Should Doulas Talk to Moms About Circumcision?

Doulas and Circumcision: an Ethical Conflict
Image via Earthside Birth Photography

When I was pregnant with my first baby 8 years ago, my doula was a personal friend, someone whose children I frequently babysat, and a great source of information throughout my pregnancy.

I remember the moment I told her I was having a boy. I had gone in for an ultrasound to determine the sex of my child, and I later met up with my doula to work on some birth art. When I proudly announced that I was expecting a boy, she responded with enthusiasm, quickly followed by, “You’re not going to circumcise him, are you?! I’ll make you watch a video. I think it’s torture.”

Kind of brash for a doula, right? Some might say so. And yet, I am eternally grateful for her direct approach, because it was one of the factors that spared my son and any future sons from an unnecessary genital cutting procedure. Our relationship as friends aided her ability to be forthright with not only her opinion on circumcision, but also the facts.

What are the facts about circumcision?

Beyond its religious and ritual nature, circumcision has been touted as a virtual cure-all in the United States since the 1800s. One of the earliest medical records of circumcision was from Claude-Francois Lallemand, who circumcised a patient to “cure him from nocturnal seminal emissions.

In 1845, research entitled A Treatise on Diseases of the Sexual Organs declared that circumcision prevents masturbation.

Circumcision was also purported to prevent or cure syphilis, epilepsy, paralysis, tuberculosis, bed-wetting, blindness and deafness.

In the 1900s, a paper called The Advantages of Circumcision claimed that circumcision was a “way to decrease the pleasure of sex, and hence to discourage sexual immorality.

A puritanical obsession with the notion that sexual pleasure is inherently sinful has driven circumcision throughout the ages. While it has been touted as a medical procedure, it is clear to see from the history of medical circumcision that it was largely quackery.

The same can be said today. The United States is an anomaly with its practice of routine infant circumcision, specifically because of its establishment in the U.S. as a puritanical treatment against normal human sexuality. The rate of routine infant circumcision in the United States is dropping; however, it was previously a highly popular procedure, reaching its peak in the 1980s.

The general idea presented by American doctors and culture is that the foreskin is somehow icky, and probably disease-ridden. It causes a lot of problems, right?

Wrong.

The so-called benefits of circumcision may sound drastic and important, but they are statistically tiny, comparable to removing the breast tissue of baby girls in order to prevent future breast cancer. In fact, because breast cancer is so rampant, routine breast tissue removal makes more sense medically than routine foreskin amputation.

The American Academy of Pediatricsa trade organization of pediatricians who happen to profit from performing circumcisions — stands alone in their statement on circumcision. While they don’t officially recommend it, their claim is that the supposed benefits outweigh the risks (while, in that same statement, there is no mention of the functions of the foreskin nor the actual risks of circumcision).

This conclusion is highly suspect when the rest of the world is considered. What began as a religious ritual and eventually transformed into a cosmetic procedure is seen as such by most other medical organizations around the world.

All of this to say: the benefits of circumcision are slim, the functions of the foreskin must be acknowledged and researched further, and it is more cultural conditioning than medical necessity that perpetuates circumcision in our culture.

Following are several official positions on routine infant circumcision from around the world:

Canadian Paediatric Society

“Recommendation: Circumcision of newborns should not be routinely performed.”

Circumcision is a ‘non-therapeutic’ procedure, which means it is not medically necessary…After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.”

The Royal Dutch Medical Association

“The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity.”

German Pediatric Association

“Therefore it is not understandable that circumcision of boys should be allowed but that of girls prohibited worldwide. Male circumcision is basically comparable with FGM types Ia and Ib that the Schafi Islamic school of law supports.”

Royal Australasian College of Physicians

“After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.”

British Medical Association

“To circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”

Response to the AAP position statement, signed by 38 physicians:

“The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.”

As anyone should be able to see, circumcision is not popular outside of the U.S.; the benefits of circumcision are wildly overstated, and numerous health organizations around the world speak out against it.

Doulas and Circumcision: an Ethical Conflict

Image via Fresh Love Birth Photography

This information leads to the question: Where does a doula’s responsibility lie in informing parents about circumcision? As a doula, I meet with my clients to review their birth plans and talk about important aspects of pregnancy, birth, and the postpartum period. This includes information not directly related to my job as a birth doula, including breastfeeding preparation, babywearing info, and safe cosleeping habits.

So what about circumcision? Do doulas have a duty to inform their clients about circumcision? Or is it outside the scope of practice?

