The issue to circumcision in South Florida is a strange one....many of the
docs I work with have decided not to do it any longer due to poor payout from
insurance companies (Medicaid doesn't pay for it ) and the liability.Then they
decided to get selective...if patient made financial arrangements and paid for
it out of pocket they would do it....so in the midst of trying to juggle
increasing patient loads we get to either break the news of yes or no your baby
won't be circed...we advise all moms that the AAP has a position that is not a
necessary procedure. I advise nursing moms that their baby may not nurse as well
for the rest of the day, but encourage them to keep them close to the breast
and try to offer comfort and pain relief..."Oh will the baby have pain?"  I
see moms asking "Will the baby be brought to them from the transition circed or
will he circed right after delivery"  I once worked with a wonderful doc who
wouldn't do circs until the 8th day..not only because of coagulation
improvement but because of the breastfeeding relationship is more established...I
celebrate when we have to send them to outpatient for circs because not only will
mom have more time to consider HER choice but she will have time to have her
breastfeeding better established. Nothing is worse than circing a baby two days
old who has had latching problems and then discharging to home within a few
hours. I am trying to get this to be a NO NO but if its a go then they should
have an appointment with the LC withi 24 hours, especially if you have a doc who
oks discharge without a post procedural void...At least the kids who have to
stick around until they void can be observed to see where the breastfeeding is
going. We have
a standing order for baby Tylenol q 6 hrs for 24 hrs post circ and the nurses
who do this have babies who are comfortable and breastfeed without
shutdown...I remind them that breastfeeding is the best analgesia for an
infant...heelsticks included.  I am going to try to get our unit to let us write a handout on
breastfeeding as an analgesic .

Leanne Jewell, RNC
SFL

             ***********************************************

To temporarily stop your subscription: set lactnet nomail
To start it again: set lactnet mail (or digest)
To unsubscribe: unsubscribe lactnet
All commands go to [log in to unmask]

The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html