So why are circumcisions done in the hospital?

[BlessedMommy2006]

Do hospitals do circs so that the circ rate won't plummet due to parents not bringing the baby back to the ped for one a week later?

As one of my friends pointed out, doing circs in the hospital makes the MRSA risk go way up.

I would prefer that infant circ be banned altogether, but as a more realistic goal, couldn't they stop doing them in hospitals?

What does it take to get circs out of hospitals? Having them de-insured? It seems like in a lot of low circ areas, hospitals don't do them anymore.

When you have to fork out $400 and pay a specialist I suppose that it makes you think twice!

So in those areas that have hospitals that don't do circs, how did that happen, and how can we replicate it in other places?

[Quirky]

Even with MRSA though I'm not sure it would be that much safer doing circs in a ped's office.....esp. because of the risk of bleeding. And ped's offices are full of germs!

[SlackerDad]

Originally Posted by BlessedMommy2006

Do hospitals do circs so that the circ rate won't plummet due to parents not bringing the baby back to the ped for one a week later?

I think that's it. When I was inadvertently born overseas, I think my parents intended to do the circ when they got back Stateside. But by then I was a couple months old, they were used to my intact state, and they figured they'd just let me choose myself when I was old enough (thank goodness).

But aside from hospitals' preference, I do also think there is a feeling among parents that (as upside down as this actually is) their baby is "deformed" until the circ is done. So they too want it to be done ASAP, so they have to look at this "oddity" for as few diaper changes and baths as possible.

[beep]

My health insurance plan will pay for a circ if it's before you leave the hospital, but not after that. That kind of insurance policy might influence people's choices.

About doing circ as part of a pediatrician visit... At the hospital where I work OB's are the ones who do routine circumcisions. Pediatricians here are usually not trained on the procedure. A parent would have to find a urologist if seeking a circ outside the hospital--meaning it would be an additional visit to a new practitioner. Interestingly, in my town there is a local urologist not affiliated with the hospital who charges less than the hospital does for a circumcision. When parents without a lot of money and whose insurance doesn't cover it (e.g. on Medicaid) request a circ, the OBs always gladly refer them to this doctor. The OBs do all the routine circumcisions requested in the hospital, but it is a disliked chore and they sometimes bicker about whose turn it is to do them on any given day. They don't make any money directly off of doing them, and often say things like, "I got into this field to treat women, not baby boys."

FWIW, I've never seen an OB or midwife at my hospital push or even recommend the procedure. They do routinely ask every mama of a boy whether she wants one as part of a list of questions about things like what feeding method she plans and what birth control method she plans to use. However, when mothers ask for advice on whether they should get one, usually the practitioner says something like, "They aren't medically necessary, though we do perform them here if the parents request. It's really up to you to decide." Not advice against doing it, but a very neutral presentation.

[Friday13th]

I would guess it has something to do with the bad old days where people thought you had to retract the foreskin to clean. I'd guess a parent who wanted their child circumcised so they didn't have to deal with that also wouldn't want to deal with that for a few days or weeks until they could get an appointment to have "have it taken care of"

I'd also imagine in the first generation of RIC it gave the parents less, if any, bonding timing with their intact infant, making it easier to remove something both parents would have grown up thinking was totally normal. There would have been no choice, the baby would have just shown up in the room like that.

[LaffNowCryLater]

My friend told me it is b/c many pediatricians don't hold surgery malpractice coverage (or whatever it is called) so OBs do it since they have to have surgery coverage to do csections and other female reproductive surgeries.

She doesn't have a son, but she was a surro mom for a couple that got their boy twin she carried for them circd () and she asked why her OB was doing the circ.

[ursaminor]

I think I remember hearing at the University of Michigan circumcision was dropped from the OB's curriculum as it has nothing to do with maternal care. So all the circs were being done by the Peds. I am pretty sure the peds do the circs before parents leave the hosp.

[an_aurora]

Originally Posted by SlackerDad

But aside from hospitals' preference, I do also think there is a feeling among parents that (as upside down as this actually is) their baby is "deformed" until the circ is done. So they too want it to be done ASAP, so they have to look at this "oddity" for as few diaper changes and baths as possible.

ITA. We had one mom, who as soon as she was in her bed on our unit (I work on postpartum; we get mom & baby 2 hours after delivery) asked when the circ would happen. This was 2 am! She could not wait to get it done. Poor baby. Then we had a grandma come and ask for another plain hospital shirt for the baby since he was getting circ'ed that afternoon and she didn't want him 'to get blood all over his good outfit.'

