It is my observation (and that of many of the nurses) that many babies feed
worse after a circ.  (Novel concept!)  There seems to be less of a negative
effect if the baby is alert and vigorous and has had several good nursings.  On
the other hand, if baby has not latched on or has just begun to make attempts at
feeding when he gets circ'd, we can just about kiss the next couple of days
goodbye.  Therefore, if the baby isn't feeding well our standard practice is to
try to talk the doc into doing it later--either later in the hospital stay if
we've got any "later" or as an outpatient or in the office.  Many of the family
practice docs can be talked into this, but our peds have been coming in after
we've explained all the reasons why the parents might like to wait and tell them
"it doesn't make any difference" and the parents say ok and then regret it.
This is a major problem since our circ rate is somewhere around 95% and our
obstetric intervention rate is high, too.  Almost all the docs do use a local
for the circ.

At any rate, one of the peds is wanting documentation that there is increased
drowsiness and/or poorer breastfeeding after a circ.  Anybody got anything?
We've been basing our recommendations on observation and common sense, but I
have a feeling this is heading toward a battle.  Anything you can suggest from
the medical literature would be welcome.  Thanks!

Becky Krumwiede, RN, IBCLC, Wisconsin, mother of an intact son
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