Letters to LLLI:
Circumcision and Breastfeeding
From: LEAVEN, Vol. 36 No. 5, October-November 2000, pp. 94-95
We provide articles from our publications from previous years
for reference for our Leaders and members. Readers are cautioned to
remember that research and medical information change over time.
Dear LLLI,
As the mother of two intact
sons, I am aware of my bias on the issue of circumcision. I am careful
not to discuss this and other "off-topic" items during LLL
meetings. However, I would like to cite LLLI sources when I am asked
to provide information to mothers.
I located a copy of LEAVEN
(Sept-Oct 1994, p. 78) which indicates that we should "avoid a
protracted discussion" of circumcision during a meeting but that
we can mention the potential effects on breastfeeding. Although circumcision
is discussed in the 1981 edition of THE WOMANLY ART OF BREASTFEEDING,
the section does not appear in any subsequent editions. Why? What other
resources does LLLI have relating to circumcision? Do we have the latest
research that addresses its effect on breastfeeding? How can Leaders
respond to questions on this issue? Does LLLI have a policy statement
on circumcision?
I am a very dedicated
supporter of La Leche League International and have been extremely proud
of my association with such a bold and accurate organization. Thank
you for considering this issue.
Sincerely,
Linda Frank
Stillwater, Oklahoma, USA
Dear Linda,
Thank you for your letter
regarding infant circumcision. It is a topic that is of interest to
many mothers - and one of many issues that can have an impact on the
breastfeeding relationship.
When a mother questions how
anything might affect her ability to nurse, or might have the potential
to change the course of her breastfeeding experience, it is logical
she would bring it up at a meeting. The Leader responds without giving
medical advice. She is aware of the LLL resources she can share and
how to respond to the mother in light of the cultural and religious
perspectives that are present in an international organization such
as LLLI. Finally, she knows how to facilitate the informal discussion
that takes place at Series Meetings.
Circumcision, in and of itself,
is not directly related to breastfeeding. However, like other elective
surgeries, this procedure can affect the early days of breastfeeding.
If a mother contacts LLL with questions, we can share general information
from such La Leche League resources as THE WOMANLY ART OF BREASTFEEDING
(see "surgery") and the BREASTFEEDING ANSWER BOOK which have information
on how any surgical procedure can affect breastfeeding. The most recent
LLLI publications on this subject are Babies and Children in the
Hospital (No. 527-24) and The Hospitalized Nursing Baby - Meeting
the Needs of Mothers, Babies, and Families in Health Care Settings
(No. 388-19). With any question about studies related to breastfeeding,
a Leader can check with the Professional Liaison Department. In addition,
the LLLI Center for Breastfeeding Information
database, with an index of over 15,000 bibliographic entries, is now
linked to the LLLI web site and can be accessed by anyone wanting research
information on breastfeeding.
It would not be appropriate
for the Leader to get into the pros and cons of an actual procedure
because such a discussion is outside our roles as Leaders and can be
construed as LLL endorsing or criticizing a particular medical choice
or procedure. Instead, Leaders refer mothers to their health care provider
who can explain the possible risks and benefits of the procedure as
well as answer questions relating to recovery time, pain medications
and so on. We need to keep our focus on what we do best-sharing information
about breastfeeding. We do that all the time whether the surgery is
a circumcision or tumor removal or broken clavicle (collarbone).
The mother may have questions
as to whether or not the separation such a procedure requires will interfere
with establishing her milk supply. There can be the issue of trauma
to the baby which may result in difficulty comforting the baby enough
to get him to nurse. The mother may become anxious, resulting in problems
with let-down or the baby picking up on her anxiety. But those are issues
that may arise in many situations and those are what we as Leaders help
the mother with, not the circumcision per se.
As with so many parenting
choices, there are good reasons for Leaders to avoid sharing personal
information because new mothers may take that as the definitive answer
to their questions. In this situation, as with childbirth, an informed
mother makes the best possible decisions for herself and her family.
These choices will be based on a mother's beliefs, religion, or customs.
