Circumcision-to or not to?

Circumcision is one of the most controversial issues of the day among midwives, doulas, doctors and new moms. Ask 10 people and you will probably get 8-10 various opinions on the subject matter. While I hate this topic, I feel it's one that I need to address, at least a tiny bit, in this blog. The American Academy of Pediatrics says the following: "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision. In circumstances in which there are potential benefits and risks, yet the procedure is not essential to the child's current well-being, parents should determine what is in the best interest of the child. To make an informed choice, parents of all male infants should be given accurate and unbiased information and be provided the opportunity to discuss this decision. If a decision for circumcision is made, procedural analgesia should be provided. " In this, note that the AAP is #1leaving the decision to the parents. They are also saying that there ARE potential medical benefits, just not enough at this time to demand and require all boys be circumcised.

Circumcision is the removing of the foreskin. It's a tiny piece of skin that is approx 1/2" at the tip of the penis. Removing this, changes the look of the penis as well as the feeling and sensitivity to various degrees.

In Jewish culture, the circumcision symbolizes the entrance of a male child into the traditional covenant with God. It is performed on the eighth day after birth and the child is often held by his godfather during the procedure. Most Jews still practice this today and it is a very celebrated part of their religion and culture. It is often celebrated with a Bris Milah. Bris means 'covenant' and Milah means 'to cut'. It symbolizes the covenant made between God and the Jews. During the Bris Milah, family is often celebrated. The baby is often passed around to various people who are being honored, at some point during the ceremony. Also during this ceremony, the baby is given his Hebrew name. This is a very important part of the Bris and is often accompanied by much emotion. In Christendom, a Bris would be similar to what we would do as a baptism, christoning or baby dedication. It is held with the same honor, respect and importance. A Bris is also done by a Mohel who is trained in ritual circumcisions. The ceremony is normally performed in the home of the family or at the synogogue or temple.

Many Christians view the circumcision in much the same way as the Jews. There is a movement in Christianity that believes that since God told Abraham to cut off the foreskin of Isaac, that there must be significant reasons and meanings to do so. They also feel that when Jesus came to earth, we all inherited the same covenental rights that the Jews had, and as part of that covenant, we too should circumcise as a sign. There is some controversy around this because the New Testament does say that "There is neither Jew nor Gentile, circumcised nor uncircumcised; for all are one in Christ". This verse (and others) have been interpreted in many various ways, but many feel that it is saying that we all have to come to Christ in the same manor, Jew or Gentile".

Most in today's society have no clue what circumcision is or does. They trust the word and knowledge of their doctor and so if he says do it, they do it. I am not here to say whether one should have it done or not. I'm not on the bandwagon of having made illegal or banning it completely. I'm one to educate the reader and my clients on the process and let them decide for themselves. Just as I would never demand one have a homebirth over a hospital birth, have an episiotomy or not, etc etc, I would never force my views of circumcision on a mother or my client either. (FTR, I have 3 sons and they are all circumcised, including my youngest, who at the time of this writing is only 15 days old and has his circumcision done yesterday).

In choosing to circumcise or not circumcise, one must really face all the issues at hand and be sure to do the proper education and reading. What most people don't know is that most hospitals will accomodate your wishes when performing this procedure. It is normally not done in a sterile room and takes approx 10-15 minutes for the entire thing. My first son was born in a large hospital here in Michigan. When it was time for his circumcision, my husband asked if he could accompany him to the room and was he was allowed to. During the procedure, he stood right next to our son, holding his little hand. Our second son was born at home and therefore it was incredibly hard to find a doctor who would perform the circumcision. What I found was that pediatricians wouldn't accept him cause he wasn't there patient. OBGYNs wouldn't take him because "I" wasn't there patient. I was told to call a Urologist, who told me they don't do them and to call a Pediatric Urologist, who told me they don't do them until the child is 2 years old and then they put them completely under to perform it. I was beside myself about it so talked to my midwife who told me to check into mohels. I called a couple and found one who was also a pediatrician with his own practice. I felt very comfortable with that and so we proceeded. His circumcision was done at a local temple, even though we are Christians and not Jewish.

