There was discussion last month about breastfeeding and circumcision.  

If your hospital has a protocol to address this issue, will you please share it 
with our lactnet community?  It is helpful for those of us in hospitals to point 
to what other facilities are doing.

My hospital has recently begun using the following check list.  I understand 
there was a great deal of "discussion" among the physician staff before the 
final, watered-down version was approved.  However, I am thankful for 
anything to draw attention to baby.  

Before circumcision can be performed, the following cleck list is to be 
completed.  Each item is noted with Date/Time of Assessment and Initials of 
RN assessing.

Circumcision Checklist
Criteria to Meet

1.  Healthy, 37-42 week gestation
2.  Infant is at least 18 hours of age
3.  Initial physical exam completed by pediatrician
4.  No pending lab test to r/o sepsis
5.  Inant stable X 4 hours
          HR less than 160
          Resp less than 60
          Temp 97.6 - 99.4 F in open crib
          Blood glucose protocol successfully completed (if indicated)
6.  Weight loss less than or equal to 7%
7.  Voided X 1
8.  Stooled X 1
9.  Circumcision consent signed
10. Procedure checklist completed

**If any of above criteria not met, please consult with pediatrician for order 
to circumcise.


Things are better but life is still rough for the little ones.  I am hopeful that the 
Academy of Breastfeeding Medicine or the Center for Infant and Young Child 
Feeding at UNC-CH will have some formal statement. 

This exquisitely painful procedure often derails breastfeeding and causes 
trouble and expense for parents trying to salvage it.  Sometimes there is an 
additional day in the hospital due to feeding related difficulties.....and those 
difficulties seem clearly linked to the circumcision to me.

Where is the evidence showing that the procedure does not interfere with 
breastfeeding?  Where is the evidence showing that feeding (shoving) a bottle 
of formula to an infant who is not eating post-circ is risk free?

Thank you for any documentation that you can share.

Pardee Henderson Hinson, MPH, IBCLC, CHTP

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