Doulas, do you discuss circ w/clients?

[arimama]

I have generally avoided the subject because I dont like confrontation and circ is hot button issue. I am begining to feel like I should include some circ info in my client packets, because I don't often feel like my clients are making an informed choice.
I have looked at nocirc but it feels kind of inflamatory and while I agree with their stance, I think my clients would appreciate a more gentle approach.
I think some info about the importance of the foreskin and something that addresses the common myths would be good.

How do you address the topic?

[Rockies5]

Originally Posted by arimama

I have generally avoided the subject because I dont like confrontation and circ is hot button issue. I am begining to feel like I should include some circ info in my client packets, because I don't often feel like my clients are making an informed choice.
I have looked at nocirc but it feels kind of inflamatory and while I agree with their stance, I think my clients would appreciate a more gentle approach.
I think some info about the importance of the foreskin and something that addresses the common myths would be good.

How do you address the topic?

it's brought up in the first video I show. we discuss it plainly afterward. I also created a folder for loan on circumcision. Info & photos from Nocirc, DVD of a circumcision in the pocket of the folder, articles, opinions form moms I've known of both side of the issue. I also teach a baby care class as the last class (in most series anyways) and we go over care of each. We've had each in the family and can answer really specific questions. It's mainly dads who want the circumcision and it's great to have dh there to field the questions and help them muddle through their reasons and decide whats best for their babies.

[SublimeBirthGirl]

I discuss circumcision with anyone who will listen. When it comes to human rights violations I think speaking up is more important than not pissing someone off. I try to teach in a diplomatic way but I definitely discuss it. If you want a good video that discusses, dispassionately, the functions of the foreskin, go to doctorsopposingcircumcision.org. They have a video about the prepuce/foreskin that has lots of good info w/out the drama of a lot of the anti-circ stuff.

I am very up front with my students about my feelings on circumcision. I am considering attending births again, and if I do, I probably will not attend births where they parents plan to circ. I have before and there was a feeling of alienation once I found out that I could not get past.

[courtenay_e]

I generally bring it up when we discuss breastfeeding. I have had three clients circ and all three have had babies who breastfed like champs before the circ and had major issues after the circ. That doesn't mean that that's the case for everybody, but we DO have statistical evidence that the relationship can be affected by the procedure, so I present it just that way (because so far every single one of my clients has wanted to breastfeed, and well into the first year, if not longer). Generally they then ask WHY it can interfere, and I briefly explain why, and then offer them articles from our own mothering mag. That's usually all it takes.

[Marilyn82]

I do discuss it but I'm very honest about my feelings. I tell them that it is out of my comfort zone to try to pressure them into making a decision either way, since I am essentially there for their support. I tell them that there was a time when I did not know that much about it and even considered having my own son circ'd before I did the research. I say that I am for all intents and purposes anti-circ and I will not lie to them and tell them that I can or will provide non-biased information....However I also tell them that I can provide them with my reasons I feel the way I do and give them websites to go for more information. I also tell them that if they do choose to have a circ done, then I highly advise looking into pain relief options since it is a very painful cosmetic procedure and this verbage usually gets them thinking and usually they are surprised to hear it referred to as 'cosmetic'. Usually they appreciate my honesty and ask for the info and I have only had one client who still decided to circ. I'm careful to let them know that I don't judge them for decisions they do make, I only hope that they make an informed choice. I feel that this leaves them more receptive to hearing my message because they don't feel threatened or defensive.

[shanesmama]

I am in training to become a Doula. I did have both of my boys circ. Though it was manly dads choice. We argued about it alot. But alot of the information he got from me, didn't seem justified for him. I believe if either my OB or doula would have given him informed information on it, he would have had given it a second thought. For some reason the words a birth professionals give some how gives more warrant then the words I give.

I do plan on given hand outs about any type of 'normal' procedures which are routinely done to babies so the parents can make their own informed choices, including circ.

[MamaRabbit]

After losing a client over the issue... I get so emotional about it and angry that I now give a packet as homework and discuss after that.

