if you are expecting...

Many expectant American mothers have little knowledge of childbirth, and some, even though they have gone through pregnancy and childbirth, remain completely ignorant of birth, its natural process and the multitude of choices that revolve around it. Unfortunately, much of that ignorance exists because of the medical community and its inability to establish and maintain doctor-patient communication and education, which often is due to the fact that obstetricians are expected by their insurance companies to see a certain number of patients in a specific amount of time, cutting down on the length of time a doctor can spend with each individual patient. Because of this, and as most women rely on their doctors to make decisions for them, many patients are not given the opportunity during their pregnancies to learn what procedures are risky or unnecessary and which options are available to them when they labor and birth.

After having a deep discussion about pregnancy with an acquaintance who already has two children, I recommended that she watch the film The Business of Being Born to better understand my philosophy of childbirth. She came back to me and exclaimed, "Why didn't anyone TELL ME this when I was pregnant?!" Like many women who are given the opportunity to rediscover childbirth in this new form, she felt an array of emotions, including shock, anger, hope and regret regarding her previous birth experiences.

But what should every pregnant woman know before she gives birth?

Educate yourself. If you are expecting, start by doing your homework. Read objective and informative resources on childbirth. Learn to make educated decisions for yourself and your baby. There are choices to make throughout pregnancy, birth, infant feeding, circumcision, vaccinations, diapering, infant sleep, parenting. Learn your options ahead of time, during the nine-month stretch before your baby arrives, and continue educating yourself along the way. Consult your doctor, midwife, and caregivers regarding important decisions, but do not rely on them to make decisions for you or because that is the procedure your caregiver regularly follows. You are an individual, and every individual/birth/child/patient is unique.

Begin by watching The Business of Being Born or by reading Ina May's Guide to Childbirth, both of which will help you explore your options in childbirth and give you a better, more realistic understanding of true natural birth. These two resources will also prove that birth does not have to be filled with fear and pain, but can actually be a beautiful, memorable transition.

Continue by learning everything you can about breastfeeding now. While breastfeeding is natural and normal, it does not mean that it is always easy. If you already know important things like how to properly latch, common comfortable positions for nursing, and how often infants infants feed, you will be well on the way to breastfeeding success. Take an afternoon to go to a local La Leche League meeting, speak with women who successfully breastfed for more than a year, watch a baby latch on to the breast and nurse--these things will be invaluable in the days following birth.

Remember, you can read every book on parenting, sleep, birth and breastfeeding. However, you will not truly get it until you are actually experiencing everything first-hand. Your baby is unique and so are you. All the information you soak up when you are pregnant will be put to the test, and you will not really get it until you are right there. In the moment. You will be thankful you did your homework, and, years down the road, your life will be richer and fuller than you ever imagined it could be.

beetle juice?

After reading about the voluntary recall by Abbott Laboratories for the 5 million units of Similac baby formula contaminated with beetle parts and larvae, I was not surprised in the least. Formula recalls are a constant and regular occurrence, with 17 major baby formula recalls since 2000, and countless more in the two decades before that, according to NABA. However, the recall is voluntary, as the FDA determined that the presence of the beetles poses "no immediate health risks," aside from"symptoms of gastrointestinal discomfort and refusal to eat."

Nor I am not surprised in the FDA's stand on this issue. Actually, many of the processed foods that are regularly consumed in the United States contain more than only traces of bacteria and microscopic insects and are considered by the FDA to be safe for human consumption. Bacteria and small insects are regularly present in all forms of baby formula sold in the US, especially as there is no way to produce a perfectly sterilized product, which, according to the FDA, there is an expected allowance, and the number of beetles in the Similac formula recall falls into that allowance.

Then I read this article, Similac Recall Outrages Parents: Are Beetles Bad? from Time Magazine. I have some knee-jerk reactions, not to the formula recall, but to the article itself.

