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Subject:
From:
"Tonya M. Kelly" <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 8 Mar 1998 19:57:31 -0600
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TEXT/PLAIN
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        Hello, my name is Tonya Kelly and I am a junior in the nursing
program at the University of North Dakota.  I would first like to start
off by saying thank you all for allowing students to participate in this
list-serve because I have found it interesting and informative to hear
what is actually being done in the clinical situation.  What nurses in
the field have experienced in real situations is valuable information
that can't be found in our textbooks.
        I recently had a sister-in-law who delivered a baby boy in
Kansas.  She had decided prior to the birth that she was going to breast
feed her baby.  Her obstetrician told her that they would do the
circumcision after the baby was two weeks old.  He told her that the
reason for the postponement was because when a baby is breast feeding
after the circumcision, there could be decreased bonding, difficulty in
latch, and lack of interest by the baby.  I found this situation
interesting because this is not what I have been seeing in the clinical
setting.  At our hospital the babies are circumcisied before being
discharged from the hospital.
        The reasoning that they gave her seemed to make sense (I was also
impressed that the doctors in that area were so pro-brest feeding). I
found limited information about the subject.  A study conducted by
Howard, Howard, & Weitzman (1994) titled Acetaminophen Analgesia in
Neonatal Circumcision: The Effects on Pain compared the level of comfort
and sucess of feeding prior to and after the circumcision.  They found
that the infants fed less fequently and were less available for
interaction after the surgery.  They also noted that the deterioration in
breast feeding lasted for at least two feedings.  The study also
concluded that the observed deterioration in ability to breast feed may
potentially contribute to breast feeding failure.  Some of the neonates
in this study also required supplememtation because of maternal
frustration and / or the neonates were judged unable to breast feed
postoperatively.
        Robert S. Van Howe, MD (1996) noted that "newborn males respond
to the circumcision with a marked reduction in oxygenation during the
procedure, cortisol surge, decreased wakefulness, increased vagal tone,
and less interactions with their environment following the procedure.
All factors which hinder the maternal-infant bonding process that makes
breast feeding possible."
        Marshall (1982) also reported that circumcision appears to affect
the feeding patterns and the mother-infant interaction.
        I was unable to find any information about when the "ideal" time
for a circumsicion to be performed is.  I am interested in what those
of you in practice have noticed.  When is the circumcision performed in
your area?  Have you found it to be useful to postpone the surgery in
order to facilitate breast feeding and bonding?  Does the surgery have a
negative effect on the length of time mothers breast feed?  What types of
problems have you seen in infants feedings after a circumcision?  Are
there any interventions that limit the problems with breast feeding, such
as medications or positions?  I would appreciate your thoughts on the
issue and any other questions or comments you may have.  Thank You.

RESOURCES
        Howard, C. et al. (1994). Acetaminophen and Analgesia in
Neaonatal Circumcision: The Effect on Pain. Pediatrics, (93)4, 641-6.
        Marshall, R. (1982). Circumcision: Effects on Mother-Infant
Interaction. Early Huamn Development, (7), 367-374.
        Marshall, R, (1982). Infant Male Circumcision Fact Sheet,
http://www.eskimo.com/~gburlin/mgm/facts.html
        Van Howe, Robert S. (1996). Neonatal Circumcision. The Journal of
Family Practice, (43)5, 431.

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