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"Some do, some don't."

post #1 of 35
Thread Starter 
This quote is from the L&D nurse who taught our hospital's childbirth class, referring to anesthesia use by the doctors there who circ. This is one of the biggest hospitals in my state, too!

I've heard people in this forum claim this kind of thing goes on, but I had somehow rationalized in my mind that it must be only a few old doctors scattered around who were holding on to their archaic methods. I guess not.

This is cruelty to babies!!!
post #2 of 35
Quote:
Originally Posted by outlier View Post
This quote is from the L&D nurse who taught our hospital's childbirth class, referring to anesthesia use by the doctors there who circ. This is one of the biggest hospitals in my state, too!

I've heard people in this forum claim this kind of thing goes on, but I had somehow rationalized in my mind that it must be only a few old doctors scattered around who were holding on to their archaic methods. I guess not.

This is cruelty to babies!!!
Well the whole RIC procedure is archaic, what did you expect?
post #3 of 35
In 1998 Stang found
Quote:
A substantial number of PEDs are performing circumcisions, and they are most likely to use anesthesia (71%), followed by FPs (56%), then OBs (25%).
Most circs were done by obs, much of the anesthesia was inadequate, sugar pacifier on its own, EMLA on its own etc.

As for the OBs, "unconscious hostile impulses" come to mind. (I cannot say what I really think.)
post #4 of 35
Unfortunately, that's right -- something like 70% of newborn male circumcisions are still being done by OBs, and probably a majority of those are done without anesthesia at all, and almost certainly without adequate anesthesia. There was a collective groan from the medical profession when the AAP emphasized anesthesia for the first time in 1999. Maybe the OBs feel that an AAP directive doesn't directly apply to them, but a lot of doctors were rather annoyed at the recommendation. Circumcisions used to be fast money, easily 4 or 5 in an hour in experienced hands, at $300 a clip. Many docs simply did not want to wait 20 minutes for analgesia to kick in, or an hour for proper anesthesia. It knocks their game off... when you expect to slice 5 boys between 7 and 8 am and meet the rest of your foreskin foursome on the golf course by 9, it's pretty annoying to be held up a couple of hours by something Tiger Jr. won't remember by the time he's caddying age. Get priorities straight!

Unfortunately, the US does not have a law like other countries to ensure proper anesthetization of infants before surgery, including circumcision. Topical analgesia does not reach the second, inner layer of foreskin that is fused to the glans. And infants feel even more pain than adults, because their central nervous systems have not developed any pain-dampening mechanisms. To an infant, it must feel like he's being murdered starting with the penis. The great majority of parents whose sons have been circumcised in this way have no clue. There is even a popular YouTube video of a Canadian circumcision with the dad in the room specifically concerned and asking about anesthesia, and the doctor just baldface lies about it.

It's an ongoing American tragedy; the shocking truth is that as long as it takes more time, trouble and money to anesthetize a baby, many doctors still won't use it. The good news is that the anesthesia issue probably has dissuaded quite a few doctors from doing circumcisions altogether.
post #5 of 35
In addition to the extra time and money Brant31 mentioned, there is also the additional risk of allergic reactions and the foreskin is then unsuitable for harvesting and selling for use in cosmetics.
post #6 of 35
wow

and they're always asking moms if she wants an epidural even if she stressed her desire to have a natural birth.

"So, you want that epidural now... how about now? ... okay, I think you're ready for that epidural dontcha think?"

but to let a baby who is fully aware, hyper-responsive to touch (a survival mechanism) undergo a penis surgery without full pain relief? wow, if thats not abusive then I don't know what is.
post #7 of 35
Quote:
Originally Posted by fruitful womb View Post
wow

and they're always asking moms if she wants an epidural even if she stressed her desire to have a natural birth.

