one on why I had no problem with Jamie (and, since then, Katie) getting the MMR, and why I wasn't bothered or put off by the hype about a supposed MMR-autism link. I'm going to have a shot at writing it now - or rather, writing them, since I've rapidly realised I have a choice between one very long and unwieldy post or a series of manageable ones on the topic, and have decided to opt for the latter. 

I'm hoping that at least some people who aren't regular readers of this blog will find this post by googling the topic.  For those people, here's my background and my possible biases on the issue: I'm a general practitioner in the UK.  I'm not a partner in a practice but a salaried GP, meaning that my income is not affected by whether or not my patients are vaccinated; however, it would affect the income of the practice that employs me.  One of my two children has autistic spectrum disorder; I do not believe this to have been caused by the MMR, for reasons that I hope to explain in a subsequent post.

I wanted to write this post because I know that the alleged MMR link has worried many parents, and thought it might help at least some people to hear from a mother and a GP about how and why I reached the decision to give the MMR and why I'm happy with that decision in retrospect.  It's not meant to be an exhaustive study of all the available evidence.  It's the story of the way the evidence looked to me when I was making my own decision about the vaccine, and the factors I took into account. (Obviously, some new and relevant points have come to light since then, all of which have only strengthened my belief that I made the correct decision.  I've included those as footnotes.  The main body of the text is about how I made the decision at the time.)

It is fair to say, first off, that I was quite strongly influenced by what I'd seen of the anti-vaccination movement.  Their arguments seemed so loaded with the features I'd learned to associate with poor science (their trumpeting of poor-quality research while ignoring large-scale studies that contradicted their hypotheses, their hints of conspiracy theories, the general impression that they’d made up their minds and now were out to find the data that suited them rather than finding what the data showed and making their minds up based on that) that my automatic inclination was to assume they were wrong.  The more anti-MMR hype I saw, the more I found myself feeling that if people who argued that way were against the MMR then I should probably be all for it.

However, in all fairness, I knew that wasn't really the best way to decide the issue.  Just because I didn't like the way people sounded didn't mean that I should be dismissing what they had to say out of hand, and the fact that they gave every appearance of jumping to conclusions certainly didn't mean I was entitled to do the same thing.  So I tried to look at the available evidence as fairly as I could.  As far as I could see, the story went something like this:

Back in the 1990s, a number of parents had noted that their child seemed to have developed symptoms of autism around the time that said child got the MMR immunisation, and started wondering, worrying, and sometimes drawing conclusions about a possible connection.  In 1998, a paediatrician by the name of Andrew Wakefield wrote a paper for the Lancet in which he wrote about twelve children that he'd seen in his outpatients' clinic with autism and bowel symptoms, eight of whom had allegedly developed symptoms shortly after having the MMR.  Wakefield theorised that there might be a link - according to his theory, the MMR might be causing bowel damage which then led on, secondarily, to autism.

So, the question had been raised.  However, so far all we had was a question, and it's crucial to remember that that's not the same as an answer.  Since autism primarily affects areas such as language and imaginative play which undergo noticeable spurts of development during the second year of life, that’s very often when parents first start to notice differences about their child, and since the MMR happens to be given around the beginning of the second year, purely by the law of averages there are going to be a certain number of occasions when parents notice autistic symptoms in their child around the time that the MMR was first given.  Not only that, but taking your child to a doctor's office to have a needle stuck in him is an unusual and nerve-wracking event that tends to stick in people's memories, so, if your child has autism and you're desperately wondering what could have caused it and are looking back racking your brain to think what was happening at around the time you first noticed the symptoms of autism, the fact that your child happened to have a vaccine around then is going to be something you'll remember.  It was entirely possible, therefore, that the associations that had been noticed in some children could be purely down to coincidence.^1,2  The question had been raised, and it needed an answer.

So - and this was the bit that somehow seemed to get left out of much of the media hype around the topic at the time - researchers set out to find that answer.  They looked at large-scale groups of children, looking for any correlation between the age at which children got their MMR shots and the age at which they were first noted to have symptoms of autism that might be above and beyond coincidence, or any link between the sort of bowel symptoms Wakefield had described in the children he'd studied and either autism or the MMR, or - most importantly - any difference in autism rates between children who'd had the MMR and children who hadn't.  Esther, over at Mainstream Parenting, has a good summary of the research in this area, but the important bottom line was that none of these studies showed any link.  Children were no more likely to show symptoms of autism just after their MMR than they were at any other time around that sort of age, there didn't seem to be any sort of link between autism and inflammatory bowel disease, and - most importantly - children who'd never had the MMR were just as likely to be diagnosed with autism as children who'd had it.

The only other arguments in favour of the MMR-autism link seemed to be a claim that there were unexplained rises in the rates of autism in recent years (except that no-one could even say for certain that this was the case, given that this coincided with health professionals becoming a lot more on the ball about picking up subtle symptoms of ASD that might have gone unnoticed before - it looked more as though we were just getting better at diagnosing the cases of ASD that had always been around), and that Wakefield claimed to have found measles virus in the bowel wall of some children with autism (which was supposedly linked in with his whole theory about MMR triggering bowel disorders which then led on to autism, but frankly sounded like a pretty tenuous and inconclusive link to me.  Besides, if it turned out that Wakefield was right about that and that measles virus really did put children at risk for bowel disorders, why on earth should that be an argument in favour of me leaving my children unimmunised and thus at risk of contracting the full-strength unexpurgated version of the virus that the vaccine was meant to protect against?)³

And that, as far as I could see, seemed to be evidence in and case closed.  We'd questioned whether the MMR might increase autism risks, looked into the matter, found out that it didn't, and that was that.  Since the result of the question being raised in the first place was that a lot of extra research had been done into the vaccine, I felt that - thanks, indirectly, to Wakefield and his cronies - I could feel particularly confident that it was safe to give to my children.

However.  I wanted to give the anti-vaccine arguments as open-minded a consideration as I could before rejecting them.  Besides, my experience with a health visitor who flat-out refused to accept that Jamie's near-complete failure to gain any weight in his first two months could possibly have anything to do with his uncut tongue tie had left me with a lot of sympathy for any parent who felt convinced that X had caused Y in their child yet was getting short shrift from medical professionals.  So, I played Devil's Advocate with my conclusion. This is the bit where I feel I'm skating on thin ice, because I know the risk that someone might be disingenuous enough to quote parts of what I'm going to say out of context to support an anti-vaccine argument.  I hope people will have the integrity not to do that, and to read the whole of my post and treat it as fairly as I've tried to look at the arguments with which I disagreed.

