To Circ or Not to Circ

It was announced this week that the circumcision rate fell from 56% in 2006 to 33% in 2009. There could be several reasons for this, one of them that several states withdrew Medicaid payment for the procedure, siting that it is elective and unnecessary. In fact the American Academy of Pediatrics has gone back and forth over this but for the past few years has remained steady in it's statement that there is no medical reason for circumcision. There have been only a few studies that have shown any sort of benefit and to be honest, when you read the studies, even a lay-person could see that they are seriously flawed.

A friend of mine said recently that she was happy the circ rates are down by so much but that she wonders what will eventually be said to bring these rates back up again. These are money-making procedures afterall and the people who make money off of them are not going to sit idly by and allow profit to just go away. It is so sad to me that things like surgery on a newborn are profit-makers. And before you question it, YES it is surgery!

I have had a few clients who choose to circumcise but many more who do not. I think the initial inclination is to make their boy like his dad but once they learn everything involved, many choose not to. So what is involved? First of all pain medication. Not that I would ever, ever want a baby to not have pain meds on board for a procedure like this but so many people go through hard labors without pain meds because they want to avoid to negative side-effects for their babies. Then 24 hours after birth they are signing the consent form to pump their baby full of medication to alleviate the pain of a completely unnecessary procedure.

Aside from the pain medication, many people do not realize that their precious, long-awaited baby boy will be strapped to a board with arms and legs tied down for the duration of the procedure. I bet all I would have to do is show parents pictures of a circumcision procedure that are in some of my textbooks and they would say "No way in heck am I putting my baby through that."

One of my moms, after a beautiful homebirth, decided she wanted her son to be circumcised. She sat in my office crying a few days later at the horror she witnessed when she insisted on being in the room during to procedure. She said they roughly strapped her screaming son to the board, injected the pain medication and the doctor began to cut before the medication even had a chance to take effect. She said after the procedure, her son was "gun shy" for days. Every time he was picked up, he jumped. Her previously peaceful baby became cranky and, probably most distressful to her, he no longer trusted that his parents would keep him safe.

So knowing all of this, what are some of the reasons parents choose to circ?

• Wanting their son to look like his dad: This is honestly the most common reason I hear. Most moms and dads who say this want to know how they are supposed to explain to their son why his penis looks different than his dads. My answer to that is to tell him the truth. What child wouldn't to hear that his parents spared him an unnecessary procedure?



• Fear that their son will choose to have the procedure later in life and will be in great pain because of it: To this I say that the procedure is the same no matter when it is performed. Will their child have an actual memory of the procedure if it is done at 24 hours? No. But there is a memory of it somewhere in the subconscious. Plus, what is wrong with allowing your child to make their own decision about this major procedure? I know several men who have told me they wouldn't have chosen to be circumcised but this decision was made for them. The decision is irreversible once you have circumcised.



• Not wanting their child to be subjected to ridicule in the locker room: In this day and age, at least 1/2 of all boys are intact making this argument null and void.



• Fear that an intact penis is unclean or may be subject to disease/irritation, etc: As with any part of the body, boys need to be taught how to clean themselves. Obviously it is there for a reason and, just as we trust in our body's ability to birth, we need to trust that the foreskin has a purpose. Once the foreskin can be retracted, at about 2 years of age, it is as simple as teaching them to pull the foreskin back and clean underneath. Several moms I know that have intact boys have told me there is no need to actually teach this because they just naturally do it.

Other things to think about:

• No form of female circumcision is considered OK in the US. In fact it is called female genital mutilation. It would never be considered acceptable to remove all or part of the clitoral hood, which is the female equivalent to foreskin. Why are boys any different?



• A boy loses over 10,000 nerve endings when the foreskin is removed. Yes the feeling is fine without, as I have been told by many circumcised males, but removing 10,000 delicate nerve endings from a very sensitive part of the body has implications which we may not yet understand.



• There can be an interruption in breastfeeding if the procedure is done too early in life. At 24 hours of life (when many circs are done) the baby has not yet learned to use the breast for comfort and thus may not breastfeed because of continued pain. Waiting a few days changes this risk but also changes the number of circs that take place. Why? Because parents become fully bonded to their boys and are less likely to subject them to an unnecessary procedure.



• The uncircumcised male often takes on a look more like a circumcised male at puberty. The foreskin can actually retract over the head of the penis, giving the boy a circumcised look once the penis grows larger.



