Intactivism *time sensitive* circ and WIC

[craft_media_hero]

I tried to post in intactivism and kept getting redirected. Also would rather post anonymous for this but cannot find that option either--mods please change if possible.

I need help, quick, please reply asap pro intactivists!

I work for WIC as a breastfeeding peer counselor. I live and work in a decidedly non-crunchy area.

At a staff meeting last week, my boss mentioned how Medicaid is no longer paying for circ (yay!), followed by eye-rolling and insensitive comments regarding use of sugar pacifier to cut the pain :(

One "lead" staff member in particular became very verbal about how she is informing folks that it can be performed at 2-30 days after birth in pediatrician's office, and after that time must be referred to a urologist and that she is advising families to save up the $350 to pay out of pocket for the procedure. 

I was horrified, my heart beating, just totally caught off guard at this unexpected exchange.

My direct supervisor (who is baby friendly and I suspect pro-intact) caught my eye and asked if I wanted to say something. I was NOT prepared and wish I had done a better job :(

I said we should note that evidence does show that circ negatively impacts breastfeeding, that we don't need to tell them to do it, and that my son was "uncircumcised" (for which I am kicking myself because he is INTACT!! and I am normally a big stickler for language changing culture). It was awkward, and lead girl gave me dirty looks, the big boss mumbled how "and that's more and more prevalent these days" and then she changed the subject. 

Anyway, I have been stressing out thinking about this educator talking to every mom who comes in her office pregnant with a son and presenting circ as the norm, not even accounting for the option of intact, and giving them the lowdown on just what to do step by step basically a check list how to cut your son now that the state won't pay for it.

My main issue (small scale) is that this topic is out of her scope of practice and she should not even be discussing it with clients--how do I make that clear among the staff in my office? I want to write a follow up email, but feel like as the days go by it will be less and less relevant, so I'd like to send it out tomorrow night (from home). How do I phrase this in a non-offensive way that doesn't look like a personal attack but makes it very clear that no staff member shall influence a family's decisions regarding genital autonomy?

Should I include facts about how as many boys die of circ complications as SIDS (which is so big a deal among human services), if so, where are the published legit facts for that? Should I include research on circ effect on breastfeeding if so where do you find those legit facts? like from a medical research paper, not just a blog, kwim?

Now: on the larger scale, I cannot find an official policy from WIC regarding circ and how staff members should handle the issue if it comes up in visits. In my mind, we should do what we are always supposed to do, which is EMPOWER moms and families to make informed decisions for themselves, refer them to self-educate and talk to relevant professionals (not that most hcps are that informed abt circ but that is another issue). So. We need to get WIC to develop a national staff policy which states "staff members will not influence families regarding decisions of whether or not to circumcise" or something like that. y'all gotta help me with that ;)

Her conversation with families should've not mentioned circ AT ALL unless the family brought it up themselves, then she shoulda said, "it's great that you are proactive in educating yourself about the issue; I'm sure that you will make the right decision for your family" or something like that. Instead, in my mind I see, "oh you're having a boy? did you know medicaid won't pay for circ and they don't do it in the hosp? you better start saving up now." WRONG WRONG WRONG.

GTG baby boy needs me! Please write back stat!

[serenbat]

If you don't have any set policy is it really going to make any difference? The educator is the issue not so much the policy (or lack there of) and you will not be in on each conversation she has. If she is pro and no policy stops her from saying what she wants how much change can you have? You could attempt to educate the director but if it's not policy how can she stop the educator from giving her point of view? WIC seems to often state "policy" that is not (ex. vaccines -no mention of exemptions- it always seems to be posted in the vac section about someone who was told they will be denied, etc).

just asking, I don't see without clear policy (consequences for not following) how much the best education is going to "educate" the educator?

[craft_media_hero]

I guess that's my intactivist point, that WIC national should have a policy which explicitly prohibits staff from influencing families in making that decision. So I need help from you all in making that happen, I hope some of you have ideas how to go about it.