"So, you want that epidural now... how about now? ... okay, I think you're ready for that epidural dontcha think?"

but to let a baby who is fully aware, hyper-responsive to touch (a survival mechanism) undergo a penis surgery without full pain relief? wow, if thats not abusive then I don't know what is.
A different Dr gets to send out a whole separate bill for an epidural. If they got to bring in an anesthesiologist, who could send out a separate bill, for circs, then it would be a whole'nother story, and babies would get all kinds of pain relief.
post #8 of 35
Then I guess it's worth lobbying for a regulation that for all surgical procedures that cut through and remove veins and nerves, an anesthesiologist's services are required. On a neonate or any other patient. I think this may be in Sweden's law. Weird that we'd even have to ask for this level of professional attention for genital surgery. It would be automatic for anything but circumcision.

Here is a bit of good news on the horizon. There have been previous attempts to get OB/Gyns out of the circumcision business (wrong gender specialty). It seems OBs picked up the habit because Pediatricians as a group have never been overly enthusiastic on circumcision, and the OBs saw it as money just lying on the table. So far, they have ignored calls to stop soliciting and performing circumcisions.

But professional ethics trudges slowly forward, and the issue is coming into better focus. Part of it is the anesthesia annoyance. The big question is, if OBs transition out of doing circs, is another specialty (Peds, Ped Urologs) ready to step in? Or should circumcision be discouraged? Or neither -- simply not mentioned? Would OBs be obligated to provide referrals?

These questions and others are probably addressed in an article just about to be published, titled "The Professional Imperative for Obstetrician-Gynecologists to Discontinue Newborn Male Circumcision" by James F. Smith MD, Department of Obstetrics and Gynecology, Westchester Medical Center, New York. Here are a few words from the abstract:

"Indications for routine circumcision remain controversial... it has persisted in the scope of practice of obstetrics and gynecology, a field specializing in the opposite gender. To excel in women's reproductive health, we should no longer passively accept or actively maintain this procedure in our specialty."

Couldn't be any clearer. I hope this time they listen.
post #9 of 35
Quote:
"Indications for routine circumcision remain controversial... it has persisted in the scope of practice of obstetrics and gynecology, a field specializing in the opposite gender. To excel in women's reproductive health, we should no longer passively accept or actively maintain this procedure in our specialty."
Another reason why obs/gyns doing circs is inappropriate (even if I believed in circs) is that they are in a weak position to follow-up, or even know of complications.

Also ten years ago at least, many obs got no training re circ+anesthesia.

In Australia a few years ago a few obs did circs. Now infant circ can no longer happen in hospitals, obs are out of the picture. So banning circs in hospitals is a powerful solution.

Quote:
Indications for routine circumcision remain controversial
Huh?
i always thought the AAP said there were no indications for circ in the
neonatal period.
post #10 of 35
Quote:
Originally Posted by eepster View Post
In addition to the extra time and money Brant31 mentioned, there is also the additional risk of allergic reactions and the foreskin is then unsuitable for harvesting and selling for use in cosmetics.


Cosmetics or other research. Here's an article about foreskins being used in HPV vax research:

"1986 – John Kreider finds a way to mass-produce HPV: He collects foreskins from infant circumcisions, infects them with HPV, and grafts them onto mice whose compromised immune systems cannot reject the graft or fight the virus."

http://discovermagazine.com/2007/may...&b_start:int=0


Foreskins can't be used in research if they've been "compromised" with anesthesia. And of course, foreskins can't be used in research if they're still attached to their original owners!!!
post #11 of 35
Brant- I look forward to seeing that paper written by the OB who says they should get out of the MGM business.

Several years ago I went to an ACOG convention and handed out this flyer I'd written.

Outlier- You asked about pain relief and how often it's used. Trust me- this situation is not just inflamatory rhetoric made up by "the anti's" ... it's much worse than you imagine. If you look at point 7. - read the Stang/Snellman paper and open the graphs to see just how bad it is.

