Doulas Have A Duty To Talk About Circumcision

Doulas Have a Duty to Talk About Circumcision

Originally published on Mothering.com

 

When I was pregnant with my first baby nine years ago, my doula was a personal friend, someone whose children I babysat often. She was also a great source of information throughout my pregnancy.

I remember the moment I told her I was having a boy. I had gone in for an ultrasound to determine the sex of my child, and I later met up with my doula to work on some birth art. When I announced that I was expecting a boy, she responded with enthusiasm, quickly followed by, “You’re not going to circumcise him, are you?! I’ll make you watch a video. I think it’s torture.”

Maybe it was a little brazen for a doula; some might say so.

And yet, I am eternally grateful for her direct approach. It was one of the factors that spared my son and any future sons from an unnecessary genital cutting procedure. Our relationship as friends aided her ability to be forthright with not only her opinion on circumcision, but the facts as well.

What are the facts about circumcision?

Beyond its religious and ritual nature, circumcision has been touted as a virtual cure-all in the United States since the 1800s. One of the earliest medical records of circumcision was from Claude-Francois Lallemand, who circumcised a patient to “cure him from nocturnal seminal emissions.

In 1845, research entitled A Treatise on Diseases of the Sexual Organs declared that circumcision prevents masturbation.

Circumcision was also purported to prevent or cure syphilis, epilepsy, paralysis, tuberculosis, bed-wetting, blindness and deafness.

In the 1900s, a paper called The Advantages of Circumcision claimed that circumcision was a “way to decrease the pleasure of sex, and hence to discourage sexual immorality.

A puritanical obsession with the notion that sexual pleasure is inherently sinful has driven circumcision throughout the ages. While it has been touted as a medical procedure, it is clear to see from the history of medical circumcision that it was largely quackery.

The same can be said today. The United States is an anomaly with its practice of routine infant circumcision, specifically because of its establishment in the U.S. as a puritanical treatment against normal human sexuality. The rate of routine infant circumcision in the United States is dropping; however, it was previously a highly popular procedure, reaching its peak in the 1980s.

The general idea presented by American doctors and culture is that the foreskin is somehow icky, and probably disease-ridden. It causes a lot of problems, right?

Wrong.

The so-called benefits of circumcision may sound drastic and important, but they are statistically tiny, comparable to removing the breast tissue of baby girls in order to prevent future breast cancer. In fact, because breast cancer is so rampant, routine breast tissue removal makes more sense medically than routine foreskin amputation.

The American Academy of Pediatricsa trade organization of pediatricians who happen to profit from performing circumcisions — stands alone in their statement on circumcision. While they don’t officially recommend it, their claim is that the supposed benefits outweigh the risks (while, in that same statement, there is no mention of the functions of the foreskin nor the actual risks of circumcision).

This conclusion is highly suspect when the rest of the world is considered. What began as a religious ritual and eventually transformed into a cosmetic procedure is seen as such by most other medical organizations around the world.

All of this to say: the benefits of circumcision are slim, the functions of the foreskin must be acknowledged and researched further, and it is more cultural conditioning than medical necessity that perpetuates circumcision in our culture.

Following are several official positions on routine infant circumcision from around the world:

Canadian Paediatric Society

“Recommendation: Circumcision of newborns should not be routinely performed.”

Circumcision is a ‘non-therapeutic’ procedure, which means it is not medically necessary…After reviewing the scientific evidence for and against circumcision, the CPS does not recommend routine circumcision for newborn boys. Many paediatricians no longer perform circumcisions.”

The Royal Dutch Medical Association

“The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity.”

German Pediatric Association

“Therefore it is not understandable that circumcision of boys should be allowed but that of girls prohibited worldwide. Male circumcision is basically comparable with FGM types Ia and Ib that the Schafi Islamic school of law supports.”

Royal Australasian College of Physicians

“After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.”

