Tonya

Thanks for your bibliography on circumcision and breastfeeding.
Here's what I observed in 15+ years of work as a maternity nurse and lactation
consultant in a hospital in Eastern Pennsylvania, where almost all baby boys
were circumcised before leaving the hospital.  We had a central nursery, even
though we CLAIMED to be running a home-like, family-friendly maternity unit.

Circs were done at the OB's convenience.  One guy used to do them in the
delivery room---a truly appalling way to welcome a new person into the world.
(He did cease this routine about 10 years ago.)  Most often the circ done was
on the morning of discharge.

The problem for me was that I worked day shift as an LC.  That meant the for
moms I had not yet seen or for moms who needed follow-up after having
difficulty on earlier days, the circumcision put a major crimp in my
effectiveness.  First, the baby would be required to fast before the
circ---and if the doctor was delayed, the nurses just made the baby wait, even
if he was screaming.  So we couldn't work on breastfeeding then.
Second, the baby would be kept in the nursery while waiting for the doctor to
show up; this was to save the nurses the trouble of fetching him from his
mom's room.  This meant that no one was even holding or rocking the baby while
he screamed.  They might give him a pacifier….that's a big help (sarcasm)!

Third, no anesthesia was used.  The babies often acted "shocked" afterwards.
By that I mean they just "shut down" for several hours, and you couldn't get
them to do anything.  The typical scenario was to let the family go home after
the baby had been observed for two hours post-circ.  As long as he wasn't
bleeding, they could go.  Whether the baby was breastfeeding effectively was
not considered an issue.  Certainly not for the OB, who did the circ---after
all, the baby wasn't his patient.

It was rare for a doc to put off the circ because the baby wasn't nursing well
yet.  Occasionally I could get them to agree if I caught them early and pled
with them, and if they could work it into their day to come back at a later
time.  I wonder, though, whether the problem was partly an issue of "doing
your share of the work."  The person in the practice who made morning rounds
at the hospital was supposed to get the circs done.  So if he or she put one
off, it ended up on someone else's "To Do" list.  That might have been
regarded as "bad form."

I remember one female OB resident we had who absolutely refused to do circs at
all.  She didn't believe the procedure had any basis in good medical or
health-care practice.  She got away with this, but her colleagues were very
snide and catty about the work she was getting out of because of her stance.

I also remember ONE young African-American mom who insisted that she was
waiting until the eighth day for her son's circ because that was what the Jews
did so it must be Bible-based.  She was a serious Christian believer.  She was
a clinic mom, and she got her way by just being firm.  I had an in-hospital
breastfeeding center at the time, so I invited her to sit in my easy chair and
nurse her baby while they waited the two hours of observation time before she
could take him home.  She was great---but she was the exception!  (For her
next baby, she went to another hospital where she could have a midwife.  This
was truly an empowered young woman.  Of course, I think that breastfeeding had
something to do with that empowerment!)

Our most gentle and enlightened OB had made several changes in the routine
circ procedure which appeared to decrease its harmful effects.  I can't
substantiate this claim statistically….it just FELT better to work with his
babies.  1) He did not require long fasting beforehand if the baby was
breastfed---after all, how much does a 2-day-old baby "get" at a feed.  10 cc?
2) He did not use a restraint board.  Instead a nurse held the baby's legs
gently while the baby lay in his crib.  3) He had sought out training in the
use of the Schullsen (sp?) clamp which is used by the moyels, Jewish ritual
circumcisers.  (In fact, the inventor of the clamp is from
Philadelphia---we're a suburb.)  It's also referred to as the Mogen clamp or
the "guillotine."  The circ procedure takes about 30 seconds this way, which
seems to lessen the emotional trauma for the baby.  After all, for lots of the
kids, it's being tied to the restraining board that starts them crying, and
I've seen them spend several minutes screaming just waiting for the doctor to
get started.

One final comment: I wish I had a dollar for every time an OB said to me, "I
really hate doing circs.  I try to talk the mothers out of it, but they
insist."  I don't know whether they said this because they knew what my
opinions were, or because they really believed themselves.  It just seems
hypocritical to me.  If it's so bad, why do it?  You're getting paid for this,
right?  You could refuse to do it, as the one resident did.  I think it would
really impress a mother if her OB told her, "I feel there's no medical
justification for this procedure, so I don't do it."  And if she heard this
from three or four different doctors….?

I have no data or impressions on long-term sequelae.

Thanks for asking.  I hope these observations from the "front lines" will be
helpful.