Ten great reasons for Obstetricians to quit circumcising babies


1.To comply with ACOG guidelines of informed consent.
Being born with a normal male sex organ is not an emergency. A male can make this decision for himself if he chooses. ACOG makes a great effort to protect the physical integrity of female patients and to secure consent for all procedures, the willingness to ignore these guidelines in order to circumcise infant males highlights a sexist double standard. Males should also be respected as whole and embodied persons.

2. Circumcision violates the Hippocratic Oath. Participation in an invasive non-medical procedure is an indicator of a physician’s professionalism.

3. American circumcision is a global embarrassment.
Callis Osaghae bled to death after a home circumcision in Ireland. Many Irish doctors were incensed when it was suggested that they should preform circumcisions for the immigrants who requested them. They felt this was an abuse of their medical training and a clear ethical broach. American doctors are protected by law, from pressure to circumcise females, yet no such legislation protects doctors from the pressure to circumcise males. Their inability to stand up to that pressure, in the absence of state mandated legislation, reflects poorly on their ability to comply with internationally accepted medical standards.

4. Obstetricians are specialists.
Despite this, obstetricians have cornered a market outside their specialty by popularizing the circumcision of male neonates. High pressure tactics in the hospital and a service industry conveyor belt give indifferent or reluctant parents the opportunity to secure a circumcision without having to do anything. A circumcising OB will rarely do any followup and will also not encounter any of the common long term pediatric or adult issues of circumcision damage. This confusion of the role of an obstetrician as child circumciser reflects poorly on the obstetric profession and abusively forces maternity nurses to cooperate.

5. Soliciting elective surgery from women in labor is abusive and unethical.
There is an implied medical endorsement when hospital staff solicits in the course of admitting patients. The AMA circumcision policy states that a lack of information and deferral of the decision until after the birth contribute to the high rate of circumcision in America. This means that if parents were given more time and more information, fewer would circumcise their son.

6. Unnecessary surgery exposes a circumciser to avoidable liability.

7. The refusal to treat infant pain is well documented. The obstetrician circumciser is the worst offender of any medical specialty; with the most appalling record right here in the northeastern US. Despite the AAP admonition that children not be exposed to the pain of circumcision, many medical schools still teach circumcision without pain relief. (using living human children)
Circumcision Practice Patterns in the United States
Stang HJ, Snellman LW Pediatrics. 1998 Jun;101(6):E5
http://pediatrics.aappublications.or.../full/101/6/e5

8. Circumcision in America did not spring from our culture, it came from our doctors.
Circumcision is now known to have no medical value, yet doctors inexplicably offer it as a cultural service, maneuvering consent from fathers circumcised in an era predating modern respect for patient autonomy.

9. Circumcision gains public acceptance at the expense of a physician’s professional integrity.
As long as physicians are willing to involve themselves in non-medical surgery, parents will be confused about the intended purpose of such surgery.

10. The best reason to say, "NO!" is your own.

This message to obstetricians comes respectfully to you from a survivor of Placenta Previa
post #12 of 35


The baby is NOT the ob's patient.
post #13 of 35
I have an aquaintance (nurse) that worked for a urologist for a while. She is strongly anti circumcision.
She told me that anesthesia was applied via injection but the doctor would then immediately begin the procedure - giving no time for the anesthetic to take effect. So, even when you have anesthesia being used, it's useless unless it is allowed to actually anesthetize the area.
post #14 of 35
Thread Starter 
Yeah, I guess I shouldn't be so stunned by this, but she just laid it all out there in our class like it was no big deal, and apparently dh and I were the only ones who wanted to scream. The nurse did make sure to say that if you want your boy circ'd to make sure they use anesthesia because it does hurt, even comparing it to labor. Of the three couples there who knew they were having boys, two were dead set on it.

