Just a question....

[campbellsoup]

I have 3 intact boys and my husband agreed wholeheartedly with our decision.  We were having a breakfast discussion this morning after reading an article in the Chicago Tribune entitled "The Circumcision Decision."  It sounded as if the AAP might be altering their stance on circumcision.  That can't be good.

Anyhow....I think circing is awful.  DH is circed and the decision not to circ our boys was because "there is no reason to....why would we?"  He thinks the argument of looking like Dad is hilarious.  But he is not as horrified by the procedure as I am.  I don't really understand, since he is a guy. 

I was describing the pain aspect (again) and he asked somewhat rhetorically....."they don't use anesthesia?"  I replied, "I don't think they do....at least not all the time."  He  was incredulous.  "In 2011 they don't do something for the pain?"  He argued that if the pain is so horrendous, that parents wouldn't  allow the procedure....at least not without pain med.  Furthermore, he said that if the pain was that bad babies would probably continue screaming days after.  Again he said, parents wouldn't be doing it if that was the case.

I would love any and all feedback.  

[MCatLvrMom2A&X]

It is true that many babies get little to no pain relief. Some get EMLA which is a numbing cream that actually isnt supposed to be used on the genitals at all and others get a nerve block shot at the base of the penis which is painful in itself but does remove the pain. But then there are the Dr. that believe that no pain relief other than sugar water is preferable because it gets the job done faster.

That isnt even counting the raw skin of the glans in the diaper with urine burning it until it is able to heal

[campbellsoup]

I read that some Dr.'s don't use anesthesia because they believe it is dangerous to babies.  Would that be the nerve block shot you spoke of?  Is that true that it is dangerous?  Wouldn't there be a protocol on how the circ is done or is it all up to the individual Dr.?

[MCatLvrMom2A&X]

It is up to each individual Dr. on how they want to do it from pain control to how much skin they remove. Some insist on "proper" pain management, while others dont see the big deal. I am not sure what the issues are surrounding the nerve block since I cannot look that stuff up without sending me into anxiety attacks. I hope someone else will come along with more information for you along with links.

[WonderfulStuff]

As far as I have read and discussed with people and nurses, it is up to the individual doctor.  Both pediatricians and OBs can do circumcisions, but of the two, only OBs are formally trained as surgeons.  I understand that there are a few options (for the doctors to use):

1. Baby Tylenol/ oral pain med

2. A pacifier dunked in sugar water

3. A shot of numbing med (lidocaine or something like what is used in dental procedures)

4. A cream (as said above)

I do not believe that parents usually have a choice in which method doctors use.  The injection is often given without enough time to take effect before the procedure.  And many (I saw a study that said up to 20% nationally***) doctors and hospitals still continue to do the procedure without pain treatment at all -- again it is up to the individual doctor.

I've heard from a number of nurses that often babies will fall asleep during the procedure.  I am not convinced that this is not due to the shock from the pain, as babies often 'fall asleep' due to other kinds of stress.

My mother and friends told me that their boys would cry for days - every time they had their diapers changed for weeks. 

***ETA:  Scratch that -- only 45% use anesthesia.... here is the study: http://pediatrics.aappublications.org/cgi/content/full/101/6/e5

Edited by WonderfulStuff - 3/21/11 at 11:49am

[LiLStar]

