Circumcision

Specialties NICU

Published

Hi! I'm wondering if preemies get circumcised, and if so, are all RNs expected to assist? I really want to work in NICU, but I'm morally opposed to circumcision, so I would not want to be a part of the procedure. I don't have any problems caring for a circumcised baby, I just can't bring myself to have a hand in the procedure. I couldn't even be in the circ room while it was being done. Is it even possible to get a job taking are of babies if you are morally opposed to circs?

Thanks for your input. :)

Work nights. It isn't an issue then cause OBs don't want to do them during the night.

I don't participate in circs and don't feel guilty about it. My coworkers know me well enough to know that it isn't me trying to get out of work and I do more than my fair share of the really ethically questionable stuff.

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I am against circs that are done improperly (botched surgical technique, inadequate pain control), but don't oppose them on moral grounds. If there are particular docs or certain practices that aggravate a situation that is already difficult for you, I encourage you to address these matters with your nurse manager so that someone can challenge the areas where change can be implemented.

On my unit, specially trained techs assist with the circs, but I have observed the procedures and know that our docs are charged with making sure that pain control is adequate and complete before doing anything. Our kiddos get Sweet-Ease on a paci, a dorsal penile block, and Tylenol. Far from the nightmare scenarios of babies arching and writhing in pain, our little ones lie quietly, and some even fall asleep. Immediately afterward, the baby is taken to mom to nurse or be held and bottle fed. Tylenol is available prn for 24 hours. Most need only one more dose, but, believe me, if they show signs of discomfort, they will be taken care of.

For those who have strong moral objections to circs, please be watchful about what you communicate to the parents. There are many people who view circumcision differently--for religious, cultural, or hygienic reasons--and they may not understand or know how to handle a nurse's negative reaction. I'm not saying that any of you would intentionally convey negativity, but sometimes subliminal messages can sneak through.

Any baby who is healthy enough for a circ to even be up for discussion is a fortunate kid. NICU nurses are a special bunch in my book.

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Specializes in Community, OB, Nursery.

On my unit, specially trained techs assist with the circs, but I have observed the procedures and know that our docs are charged with making sure that pain control is adequate and complete before doing anything. Our kiddos get Sweet-Ease on a paci, a dorsal penile block, and Tylenol. Far from the nightmare scenarios of babies arching and writhing in pain, our little ones lie quietly, and some even fall asleep. Immediately afterward, the baby is taken to mom to nurse or be held and bottle fed. Tylenol is available prn for 24 hours. Most need only one more dose, but, believe me, if they show signs of discomfort, they will be taken care of.

For those who have strong moral objections to circs, please be watchful about what you communicate to the parents. There are many people who view circumcision differently--for religious, cultural, or hygienic reasons--and they may not understand or know how to handle a nurse's negative reaction. I'm not saying that any of you would intentionally convey negativity, but sometimes subliminal messages can sneak through.

Our babies get most of the same things, and many scream anyway. I'm not discounting what you're saying, Miranda, just stating my own experience. We can't do pacis on breast babies unless parents provide them (orders specifically say so, though I don't agree with them).

After the docs talk with parents about circ, part of my job is to get the consent signed by mom. So I have to talk with them about it too, if for no other reason than to make sure their questions are answered. I really try hard to be objective...but some of the questions parents ask, I have to be honest about. I tell them, "I will admit that I'm not an expert in XYZ [home care of a circ, for example] because my son is not circumcised." If they don't look at me like I have three heads (which sometimes happens) it usually opens a door to an intelligent conversation on both sides. Both sides usually learn something. Nobody's mind is changed. But at least people know that there is an alternative; there are people who haven't had their boys circed, and we are all fairly normal people. Well, somewhat normal....

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Specializes in NICU, Telephone Triage.
Usually, there are enough people around to cover for your circ if you do their feeding, VS, whatever for them. It's really not that big a deal.

I hate circs too, but everyone knows it; I don't think it happens that often in NICU. The parents are usually so happy to get the kid out of there, they don't even think about the circ. Either they have the pediatrician do it in the office, or, if Jewish, hold the Bris after d/c.

We had a chronic kid who died after many, many months in the unit. The parents were Jewish, and the Director of the unit and another Jewish doc went down to the morgue and did the circ as a courtesy for the parents. I thought that was a wonderful thing to do.

Your experience with circs has been different than mine. I see that most parents want a circ before they go home, even if the baby was a chronic premie! It's sad, IMO. Or, they have the circ done during surgery for other things! I see it is a too much of a priority sometimes with sick babies. I'm not sure why the parents worry about getting it done before discharge!

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Specializes in NICU.
Your experience with circs has been different than mine. I see that most parents want a circ before they go home, even if the baby was a chronic premie! It's sad, IMO. Or, they have the circ done during surgery for other things! I see it is a too much of a priority sometimes with sick babies. I'm not sure why the parents worry about getting it done before discharge!

When our kids are delivered, they go to an area on the L&D floor for stabilization before they head down to the unit. I have had parents of complex cardiac kids ask me IN THAT ROOM when the baby can be circ'ed. That's right up there with "when can he eat?"

