The Circumcision Discussion - page 90

I know this can be a HUGE debate, and I'm not looking to start any arguments. I was just wondering as you are OB nurses. I'm expecting a boy in July and not sure if we should circ. or not. My... Read More

  1. Visit  consult2 profile page
    2
    "BTW I have assisted with a few and the babies get a local (most doctors these days)"

    Sure they do...

    A recent retrospective study was performed at a top hospital in Chicago.
    Publlshed October 11, 2004, by Peggy Peck, this study is titled "Analgesia Underused for Management of Circumcision Pain".

    In this study, a researcher went back through 5 years (1999-2004) of hospital records and checked whether anesthetic use had been recorded.

    Out of 108 circumcisions, only 8 were marked for anesthetic.

    The researcher couldn't believe it, so they checked the pharmacy charts to see whether anesthetic had been ordered.

    They found that anesthetic had been ordered from the pharmacy, for only 35%-40% of circumcisions.

    An excerpt from the study:

    Of 191 male infants identified in the review of 400 charts, "56% underwent circumcision," .....
    .....
    All circumcisions were performed by obstetricians. "Dorsal penile block was used in seven infants and subcutaneous ring block was used in one infant,"...

    ....Another telling finding, he said, was that the medical charts indicated no discussion of circumcision pain management with parents.

    If you want to view it instead of just taking my word for it, first you must register here:
    https://profreg.medscape.com/px/registration.do?cid=med

    Then click this link:
    http://www.medscape.com/viewarticle/491035
    dnp2004 and deege58 like this.
  2. Visit  xokissmekatexo profile page
    0
    I'm only a nursing student but I just finished my clinical rotation in OB. There wasn't a whole lot going on for us to get involved in so when circumcisions were being performed, we all watched. I think in the 12 weeks of clinical rotation I probably saw 8 circumcisions. Every doctor I observed performing a circumcision used a numbing agent. It is standard now (that's what the doctor told me). Babies are unable to localize pain, so when they are hurt, they feel it everywhere. That's why nurses (good nurses) will keep the baby swaddled and only take out a leg when they give injections. When the baby boys are strapped down in the nursery to have the circumcision performed, they are upset with the fact that they can't pull their arms and legs in towards their bodies. They are most likely NOT crying because they are in pain. The initial poke of the injection causes some discomfort. The nurses I watched all had a pacifier with sugar water ready because glucose (sugar) is shown to have an analgesic effect on infants.
    I don't know the specific name of the medication the doctors used to numb, but I know it works, because I watched one little boy sleep through his circumcision!
    Hope this helps!
  3. Visit  consult2 profile page
    4
    "I don't know the specific name of the medication the doctors used to numb, but I know it works, because I watched one little boy sleep through his circumcision!"

    It is called lidocaine--and it only REDUCES the pain..

    "In summary, analgesia is safe and effective in REDUCING the procedural pain associated with circumcision " (emphasis added)

    http://aappolicy.aappublications.org...rics;103/3/686

    EFFECT OF NEONATAL CIRCUMCISION ON PAIN RESPONSE
    THE LANCET, Volume 349 Number 9052: Pages 599-603, March 1, 1997.

    Meritcare (Internet) states that "Besides anesthesia, securing your child in the padded restraint chair and giving him a sugar-dipped pacifier can help reduce his level of stress (and yours). Used together, these methods can decrease discomfort by more than 50%."

    http://www.meritcare.com/kidshealth/...77&lic=19&pg=3


    http://www.nichd.nih.gov/cochrane/Br...BRADYFRYER.HTM

    None of the studied interventions completely eliminated the pain response to circumcision

    As for when it is used, what didn't you understand about the rate of usage I posted above.

    Sleep through it?

    HARM CAUSED BY CIRCUMCISION
    The increasing doubts about Jewish circumcision are based on the understanding that it causes harm. Anatomical, neurochemical, physiological, and behavioral studies confirm what mothers already know: infants feel pain. Drs. Anand and Hickey, in a comprehensive review of recent medical literature on newborn pain, conclude that newborn responses to pain are "similar to but greater than those in adult subjects."11 This study is accepted by virtually all medical authorities and is often cited in the literature whenever there is a discussion of infant pain. As a surgical procedure, circumcision has been described as "among the most painful performed in neonatal medicine."12 Studies of infant responses show that the pain of circumcision is not like that of a mere pin prick. It is severe and overwhelming.

