Infant Circumcision in Nursing school

[AmberLB]

I am starting my second semester of an RN program right now, the families semester. I'm really excited to start the semester, as I am becoming an RN on my way to become a lactation consultant, and this is my area of interest. One thing I am very concerned about, though, is that I will possibly be involved in the practice of infant circumcision. I am morally opposed to this, and I don't think I can be involved in such a thing. I know you have to put your own feelings aside sometimes in nursing, like if you are caring for a patient that does something you disagree with, like taking drugs while pregnant, and I think I will be able to take care of someone like that, even if I dislike it, because I am simply doing my job of providing them with nursing care. For me, I feel different about infant circumcision, because I would actually be involved in the procedure that I am against. Anyone know if we normally have to see/participate in infant circumcision during nursing school?

[CBsMommy]

Here's the rub. You want to be an OB nurse. On my rotation, the nurses were cross-trained to two of three areas--PP, L&D, or nursery. The circ supplies and table were prepped by the nursery nurses, and the circ was performed there.

As a PP nurse, you will be required to provide circ care and parent teaching. You will also probably get the baby ready for transfer to the nursery.

If you want to be an OB nurse, you probably won't be able to avoid some type of involvement in the circ. What are you going to do then?

ETA: I know you want to be a lactation consultant, but unless you can get your certification (many, many hours of training and a periodic examination/reexamination), you'll probably have to be an OB nurse first.

As for clinicals, if you're truly against it, you can talk to your CI if the observation is required...but be prepared for the consequences.

At the hospital in my area, a Lactation Consultant and PP Nurse are two separate specialties altogether and I never saw the Lactation Consultants in the area where the circs' were completed.

OP - I think you'll be okay.

[Dazglue, ADN, BSN, MSN, RN]

There is a possibility that you may not have to witness one. Just depends on what time of the day it is I guess. I witness about 5 or 6 back to back. As students we just watched. I'm not against it. To me it's a personal choice for the parents. It was very quick and the doctor I saw do it was very informative. This may be something you have to discuss with your instructor IF this problem may arrive. If I were you I wouldn't mention it until I knew one would be happening. Our teachers asked us if we wanted to see it. All the nurses did was lay out supplies, lay baby down, and comfort baby.

[dudette10, MSN, RN]

At the hospital in my area, a Lactation Consultant and PP Nurse are two separate specialties altogether and I never saw the Lactation Consultants in the area where the circs' were completed..

True, but the most common pathway to obtaining the 1000 clinical practice hours required to sit for the Lactation Consultant exam is through being a PP nurse first.

I just don't know where the OP wants to draw the line on involvement on circs. That's often the sticking point for people who have a moral issue against certain medical procedures, whether it be administering blood products, abortions, or circs.

[OB-nurse2013, BSN, RN]

I beg to differ on circumcision hurting the babies. There is plenty of doctors who will tell you newborns can feel pain. A quote from Dr. Sears "

Yes, it hurts. The skin of the member of a newborn baby has pain receptors completely sensitive to clamping and cutting. The myth that newborns do not feel pain came from the observation that newborns sometimes withdraw into a deep sleep toward the end of the operation. This does not mean that they do not feel pain. Falling into a deep sleep is a retreat mechanism, a withdrawal reaction as a consequence of overwhelming pain. Not only does circumcision cause pain in the member, the newborns over all physiology is upset. New research shows that during unanaesthetized circumcision, stress hormones rise, the heart rate speeds, and valuable blood oxygen diminishes. Babies should never be subjected to the shock of unanaesthetized circumcision. "

And I understand sometimes you have to hold patients down, but usually it's for their own good. Routine infant circumcisions are purely cosmetic, and remove a functioning organ that has a purpose.

And no, you don't have to be an RN to become a IBCLC but it makes it easier to find a job as one.

I did not need a lesson on whether infants feel pain and I did not think that they didn't, but in my state an unanaesthetized circumcision doesn't happen these days, it did 20 years ago but not in the past ten years at least. As a nurse you are going treat people from many different cultures and many different belief's from your own and it may serve you well to learn how to become respectful of that and not so sensitive.

[luv2b_a_nurs]

@asp40, I know I have to set my feelings aside at times, but I really don't think I could hold/strap a baby down to a table to be circumcised. I mean, I understand I have to set my feelings aside at times, but this wouldn't be a passive act. I would be forcing someone down who can't understand or consent to chop off a functioning organ. It's just one of those things I'm thinking I'm not going to be able to set my feelings aside for. I remember my instructors saying that sometimes you have to set your feelings aside and do your job, but if you know it's not something you will be able to handle, sometimes you have to excuse yourself from the situation. I'm hoping they will be understanding that I just can't be a part of that procedure.