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Usually, there are enough people around to cover for your circ if you do their feeding, VS, whatever for them. It's really not that big a deal.

I hate circs too, but everyone knows it; I don't think it happens that often in NICU. The parents are usually so happy to get the kid out of there, they don't even think about the circ. Either they have the pediatrician do it in the office, or, if Jewish, hold the Bris after d/c.

We had a chronic kid who died after many, many months in the unit. The parents were Jewish, and the Director of the unit and another Jewish doc went down to the morgue and did the circ as a courtesy for the parents. I thought that was a wonderful thing to do.

I agree with this. My son is circ'd, but we made this decision a little later, with pain relief, when he was about 4 months old. My twins were under 5 lbs when I brought them home and there was no way I was going to subject that little guy to something like a circ that early.

I waited until he was about 8 lbs. He tolerated the procedure extremely well, and kept his wound slathered with cream and watched his diapers like a hawk until he healed.

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Specializes in NICU.
When our kids are delivered, they go to an area on the L&D floor for stabilization before they head down to the unit. I have had parents of complex cardiac kids ask me IN THAT ROOM when the baby can be circ'ed. That's right up there with "when can he eat?"

I've had the same exact thing happen! We had these twins, both with HLHS, and I remember the dad asking me if they would do the circs then or if they'd wait a while. He obviously didn't realize the magnitude of the diagnosis .... and the fact that both his kiddos had it.

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I am against circs that are done improperly (botched surgical technique, inadequate pain control), but don't oppose them on moral grounds. If there are particular docs or certain practices that aggravate a situation that is already difficult for you, I encourage you to address these matters with your nurse manager so that someone can challenge the areas where change can be implemented.

On my unit, specially trained techs assist with the circs, but I have observed the procedures and know that our docs are charged with making sure that pain control is adequate and complete before doing anything. Our kiddos get Sweet-Ease on a paci, a dorsal penile block, and Tylenol. Far from the nightmare scenarios of babies arching and writhing in pain, our little ones lie quietly, and some even fall asleep. Immediately afterward, the baby is taken to mom to nurse or be held and bottle fed. Tylenol is available prn for 24 hours. Most need only one more dose, but, believe me, if they show signs of discomfort, they will be taken care of.

For those who have strong moral objections to circs, please be watchful about what you communicate to the parents. There are many people who view circumcision differently--for religious, cultural, or hygienic reasons--and they may not understand or know how to handle a nurse's negative reaction. I'm not saying that any of you would intentionally convey negativity, but sometimes subliminal messages can sneak through.

Any baby who is healthy enough for a circ to even be up for discussion is a fortunate kid. NICU nurses are a special bunch in my book.

This is my experience as well. We rarely have a baby cry.

I was against circing my 3 boys but Daddy was in favor. So, they are circd.

steph

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Specializes in NICU.

They both had it? Wow, I don't think I've ever heard of that. Our hospital is doing a study on the genetics of congenital heart disease; I'm sure they'd love to get their hands on your kids! We had a sad one with one twin with HLHS and the other got stuck coming out, got pushed back up and sectioned, ended up with severe HIE. The HLHS twin was actually in the NICU for less time, if you can believe it.

What's funny is that although I have a very heavily orthodox Jewish patient population, they're NOT the ones pushing us to circ, as their mohels do it themselves.

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Specializes in NICU.
They both had it? Wow, I don't think I've ever heard of that. Our hospital is doing a study on the genetics of congenital heart disease; I'm sure they'd love to get their hands on your kids! We had a sad one with one twin with HLHS and the other got stuck coming out, got pushed back up and sectioned, ended up with severe HIE. The HLHS twin was actually in the NICU for less time, if you can believe it.

What's funny is that although I have a very heavily orthodox Jewish patient population, they're NOT the ones pushing us to circ, as their mohels do it themselves.

Yep, they both had it. Which in a way it makes sense that both identical twins would have it, right? I thought it was really interesting though and it was my first cardiac kid, so I'll always remember them. I've got a link that shares part of their story, if you're interested just PM me and I'll send it to you.

To answer the OP, I would definitely bring it up in the interview, if it's that important to you and it'd be something that would affect your job ...... then yes, I would be upfront and voice my concerns.

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The parents are usually so happy to get the kid out of there, they don't even think about the circ.

That is what happened when we had our son---LOL, after his 6-8wks in NICU, we were so elated to get him home, LOL we didn't even THINK about circumcision until AFTER. It just skipped our minds. I think his grandmother is the one who noticed.

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Specializes in NICU, PICU, educator.

I wouldn't say that you will never ever have to help, but if your co-workers are busy, you are going to have to step up. In our unit, we just strap Junior in, and the OB's do the rest. We make sure we have their pacy and Toot sweet. There are a lot of things that I am "morally" against, but it is my duty to take care of my patient and make sure things are done right. Just be prepared to answer to a mom when she asks if you will be with her baby when it is done...we have moms ask us all the time if we will be there for the baby if they can't.

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