One particular aspect of the article, the statement, "It may be extremely difficult to determine whether beetles are responsible for a baby's symptoms. Inconsolable crying might simply be, well, inconsolable crying, which is sometimes just what babies do," was a jaw-dropper for me. Inconsolable crying is not normal. It is a sign that something is wrong. I know my babies. If they ever cried inconsolably (which was very, very seldom, as their needs were met directly, and in most cases, before it came to crying), then I knew that there was something seriously wrong. Inconsolable crying is a very direct cue for the mother or father to find out what is wrong and fix it promptly.

Another statement that then floored me was the closing of the article:

Not surprisingly, news of the recall rekindled bottle vs. breast animosities, if only online. One woman predicted breastfeeding advocates would wax triumphant. "Very upsetting, and here comes the ‘breast is best!' brigade to add to the anxiety by telling us all we asked for it." Sure enough, another poster wrote, "Yea, breastfeeding is the best. My breastmilk has never ha(d) beetle parts in it." [...] As millions of parents are reeling from the thought that their babies have chowed on bugs, it's a time for support, not gloating.

First of all the Breast is Best 'brigade' (or campaign) exists primarily to promote awareness of the true dangers of formula feeding. Breast IS the best provider of nutrition and immunity for baby, and formula is inferior in that babies who are fed formula as their sole source of nutrition tend to, on average, have lower IQs, suffer from more ailments and infections, and cry more than their breastfed counterparts. When a mother chooses formula, as with anything processed, she takes a risk with the health and nutrition of her baby.

However, for the Breast is Best campaign to be considered successful, facts and information must be available and presented to ALL mothers up front in order for a mother to make an informed decision on how she chooses to feed her infant. Furthermore, informed consent is only valid if the mother who tried (and failed) to breastfeed received TRUE assistance and diagnoses in regards to the problems she faced. How many women do I know who state they "could not" breastfeed for reasons that I, as a birth and postpartum professional, realize are fairly easy fixes had the mother actually had true, trained and knowledgeable assistance? The number is countless. And growing at a steady rate. Many times, it is hard for a mother to know which advice is sound and informed, and which advice is unintentionally misinformed or just plain ignorant.

As a mother who once was faced with the option of breastmilk or formula, I would rather have the facts--the other course is to sugar-coat everything and leave out what is legitimately important information to a major decision of parenting. That this article yet again plays the "guilt" card, comparing any pro-breastfeeding statements to "gloating," irks me. After hearing about this recall, I am thankful that I breastfeed. I am glad I had the foresight, resources and ability to seek out true, factual information regarding the risks of formula when I was pregnant with my first child. And I consider it a true disservice not to pass on my knowledge and the facts to other mothers. Every mother deserves truth and knowledge to lead her to an informed decision. I am glad I did not have to face any of the severe gastrointestional problems many babies are currently recovering from. My heart goes out, yet I continue to remain thankful.

considering the cesarean section

The rates of cesarean births are increasing alarmingly each year, with over one in every three births ending in major abdominal surgery. When a cesarean is necessary, it can be a life saving technique for both mother and baby. With countless documented medical risks to the mother's health, including infections, hemorrhage, transfusion, injury to other organs, anesthesia complications, psychological complications, and a maternal mortality two to four times greater than that for a vaginal birth, it is hard to understand why cesarean births are becoming the new norm. Even the World Health Organization states that no region in the world is justified in having a cesarean rate greater than 10 to 15 percent. If we hope to do anything meaningful to decrease the rate of cesarean births, we need real culture change. However, change can only begin with understanding the barriers. This post highlights the common reasons cesarean sections are performed.

Placenta Previa This occurs when the placenta lies low in the uterus and partially or completely covers the cervix. One in every 200 pregnant women will experience placenta previa during their third trimester. The treatment involves bed rest and frequent monitoring. If a complete or partial placenta previa has been diagnosed, a cesarean is usually necessary. If a marginal placenta previa has been diagnosed, a vaginal delivery may be an option.

Since placenta previa involves pre-term bleeding, it can be a very traumatic experience for pregnant women, especially as some women believe they are miscarrying. The diagnosis can help medical practitioners rectify the problem, but the baby is usually delivered by cesarean. In this case, is definitely safer to have it by cesarean than to try to push a baby over a placenta, especially when it can detach during the birthing process. There is truly a difference between placenta previa and a low lying placenta, though in the case of true placenta previa, cesarean births are definitely worth the risk.

