31 August 2011

Circumcision: A few facts

Since finding out I was having a boy, one of the things that my husband and I thoroughly researched was the topic of circumcision. Was there really any reason to do it? Would there be any benefit to him going through that pain? What exactly does a circumcision remove? If we don't circumcise, how do we keep him clean?

For starters, I will point out, for those just learning about circumcision, throughout my blog, I will be using "intact" and "whole" to refer to a boy who is not circumcised. The term "uncircumcised" implies that circumcision is what is normal. An intact boy is no more uncircumcised than someone with all of their limbs is unamputated.

I did exhaustive research. I pulled studies and articles regarding urinary tract infections, sexually transmitted diseases and hygiene. I looked up rates of circumcision in our area, in our country, and around the world. I even asked my husband his feelings and thoughts regarding the old "locker room argument" (that an intact boy is highly likely to get relentlessly teased for being different), and my question essentially got laughed at and I was told that a guy who admitted to "noticing another guy's junk" was likely to get ridiculed. Also, we discussed that kids will be cruel, and if they want to pick on someone, they will find SOMETHING to pick on them about, regardless.
What I found out surprised me. And the more I researched it, the more strongly I have become opposed to Routine Infant Circumcision (RIC).

As I'm posting from work, I can't link gather to share many of the most informative posts that I have found from the Peaceful Parenting Blog, as some of them have some pictures that rather explicitly show the difference between an intact and circumcised penis, as well as showing what actually occurs during a circumcision.

  • Cleaning an intact boy is easier than cleaning a circumcised boy. You don't have to care for a healing wound that is sitting in a diaper, and you do not retract an intact infant, whereas with a circumcised infant, you often have to retract the remainder of the prepuce (foreskin) regularly to prevent adhesions.
  • Up to 96% of infant circumcisions in the United States and Canada no anesthetic is given. And often, when anesthetic is used, it is often only minimally effective, or is specifically contraindicated for use on infants and/or for circumcisions. Infant Circumcision with Anesthesia Article on TheWholeNetworkCircumcision Study Halted Due to Trauma 
  • The circumcision procedure is especially violent on an infant or child. At birth, the prepuce is not retractable, but is fused to the head of the glans. The age at which a child can retract varies widely, and may not happen until puberty. Prior to this, a circumcision requires not only the excision of the prepuce, but also requires ripping the prepuce away from the glans.
  • Studies on UTI rates fail to specify whether the intact infants were being retracted. In a culture where doctors will try to retract an intact infant and will tell parents that they should be doing this regularly to clean out things that "get caught" in the prepuce, chances are good that at least some of these infants were not being properly cleaned (again, "proper cleaning" means leave it alone; "only clean what is seen", "When intact, do not retract").
  • The American Academy of Pediatrics recognizes that "Some forms of [Female Genital Cutting] are less extensive than the newborn male circumcision commonly performed in the West.", but they still waver over taking a stand against male circumcision, taking an on the fence stance, stating "Existing scientific evidence demonstrates potential medical benefits of newborn male circumcision; however, these data are not sufficient to recommend routine neonatal circumcision." as of their official statement in 1999, which was reaffirmed in 2005. It's significant to note that despite it being an exceedingly common practice, the AAP doesn't even outright endorse the procedure.
  • 20 out of of 100,157 (0.02%) circumcised boys got UTIs, compared with 88 out of 35,929 (0.244%) intact boys. If circumcising the 35,929 boys would have reduced the incidence from 0.244% to 0.02% (7 boys), the Number Needed to Treat is 35,929/(88-7) = 444 circumcisions to prevent one UTI. Circumcision and Urinary Tract Infections, Circumstitions.com
  • 100-200 baby boys die annually from circumcision and this practice continues. Yet, when 30 infants die over the span of 10 years, all drop-side cribs are recalled. The Guggie Daily: How many Babies Must Die from Circumcision?
  • Is Religion a reason? There is an increasing Jewish movement against circumcision, replacing the ceremony with the naming ceremony used for infant girls (Beyond the Bris). As for Christians, the New Testament actually has several passages that indicate that the circumcision covenant is no longer required (Circumcision and the Christian Parent; NOHARMM).
  • Female Circumcision (FC) was outlawed in the U.S. in 1996. Prior to this, it was legal for infant girls to be circumcised, even if it wasn't commonplace. People would balk at the idea of allowing FC to be a routine practice, even though, as already mentioned above, even the AAP recognizes that there are forms of FC that are less severe than the Male Circumcision that we practice here in the U.S. The law doesn't give religous or cultural exemption. In fact, in 2010, the AAP recommended allowing a "ritual pinprick" in lieu of FC in an attempt to prevent families from taking their daughters overseas to be circumcised, and there was an outcry that caused them to quickly backpedal on this suggestion.
This is just a start of some of the double standards and misinformation that I uncovered regarding circumcision.