[Crunchy Frog]

I don't buy that OBs do it because they're surgeons. I think it simply became their "territory" when childbirth first moved into hospitals. Also, I think it varies regionally, with peds doing it in some areas and OBs in other areas.

Also being done by OBs doesn't necessitate it taking place in the hospital, as they are perfectly capable of doing it in their offices. It's probably generally more convenient for them though, to round up all the babies in the nursery and do them all at once.

Around here, it's the OBs who do it, but it's not because they're surgeons. My OB that I had for my twins doesn't do them in the hospital, but in his office after mother and baby are discharged. He has a nurse practitioner who also does them in his office, and she sure as hell is no surgeon. It's actually not at all uncommon for advance practice nurses and CNMs to add circs to their repertoire of services.

I was reading on a nursing board recently that some hospitals actually lose money on the circs. Apparently alot of parents whose insurance doesn't cover it have it done anyway and then skip out without paying. Also, the prices that are charged don't really cover the expenses of the hospital setup.

I think it's done in hospitals by OBs just because it's been that way for so long and has become thoroughly ingrained in our culture. It also keeps the circ rate very high, because it enables parents to get it done without even thinking about it, and without exerting the slightest effort beyond simply signing a form. I do think there are lots of people in this country's medical establishment who like it and want to keep it that way.

I think if we could get them out of the hospitals it would be a huge step in the right direction.

[Fyrestorm]

I still want to know why an OB who specializes in woman's parts thinks they have any business messing around with something that they know nothing about. (except how to remove it of course)

[SlackerDad]

Originally Posted by Fyrestorm

I still want to know why an OB who specializes in woman's parts thinks they have any business messing around with something that they know nothing about. (except how to remove it of course)

I think many of us on this site would question whether OBs really know all that much about normal pregnancy and childbirth either!

[LaffNowCryLater]

I don't think it is b/c OBs are surgeons either but I do think it has a lot to do with the fact that peds do not pay the $$$ surgery malpractice insurance just to do random circs, whereas OBs have to have this insurance anyways b/c they do tons of surgeries. It is different in places like military hospitals though since the military covers the malpractice insurance for its practitioners.

[WC_hapamama]

The small, community hospital that my oldest son was born at didn't do circumcisions in the post-partum ward/nursery at all.

[calpurnia]

Obstetricians do circumcisions in America?? I had missed that before. Seriously?

In the UK, if you had to have a circumcision, it would be done by a paediatric urologist. Obviously.

[minkajane]

If DS had been circumcised, the pediatrician would have done it, but our situation was unique. We were in a civilian hospital, but being seen by military docs. My OB and the ped were both military. At both the bases I've been at, the peds do all the circs. And apparently they see a LOT of boys who "need" circs later, for infections or UTIs.

[babygrant]

Here the GP's do the circ's. The main hospital here there's 7 or 8 general practitioners who specialize in deliveries. Out of the 7 or 8 GP's, only one will do circ's. The doctors do four day rotations. So if you deliver when the one circ doc is at the hospital, then it can be done before you leave the hospital, otherwise you need to wait until that doc is back on call at the hospital and they'll schedule an appointment. A woman never see's an OB unless they are high risk or need a c-section. You see a general practitioner through your entire pregnancy and the GP delivers the baby.

Fortunately, although still too high, the circ rate here is about 8%.

[Frank Koehler]

Hospitals do circs because it is an income stream. That's right. Follow the money. Why do you think docs and nurses keep asking the parents if they want circumcision after they've said no the first time? It's a money-making add-on sale. Not only do they get to charge for the circ, but the extra half-day hospital stay, too.

[Ann-Marita]

I think it's so the OBs get the money, instead of the pedi's.

[SlackerDad]

Originally Posted by Frank Koehler

Hospitals do circs because it is an income stream. That's right. Follow the money. Why do you think docs and nurses keep asking the parents if they want circumcision after they've said no the first time? It's a money-making add-on sale. Not only do they get to charge for the circ, but the extra half-day hospital stay, too.

There may be something to that, but it's not as much of it as some people think. After all, while the doctors and hospital administrators may increase their bottom line this way, is it really so helpful to the nurses when there is already a nursing shortage? I think it's more because it's a social norm and it looks weird to them when it's not done.

[baby duck]

Here, I think, that both OB's and pedi's do circs. My sons pediatrician has made it clear that "nobody touches her babies" while they are in the hospital, so I didn't have any questions about circ or vaxes while we were in the hospital. Love her.