    The relationship between infant pain and vocal response needs explanation. The cry may be reduced by the effect of anesthetics given to the mother during labor.13 These anesthetics enter the infant's body and, according to pediatrician T. Berry Brazelton, it can take over a week to leave.14 Other factors can also account for minimal vocal response. Justin Call, infant psychologist and professor-in-chief of child and adolescent psychology at the University of California, reports that "sometimes babies who are being circumcised . . . . lapse into a semi-coma."15 Tonya Brooks, president of the International Association for Childbirth at Home and a midwife, observes, "In four of the nine circumcisions that I have seen, the baby didn't cry. He just seemed to be suddenly in a state of shock!"16 Studies demonstrate that even though an infant may not cry during circumcision, the stress hormone level in the blood still increases dramatically, and medical researchers consider this change to be the most reliable indicator of pain response.17 Therefore, lack of crying does not mean that the infant feels no pain. It could mean that he is withdrawing from unbearable pain.

    http://www.circumcision.org/spectator.htm

    http://www.cirp.org/pages/parents/circ-why/

    PAIN, STRESS AND RISKS

    Until recently it was believed babies felt no pain due to their immature nervous systems. Studies however, indicate that babies experience physical and psychological stress both during the circumcision and for hours thereafter. The procedure is undeniably painful. Some babies cease to cry or lapse into a deep sleep or coma which is how they are able to cope with the traumatic experience.

    Some babies are so severely traumatized by the experience that they fall into a semicomatose state. Some circumcisers still pretend that these babies are just falling asleep! Nothing could be further from the truth. No one falls asleep when his sex organs are being cut with a knife. Because he is tied down, a baby has no way to escape, no matter how much he thrashes. Going into a comalike state is one way for the baby to distance himself from his agony, but it has dangerous consequences for the brain, as you will read below.

    http://www.nospank.net/fleiss1.htm

    "They are most likely NOT crying because they are in pain. The initial poke of the injection causes some discomfort. The nurses I watched all had a pacifier with sugar water ready because glucose (sugar) is shown to have an analgesic effect on infants."

    I can't believe medical people are still trying to use this tired old rationale.

    http://www.cirp.org/news/cin/1995.04.12

    993; 270: 850-53 [Benni F et. al] Their study confirmed the permanent psychological damage inflicted on infants subjected to unanesthetised penile reduction surgery. The severe and unalleviable pain of circumcision permanently alters the neural pathways in an adverse fashion. From JAMA 1988; 259: 1507-11 [Stang HJ, et. al] They found that an injection of lignocaine hydrochloride reduced the plasma cortisol concentration slightly, but left the babies with a concentration of 331nmol/L, whereas a content infant at rest has a plasma cortisol concentration of 28-138 nmol/L. Sadly, the Benni group found that EMLA (lignocaine/prilocaine local anesthetic cream) could only reduce the circumcised child's heartbeat from 180 to 160 beats a minute. No infant's heart should beat at 160 beats a minute, nor should his plasma cortisol concentration be 331 nmol/L. These rates are consistent with torture. With or without anesthetic circumcision will cause psychoneural damage.

    Note: the change in the heartbeat rate is 60 bpm.

    The above values includes this increase. Therefore the delta rate of 60 must be added to ANY resting rate to determine the absolute values. Then the comparison of rates can be done with other procedures.

    PEDIATRICS, Volume 71 Number 1, Pages 36-40,
    January 1993.

    Physiologic Stress Reduction by a Local
    Anesthetic During Newborn Circumcision
    Paul S. Williamson, MD, FAAFP, and Marvel L. Williamson, RN, MSN

    http://www.cirp.org/library/pain/williamson/

    http://www.cirp.org/library/anatomy/cold-taylor/

    Although most neonatal and childhood circumcisions are performed with no anaesthesia [37], the complicated innervation of the penis explains why a dorsal penile nerve block provides incomplete pain relief for neonatal male circumcision [37,38].

