Postpartum nurses and circumcisions?

[AmericanChai]

I am a pre-nursing student, former doula student with some births under my belt. I would love to work postpartum when I get my degree. I would like to help the women heal and assist them in establishing nursing if that's what they wish to do. There is just one thing bothering me-- I am really against circumcisions of healthy baby boys. I don't want to start a debate about circumcisions here. My question is, do all postpartum nurses have to assist in curcumcisions, or will the workplace respect the wishes of the nurse and her personal or religious beliefs and not ask her to assist in those? I know how to keep my mouth shut and keep my beliefs to myself in front of the patients, of course. I would act professionally. I would just rather not participate in the procedure itself because it goes against my personal beliefs.

Any advice or thoughts? Or do I just have to help with the circs and that's just goes along with the job of postpartum nursing?

[RGN1]

Being from the UK I think circs on newbrns is just the most barbaric thing I can imagine! Luckily here it's just not done as a norm. Jewish boys get done at home but that's their concern, I don't have to get involved.

Where I used to work there was a consultant who would do circs on newborns in his clinic. I always went for my break when he had one scheduled, I couldn't bear to be in the department when it was going on. I'd just say to my consultant that I was off & he'd usually join me because he knew why I wanted to go (free coffee - yeah!)

I'm not going to be going into obs/gyn in the USA & I'm glad! I'd be a complete wreck if I had to deal with that!!

[q12RN]

Our hospital does em all the time. I havent had to assist with one yet. BUt when our baby had a circ i asked for tylenol afterwards and they told me they couldnt give him any. SO I told my husband to go to the store and bring me some infant tylenol so I could give him some. It sure did help and he didnt stop crying til then. I intend to do the same if this baby is a boy. I just dont tell the Girls working until after I go home:)

[Spidey's mom, ADN, BSN, RN]

AMEN! That's what I say! I think it is unethical for a Doctor to not use pain relief during a circ, if it is safe and medically appropriate. I'm suprised the hospital let's him get away with that.

He does not give shots of lidocaine because he says there was a case of the shot doing irreparable damage to a baby's member.

I helped with a circ today - the baby was numbed up fine and this doc and I don't tie the baby's arms down, just the legs, and that seems to not bother them so bad. This baby took a pacifier (we don't use sugar) and didn't make a peep.

steph

[Elvish, BSN, DNP, RN, NP]

He does not give shots of lidocaine because he says there was a case of the shot doing irreparable damage to a baby's member.

And a circ runs the risk of....??

In our NBN it is the nursery CNA who sets them up and assists. The nurses do the circ checks afterward. I am thankful for this, as I decided that I hated circs since the first one I saw. I wish they would be outlawed.

I have a friend who is a pediatrician in Finland where circs are not the norm (as in most of the rest of the world) and she says that if there is a problem down the road such as phimosis, they do preputiotomies first to try and save the foreskin. Circ is a last resort. I like that idea.

[htrn]

We do an awful lot of circs at our hospital. The peds don't do them because as a group they decided that they would not perform an unnecessary surgery on a newborn!!!! Good for them. Our OBs and some of the FPs do them. They all now use lidocaine (took one a while to come on board with the lido, but started having alot of patients ask for it and finally started doing it). We also give them a lemon glycerin swab during the procecdure - their first little lollypop. A few of our docs have us swaddle the arms, but most of them want those kids strapped down tight.

I hate them and do my best to make myself scarce when there is one to do. I think parents should have to watch a video, with audio, of an actual circumcision from start to finish before they sign the consent.

[Spidey's mom, ADN, BSN, RN]

And a circ runs the risk of....??

I know, I know . . . .

One thing that the nurses and CNA's hate is that all the docs put on gauze with petroleum jelly or neosporin . . .that gauze is very hard to remove . . . as soon as the doc is gone, we remove the gauze and just slather with petroleum/neosporin sans gauze . . . .

The CNA's can assist.

The doc from yesterday usually does everything himself, including the clean up. However I wanted some time off the floor yesterday so I set him up with instruments and then changed the baby's diaper and placed the pacifier.

steph

[mitchsmom]

I have managed to stay away from them so far (I've been doing mostly labor although we are an LDRP). I hope to keep it that way. If it comes up I will probably try to be gone or switch the duty with someone else. We have about 4 OB's and 1 or 2 pedis who will do them and I think only one uses pain meds (but I've also heard he does the worst circs... so what are ya gonna do?). I believe they all use Gomco's. We do use paci's but I don't think we even have sweet-ease; I don't know if anyone uses sugar water or not but I don't think so.

Our medicaid doesn't pay for them. If people are going to pay cash for it themselves we send them to do it after discharge because it is really expensive with the added hospital charges if done in house. If they have private insurance that pays it then it is done while still at the hospital.

Our babies all generally scream and cry and it makes me sick to my stomach, I can't even stand to hear it so I usually try to go away if I'm in the area.

[Spidey's mom, ADN, BSN, RN]

The babies w/o medication usually scream and cry and I hate that too.

I will say that the ones with lidocaine do not usually scream and cry. This one doc I've mentioned who is so good usually does not have a crying baby. I'm very grateful for that.

All my boys are circ'd although I personally did not want it done. The two oldest are glad - they have told me they would be very angry with me if I had won the argument with their Dad.

This won't go away - people will circ. I'm just grateful that some docs do NOT USE those horrible Gomco's and do use pain meds.

And I reserve the right to not work with the doc from hell.

steph

[RNmommy]

At my old job, the peds did the circs and I worked a lot of day shifts, so I assited with lots and lots of circs. Everyone had their own way of doing it. Some used Gomcos, some used Mogens and some used plastibels. All but one used Lidocaine or EMLA. Even though I am as anti-circ as can be, I really didn't have a problem with assisting. I felt that I was a great advocate for the babies comfort while I assisted. I made sure they got in their full 2 minutes of suckling on Sweatease before the procudure was started and tried to be a calming presence.

Now, I work nights and the OBs do the circs on the day shift and the NBN RN is responsible for assisting. I can't say that I have missed that part of my job.

Part of being a good nurse is understanding why people choose to undergo procedures you would never choose for yourself or your family and to assist them through that procudure with as much compassion as possible. Our job is not to judge. You will make yourself crazy judging all of the abismal parenting choices you will come across in postpartum.

[Clarise]

Just to clarify one thing I read on this thread, my OB Instructor stated that the reason why Peds don't do circs is because they are not trained surgeons. OB's are trained which is why they do the circs.

As a current nursing student who just finished her OB rotation, I was able to watch a number of circumcisions, using both of the surgical techniques. I didn't think it was that bad, some of the babies screamed, others weren't bothered at all. I think strapping them to the board made them scream the most. The OB's did four shots of novocaine on the base of the skin where the member enters the body. And the babies all got the sugar water during the procedure.

[EricJRN, MSN, RN]

Just to clarify one thing I read on this thread, my OB Instructor stated that the reason why Peds don't do circs is because they are not trained surgeons. OB's are trained which is why they do the circs.

In general, she's right. I've worked with both pediatricians and neonatologists who were trained in circs though.

[sanctuary, BSN, MSN, RN]

Some day circs will be in the same class as female genital mutilation.