Although I had intended on writing about birth resources and my own birth experience after my pregnancy post, the news about the circumcision debate/law in California has got this at the forefront of my mind. When I have a bit more time, I'll write more about San Francisco, the State of California, and circumcision law.

25 August 2011

Pregnancy Resources - Preparing for Birth

Finding out you're pregnant can be tremendously overwhelming; whether that pregnancy was planned or not. Trying to navigate the sea of information once you're pregnant is a daunting task. What books should you read? What things do you need to buy in preparation of the baby? The many choices and decisions you have to make over those 9 months can sometimes feel like a huge weight.

No matter who you ask, everyone will have a different opinion about what sources and information you should surround yourself with as you journey into parenthood. The easiest way to start figuring out what will work for you is by thinking through what type of birth you want to experience and what your parenting style will be. (Ah, but then there's the catch 22: how can you possibly decide if you don't know what your options are?)

Let me share a secret with you: I have yet to spend money on any pregnancy, birth, and/or parenting books. And I have no intention of doing so. Every piece of research I did, I did through the internet (thanks, Google!). I checked out one solitary book from the public library. Every piece of medical information I wanted verification or futher information on, I discussed with my midwife. I do wish that I'd taken the time to learn more about a few things, but overall, I felt ready when my labor started, and because I knew and understood my options, I felt empowered and in control of my birth experience. And those few things that I wished I'd know more about I will look into and be ready for if and when we ddecide to add to our family. Because I took the time to educate myself well before birth, I know absolutely what I could and will try differently next time around.

When you first start meeting with your healthcare provider(s), whether it will be an Ob/Gyn, a midwife, a doula, and/or your family doctor, the best first step you can take is to discuss expectations. What are your expectations for the pregnancy and birth? What sort of testing and prenatal appointment expectations does your healthcare provider have? If you will be declining any of the recommended testing, will this affect whether or not this provider will keep you as a patient? In some cases, health care providers may refuse to continue to provide care if you decline some tests. If this will be the case, it's good to know this ahead of time so that you can find a provider who will be a good fit to your prenatal care preferences and expectations. A sample prenatal testing schedule can be found here. Not all of these tests apply to everyone, but it gives a fairly good overview of what standard tests are done and during what stage of pregnancy.

One of the things that got me thinking about my birth options was making a birth plan. I found a fairly comprehensive one at http://www.birthplan.com/ that got me thinking about things that I hadn't even considered, like episiotomies, delayed cord cutting, and pitocin use. It also helped give my midwife a good idea of what my husband and I expected of birth and delivery and for us to discuss our preferences, her recommendations, and where the two may not have coincided and why.

Another important resource is having others you can talk to about your experiences. I found the forums at BabyCenter extremely helpful in finding women that I could share my experiences with. They automatically add you to a forum for women who share your same expected due month. Granted, as you progress in your pregnancy, there will be wide variation between the women at the beginning of the month and those at the end, but it's a good way to meet other women who are experiencing pregnancy at roughly the same stage you are. A year later, I still stay connected to a small group of these women (about 50ish or so of them), although we were all due in July, our babies range from being born in May to Mid-August. There are other sites with discussion forums for expectant mothers, but most of my baby-related forum time was spent on BabyCenter, so I can't personally name or recommend any of them.

What books, websites, and/or other miscellaneous resources did you find helpful in knowing what to expect during pregnancy? What tips can you offer others?

19 August 2011

My Pregnancy Experience

It seems most appropriate that I start my parenting blogging experience talking about my pregnancy and birth experience with my son. I wish that I'd decided to be an active blogger during my pregnancy so that I could have accurately captured the many emotions and experiences throughout the pregnancy, but alas, I did not. Perhaps when my husband and I are ready to add to our family, I will be better about that aspect.