I've seen the procedure done two times. It was my choice, not something I had to do. However, 1.)the infant is strapped to a board, you don't hold him down. 2.)The member is numbed and both babies I watched didn't cry a bit. 3.) They are not "chopping off a functioning organ!" It is simply a very small piece of skin that covers the tip of the member and serves no function and removing it makes the member cleaner and easier to care for.

[krimicrat]

I, too, am going into my OB/Peds rotation, and am also ethically opposed to forced circumcision. I will observe, but till not participate or help in any way with the procedure.

This is the only legal procedure I would ever refuse to participate in, BTW. All other procedures I have thought about, the patient can consent. In end of life care, while I may disagree with a choice (usually to extend life despite suffering), I could still carry out the family's wishes, etc.

But not with infant circumcision. Won't do it.

I do not anticipate any problems with my nursing school or instructors. They have been very open minded and tolerant, and I do foresee any drastic change from this mode of thinking on this issue.

I plan not to say anything until I am asked to participate, in which case I will politely decline. If asked, I will say my moral code dictates that I not participate in infant circumcision.

[krimicrat]

It is simply a very small piece of skin that covers the tip of the member and serves no function and removing it makes the member cleaner and easier to care for.

Hmmm, I think the 80% of men around the world WITH their foreskin would beg to differ with you.

The human foreskin serves many purposes, some of which include:

1. Protecting the member and preserving it's intended soft, supple state. A whole member (the head) is a mucosa surface, like the inside of one's mouth. A circumcised member dries out and the skin thickens.

2. The foreskin containes thousands of nerves, and serves as errogenous tissue.

3. Providing a gliding motion during intercourse. An intact member usually does not require lubrication during sex.

4. Protection from infection during the diaper years - the foreskin is fused to the glans for the first several years of life, keeping germs out. The opposite belief is a common misconception among Americans - we fear the foreskin. Rediculous and hilarious, really.

5. There are stretch receptors in the foreskin, providing another pleasurable sensation during sex.

ETC.,....

[Bruce_Wayne, ASN, RN]

I don't understand why this is a big issue. If you don't want to be involved in infant circumcisions then DON'T, I'm sure there's a long line of nurses willing to take that job that don't have your scruples.

If that causes you to lose a job or get a lower grade or whatever, it doesn't matter as long as you maintain your ethics.

I'd advice you to re-examine your staunch position on this though, it seems like the only good that will come out of this is that it will hurt your chances of getting a job you want. It's not like just because you disagree the parents and doctors are going to cancel the procedure. And you shouldn't really council people about he evils of circumcision, that'd be unproessional IMHO. So if it's going to be done anyway, why let that stop you from reaching your own career goals.

[krimicrat]

ALSO, it is a myth that a circumcised member is 'easier to care fore.'

Because the foreskin is fused to the head for the first several years of life - there is absolutely ZERO that needs to be done during the diaper years. You wash it like a finger.

However, for those boys who have been circumcised, there is a lot to do. First, there is wound care during the healing process. Caring for a wound that is constantly surrounded by pee and poop has got to be unpleasant. Then, there is the constant worry about adhesions. One must constantly push back the remaining foreskin stump for months and sometimes even years, in order to avoid adhesions. I personally did not want to get that involved with my son's member, and have been glad to have to do NOTHING.

Later, an intact boy will wash his member like any other body part. Not an issue. Another American foreskin "myth."

I know this isn't a debate thread, but when mistatements are posted about the foreskin, I feel it is important to correct them.

[CBsMommy]

True, but the most common pathway to obtaining the 1000 clinical practice hours required to sit for the Lactation Consultant exam is through being a PP nurse first.

I just don't know where the OP wants to draw the line on involvement on circs. That's often the sticking point for people who have a moral issue against certain medical procedures, whether it be administering blood products, abortions, or circs.

I agree that the OP will need to be a PP nurse prior to sitting for the exam but I don't think the hospital where she is hired will make her participate in circs. Who knows. So many hospitals, so many rules.

[KareBear0609]

I am not a nurse, I am not in nursing school yet but I wanted to share my opinion for whatever it's worth.......

When working with the public, you have to put your own feelings and beliefs aside sometimes (more often than not). You are there to care for someone and in all honesty, your belief isn't going to change a parents decision about their child. There are tons of controversial topics out there (abortion, circumcision, etc.) that you will encounter working in the health care field and you will just have to swallow your feelings and do what you gotta do.

Ask yourself this... what if you were giving birth to a baby and a nurse didn't like your decision NOT to circumcise, so she/he decided they weren't going to participate in your labor/delivery? Seems pretty silly, right?

Either way, a parent is going to do what they want to do. It is a known controversial topic and people aren't going to stop and hear your side of the story. Most people have their minds made up already about this stuff and it is not easily changed.

[krimicrat]

The OP is not saying she won't participate in the labor and delivery. She is simply saying she will not participate in the circumcision. Really not a big deal, and I know some L&D floors accomodate this routinely....