[onlyboys]

I do discuss it. It can be very uncomfortable, but it's important information to give as many have no idea what circ is all about. I also give a copy of the "Informed Disclosure" which is highly referenced and then offer to give them a video on the subject, if they seem receptive.

Then, I let it go. Unfortunately, RIC is still a choice for the parents and I can't change that right now. It's very hard to see a sweet little new guy who I know will be cut in the next couple of days. But, I let it go.

[Jyotsna]

I have just recieved a FREE DVD in the mail that I will be using from the Boys Health Advisory and the National Organizagtion of Circumcision.

I watched the video and cried! As a mother, it really struck a cord in me. I can't see how anyone would have this done to their child...something that is near what female mutilation is. I did talk to a client about the video after watching it, (she doesn't know what the sex of her baby is) so her comment was, "why would you watch that!". Her son is circumcised, because the dad wanted son to look like him. I know this is very much why most circumcisions occur, and the dad is Jewish. But I know Jewish families who had decided to not circumcise their son.

So this is a very good discussion because it is such a touchy subject. My son is intact, and any other son's if ever, would be intact. So I can't even imagine how someone makes the decision to allow someone else to cut off the foreSKIN of a boy baby. The baby in the video cried so hard, and the pissy doctor went on with the procedure talking like he couldn't hear the baby. No one attempted to comfort the baby! It was tramatic to watch. I think I will get a few more copies to keep on hand and send out in packets (for the family to return to me). If anyone see's this procedure, they will not have their son circumcised...I hope anyway.

[arimama]

I have just recieved a FREE DVD in the mail that I will be using from the Boys Health Advisory and the National Organizagtion of Circumcision.

I got that free video too and I thought it was very poorly done. I didnt watch the actual circ footage. But the rest of the video was weird imo.
I do think parent should watch a circ before doing in though.

[SublimeBirthGirl]

I have that video as well. The circ procedure is very high impact. And it is what it is. If you can't watch it, how you can you have it done to your baby? Every parent should watch a circumcision before they decide to do it to their own baby.

The video is a collection of things from other places. The prepuce thing is from doctorsopposingcircumcision.org. The thing w/ the different people talking about circumcision is from some sort of documentary which I also have on tape. I think the procedure is from Birth as We Know It. It's just a collection of visual resources, edited and pasted into one spot.

[arimama]

I can see how showing a video in a CBE class would work. But I fear showing such a horrific thing to someone unexpectedly in their home during one of our prenatal meetings. I imagine the mood would go down hill quickly
Do any of you show it to clients at their homes?

[Organicavocado]

I also have the free DVD. As a plan I was not discussing it but if it came up and they were planning to circ I would refuse to take the client for moral bias. I personally think I might give off an air of disapproval to a client and they don't need me as their doula in that case.. it defeats the purpose. Its in both of our interests to not be a team.

But thanks to this thread I think I will make it a point to make a packet, have them go over it, and discuss it perhaps at the very first meeting. I have a lot of information and I can make a good packet, I think coming out with your opinion and apologizing for not being able to be unbiased on the matter is a good idea, I would hate for it to come up later and struggle with the matter of refusing them or not in the middle of their pregnancy.

All good stuff, subbing.

[tlcdoula]

Originally Posted by SublimeBirthGirl

I have that video as well. The circ procedure is very high impact. And it is what it is. If you can't watch it, how you can you have it done to your baby? Every parent should watch a circumcision before they decide to do it to their own baby.

I don't so much know if I agree with this line of reasoning because my husband struggled to watch me birth his children - does that mean we shouldn't have had kids or he shouldn't have "done that to me?"

[Organicavocado]

Thats true, but comparing birth to RIC is like comparing night and day. Birth is in essence a powerfully positive thing to go through to get a positive result- a baby. Routine circumcision is a negative experience to get to a (IMO) negative result.

[Katielady]

This is something I'm struggling with as well. Initially I had planned to include info about it in my informational "decide if they want to hire me" interview, and to let them know that I can't accept clients who plan to circ. As a pp said, I feel a lot of alienation from moms when I know they're going to circ, and I feel like that would be detrimental to the doula-client relationship.