What if, I asked myself, what if there was a grain of truth in the midst of the hype, a flicker of flame in amidst all the smoke?  The thing is, no study can prove a negative - that's just a simple fact of science.  No study can ever prove that there is absolutely zero chance of any risk associated with a particular thing or action.  So, what if just a few of the parents who believed the MMR had triggered autism actually were right?  What if the risk wasn't actually non-existent, but just so small that all the studies to date had missed it?  It would, of course, have to be a pretty miniscule risk for that to be the case; but it remained a theoretical possibility.  I felt comfortable with the evidence for the MMR's safety, but I did also recognise the fact that it was not possible to absolutely completely one hundred per cent exclude any chance of any risk of the MMR causing autism.

This is what I call the 'Death Rays From Mars' argument.  The name comes from a scene I once saw on a television drama.  I have no idea what the drama was or even what most of the plot was, since I wasn't actually watching it - someone else had the TV on and I happened to be in the room.  From what I remember of it, it was a courtroom drama in which a doctor was accused of having caused the death of one of his patients through being unfit to practice.  In the scene I remember, the defence lawyer was questioning one of the witnesses, also a doctor, and asked the witness about the possibility that the patient might in fact have died from such-and-such an alternative (and highly unlikely) cause.  Was it possible, the lawyer asked the witness, that this whatever-it-was other cause might in fact have been what killed her?  The witness fixed him with a weary stare and replied "It's possible that death rays from Mars killed her."

The moral being, of course, that just because something's possible in the can't-one-hundred-per-cent-disprove-it sense doesn't mean that it's a possibility we actually have to take seriously for practical purposes.  But also that the whole 'but it's possible that...' argument can get very silly.  If we're going to worry about the possibility that something might happen even in the absence of any evidence that it will and/or the presence of positive evidence that it won't, then where do we stop? 

So, my answer to the idea that, theoretically, there might still be an infinitesmal risk of the MMR causing autism was "Compared to what?"  If you're going to start worrying about hypothetical undetectably small risks of the MMR causing autism, why stop there?  The whole point about vaccines, after all, is that they're given in order to stop a child contracting the actual diseases.  It's every bit as logical to hypothesise that infection with measles or mumps or rubella themselves might carry that risk.  It seems to me to be rather more illogical to claim that the weakened viruses in the injection are too risky to give to a child but that it's quite all right to leave that same child unprotected against the full-strength viruses that they might then catch.  At least the possibility has been thoroughly studied in the case of the MMR vaccine - I don't know of any study reassuring me that children aren't at any increased risk of developing autism as a result of catching rubella.

But I did, on the other hand, know of incontrovertible evidence of problems and risks that are associated with catching measles or mumps or rubella.  Fatalities and serious complications from measles or mumps may be rare in healthy children, but they do happen.  Rubella wasn't something that would cause Jamie himself any problems, but what if he caught the disease and passed it on to a pregnant woman?  A decision on my part not to immunise my own healthy child could indirectly have devastating lifelong consequences for another child. And, of course, if Katie wasn't immunised against rubella she ran the risk of having a severely damaged child herself - an actual, known, proved risk, unlike the theoretical in-the-face-of-all-the-evidence risk that the MMR supposedly carried.

Even an uncomplicated case of these diseases can be pretty darned unpleasant experience for the child.  My sister had measles as a child - no complications, no problems, just a straightforward case with a straightforward recovery.  Over twenty years later, I can still remember how miserable she was with that particular 'simple childhood illness'.  I didn't find it at all difficult to decide that I'd like my children to be spared that experience.

So, there you have it.  My decision wasn't based on a belief that there's absolutely no chance that the MMR could possibly have caused autism in any child ever ever ever.  It was based on a belief that, between a theoretical possibility of an MMR risk too small to show up on any studies and a theoretical possibility of a completely unstudied and unquantified autism risk with measles or mumps or rubella, on top of the actual known side-effects of those diseases, I found it a no-brainer to go for the option that had been most extensively studied and had repeatedly come up in the studies as showing no problems.  In other words, the MMR.

Coming attractions: Why I didn't want to opt for single jabs either, why I wasn't reassured by arguments about how rare these diseases are in our wonderful modern age, and why Jamie's diagnosis of ASD has in no way swayed my belief that giving the MMR was the correct decision.

...................................................................................................................................................................

Footnotes:

1. One other factor here is the possibility that, once a few people have voiced their concerns about the MMR and thus started other people wondering, this in itself can make people more likely to conclude that their child's disorder may have been caused by the MMR, and that can affect the way in which people remember and interpret events.  There is now evidence that at least some of the children who are believed by their parents to have developed autism only after the MMR actually had documented evidence of autistic features and/or of concerns about their development before having the MMR, Michelle Cedillo being the most famous such case.

2. With regard to Wakefield's paper, it has now turned out that it was indeed not a coincidence that several of the parents whose children came to see him reported their child showing symptoms of autism after the MMR.  However, the link wasn't due to the MMR having caused autism.  It was due to the fact that Wakefield had previously expressed sympathy with the belief in an MMR-autism link, and thus lawyers representing families with this belief in planned court cases against the vaccine manufacturers were deliberately advising them to go to Wakefield to get their children seen by him.  Wakefield knew this perfectly well but didn't report it in the paper he wrote, despite the fact that it would have put an important new slant on others' interpretation of the results to know that all these children hadn't shown up in one hospital's outpatient clinic through sheer random chance.  He also didn't report the payments he was receiving from the lawyers for this work, even though it's considered ethically correct for the author of a medical paper to report all conflicts of interest at the end of the paper.

3. Wakefield's laboratory experiments in this area have since been completely discredited, as it has been shown that his work was riddled with errors in technique that could have caused false positive results.  The same studies have been attempted by other researchers using correct techniques, and no-one else has found any sign of measles virus in the guts of autistic children.

It's April, so...

...according to the somewhat optimistic promise on the button that you may have noticed on the left of my blog, I am now supposedly blogging for autism awareness. 

You may also have noticed that I don't, so far, appear to have been living up to this promise.  This is not for lack of trying, but, as usual, for lack of spare time - I have spent the month so far trying to work on this post while feeling that blogging for autism awareness is something I might be able to see my way clear to finding a few minutes to do some time around, oh, say, September.  Of 2009.  Possibly.  But there is currently at least some of April left, so here is my first stab at a Blogging For Autism Awareness post.