I told dh that if our baby is a boy, he (dh) is not allowed to let the baby out of his sight the entire time we're in the hospital. I think we'll bring a sharpie marker with us and may consider writing on the baby depending on the situation.
post #15 of 35
Quote:
Originally Posted by brant31 View Post
Unfortunately, the US does not have a law like other countries to ensure proper anesthetization of infants before surgery, including circumcision. Topical analgesia does not reach the second, inner layer of foreskin that is fused to the glans. And infants feel even more pain than adults, because their central nervous systems have not developed any pain-dampening mechanisms. To an infant, it must feel like he's being murdered starting with the penis. The great majority of parents whose sons have been circumcised in this way have no clue.
Ironically, one of the main reasons I hear from parents who are going to circumcise (second only to the "look like dad/tradition/culture" reason), is the old, "it will hurt much more if he has to have it done when he's an adult."

Jen
post #16 of 35
Those numbers are so sad and make my heart think. How can doctors who swore the Hippocratic Oath seriously skip anesthesia for such a procedure? Do they really think babies don't feel pain or it doesn't matter since they won't remember as adults? Obgyns just sunk a whole 'nother level deeper in my eyes. I often discuss medical decisions and tendencies with my MD sister (we are born and raised in Germany, my family still lives there). Of course we are not always of the same opinion (she thinks birth out of the hospital is dangerous e.g.), however circumcision is something we would never do without clear medical indication (a true condition must exist) and surely not without anesthesia. She didn't want to believe me when I first told her how it is not done at all or only EMLA cream or such... Now that I know the sort of current statistics on how often it is used, I will ask her to talk to her peers, I'd love to find out how other docs back home feel about that fact. I want to know it that's an American thing or if all docs are like that. My sister clearly as a mom of a boy is very protective and might have a different stance. Do you guys know of any medical professionals outside of the US and have asked them how they feel about this situation?
post #17 of 35
I am reading What Your Doctor May Not Tell You About Circumcision, and the authors are talking about complications from circumcision. The tone is that most anesthesia techniques are associated with a higher complication rate for newborns than adults. Is this right? How "safe" is it to anesthetize an infant, even if there is a true medical indication (which there is not in RIC)?

They say that with local injection anesthesia (penile block), the doctor has to inject in just the right spot where the nerves are, in order for it to work. But, the doctor can't know if they actually injected the anesthesia in the right place or not. If they inject too deeply, it can cause erectile dysfunction, although I am not clear on if this is a risk only in adult circumcisions.

Also, they say that one manufacturer of EMLA cream states that the product is NOT for use in surgery.

I don't remember any discussion on the ring block local injection method. Does anyone know which method is usually used? Or is it a crap shoot, since there is no guarantee that the OB will even use anesthesia?
post #18 of 35
Quote:
Originally Posted by PuppyFluffer View Post
I have an aquaintance (nurse) that worked for a urologist for a while. She is strongly anti circumcision.
She told me that anesthesia was applied via injection but the doctor would then immediately begin the procedure - giving no time for the anesthetic to take effect. So, even when you have anesthesia being used, it's useless unless it is allowed to actually anesthetize the area.
Yes.

How many times have I heard parents say "It wasn't a big deal, he was only gone for five minutes." If he was only gone for five minutes, you can guarantee that that baby received NO pain relief.
post #19 of 35
I saw a friend of mine today who is a former NICU nurse. She said they would circ the NICU babies on the day before of day of departure (when requested by the parents). Assisting with circumcision was a required part of her job. She said none of the doctors liked doing them and they did them as fast as possible. They would inject anesthetic and immediately begin the procedure.
post #20 of 35
Quote:
Originally Posted by PuppyFluffer View Post
I saw a friend of mine today who is a former NICU nurse. She said they would circ the NICU babies on the day before of day of departure (when requested by the parents). Assisting with circumcision was a required part of her job. She said none of the doctors liked doing them and they did them as fast as possible. They would inject anesthetic and immediately begin the procedure.
Doesn't anesthetic need time to take effect? From what i've heard, this is another problem with circumcision. They may give the anesthetic, but they won't give enough time for it to take effect.
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