While that sounded good in theory, when it came time to actually do it I found that I didn't feel right about that plan. The first client who I met with (and ended up hiring me) was an observant Jew, and I knew the moment I started talking with her that there was no way she was planning to have a "bliss" instead of a bris. She shared so much with me even in that initial conversation over the phone; I couldn't imagine meeting with her, having her decide she wants to hire me, and then telling her I couldn't work with her if she were planning to circ.

So here's my new plan:

1) I included a ton of pro-intact info on my web site.

2) I plan to include the mothering article plus the first brochure from this page: http://www.coloradonocirc.org/pamphlets.php in my prenatal meeting packet.

3) At the prenatal meeting, I plan to ask about circ and give them some of the most important facts, such as the function of the foreskin and the fact that any medical benefits are slight and are outweighed by the risks.

4) With religious Jewish clients I don't discuss circ or include any info about it in my packets, although of course it's still up there on my web site. If invited to the bris, I politely make an excuse and don't attend.

If after all that, the client still wants to circ, I guess I'll be deeply disappointed but will have to deal.

[SublimeBirthGirl]

Originally Posted by tlcdoula

I don't so much know if I agree with this line of reasoning because my husband struggled to watch me birth his children - does that mean we shouldn't have had kids or he shouldn't have "done that to me?"

Did your husband impregnate you against your will, then during labor tie down your arms and legs and force you to give birth without drugs? Very weak analogy. We're talking about a painful, invasive, disfiguring surgery for no medical reason on a tiny baby who can't consent. That doesn't compare to a man having a hard time with his wife, who is an adult woman willingly giving birth to his child, in pain.

[onlyboys]

Originally Posted by Katielady

This is something I'm struggling with as well. Initially I had planned to include info about it in my informational "decide if they want to hire me" interview, and to let them know that I can't accept clients who plan to circ. As a pp said, I feel a lot of alienation from moms when I know they're going to circ, and I feel like that would be detrimental to the doula-client relationship.

While that sounded good in theory, when it came time to actually do it I found that I didn't feel right about that plan. The first client who I met with (and ended up hiring me) was an observant Jew, and I knew the moment I started talking with her that there was no way she was planning to have a "bliss" instead of a bris. She shared so much with me even in that initial conversation over the phone; I couldn't imagine meeting with her, having her decide she wants to hire me, and then telling her I couldn't work with her if she were planning to circ.

So here's my new plan:

1) I included a ton of pro-intact info on my web site.

2) I plan to include the mothering article plus the first brochure from this page: http://www.coloradonocirc.org/pamphlets.php in my prenatal meeting packet.

3) At the prenatal meeting, I plan to ask about circ and give them some of the most important facts, such as the function of the foreskin and the fact that any medical benefits are slight and are outweighed by the risks.

4) With religious Jewish clients I don't discuss circ or include any info about it in my packets, although of course it's still up there on my web site. If invited to the bris, I politely make an excuse and don't attend.

If after all that, the client still wants to circ, I guess I'll be deeply disappointed but will have to deal.

I think this is a really wonderful way to handle it!

[jessjgh1]

circumcision information packet for birth professionals

Forgive me for responding, but i noticed this and its a topic near and dear... especially this week.
I just attended BOLD and saw the play Birth. I helped organize a Circumcision Information & Intact Support booth (with NOCIRC) for the birth fair before the play.

I put together a packet for the birth professionals that would be attending and spoke to many midwives doulas and nurses that stopped by with questions and requests for resources. It was a wonderful experience to hear their questions and I hope that we provided the information that they need and some incentive to take the initiative to make this an important part of the education that they provide- part of the package, so to speak, of education, care, and SUPPORT.

One of the pamplhets by Colorado NOCIRC says:
His parents education is his only line of defense

That really speaks truth to what we see on the regrets thread at CAC (Case Against Circumcision) and what seems to be very common. Please dont' ASSUME the parents are getting information, because they usually are not. In cases where the client gets information, it is generally biased in favor of circumcsion and does not provide true informed consent.