If someone with a handy crystal ball had told me, a few months back, that I would be Blogging For Autism Awareness This April, I would probably have been fairly surprised.  I do not mean that in the "I never expected to find myself dealing with the world of autism" sense (that, I'd completely expected) - I mean that I would have been surprised at the idea that I'd think blogging for awareness was something to which I could productively contribute.  People already are aware of autism - everybody's heard of it, haven't they?  I wouldn't have had any particular inspiration as to what I should say to increase this awareness.  "Hey, everyone!  Did you know that some people are autistic?" doesn't really seem like a promising beginning to pad out to blog-post length.

After all, everybody knows the important stuff about autism.  Right?  We've all read the newspaper articles and the magazine stories and the heart-wrenching True Life stuff about Our Autism Nightmare or My Child's Terrible Affliction.  So we all know about autism.  Don't we?  Helpless, hopeless, a life-destroying disaster that renders a child incapable of enjoying life or doing any of the things normal people do, unaware of what's going on around him, and, barring miracles, devoid of hope for any sort of future.

In other words, the general public thinks about autism in pretty much the same way as it used to think about physical disability.  A few decades ago, that last sentence would have exactly described the kinds of attitudes a child in a wheelchair would have to face.  People talked about them as though they weren't there, assumed they were incapable of learning, working, or contributing usefully to society, and wrung their hands over the tragedy of it all.  Disabled people tried to point out that they'd actually vastly prefer it if everybody else shut up with the pity and the stupid assumptions and got on with something useful, like building ramps, but unfortunately nobody really seemed to want to listen.  Which, of course, is still the case to a depressing degree.  But, in general, society's attitude towards the physically disabled has improved a hell of a lot over the last several decades.  There's still a long, long way to go.  But if you heard someone today describing children in wheelchairs by gushing about what a tragedy it was, how awful it must be for them to have such hopeless lives, and how awful it must be for their families to have to bear such a burden, then you'd probably recognise that they were being both ignorant and offensive.

When it comes to the autistic, however, we think absolutely nothing of talking that way about them.  It's standard phraseology for any story about autism.  How often does it ever occur to any of us that we might be just as wrong - and causing just as much offense - as we would be if we talked about other forms of disability in that way?

Over the past few months, I've been reading a lot about autism, browsing through weblinks.  At first I was just trying to brush up on my knowledge of diagnosis and current treatment approaches, and the stuff I found when I Googled was pretty standard stuff along those lines - DSM criteria, early signs to look for, applied behavioural analysis therapy, biomeds, yadda yadda yadda.  And then, gradually, I found more and more links to webpages and essays that challenged a lot of the traditional views about autism and its treatment.  Quite a bit of the stuff I was reading was from autistic people themselves - the very people that we've always thought to be incapable of communicating.  They're voicing their opinions, loud and clear, on just what they think of society's attitudes.  It makes fascinating, thought-provoking, challenging, uncomfortable reading.  Turns out we've assumed a whole lot of stuff about autistic people that's wrong.

We've assumed that, because autistic people have a hard time speaking and often can't learn to speak at all, that this must mean that they can't communicate.  In fact, lots of them can learn how to communicate fluently in other ways - just as a deaf or paralysed person might find it easier to use communication tools other than speech, so can autistic people.  Many can type far more articulately than they can talk.  Others might benefit from using picture card systems.

We've assumed that, because autistic people don't seem to react to their surroundings, this must mean that they're not aware of them.  In fact, it seems the lack of reaction is more likely to be due to lack of processing/reacting skills than to lack of awareness - just as a totally paralysed person can hear everything you say despite not being able to respond to it, so too can even a severely autistic person.  (And... you know all those times people talk about what an awful burden it is to have an autistic child or how autism is some kind of terrible living death?  Yup.  If you're talking that way in front of an autistic person, or writing that stuff in a newspaper that they can read, or putting it on a television programme where they can see it, then that person is probably listening and understanding.  And is probably just as hurt and offended by having their life described in such a way as a non-autistic person would be.)

We've assumed that, because a life looks different from ours, it must not be worth living.  We've assumed that autism is a terrible affliction and that the only hope for people thus afflicted is for us to come up with A Cure, something that will get rid of that awful autism and let the person be just like everybody else.  In fact, it seems that most autistic people don't want that at all.  What they want is to have practical help with dealing with the ways their disability impacts on their lives, help that starts from the point of what they actually need rather than from an assumption that the most important thing is for them to look as normal as possible.  To be allowed to be different, as long as those differences do not harm others.  To have their opinions listened to.

As I read more and more on those subjects, I was amazed and excited and saddened.  Amazed by how little I'd really known about autism, after a lifetime of interest in the subject.  Excited by all that I was learning.  And saddened that these issues aren't far more widely known about.  The growing popularity of computers and the Internet mean that autistic people have more chance than ever before to let people know how they really feel about the way that autism is portrayed in society and about the treatment (in both senses of the word) that autistic people get.  But very few people know that these things are even issues.  In fact, the impression I've been getting is that a lot of people aren't even interested in hearing more when autistic people try to tell them.  People don't want to listen.  But we need to.  Otherwise, autistics will continue to be short-changed.

So that's why I'm blogging for autism awareness this April.

Just in case there aren't enough opinions out there already on the Madonna-and-child story...

The 'for the best' concept I was musing on in my last post set me off on a tangent talking about the Madonna adoption story, which I was originally going to put in as a note on the last post but ended up growing until it took on a post of its own.  So, some general philosophical ramblings on the whole subject of whether or not the adoption is the right thing for David:

I think that what has underlain (is that a word?) the debate so far is a lack of recognition of the fact that sometimes it just isn't as clear-cut as talking about The Right Thing or The Best Thing.  That way of putting it can sometimes make it sound deceptively simple - as though it was just a matter of adding up the pros and cons of each option like different columns of numbers and see which total is bigger at the end. Voila!  The Best. 

The difficulty in real life is that an option that's better in one way may be worse in another, and the two don't just cancel each other out like negative and positive numbers.  The pros of one option may outweigh the cons, but that doesn't mean that the cons all shuffle quietly away and stop bothering everyone.  And it also doesn't mean that everyone's going to agree on how much priority should be put on one set of pros or cons rather than another.