British Medical Association

“To circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”

Response to the AAP position statement, signed by 38 physicians:

“The other claimed health benefits, including protection against HIV/AIDS, genital herpes, genital warts, and penile cancer, are questionable, weak, and likely to have little public health relevance in a Western context, and they do not represent compelling reasons for surgery before boys are old enough to decide for themselves.”

As anyone should be able to see, circumcision is not popular outside of the U.S.; the benefits of circumcision are wildly overstated, and numerous health organizations around the world speak out against it.

 

Doulas and Circumcision
Image via Earthside Birth Photography

This information leads to the question: Where does a doula’s responsibility lie in informing parents about circumcision? As a doula, I meet with my clients to review their birth plans and talk about important aspects of pregnancy, birth, and the postpartum period. This includes information not directly related to my job as a birth doula, including breastfeeding preparation, babywearing info, and safe cosleeping habits.

So what about circumcision? Do doulas have a duty to inform their clients about circumcision? Or is it outside the scope of practice?

There certainly are doulas who believe that circumcision is a parental right and discussing it is outside the scope of practice, but I would argue that it is well within the job description of a doula to help parents make fully informed decisions about routine infant genital cutting. My job as a doula does not begin solely at birth, nor end entirely when the baby is born. Providing parents with accurate information is a major part of my goal.

If it is a doula’s duty to help parents get proper information about circumcision in order to make a fully informed decision, at what point should a doula have this conversation with her clients?

Thankfully, each doula client I have had was already against circumcision, so I’ve never had to bring it up, but the issue may not be as easy to tackle as one might think.

Minnesota birthwoker, Doula Jen makes some important points. She says, “Part of me wants to just post a banner on my website that says ‘I will not consider working with anyone who plans to circumcise.’

But, I don’t know if that would actually keep anyone from cutting their kids. They would just interview another doula, and they wouldn’t get the chance to hear me talk their ears off about the importance of keeping their children whole.

Considering that many American parents are raised in a culture that views the foreskin as inherently bad, unnecessary, and disease-ridden, it is crucial for parents to receive accurate information about the benefits of the foreskin and the harm of circumcision. If a mother cannot count on her doula to give her this information, who else? Her best hope is that she has an unbiased, ethical doctor who is up-to-date on the circumcision recommendations from around the world, and that is rare to find in the United States.

But can a doula continue to serve a mother who intends to circumcise, if the doula is adamantly against it?

Doula Amy Wright Glenn shares her thoughts:

Currently, the American practice of routinely circumcising infant boys is presented as a birth option for parents to consider. More and more Americans are coming to see the practice of cutting a child’s genitals within a human rights framework and they are rejecting a parental choice framework. Rates of cutting continue to fall each year.

This is significant. Why?

If a child has a right to physical integrity then the practice of cutting off a healthy, important, and functional part of the the child’s body violates her or his right. Within a human rights framework, it is unethical for a doula, or anyone, to support a parent in violating a child in this way.

Hence, from within a human rights framework, circumcision is clearly a violation of the principle of consent and an assault on an innocent child’s physical integrity.

For a doula who sees circumcision within such a framework, she needs to ask herself two important questions:

1. Should I tell prospective clients about my human rights vision with regard to protecting a child’s physical integrity?

2. Can I, in good conscience, support a birthing mother’s choice to authorize the performance of an elective, non-consensual, painful surgery upon the genitals of her son?

I believe the answer to the first question is absolutely yes. A doula who embraces a human rights framework regarding circumcision would be wise to disclose her perspective. She certainly would be well within her scope of practice to include information concerning the peer-reviewed best practices relating to the benefits of keeping children intact in whatever literature she may give to prospective clients.

Of course, a doula with a human rights perspective finds herself unable to support in good conscience a client who has a parental choice perspective, she should kindly refer the expectant mother to doulas who see circumcision within a parental choice framework.

This brings up the question: at what point in time should a doula discuss circumcision with her client? If she broaches the subject initially, might she scare a potential client off? If she waits to discuss it until a bond has been formed, is it ethical to discontinue working with the mother if she still plans to circumcise?