I don't see why an anesthesiologist isn't required to be present at *all* circs. And since its ELECTIVE, there would be a required anesthesia consult before. I had to have an anesthesia consult before I had my wisdom teeth out of all things, so why on earth not for amputative surgery? @@ sheesh. I wonder what would happen to circ rates if anesthesiologists were required? It sure would change a lot about how, where, and when they're performed. More work, more cost, less convenient, and the anesthesiologist's present could do 1 of 2 things..give the impression that this is a SERIOUS and PAINFUL thing and a "real surgery" and maybe make parents think a little. Or it could reassure parents that its "no big deal" because the baby won't feel pain :/ Then what about the anesthesiologists, are they going to greedily want the extra income, or will they be annoyed by attending them all. Would the hospitals who don't do circs at birth anymore then start offering them again, simply because it would be impossible to just do it in the ped's office a week or 2 later? Or would it simply become more of a hassle to get a circ because you'd have to schedule an appt at the hospital after discharge. Would more insurance companies quit paying for it because the anesthesiologist fee ups the cost? Would it then become out of reach for families to pay for out of pocket so they'll just skip it since they can't afford it? So many possible consequences... I've thought about what would happen quite a bit. The worst case I've thought of was cattle call style anesthesiologist consults in a big group, followed by assembly line circs and parents who think nothing of the procedure because the magic anesthesiologist will take all the pain away. 

[WonderfulStuff]

Originally Posted by LiLStar 

 The worst case I've thought of was cattle call style anesthesiologist consults in a big group, followed by assembly line circs and parents who think nothing of the procedure because the magic anesthesiologist will take all the pain away. 

I think we've got 2 out of 3 happening already.  When circs are done as routine hospital procedures, I've heard of babies being lined up strapped to boards waiting for the pediatrician (this story was on a nurses forum).  And parents who don't know any better already think the doctor gives the baby something magical to prevent the pain.  Only thing missing is the anesthesiologist.

[LiLStar]

Originally Posted by WonderfulStuff 

I think we've got 2 out of 3 happening already.  When circs are done as routine hospital procedures, I've heard of babies being lined up strapped to boards waiting for the pediatrician (this story was on a nurses forum).  And parents who don't know any better already think the doctor gives the baby something magical to prevent the pain.  Only thing missing is the anesthesiologist.

At the very least, requring by law proper anesthesia would make it slightly less traumatic for those poor babies 
 

[A&A]

Babies pass out from the pain, and then the doc reports that the child "slept through it." 

[Sarah]

Read the link that Wonderfulstuff posted- open the charts, the stats are very damning.  Remember that these stats do not reflect the number of circumcisions... but the number of circumcisers doing circumcisions.  Because most circumcisions are done by OBs- the rate of anesthesia use by the OB circumcisers is more indicative of the overall rate than an average between all specialties.

[moonfirefaery]

My baby had no pain relief. They told me he'd have anesthesia and they gave him someone's finger dipped in sugar water to suck on instead. For babies that do get anesthesia, it's usually topical in the form of an ointment, which doesn't do a very good job of numbing it. I've heard reports that they rarely wait long enough after applying the topical ointment before starting the procedure. Sometimes anesthesia is given in the form of a shot, but I doubt it eliminates all the pain and a shot is still painful. In any case, why would you want to cut your baby for no good reason--or inject pain killers in your baby, in order to amputate a useful organ for no good reason?

[Llyra]

I'd love to ask one of those docs to volunteer to have me peel back the skin off his little toe, and snip it off, with nothing but a lollipop for pain relief.

[PediNP]

Babies can and do sleep through circs on an hourly basis. I have never seen one "pass out" from pain. If they use a penile block, then there is zero pain during the procedure.

[CatholicBFMama]

Originally Posted by PediNP 

Babies can and do sleep through circs on an hourly basis. I have never seen one "pass out" from pain. If they use a penile block, then there is zero pain during the procedure.

It's not passing out so much as a shocked "retreat" from the pain. And even if the penile block prevents the pain of the actual cutting, how much does the penile block itself hurt?!? I had lidocaine injected into my inner labia for suturing after my first daughter's birth, and that pain rivaled the pain of the drug-free birth I had just been through!  
 

[LiLStar]

NO KIDDING! Lidocaine injections hurt like hell! I had stitches in my toe as a teen and that horrifying burn is not something that is quickly forgotten! My 22 month old ds had to have stitches a couple weeks ago and while we were waiting I was literally shaking in horror at the thought of holding down my baby while someone inflicted that kind of pain on him :( THANKFULLY they were able to use a topical (not emla) which worked fine, so he was spared. Whew. 

