Some Practical Considerations on Having a Family

Plans Before Marriage

During courtship the young couple who are planning to marry are provided with a chance to get to know one another and discuss in much intimate detail their hopes and desires, their likes and dislikes-in fact their general attitude to life. This gives them an opportunity, if they so wish, to change their minds before taking the final step of marriage. In this exchange of confidences, the subject of having a family is most important for it sets the shape of their whole future. The great majority want to have a family.

Hereditary Factors

In a few cases some doubt may arise about the desirability of having children because of a physical defect in one of the potential parents or in his or her family. In such cases the young couple should consult the family doctor. Epilepsy is a disorder which seems to be inherited in some families and it is advisable for persons from such a family not to have children.

Where epilepsy occurs as a solitary instance in a family, the affected person married to a normal person is no more likely to produce an epileptic child than two normal people. A person with muscular dystrophy or a related muscular disorder carries within himself (or herself) a factor causing defective muscular development.

Al-though this factor is not a dominant one, nor is it very common, the mating of two people each with such a factor greatly increases the likelihood of their producing an infant with muscular dystrophy.

Mental disorders and mental deficiency vary greatly in their causative factors. In manic-depressive psychoses and in schizo-phrenia, the disorder occurs ten times more frequently in families with the trait than in ordinary families.

In the case of Down's syndrome (mongolism) there seems, as far as recent investigations are concerned, to be some familial defect in the genetic make-up, but how it arises is not yet clear.

It is certainly true, however, that the older a woman becomes, so the risk of her producing a mongol child increases. This is due to a defect in the eggs which are released from the ovaries in later years.

Tuberculosis is not inherited, but the baby of a mother with active disease is in danger of developing TB in the neo-natal period.

Any woman with a history of TB or who is suspected of having TB should have a chest X-ray performed either before pregnancy is considered, or as early as possible in the pregnancy. Similarly, if a woman has syphilis or gonorrhoea (VD), every step should be taken to diagnose it; syphilis, in particular, may cause the death of the foetus, or a still-birth, if untreated.

Deformities such as harelip and cleft palate, spina bifida, and clubfoot are due to malformations during the development of the infant and the chances of one of these anomalies happening are small. However, where one or both parents suffer from harelip or cleft palate, there is an increased incidence of the condition in their children.

Conditions such as anencephaly, hydrocephaly, spina bifida, and meningocele are not hereditary but where a woman has produced two such affected children the chances are high that any further children will be similarly affected.

There are now, in most centres, Genetic Counselling Units which will be able to pre-dict with some degree of accuracy the chances of a particular defect or disease being passed on to the children. Consultation can be arranged through the family doctor.

Blood group differences in the two potential parents are no bar to the production of healthy children now that medical science can cope with the occasional complication due to an infant having a Rhesus factor different from that of the mother.

If one of an engaged couple knows that there is no likelihood of his (or her) being able to have a child, or that it is inadvisable because of the risk of passing on some defect, it is wiser that this should be made known to the other before marriage, and perhaps discussed with the family doctor, who may advise on adopting a child.

Budgeting for Baby

In general, the longer the engagement, the more ready are the couple to set up house, home and family once they are married. Again, if there is little money, the young woman may remain at work for a while to help set up the home, deferring the question of starting a family until a certain sum has been earned.

It is much better for the future harmony of the marriage that these items are planned in outline early rather than that they should be left to chance.

Career Versus Baby

There are many women who have special gifts and training and who feel that they should make use of their capacities outside the home circle.

For career women who marry and have children, too, the fitting in of the dual role may mean many sacrifices, and careful planning of both work and family routines.

There is now good evidence to indicate that even very young babies, from three months onwards, are much more aware of their surroundings than was previously thought.

A baby requires a single stable figure, usually the mother, during the all-important first five years. Where a nurse or permanent nanny is employed, there will inevitably arise a confusion in the young child as to who is the dominant figure.

This is particularly important when considering separation of the child and mother for even a few days, e.g. when the mother goes into hospital to have other children. Such separations are unavoidable, and the best place for the child is in his own home, surrounded by familiar objects, and looked after by someone with whom he is familiar, preferably the father.