    Likewise, a penile ring block cannot block the visceral afferent fibres from the cavernosal nerve nor the posterior scrotal somatosensory branches of the perineal nerve [38]. A eutectic mixture of local anaesthetic cream (EMLA) does not relieve the pain associated with circumcision because of the complexity of penile innervation and the multiple layers that would have to be penetrated by the topical cream in the newborn penis [39]. Amazingly, some modern urology textbooks even recommend wine as an anaesthetic for newborn circumcision [24].

    "Pain and its Effects in the Human Neonate and Fetus." By K.J.S. Anand & P.R. Hickey. New England Journal of Medicine, November 19, 1987. Page 1325 states: "Most recently the motor responses of 124 healthy full-term neonates to a pinprick in the leg were reported to be flexion and adduction of the upper and lower limbs associated with grimacing, crying, or both, and these responses were subsequently quantified. Similar responses have also been documented in very premature neonates, and in a recent study, Fitzgerald et al. found that premature neonates (<30 weeks) not only had lower thresholds for a flexor response but also had increased sensitization after repeated stimulation." Page 1325 states: "In other studies of the cry response to painful procedures, neonates were found to be more sensitive to pain than older infants (those 3 to 12 months old)…" This article uses the obstetric method of counting from the last menstrual period, as evidenced by the chart on page 1322, which uses a gestation of 40 weeks for pregnancy. Two weeks must be subtracted to provide the actual time since fertilization.

    "Symptom Management: Acute Pain, Chapter 3 - Pain in Preverbal Children." United States National Institutes of Health, Publication Number 94-2421. June 1994.
    Accessed at http://www.nih.gov/ninr/research/vol6/preverbal.pdf in September of 2002. Page 2 cites one possible reason why younger humans are more sensitive to pain: "Serotonin (5HT) is a biogenic amine transmitter that serves an important role in pain modulation. … Serotonin levels in the young infants are low and may limit the effectiveness of the endogenous pain control mechanisms (Fitzgerald 1991b)."
  4. Visit  Joe12 profile page
    3
    Quote from Balder_LPN
    You can find paper after paper of peer reviewed, published, scientific studies that support both. Several have shown a lower incidence of HIV infection in areas of Africa for men who are circumscised.


    Thats why it's a personal choice, and parents make many choices for their children who are not yet competent to make thier own. I am sure glad mine was done as an infant when I don't remember it. I would certainly have wanted it done as a teen (90% of my peers were cut), but would not likely have choosen to go thru the painful procedure.
    There has been a lot of discussion about those studies and the bottom line is that even if they are accurate the prevalence in the US does not justify the use. But let me ask you about the bold part. How can you justify authorizing a procedure for someone when you yourself wouldn't go through it? That is one of the primary considerations of proxy consent, the substitute judgment test and why when have procedures performed with proxy consent it is necessary that the least invasive, reasonably effective option always be taken first. Hint, circumcision isn't it.

    Quote from Balder_LPN
    BTW I have assisted with a few and the babies get a local (most doctors these days) and they Don't always scream, nor do we feel that we have been Maimed. The first TWO i was present for had no screaming, just a little boy sucking on my gloved finger.

    It surprises me how militant some of these voices seem, and they seem to be almost exclusively women. maybe they can let the men police this almost exclusively male issue. I dont know of any support groups for men who feel they are maimed, or deformed by having been circumscised, nor do I know of any male, personal or professional knowledge, that has any issues with being cut (although I am sure I will hear of several any second now)

    I am a guy most people I knew were cut I wouldn't have wanted it done and I think it's abuse. I also have several friends who while not openly hostile are irritated that they were 'cut' for no good reason and would have preferred the choice. Standard medical ethics should have stepped in to give them that choice but for some reason there is an exception to circumcision in the code of medical ethics.

    Let me ask you this, if I surgically removed a infant's earlobes, and of course I would use ELMA or Lido so it wouldn't hurt, would you find that acceptable? Why or Why not?