At least in my training, I was taught that if something is not within my scope of practice (ie has to do with breastfeeding or specifically impacts breastfeeding) that I should refer to their health care provider or other professional, I should NOT tackle that issue with my own opinions regardless of how informed they might be. SO, if a client asked me about circ, I could (within my scope of practice) say, "there are studies that link circ with difficulties in breastfeeding; talking about with a lactation consultant might clear up the decision for you. Your doctor might have more info, too. I definitely encourage you to research the issue for yourself" and that would be okay as it is within my scope of practice and I am referring her to her doc, an IBCLC for further info on the circ/bf link, and empowering her to self-educate.

Assuming all families will circ as soon as they say they are having a son (which is par in my area), informing that medicaid doesn't pay, and giving them a step by step plan of how to save up for it is in no way within a WIC educator's scope. She shouldn't be bringing it up and she should be referring out if someone asks her about it.

I think that if I make a staff wide statement about how discussing circ is out of our scope of practice (which it surely is and should be pointed out!), then she will at least know that she is not supposed to be having that conversation if she chooses to do so and can therefore be held accountable if she does cross that line and a mom comes back and says, "WIC told me to save up to get my son circ'd" kwim?

Help, please!

[Siouxsie]

The AAP states, "Except under special circumstances, the newborn infant should remain with the mother throughout the recovery period. Procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized."

It seems out of line to me that your associate is encouraging people to kind of 'get around' the system. I think that the bigger issue of WIC not having a policy regarding circumcision should be addressed. Parents have the right to know how procedures can effect their baby and their breastfeeding relationship. (I also don't understand why the LLL has removed information regarding circumcision)

I think it's great for you to send a follow up email. I'd maybe stick to the facts about circ negatively impacting breastfeeding because that is directly relevant to your job.

here's what the LLL used to inform their leaders http://www.cirp.org/library/birth/leaven1/

Good luck!

[craft_media_hero]

Thank you for that!

Do you have the link to the AAP quote, too? I looked on their site and though it says they do not recommend it to be routine, the language is still pretty pro-circ in my opinion with references to the supposed "benefits" (lowers HIV, stds, cervical cancer which I think is all a load of hooey and I don't necessarily want to pass that weak info on).

You are right about the main problem being that WIC (nationally not just my office) not having a policy.

Intactivists, activate! How do we go about the national problem and the office problem?

[Siouxsie]

That quote is here under " recommended breastfeeding practices" http://pediatrics.aappublications.org/content/100/6/1035.full

I'm not sure how to go about addressing the lack of policy.......I received help from WIC when I had my first son when I was a teenager and I know a lot of young moms who rely on WIC. I hate to think of your associate there advising them that way. They should be given all the information they need to make an informed decision and like you said your input would go as far as letting them know that studies have shown it can effect breastfeeding.

I don't really know how WIC is set up but is this something you can inquire about there at your level? Please let me know what happens and if I can do anything. I would definitely write a letter at the very least.

[craft_media_hero]

Please write a letter to WIC on the national level asking them to train their staff *not* to influence families concerning circumcision. Ask them to include evidence-based training materials for their educators and breastfeeding support staff which address circ's effect on breastfeeding if families bring up the issue themselves and that they should refer out (IBCLC, HCP) and empower parents to research the issues themselves. YES!

I don't feel that I have access where I am at to inquire about WIC's national policy. I don't think they have one, but they do state in our training that we should refer out and not address issues outside of our scope of practice.

I will address the issue with my office staff on the small scale, and I will support any kind of large scale intactivist effort to ask WIC to address circ in their training materials (concerning bf coz really that's the only connection that circ has in a WIC office), but I do not feel able to be the front-liner in a national effort.

We have bf baby models in my office, and my previous trainer made a point to order all male babies and order them all circ'd and to point out to all of us (3 being trained at the time) that they were circ'd :( like, have a bit of an agenda there? We really are in a super "backward" area culturally as far as circ, bf, and other "progressive" parenting issues.

I don't care if I am unpopular at the office for bringing this back up, but I do value my job and don't want to be seen as a PITA and get fired for "some other reason" but really for being a crunchy PITA, if you know what I mean.

That is why I am asking for *your* (collective) help in addressing WIC on the national scale.

Thank you!

[craft_media_hero]

Originally Posted by Siouxsie 

I'm not sure how to go about addressing the lack of policy.......I received help from WIC when I had my first son when I was a teenager and I know a lot of young moms who rely on WIC. I hate to think of your associate there advising them that way. They should be given all the information they need to make an informed decision and like you said your input would go as far as letting them know that studies have shown it can effect breastfeeding.