Sending very young children away to friends, relatives, or nurseries is to be avoided if at all possible.

Many young mothers today, realising how important the first four or five years are to a small child, forgo their careers for those years and go back to their professions or special work once the child reaches school age.

Part-time Earning

For mothers who wish to earn a little extra money or be partly occupied with a job out of the home, the difficulty is not so intense, though planning for a first-class mother-substitute is equally important.

Today, once the children are at school, part-time earning is increasingly a way out for innumerable women-in some cases they need extra money to supplement a husband's small wage, in others they seek adult companionship or the interesting stimulus that the work may provide. Fortunately, more and more employers in shops, factories and offices are revising their work hours to suit part-time married women with families.

Fertility Problems

Not every young couple who sets up home with the intent to have a family is able to produce babies. There are many possible reasons for this inability to have children and, if the years go by and children do not come, the obvious course is to seek medical opinion and examination.

In the early months of married life it may be just shyness, or ignorance of how the body works and is formed, which leads to in-adequate intercourse. This may be due to frigidity on the part of the wife, or impotence in the husband.

If marital relations are satisfactory but no child has arrived, intercourse at the wife's high fertility times may be utilised.

Fig. indicates a period of high fertility in a woman five days before, during ovulation day, and three days after it. The maximum fertility, as far as is known, is on the day prior to ovulation and the ovulation day itself (14 days before the next period in a 28-day cycle). Intercourse on those two days is more likely to result in pregnancy than at any other time.

Fitness to Conceive

Only about 2 per cent of women who seek medical advice about their infertility, have a medical condition which would make pregnancy inadvisable.

Pulmonary tuberculosis, for instance, should be cured before a woman has a baby because she runs a serious risk of high blood pressure and an extension of the disease after child-birth; pregnancy should not be undertaken by women with chronic kidney disease.

Infertility due to abnormalities in structure of the child-producing organs poses a very different problem. These anomalies can only be assessed by careful medical examination of either or both prospective parents. Once diagnosed, the condition may be corrected by a small operation.

Families in Early and Late Marriages

The tendency for earlier marriage, the couple still being in their teens, poses a problem, especially for those with smaller incomes, of having a baby or a family with-out adequate housing or household goods to accommodate the new family group.

Living with In-Laws

If economic circumstances make it necessary for a young couple to share a house with parents, the first essential is to come to an agreement at the outset for each pair largely to lead their own private or independent lives. The young couple must have at least one room in which they can be completely private and invite their friends (or the parents) when they wish. If this separation is firmly established at the beginning much heartache and bitterness is saved later on. It will not be long before the young people consider the question of having a baby.

It is a great anxiety to bring up children decently in shared houses. The poor infant is usually unduly checked and scolded so as to prevent his disturbing the rest of the house-hold. The young mother is increasingly fearful that the baby may be resented if he cries and that her ideas of child care are being well criticised. Great forbearance and much genuine affection between the old and the young are necessary for such an arrangement.

Late Marriages

For mature people who marry later in life the matter of having a child or family, before the wife's capacity for child-bearing has become reduced, is often a point of serious concern. Much depends upon the age of the woman. Fertility in women decreases in many cases after the age of twenty-eight although there are the exceptional women who bear two or three children after marrying later than forty years of age.

If a family is desired and a pregnancy is not begun in the first year of marriage do not delay seeking medical help and advice. Some-times the stimulus of sex-hormone tablets may be enough to put the matter right or the doctor may advise dilatation of the passages or other necessary procedures. The ovulation days of maximum fertility should be chosen for intercourse.

Adoption

When, after medical consultation, a couple know that they will not be able or are unlikely to have a child of their own, they may decide to complete their home life by adopting a child. It is always best to tell an adopted child as soon as possible that he is adopted, preferably before he starts school. Experience has shown that this is the wisest course; it prevents the child learning about his adoption from out-side sources or when he is much older-either of which may prove a disturbing shock. If he grows up knowing he was `specially chosen' by the parents and is loved none the less it should not affect his sense of emotional security.

Source :
Family Physician.

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