The first part of the story is sort of funny. My husband and I decided to start trying to conceive. So I made a doctor's appointment with my new doctor (we had just moved) for my annual check up and for pre-conception information. The most important preconception information that my doctor gave me was to start taking folic acid before I got pregnant.

At that appointment, my doctor also recommended that since I hadn't had a Tetanus/Pertussis booster in the past 10 years, that I should get that. However, there was the most minute chance that I could have been pregnant, so they wanted to wait until I had cycled, or to come back in a few weeks for a pregnancy test before they gave me the booster. As it turned out, that "minute" chance was actually a pregnancy, which was quite a surprise to my husband and I, because it was less than a month since we'd decided to try conceiving. Good thing I went right out and started folic acid right after my appointment with the doctor!

My pregnancy itself was about as "textbook" as you could get, really. I had morning sickness from about 1 month in until nearly 4 months. It wasn't until I was nearing the end of that phase that I finally found the best ways to alleviate the sickness; keeping freshly cut lemons next to the bedstand at night, and constantly wearing Sea-Bands. When I was feeling particularly nauseated in the middle of the night, I would bite into a lemon, but for the most part, the scent of the lemons kept the sickness at bay. I don't even know how many lemons I went through keeping away the morning sickness, since we cut up about half of a lemon every night so that the smell would be strong enough. I slept for at least 12-14 hours a night, and even then, I would sometimes need to fight falling asleep at the desk at work.

Once the morning sickness abated, I spent much of the 2nd trimester with evening heartburn. The only cure for this was lots and lots of milk, ice cream, and late in the evening, sometimes Tums.

We had our anatomy scan at 18 weeks, and at that point found out that we were having a boy. Prior to this, we had already discussed circumcision, and were in absolute agreement that we were going to leave any sons intact and that that was their choice to make.

I felt at my best during the 3rd trimester. Aside from slightly swollen ankles, which I made sure to keep propped up as much as possible, I was energetic - despite not always getting great sleep.

Throughout my pregnancy, I had a midwife from the hospital that I was going to be delivering at. This hospital uses a team of midwives; each midwife works at different health centers in the area for prenatal and postnatal appointments, so I had a set midwife for that care (my midwife did change once during this time, but that was because the midwife I started with had a shift in her responsibilities - I could have opted to keep her, but would have had to go to another location). However, in the hospital, the midwife who would be at the delivery depended on who was on call at the hospital.

My birth preferences were that I would do a vaginal delivery with no medical interventions. However, I did realize that in the moment, I may want pain management alternatives, and so I did my research about the different types of medications. We discussed my desire to not have an induction and to carry as long as possible until natural labor set in, since due dates can be wrong, and generally babies will come when they are fully ready to handle life outside the womb. We wanted to delay cord cutting, and I absolutely wanted to avoid both a c-section and an episiotomy.

My prenatal appointments were super easy. I went in, peed in a cup, they took my blood pressure and weight, my midwife would do my fundal height and we'd listen to the heartbeat, and then we'd do questions and answers. In the later stages, my midwife would feel for my son's positioning, but this was always done externally. At no point did we do any cervical checks -  you know why? Because they aren't necessary, and aren't reliable predictors of when you're going to go into labor.

What I learned from my pregnancy:
  • Decide on your birth preferences
  • Educate yourself about the alternatives
  • Lemons & Sea-Bands are fantastic
  • The drink you have to drink for the gestational diabetes test is not gross like most people say it is; it tastes like Orange Crush
  • I am no longer afraid of needles (amazing how a prenatal panel of bloodwork will do that for you)
I may have to add another post to discuss the pregnancy experience in a bith more depth and provide more resources, but at the moment, I am short on time.

Hello!

I decided that I wanted to start a blog that would be primarily dedicated to parenting and those aspects of parenting that I feel most passionately about. I'm sure that as life interferes, there will probably be a few asides, but I am hoping to keep this blog mostly on topic.

I am hoping that as I add to this blog, I will find people who are both like-minded, and of different opinions. Perhaps we can educate one another.

By way of introduction, I am a mother of one son who just turned a year old. I am married, and both my husband and I have full time jobs with alternating hours (I work days, he works nights). I breastfeed, babywear, and co-sleep. I am anti-circumcision and spanking. We live in the Boston area.