Although some people may
not consider circumcision a religious issue, the fact remains that for
some parents, it is. As a nonsectarian organization, La Leche League
endeavors to avoid religious references, with or without disclaimers,
that might make some parents feel unwelcome or uncomfortable. As stated
in the American Academy of Pediatrics Policy Statement on Circumcision,
"The percentage of male infants circumcised varies by geographic location,
by religious affiliation, and, to some extent, by socioeconomic classification.
Circumcision is uncommon in Asia, South America, Central America, and
most of Europe. In Canada, 48% of males are circumcised. Some groups
such as followers of the Jewish and Islamic faiths practice circumcision
for religious and cultural reasons." Devorah Schesch-Wernick, a Leader
in Israel, writes, "Jewish circumcision is performed by expert practitioners,
on the eighth day after birth, or later if there are medical complications.
At this age, breastfeeding is normally well established. In my personal
experience of breastfeeding two sons, and in the experience of other
Israeli Leaders, Jewish circumcision has no effect on breastfeeding."
In the 1981 edition of THE
WOMANLY ART OF BREASTFEEDING under a section called "Elective Surgery
for You or Your Baby," there was mention of circumcision as well as
tubal ligation. However, it was omitted in all subsequent editions because
these issues were considered mixing causes. We consider circumcision
to be outside the realm of our expertise in La Leche League. Other organizations
can do a better job of educating parents about circumcision than LLL.
(See reference list below.) Because it is not, in and of itself, a breastfeeding
issue, LLLI does not take any position on it, nor does the Board of
Directors plan to issue any sort of policy statement about it. We see
a distinction between making published statements in LLLI publications
distributed worldwide and responding to mothers' concerns in the context
of informal discussions at Series Meetings.
This is an important point
to bring out at Series Meetings if mothers voice strong opinions on
the matter. There are no specific rules about what to say or avoid about
circumcision at an LLL Series Meeting. It is natural that this topic
might come up as part of a discussion about childbirth decisions and
the early days after birth. La Leche League welcomes all mothers who
want to breastfeed, regardless of decisions about circumcision - and
we rely on Leaders to present material and facilitate discussions with
this idea in their minds and hearts. We want parents to be able to hear
our message about breastfeeding without being sensitized by other issues.
Each Leader knows the sensitivities of the mothers in her Group best.
We rely on the Leader to bring the discussion back to the issue of breastfeeding
and helping the mother decide what is best for her family.
Sincerely,
Cynthia Sherar
LLLI Board of Directors
Mahtomedi, Minnesota, USA
Judy Minami Western
United States Division,
Professional Liaison Editorial Advisor
Portland, Oregon, USA
Here are some questions
that mothers might ask regarding circumcision and ideas about how Leaders
might respond. Thanks to Leaders Ann Calandro, Waxhaw, North Carolina
USA; Brandel Falk, Jerusalem, Israel; Devorah Schesch-Wernick, Efraim,
Israel; and Karen Zeretzke, Baton Rouge, Louisiana USA, for providing
suggested responses.
- I feel really strongly
that children should not be circumcised and I've brought some information
with me tonight that I think all of you should be aware of regarding
this issue.
[Name], it's evident
that this issue is very important to you. Since LLL has no policy
on circumcision - we focus only on breastfeeding - perhaps those
who would be interested in your information could see you after
the meeting?
- Why doesn't LLL have
more information on circumcision? When I look in THE WOMANLY ART OF
BREASTFEEDING, there isn't anything mentioned on this topic.
Because La Leche League
focuses solely on breastfeeding, there are many issues on which
there is little or no LLL information. There are organizations whose
function is to educate prospective parents about circumcision.
- You're worried about
offending mothers who choose to circumcise? Well, this is one mother
who chose not to circumcise who is deeply offended! My fourth baby
and I stopped attending meetings, and I do not promote LLL the way
I used to. Now you'll have to start worrying about the women you are
offending by your silence on this matter.
I am very sorry that
you feel LLL let you down over the circumcision issue. We are a
single-purpose organization whose focus is breastfeeding and don't
feel that it is prudent for LLLI to take a position on this matter!
