I like the format Cindy used so I too will answer Tonya Kelley's questions
in caps, with no intent of shouting.

I WILL POINT OUT THE OBVIOUS, THIS IS AN ELECTIVE PROCEDURE.  IN MY
INSTITUTION IT IS VERY COMMONLY DONE.

When is the circumcision performed in your area?   BEFORE DISCHARGE UNLESS
THE PARENTS PLAN A BRIS ON DAY 8.  TYPICALLY THE CIRC IS NOW PREFORMED
AROUND THE END OF DAY ONE OR THE START OF DAY 2.  OUR PATIENTS ARE
DISCHARGED AROUND 48 HOURS POST BIRTH ALTHOUGH SOME ARE EARLIER AND
CSECTIONS ARE ON DAY 4.  THE TIMING OF THE CIRCUMCISION IS DETERMINED BY THE
OBSTETRICIANS SCHEDULE WITH SOME FEEDBACK ABOUT THE MOTHERS PLANNED
DISCHARGE TIME.  CIRCS ARE NOW DONE A BIT LATER BECAUSE INSURANCE COMPANIES
CAN NO LONGER FORCE DISCHARGE AT 24 HOURS.

Have you found it to be useful to postpone the surgery in order to
facilitate breast feeding and bonding?  YES! YES! YES!  ESPECIALLY IF THE
INFANT IS NOT YET EFFECTIVELY FEEDING. IN FACT, OUR LC GROUP HAS JUST DONE
AN INSERVICE WITH THE OBs PLEADING THE CASE FOR INPUT FROM THE NURSING STAFF
AND LCs REGARDING INDIVIDUALIZING THE TIMING FOR INFANTS HAVING TROUBLE
FEEDING.  RESPONSES FROM THE OBs HAVE VARIED BUT HAVE INCLUDED MANY POSITIVE
RESPONSES.  IN OUR INSTITUTION THE CIRC PERMIT IS SIGNED MOST OFTEN JUST
BEFORE THE PROCEDURE.  IF THE INFANT IS NOT FEEDING WELL MOMS WILL SOMETIMES
REFUSE TO SIGN UNTIL FEEDINGS ARE EFFECTIVE.  WE ALLOW INFANTS TO BE
DISCHARGED WITHIN A FEW HOURS OF THE CIRCUMCISION IF BLEEDING IS WELL
CONTROLLED.

Does the surgery have a negative effect on the length of time mothers breast
feed?  WE DON'T FOLLOW THIS DIRECTLY OR LONG TERM SO I DON'T KNOW HAVE
STATISTICS BUT I WOULD THINK IT WOULD.  MANY INFANTS ARE NOT FEEDING WELL
POST CIRC AND BECAUSE OF OTHER HOSPITAL POLICIES ARE SUPPLEMENTED IF
EFFECTIVE BREASTFEEDING DOES NOT OCCUR IN 6 HOURS.  THIS IS IMPOSED BY OUR
MEDICAL POLICIES AND IS NOT SOMETHING I BELIEVE IN.  CINDY FELT MOST INFANTS
FED WELL BUT NOTED THE USE OF ANESTHESIA DURING THE PROCEDURE.  I AM SAD TO
SAY ANESTHESIA IS RARELY USED IN MY INSTITUTION.  OUR BABY BOYS ARE MOST
OFTEN IN A DEEP STUPOR FOLLOWING THE CIRC.  SOME OF FUSSY BUT MORE SEEM TO
SAY "I THINK I'LL SLEEP, THIS WORLD IS NOT A WELCOMING PLACE TO ME, LET ME
ESCAPE".  MANY MOTHERS I HAVE TALKED TO WHOSE BABY'S ARE CIRCED ON DAY 8 AT
HOME, PERHAPS WITH A SUCK OF WINE, REPORT WHAT CINDY REPORTED - THAT THE
BABY FEEDS WELL JUST AFTER THE CIRC.  IN OUR INSTITUTION I FIND IF I CAN
RETURN THE BABY TO THE MOM QUICKLY ENOUGH AFTER THE CIRC, BEFORE THE DEEP
SLEEP SETS IN I HAVE BETTER RESULTS WITH FEEDING.


What types of problems have you seen in infants feedings after a
circumcision? USUALLY
DEEP, PERSISTENT SLEEP, SOMETIMES FUSSINESS, SOMETIMES REFUSAL TO BREASTFEED
FOLLOWED BY SUPPLEMENTATION

Are there any interventions that limit the problems with breast feeding,
such as medications or positions?  TIMING, IF THE BABY HAS FED WELL PRIOR TO
THE CIRC THEY ARE MORE LIKELY TO FEED WELL AFTER.  GET THE BABY OUT TO MOM
AS SOON AS POSSIBLE, TEACH MOM TO DO SKIN TO SKIN RIGHT AWAY.  OFFER BREAST
BEFORE BABY GOES INTO DEEP SLEEP.  THE DIAPER SEEMS TO PROTECT THE SITE
ADEQUATELY AND I DON'T FIND A NEED TO DO SPECIAL POSITIONING BUT CONTINUE TO
PLACE INFANT VENTRAL SIDE TOWARD MOTHER.  I DO BELIEVE ANESTHESIA WOULD HELP
THESE PROBLEMS AND AM TRYING TO FACILITATE THE USE OF ANESTHESIA WHEN CIRCS
ARE DONE IN MY INSTITUTION.

CARLA