What has to happen before circ at your place?

Specialties Ob/Gyn

Published

Specializes in Community, OB, Nursery.

Here is my question: is there a certain set of events that occur where you are that have to occur before a baby boy can be circumcised?

I'm asking because we have no policy in place stating the baby has to void, or be a certain age, or be seen by peds before they're circed. Then OB (mostly the residents) come and want to circ these kids when they're mere hours old, and I don't like it. I don't generally like the practice of circ anyway, but I REALLY dislike doing it when a) the kid hasn't peed yet; b) he's not yet 24 hours old; and/or c) pediatrician hasn't examined him. If I'm in charge in the nursery it's me that currently takes the heat for not letting them circ babies that were just born. It's totally unnecessary and some act like I am doing the human race a great disservice.

I think it's wrong, and I think it's asking for trouble. I am interested to see what you all are doing. Thanks.

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Specializes in OB.

My facility- babe has to be 24 hours old, by then Peds has rounded on this babe at least twice. Has to have peed, consent signed by parent, we use lidocaine tylenol and sweet-eze time out called, then the procedure.

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Same here-except we are supposed to sing during the procedure! Geesh-think we've gone a bit overboard there, eh? heh heh

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Specializes in nursery, L and D.

Elvish, even at the "bad" hospital, lol, baby had to be 22 hours old(b/c some went home at 24), peed at least once and seen by pedi.

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Specializes in Rural Health.

We are spoiled by our peds docs....:D

They round on the baby, they make sure baby has peed at least once, they talk to the parents and they get the consent signed. We have information sheets that go out to all boy parents after delivery and the doctor does expect those to have been read by the parents before they talk to them.

As far as age, most are nearing the 24 hour mark if not darn near 48 hours (we have a HUGE and VERY HIGH c-section rate where I work). If the parents are insistent on leaving - baby can be discharged home and the circ will be done in the office at a later date.

We probably only circ 50% of our boy babies in the facility which I'm OK with because out of everything dealing with newborns, I really don't like the whole circ process.

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At our hospital, a baby has to be 24 hours old before it can have a circumcision and has to void before it goes home, and a minimum of 4 hours has to pass between the circ and discharge.

I am very, very proud of the pediatricians at our hospital that ALL of them use anesthetic, and the babies don't even flinch.

It is a nice thing to report back to Mom, and it always makes them smile to know that their son didn't feel a thing.

I agree with circ's (and don't want to turn this into a circ debate), but the practice of NOT using appropriate anesthetic is barbaric and no hospital should allow that practice.

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Here is my question: is there a certain set of events that occur where you are that have to occur before a baby boy can be circumcised?

I'm asking because we have no policy in place stating the baby has to void, or be a certain age, or be seen by peds before they're circed. Then OB (mostly the residents) come and want to circ these kids when they're mere hours old, and I don't like it. I don't generally like the practice of circ anyway, but I REALLY dislike doing it when a) the kid hasn't peed yet; b) he's not yet 24 hours old; and/or c) pediatrician hasn't examined him. If I'm in charge in the nursery it's me that currently takes the heat for not letting them circ babies that were just born. It's totally unnecessary and some act like I am doing the human race a great disservice.

I think it's wrong, and I think it's asking for trouble. I am interested to see what you all are doing. Thanks.

I am pro-circ but I TOTALLY agree with you on that one.

I would suggest that the hospital have a protocol on that issue, that stops physicians from pulling crap like that.

The birth process is traumatizing enough to an infant and it needs to rest. To me it is also dangerous because it's also important to be able to assess the infant, see if it's feeding ok, awake, alert, crying, etc before another procedure is performed.

That is a Pediatrician that is wanting to work on his own schedule and not looking out for his patient.

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Specializes in Community, OB, Nursery.

Thanks all for your responses and would welcome more.

Thing is, our pediatricians have nothing to do with our circs. It's the OBs who do them, and they are the ones responsible for talking w/ the parents so they can be 'informed'. I don't agree with this but it is out of my realm of control. The thinking, apparently, is that OBs are trained 'surgeons' and pediatricians aren't. I don't agree with it, like I said, but that bit is not going to change.

Our OBs come into the nursery at all hours of the day/night and want to circ babies that are recently born. I fight them on it when babe isn't 24 hours old yet. Most of the time I win, but there is no policy to back me up. And I'm one of the few who fights it. I don't really care for it to be about me 'winning'. I just want, assuming we're going to be doing something like this, to have it done in the safest way possible.

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Specializes in OB, House Sup, ER, Med Surg.

At our facility, the babe sometimes the doc will do it at 24 hrs, sometimes at 36 hrs, never on weekends or holidays. They are only done at 7:30am. The babe must ballard at 38 wks, the member must be 1.5 cm in length. There are several other little rules that change from day to day. Most private insurance will only pay for circs if done in the hospital during original nsy stay - Medicaid doesn't cover them at all.

If the circ is to be done in the office, it can't be the same day as the 1 wk check, it can only be at 0900 or 1300, payment arrangements must be in place, etc...

The only doc who does circs at our facility is a family prac doc (who does not deliver babies.) Circs are a huge pain in the neck - not the procedure itself, but getting arrangements made.

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Wow! You measure their member? I can just see the arguments that would ensue at our hospital over that one!

I think having them do the circs in the office would be great-that way the whole procedure, along with the tylenol we give before and 4 hrs after, wouldn't throw such a kink into the whole breast feeding process. Tough to get a baby awake sometimes afterward and if they were done later perhaps the breast feeding hurdle would be past.

Connie

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Thanks all for your responses and would welcome more.

Thing is, our pediatricians have nothing to do with our circs. It's the OBs who do them, and they are the ones responsible for talking w/ the parents so they can be 'informed'. I don't agree with this but it is out of my realm of control. The thinking, apparently, is that OBs are trained 'surgeons' and pediatricians aren't. I don't agree with it, like I said, but that bit is not going to change.

Our OBs come into the nursery at all hours of the day/night and want to circ babies that are recently born. I fight them on it when babe isn't 24 hours old yet. Most of the time I win, but there is no policy to back me up. And I'm one of the few who fights it. I don't really care for it to be about me 'winning'. I just want, assuming we're going to be doing something like this, to have it done in the safest way possible.

WOW...things sure are different in different areas.

I have never heard nor seen (I've worked, so far, at 5 hospitals during rotations), an OB-GYN doing a circ.

Wow.

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Specializes in OBGYN, Neonatal.

Our rule is they have to be 24 hours old, have urinated at least once and have been examined by the pediatrician at least once.

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