Hence the dispute over whether David will be better or worse off as a result of being adopted.  The simple fact is, both are true; he'll be better in some ways and worse in other ways.  He'll be better off materially - to a degree rarely encountered outside fairy tales - but he'll be worse off in terms of his day-to-day experience in the immediate future (because he'll lose the security of the caregivers he's used to, which is what actually matters to children his age) and in terms of connection to his birth family and his culture long-term.  So the question is - which of these things are most important?

Some people seem to lose sight of the fact that they're all important.  I think this is partly because there's a tendency to assume that there's something shallow about caring about material advantages or about thinking they're more important than such values as family, security, and culture.  But let's not forget that in this case, material advantages don't just mean the vast fortune that he'll now share in (which, true, isn't as important as other factors).  Material advantages mean such basics as enough decent food and proper medicine if he gets sick, better education, and way more options and choices open to him when he grows up and decides what he wants to do with his life. 

I think it's worth remembering that there actually isn't a Right or Wrong answer to the question of which of these many things are most important, because the fact is that not only are all of them important, but different people will put different priorities on different things, and it's an area where there genuinely is room for different opinions.  What actually matters at the end of the day is which of these things are going to be a priority to David.  Which, of course, we don't know, because he's not old enough to make an informed decision on the subject. And the person whose job it is to decide such things - his father - decided that the priority should be giving him opportunities for the future. 

Is it fair to assume that David's father - who knows not only his son but the life and the future that would have been waiting for him had he stayed where he was - is making the wrong decision?  There's a tendency to get a bit patronising there and assume that we know better than he possibly could, this poor uneducated man.  And maybe we do - after all, parenthood, unfortunately, does not give one immunity to making wrong decisions - but let's bear in mind that it's quite possible that we're the ones who don't know what we're talking about.

And yet... I'm still uneasy about it.  Less so than I was - my initial reaction to this story, I've got to admit, was to leap to the conclusion that she must just be the kind of stereotypical adoptive parent that drives other adoptive parents nuts; a clueless do-gooder with a saviour complex.  Didn't she realise it might be a bad idea to take a child away from everything he knows, to uproot him like that and assume it's All For The Best?  When I realised that I seemed to have started channeling Tricia Smith Vaughan, I had to give some good hard thought to why I was reacting so differently to this than to, say, Jo or Karen adopting.

Some of it was my own stereotyping.  Because Madonna is rich and famous, my automatic assumption was that she was merely rushing in to throw money at a problem without bothering to think through The Issues (unlike all of us less rich and hence naturally more morally superior people).  And that's no fairer than any other type of prejudice.  But... from what I've been reading of the Oprah interview and her comments on the matter, I honestly don't get the impression that she has thought much about the issues involved. 

Which may very well be completely and hopelessly unfair, because I didn't see the Oprah interview, and all the snippets I've read of what she's said or done have come via the filter of the media.  One of life's lessons that I try to keep in mind is never, ever, ever to underestimate the power of the media to distort a quote or story or incident almost beyond recognition.  Maybe she actually has thought deeply about all the possible problems and how she will deal with them as best as she can; maybe she's talking about all this stuff and the media just aren't bothering to make headline news out of it.

I hope so.  Because... part of doing the best we can with whatever reality is out there involves recognising the bits that aren't best, the list of cons that stubbornly refuses to disappear no matter how the pros outweigh them, the problems that don't fade away into Happily Ever After the way they do in a fairytale or Disney movie.  Recognising and acknowledging them, in order to figure out how best to deal with them. That's why approaching adoption with a how-great-it-is-that-I'm-saving-a-child attitude just isn't such a great idea, because someone who feels that way is probably not going to be acknowledging the disadvantages.  And when you refuse to acknowledge the existence of something, you probably aren't putting yourself in an optimal position to deal with it.

I think that one thing that maybe we can all agree on is that whatever Madonna had done, there would have been disadvantages for David.  There are disadvantages for him in being adopted; there would have been disadvantages for him in being left where he was.  We can argue all we like about what that nebulous and elusive Best would be in this situation, but that's water under the bridge; the really important issue now is how Madonna can go about giving him the best possible life now that he is here.  To do that, she'll need to recognise that 'the best' will involve more than just swooping him into a fabulous but alien life and expecting that the improvement in his material circumstances will make up for everything else.

And I'm trying to fight my cynicism as to whether she'll be able to do this.  Fact is, I don't know her, I don't have a clue what kind of mother she is, and it's not exactly as though it were my business anyway.  So, I hope she's thought about this more deeply than the media seem to be portraying; but I figure she deserves the benefit of the doubt.  Besides, ultimately it's David, not any of us, who will have the right to make that call.

Interesting discussion on Dawn's blog...

Dawn recently made one of her great posts on her blog about her spiritual beliefs around her child's adoption, and then followed it up by opening the discussion to her readers.  She writes:

I would really love to hear how other members of the [adoption] triad manage their faith around their adoption stories... How did your understanding of God impact your feelings around adoption? How did your feelings around adoption impact your understanding of God?

Not being a member of an adoption triad (i.e., I haven't given up a child for adoption, haven't adopted a child, and am not adopted myself), I didn't think that responding in the debate over there would be the appropriate thing to do.  I couldn't resist writing something, though, since it's such an interesting discussion in terms of general philosophy of life, not just adoption-specific beliefs.

I'm not a believer in the whole 'everything that happens was meant to be and God makes it all work out for the best' philosophy.  Well, I'm not a believer in God either, but my rejection of this particular philosophy came before my atheism - I would have no philosophical problem in believing in a God who allows us to make mistakes and mess our lives up as part of free will, but who's still there to provide us with support and guidance when we want it.  (I don't believe in that sort of God either, but that's another story.  The point I was trying to make is that, unlike many people, I wouldn't regard the whole so-much-evil-in-the-world thing as a reason not to believe in God at all.  I'm an atheist for other reasons.)

I don't believe anyone Up There is making Things All Work Out For The Best, because it's too easy to see examples of things that are clearly not for the best.  What I believe is that it is our responsibility, as human beings, to do the best we can in any given situation.  To do what we can to make things work out for the best.

So... I don't believe that some sort of Supreme Being is saying "OK, now - I shall afflict _this_ woman with infertility and _this_ woman with an unwanted pregnancy because I want them to work it out between themselves as a Personal Growth Opportunity."  I don't believe some of the incredibly painful stories behind adoption were ever meant, by anyone, to happen.  All I believe we can do is respond to them in the most ethical way we can, trying to find the 'best' (by which we mean the least imperfect) situation, and always being aware of the flaws in the situations we do find so that we can maximise our chances of dealing with them.