There certainly are doulas who believe that circumcision is a parental right and discussing it is outside the scope of practice, but I would argue that it is well within the job description of a doula to help parents make fully informed decisions about routine infant genital cutting. My job as a doula does not begin solely at birth, nor end entirely when the baby is born. Providing parents with accurate information is a major part of my goal.

If it is a doula’s duty to help parents get proper information about circumcision in order to make a fully informed decision, at what point should a doula have this conversation with her clients?

Thankfully, each doula client I have had was already against circumcision, so I’ve never had to bring it up, but the issue may not be as easy to tackle as one might think.

Minnesota birthwoker, Doula Jen makes some important points. She says, “Part of me wants to just post a banner on my website that says ‘I will not consider working with anyone who plans to circumcise.’

But, I don’t know if that would actually keep anyone from cutting their kids. They would just interview another doula, and they wouldn’t get the chance to hear me talk their ears off about the importance of keeping their children whole.

Considering that many American parents are raised in a culture that views the foreskin as inherently bad, unnecessary, and disease-ridden, it is crucial for parents to receive accurate information about the benefits of the foreskin and the harm of circumcision. If a mother cannot count on her doula to give her this information, who else? Her best hope is that she has an unbiased, ethical doctor who is up-to-date on the circumcision recommendations from around the world, and that is rare to find in the United States.

But can a doula continue to serve a mother who intends to circumcise, if the doula is adamantly against it?

Doula Amy Wright Glenn shares her thoughts:

Currently, the American practice of routinely circumcising infant boys is presented as a birth option for parents to consider. More and more Americans are coming to see the practice of cutting a child’s genitals within a human rights framework and they are rejecting a parental choice framework. Rates of cutting continue to fall each year.

This is significant. Why?

If a child has a right to physical integrity then the practice of cutting off a healthy, important, and functional part of the the child’s body violates her or his right. Within a human rights framework, it is unethical for a doula, or anyone, to support a parent in violating a child in this way.

Hence, from within a human rights framework, circumcision is clearly a violation of the principle of consent and an assault on an innocent child’s physical integrity.

For a doula who sees circumcision within such a framework, she needs to ask herself two important questions:

1. Should I tell prospective clients about my human rights vision with regard to protecting a child’s physical integrity?

2. Can I, in good conscience, support a birthing mother’s choice to authorize the performance of an elective, non-consensual, painful surgery upon the genitals of her son?

I believe the answer to the first question is absolutely yes. A doula who embraces a human rights framework regarding circumcision would be wise to disclose her perspective. She certainly would be well within her scope of practice to include information concerning the peer-reviewed best practices relating to the benefits of keeping children intact in whatever literature she may give to prospective clients.

Of course, a doula with a human rights perspective finds herself unable to support in good conscience a client who has a parental choice perspective, she should kindly refer the expectant mother to doulas who see circumcision within a parental choice framework.

This brings up the question: at what point in time should a doula discuss circumcision with her client? If she broaches the subject initially, might she scare a potential client off? If she waits to discuss it until a bond has been formed, is it ethical to discontinue working with the mother if she still plans to circumcise?

To this, Amy Wright Glenn says, “For doulas with a human rights perspective, I suggest that this topic be brought up in the first meeting with prospective clients. The topic can be presented with kindness, clarity, and honesty.

Georganne Chapin, Executive Director Intact America (described as “the largest national advocacy group working to end involuntary circumcision in America”) takes a bold stance that I find personally inspiring as a birth worker.

She says, “It is absurd that doulas are prohibited from advocating for the rights of the baby. If a mother told her doula she planned to leave her baby alone and unattended all day, would the doula say that’s a fine plan? A doula should be trained to advocate for safe perinatal practices and against unsafe practices. Circumcision is medically unnecessary, unsafe and unethical.

Chapin points out, “No medical authority, including the Academy of American Pediatrics, has ever called infant circumcision medically necessary.

The truth is that most doulas, if not all, would very likely speak up if a parent planned to leave their baby unattended, or to not use a carseat, or to practice unsafe cosleeping habits. There are numerous examples where a doula would probably find it important to provide alternative, evidence-based information.

My job as a doula is to serve mothers prenatally, during birth, and throughout their postpartum period. This work is important for many reasons, in part because of the positive effects doulas can have on physiological birth. The wellbeing of both mother and child is a major part of what drives me as a doula, birth educator, and activist.

Researching the history, the harm, and the supposed benefits of circumcision for 8 years now, it is clear to me that the act is inherently damaging, as it removes an important part of the penis. One cannot change form without changing function, and that is essentially what circumcision does. I think it is my duty as a doula and birth educator to present evidence-based information that is in the best interest of both mother and child.