Thanks, Siouxsie!

This is what really upsets me, we work with a vulnerable population, many of whom are young, first time moms who may not be confident enough or have access to resources to self-educate and go beyond what an "authority figure" (in the form of WIC educator) tells them. I am fairly certain that this "educator" is having a huuuuuge impact on these mothers' choice as to circumcision which they may not have even thought of, or may just skip since Medicaid isn't paying for it (which is great!), before she puts it in their mind that it must be done and they need to save up for it. That's why I feel so moved to do something.

It is kind of scary, though, and I am sure that she is going to pretty much see this as me publicly singling her out in front of all the staff (but I think it has to be staff wide or there is no accountability if she keeps doing it which I think she would if I were to just talk to her individually), and as I said, she is a "lead" staff there, but . . . whatever! Girl shouldn't be telling mamas to cut they sons! It's not her business.

[Siouxsie]

I will and I'll spread the word.

[tropicana]

you are in the right, here, but if you want to keep your job, make sure you cover your butt and don't offend the wrong people by sending out an email that oversteps your jurisdiction.

your direct boss is on your side, it sounds like, and invited you to comment. you said something, but upon further reflection, are able to articulate more ideas on the subject, in writing.

pass these ideas along to your boss... and word it in a way that he/she can forward on directly without appearing to be giving orders to others that are not his subordinates.

personally i would probably draft a "fact sheet" on the topic of circumcision, highlighting your area of expertise (ie, how it negatively affects breastfeeding), and then further describing the other reasons not to do it.

the last part of the fact sheet would draw the conclusion (based on the facts listed above it) that circumcision need not be recommended, that indeed it should be discouraged. 

let that stand as speaking only facts, and not personal opinions on whether one should or should not promote it.

email the fact sheet to your boss with a comment thanking him/her for the opportunity to respond to the statements expressed during the staff meeting, and that here is your response... and inviting your boss to use the information in full or in part to share with others in the company as appropriate.

good luck!

[serenbat]

you are in the right, here, but if you want to keep your job, make sure you cover your butt and don't offend the wrong people by sending out an email that oversteps your jurisdiction.

your direct boss is on your side, it sounds like, and invited you to comment. you said something, but upon further reflection, are able to articulate more ideas on the subject, in writing.

pass these ideas along to your boss... and word it in a way that he/she can forward on directly without appearing to be giving orders to others that are not his subordinates.

personally i would probably draft a "fact sheet" on the topic of circumcision, highlighting your area of expertise (ie, how it negatively affects breastfeeding), and then further describing the other reasons not to do it.

the last part of the fact sheet would draw the conclusion (based on the facts listed above it) that circumcision need not be recommended, that indeed it should be discouraged. 

let that stand as speaking only facts, and not personal opinions on whether one should or should not promote it.

email the fact sheet to your boss with a comment thanking him/her for the opportunity to respond to the statements expressed during the staff meeting, and that here is your response... and inviting your boss to use the information in full or in part to share with others in the company as appropriate.

good luck!

very positive

[serenbat]

informing that medicaid doesn't pay

who do you think should say this? just hope the OB tells them?

like it or not and surprise $$$ is not what most family want to hear

I would hate to see a family take money from one area to pay for another if that ment short changing (food) for others at the last minute.

[craft_media_hero]

serenbat, I just don't think that WIC should be bringing up circ at all. If a family says, "I heard Medicaid is no longer paying for it" then it would be fine to reply "yes, that's true, Medicaid is no longer funding circ" and that is all the staff should say about it. If the family asks why, "RIC is no longer recommended by the AAP and is recognized as an unnecessary, elective procedure which does carry risks to the infant" if the family continues to ask for info "studies have linked circ to difficulties in breastfeeding, perhaps an IBCLC or HCP would have more information for you".

But to proactively inform folks that they need to "save up for it" sickens me . . . :(

If the issue is important to a family, then the parents will look into it on their own, they don't need an authority figure speaking out of their scope of practice advising them about it either way, that is taking the authority of your position and abusing it (IMO) to influence others according to your own opinions. Even though I am passionate about keeping boys intact, I would never presume to bring the issue up with a client and give them my personal opinion on it--with a friend? if I felt it was appropriate, sure, but not within my role as a WIC employee. Beyond how circ impacts breastfeeding, it should not be addressed in a WIC office.

