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#1 of 35 Old 03-21-2011, 10:47 AM - Thread Starter
 
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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.

 

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#2 of 35 Old 03-21-2011, 10:57 AM
 
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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 greensad.gif

 
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#3 of 35 Old 03-21-2011, 11:06 AM - Thread Starter
 
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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.?


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#4 of 35 Old 03-21-2011, 11:29 AM
 
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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.

 
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#5 of 35 Old 03-21-2011, 11:36 AM
 
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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

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#6 of 35 Old 03-21-2011, 12:37 PM
 
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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. 

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#7 of 35 Old 03-21-2011, 12:50 PM
 
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Originally Posted by LiLStar View Post

 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.

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#8 of 35 Old 03-21-2011, 01:11 PM
 
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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.

mecry.gifpuke.gifAt the very least, requring by law proper anesthesia would make it slightly less traumatic for those poor babies 
 

 


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#9 of 35 Old 03-21-2011, 04:14 PM
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Babies pass out from the pain, and then the doc reports that the child "slept through it." 


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#10 of 35 Old 03-22-2011, 06:10 AM
 
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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.

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#11 of 35 Old 03-31-2011, 08:22 PM
 
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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?


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#12 of 35 Old 04-01-2011, 08:24 AM
 
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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. Cuss.gif

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#13 of 35 Old 04-04-2011, 02:01 PM
 
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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.

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#14 of 35 Old 04-04-2011, 02:41 PM
 
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Originally Posted by PediNP View Post

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!  
 

 


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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. 


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#16 of 35 Old 04-04-2011, 06:46 PM
 
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Originally Posted by PediNP View Post

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).

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#17 of 35 Old 04-05-2011, 12:46 PM
 
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Originally Posted by PediNP View Post

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.

 

 

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#18 of 35 Old 04-05-2011, 03:37 PM
 
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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.
 

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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!  
 

 



 

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#19 of 35 Old 04-05-2011, 03:55 PM
 
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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.
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#20 of 35 Old 04-05-2011, 05:41 PM
 
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Originally Posted by PediNP View Post

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.

 
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#21 of 35 Old 04-06-2011, 10:45 AM
 
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Originally Posted by PediNP View Post

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.


I would truly love to see video of the babies sleeping peacefully from start to finish of the procedure (i.e. they just peacefully drift off to sleep, without screaming for a while first.) I would also love to see EEG/EKG evidence that the "sleep" they experience is identical to normal infant sleep - that their brainwaves, heart rate, etc. are not any different from a healthy, unstressed baby sleeping in its mother's arms.

 

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#22 of 35 Old 04-06-2011, 10:55 AM
 
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I can only speak to the one experience I witnessed... My second son's. The OB applied a numbing cream and then the procedure was done about 20 minutes later. He was strapped down, and fussed a bit about that, but that was the end of it. He didn't cry, nor did he go to sleep. He didn't seem to experience any discomfort afterwards, during diaper changes, or when he peed or anything. He nursed, he slept, he was a normal newborn. 

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#23 of 35 Old 04-06-2011, 11:16 AM
 
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Originally Posted by treeoflife3 View Post

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 didn't mean to imply I had a bad birth experience--I didn't. I've had all 3 of my babies naturally, but I'm not going to lie and say it didn't hurt. smile.gif I just meant to stress how much the lidocaine injections hurt by comparing them to the intensity of the birth process. FYI, my tearing was also internal, since my daughter came out with her arm up by her face.  It's a testament to my midwives that I never tore externally, and only had minimal tearing along that scar tissue during my 2 subsequent births, which isn't something anyone could have prevented.  