Placental Abruption This complication occurs when the placenta separates from the uterine lining before the baby is born. Approximately 1% of all pregnant women will experience placental abruption during the third trimester. The mother will experience bleeding from the site of the separation and pain in the uterus. This separation can interfere with oxygen getting to the baby and, depending on the severity, an emergency cesarean may be performed. There are two types of placental abruption, partial placental abruption and complete placental abruption. In the case of a partial separation, a cesarean is not necessary if the bleeding stops and the baby is not in distress. A complete separation, however, is a true medical emergency requiring immediate cesarean.

Uterine rupture In approximately 1 in every 1,500 births, the uterus tears, or ruptures, during pregnancy or labor, leading to hemorrhaging in the mother and interfering with the baby's oxygen supply. Uterine rupture is a reason for immediate cesarean as it can lead to a hysterectomy and death if it is not repaired right away. While uterine rupture can occur during any form of birth, the risk is higher for women who have had a previous cesarean birth, which in itself increases the rate of repeat cesarean birth.

Breech Position When dealing with a breech baby, a cesarean delivery is often considered by obstetricians to be the only option, especially due to the increased chances of cord prolapse and fetal distress. Even if the baby is in a breech position before the pregnancy is full-term, a cesarean may be preformed pre-term, resulting in premature delivery. Since medical schools no longer teach obstetricians how to deliver breech babies, cesareans are considered the 'safer' option for the baby. However, breech babies are commonly and safely born vaginally every year. In Canada, for instance, cesarean birth is no longer routinely performed for breech babies. Birthing position (such as squatting or hands and knees) is the key factor in order for a woman to successfully birth a breech baby vaginally. Breech birth is only a variation of normal childbirth, not necessarily something that is completely abnormal and to be feared.

Cord prolapse This situation does not occur often, but when it does, an emergency cesarean is performed. A cord prolapse is when the umbilical cord slips through the cervix and protrudes from the vagina before the baby is born (occurring, for instance, when the water breaks and there is too much space between the baby’s head and the cervix). As the uterus contracts, pressure is placed on the umbilical cord which diminishes the blood flow to the baby. Increased risk for cord prolapse occurs when the water is artificially broken. In the case of a cord prolapse, the baby must be delivered immediately, often by cesarean, so his oxygen levels do not decrease; if oxygen is cut off for too long, death or mental retardation may result.

Fetal distress The most common cause of fetal distress is lack of oxygen to the baby. If fetal monitoring detects a problem with the amount of oxygen that the baby is receiving, then an emergency cesarean may be performed. When this is correctly diagnosed, a cesarean is the best option. Unfortunately, fetal distress is often misdiagnosed in order to move labor along and get a woman to deliver faster. However, numerous tests are available to make sure the baby is not actually in fetal distress. It is common for a baby's heart rat to slow during contractions; a change of position may show that the baby is not in distress at all. If there is true fetal distress, however, changing positions will not help, and if a woman is not far enough along in her labor to speed a vaginal delivery, a cesarean may be imperative. 

Failure to progress Once a woman is in labor, a failure to progress can occur when the cervix has not dilated completely, labor has slowed down or stopped, or the baby is not in an optimal delivery position. Since the first phase of labor (0-4 centimeters dilation) is almost always slow, failure to progress is diagnosed correctly only when the women is in the second phase (beyond 5 centimeters dilation). Once a woman reaches active labor (more than 4 centimeters dilation), it is commonly thought that dilation should proceed by once centimeter every hour. However, as labor is drastically different for many women, some women will open faster, some much slower.

Unless there is an actual medical emergency that requires the baby to be delivered immediately, failure to progress is not a good reason for a default cesarean, even though many medical professionals believe that some women's bodies just cannot handle labor and cannot give birth. In its natural course, labor naturally speeds up and slows down and plateaus and then speeds up again. Sometimes a laboring body needs time to rest and gain strength for the next leg of the race. If labor 'stalls,' a woman can change positions, walk around, and be active in order to get things moving again.