    ETA: And you should google foreskin restoration. There are more than a few people who are making a very comfortable living selling devices to help restore.
    Last edit by Joe12 on May 18, '09
    Equinox_93, Smurfette752, and JanisM like this.
  5. Visit  Joe12 profile page
    1
    Quote from xokissmekatexo
    I'm only a nursing student but I just finished my clinical rotation in OB. There wasn't a whole lot going on for us to get involved in so when circumcisions were being performed, we all watched. I think in the 12 weeks of clinical rotation I probably saw 8 circumcisions. Every doctor I observed performing a circumcision used a numbing agent. It is standard now (that's what the doctor told me). Babies are unable to localize pain, so when they are hurt, they feel it everywhere. That's why nurses (good nurses) will keep the baby swaddled and only take out a leg when they give injections. When the baby boys are strapped down in the nursery to have the circumcision performed, they are upset with the fact that they can't pull their arms and legs in towards their bodies. They are most likely NOT crying because they are in pain. The initial poke of the injection causes some discomfort. The nurses I watched all had a pacifier with sugar water ready because glucose (sugar) is shown to have an analgesic effect on infants.
    I don't know the specific name of the medication the doctors used to numb, but I know it works, because I watched one little boy sleep through his circumcision!
    Hope this helps!
    Same question: If I surgically removed a infant's earlobes, and of course I would use ELMA or Lido so it wouldn't hurt, would you find that acceptable? Why or why not?
    consult2 likes this.
  6. Visit  natusia84 profile page
    0
    We have circs done A LOT in our hospital. I think, personally, I would want my son to be circumcised only if I knew the OB had a good reputation for making the procedure as quick and painless as possible, because I have seen way to many Residents doing a job gone wrong.
  7. Visit  dnp2004 profile page
    5
    Quote from natusia84
    we have circs done a lot in our hospital. i think, personally, i would want my son to be circumcised only if i knew the ob had a good reputation for making the procedure as quick and painless as possible, because i have seen way to many residents doing a job gone wrong.
    if you son has a healthy foreskin why would you want him circumcised at all? i am an ob/gyn and only have had to perform four medically necessary circumcisions in my whole career. i'm in my 60's.

    i never have performed them based on parental requests. when i was overseas it was considered a cosmetic procedure that was forbidden unless it was to correct a disorder.
    Equinox_93, consult2, JanisM, and 2 others like this.
  8. Visit  consult2 profile page
    0
    Quote from natusia84
    We have circs done A LOT in our hospital. I think, personally, I would want my son to be circumcised only if I knew the OB had a good reputation for making the procedure as quick and painless as possible, because I have seen way to many Residents doing a job gone wrong.
    Where in this equation is there any consideration of the KNOWN risks (many & common), and the known and proven harm?

    Experience, be damned, accidents happen and complication occur in ANY surgery -regardless of degree of experience.

    So, can anyone supply a rational and logical reason for this unnecessary procedure at all? If not, then most of these rationales and conditions are simply excuses for the inexcusable.
  9. Visit  Elvish profile page
    0
    Some of the worst circs I have seen were done by attendings.....and some of the best (if there is such a thing) done by residents.
  10. Visit  libnat profile page
    0
    If you son has a healthy foreskin why would you want him circumcised at all?
    Looks, circumcised looks better.
  11. Visit  Elvish profile page
    0
    Quote from libnat
    Looks, circumcised looks better.
    That's a fairly subjective assessment, and most of the rest of the world has a differing opinion.
  12. Visit  libnat profile page
    0
    there was a poll i might search for later with the majority of american female respondents saying they preferred the look of circ, apparently agreeing with me but either way my kid, my look preference.
  13. Visit  morte profile page
    4
    Quote from libnat
    there was a poll i might search for later with the majority of american female respondents saying they preferred the look of circ, apparently agreeing with me but either way my kid, my look preference.
    they prefer it because it is the known......believe me, uncirced is more comfortable and pleasurable for both parties........
    JanisM, GooeyRN, Elvish, and 1 other like this.

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