This is why I will continue to speak up and help dismantle the myths surrounding circumcision. Will you?

Doulas and Circumcision: an Ethical Conflict
Image via Kimberly Collins Birth Photography

19 thoughts on “Should Doulas Talk to Moms About Circumcision?”

  1. I have seen so many mothers say, “I wish someone had warned me about genital cutting. If I had known better, I would not have let that happen to him.” It is far better to speak up, and share the true facts about forced genital cutting with pregnant women. Some women will still insist on cutting, but at least they can’t say that no one talked to them about the risks.

    1. I have to agree with Angela. This was my biggest regret as a parent. The information I received prior to decision-making was highly influenced by the US culture and my family’s own “1980s peak popularity” perspectives, and included books with information from the Mayo Clinic and AAP. It wasn’t until after the procedure that I became integrated into the circles of information representing “Attachment Parenting”, “Peaceful Parenting” and other perspectives. Please, get the information out there, so other parents won’t have the weight of this regret on their shoulders.

  2. Absolutely wonderful article highlighting the stark contrast in medical “logic” between the US and other western countries. I hope its outlawed during my lifetime – every body deserves their whole and entire useful and functional body. In fact, they have a right to it.

  3. This is such an excellent article, devoted to the human rights perspective on behalf of the bodily integrity of the baby. A few observations:

    Is it not the case that the baby is your client as well as the mother? From gestation to post-natal care, you have two clients, yes? So, advocating on behalf of the baby is a responsibility, not an option, right?

    As for when to discuss the circumcision/genital mutilation issue, I would suggest the doula’s website and marketing materials make very clear the human rights/no genital cutting policy, both for girls and boys!

    You present such a strong case against the medicalized “Parental Choice” meme. That’s where the buck stops. There are no exceptions to surgical procedures on a minor child with no medical necessity. Since the AAP/CDC admit it is medically unnecessary, then everything after that is bogus/illegal in fact, if not in custom and practice. Non-cooperation with unethical policies is in order. I say this for the doctors and nurses, who worry about losing their jobs when the hospital/ Board require them to perform a procedure that violates the Hippocratic Oath.

    Would referring a client to a pro-cutting or accepting-cutting doula involve compromising one’s own ethical responsibility? That is the work of the parent who rejects the human rights perspective, yes?

    Thank you again for this excellent article – I am posting it! 🙂

  4. EXCELLENT ARTICLE! As a doula….. This has always been my code of ethics……. I address circumcision in the very first meeting. This gives both the doula and prospective client the opportunity to decide if they can work together or not and getting that established in the first meeting saves time for both parties. I call it being honest…….

  5. Wow. I find this offensive. If the doula is againts it she needs to tell her clients upfront so they can choose to go elsewhere if they have decided to circumcise for whatever reason, which isn’t anybody’s buisness btw and it’s pretty disturbing strangers are worried about other people’s kids genitals. I would have dropped my doula in a heartbeat if she pulled these intactivist shenanigans. It’s one thing to say ” I’m againts it because of x reason” then to force a mom to watch a video or be harassed about it. Things like this turns me off from doulas. Also one’s complaining about other doula’s charging less or not at all calling them unprofessional is just disgusting. I think they should do what they were trained to do. Support mom during l&d and let them decide what’s best for their kids Physical body. What next? Doulas who refuse to support a mom because she ff instead of bf? If you cannot support moms choices whatever they may be, you have no buisness being a doula!!

    1. And similar to that, I would drop a doula that I knew supported genitally mutilating newborns, so hopefully they will be forthright with that.

    2. I just don’t get it! Yes they are your (male) child but why do you think that their penis is your as well? Their not a dress you take to the seamstress for a better fit or improved look for god sake.

      Most men wont tell you that they wish they knew what it would be like to have their foreskin and are actually angry about losing it!

      A circumcision at birth does so much damage to the undeveloped penis it so sad just the top 3 are size, sensation, and function. Now the last one function is two fold because as it provides protection in many ways (look it up) it provides sexual pleasure for both parties.

      You know I don’t blame my parents because back in the old days 1900-1960 the just did the circumcision and didn’t even ask the mother and maybe didn’t ask the father either. I know this because I asked my mother who happens to be Belgium (where their boys are intact) and she couldn’t recall being asked.

      Why is it so taboo to even talk about the penis and not refer to it as his thingy. Parents talk to their children about not fighting and using their fists to hurt someone else but don’t give boys instructions about the proper use for their penis when the time their of sexual maturity.