Our 3rd son was born on January 9th, 2007 at home. We contacted the mohel who had done our last son and he said he would do this one too. We ran into some snags and ended up cancelling with him. I contacted several other local mohels and 'interviewed' two of them on the phone and went with the one we chose, and as stated earlier, it was performed yesterday. We decided to make it a bit more 'ceremonial', although we couldn't offer our own prayers or blessings since it too was done in the temple, but my husbands two best friends accompanied him and Jacob. It was actually a very special time for all of them (something we as females and moms will probably never understand).

So, this whole blog has been written to get to this-if you are going to have a son and are caught in the middle as to what to do, sit on neutral ground and ask questions. One thing I've found is that if you visit message boards and ask questions, you will get a few who are very adamently against circumcision and they will rule the conversation. You will get very little in unbiased information or answers. Steer clear of those. ;)

Things to know & ask your doctor or mohel:
1. How many circumcisions have they done?
You do NOT want someone operating on your young sons penis as his first circumcision. The mohel that did our son yesterday has done over 12000. The mohel who did our second son had done about 300. We were confident in that. The doctor (done in the hospital) who did our first son had done approximately 500. At the time, we thought that was a great number and were confident in that. While I still am confident in that number, the 1200 is much more reassuring to me.

2. What procedure do they use?
There are 3 various procedures that are used during a circumcision. The gomco clamp is what most doctors tend to use. Most of them feel that it gives a better appearance and is easier to use. It involves stretching the foreskin over a belllike applying pressure and then the removal of the clamp and device. It takes approximately 3 1/2 minutes to complete.

The mogen clamp is most widely used in Bris Milah. It is said to be more effective, less painful and more precise. Research says that babies cry less during this procedure, have higher oxygen levels and less increase in heart rate. The procedure takes approximately 90 seconds with the mogen clamp. There is no bell shaped part of this clamp so it involves the mohel/doctor situating the clamp and closing it to complete the procedure.

The plastibell is another method used. In this procedure, the foreskin is lifted and a plastic ring is inserted. After five to eight days, the bell and dead foreskin tissue detach. In this method, there is very little extra care that needs to be done afterwards as there is no dressing to change and no stitches.

3. What is offered for pain control during the procedure?
This is one place I'm a stickler. DEMAND that your doctor or mohel offer pain management during the procedure. Some doctors will use only a topical anistetic, which in my opinion, is not enough. There are two different methods used for numbing the area through local aniesthesia. The first is to inject right into the shaft of the penis. This will cause numbness and pain relief for several hours. Most mohels will not use this method however. They believe that if you inject the anesthesia just into the foreskin, that it will create a less stressful 'recovery period' for the baby. Think about when you go to the dentist for a filling or root canal. For the next several hours, your face is tingly and then, as the numbness wares off, you get that itchy, annoying feeling. With a local anesthesia to the shaft of the penis, this is what many feel happens to the baby. For the next few hours, there is that nagging feeling as the numbness subsides. Regardless of that type of pain relief used, demand something. Some doctors still have the mistaken belief that babies don't really feel any pain during the procedure and that they are only crying cause they are strapped down. Take it from a mom of three....they are mistaken!

Just as with any other pain, Tylenol is often used, and should be used, if baby is acting distressed in any ways.

In closing, if you are giving birth to a baby boy, it is up to you, the parents, to make the right decision of what is best for your family and your child. Weigh the options, ask the questions and do the research. Don't be bullied into a choice, whether for or against, but do what you feel is best. The choice is yours...



*** Author Notification *** We ask that you notify the author of publication of her work. Kelly Milano, can be reached at: kmilano@gmail.com Please provide a link to her work on your site.
Do not publish without permission of the author.
2007