Off-label parenting

An addition to the voting has put "Why I'm Not An Attachment Parent" into first place as The Post Readers Most Want Me To Write Next. 

I hope that's not too misleading a topic description - this isn't going to be one of those anti-AP polemics from people who are convinced, based on apparently no knowledge of child psychology whatsoever, that AP makes children excessively dependent or spoiled or the like.  Personally, I'm fine with the philosophy behind it - it's hard to object to the idea that parents should seek to foster strong emotional bonds with their children, that breastfeeding is highly beneficial, that parents should be physically affectionate and emotionally responsive.  I don't like the way that its advocates tend to mistake some potentially useful ideas for Commandments As To How Thou Shalt Parent engraved in stone and handed down from On High, but that's hardly unusual in the world of parenting, and blaming AP advocates specifically for that behaviour would be a little unfair. 

What I reject, and have always rejected, is the label.  Even in Jamie's early months, when I was battling heaven and earth to keep him exclusively breastfed in the face of difficulties, carrying him everywhere to an extent that Jean Liedloff could barely have found fault with, and abandoning all my pre-baby plans about getting Jamie used to his cot from the start in order to curl up on a mattress with him every night and blissfully co-sleep, I flat-out refused to call myself an Attachment Parent.

(I want to stress, here, that this is how I feel about the label - it isn't how I think anyone else should necessarily feel.  It says particular things to me that I don't like; it won't say those things to everyone, and nor should it.  If it's a label that suits you, excellent.  None of what I say is intended to be an attack on attachment parents collectively, and I truly hope it isn't taken that way.)

There is no doubt that labels have their uses in life - they're what make it possible for us to conceptualise, to categorise, to think about things in a structured way.  But that's a double-edged sword.  Labels can also narrow our thinking.  Labels can be a way of tidying something away into a neat little box in our minds.  There are a great many things in my life that I'd love to have tidied away into neat little boxes (any volunteers?) but my parenting has never been one of them.  I wanted more space to let things flow as they might (and, apparently, to mix metaphors sufficiently to make an English teacher's brain explode).

Once, on the AP mailing list I subscribe to, a mother was talking about the difficulties she was having with setting limits for her three-year-old son - he'd start to cry and fuss, and she'd feel obliged to give in.  When I inquired as to what she found difficult about letting him cry, another mother on the list objected that I clearly hadn't understood what AP was all about.  Now, as it happens, I know perfectly well that AP is not all about giving in to your child's tears no matter what - that's just the stereotype of AP held by people who know next to nothing about it - and I dug up some apt quotes from the Sears' webpage to back this up.  But it occurred to me afterwards that this touched on a key part of why I dislike the idea of putting any one particular label on my parenting.  I don't ever want to make my parenting decisions based on "what Parenting Style X is all about", regardless of what the X might be.  I want to make them based on what Barry and I feel is right for Jamie and right for us, right for our family as a whole, whether or not they happen to agree with what it says in the Officially Sanctioned Handbook Of Parenting Style Whatever.

Labels can also be divisive.  As I said above, AP advocates are hardly the only parents prone to OneTrueWayism - that attitude certainly isn't something I'd blame on AP, as such.  But I do think that, to some extent, it's something I'd blame on the very act of labelling.  A label can be a way of saying that I'm doing things Right while you're doing them Wrong.  When we talk as though one group of parents has some sort of exclusive claim to something that should, after all, be a deeply inherent part of parenting in general, what sort of attitudes does that foster towards parents who do things a little differently? 

I have actually heard the term 'detachment parenting' used by die-hard AP-ers to dismiss people who don't parent according to AP-sanctioned principles.  Even where that specific term isn't used, stereotypes abound.  The usual alternative with which I've seen AP parents compared in AP writings is the mother (and it is usually the mother who's specified) who Leaves Her Baby To Cry In A Crib In A Room Down The Hall.  (Among other things, non-AP parents apparently all have unusually large houses - the rooms of these hypothetical non-AP'd babies are always 'down the hall'.  We never seem to hear references to babies In A Crib In The Room Next To The Parents.)  When these babies are taken out of the Room Down The Hall, it's apparently only to shift them from one Plastic Bucket to another - 'plastic bucket' not being meant literally, but as a derisive term for anywhere you can put a baby (car seat, bouncy seat, swing, high chair, pushchair) that isn't a sling.  And, of course, putting babies in these Plastic Buckets means that you can't possibly be forming any decent sort of attachment to them.  No, indeedy!

The problem is that AP sometimes seems to lose sight of the wood for the trees.  Breastfeeding into childhood, babywearing, and co-sleeping are looked at as the cornerstones of attachment.  (Oh, yes - and, of course, signing the blood oath that you will Never Abandon Your Child To Cry and will, in fact, spit in contempt whenever the name of Ferber is mentioned.)  Now, personally, I can think of excellent reasons for doing all these things (apart from the spitting in contempt) - we all know the health benefits of breastfeeding, babywearing can be both convenient and fun, and co-sleeping was, for me, a gift from the Parenting Gods and the saviour of what tattered shreds are left of my sanity.  But I think they have a fairly limited relationship to the strength of your attachment to your child.  It is perfectly possible (and not even particularly difficult) to wean your baby early or start her on formula from Day 1, use a pushchair for trips and a cot for night-time, and still foster a wonderful attachment.

I have to borrow Beanie Baby's excellent analogy here - breastfeeding, babywearing and co-sleeping as routes to Better Parenting are like footrubs and candlelit dinners as routes to Better Marriages.  They're potentially good ways of improving bonding, but hardly the be-all and end-all, and not even the only way to a blissfully happy and well-bonded relationship.  Far from it.  Attachment is the sum total of how you respond to and interact with your child in a thousand tiny ways day after day after day throughout his childhood.  There isn't a single specific way to go about this, and, paradoxically, thinking that there is can actually interfere with your ability to meet your child's needs - while the vast majority of children will thrive on AP (as they will on most parenting methods) it can cause problems for the child who really needs to be left alone to cry for a few minutes to release tension or whose mother is struggling with such severe breastfeeding problems that continued efforts to breastfeed are actually impeding her attachment.  AP is no more immune than any other child-rearing how-to to the potential problem of letting the dogma get in the way of the baby.

