Some questions for me....

SmilingBluEyes · Sep 21, 2005

]I hope no one minds me asking a couple of questions here... I am soon to be student but not a nurse yet, getting ready to have baby #2.

Congratulations and welcome to allnurses.com and the OB nursing forum.

I keep reading the national circumcision/not rate is 60/40%. Is this what you generally see? Or am I looking at websites that are anti-circ so they slant the info? I am kind of against, DH is for, just trying to make the decision. Also, any opinions, things you have seen, etc.

I see roughly that statistic....maybe more opting "not" everyday. I say, if it's not something you want to do, do not. Remember, it is ELECTIVE, not mandatory or even recommended for "health" reasons anymore. A circ is an elective surgery that carries inherent risks of hemorrhage, infection and in the worst case, problems with urination/penile function (for really badly done jobs and yes, this has happened).

Make darn sure you choose a physician WELL VERSED in circumcision if you choose to do so----someone who can explain fully and completely what he/she will do and how. And make sure you have read the consent forms and understand fully what you consent to---you are consenting FOR your child to have an elective procedure. It's surely up to you. Many still do this----for many reasons. Work this one out w/your husband now, in advance of the birth. And best wishes, whatever you decide. My boy IS circumcised, but this was 13 years ago and if I had the same choice today, I would defer for the reasons given. No judgement on those who do it----but I would not just for cosmetic reasons do a surgery on my son, as a mom.

Also, since DH wil be here for this birth (in Iraq for the last) we have been discussing my wishes for the birth. Unfortunately the (military) ob practice has changed from mostly midwives to mostly docs who are pretty intervention-minded from what I have heard. So some questions I have:

NUMBER ONE PIECE OF ADVICE: get a doula or strong advocate for your birth experience, NOW. Someone who is not afraid to communicate your needs or wishes for you when you may not be able to yourself. ALSO work ahead of time w/the dr or midwives you have about how you would like things to go.

What are the risks of not accepting pitocin, AROM, forceps/vaccuum?

These are risks you need to discuss w/your midwife or dr. The risks MAY outweight the benefits in certain cases. For example, if a baby is stuck (dystocia) a vacuum extraction BENEFIT may outweigh risk in that case. Would I elect to do elective induction w/pitocin? NO, but my bag of water were ruptured a long time (all day) I would probably consent to pitocin induction if labor stalled or stopped. Infection is a risk in extended rupture times. YOU MUST DISCUSS each INTERVENTION OFFERED AT EVERY JUNCTURE as it comes up and decide. If you need an advocate, perhaps, hire a doula to help you out there. They are a wonderful resource for the birthing family and can help communicate your wishes when you feel unable or overwhelmed, or help you "stay on track" to your birth plan, if need be. They do not take the place of your health care providers, obviously, for advice, but are wonderful advocates for YOUR wishes and needs, as well as a great source of comfort for your labor experience. For info about doulas see:

http://www.dona.org

I know infection after prolonged rupture of membranes, but what others? Say, baby's heart rate is fine, I am fine, no temperature, doc's impatient.

If you sense impatience on the part of the dr, ASK ASK ASK WHY is this being done? And decide if this is truly needed. DO you worry NOW about your dr? Is he/she someone you can talk to you IN ADVANCE about your wishes/intentions? If so, do it NOW, verbally and in writing, but remember, being flexible is a benefit to you BOTH! Sometimes the birth situation can change on a dime. I hope you feel you can trust your care provider when the chips are down; if you cannot, perhaps you need to ask yourself "why" and see what you can do about it.

How long is too long to push?

We have moms pushing 3 or 4 hours in cases where babies and moms are doing well. Average seems to be 1.5-2 hours for first-time moms. PLEASE QUIT watching BABY STORY now---it is not educational and won't give youa real clue to your experience. Your birth experience cannot be plugged into a 30 minute time slot. MAKE NO COMPARISIONs and just "go with the flow" where possible. I pushed 3 hours w/my first son. It was hard but well worth it. And NOT out line for a first baby.

On a Baby Story it seems to be about 15 minutes before going to c-section :eek: , but in real life, how long? If baby isn't in distress that is. And what problems would be associated with prolonged pushing? Large baby, nuchal cord? Would any real issues cause a problem with baby's heart rate?

Issues can and do arise w/baby heart rates. This is not that common. Just again, I stress, you need to trust your care provider and discuss ahead of time what your want your experience to be like. The more you work out ahead, the better off you will be, and more empowered you will feel.

Sorry if my questions are really basic, I lurk here a lot and see a lot of good info. I know I can't get medical advice here, I just want to clarify what I have heard from Bradley class, books, etc.

Thanks! Courtney

You are more than welcome. Hope this helps.

deb, experienced OB nurse and mom of 2.

SmilingBluEyes · Sep 21, 2005

you can also construct a birth plan, if you desire. There are sites that offer "shells" for such, if you want to do this.