Repeat cesarean A cesarean section is major abdominal surgery. While the first cesarean is not necessarily considered a big deal, subsequent cesareans are particularly dangerous. Any number of complications can arise, including placenta previa, placenta accreta (abnormally deep attachment of the placenta into the middle layer of the uterine wall), uterine rupture, injury to internal organs during surgery, excessive blood loss, need for hysterectomy, and maternal death. These risks rise with each subsequent repeat cesarean delivery. However, nearly 90% of woman who have already had a cesarean birth are candidates for a vaginal birth after cesarean (VBAC) for their next birth. The biggest risk factor involved in a VBAC is uterine rupture, which is common in 0.2-1.5% VBACs. There is certain criteria a mother must meet in order to be eligible for a VBAC; women should consult their care providers in order to understand their options. The U.S. has such a low VBAC and high cesarean rate because obstetricians deliver most of our babies, and obstetricians are not primary care clinicians. In his article VBAC rates are low, but are obstetricians to blame?, Kenneth Lin, MD, explains that labor managed by family physicians and professional midwives is considerably more likely to result in a vaginal birth than labor managed by an obstetrician, especially when considering VBACs. As with labor in general, there are risks in VBAC, but the risks are far greater with a repeat cesarean.

Cephalopelvic Disproportion (CPD) A true diagnosis of CPD occurs when a baby’s head is too large or a mother pelvis is too small to allow the baby to pass through. Like failure to progress, most cases of CPD are misdiagnosed (based upon the belief that the baby is too big for the mother to sufficiently dilate in a timely, scheduled manner), especially as pelvic measurements are based upon estimations. If a woman has rickets or something else has altered her pelvic bones, CPD can be legitimately diagnosed. But for the most part, a woman's body naturally will not make a baby bigger than she can push out, especially not the 30% of women in the US who give birth via cesarean. Remaining active and maintaining mobility helps a baby to position itself for vaginal delivery and helps a mothers cervix to dilate.

Active genital herpes: If the mother has an active outbreak of genital herpes at the end of her pregnancy (diagnosed by a positive culture or actual lesions), a cesarean may be scheduled. A cesarean is necessary in this case in order to prevent the baby from being exposed to the virus while passing through the birth canal. However, if the mother does not have an active outbreak, she is perfectly able to have a vaginal delivery safely without exposing the baby to the disease. 

Diabetes If a mother develops gestational diabetes during her pregnancy or is otherwise diabetic, her likelihood for having a baby larger than normal increases, as does the likelihood for other complications to arise. If the case of diabetes is uncontrolled or undiagnosed, the baby may grow too large for the mother to push out. However, diet goes a long way in controlling diabetes and baby growth; by discussing options with her care provider, a mother can control the diabetes to prevent excessive growth in the baby and successfully have a vaginal birth. 

Preeclampsia Preeclampsia is a condition of high blood pressure during pregnancy, which prevents the placenta from getting the proper amount of blood and decreases oxygen flow to the baby. This condition is very severe, and, once diagnosed, a mother is closely monitored. Delivery is sometimes recommended as treatment for this condition, and most women are able to deliver vaginally, but there are rare, extremely severe cases of preeclampsia where an emergency cesarean is necessary in order to save the mother and baby. 

Birth defects If a baby has been diagnosed with a birth defect, a cesarean may be performed in order to reduce the risk of any further complications during delivery. In some instances, a vaginal delivery will only complicate a particular birth defect, especially when the baby rotates and shifts during the birth process. Since this shift does not occur during cesarean birth, a cesarean is the lesser of two evils. 