And the other problem with labels is that they can blind us to the fact that, in real life, it actually isn't that easy to categorise people - we do have this annoying tendency of not fitting into those neat little boxes.  I breastfed Jamie into toddlerhood, took him into bed with us every night until he started sleeping through of his own accord, carried him everywhere during his pre-crawling months, own four different types of baby carrier, and go out to work only because my husband is staying home and therefore one of us is always with our child.  I also started him on formula supplements from four months old, left him to CIO when he was thirteen months, weaned him when he was sixteen months, use a pushchair when I want to take him anywhere, and am planning to put him into his own room (which isn't Down The Hall, but would have been had we managed to get the house we'd originally planned on buying) within the next couple of weeks.  All of these are decisions I'm happy and comfortable with, decisions that were right for our family.

So, does all this mean I'd qualify as an Attachment Parent or not?  I'm guessing that, if that was ever voted on, votes would be divided.  And I don't particularly care.  I might or might not be considered an Attachment Parent, but I'm an attached parent.  Not because of, or in spite of, any of those things, but because of the way I've reacted to and responded to my son over the twenty-one months since his birth - being there for him, responding to his needs and wishes, caring for him, letting him know at every stage just how much I love him.  I don't see any of that as being, specifically, an Attachment Parent.  I see it as being a parent.

Guilt-edged advocacy

In follow-on from the discussion about the NYT article on breastfeeding, Jamie Selkie has been discussing guilt.  Why, she asks, is the guilt card a conversation stopper in discussions about breastfeeding and breastfeeding advocacy?  Is it possible to avoid making anyone feel guilty about this topic?  Should we even be trying to do so?

The short answer to that is: Of course not.  You are not going to be able to please all of the people all of the time.  The G Word should not be an automatic veto of a subject, because that would leave us unable to talk about anything more contentious than the weather.  There is simply no way to discuss hot-button topics, even in the mildest and most unjudgemental of terms, without leaving somebody somewhere feeling guilty.  (Jamie's story about the LLL leader she knows reminded me of my days as a vegetarian - on a number of occasions, I would mention to someone that I was vegetarian and be met with a hasty "Well, I don't eat meat often!  Really!  And when I do it's mostly chicken, and not beef or...". The mere fact that I had decided to avoid meat myself apparently caused some people to mistake me for someone who gave a damn what anybody else did or didn't decide on this particular issue.)

The problem isn't with the existence of guilt in this discussion.  It's with the way it's used.  Although a number of breastfeeding advocates don't seem to make any distinctions here ("What?  You mean we can't nag women about how stupid and dangerous formula-feeding is?  Dammit, we're just not allowed to say anything about breastfeeding these days!"), there's actually a crucial difference between seeing guilt as an occasional unavoidable evil, and seeing it as a deliberate strategy.  Yes, the former should be accepted.  But, as I've already written, I think there are very good reasons to try to avoid the latter; and we should recognise the difference.

(And this is before we even get onto the subject of a particularly unpleasant habit of some of the more militant wing of breastfeeding advocates - using guilt as revenge.  That, I have realised, requires an entire separate post in itself.)

When we raise the subject of breastfeeding, some women, somewhere, are going to feel a pang of guilt about the subject.  As good as it would be to be able to avoid that entirely, the cost of doing so would be to deprive other women of the information and support that they need in order to make fully informed choices.  We should be willing to raise the subject of breastfeeding with mothers-to-be and new mothers, to check that their reasons for choosing not to breastfeed or to supplement aren't based on misinformation, to make sure they know where to get more information if they want it.  But that doesn't mean we have to be critical or tactless or bossy or bitchy about doing so. 

The question we should be asking ourselves about our attempts at promoting breastfeeding is not "Will this make any women feel guilty?", but "Is this constructive rather than destructive?  Is it, overall, likely to be helpful?"

To be continued...

And I like broccoli, too

Homebirth has once again come up as the hot topic du jour, and Jamie (the blogger, not the toddler) has written with her usual eloquence on the subject.  (Do go and read the post if you haven't already.  Apart from anything else, it's the only way you'll ever find out what the title of this post means, since I'm too lazy to explain it.)

If anyone was thinking "Oh, brilliant - now we can get a doctor's opinion on the subject!" then I'm afraid you're going to be disappointed, since I'm not going to weigh in with my own opinions.*  This is because I've already written my comments on the original post, and there simply isn't anything left for me to say on the subject right now that Jamie hasn't already said more articulately and with better references than I could manage.  I'm posting purely for a bit of reminiscing about my own personal decisions on the subject, in response to Jamie's question (the fourth and non-rhetorical question, that is). 

Yes, I would consider and have considered a homebirth, although I didn't have one and probably won't - my son was born in a birthing centre, and Hoped-For Sibling most likely will be as well.  My reasons (for considering homebirth, and for not choosing it) are not going to add much to the philosophy of this debate, as they're entirely practical.  I have a pragmatic approach to birth - for me, it's about getting a baby out of my body with the minimum short- and long-term unpleasantness to me and to the baby.  I'm not out for some kind of deeply spiritual experience in which I explore the core of my essential womanness, but I do have a strong preference for avoiding incisions in my abdomen or genitals, needles in my spine, the possible side-effects of opiates, and other similarly unattractive prospects.  In other words, I did not make my decisions in order to have a good experience, as the Neonatal Doc scornfully comments; I made them in an attempt to avoid bad experiences.

This meant that hospital promptly went to the bottom of the list, for starters.  Avoiding opiates (Pethidine or epidurals) is a pretty effective way of avoiding opiate side-effects, and there is evidence that it may reduce the risk of Caesarean/forceps/vacuum delivery.  Whether I'd be able to deal with an opiate-free labour was something I obviously couldn't know in advance, but I felt it made sense to maximise my chances as much as possible, and one way of doing this was to make it harder for me to get the darned things.  I knew I could transfer to hospital if the pain became too much for me to bear, but I figured that if I was tempted to go for the epidural when the going got tough, it would be less tempting if I knew that it involved getting in an ambulance and going somewhere else rather than just asking.  Besides, hospitals are full of sick people, which means they're full of germs, which didn't strike me as the environment to which I most wanted a brand-new baby exposed.

If there hadn't been a local birthing centre, homebirth would therefore have taken the top slot by default.  However, since there was, that was the option I preferred.  This wasn't so much because I cared at which of the two places the actual birth took place, but because the after-effects of birth were hopefully going to include the need to take care of a newborn.  This was a decidedly alarming prospect.  Personally, I felt a lot more comfortable about the thought of spending the first day or two in the company of people who had more experience of the task than me.  I know that midwives come round to the house to check on you after a homebirth; I know that they'd only be a phone call away if I wanted any advice; but, as a novice parent, I felt a lot easier in myself knowing that I could speak to someone in person just by shuffling into the next room.

