Why is it considered okay to use local only (if that!!!) on a newborn??

[azgirl]

I mostly lurk.

I am incredibly lucky that not circing was an established norm among a bunch of our friends (crunchy and non-crunchy alike) before I had DS 3 years ago and none of my friends has circed since then.  I didn't try to convince anyone, but I am very vocal about the path we took to leaving our son intact, and I am a very vocal person.

I have ended up in a good, but vague convo about circ with a dear friend who is planning on doing it. Since this is an issue I am really passionate about it has been really cool to have the opportunity to discuss it with someone who is planning on doing it but is open to exploring the issue. I realize that I am equipped, having worked through my issues surrounding circ and my husband's issues, to see the "other" side and therefor have a heart-felt response for it. In other words, if someone is worried about cleaning it, I can relate and talk about how I was worried about that and go on to describe my experience having to do absolutely nothing etc.  Am I making sense so far?

There is one thing I don't understand and I am not sure I am willing to Google "pro-circumcision arguments" or whatever to find out. I think it's a common stated reason for RIC: better do it to a baby than later when it would be a more involved procedure and require general anesthesia. My understanding of infant foreskin function/anatomy vs older child/adult function/anatomy leads me to conclude that circumcising a baby is a much more traumatic procedure than circumcising an older boy/man...if circumcision can ever be "less traumatic" my point is, I could easily argue against the "less traumatic" part, even if I'm actually wrong!?? Anyway, it's the anesthesia thing that confounds me...

Why is it considered okay to perform circ without GA on a newborn. I don't think it's okay. Why is it considered okay? I have some ideas but they are pretty hysterical, or would come off that way, frankly. I want the official, medical rationale.

Are there other procedures that can be done sans anesthesia on babies that can't be done without going under at 1 year of age? I can't think of one off the top of my head. I feel like I have heard of botched circumcisions being fixed under general at a few months of age...what are the guidelines for the use of general anesthesia for penis surgery or any other procedure?

Discussing adequate pain control for babies is a very triggery, emotionally charged issue for me, I wonder if I am missing the obvious because of my issues.

[mntnmom]

For a while, there was a theory that babies nerves weren't developed enough to feel pain the way adults do. We now know that isn't true (somebody knows the studies), but even a lot of doctors have held on to this idea. In reality, I fear it is a matter of convenience. A newborn can't really fight you, but a 4 yr old can, and an adult would punch you. Men especially, seem to use the rational that if they can't remember the pain of having it done as a baby, that must be better than remembering as an adult.

[MCatLvrMom2A&X]

They wont remember the pain after all so local and in some cases just a sugar paci is all that is needed *insert heavy sarcasm here* honestly though that is how many people including most Dr's look at it.

I have a really hard time wrapping my head around the fact that many dont believe a baby feels pain like a grown up or child does. Having had 2 babies and having accidentally scratched both of them I know for a fact that they feel pain acutely and unlike an adult dont have the mental ability to deal with it like a grown up would.

[sosurreal09]

There is actually proof that babies feel MORE pain b/c of the greater sensitivity of their nerves etc. I have *witnessed* many circ (in medical training) and they all got sugar on a paci! It was HORRIFYING. Those poor poor boys. I was told "they couldn't feel it b/c the sugar distracts them" So I suppose if someone cuts off my clitoral hood real quick while I am watching TV or eating a cookie I wouldn't even feel it right?

I absolutely agree with PP it is about convenience. It was started in the US to stop masturbation (on girls too) by Dr. Kellogg (like the cereal!) when I tell people that they tend to think twice.

[Treece]

NAK

And let's not forget that open heart surgery was done on babies with anestesthia as recently as the 1980s. I dont have a link, but will provide one later

[vachi73]

I'm not sure that this is the answer that you're looking for, but the reason nothing/sugar/local are used instead of general anesthesia is due to the risks associated w/ general anesthesia. Obviously, general anesthesia is always more risky than a local, but GA is particularly risky for newborns/babies to at least age 1, and *I* would add children to at least age 12 to that, but that's just the mama bear in me!

I think the "do it while the baby won't remember it" belies an assumption that the foreskin is inherently illness-prone/dangerous for the child, and *of course* he will ultimately need to be circumcised and will remember how intensely painful/horrible it was. Well, 90% of the earth's men are proof that the foreskin ISN'T inherently bad. So are most of our grand- or great-grandfathers (who, beyond a certain number of years back, were very likely left intact after being born at home!) And as to how intensely painful and horrible a circ is at age X versus as a newborn ... I'd guess that it's at least equally painful to a newborn, if not more painful to a baby with "new" and more "raw" nerve endings. Just my opinion, though.

