When 7-year-old Brianna asked to be present during the birth of her sibling, her mother, Trudye Weisberg, thought it over long and hard. "I was very reluctant to do it," Mrs. Weisberg says. "I did have concerns."
But after serious considerations and discussions with health professionals, the Weisbergs decided that giving birth should be a family event.
Some parents, like the Weisbergs, say having their children present when the mother gives birth provides a bonding experience that strengthens family relationships. Others, however, think it would be too upsetting for children to view the highly emotional and physically traumatic delivery process.
Some area hospitals, while not advocating either position officially, are at least providing parents and children the choice of sibling-witnessed births.
Allowing children into hospital birth rooms is a natural progression from the days when people had children at home, says Susan Will, a clinical nurse. Ms. Will, who works at Sinai Hospital, holds classes for children who want to be present when their moms give birth.
Other Baltimore-area hospitals allow children in the birth room and have guidelines governing their inclusion, but Sinai is one of the few that require that children attend a class before witnessing the event.
At Sinai, children must be at least 4 years old to participate in the individualized classes. Ms. Will emphasizes that giving birth is hard work, and she uses graphic pictures and a "pregnant" doll that leave nothing to the imagination.
"We talk about grunting, groaning and sweating. We talk about how this is a work process," she says, adding that she uses the analogy of a weightlifter who strains under pressure to explain that part of the birth procedure. And Ms. Will sticks two fingers in her mouth, stretching it, explaining how the skin might split if stretched too far. Children learn that after the baby's birth, the placenta comes out. And Ms. Will warns children: "You will not see the Gerber baby come out."
Ms. Will also recommends the family watch a birth video together.
In addition to the class, Sinai insists children and parents meet other requirements before birth time: a "support person" for every child present must be in the room, and the family is requested to do library research on its own. The child must accompany the mother on an appointment to meet the doctor and tour the ward and the room where the baby will be delivered.
Also, the mother must be comfortable with having her other children in the room, and the child can opt out of the experience at any time. If there are any birthing complications, the children must leave the room. "Sometimes if the child seems too naive or too dependent on mother, I will suggest that the child should not go through it," says Ms. Will. "But ultimately, I will leave it up to the parent," Ms. Will says.
Although the ultimate decision is left up to the parents, Ms. Will says, "the child really should initiate this."
"Some parents are surprised that we talk over the whole process. But you have to show them everything and tell them everything," she says. "You do not want them to be surprised."
During the birth, children react in different ways. Some children hang in a corner of the room and kind of peek at the process, "while others are right up in front with their eyes wide open," Ms. Will says.
Most parents who request having their other children present during birth do express reservations about it. And they should, Ms. Will says. "I tell them there should be some ambivalence and some concern. If not, I would think something is wrong," she says.
Andi Winkle is a nurse who's expecting any day now. Her two children will witness the birth of their sibling. "We are doing this so they would feel more included," Mrs. Winkle says. "Especially because this is a second marriage for me. We didn't want them to feel left out."
However, she is worried about how the children, Stephanie, 11, and Michael, 6, will react. "Yes, it's a concern," she says. "So we are not exactly sure if they will stay through the whole thing. We'll play it by ear."
Both children share their mothers' apprehension about seeing the birth of their sibling. "I'm not sure I will be there the whole time," says Stephanie, who knows it could be a rough emotional ride. "This is a part of us," she adds, explaining why she wants to be included.
Mrs. Weisberg, the mother whose oldest child already saw her sister's birth, understands the ambivalent feelings.
She worried about how Brianna would react to seeing her in pain and bleeding. "But she really wanted to be a part of it," Mrs. Weisberg says. For help in making the decision, the mother turned to her pediatrician, who thought it would be fine. But her obstetrician wasn't so sure. "He suggested that I call Susan Will," Mrs. Weisberg says.
After attending Ms. Will's class, Brianna was prepared -- and grateful. "She thanked me for letting her be a part of it and was so happy, she began crying," Mrs. Weisberg says. "Then we both were crying. It was one of those magical moments. For this child, it would probably have done her more damage not to have been there."
"I wanted to do it," Brianna says. "I wanted to see my sister being born."
Long-term effects unknown
Mrs. Weisberg is happy her daughter was there but also is concerned about how the experience will affect Brianna in the future. No research has been done to determine any long-term effects on children who witness their siblings' birth.
And some experts feel the potential risks outweigh the potential benefits. "It's such a double-pronged thing," says Gail Rosenberg, a clinical child psychologist at Sheppard and Enoch Pratt Hospital.
"The benefit would be to provide a strong family bond. Another potential benefit would be that the child would feel less threatened and competitive with the new sibling. But there is no way to assess the long-term effect," Dr. Rosenberg says.
"Also, no matter how well prepared, nothing can prepare a child for seeing her mother in overwhelming pain," the psychologist says. "My feelings are that the child will witness this as a trauma. That could be pretty overwhelming."
And because childbirth and sexuality are intertwined, she says, how the baby got there in the first place is an issue sure to come up.
"Sex education should be geared to the readiness of the child," Dr. Rosenberg says.
For Dr. Rosenberg, letting children witness the birth process is a disturbing sign of the times.
Certain things are better left done in privacy, the doctor says. "We go to the bathroom alone. We have sex without the children there," she says. "We are beginning to believe that boundaries are considered to be wrong. But boundaries are appropriate. Boundaries help to define a child. My personal opinion is that there would be more risks than potential benefits, at least for children up to age 12 or 13."
However, Doug Teti, an associate professor at the University of Maryland Baltimore County and a developmental psychologist, has a different view. "My hunch is if the child is witnessing the birth in a warm family environment, it could be a positive experience.
"It is much better than leaving the child at home with a baby sitter," says Dr. Teti, who works with young children.
And children often have negative reactions when a new sibling is born, he says. "The more the family involves the child in the caring, and even being there at the birth, would be a good thing."
If the mother is having a truly difficult time with pain, however, he says the child could be moved to a nearby room.
Parents are not flooding hospitals with requests to allow their young ones to be present when their siblings are born. "The demand is not that great," Ms. Will says. "We may have two or three families in one month and then go three or four months without one."
And listen to Doug Wallis, the father of two children: "People are going overboard with it. They are making it too much of a sideshow. I don't think it is necessary for children to see it."
Shawn Taylor, witness to the birth of two of his three kids, explains it this way: "It is a miracle, but it ain't the prettiest of sights!"
"I take my hat off to all women who go through that!" says Timothy White, a father of three. "But even though you could explain it to a kid, it would still be scary."
But Ms. Will, the nurse who conducts classes for children who witness births, believes other things are more traumatizing to a child.
"I am amazed at what people let their children see on television but that they won't let them see this," Ms. Will says. "Birth is an intense but natural life experience."