Here are some:

http://birthplan.com/

http://www.thelaboroflove.com/forum/attachment/2.html

http://pregnancy.about.com/cs/birthplans/a/birthplan.htm

this will give you a general idea. GOOD LUCK and best wishes.

fergus51 · Sep 21, 2005

Smilingblueyes covered it all very well! I would just add, congrats on the baby and good luck!!!

CEG · Sep 21, 2005

I trust my midwife absolutely and have discussed my preferences with her (she also caught my DD). Unfortunately anyone could be on call, and I have heard some bad stories about some of the new docs. I am hoping my midwife will be able to come in and catch this baby too but no guarantees. Thanks for the help!

]I hope no one minds me asking a couple of questions here... I am soon to be student but not a nurse yet, getting ready to have baby #2.
Congratulations and welcome to allnurses.com and the OB nursing forum.
I keep reading the national circumcision/not rate is 60/40%. Is this what you generally see? Or am I looking at websites that are anti-circ so they slant the info? I am kind of against, DH is for, just trying to make the decision. Also, any opinions, things you have seen, etc.
I see roughly that statistic....maybe more opting "not" everyday. I say, if it's not something you want to do, do not. Remember, it is ELECTIVE, not mandatory or even recommended for "health" reasons anymore. A circ is an elective surgery that carries inherent risks of hemorrhage, infection and in the worst case, problems with urination/penile function (for really badly done jobs and yes, this has happened).
Make darn sure you choose a physician WELL VERSED in circumcision if you choose to do so----someone who can explain fully and completely what he/she will do and how. And make sure you have read the consent forms and understand fully what you consent to---you are consenting FOR your child to have an elective procedure. It's surely up to you. Many still do this----for many reasons. Work this one out w/your husband now, in advance of the birth. And best wishes, whatever you decide. My boy IS circumcised, but this was 13 years ago and if I had the same choice today, I would defer for the reasons given. No judgement on those who do it----but I would not just for cosmetic reasons do a surgery on my son, as a mom.
Also, since DH wil be here for this birth (in Iraq for the last) we have been discussing my wishes for the birth. Unfortunately the (military) ob practice has changed from mostly midwives to mostly docs who are pretty intervention-minded from what I have heard. So some questions I have:
NUMBER ONE PIECE OF ADVICE: get a doula or strong advocate for your birth experience, NOW. Someone who is not afraid to communicate your needs or wishes for you when you may not be able to yourself. ALSO work ahead of time w/the dr or midwives you have about how you would like things to go.
What are the risks of not accepting pitocin, AROM, forceps/vaccuum?
These are risks you need to discuss w/your midwife or dr. The risks MAY outweight the benefits in certain cases. For example, if a baby is stuck (dystocia) a vacuum extraction BENEFIT may outweigh risk in that case. Would I elect to do elective induction w/pitocin? NO, but my bag of water were ruptured a long time (all day) I would probably consent to pitocin induction if labor stalled or stopped. Infection is a risk in extended rupture times. YOU MUST DISCUSS each INTERVENTION OFFERED AT EVERY JUNCTURE as it comes up and decide. If you need an advocate, perhaps, hire a doula to help you out there. They are a wonderful resource for the birthing family and can help communicate your wishes when you feel unable or overwhelmed, or help you "stay on track" to your birth plan, if need be. They do not take the place of your health care providers, obviously, for advice, but are wonderful advocates for YOUR wishes and needs, as well as a great source of comfort for your labor experience. For info about doulas see:
www.dona.org
I know infection after prolonged rupture of membranes, but what others? Say, baby's heart rate is fine, I am fine, no temperature, doc's impatient.
If you sense impatience on the part of the dr, ASK ASK ASK WHY is this being done? And decide if this is truly needed. DO you worry NOW about your dr? Is he/she someone you can talk to you IN ADVANCE about your wishes/intentions? If so, do it NOW, verbally and in writing, but remember, being flexible is a benefit to you BOTH! Sometimes the birth situation can change on a dime. I hope you feel you can trust your care provider when the chips are down; if you cannot, perhaps you need to ask yourself "why" and see what you can do about it.
How long is too long to push?
We have moms pushing 3 or 4 hours in cases where babies and moms are doing well. Average seems to be 1.5-2 hours for first-time moms. PLEASE QUIT watching BABY STORY now---it is not educational and won't give youa real clue to your experience. Your birth experience cannot be plugged into a 30 minute time slot. MAKE NO COMPARISIONs and just "go with the flow" where possible. I pushed 3 hours w/my first son. It was hard but well worth it. And NOT out line for a first baby.
On a Baby Story it seems to be about 15 minutes before going to c-section , but in real life, how long? If baby isn't in distress that is. And what problems would be associated with prolonged pushing? Large baby, nuchal cord? Would any real issues cause a problem with baby's heart rate?
Issues can and do arise w/baby heart rates. This is not that common. Just again, I stress, you need to trust your care provider and discuss ahead of time what your want your experience to be like. The more you work out ahead, the better off you will be, and more empowered you will feel.
Sorry if my questions are really basic, I lurk here a lot and see a lot of good info. I know I can't get medical advice here, I just want to clarify what I have heard from Bradley class, books, etc.
Thanks! Courtney
You are more than welcome. Hope this helps.
deb, experienced OB nurse and mom of 2.