Multiple births As multiple births are labeled as 'high risk,' these babies are usually delivered via cesarean. However, vaginal delivery is a safe option for many multiple births given that the babies are in a favorable position (any position other than transverse). If she is pregnant with multiple babies and hopes to deliver vaginally, she should find a supportive care provider who is confident in the female body's ability to naturally birth multiples, who believes twins do not require additional interventions, and who is knowledgeable about positions that are favorable for delivering multiples.

preparing for natural childbirth

One of the most important choices a pregnant woman will make is how she will give birth. While it is common for many birthing women to choose medications and synthetic drugs to manage pain during labor, choosing to do so brings on a greatly increased risk of birth complications and further labor intervention procedures. While childbirth may be painful, in a healthy pregnancy, a natural, drug-free childbirth is by far the best option for having a healthy delivery. A woman who trusts in her body's natural ability to labor and birth will have the most rewarding, emotional and powerful birth experience.

There are many steps you can take during your pregnancy in order to prepare for a natural birth. Make sure you keep a healthy lifestyle during your pregnancy, eating primarily nutritious, whole foods and getting plenty of easy exercise by walking, doing stretches, and yoga.

Once you decide you are serious about having a natural childbirth, hire attendants who are more likely to support your decision to birth naturally. Consider hiring a midwife rather than an OB. Midwives are autonomous practitioners and are the primary carer for the vast majority of women in both the developed and undeveloped worlds during their pregnancy. Provided a pregnancy is progressing normally, a woman need never see a doctor. According to Catherine Taylor in her book Giving Birth: A Journey into the World of Mothers and Midwives, midwives have a 19% lower rate of infant deaths and a 33% lower rate of neonatal mortality (infant death in the first month) than doctors attending comparable births, and midwives who attend hospital births have a cesarean rate that is half the national average. Additionally, midwives tend to be more open to different methods of childbirth. And, if complications do arise, midwives are assuredly knowledgeable and capable.

Whether you choose to hire a midwife or not, you may also consider hiring a doula. Essentially, a doula is a natural-childbirth coach and advocate for the birthing mother and her family. If you have a doula present at your birth, she will be able to remind you of the reasons you chose to birth naturally and gently push you to continue as you had planned when you are in the throws of labor. She will also be able to assist you with relaxation, breathing and pain-relieving techniques and help labor move along as smoothly as possible. In addition to providing emotional and physical labor support, she will advocate your wishes and can assist in communication with medical staff in a hospital setting, as well as obtain information for you to better be able to make informed decisions in regards to procedures and possible interventions.

Perhaps the most important step to preparing yourself for a natural childbirth is to educate yourself about every aspect of the birth experience. You have nine months to learn all you can about labor options, birth attendants, common procedures, possible necessary and unnecessary interventions, and the common and unique qualities of other successful natural childbirths. With the internet, there are literally countless resources at your fingertips. There are also many books that focus objectively on natural birthing options, including my favorites, Birthing from Within: An Extra-Ordinary Guide to Childbirth Preparation by Pam England and Rob Horowitz and The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas, and All Other Labor Companions by Penny Simkin. When browsing birth-education reading material, be sure to choose books and sources that positively support your decision to have a healthy, aware, and natural childbirth.

Another step you can take to prepare yourself for a natural birth is to participate in childbirth education classes. While many hospitals offer basic classes for pregnant couples, there are many alternative options that actually focus on natural labor techniques. Lamaze is the most discussed method of birth education and natural pain management, teaching techniques for focused breathing. Lamaze will help you focus on making it through each contraction, though it does not necessarily prepare women for what to expect in regards to the intense pain involved in labor. Becoming increasingly popular, however, are comprehensive natural childbirth classes such as Hypnobabies, The Pink Kit, and Birth Outside the Box. These well-rounded, objective courses are comparably priced and available to you in the comfort of your own home or in small group settings, and they will provide you with options for natural pain-relief and a solid foundation on which to build your natural birth experience.

Lastly, be confident about your decision to have a natural childbirth and your body's ability to birth. For most women who choose natural childbirth, their main goal is to be lucid and alert after the delivery of their baby, to be able to immediately and peacefully see, hold and bond with their baby. Visualize this positive outcome throughout your pregnancy and be confident that this is what your want. If you expect horrible labor pain, you are more likely to actually be in pain. Confidence is actually a big step in making the labor process more bearable.

