A Mixed Bundle of Joy

My first encounter with a baby occurred in a public restroom when I was 8 years old. I was engaged in that time-honored female tradition of waiting in a long line. Suddenly a laminate-covered, hinged door flung open and the middle-aged woman ahead of me stopped, hopped from one foot to the other, turned my way, and  thrust a tiny child at me.
“Hold her?”
It was more of a demand than a question. Before I could answer she dropped the bundle into my arms and rushed into the stall. There I stood, peering down at a very small creature, a baby who, with its bald head, glassy eyes and wrinkles, more resembled an old man. Or a fish. Or an alien.
Recently, I visited a friend who was relegated to her house, caring for her newborn. Within minutes she was off to the bathroom and history repeated itself.  Me. A baby.
Some might find it shocking to learn that not all women are innately comfortable with babies. Here’s another shocker: Some women – and I might be among them – don’t even want to have children.
 I was all too familiar with the social taboos of deciding to live child-free. (In fact, at least five women I know who have chosen not to have children and are happy with their decision refused to speak on the record for this article. Each one prefaced their decision with “I love kids but…” as if to admit otherwise was some punishable crime.)
But besides the social consequences of not having children, are there physical consequences as well?  
It turns out that when it comes to health, the risks and benefits of not having kids are a mixed bag.
Leo B. Twiggs, chair of the University of Miami Miller School of Medicine department of obstetrics and gynecology, says women should make the decision based on their core values rather than health issues. “If all of the sudden a woman says she doesn’t want saggy breasts and if that is a core value,” Twiggs says, “then she has to decide what to do with her life.”
But even Twiggs acknowledges that a woman’s propensity for childbearing (or lack thereof) can have health consequences.
On the positive side for women who don’t have children, recent studies show that, overall, women who don’t have children are healthier than those who do. A study at Ohio State University  found that 81 percent of childless women were in “excellent to good” health, compared with 68 percent of women who had been pregnant.
And being childless also seems to help mental health, since childless women don’t have the same worries as mothers. In general, it may be risky to have kids if a woman suffers from mental disorders, such as depression or schizophrenia.
But depression is so common, says psychiatrist Dr. Eva Ritvo, vice chair for professional and community development at the UM Miller School of Medicine, that it should not be a reason for avoiding pregnancy.
Dr. Elizabeth Etkin-Kramer, a gynecologist at Mt. Sinai Medical Center in Miami Beach, says that while making the decision to become pregnant is multi-factorial, there are instances when it is better for a woman’s health to skip getting pregnant. One example: if a woman has a serious health condition, such as cardiac malformations (congenital heart disease).  
Etkin-Kramer says studies show that women who have children are more prone to pelvic relaxation than women who do not have babies, regardless of the route of delivery, because of tissue changes. And diseases like asthma and depression may worsen for the duration of a pregnancy.
The biggest health impact seems to involve cancer. When a woman becomes pregnant, hormones wash over her body, which, combined with other physical changes, provide some long-term guards against certain cancers.
Twiggs says women who do not have children run a slightly higher risk of contracting breast cancer. Breastfeeding causes a change in the hormone environment of the breast, leading to less estrogen. If a woman breastfeeds her infant, the risk of breast cancer decreases by 4.3 percent for every 12 months of breastfeeding, with an additional decrease of 7 percent for each birth thereafter. And early-aged pregnancies reduce breast-cancer risk.
The risk of ovarian cancer doubles for women who don’t have children. One belief is that ovulation increases the risk; and since women don’t ovulate while pregnant, the risk goes down. The chance of endometrial cancer also is higher for non-childbearing women, probably because the higher levels of progesterone during pregnancy help thin the lining of the uterus, reducing any buildup caused by estrogen.
Still, the biggest impact of going childless seems to be emotional. In an ideal world, the goal should be to make an informed decision when it comes to such an important lifestyle choice.
Instead many women would rather avoid the decision altogether. Etkin-Kramer says she is seeing an increased number of women who stop taking contraception to let fate decide whether they should have kids.
“I used to see women who, when they chose to get pregnant, it was more of a planned decision,” Etkin-Kramer says. “More young women – in their 20s to mid 30s – and more single women are rolling the dice.”
Yet others are thinking it through very carefully. Just ask 24-year-old Melissa Cantor, who is getting married and undecided about having kids. She is used to getting grief when she states her opinion.  “People tell me I’ll change my mind,” says Cantor.
“People acknowledge the selfless aspect of having children, but for a lot of people who have kids, I think the impulse is a selfish one,” she says. “I hear my friends say, ‘It’ll be a mix of me and my husband,’ and so it’s all about them.”
She finds people do not take her seriously and question her motives, making her feel as if “almost everyone is on the other side.”
Surrounding yourself with people who support your decision and validate your opinions is one way to avoid being stigmatized or discounted, Ritvo says. And while it may be tempting for some women to not face their decision head-on, she advises against such an approach.
“Having children is a huge commitment and should be done only if the woman wants to,” Ritvo says, “not to conform or please someone else. It is a day-in, day-out job, so it should be entered into very thoughtfully.”
Cantor, for one, remains unfazed, even as her father begs her for a grandchild. “If people have a problem with my decision that’s their problem,” Cantor says. “If anything I think [people who have children] should think about [their decision] more.”