To this, Amy Wright Glenn says, “For doulas with a human rights perspective, I suggest that this topic be brought up in the first meeting with prospective clients. The topic can be presented with kindness, clarity, and honesty.

Georganne Chapin, Executive Director Intact America (described as “the largest national advocacy group working to end involuntary circumcision in America”) takes a bold stance that I find personally inspiring as a birth worker.

She says, “It is absurd that doulas are prohibited from advocating for the rights of the baby. If a mother told her doula she planned to leave her baby alone and unattended all day, would the doula say that’s a fine plan? A doula should be trained to advocate for safe perinatal practices and against unsafe practices. Circumcision is medically unnecessary, unsafe and unethical.

Chapin points out, “No medical authority, including the Academy of American Pediatrics, has ever called infant circumcision medically necessary.

The truth is that most doulas, if not all, would very likely speak up if a parent planned to leave their baby unattended, or to not use a carseat, or to practice unsafe cosleeping habits. There are numerous examples where a doula would probably find it important to provide alternative, evidence-based information.

My job as a doula is to serve mothers prenatally, during birth, and throughout their postpartum period. This work is important for many reasons, in part because of the positive effects doulas can have on physiological birth. The wellbeing of both mother and child is a major part of what drives me as a doula, birth educator, and activist.

Researching the history, the harm, and the supposed benefits of circumcision for 8 years now, it is clear to me that the act is inherently damaging, as it removes an important part of the penis. One cannot change form without changing function, and that is essentially what circumcision does. I think it is my duty as a doula and birth educator to present evidence-based information that is in the best interest of both mother and child.

This is why I will continue to speak up and help dismantle the myths surrounding circumcision. Will you?

Doulas and Circumcision
Image via Kimberly Collins Birth Photography

 

Thumbnail image via Fresh Love Birth

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4 thoughts on “Doulas Have A Duty To Talk About Circumcision

  1. I couldn’t agree more. Personally, I’d pay a year’s salary rather than be circumcised or have my son circumcised. Why would I want the most sensitive and pleasurable parts cut off? That little bit of skin makes a big difference.

    Why don’t we just let everyone decide for themselves whether or not they want irreversible genital surgery? It’s their body after all.

    It’s not like it can’t wait. It’s pretty much only the USA (at around 60% and dropping) and Israel where more than half of baby boys are circumcised. Other countries circumcise, but not till anywhere from the age of seven to adolescence. Only about 12% of the world’s circumcised men were circumcised as babies. Around two thirds of the world’s men (88% of the world’s non-Muslim men) never get circumcised.

    Drops in male circumcision since 1950:
    USA: from 90% to around 60%.
    Canada: from 48% to 17%.
    UK: from 35% to about 5% (about 1-2% among non-Muslims).
    Australia: 85% to 11% (“routine” circumcision has recently been *banned* in public hospitals in all states except one).
    New Zealand: 95% to below 3% (mostly Samoans and Tongans).
    South America and Europe: never above 5%.

    This is what some national medical organizations say:

    Canadian Paediatric Society
    http://www.cps.ca/en/media/release-communique/canadian-paediatricians-revisit-newborn-male-circumcision-recommendations
    “OTTAWA— In an updated statement released today, the Canadian Paediatric Society (CPS) continues to recommend against the routine circumcision of newborn males.”

    Royal Australasian College of Physicians
    http://www.racp.edu.au/docs/default-source/advocacy-library/circumcision-of-infant-males.pdf
    “After reviewing the currently available evidence, the RACP believes that the frequency of diseases modifiable by circumcision, the level of protection offered by circumcision and the complication rates of circumcision do not warrant routine infant circumcision in Australia and New Zealand.”
    (almost all the men responsible for this statement will be circumcised themselves, as the male circumcision rate in Australia in 1950 was about 90%. “Routine” circumcision is now *banned* in public hospitals in Australia.)