I've included my table of content below... almost ALL of it is online, but please contact me if anyone here would like a copy of it and especially if you have suggestions and comments! Emial is better as my MDC mailbox is near to full.

I've been trying to put together my thoughts for a quick letter to be sent out with the packet. This is somewhat of a draft and brainstorm of what I want to outline in my letter from what came up at the fair or as 'tips':

#1 Please bring this up with clients. Don't ask what they know, just give them the information you feel is necessary to make an informed choice, (hopefully that includes the function of the foreskin and benefits of intactness, and not just circumcision information). Put it out there and then be open to discussing it.

#2 Keep in mind that circumcision is NOT medically necessary-- DON"T WORRY so much ABOUT 'bias'. Circumcision is NOT necessary, it is not even recommended, the normal natural default is intact. It is okay to talk about it as normal!!!

#3 Keep in mind that sometimes parents just need a reason to consider intactness, especially a dad that is circed. He may ignore his wife's emotional pleas for months, but the second a doctor or midwife (medical figure) says it is not medically necessary he will change his mind.
As an 'authority' you may be able to give the person an 'out'-- a way of backing down from their position w/o losing face-- and arm the parents too--- they can then tell their family, "the midwife didn't recommend it, things have changed!" (you can even mention the change from formula back to breastfeeding as a parallel example)

#4 Support. Typically a mother wants to protect her son and the father pushes for circumcision. Support the mother (or father) just as you would support them in their birth choices. Her instincts are at work to protect her son and supporting her allows her to feel confident in trusting her instincts.
Regrets are more likely to come up when a mother (or father) gives in and goes against their instincts. Honor and support parents who are trying to listen to their instincts.

#5 Some places to start (besides CAC here, of course...)
www.nocirc.org and
www.coloradonocirc.org <-- that's where the childbirth professional pamphlet that I quoted is from
http://www.babyboy.info/birth_care.html
www.cirp.org
Colorado NoCirc also has a packet on Informed Consent

#5 Some ways to approach the issue...
NO medical organization in the world recommends it (It is NOT medically necessary)
From the point of providing informed consent
CIMS: #9 Discourages nonreligious circumcison
Reminding parents of the potential effect on breastfeeding

Ok, its late, I wish I could say more and edit that,but I can't...

Finally since someone mentioned the DVD's, there are 2 DVD's for birth professionals (both from NoCirc) out there. I believe one must be an older version (it has a video of female circumcision, where hte newer one does not). The other one (from www.babyboy.info) has the NoCirc PSA, Anatomy, a circumcision, which the previous video has and in addition it has DOctors speak out, and The Nurses of St Vincent.
All the individual pieces are online between NOCIRC and YouTube, I believe. The Birth Into Being and Gentle Birth Choices DVD's both have sections on circumcision, as do other birth videos.

I hope that helps!

Jessica


Here's my 'table of contents...' most of it is available online


Circumcision Information & Intact Support
for Health Care and Birth Professionals


PAMPHLETS
Circumcision and Childbirth Professionalswww.coloradonocirc.org/pamphlets.php
“His parents’ education is his only lines of defense”

The Elements of Informed Consentwww.coloradonocirc.org/pamphlets.php
With Suggested Applications to Male Infant Circumcision

Answers to Your Question About Your www.nocirc.org/publish/
Young Son’s Intact Penis(NOCIRC #4)

Should Your Baby Boy Be Circumcised?www.coloradonocirc.org/pamphlets.php
Circumcision: Information for Expectant Parents

Circumcision vs Breastfeedingwww.circumstitions.com/Docs/nursing.pdf

ARTICLES AND REPORTS

The Anatomy and Physiology of the Human Prepucewww.coloradonocirc.org/pamphlets.php
Scott, Steve. “The Anatomy and Physiology of the Human Prepuce.” Male and female Circumcision,
edited by Denniston et. al, Kluwer Academic/Plenum Publishers New York, 1999, pp. 9-18