Once you educate yourself about your options and decide on birth attendants who support your decision to birth naturally, you will be able to develop a clear picture of your own expectations for a emotionally fulfilling positive birth experience. If you begin feeling discouraged at any point during your pregnancy or labor, remember this one simple thing: You were made for this.

modern midwifery

In the United States, less than 1% of births take place at home. It is difficult for the other 99% of Americans to make the transition from believing that technology is the benchmark for establishing worldwide leadership to the understanding that, in reality, the human body is designed to give birth. Our bodies are generous and amazing in their abilities to give birth naturally.

The rates of surgical birth and birth intervention in the US have soared beyond those of other developed countries around the world. The rate of maternal and infant mortality is not only significantly higher in the US than that of other developed nations, but also has not improved in nearly thirty years. Despite a significant improvement in the US maternal mortality ratio since the early 1900s, it still represents a substantial and frustrating burden, particularly given the fact that essentially no progress has been made in most of the US since 1982. Additionally, the Centers for Disease Control and Prevention has stated that most cases of maternal mortality are probably preventable. Among the causal deaths that could be prevented were those that involve both underlying health issues such as poor nutrition and high blood pressure as well as those that are physician-caused, including infection and hemorrhage.

There are many preventable risks of placing birth in a hospital environment. To begin with, bacteria can be introduced, first by the mother arriving in an environment where diseases are being treated, as well as from
infiltrating the natural barriers we have against infection through vaginal exams and, of course, surgical delivery. Additionally, there are higher incidences of hemorrhage from forced delivery of the placenta (when a care provider intentionally pulls on an umbilical cord). Furthermore, injuries and deaths related to the physician’s care range from the off-label use of medicine for the induction of labor as well as the sanctified use of surgical delivery, which is one of the leading causes of maternal mortality and a risk directly associated with cesareans and hospital births.

It is important to remember that pregnancy is a normal, low-risk, significant time in a woman's life. With knowledge of her body, a woman can interpret her body’s signals and maintain her own health. She can educate herself about care options and make good choices based on impartial and complete information because she knows her own body. Modern midwifery care is based on many concepts which are proven to reduce maternal and infant mortality rates and increase a mother’s joy in her birth experience.

Pregnancy effects and is effected by all aspects of a woman’s life: social, economic, professional, familial. A woman who knows about her body and how she gives birth is less likely to need medical interventions. An experienced midwife spends time with her clients. She gets to know them, teaches them and helps them think through their options to make reasoned decisions. She spends time with the client’s partner, observing the dynamics and providing holistic support. She helps identify how best to prepare the chosen space for labor and birth. Under a midwife's care, a typical prenatal visit lasts 30-60 minutes, labor accompaniment is consistent through the active labor and birth, and postnatal care includes several follow-up visits. It is estimated that midwives spend 10-15 times as many hours with a client as doctors spend--at about half the price! Midwives still do 70% of the births in the world and are experts not only at “normal” birth but at keeping infants normal around the birthing process. Midwifery care makes sense for normal pregnancies because midwives are skilled at keeping the pregnancy normal.

Women deserve knowledge to care for themselves before conceiving and during pregnancy and birth. Women gain the best birth knowledge from other women who have chosen natural childbirth with supportive birth care. Women are naturally intuitive and need not accept the negative images of labor that the media portrays. Women, their partners and their advocates can differentiate between normal birth and situations that may require medical guidance. Women want to choose important aspects of their birth experience based on credible information, not fear of litigation. The most favorable physical, mental and emotional birth outcomes for mothers and their babies are best supported by midwifery care.

Women have the right to choose a care provider and with whom and where to give birth. Every woman, and her family, must be recognized as being an individual with her own unique expectations for hers and her baby’s birth. It is a myth that women who seek a homebirth are willfully putting themselves at risk. Women are fully capable of considering their options and choosing how to care for themselves.  It is not rational to say homebirth is never safe; saying so is the product of hysteria. All birth information providers must create a more personable environment for the woman to learn about birth, her body and her birth options.  Protecting choice, not limiting choice, is good, no, GREAT health care.