    British Medical Association
    http://bma.org.uk/-/media/Files/PDFs/Practical%20advice%20at%20work/Ethics/Circumcision.pdf
    “to circumcise for therapeutic reasons where medical research has shown other techniques to be at least as effective and less invasive would be unethical and inappropriate.”
    “The medical benefits previously claimed, however, have not been convincingly proven, and it is now widely accepted, including by the BMA, that this surgical procedure has medical and psychological risks.”

    Danish Medical Association
    http://www.thelocal.dk/20161205/danish-doctors-come-out-against-circumcision
    “The Danish Medical Association (Lægeforeningen) has recommended that no boys under the age of 18 be circumcised in Denmark.
    The association released its recommendation on Friday, saying that circumcision should be “an informed, personal choice” that young men should make for themselves.”

    The Royal Dutch Medical Association
    http://knmg.artsennet.nl/Diensten/knmgpublicaties/KNMGpublicatie/Nontherapeutic-circumcision-of-male-minors-2010.htm
    “The official viewpoint of KNMG and other related medical/scientific organisations is that non-therapeutic circumcision of male minors is a violation of children’s rights to autonomy and physical integrity.”

    Swedish Paediatric Society
    “Circumcision of young boys for religious and non-medical reasons ought to be banned in Sweden, urged the Swedish Paediatric Society (Svenska barnläkarföreningen, BLF).”
    http://www.thelocal.se/20120219/39200

    Mexican Secretariat of the Interior
    ” Evitar como práctica rutinaria la circuncisión, toda vez que no existe evidencia científica que compruebe un beneficio directo a la persona recién nacida.”
    Sec 5.7.13 “Avoid circumcision as a routine practice, since there is no scientific evidence to prove a direct benefit to the newborn person.”
    http://www.dof.gob.mx/DOFmobile/nota_detalle.php?codigo=5432289

    http://www.crin.org/resources/infodetail.asp?id=31830
    “[30 September 2013] – At a meeting today in Oslo, the children’s ombudspersons from the five Nordic countries (Sweden, Norway, Finland, Denmark, and Iceland), and the children’s spokesperson from Greenland, in addition to representatives of associations of Nordic paediatricians and pediatric surgeons, have agreed to work with their respective national governments to achieve a ban on non-therapeutic circumcision of underage boys.”

    German Pediatric Association
    http://www.intactamerica.org/german_pediatrics_statement
    (very long, but very much against circumcision, and includes the following)
    “Therefore it is not understandable that circumcision of boys should be allowed but that of girls prohibited worldwide. Male circumcision is basically comparable with FGM types Ia and Ib that the Schafi Islamic school of law supports”

  2. As a doula and an RN, I always share my perspective on the harm that circumcision is, to a baby boy and the man he will become. All people deserve the right to keep their genitals as God/nature made them. No one should be deciding what or how others genitals should look or work, they have the right to bodily autonomy and can make decisions themselves on what to do with their bodies and future sexual lives! Sorrells conducted a real study, looking at sensitivity in the intact vs circumcised penis. The most sensitive part of the cut penis was the area where the foreskin had been! Since the foreskin has over 20,000 nerves and specialized cells for sensation, like the lips and the eyelids, of course, removing it will make the cut penis less sensitive. Condoms, monogamy and testing protect people against STIs and HIV, not cutting. Circumcision, the more you know, the more you are against it.

  3. Keep up the good work. I am 63 years old and wish I had not been circumcised as a child – I’ll never have a chance to know how much more enjoyable intact sex could be for both me AND my wife! I believe this is first & foremost a rights issue for the child!

  4. Great post! And comments. I could have used all of this 11 years ago when I was pregnant with my son. This was a huge issue between my husband and me. I was so adamantly against circumsising and thoroughly shocked to find out during a conversation with friends, who had recently had a boy that they did not circumcise, that my husband assumed that of course we would do it – mainly because he had been circumcised as a baby. We argued very heatedly about it for months and luckily in the end he deferred to me even though he never really understood my position. Even his own mother didn’t circumcise his youngest brother because she had figured out by then that it was totally unnecessary. I gave birth at home and it would have meant a special trip to the hospital. There was no way I was going to give in on this.

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