      Somewhat off track but still related so remember it’s our body and if we decide we hate our foreskin we will decide when we are old enough just like you wouldn’t let us get a tattoo at 15 you shouldn’t let a doctor remove MY foreskin.

      Think about this, most parents take longer to decide and research a crib than they do the removal of a very important part of our male bodies!!!

  6. Should doulas….? Only if the client wants the information. And not with this tone/agenda behind the conversation. I though doulas provided 100% unbiased, non-judgemental support. If not… I don’t want that doula!

    1. I agree! I wonder how the doulas react if the parents tell them they are circumcising. I hope to God the doula’s drop it because if they continue to harass and push their own intactivist agenda, they have no business being a doula.

  7. I’m from Denmark, a country where circumcision is almost unheard of except for a few religious minorities. I’m appalled by the prevalence of circumcision in US. How anyon can call furthering boys’ basic human rights an “agenda” – and a dubious agenda at that – is beyond me.

    Boys are human beings. Boys have the same rights as any other human being. Specifically the same right to genital integrity.

  8. When the time comes that have sons myself, my husband and I have already decided that we will keep them intact. The personal and ethical sides to this issue, I completely agree with on an individual level. But as a doula, I cannot and do not support this article in the slightest. It is NOT my job to tell parents what they need to know. By doing so, I’m assuming I know their needs better than they do, that they don’t know how to communicate their desires and questions, that they need me to save them from… their care provider, the hospital, their own ‘lack’ of knowledge, or whatever. I can be an advocate and a doula, but not at the same time. When I am with my clients, I am there to make sure they feel supported with the information they have at hand and to give more WHEN ASKED. I am not there to make sure they choose something or not. How disempowering to tell a woman that what she does or doesn’t know isn’t good enough. Let’s treat women like the adults they are and trust them to make their own decisions and ask their own questions. If they wanted unsolicited advice, (whether it’s direct comment or question, or a passive aggressive implication that they need to know more), they can go about a million other places for it. A doula should be the one person a family can count on to receive complete unbiased support.

    1. So, you don’t provide your clients with any information on prenatal health, birth, breastfeeding, safe cosleeping practices, babywearing info, etc. etc. unless they specifically ask about each issue? Interesting. I would argue that it is unbiased to give parents accurate information about circumcision, because what they hear from American doctors is very likely inaccurate. THAT is biased; the truth is not.

    2. I agree with you Aly. I do not advocate for my clients. I help them advocate for themselves. You are right that we cannot be doulas and advocates at the same time. I do not in any way agree with circumcision but there are a lot of things that my clients do that I do not agree with. And that’s what makes me a good doula: that I support them whether or not I agree with them. I do feel that circumcision is a human rights issue but I’ve also seen obstetric violence and I can’t save a woman from the care provider that she chose. We see a lot of horrible things as doulas but you keep going if you want to continue to do this work.

      1. You cannot be a doula and an advocate? How do you help someone advocate, anyway? I could see if someone needed say, an interpreter (someone who doesn’t speak the main language at the hospital or who is Deaf and uses sign language), but other than that, if someone has to advocate for themselves anyway, how would you help that? It’s convenient that you say you can only help someone advocate when clearly a newborn baby hasn’t the means to advocate for himself/herself.

  9. Mothers have a right and a responsibility to become fully educated about what circumcision does to boys and the men they will become. Part of that education, beyond the important human rights issues, involves the adverse long-term physical, sexual, emotional and self-esteem consequences that men are beginning to speak out about. They are documented in the ‘Preliminary Poll of Men Circumcised in Infancy or Childhood’ (www.noharmm.org/images/Preliminary Poll 1999.pdf) and in the more recent Global Survey of Circumcision Harm (www.CircumcisionHarm.org)

  10. I agree with some of the above who have commented against this article; while I found it thoughtful and well written, there is such a thin line between presenting unbiased information to parents to help with informed decision, and pushing agendas. I have known, and seen, SO many doulas who have pushed their own “advocacy” on families because they are passionate about issues – which while admirable, is also fully against the idea of supporting families in THEIR choice for THEIR birth and children. Home births make me antsy (I attended a very traumatic one) but I don’t feel the need to give homebirth parents statistics on home birth being unsafe. C-sections come with TONS of risks, but if a mother comes to me happy and confident in her decision to have one, having discussed it with her doctor, who am I to try to convince her otherwise? I ALWAYS encourage open, honest communication with their care team. But it is not the job of doulas to demonize a family’s religious or personal practice – as a doula and as a mother, I have been shamed both for formula feeding and circ my own son. It breaks my heart every time I see it happen, it truly does.

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