Artwork: Music by Katie M. Berggren

the politics of infant male circumcison

Infant male circumcision is commonplace in the United States. Since the 1970s, according to the US Circumcision Statistics Report, it is estimated that approximately 60% of infant boys had the circumcision procedure performed on them. However, within recent years, this trend has begun to decline as parents become more knowledgeable about the varied negative effects and untruths of the procedure.

As part of my postpartum doula training, I saw a circumcision procedure being performed on an infant boy. I kid you not--it was the most traumatizing thing I have ever experienced in my life. The helplessness and extreme pain that the child encountered was something I will never forget, though it is not the only reason I am against circumcision.

I came across this article, Would you Circumcise your Daughter? which presents an interesting perspective of highlighting the cruelty of female circumcision and then comparatively switches focus to the the circumcisions we have performed on infant boys for decades. When a circumcision is performed on an infant, it is just plain genital mutilation, and it indeed disregards the human rights of our children. As the author says, "We've trampled on the human rights of our baby boys, and we've done it holding our heads high and justifying ourselves." Whether for boys or girls, it is about time we rethink the circumcision procedure.

I firmly believe that you really do catch more flies with honey than with vinegar, so to say, but the author took a completely unique approach by bringing the subject of female circumcision into the picture before making the connection to the largely accepted practice of male circumcision. Many new parents are not even aware that they have the option to deny the procedure as it is so accepted in the US--and by taking an accusatory standpoint, the author really does run the risk of losing her audience's respect and causing needless guilt in certain members of her audience. However, you must also consider who the article was directed at--by the looks of the blog, it is likely feminists who are seeking passionate arguments that will rile them up and get them thinking about a new idea.

The author fortunately provided plenty of resources out there that site good, peer-reviewed information on the subject of circumcision, and as of now, it is parents' right to make the decision whether to leave their child intact or not. I firmly believe, however, that, as parents, we must make appropriate decisions to keep our children healthy and whole. It all comes down to informed consent. Our country's medical ethics state that it is absolutely unethical and illegal to perform an unnecessary procedure on an individual who does not have informed consent. Infants, as individuals, cannot give informed consent, and therefore should not be circumcised. If our own standards of ethics were unbiasedly applied to the common practice of infant circumcision, it would certainly be an illegal procedure. Our children's healthy bodies should be preserved as best as possible for them to make decisions of alteration when they are old enough to do so.

Additionally, not a single national medical association in the world recommends infant circumcision as it offers no significant health or medical advantage over the intact state for the vast majority of males. In fact, many European nations look down on the US for performing such a barbaric procedure. Circumcision is literally a painful mutilation of a healthy, functioning body part, and when performed on an infant, it is done so without the consent of the person whose body is being modified, risking complications (in an alarming 2-10%, a statistic believed to be under-reported), and botched circumcisions (>1%) which often result in the need for reparative surgery, and even, in some drastic circumstances, gender reassignment.

Some may argue that parents must make medical decisions on behalf of their children in order to keep them healthy until they are old enough to take care of themselves on their own. As such, circumcision is often compared to vaccination, another common childhood medical incident--the argument often being the administration of vaccine is often painful, and, if given the option, children would most likely choose not to receive them. My arguments against vaccination aside, inoculation is a completely different issue and not at all comparable with circumcision for several reasons.

Firstly, by administering a vaccine to a child, scientifically engendered toxins are actually added to the body. Circumcision, on the other hand, surgically removes an otherwise healthy and functional body part. As the author questions in the article, should you remove all the child's teeth as they come in just because someday he may end up with a mouth full of cavities? Probably not.

Secondly, vaccination does not deprive individuals of functional body parts. On the other hand, infant circumcision always deprives the male of the protective and sexually enhancing gliding mechanism of the foreskin, as well a substantial portion of genital tissue, hundreds of nerves and thousands of nerve endings contained in the foreskin. Consequently, infant circumcision reduces a male's full range of natural penile functioning.

Thirdly, inoculation can prevent common diseases over which individuals may have little control; on the other hand, circumcision does not prevent any disease--at best, circumcision is only alleged to "reduce risk" of certain rare diseases, all of which are behavior-related, and most of which take place after a man is mature enough to make the decision for himself.

