Circumcision Decision

By Deena H. Blumenfeld, RYT, RPYT, LCCE

Adapted from the original article at Science & Sensibility, Parental Autonomy in Decision Making: A Follow-Up to the AAP's Newborn Male Circumcision Policy Statement http://www.scienceandsensibility.org/?p=5322

As parents, we face many decisions regarding how we raise our children. It's everything from what toname them; which car seat to purchase; choosing a pediatrician; what school to send them to; and so on. If you are having a boy, you may be wrestling with the choice of whether to circumcise your son, or to leave his penis intact. It's not an easy choice to make for some families; others have no doubt about what they will do when their son is born. Hopefully, this article will assist you in feeling confident in your decision regarding circumcision.

On August 27, 2012 the American Academy of Pediatrics (AAP) released their new Policy Statement on Male Circumcision. http://pediatrics.aappublications.org/content/early/2012/08/22/peds.2012-1989.full.pdf+html It caused somewhat of a stir in the online parenting communities and in the media. Ok, so maybe it caused a big stir& In much of the coverage I've read online, I found much vitriol, anger and self-defensiveness, as well as overly aggressive behavior and dismissive or patronizing attitudes. This is entirely unsurprising. Circumcision has been a hot button issue for many years. This reaction comes not only from the mainstream media and inpiduals, but from the anti-circumcision organizations as well.

I'd like to explore the issue in a more objective and compassionate manner. Looking at the rationale behind circumcising (or not), we find multiple reasons, falling into two main categories: social and medical.

Social reasons regarding circumcision:

• Religious beliefs
• Perceived sense of what's normal with regards to how his penis should look.
  • Wanting the baby to look like his dad.
  • Fear of the child being the only one in the locker room who doesn't look like his friends.
• Ethical belief that:
  • Circumcision is genital mutilation.
  • The child has autonomy.

Medical reasons regarding circumcision (cited from the AAP's policy statement):

• Reduction in rates of:
  • Urinary tract infections
  • Penile cancer
  • Transmission of some sexually transmitted infections, including HIV
• Systematic evaluation of English-language peer-reviewed literature from 1995 through 2010 indicates that preventive health benefits of elective circumcision of male newborns outweigh the risks of the procedure.

From the new policy statement, the AAP concludes:

"Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns. It is important that clinicians routinely inform parents of the health benefits and risks of male newborn circumcision in an unbiased and accurate manner.

Parents ultimately should decide whether circumcision is in the best interests of their male child. They will need to weigh medical information in the context of their own religious, ethical, and cultural beliefs and practices. The medical benefits alone may not outweigh these other considerations for inpidual families."

So, as a parent of a baby boy, how do you make this decision? It is a multifaceted issue and no one person can tell you what the right choice is. For some parents, the medical reasons carry greater weight than do the social or religious reasons. For other parents, the social or religious reasons carry greater weight over the medical reasons.

On the medical side, just as we do with prenatal testing, medications or procedures during labor, vaccines for our children, etc., we look at the benefits of the treatment and the risks. We compare these to our own risk tolerance levels and then decide Is this treatment / medication / procedure right for me?

On the softer, but no less valid side, are our belief systems. We use our religion, our upbringing, and our societal norms to help us determine the right course of action.

How does the AAP feel regarding the social and religious influences on circumcision decision making?

"Parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for inpidual families."

"Parents and physicians each have an ethical duty to the child to attempt to secure the child's best interest and well-being. Reasonable people may disagree; however, as to what is in the best interest of any inpidual patient or how the potential medical benefits and potential medical harms of circumcision should be weighed against each other. This situation is further complicated by the fact that there are social, cultural, religious, and familial benefits and harms to be considered as well. It is reasonable to take these nonmedical benefits and harms for an inpidual into consideration when making a decision about circumcision."

This theme of parental choice is written throughout the document, overshadowing the medical evidence presented.

Trends and statistics in the United States:

Right now the circumcision rate in this country stands at about 50-60%, depending which survey you look at. (All of the surveys are in regards to hospital circumcision.) The rates of circumcision in the U.S. are declining, overall.

Coming full circle: When you, as a parent, are trying to decide whether it makes sense to circumcise your baby boy, or to leave him intact, understand that the decision lies solely in your hands and that there is no right choice. Circumcision should be discussed by your obstetrician or midwife. It should be discussed by your childbirth educator. Your pediatrician will offer guidance. Your family and friends will have their own opinions and the online universe will work diligently to try to convince you one way or the other.

Take a deep breath. Understand, as the AAP does, that you are the only one who knows what's best for your baby, and whatever choice you make will be the right one for him.

How is this approached in your childbirth education class? Every instructor will have her own approach. However, she should be fair, compassionate and keep the environment of her classroom well balanced and safe for all students.

What should be covered in your childbirth class?

• The medical and social reasons to circumcise (or not)
• Addressing circumcision in your birth plan
• How the procedure is done
  • Including risks and benefits
• Your options, should you choose to circumcise
  • Shortly after birth, in hospital
  • A few days or weeks after birth in your pediatrician's or family practice doctor's office
  • At home, with a religious ceremony, such as a Bris
• Care of the circumcised penis
  • Including warning signs for infection, etc.
• Care of the intact penis
  • Including what is normal, bathing, etc.
• She may provide a handout with additions resources to which you may refer later.

Deena is a Certified Khalsa Way" Prenatal Yoga Teacher and Lamaze® Certified Childbirth Educator. She has been practicing yoga for more than 15 years. She became a certified Yoga instructor through 3rd Street Yoga in December 2008. She completed her 60 hour Prenatal Yoga training in February 2009 in Los Angeles at Golden Bridge Yoga with Gurmukh.

Her Lamaze certification was completed in October 2010, through Magee Women's Hospital and Lamaze International. She is an advocate of empowered birth for women. Through the teaching of Prenatal Yoga and Childbirth Education classes, she helps women become more confident in their choices regarding pregnancy, birth and parenthood. Deena has also studied yoga with Doug Keller, Max Strom, KK Ledford and Shakta Kaur Khalsa. Her ongoing professional development as a Childbirth Educator has been with Ina May Gaskin, Penny Simkin, Gail Tully of Spinning Babies and other childbirth professionals.

Deena is also a mom of two a son, born via c-section in April 2005, and a daughter in March 2009, a VBAC. She is an active member of the local ICAN chapter and a member of the Coalition for Improving Maternity Services.