Jayla · Sep 22, 2005

If you like to read (and have time) I would recommend the book: The Thinking Woman's Guide to a Better Birth (author: Hence Goer). It lays out research-based info on a lot of the questions you asked. It's definitely biased towards less medical intervention, and should enable you to ask more informed questions of the OB/GYN (if your midwife happens not to be on call).

Good luck!

Mrs.S · Sep 22, 2005

Where I work (in the midwest) we still do lots and lots of circs. It seems to be a cultural thing around here, also, with Hmong and Hispanic families usually not having it done, but almost everybody else.

My first son was circ'd because my husband felt strongly about it; I figured he was the one with the member so he could have the final say :) But by the time my second son was born my husband wasn't quite so sure anymore, so Boy #2 was not circ'd, and we have no regrets about either of those decisions.

If you have your son circ'd make sure the doc uses anesthesia! Dear Lord I hope this is not happening anywhere else, but I know of two family practice physicians in this area who do not. One of them practiced at the hospital I left this spring; apparently he would always say that the parents refused anesthesia. I would have liked to hear what he told parents pre-procedure when he was getting the consent.

Question · Sep 22, 2005

Here is a great link to an article published by the British Medical Journal in June 2005 about home births.

http://bmj.bmjjournals.com/cgi/content/full/330/7505/1416

wannabeL&D73 · Sep 22, 2005

Congrats on your upcoming birth!

Just wanted to say that I pushed for 3 1/2 hrs. with my first and I am so incredibly thankful that the dr. was patient. It was a beautiful experience and just about the only "normal" aspect of either of my pgs. Good luck!

Shannon

RNnL&D · Sep 22, 2005

]
I see roughly that statistic....maybe more opting "not" everyday. I say, if it's not something you want to do, do not. Remember, it is ELECTIVE, not mandatory or even recommended for "health" reasons anymore. A circ is an elective surgery that carries inherent risks of hemorrhage, infection and in the worst case, problems with urination/penile function (for really badly done jobs and yes, this has happened).

Actually, I'd say worst case, death. Chances are very slim, but it has happened. Possible adverse side effects that I wish someone would have explained to me before I had my oldest sons circed :post op infection, hemorrhage, injury to the urethra, penile amputation, death. I wish I had known more before I agreed to circ simply because my husband is. I opted not to circ our youngest because I researched it more and am uncomfortable with the risks associated with a procedure that is elective and cosmetic. Not to mention the procedure itself. In my naivete, I thought it was simply pulling the foreskin up and cutting it off. I didn't realize that the foreskin does not retract for a few years. It has to actually be torn away from the head of the member to amputate it.

There is a good article in Mothering magazine this Sept issue about circumcision. Try www. mothering.com You may be able to access it there. It is slightly biased towards non circ, but when we're making decisions for a new little being who doesn't have a say in it.......

Everything else, I agree with. :) I especially agree with thinking about a doula. Since you have delivered before, (right?) consider staying home as long as possible with this labor. The less time you are in the hospital, the less intervention can be offered, encouraged, coerced......

wannabeL&D73 · Sep 27, 2005

Just found something else that made me glad we chose not to circ.

"The procedure is a meatotomy. Basically there is a piece of skin left over from his circumcision that is right in front of the hole where he pees from. The urine hits this skin and it is deflected all over instead of coming out in a stream."

This child is 4 years old and has to be placed under general anesthesia for what I would imagine is a painful procedure. Just something to consider.

Shannon

wannabeL&D73 · Sep 27, 2005

More info.

Pathophysiology: After circumcision, a child who is not toilet trained persistently exposes the meatus to urine, resulting in inflammation (ammoniacal dermatitis) and mechanical trauma as the meatus rubs against a wet diaper. This causes the loss of the delicate epithelial lining of the distal urethra. This loss may result in adherence of the epithelial lining at the ventral side, leaving a pinpoint orifice at the tip of the glans. Because this condition is exceedingly rare in children who are not circumcised, circumcision is believed to be the most important causative factor of meatal stenosis. Another hypothetical cause of this condition is ischemia due to damage to the frenular artery during circumcision, resulting in poor blood supply to the meatus and subsequent stenosis.

Frequency:

Internationally: Incidence is 9-10% of males who are circumcised

This is from

http://www.emedicine.com/ped/topic2356.htm

Shannon