Moreover, while it can be argued that a parent must make decisions based on what they believe is best for the health and well being of their child, it must be considered that, unlike vaccination, the motivation for circumcision is based primarily on religious and social customs, and alarming little research was done on the medical aspects of the procedure before it became wide-spread in the US.

I will not argue the pros and cons of vaccination here. I do, however, feel it is completely necessary to understand how drastically different circumcision is from vaccination, and how completely incomparable the two procedures are.
It should also be acknowledged that infant male circumcision is a medically unnecessary procedure with Biblical roots (Leviticus) based on the Kosher laws of cleanliness--essentially to prevent boys from masturbating by removing the pleasure the foreskin naturally adds. As such, it is a ritual that is not unlike the many other customs of childhood bodily modification from around the world.

For instance, there is the practice of foot-binding common in China in the 10th through 20th centuries, a fashion trend that caused painful disabilities in millions of young girls and women over that time period. There is the skull shaping and artificial cranial modification common in ancient Andean and Egyptian societies and still practiced in some cultures around the world today, a gradual procedure that is performed on children, whether to designate spiritual maturation or simply to be aesthetically pleasing. Also, there is the practice of neck stretching on girls from neck rings in certain African and Asian cultures; the elongated neck is a symbol of beauty in these cultures. When neck stretching is performed gradually, starting at ages three or four and continuing through puberty, it is not a painful modification (though rapid neck stretching, occurring when a girl reaches puberty as a right of passage, is extremely painful) and it does weaken the neck muscles and inhibits the ability to hold up the head once the rings are removed.

Despite their social popularity throughout history, we now find many of these traditional modifications to be barbaric and disabling. We, as parents in the US today, would not perform these procedures on our children because they would cause them pain and visually mutilate their bodies. However, it is considered perfectly acceptable to surgically remove the genital foreskin of our vulnerable baby boys in a painful procedure.

So why, when so much of the world does not circumcise their baby boys, does society and the medical community in the US still believe circumcision to be necessary? It always comes down to this one thing: Money. As Thomas Wiswell, MD, said back in 1987, "I have some good friends who are obstetricians outside the military, and they look at a foreskin and almost see a $125 price tag on it. Each one is that much money. Heck, if you do 10 a week, that's over $1,000 a week, and they don't take that much time." Over the two decades since Dr. Wiswell admitted this honest observation, the cost of the procedure has tripled, and in some areas, quadrupled, and is still on the rise.

Not only do they charge a pretty penny for a circumcision procedure, the foreskin itself is sold by the hospital for profit for medical research; one single Neonatal Foreskin Epidermal Keratinocytes goes for a profound $250 at the Coriell Institute for Medical Research. If you consider that 55% of boys are circumcised these days, that is a stark statement of how much medical professionals and hospitals are making on a 15 minute procedure.

My father was born and raised in Germany, and, as infant circumcision is nearly nonexistent in continental Europe, he has an intact foreskin. I once asked him, when we were discussing the politics of circumcision in the US, if he had the option, would he have his foreskin removed. Not surprisingly, he said no. He also does not regret that he was not circumcised as an infant. If you asked me if I wanted my labia removed, I would sure as hell say no. If an infant boy had the mental competency to make an informed decision on whether he should remain intact or not, what do you think his answer would be?

I believe it all boils down to one thing: Informed Consent. As parents, we should respect our children's bodies. Medical reasoning for infant male circumcision has not shown me any research to make me feel that the procedure is necessary or even warranted. Quite the contrary, actually. Informed consent is a beautiful thing, but is so often disregarded by the medical community, especially in obstetrics and pediatrics.

Unfortunately, much of our society does not even know they have a choice--a choice that should be a basic human right. Educate yourself. Research unbiased information. Spread the word.

Choose informed consent.


 References:

Would you Circumcise your Daughter? Woman Uncensored, 12/28/09
US Circumcision Statistics Report, The Circumcision Reference Library
Estimated US Incidences of Neonatal Circumcision Complications,  NoHarm.org
There's Money in Circumcision, Circumstitions Intactivism