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Monday
Jun272011

Circumcision & Nursing School

Great question from a Facebook reader (paraphrased):

I have serious concerns regarding my future goal of becoming a Certified Nurse Midwife. I don’t support infant circumcision unless it’s for medical reasons and I’m seeing that many midwifery schools require at least one year of experience in obstetrics. I don’t want to be involved in any way with MGM (male genital mutilation); is that inevitable when working in L&D? Would there be any way around this so I don’t compromise my beliefs?

To my RN & CNM friends, do let me know if your program was different and what, if anything, was done if something came up that was against your beliefs. This is a fantastic question to explore!

I say:

First, not sure why you think L&D has anything to do with circumcision because circs are done postpartum. The postpartum RNs are the ones that help in that arena. L&D nurses, unless they're rotating through postpartum, won't have to concern themselves at all with it.

Second, part of the process of nursing and then midwifery school is to expose you to other sides of issues you haven't thought of yet... not because you're stupid, but because you haven't had the opportunity to explore them. I used to be quite the breastfeeding nazi, really believing ALL women could breastfeed and the ones that said they couldn't really weren't trying hard enough. When I had a client tell me she wasn't going to nurse about 20 times and I kept telling her how great it was and how if she just tried, she'd find out how much she'd like it. She finally leaned over and got in my face, telling me she'd been molested and the primary part of her body molested was her breasts and she was going to bottle feed. It was then I realized, not only is breastfeeding a woman's choice, but that sometimes, the most empowering thing a woman can do for herself is to schedule a cesarean/bottle feed/have general anesthesia/etc. Things I wouldn't remotely consider can be the most empowering to a mom.

Now, I know the arguments about circ... very well. I circ'd my first son, but not my second. After studying to become a Jew for 15+ years, I left Judaism behind because of two issues: circumcision and the mikvah (the mikvah's a different story). Yet, we all make choices that affect our child forever. I do believe a family should let the baby make his own choice, but I also know that some families who choose to vaccinate their children live with those consequences... just as the families that choose not to vaccinate have to live with the reality that the decision might mean death to their child. Believing that circumcision is the only time a family should consider letting the grown person make the decision is absurd. Mothers & fathers make decisions for their kids Every. Single. Day.

So, while I believe that, for me, the circumcision decision is best left to the adult person to make and I whole-heartedly believe in educating (NOT terrorizing) parents about the realities of circumcision, I also believe there is a tolerance that can come, not only for allowing parents to make their own decisions about this issue, but that you are able to release the decision-making to the parents about all sorts of issues you disagree with.

For, farrrrrr more often, you will stand in a room with a woman you know has zero business (in your opinion and experience) being induced, but who is choosing to be... with a woman who was bullied into a cesarean... with a woman you are required to counsel to be kept in bed... and the long, long list goes on and on.

(Adding for this post -) Think about the different cultures you’re going to see, the cultures where women are less than the cows on the street. You’ll be assisting at those births. You’ll be there for the births hold religion above all else (hmmm… some types of Judaism, anyone?) and nothing you say would change anyone’s mind, so you know to do your job and leave the religion to the families involved.

I admire your stand... please know I do. But, I encourage offering families some grace and finding a place of peace that parents really are doing the very best they can with the information they have.

(Adding again -) Doctors are not forced to learn to do abortions when it is against their beliefs. As a homebirth midwife, I wouldn’t have accepted a client that had beliefs extremely counter to my own. (They wouldn’t have selected me in the first place, but same thing.) If you were asking if you had to circumcise a baby to get an RN license and is there a way to bypass that requirement, I’d be first in line to help you find a way to avoid that requirement. But, dealing with circumcision as an RN is going to be different than that. Trying to maneuver your education based on a family’s legal choice is almost akin to burying your head in the sand. Please don’t.

Not sure if this helps, but do hope it offered other ways to look at the topic. Much good luck on your path! 

 

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    - Navelgazing Midwife Blog - Circumcision & Nursing School
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Reader Comments (11)

I love this response. Walking with women while they make choices that conflict with my own values is a difficult yet crucial part of providing care to women. Well written.

I would add - and I think you touched on this - that witnessing violence is a regular part of maternity care, and understanding the roots and expression of medical abuse is important for those of us who want to enact change to be able to do so. We can also start by doing whatever we can to lessen the trauma to the woman or baby. We may not be able to prevent it but we can soothe it and try to reduce long-term effects.

June 27, 2011 | Unregistered CommenterMegan

really good post!!! I agree with you too with the circ and vax issue :) I am jewish and I have lost a lot of faith in my religion when i started researching circ and then went to one of my friends' son's bris.. never again will i go to one no matter how close of a friend/family it is AND I don't believe in the mikvah theory either (i didn't do it before my wedding but numerous friends have). it has to be really hard for students going to med school/midwifery who have strong beliefs in things (like i do) because come the time you have a parent who wants to do the opposite of what you want to there's only so much you can do

June 27, 2011 | Unregistered Commenterhillary

It's so important to be familiar with how things are done "on the other side". I used to be rabidly anti-circ, still am, really, but I learned that I will not change everybody's mind. Even without insurance reimbursement, if people want it done, they will find a way. The truth is, the parents really, honestly, from the bottoms of their hearts, believe they are doing the best for their baby boy.

What do you do? Present the facts. The FACTS, not your personal opinion. Find a local mohel with an excellent reputation that will do non-religious circumcisions. Learn about post-procedure care so your families can rely on you for information.

