Choosing a Birth Location and Care Provider
Interviewing a Home Birth Midwife (5 part series)
The routine circumcision of healthy baby boys has no net medical benefits, yet many people continue to decide to circumcise for a variety of cultural reasons. The United States of America is the only country in the world that routinely circumcises a large percentage of baby boys for non-religious reasons. The rate is currently about 50% and dropping. People in other countries are baffled as to why it's so common here as the males in their non-circumcising countries do not suffer from the perceived health, hygiene, and social misfortunes that American circumcision advocates claim will occur if the surgery is not performed. I highly recommend reading the articles "The Case Against Circumcision" by Dr. Fleiss (published in Mothering Magazine) and "Separated at Birth" by Mark Jenkins (published in Men's Health Magazine). The Canadian Paediatric Society gives an excellent overview as well.
Things to Consider
- No medical organization in the world recommends routine infant circumcision.
- Rates are dropping. "Everyone" is not doing it. In 2003 approximately 56% of newborn boys were circumcised and 44% were left intact. The rate has dropped quite a lot since you and your partner were born. Still concerned about the locker room? Read this.
- Circumcision is not necessary for hygienic reasons. Circumcised males have to wash, too! It is easier to care for an intact infant rather than a circumcised one because the foreskin is attached at birth and all you need to do is wipe the outside. Once the foreskin is retractable a quick 3-second rinse in the shower is sufficient. It takes a lot more time and effort to clean an intact female. Circumcised boys have a wound that has to heal inside a diaper. After it heals, you must be vigilant about preventing adhesions (where the remaining foreskin tries to heal by reattaching to the glans).
- The foreskin is not a birth defect. It has a purpose. It has sexual as well as health benefits. It is not a simple "flap of skin". For one it doesn't flap at all (it is attached during infancy much like a fingernail to the nail bed). For another it is densely innervated, highly erogenous tissue.
- Your son won't care if his penis matches his dad's or not. Many intact American boys have circumcised fathers. It is not an issue that you need worry about. Many intact American boys have circumcised older brothers as well. Again, it's not something that should prevent you from letting your newborn son keep his foreskin. Each child is an individual. He will have unique physical and personality characteristics. There is a good argument that we should accept and love our babies as they are.
- Circumcision is not a simple snip. Circumcision removes what amounts in an adult to 15 square inches of erogenous tissue (the size of a 3 x 5 notecard), that's approximately 50% of the penile shaft skin. Here's a link to overviews of the various methods. Here is a video of the procedure.
- Circumcision is painful and most babies do not receive any anesthesia. There is no pain relief that is 100% effective that is safe enough to use on fragile newborns. If you have studied pre- and peri-natal psychology you know that babies remember. You cannot brush off pain and trauma with a "he won't remember it, so it's ok". Your baby's experience of pain during circumcision is real and should not be treated lightly. Babies do not sleep through circumcisions. Some babies may appear to be asleep because they withdraw as a coping mechanism. When the baby is monitored for signs of stress and pain, medicated and "sleeping" babies have elevated levels, indicating that they do feel what is happening.
- Circumcision has risks. Most of them are minor, but some are quite serious (including amputation or even death). One risk that is not commonly included is the risk that your son may not agree with your decision regarding circumcision. If you choose to circumcise and your son later decides that he would rather have his foreskin, there's nothing he can do. If you choose not to circumcise and your son later decides that he would rather be circumcised, he can have that done (with fully effective pain relief and fewer risks regarding too much/too little skin being removed).
- Christians have no religious requirement to circumcise. If we did, we would have a religious ceremony attending it. During the Council at Jerusalem Peter, Paul, and the other leaders of the Church had to decide whether or not new gentile converts must first convert to Judaism prior to being baptized as followers of Christ. The Jews who became Christian wanted to continue following the Law of Moses, including circumcision, and wanted new converts to do the same. The Council at Jerusalem determined that Christ fulfilled the Law of Moses and circumcision no longer had any religious significance. Here is a well-written article on the Council at Jerusalem. Scriptural references against religious circumcision for Christians can be found in Acts 15:1 - 35, 1 Corinthians 7:19, Galatians 5:6, and Galatians 6:15. If you are a member of The Church of Jesus Christ of Latter-day Saints (LDS), read Moroni 8:8 and D&C 74.
- Another item to consider regarding religious circumcision is that the form done in Biblical times is not as severe as what is done today during modern hospital circumcisions.
- Medicaid in Utah does not cover routine infant circumcision.
If You Decide to Circumcise
- Research the various methods and the risks and choose a doctor who is skilled in performing the desired method. Remember that obstetricians are the least likely to use pain relief and pediatricians are the most likely. A pediatric urologist is the doctor least likely to cause complications.
- Take a look at this model circumcision consent form.
- Make sure your baby receives as much pain relief as he can. It will not be 100% painless, but it will be better than nothing. Topical numbing cream such as EMLA combined with an injected ansethetic appears to be the most effective. EMLA topical numbing cream should not be used alone. Keep in mind that babies do remember and that babies who "sleep" through their circumcisions are likely simply passing out from the pain! Newborns have no coping mechanisms and therefore "shut down" in stressful or painful situations.
- Be with your baby during the surgery to comfort him and to ensure that pain relief is given.
- Administer oral pain killers (such as Tylenol) during the healing period.
- Be clear on how to care for the wound.
- Be mindful of how to prevent adhesions.
If You Decide to Leave Your Baby Intact (not circumcised)
- You are not alone! In 2003 the circumcision rate for newborns was about 56% circumcised, 44% intact nationwide.
- Review how to care for an intact penis (hint: don't retract the foreskin).
- Review how to care for an intact penis with any relatives or baby-sitters who might be changing your child's diaper as many people mistakenly believe they must retract the foreskin.
- Find a foreskin-friendly doctor (one who won't advocate circumcision or try to retract) and consider reviewing the Intact Care Agreement with him or her.
- Review common misconceptions that cause doctors to mistakenly recommend circumcision as a cure. Read this article by Dr. Fleiss on protecting your intact son.
- Be on alert if you are giving birth in a hospital (put a note in the baby's bassinette) as you want to avoid an accidental circumcision.
Articles and Research
- Mothering.com's "Ask the Experts" features circumcision expert nurse Marilyn Milos.
- "The Case Against Circumcision" by Dr. Fleiss (published in Mothering Magazine)
- "Separated at Birth" by Mark Jenkins (published in Men's Health Magazine)
- The National Organization of Circumcision Information Resource Centers
- Catholics Against Circumcision
- Jewish Circumcision Resource Center
- Circumcision Information Resource Pages (convenient compilation of circumcision articles and studies)
- "The Truth About Circumcision and HIV"
If You and Your Partner are Disagreeing
- Read "Regarding Circumcision and Intactness" the writings of Vincent Bach
- Marilyn Milos answers the question "I'm not very much in favor of circumcision, but my husband wants our son to look like him. What do you suggest that I tell him?"
- It is often helpful for your partner to view a video of a circumcision so that he or she is aware of what circumcision is really like.
- Some parents choose to put the burden of proof on the parent who is advocating surgery on a healthy infant.
- Some parents choose to let the child decide when he is older if they disagree when he is an infant.
- In my experience, reasonable partners have totally changed their opinion on circumcision after reviewing the common myths and realizing the pain and trauma involved.