Foreskins for Keeps: An Idea Whose Time Has Come
LeMay, Gloria, “Foreskins for Keeps: An Idea Whose Time Has Come” http://www.midwiferytoday.com/articles/foreskins.asp
Midwifery Today, Issue 81, Spring 2007, pp. 32-3, 67-88


How Male Circumcision May Be Affecting Your Love Lifewww.coloradonocirc.org/pamphlets.php

Abstract: Fine-touch pressure thresholds in the adult penis
Morris L. Sorrells, James L. Snyder, Mark D. Reiss, Christopher Eden, Marilyn F. Milos, Norma Wilcox, Robert S. Van Howe. Fine-touch pressure
thresholds in the adults penis. British Journal of Urology (BJU) International, April 2007, Volume 99, Issue 4, Page 864-9.
Full study available at: http://www.nocirc.org/touch-test/touchtest.php



Miscellaneous Materials and Additional Pamphlets
A Sample of Available Media (handout)

Weighing the Risks(handout)

Answers to Your Questions About Infant Circumcision (NOCIRC #4)www.nocirc.org/publish/

Answers to Your Questions About Your Young Son’s Circumcised Penis (NOCIRC #5)www.nocirc.org/publish/

Answers to Your Questions About the Bioethicswww.nocirc.org/publish/
Of Infant Circumcision (NOCIRC #10)

Conscientious Objection to the Performance of
Non-therapeutic Circumcision of Children http://www.doctorsopposingcircumcisi...lications.html

Addressing Questions About HIV and Circumcision Request through Colorado NOCIRC / www.coloradonocirc.org

Summary of Articles & Resources at Mothering.comfrom:http://www.mothering.com/articles/ne...cumcision.html


Downloads & Further Resources

Full Disclosure: Circumcision Information for Health Professionals and Parents www.icgi.org/Downloads/FD2.pdf
The International Coalition for Genital Integrity

Circumcision and Penile Care Resources for Birth Care Providers www.icgi.org/birth_care_providers.htm
The International Coalition for Genital Integrity



Circumcision, Breastfeeding and Maternal Bonding
Information Available Online



Articles

Exerpts from The Breastfeeding Answer Bookwww.cirp.org/library/birth/mohrbacher1/
Nancy Mohrbacher, Nancy and Stock, Julie. The Breastfeeding Answer Book, (Third Revised Edition).
La Leche League International, Schaumburg, Illinois, 2003.,

Letters to La Leche League Internationalwww.llli.org/llleaderweb/LV/LVOctNov00p94.html
LLLI: Letters to La Leche League International. Leaven. Vol. 36 no. 5. Ocotber November 2000. pp. 94-95

CIRCUMCISION by Marian Tompson, co-founder of La Leche Leaguehttp://www.icgi.org/birth_care_provi...#breastfeeding
The People's Doctor: A Medical Newsletter for Consumers" by Robert S. Mendelsohn, M.D. Vol. 4, No. 12, p 8.

ELECTIVE SURGERY FOR YOU OR BABY excerpt from "The Womanly Art of Breastfeeding,"http://www.icgi.org/birth_care_provi...#breastfeeding
La Leche League International, Franklin Park, Illinois, July 1981: 92-93.

News Bulletin: Circumcision Leads to Breastfeeding Complicationshttp://www.mothering.com/sections/ne...ember2005.html
Journal of Human Lactation 19(1), 2003.


Pamphlets
Circumcision vs Breastfeedingwww.circumstitions.com/Nursing.html

Pamphlet & Other informationwww.circumstitions.com/Docs/nursing.pdf

Circumcision and Penile Care Resources for Birth Care Providers www.icgi.org/birth_care_providers.htm
The International Coalition for Genital Integrity

[Jyotsna]

Jessica,

Thank you for that information! Wow! I will definately come up with a INTACT PAC for my families, to allow the parents a chance to open up the discussion with each other in a non-defensive way. In the end, I would be willing to sign the INTACT PAC with them if they choose to keep their son intact.