For the prospective second time around, I'm still approaching the decision pragmatically, but obviously the factors under consideration are somewhat different.  On the one hand, having had one baby, I have enough of a clue about their care that I feel comfortable with the thought of muddling along between midwife visits.  On the other hand, I also have more experience in giving birth than I did before, and managing one labour has left me with a lot more confidence in my ability to manage another;  I no longer feel that a hospital birth would have me yelling for the painkillers just because they were there.  So neither of those factors is going to play a part in my decision.

The main factor next time around is going to be my husband's utter opposition to the idea of homebirth (which obviously existed last time around as well, but wasn't really an issue then since I preferred the idea of the birthing centre anyway).  I honestly don't care all that much any more where the birth takes place, as long as it can do so with the minimum of hassle, so, unless health factors in the next pregnancy make the decision for me, it is going to boil down largely to whether arguing the homebirth case with my husband is going to be more or less difficult than getting to somewhere other than my home while in labour.  Currently, the latter option looks decidedly better (although if the rumoured closure of the local hospital, which houses the homebirth unit, actually takes place, that decision might start looking considerably different).  Another factor is Jamie (the toddler, not the blogger) - I yelled uncontrollably through the end of my labour, and I think that's something he'd find very frightening if I was within earshot of him this time.  So, all in all, a birthing centre is currently my top choice for next time around as well.

By the way, in case you're interested, last time went spectacularly well.  I had a straightforward, opiate-free, manageable labour with a hasty last-minute journey to the birthing centre when things went faster than I'd expected and a normal, uncomplicated delivery half an hour after that.  I could not have wished for better.  I honestly don't care all that much where my next delivery takes place - if it goes as smoothly as my last one, then it will be an experience that I will be extremely happy with.

*I do, however, want to correct Jamie on one point.  I know I must have had detailed knowledge of the Krebs cycle at one point, because that was the only way anybody ever passed first-year biochemistry.  But if you think that my knowledge can accurately be described in the present tense, then, dude, you're being waaaaay optimistic.

Decisions, decisions

Firstly, thank you to all of you who answered my question about how you chose the way you chose to bring children into your family.  It was fascinating reading... all of it.  I love being privileged with these sorts of glimpses into people's minds and hearts. 

As promised, although belatedly, this is my attempt at answering the same question - in my case, an explanation of why I chose to give birth rather than adopt.  Writing it out like this probably makes it look as though I thought it out at the time in considerably more detail than, in fact, I actually did - I knew from the start that it was the right choice for us, and, since it's the default choice in this society, it wasn't one I needed to analyse particularly at the time.  But there were reasons behind it that I can clarify when I think about it, and this, for what it's worth, is what they were. 

Three main ones, I'd say.  The first was laziness.  I wasn't naive enough to assume that getting pregnant actually would be the easy way to do things, but I did recognise that if things went as they were supposed to and as they did, after all, go for the majority of people, then doing things naturally would be a lot easier than adoption.  I did spend quite a lot of time thinking about what Plan B would be if I had fertility problems, and, although it was very much a 'need more information'at that stage, I did feel that adoption sounded considerably more positive than fertility treatment.  But getting pregnant the conventional way sounded a darned sight easier than adoption, and I figured I wasn't going to subject myself to filling out twenty million forms and answering a bunch of questions from strangers about my supposed parenting skills without at least checking out whether having sex might be a feasible alternative option.

The second was curiosity.  I have always been completely fascinated by pregnancy and birth.  I read extensively on the topics as a child.  I knew more about natural childbirth by the age of ten than most people bother learning in their lives.  (Yes, I am a total geek and weird with it.  Sue me.)  I really wanted to find out what these experiences would be like for me.

The trade-off of that one, of course, is that I lost out on the experiences that come with adoption.  Unless I make a different decision with subsequent children, I will never know what it feels like to open up a packet and see your daughter's face for the first time, to travel half-way round the world and toss and turn in a hotel room knowing you will meet your child the next day, to file into a room with a crowd of other imminent parents-to-be and wait with pounding heart for your name to be called and your child to be handed to you, to get to know a child who has had months or years to develop as a person already.  And the thought of these experiences fascinates me as well.  It's why I'm so fascinated with adoption blogs - living vicariously. 

Still, I'm glad I made the choice I did this time around.  Pregnancy and birth weren't just experiences that happened to me - they were things my body did.  I was fascinated to see how my own body went about the reproduction business.  I know now that so-called morning sickness manifests itself in me as persistent low-level queasiness rather than the more traditional form, that I not only don't get cravings but get the exact reverse and develop complete aversions to a variety of foods (fish was the worst, but there were others), that I labour with unexpectedly brisk and efficient contractions, that I don't feel a let-down sensation when nursing.  It's not that any of this is particularly important or earth-shattering - just that it's part of me, and I'm glad to know about it and have those memories, those stories.

The third reason was that (warning: we are now entering the realm of irrationality) I somehow felt that giving birth didn't impose the same standards of obligation on me as adopting would.  One of the hard things for potential adoptive parents is the thought of having their lives and supposed parenting abilities scrutinised by strangers who get the right to decide whether or not you'll make a fit parent, and I found this just as daunting as anyone else does.  But I also recognised on some level - although it was not something I would have articulated to myself at the time - that the reason I would find it quite so difficult was because they are the representatives of the future child to whom you will really have to justify your parenting some day.  Of course, this is true however that child enters your family.  However, if a child owes me his existence, I could feel I was starting off with a few points in the credit column.  Not that I'm one of those ghastly clichés who expect permanent gratitude for having Brought You Into This World (though, in case Jamie ever reads this, I shall point out that I wouldn't actively object to that) - it just made me feel more at ease about the possibility knowledge that I'd get things wrong plenty of times along the way.  As the saying goes; you give your kids life, so if you then kill 'em, all you've done is break even.

With an adopted child, I wouldn't be able to feel that way.  I'd be taking a little person who already existed perfectly well without me, thankyouverymuch, and undertaking to give him or her a life that was at least as good as what the alternative might have been.  Granted, that might not be so difficult if the alternative was a foster home or an institution, but it was still more of an undertaking than if the alternative was non-existence - and I'd also be forever aware of the possibility that another, superior, set of parents might have taken that child if I hadn't been there.  Stepping into the life of an existing child in this way somehow seemed to me to imply a particular obligation to get it right.  Being Good Enough Mum wouldn't be good enough, so to speak.  I would feel obliged to be Superlative Mum, and I felt a little uneasy about that kind of pressure.