 


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#24 of 35 Old 04-06-2011, 11:23 AM
 
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I remember being told when I was working in the nursery years ago that the babies cry more out of frustration of being strapped down than any actual pain they're feeling during the procedure. I bought that at the time, but now after having 3 children I believe that's a bunch of crap. The sound of a "pain" cry is totally different from that of a "frustration" cry, even in a newborn, and what I heard during the circ I witnessed was pain. greensad.gif


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#25 of 35 Old 04-06-2011, 01:31 PM
 
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This reminds me of the movie "Cut." In it, there is an OB who performs circumcisions both as on OB and as a Mohelet. When she is being interviewed, she explains that the babies cry because of being exposed to cold when their clothes are removed and because of being held down. Later in the show, they show her performing a circumcision. The baby does not cry or fuss AT ALL as he is laid down on his back on a table. He does not cry or fuss AT ALL when his bottom clothes and diaper are removed. He does not cry or fuss AT ALL when his groin is swabbed with gauze soaked in betadine (and we all know how cold and icky it feels to be swabbed with betadine.) He does not cry or fuss AT ALL when the woman begins touching and moving his penis. His high-pitched, loud, scared and pained screaming begins the very second she closes the hemostat clamp on his foreskin, and it doesn't stop until the procedure is all over and the screaming turns to a hiccuping crying as his mother holds him.

 

I am amazed at the cognitive dissonance that this woman displayed. How she can go on believing that babies cry during circumcision because of cold or annoyance at their position, when right there in front of her was a baby who was not at all bothered by nakedness, being held down on his back, or being cold. What he really seemed to mind was the CLAMP and the SCALPEL on his genitals.

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#26 of 35 Old 04-06-2011, 05:21 PM
 
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This reminds me of the movie "Cut." In it, there is an OB who performs circumcisions both as on OB and as a Mohelet. When she is being interviewed, she explains that the babies cry because of being exposed to cold when their clothes are removed and because of being held down. Later in the show, they show her performing a circumcision. The baby does not cry or fuss AT ALL as he is laid down on his back on a table. He does not cry or fuss AT ALL when his bottom clothes and diaper are removed. He does not cry or fuss AT ALL when his groin is swabbed with gauze soaked in betadine (and we all know how cold and icky it feels to be swabbed with betadine.) He does not cry or fuss AT ALL when the woman begins touching and moving his penis. His high-pitched, loud, scared and pained screaming begins the very second she closes the hemostat clamp on his foreskin, and it doesn't stop until the procedure is all over and the screaming turns to a hiccuping crying as his mother holds him.

 

I am amazed at the cognitive dissonance that this woman displayed. How she can go on believing that babies cry during circumcision because of cold or annoyance at their position, when right there in front of her was a baby who was not at all bothered by nakedness, being held down on his back, or being cold. What he really seemed to mind was the CLAMP and the SCALPEL on his genitals.

 

I am going to have to watch it again to see that, I don't remember; the problem is I can't stand those parts of the film.
 

 

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#27 of 35 Old 04-09-2011, 06:18 AM - Thread Starter
 
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I appreciate all this feedback.  Especially hearing from nurses and parents who were present is helpful.  More than one poster has mentioned that if "appropriate" pain relief is given, they don't always wait for it to take affect.  How do we know this?  If a doctor realizes this is a painful procedure and opts for a "real" pain medication and not sugar water..... why would he not wait for it to take full affect?  Surely he is aware of the amount of time it takes.    

 

It seems people agree that the penile block is the best option for blocking pain..... any shot in that sensitive area would be painful ..... but are posters comparing it with lidocaine or is it lidocaine?


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#28 of 35 Old 04-09-2011, 07:54 AM
 
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It is lidocane or the equivalent of it like novicane or one of those types of numbing meds.

I wish I knew why some Dr's didnt wait. All I can come up with is that they feel that since the baby wont remember the pain then it is OK to inflict it. Or they are just so wrapped up in the precedure itself that they dont think about the baby itself.

 
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#29 of 35 Old 04-09-2011, 09:47 AM
 
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or the pain medication is for the parents. "oh, of COURSE there will be pain relief. I'll give him a nice numbing shot, it'll be fine!"


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#30 of 35 Old 04-11-2011, 08:55 AM
 
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Also, even a Dorsal Penile Nerve Block, which is the best they can do, does not touch the Pudendal Nerve, which innervates the underside of the penis.  All this discussion of "It does not hurt" is a disgusting relic of the time when they used to do open heart surgery on babies with nothing but muscle relaxants.  EVEN IF CIRCUMCISION WERE ENTIRELY PAINLESS DURING AND AFTER, IT DOES NOT MAKE IT OK.  Removing part of another person's body without their permission is never okay.

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