If they don't have the money and because of that they don't have it done, then their sons will retain genital autonomy. The state should not be paying for elective surgery on neonates. The state recognizes that it is elective and that the AAP no longer recommends RIC and that's why they're not automatically paying for it. It is appropriate for parents who insist on circ to go the extra step to look up a doctor and pay out of pocket to get the procedure done rather than relying on "the system" to automatically enable it to happen. That is a huge step forward, in my intactivist book!

[LonelyPageTurnr]

This is really unfortunate.  It sounds like she's totally out of her area of expertise, and further, utilizing her position with WIC (who a lot of people look to for advice) to advance a pro-circumcision agenda.  It sounds totally outside the scope of her job responsibilities.

Personally, I think that's what you should focus on.  The number of children who die during circumcision is not really a firm number.  The best people have is an estimate, not an official study.  It's more of a hypothesis than a study.  Personally, I don't think studies are even necessary, really.  The fact is, she's there to counsel women on their breastfeeding relationship with their babies, NOT encourage them to perform unnecessary surgery on them.  She's not a urologist, ped or OBGYN (who shouldn't even do circ anyway, IMO), and she's not their family doctor.  For whatever reason, circumcision and families circumcising is really important to her, but that is not the platform for that discussion.

I think your best bet, instead of trying to proselytize to people about intactivism and not-circumcising, would be to point out the fact that she's not doing her job.  Would it be ok if she were talking about...say, cry it out (outside of the purview of breastfeeding) or maybe...I don't know, baby-led weaning?  Why disposable diapers are so much better?  I think since it sounds like you have a good rapport with your boss, you should talk to her first about the woman using WIC as a platform to espouse her own views, and how that's inappropriate in the context of her job.  Not because it's pro-circumcision and you're against it, but because she's endorsing it and making it seem as though that is WICs official stance, and the time she's talking about that is time she could be using to actually talk about what she's supposed to be talking about. 

That's what I would do if I were you.  I don't think you'll 'win' by posting studies and such.
 

Originally Posted by craft_media_hero 

I tried to post in intactivism and kept getting redirected. Also would rather post anonymous for this but cannot find that option either--mods please change if possible.

I need help, quick, please reply asap pro intactivists!

I work for WIC as a breastfeeding peer counselor. I live and work in a decidedly non-crunchy area.

At a staff meeting last week, my boss mentioned how Medicaid is no longer paying for circ (yay!), followed by eye-rolling and insensitive comments regarding use of sugar pacifier to cut the pain :(

One "lead" staff member in particular became very verbal about how she is informing folks that it can be performed at 2-30 days after birth in pediatrician's office, and after that time must be referred to a urologist and that she is advising families to save up the $350 to pay out of pocket for the procedure. 

I was horrified, my heart beating, just totally caught off guard at this unexpected exchange.

My direct supervisor (who is baby friendly and I suspect pro-intact) caught my eye and asked if I wanted to say something. I was NOT prepared and wish I had done a better job :(

I said we should note that evidence does show that circ negatively impacts breastfeeding, that we don't need to tell them to do it, and that my son was "uncircumcised" (for which I am kicking myself because he is INTACT!! and I am normally a big stickler for language changing culture). It was awkward, and lead girl gave me dirty looks, the big boss mumbled how "and that's more and more prevalent these days" and then she changed the subject. 

Anyway, I have been stressing out thinking about this educator talking to every mom who comes in her office pregnant with a son and presenting circ as the norm, not even accounting for the option of intact, and giving them the lowdown on just what to do step by step basically a check list how to cut your son now that the state won't pay for it.

My main issue (small scale) is that this topic is out of her scope of practice and she should not even be discussing it with clients--how do I make that clear among the staff in my office? I want to write a follow up email, but feel like as the days go by it will be less and less relevant, so I'd like to send it out tomorrow night (from home). How do I phrase this in a non-offensive way that doesn't look like a personal attack but makes it very clear that no staff member shall influence a family's decisions regarding genital autonomy?

Should I include facts about how as many boys die of circ complications as SIDS (which is so big a deal among human services), if so, where are the published legit facts for that? Should I include research on circ effect on breastfeeding if so where do you find those legit facts? like from a medical research paper, not just a blog, kwim?