In my last post, I mentioned that niggle of doubt about whether I'd love a child without the postpartum hormones doing the job for me, and I wondered whether I should include that as Reason 4 here.  But insofar as it even was a reason (and I do want to stress that I'm talking niggle of doubt here, not crisis of confidence - rationally, I believe I would bond with any child I mothered the same way as I did in fact bond with Jamie, through the day-to-day process of taking care of that child and seeing what an amazing little person he or she was), I'd say it was a part of Reason 3 rather than a separate reason. After all, it would be the child who would ultimately be hurt.

We'll be making the same choice for our second baby, although it's a little harder to define the reasons why - after all, Reason 3 doesn't sound that logical to me any more, especially not now I've proved I have at least some passable mothering skills, and Reason 2 is, as I pointed out, a double-edged sword.  Reason 1 is still true, and may even be more so - I've heard that in the UK it can be difficult to get approved for adoption when you have a bio-child.  So, logically, it makes more sense to try the DIY option first.

But it goes deeper than that.  It's like choosing to go back to the place where you had your dream holiday before.  Yes, the world is full of other places that you might never get a chance to go to - yes, going back to this place means that you could be missing out on a different dream holiday somewhere else.  But sometimes you don't want to seek out a different dream holiday.  You want to go back to the place that's comfortable in its familiarity, redolent with rich memories, yet so wondrous that you know you won't be bored, that there will be plenty of different details this time around even if it's the same place.  I'm choosing to at least try to have my second child through pregnancy because I'm happy with the choice I made before, and I'd like the chance to make the same choice again.

I say 'try', because I do know that that choice is never a given, that I might find that door won't open for me a second time round.  My thoughts on what I would do if it turns out the clock has run out on my fertility would fill another entire post, and this one's already far too long.  The bottom line?  I'd opt for adoption rather than fertility treatment.  And I know that if that happens, there will be a part of me that will grieve the loss of the chance to be pregnant and give birth and nurse a child again, and a part of me that backs away in terror and says, no, I can't do all the things involved in adopting a child, I don't have what it takes... and a part of me that would leap up and down cheering at the thought that I'd have an excuse to adopt, to have that experience as well.

Some more on adopting vs. not adopting

As I've mentioned before, I love getting comments.  I particularly love getting thoughtful, articulate, pleasantly worded comments.  And I really love getting comments that thoughtfully, articulately, and pleasantly disagree with me, because then I have something interesting to think about. 

So, as you can imagine, I was exceedingly pleased to get Brooklynmama's comments.  And, to update this (I started this post last Sunday and saved it part way through) I was also exceedingly pleased to get Jo's and Susan's comments.  I feel I ought to acknowledge them, and I'm finding this discussion highly interesting, but whether I can add anything remotely profound and significant to what has already been said is another matter.

I completely agree that society in general and individuals in particular have a bias against adoption.  I do also think that a personal preference for enlarging your family through birth rather than adoption isn't necessarily anything to do with bias or prejudice.  But B'mama raised the question of where preference stops and prejudice begins.  I really don't have any answer to that, probably because there just isn't one.  When someone's feelings on the subject go beyond "I'd rather give birth than adopt, if I can" and turn into "Even if I can't, I'd rather remain childless than adopt", is that necessarily prejudice?  Does it depend on the reasons why they're saying it?  Somehow, nuances get lost in hypothetical situations.

I do still think (to go back to B'mama's original post) that a belief that you, personally, could not love an adopted child does not necessarily equate to a belief that other families couldn't love an adopted child.  One belief is about your own personal capacities, the other is about other people's capacities.  So, I agree that "I couldn't love an adopted child" might very well be a prejudiced statement, but I still don't think it necessarily equates to "And I don't believe you really love yours."

B'mama asked why someone wouldn't believe they could love an adopted child.  I think Susan pinpointed the answer nicely - because people worry, in general terms, that they won't love their children.  I'm going to try to expound on this, but I'm not sure I can do it without potentially offending anyone, so please bear with me until I've finished explaining myself and then feel free to administer a swift kick if you feel I need it. 

As much as you may love children in the abstract, the kind of fierce individual personal love that you need to carry you through all those years of day-to-day care is a different matter, and it's one of those things like romantic love or sexual desire - you just can't really know what it's going to feel like until it happens.  How does someone know - really know - in advance that they'll be capable of that kind of love?  Now, of course, this is true however you go about bringing a child into your family, but (and this is where I know I'm treading on a potential minefield, and I do hope this comes out expressing what I want it to) at least with giving birth you have the fallback of biology.  As someone who chose to give birth rather than adopt, I know that I found it very reassuring to feel that when my baby arrived in my life, a rush of hormones fine-tuned over millions of years of evolution to optimise the bonding process would arrive simultaneously.  I didn't have to worry about whether I had the kind of character necessary to come up with that kind of love, because I knew my glands would do it if I didn't.  Logically, I believe that I'd love an adopted child (and I have no doubt at all that there are people who do), but emotionally, I felt better for knowing there was that backup.  This wasn't really a major reason why I chose to give birth rather than adopt, but I can't hand-on-heart say that it wasn't in there somewhere.  I would say that's self-doubt rather than prejudice.  But am I wrong there?

Anyway - the baby is due to wake up any minute, so here's where I want to widen this discussion out a bit, and also call for some more audience participation.  At the end of my last post, I talked about hearing people on the subject of how they made a particular life choice.  That's what I want to do here.  I know Brooklynmama's already held a similar discussion on her blog a while back, and I found that fascinating reading, but that was specifically for adoptive parents and I'd like to hear from anyone on this topic. 

What led you to make the decisions you made about children?  How did you make the decision to give birth or to adopt, to adopt from one country rather than another, or, for that matter, to have children at all?

I'll write my own answer in a subsequent post when I get time (I really do have to go get the baby if I want to have any hope of him sleeping at a halfway decent hour tonight, and since we're away this weekend, I don't know quite when I'll get back to this - but I will.)  Meanwhile, if anyone feels like sharing (in the comments section here or on their own blogs), I would be really interested to read what you have to say.  And keep any other comments coming as well - I love this discussion.  Trackback rocks.