Circumcision on a few hour old newborn?

Specialties Ob/Gyn

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Tonight at work we had an MD come in and and want to do a circumcision on a newborn that was only a few hours old... so he wouldn't "have to come back later". Baby was delivered via C/S. Usually our docs come in the day after delivery and do the circumcision then or wait until the day of discharge. Just a few times have I known an MD to want to do one just a few hours after the baby is born. We addressed this issue to our manager and clinical instructor, but we have no written policy that a circumcision is to be done after a certain time frame. Needless to say, the doctor proceeded with the circumcision. Have any of you encountered this? When do circumcisions on your newborns get done? And do you have a policy for when it should be done? Just curious what other hospitals practice?

BETSRN

1,378 Posts

Tonight at work we had an MD come in and and want to do a circumcision on a newborn that was only a few hours old... so he wouldn't "have to come back later". Baby was delivered via C/S. Usually our docs come in the day after delivery and do the circumcision then or wait until the day of discharge. Just a few times have I known an MD to want to do one just a few hours after the baby is born. We addressed this issue to our manager and clinical instructor, but we have no written policy that a circumcision is to be done after a certain time frame. Needless to say, the doctor proceeded with the circumcision. Have any of you encountered this? When do circumcisions on your newborns get done? And do you have a policy for when it should be done? Just curious what other hospitals practice?

We NEVER do circs on the day of birth. I don't even think we have a policy about when.

rainrn12

4 Posts

Specializes in Med surg, L&D.

For the most part our docs wait until after the pedi sees the infant. We also do not have a specific policy of when the circ should be completed.

Specializes in Behavioral Health.

Our policy only states that the ped has to examine the baby first. Most of our OB's wait until they are 24 hrs. old...

Jolie, BSN

6,375 Posts

Specializes in Maternal - Child Health.

I 've had co-workers tell me about the olden days when the OBs did the circs right in the delivery room! UGH!

I don't think I've ever worked anywhere that had an actual policy on the matter, but simple logic would dictate that a few hours is hardly a sufficient period of time to assess a baby's transition before subjecting him to a (needless) surgical procedure. Of course, OBs don't always seem to posess simple logic. Can you imagine the potential liability the OB would face if he performed a circ on a a baby with an undiagnosed cardiac defect, early-onset sepsis, borderline RDS, or glucose instability, causing the baby to "go over the edge", so to speak. Heck, we don't even bathe newborns if we have any concerns about their physical stability.

Let me guess, he didn't use any anesthesia, either.

Sounds like the doc in question needs a refresher on basic principles of newborn care. Why would someone work so hard with the parents for 9 months to ensure a healthy pregnancy and delivery, only to treat the infant so inappropriately?

SmilingBluEyes

20,964 Posts

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

That would not happen where I work. The baby who is hours old may not be stable enough for a circ. Case in point: some cardiac lesions don't present a problem for 12-24 hours after birth. The newborn appears normal then takes a dive in sats and heartrate-----next thing you know, you have a crumping "blue baby" who needs your full attention and may even code. NOW you add a circ to that????

Bad deal. I know worst case scenario-----------but I have witnessed this......babies need to establish bonding and feeding. NO newborn only hours old needs this stress in the huge transition from inutero life to life outside the womb! This is a horrendous practice to circ at only a few hours old. You are right to be concerned.

CHATSDALE

4,177 Posts

with the push to get the mother out the door [not as bad now as a few years ago] i suppose there would be a push to circumcise infant...

the ped md usually does this in most places

SmilingBluEyes

20,964 Posts

Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Well our moms DO leave pretty quickly, but that is a major reason we dont circ much in the hospital anymore .Most babies are circ'd at their first newborn checkup with their follow-up pediatrician. And I do share w/parents it's much safer AND cheaper to do it this way!

camay1221_RN

324 Posts

Our policy only states that the ped has to examine the baby first. Most of our OB's wait until they are 24 hrs. old...

Ditto.

camay1221_RN

324 Posts

Well our moms DO leave pretty quickly, but that is a major reason we dont circ much in the hospital anymore .Most babies are circ'd at their first newborn checkup with their follow-up pediatrician. And I do share w/parents it's much safer AND cheaper to do it this way!

That sounds great!!! I wish it were done that way around here!

baby&mommynurse

222 Posts

Specializes in OB.
Let me guess, he didn't use any anesthesia, either.

Sounds like the doc in question needs a refresher on basic principles of newborn care. Why would someone work so hard with the parents for 9 months to ensure a healthy pregnancy and delivery, only to treat the infant so inappropriately?

My shift had already gone home when the doc came back to do the circumcision, but I'm certain that he did use a block. Our hospital now requires that some kind of anesthetic be used. This particular doc, as you can already tell doen't rank high with the nurses... he used to be one of the docs that never used any anesthesia. As much as we tried to argue with him about not doing the circ, there was no swaying his decision to do it then. I'm just as surprised that the parents signed the consent and agreed to have it done so early. Of course, they probably didn't know the risks.

Well our moms DO leave pretty quickly, but that is a major reason we dont circ much in the hospital anymore .Most babies are circ'd at their first newborn checkup with their follow-up pediatrician. And I do share w/parents it's much safer AND cheaper to do it this way!

Most of our OBs do the circumcisions. We only have a few Peds that do them from a certain group. Most of the circs get done in the hospital while the docs are making rounds, so they won't have to do them later.

Thanks for your input everyone. It'll help me state my case and push for some kind of hospital policy on when circumcisions should be done.

Specializes in Nurse Manager, Labor and Delivery.

This post has made me want to do some research on recommendations for circs......how long after birth etc. I wonder if the AAP site has info. Will have to look...will let you know if I come up with anything.

Our OB's do the circ's, and they usually wait till the day of discharge to do them. I think ONE time we did one when the kid was 12 hours old.

I hate the "I can't make it back to do it" mentality. I am really really really fed up with medicine based on what is good for the doc and not the patient...but it seems that is the trend here. I better stop here....or I will really get started...lol.

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