[Night_Nurse]

Originally Posted by PediNP 

Babies can and do sleep through circs on an hourly basis. I have never seen one "pass out" from pain. If they use a penile block, then there is zero pain during the procedure.

Welcome. I see you are new here. Although I am not a NP, I am a RN with almost 20 years experience (over 10 yrs in OB). I'm not going to dispute what you may or may not see in your practice but if the babies in your facility are all sleeping through their circs, I'd like to know where that is, maybe I can apply to work there. I've seen circs with and without pain relief, including a penile block. I've never seen a child not cry. I've never seen a baby sleep through a circ, either. Even the videos that doctors and teaching hospitals put out to promote how well they do their circs even show the baby screaming in pain (and they all get the pain block as well).

[ammiga]

Originally Posted by PediNP 

Babies can and do sleep through circs on an hourly basis. I have never seen one "pass out" from pain. If they use a penile block, then there is zero pain during the procedure.

How do the babies do after the circ? Now that they have an open wound that they urinate on, I'd assume they experience a tremendous amount of pain until the wound heals. Anytime I have an open wound, I'm in pain, and I don't pee on my wounds.

[treeoflife3]

I loved giving birth completely naturally!  It was absolutely amazing and I can't wait to do it again.  However the shots I got to get stitched up made me scream and cry and were easily literally the worst part of the entire last 9 months prior to those shots including the three month long 'morning' sickness and the constant bad hip pain the last month and the 'ring of fire' at crowning AND the charlie horse I got just before crowning.  In fact next time I sincerely might just skip the shot altogether and get stitched up with nothing more than my remembering how awful the numbing shots are if I need to be stitched up again.  I couldn't imagine making ANYONE take something like that for something so unnecessary, most especially a tiny little baby.
 

Originally Posted by CatholicBFMama 

It's not passing out so much as a shocked "retreat" from the pain. And even if the penile block prevents the pain of the actual cutting, how much does the penile block itself hurt?!? I had lidocaine injected into my inner labia for suturing after my first daughter's birth, and that pain rivaled the pain of the drug-free birth I had just been through!  
 

[philomom]

Originally Posted by treeoflife3 

I loved giving birth completely naturally!  It was absolutely amazing and I can't wait to do it again.  However the shots I got to get stitched up made me scream and cry and were easily literally the worst part of the entire last 9 months prior to those shots including the three month long 'morning' sickness and the constant bad hip pain the last month and the 'ring of fire' at crowning AND the charlie horse I got just before crowning.  In fact next time I sincerely might just skip the shot altogether and get stitched up with nothing more than my remembering how awful the numbing shots are if I need to be stitched up again.  I couldn't imagine making ANYONE take something like that for something so unnecessary, most especially a tiny little baby.
 

I agree with some of this post. I had an amazing natural childbirth experience but experienced a very small vaginal tear... not the perineum, but the actual birth canal. We joked the baby must have had long fingernails or something. The shot to numb up for the three little stitches was excruciating. I cried and I NEVER cry.

[QueenOfTheMeadow]

Originally Posted by PediNP 

Babies can and do sleep through circs on an hourly basis. I have never seen one "pass out" from pain. If they use a penile block, then there is zero pain during the procedure.

Hmm, my mom was a maternity nurse for over 20 years and is now a childbirth educator. She has always been appalled by the unnecessary pain that baby boys are put through for cosmetic surgery, not to mention how many complications she has seen. I wonder exactly what all the OBs that she has worked with were doing wrong? Of course there were some who would not use pain medication, and others who would not wait until the medication was actually working. They there were the ones who used penile blocks, etc, and yet the baby still screamed bloody murder, and then continued to scream everytime they had their diaper changed or peed or pooped. And then, of course there is the fact that circ interrupts the breastfeeding relationship (mom is also a IBCLC, so she deals with that on a regular basis as well.) The research and common sense are there that indicate that babies do not simply "sleep" through having painful injections and part of their anatomy cut off.