When I was still a student, I witnessed several circs done by the OB I was apprenticing with, also I was invited to several Bris for the baby sons of Jewish families I attended. It wasn't easy, but seeing the differences in how it was performed was eye opening. The mohel that did the circs is in my referral list, his number saved in my contacts, because he is the best at what he does, been around forever, and does a really good job, leaving the baby "room to grow".

I have taken care of women who themselves had been circumcised, and who were planning on taking their daughters back home to be circumcised, too. What can you do?

The most surprising and wonderful thing about letting go of my need/agenda to convince parents not to circ is that I can STILL love them, and care for them, without judgement. And that lesson expanded to loving and caring for women who choose not to breastfeed, who vaccinate, who have different religious views and practices, there's a whole world of awesome people out there!

June 28, 2011 | Unregistered CommenterColleen, LM

What a good question and an excellent answer. Thank you so much for your candid response.

Susan

June 28, 2011 | Unregistered CommenterSusan

Really great post, Barb! Kudos to you for mentioning the crap that goes on in births, at a hospital. Part of my training as a doula has been to let that stuff go when I leave my house to attend a birth. It's not MY birth, it's not MY body, it's not MY decision! Repeated ad nauseum.

Oh, and I just have to mention....CM!! My program at Philadelphia University did not hold it against me that I had never been to a birth besides my own. It's more about philosophy, belief in the midwifery model of care, etc. that they are looking for. I am sure other programs out there are like that.

And I am sure that as an RN, if she really didn't want to attend circumcisions (which the surgeons do, not the nurses, although they assist), she could probably work her way around that. I am not so sure I could witness one myself!

June 28, 2011 | Unregistered CommenterJen B

As a Labor and Delivery/Postpartum RN (we do everything at our hospital) we are given the option to refuse to do anything that is against our moral convictions whether they be religious or secular in nature. We simply have to write a formal statement of our convictions to be placed in our personnel files so that our managers/supervisors know of the issue.

I very seriously considered doing this for circumcision when I began working as an RN. I am glad that I did not. As the other posters have said, I would have been locking myself into a moral closet unable to see what goes on outside of it and utterly incapable of caring for families who need all of the information I had to give WITHOUT judgement.

I have assisted with circumcisions primarily BECAUSE I don't agree with them. I provide as much care and assistance to the baby boy as I can to help him through the traumatic experience. I talk to him, quietly, soothingly. I tell him what is happening and how it is going to feel... I help comfort him when he cries out in pain and I offer the little comforts that I have found that DO help, like holding him IMMEDIATELY after and getting him back, skin to skin, with his mother as soon as humanly possible afterward.

I have found that by doing these simple things I am able to at least in a small way lessen the trauma that is the circumcision and improve breast feeding resumption after (which is often interrupted by 6-12 hours d/t the baby's pain/trauma).

June 29, 2011 | Unregistered CommenterBrenna

I am so, so glad to see the nurses and midwives nod in agreement. I hope the OP is able to appreciate the inner knowledge and how many of us have felt exactly the same.

Thanks so much, everyone, for your comments.

June 29, 2011 | Registered CommenterNavelgazing Midwife

It was certainly easy to get through my nursing school without seeing a circumcision. And if you work on labor and delivery and never, ever float to postpartum, you wouldn't deal with a circumcision either. I really like Brenna's point about how much good a nurse who knows the problems of and surrounding routine infant circumcision can do for the infant who will nonetheless be subjected to it.
I do wonder if the ways in which mothers who birth in the hospital are often treated set them up to be desensitized to the brutality of the circumcision procedure.

July 4, 2011 | Unregistered CommenterChristie B

Christie: That is a fanTASTic point! I absolutely believe you are right there. Never quite put two and two together before, so a total A-HA moment going on here. And a Duh one, too, sadly.

Thanks for pointing that out. Brilliant.

July 5, 2011 | Registered CommenterNavelgazing Midwife

I worked on an all-LDRP unit for years, and everyone did everything, including floating to the level II nursery. I hate circumcision. I find it appalling that we would do cosmetic surgery on a newborn. Luckily, in my state at the time Medicaid and insurance had stopped paying for circumcision and the rate at our hospital was less than 20%.

I don't believe in conscience clauses in health care. My job is to take care of my patient. I don't get to judge her care decisions. If I felt I truly could not take care of women having abortions, or women choosing circumcision, I would have no business in L&D, because that goes with it. Separating one's personal beliefs from one's patient is crucial, because it's not about us. It's not just about being around birth and catching babies, it's about the patient. We are not the stars of the show. We are not the focus of the care. One of the problems I have with hospital obstetrics is the placement of the hospital and providers' needs as primary, when what should be central are the needs -- and choices -- of our patients.

September 8, 2011 | Unregistered Commentermeghan

My feeling is that if I assist at Circs I am lending my approval - so I stopped doing it long ago. Maybe if more midwives and nurses refused on moral grounds, people would think twice about mutilating their baby boys (and girls) for "culture" or "tradition". These days I ask parents to see some of the graphic Youtube videos and then ask themselves whether the baby "really" wasn't in pain. Also it helps that I can now tell them that our national medical body now has a statement which says that Circumcision is medically unnecessary except in rare diagnoses (eg true phimosis). There are also plenty of stories from adult men who wish their parents had thought twice - please ask your clients to read them...they are heart-breaking.

January 30, 2012 | Unregistered CommenterComadrona

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