- What advice can you
give me - we are planning to circumcise my son and I want to know
how to minimize its effect on him?
The majority of babies
are sleepy at least twenty-four hours after birth. If they are already
sleepy, and have not nursed well or often, the circumcision being
performed early in the hospitalization may cause breastfeeding problems.
As a mother and a patient, it is your choice to ask the physician
to wait until the last hospital day to perform the surgery, or to
ask if it could be done later. Also, you may request that the baby
be brought back to you immediately if there is no prolonged bleeding.
He will feel safer and more comforted in your arms and at your breast
than he would in a hospital nursery. You can assure the nurses that
you will check his bandage frequently and let them know if you see
bright red bleeding. If you feel your baby is in pain, ask about
pain medication in the early hours after the surgery.
- Who can you recommend
to me? I need to find a doctor to perform my son's circumcision and
want to find one who is supportive of breastfeeding.
This would fall into
the same category as recommending a doctor for any reason, which
LLL does not do.
- I do not want my son
circumcised and my husband does. My husband and all of his male family
members are circumcised. They insist that our son also be circumcised,
but I do not want to give in to their pressure tactics. I just cannot
do this to my precious baby. This is causing me a lot of stress. I'm
wondering if other mothers have run into this and how they dealt with
it?
Communication is the
best tool to resolve differences. When strong opinions don't agree,
sometimes a good place to begin is by reviewing what you both have
in common: love for your son and the desire to make a decision you
both can tolerate! You might also inquire on what basis the decision
was made to circumcise those who are circumcised in your husband's
family, and discuss together if those reasons are still valid.
- My son was circumcised
yesterday and now I cannot get him to nurse. Things were going just
fine before this was done. What do I do to get him to take the breast?
It sounds like your baby
is hurting. You might want to talk to your son's health care provider
about pain relief while he is healing. Has he fed at all? It is
very important that newborns are fed frequently and that you are
maintaining your milk supply by hand expressing or pumping. Some
mothers find that they can feed their babies who are unwilling to
nurse their own expressed milk using a cup or a spoon. You could
spend lots of time snuggling with your baby up against your bare
breast, reminding him what he is missing. Once his discomfort decreases,
it is likely he will again breastfeed well.
- Our son was not circumcised
at birth, but now - at age four - his foreskin has still not retracted
fully. He has not had an infection, but he does get sore occasionally.
Our pediatrician says that he will eventually get an infection, and
then the surgery will be even harder on him. Is it really necessary
to put him through this now?
La Leche League Leaders
are trained and qualified breastfeeding counselors. This question
is beyond the scope of the expertise of a Leader. If you are uncomfortable
with information you have received from a medical practitioner,
you may wish to consider getting a second opinion.
Abstract from
the Circumcision Policy Statement (RE9850), March, 1999, American
Academy of Pediatrics Task Force on Circumcision.
"Existing scientific
evidence demonstrates potential medical benefits of newborn
male circumcision; however, these data are not sufficient
to recommend routine neonatal circumcision. In circumstances
in which there are potential benefits and risks, yet the procedure
is not essential to the child's current well-being, parents
should determine what is in the best interest of the child.
To make an informed choice, parents of all male infants should
be given accurate and unbiased information and be provided
the opportunity to discuss this decision. If a decision for
circumcision is made, procedural analgesia should be provided."
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References:
American Academy of Pediatrics:
"Circumcision: Information for Parents" http://www.aap.org/family/circ.htm
American Academy of Pediatrics,
"Circumcision Policy Statement." Pediatrics March,1999; 103:
3, 686-93. http://www.aap.org/policy/re9850.html
Popper, B. Babies and
Children in the Hospital LLLI, 1998. Publication No. 527-24.
Popper, B. The Hospitalized
Nursing Baby-Meeting the Needs of Mothers, Babies, and Families in Health
Care Settings LLLI, 1998. Publication No. 388-19.
Page last edited Sun Oct 14 09:31:57 UTC 2007.