• There are risks to the procedure that no one seems to ever talk about. There is a risk of infection. There is a risk of hemorrhage. There is a risk of undesirable cosmetic appearance. Did you know there is even a risk of losing the penis all together??? It is a very small risk but how could you live with yourself if you chose for your son to have a procedure that ended in the loss of his penis? How could this be explained?

These are all things that I wish people would think about before they decide to have a circumcision. I find that when people can rationally think about these issues, they almost always choose not to circumcise. Need more info? http://www.nocirc.org/

Mentoring the Mentor

I've been reading this book called Sacred Contracts by Caroline Myss and it has totally changed how I think of myself, my place in this world, and who my tribe is. The book is all about how each of us has several archetypes which influence our personality and our actions. We can live in the shadow aspect of these archetypes or in the light of them. Through this reading I have found that one of my archetypes is that of the mentor. I can remember "mentoring" other kids as far back as elementary school. In first grade, I took a so-called "troubled" boy (really I think he was just a normal, kid who couldn't sit for 6 hours straight) under my wing and mentored him. All I did was talk to him and told him something along the lines that I knew he wasn't a bad kid and I knew he could do better. And lo and behold, he did! I was 7 years old.

There have been many more people on my path that I have mentored in one way or another and honestly, I thrive in it. There is nothing better than giving a few words of encouragement, sending intention, and hearing later that those very words and support changed someone's life for the positive. It's not the thank you that I need. What I need is the knowledge that a few words of encouragement can spur someone into self introspection and that they themselves do the work that is necessary to change for the positive.

But I do believe that one cannot go about only being a mentor. A mentor needs a mentor, or probably more accurately, several mentors. I have myself had several over the years and this weekend I met another one.

I've read several things written by Dr. Michel Odent and was surprised that I agreed with nearly everything he said regarding natural birth, even though I came to my conclusions based on my own experience. It is always cathardic when someone else observes the same thing and comes to the same conclusions. I was very interested when I learned that Dr. Odent was going to be speaking at the DONA conference, especially when I read that his topic was about re-evaluating midwifery practices.

There were so many things that spoke to me in his talks but most of all was his reminder to me that midwifery is fundamentally supposed to be about selective care, not routine care. We should treat each woman as an individual, because she is! As soon as we start making arbitrary rules about what the supposed line of health is, we weaken midwifery a little more. Right now the rules say you are only within normal limits if you go into labor sometime between 37 and 42 weeks, if your baby is head down, if you only have 1 baby, if you are not "infected" with GBS, if you do not have gestational diabetes, if you hemoglobin/hematocrit levels are within the proper range, if, if, if. What happens when we, as Dr. Odent suggests, use these limits as a sign to increase vigilance. We use watchful waiting. We give positive emotional support and make sure the woman does not feel that there is something wrong with her body. What if we teach her how to check in with herself and her baby, something many women don't know how to do and something that could arguably help her long beyond pregnancy.

Dr. Odent spent great length answering my question regarding care for women when they approach 42 weeks. It is never my choice to push an induction, even if it is a "natural" one. Mostly this comes from the fact that I myself went beyond the 42 weeks mark, albiet by just 1 day. I knew there was nothing wrong, that it was normal for my body and my baby, and mostly I knew that my baby was healthy and knew the right time to be born. It is interesting to me how few people truly believed that as I was going through it. Of course few people actually spoke to me directly about it but I heard the whisperings of "How late is she going to go? Can you go past 42 weeks? Do you think she's really OK?" I know that there was pretty much no way that I was going to do anything to "augment" my labor, even if it was supposedly natural. So I have a very hard time telling someone else that they should.

After spending such time in answering my question, I felt that tingling of what I know others feel when I speak to them as a mentor. I can see it in their face that I am saying something that is hitting them on a very deep level. I can see the change starting to happen, the wheels beginning to turn. I wonder if he saw that in me.

After the workshop, I was sitting at a table of friends eating my lunch when I hear from behind me "Ahem, pardon me, is anyone sitting here?" and who do I see but Dr. Odent himself plopping down in the seat next to me. We discussed a few more things but the change had already happened for me. Don't get me wrong, I was honored! But, I didn't need any more from him. I already got the tell-tale changing phrase that started the wheels cranking in my head. Thank you Dr. Odent for mentoring the mentor!