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