[azgirl]

Originally Posted by Treece 

NAK

And let's not forget that open heart surgery was done on babies with anestesthia as recently as the 1980s. I dont have a link, but will provide one later

I am the mother of a 25 weeker who spent 4.5 months is the NICU. He was in enormous amounts of pain and received very aggressive pain control (it took 6 weeks to wean him off the huge amounts of morphine he was on) I was absolutely horrified to learn of the history of preemie pain control, or lack thereof, in the last 30 years. It's just horrifying. I was hoping for a less sinister answer because the actual situation wouldn't be very believable...

[azgirl]

Originally Posted by vachi73 

I'm not sure that this is the answer that you're looking for, but the reason nothing/sugar/local are used instead of general anesthesia is due to the risks associated w/ general anesthesia. Obviously, general anesthesia is always more risky than a local, but GA is particularly risky for newborns/babies to at least age 1, and *I* would add children to at least age 12 to that, but that's just the mama bear in me!

I think the "do it while the baby won't remember it" belies an assumption that the foreskin is inherently illness-prone/dangerous for the child, and *of course* he will ultimately need to be circumcised and will remember how intensely painful/horrible it was. Well, 90% of the earth's men are proof that the foreskin ISN'T inherently bad. So are most of our grand- or great-grandfathers (who, beyond a certain number of years back, were very likely left intact after being born at home!) And as to how intensely painful and horrible a circ is at age X versus as a newborn ... I'd guess that it's at least equally painful to a newborn, if not more painful to a baby with "new" and more "raw" nerve endings. Just my opinion, though.

This is exactly the info I needed, thank you. It still doesn't explain why it has to be done to a newborn, though, right? If it's okay for a newborn to forgo GA why do they insist older kids get GA? It's really that it is less dangerous therefor more necessary? I guess I am still confused.  I had a critically ill infant, so he was administered a lot of dangerous drugs and went through a lot of dangerous procedures. I wasn't aware that GA was more dangerous to newborns. Ugh, my little guy needs to go under for surgery soon :(

My thought is that it would be less traumatic to remove the foreskin after it had separated completely?  It's not an educated opinion AND a moot point at that. I just don't get why it would be LESS traumatic to a newborn...

Can I add that we had a mostly wonderful, fabulous, incredible experience with the medical profession while we were in the NICU.  I think I want to give them the benefit of the doubt sometimes but you cannot underestimate the POWER of cultural norms to allow otherwise compassionate professionals to do cruel things and disregard scientific evidence...It appears that the same docs who insisted my son get morphine, sedatives and anti-anxiety drugs to cope with his procedures may have been willing to perform a circumcision with little or no anesthesia...weirdly enough none of the (mostly foreign-born, if that matters) neonatologists that put so much effort into saving our son so much as mentioned circ. It was some NP I don't ever remember meeting in the 4.5 months we were there that called and offered to do it the night before we took him home from the hospital. Hmmm...I wonder if those other docs wanted to avoid the topic and not know what we ultimately did...and they were nosy enough to tell me to keep breastfeeding, get rid of our pets and not send DS to daycare, they weren't above giving their opinions...

Maybe I am over thinking this. It's just an emotional issue for me...

[azgirl]

Preemie/newborn/fetus anesthesia article:

http://www.nytimes.com/2008/02/10/magazine/10Fetal-t.html?_r=1&sq=fetal+pain&st=nyt&scp=1&pagewanted=all

warning: this goes into the fetal pain/abortion debate also...but the preemie/newborn/circumcision angle is really fascinating...

[T-man's Mama]

I don't know quite how to frame the point I am going to attempt here, but bear with me. What I find incredibly absurd about this debate of whether newborns experience pain is the juxtaposition of this concept with abortion laws. Some states, like Nebraska, place the dividing line on legal abortions at 20 weeks on the premise not of viability but that a fetus would feel pain. Other states and organizations differ in their ideas of when the fetus would feel pain, but nobody is claiming a fetus cannot ever feel pain -- just whether that develops at 20 weeks, 24 weeks, 28 weeks, etc. So how can one believe that a fetus feels pain during the last 3-5 months in the womb, but NOT once it is born?!?!  And be all fine with a non-anesthetized surgery?!?!  It just seems so...schizophrenic.

[T-man's Mama]

I did not see this post when I added my comment, but interesting...
 

Originally Posted by azgirl 

Preemie/newborn/fetus anesthesia article:

http://www.nytimes.com/2008/02/10/magazine/10Fetal-t.html?_r=1&sq=fetal+pain&st=nyt&scp=1&pagewanted=all

warning: this goes into the fetal pain/abortion debate also...but the preemie/newborn/circumcision angle is really fascinating...

[jenP]

That was an excellent article, thank you azgirl. I am looking forward to the author's upcoming book on "the lasting effect of early experience."