Now: on the larger scale, I cannot find an official policy from WIC regarding circ and how staff members should handle the issue if it comes up in visits. In my mind, we should do what we are always supposed to do, which is EMPOWER moms and families to make informed decisions for themselves, refer them to self-educate and talk to relevant professionals (not that most hcps are that informed abt circ but that is another issue). So. We need to get WIC to develop a national staff policy which states "staff members will not influence families regarding decisions of whether or not to circumcise" or something like that. y'all gotta help me with that ;)

Her conversation with families should've not mentioned circ AT ALL unless the family brought it up themselves, then she shoulda said, "it's great that you are proactive in educating yourself about the issue; I'm sure that you will make the right decision for your family" or something like that. Instead, in my mind I see, "oh you're having a boy? did you know medicaid won't pay for circ and they don't do it in the hosp? you better start saving up now." WRONG WRONG WRONG.

GTG baby boy needs me! Please write back stat!

[Adaline'sMama]

I'm really sorry you are having to deal with this at work. Does medicaid not cover circ in any states now?

[craft_media_hero]

Originally Posted by Adaline'sMama 

I'm really sorry you are having to deal with this at work. Does medicaid not cover circ in any states now?

Yeah, it really sucks :( I've never found myself in a position where my activism could really cramp up my personal life, kwim? Make things real uncomfortable at work, like. I still haven't written up an email yet. I will draft it this weekend.

Thank you all for the thoughtful responses. I'm mulling it around internally before I commit and shoot off something that might get me "in trouble".

Adaline'sMama, not sure if Medicaid doesn't cover circ in the US at all anymore, but I hope that is the case. I think it's an awesome step forward in minimizing the RIC rates, especially with everybody yammering on about circ cutting stds and hiv--where are the #s for this? I don't believe it, I think it's a propaganda spin-off ever since Africa has taken such a huge pro circ stance to fight HIV which is totally backfiring because now no one is using condoms since they think circ is prophylactic against transmission :(

[puddle]

Originally Posted by Adaline'sMama 

 Does medicaid not cover circ in any states now?

Medicaid still funds RIC in many states.  This map shows which.

[Peony]

Late to the conversation. I'd bring it up to your direct boss, I'm guessing that is the coordinator of the PCs from what you are describing. I work as a IBCLC for the PC program in my local WIC. If this came up in my office, and I could easily see this happening, as a supervisor I report to the WIC director and I'd be bringing it to her attention. I have no power over what the educators are telling the moms, if I catch wind of something fishy then I head to my boss and inform her, that is all I can do in most cases. You might be able to brainstorm with higher powers and present something at the next staff meeting. My old boss was middle of the road on circs but we had a family nurse at the health dept that was very anti circ and would go around "loaning" a DVD (no idea which one) for all the different staff meetings to watch. We watched it at one of our all WIC staff meetings. Something like that might be excellent way to educate everyone about the dangers. 

[sharon71]

I'm dumbfounded as to why WIC has anything to to with circumcision at all or why it is even being mentioned to parents?

[craft_media_hero]

Originally Posted by Peony 

Late to the conversation. I'd bring it up to your direct boss, I'm guessing that is the coordinator of the PCs from what you are describing. I work as a IBCLC for the PC program in my local WIC. If this came up in my office, and I could easily see this happening, as a supervisor I report to the WIC director and I'd be bringing it to her attention. I have no power over what the educators are telling the moms, if I catch wind of something fishy then I head to my boss and inform her, that is all I can do in most cases. You might be able to brainstorm with higher powers and present something at the next staff meeting. My old boss was middle of the road on circs but we had a family nurse at the health dept that was very anti circ and would go around "loaning" a DVD (no idea which one) for all the different staff meetings to watch. We watched it at one of our all WIC staff meetings. Something like that might be excellent way to educate everyone about the dangers. 

Thanks for replying. This is what I have decided to do and that way its not seen as a direct attack by me on the educator.

Sharon71, exactly!

This has been stressing me out so much since it happened, and I didnt know how far to personally take, but I feel good about Peony and other pp's suggestions.

Please do continue to contact National WIC directly to ask them specifally to address this issue as we discussed above!

Thank you all so much!