Thursday, June 07, 2007

Being on vacation... giving me a lot of time to think about things, I guess. Three things that have been on my mind lately: Birth, Breastfeeding, and Circumcision.

Well, this is a topic that I think about a lot, anyway. I love birth stories, and I find it amazing what a range of feelings these stories can cause. Anything from pure joy and happiness to disappointment, anger, and sadness. They all generally end the same, with a happy healthy baby, but they can produce a whole range of emotions. We live in a country where women have to fight constantly for their right to have a baby at home, attended by a midwife, and at the same time, women have the right to ask their doctor to induce labor, sometimes weeks before their due date, for no good reason other than being tired of pregnancy, or scheduling around their husband's work, and the doctor will agree to do that. Women have to fight for the right to birth at home, which has been proven to be safe over and over again, yet they also have the right to request a c-section, for no reason other than to avoid labor, or to keep their vaginas from stretching too much, or whatever, and a doctor will agree to that, even though it is well known that c-sections carry a greater risk for mother and baby than vaginal birth does. How does all this make sense? Technology keeps improving, the rate of medical intervention during labor and birth keeps rising, as does the rate of babies born via c-section, yet there has been no improvement in neonatal and maternal outcome since the early 80's. Still, we have such a firm believe in medical technology, and all the good doctors do for us. We can't imagine that birth could happen safely without all the mointors and drugs and surgeries. It's true, in some cases that technology can be life-saving, but what we are ulitmately doing by pushing women into hospitals to birth their babies is lose the art that is childbirth. The experience that so absolutely forms who a woman is. Becoming a mother is a life changing event, and it is so much more than merely pushing out a baby. It is so much more than a physically healthy mother and baby. What is neglected is the emotional health of the mother. Going through childbirth is an immensly intense experience. It is so amazing what the woman's body is doing to end many months of growing a new little human. It's amazing to think about all the intricate details that make up the process we call labor. How everything fits together just right, all the chemicals in our bodies are flowing just right, all the muscles are contracting just right, all to give birth to a miracle. And then we leave women alone with this intense, powerful experience. We strap them down in bed, hook them up to a monitor, and just leave them alone. Generally, husbands are expected to be of support, but a birthing woman is often quite an overwhelming sight for a man. Especially when that man is the father of the baby, and quite emotional himself. Some men live up to the challenge and make wonderful coaches, but many others don't. And sometimes, for one reason or another, the woman really is alone. Nobody else can be there with her. As happened to my friend just a couple of weeks ago, and she had to beg her nurse to stay with her and give her support for just a few minutes. Beg. I know how to check your blood pressure, how to read your monitor, how to put in your IV - sorry, I can't be your support person, I have one other mom in labor right now. One. So for half an hour I'm busy with the two of you, and the other half hour? I'll go chat with my nurse friends really quick. It makes me sick to hear stories like that. It makes me sick and mad and angry, and more than anything really really sad, that women are left to themselves like that. What we really need is more midwives. Midwives who can legally attend home births, birth center births, and more midwives for women who choose hospital birth. Midwives who care for the women during labor, and don't just run in at the last minute to catch the baby. Who get to know women throughout their pregnancies, and offer real support during labor. What we need is more doulas, who are welcome by hospital staff because they fill in where nurses sometimes fall short (and often, it really is because they are overworked). Yet both midwives and doulas are often under-appreciated, and some doctors and hospitals are flat out hostile towards them. What we need is more people to realize that birth is a natural, amazing, and wonderful process, not a medical emergency waiting to happen. Let OB's handle the true high-risk cases, the true emergencies, and give normal birth back to women, attended by those who know the art it is to help a woman bring a baby into this world. Safely. With a baby and a mother who are not only healthy physically, but healthy emotionally, as well. One can dream, right? Hope, maybe?

My sister-in-law (hi Nicci!) recently blogged about her trying to get their little boy to take a bottle occasionally, and how they weren't being very successful. It made me smile, and chuckle. It made me reflect on my experiences with breastfeeding and trying to get baby to take the occasional bottle. With my first baby, it was necessity, because I went back to school full time and he needed a bottle while I was gone. With the other two, I wanted them to be able to take a bottle so I could get the occasional break. Here's what happened. When Bryan was little, I introduced a bottle fairly early on, and it worked pretty well. I thought that was great, since it would give me the chance to leave if I needed to. Well, I tried leaving once, and while he was happy with the bottle, my breasts were not happy with the extra milk left over from a missed feeding. Lets just say I was in pain, and they let down because, you know, it was feeding time, and I was soaked. Too early to try this, I thought, but kept up with the bottle so Dave and I could go on a date sometime when Bryan was a bit older and I wasn't over-producing quite so much. Well, by the time I finally felt ready to leave the little guy for a couple of hours, he was old enough to have separation anxiety. Dave and I went on our date, but it really didn't matter that Bryan could take a bottle. He screamed relentlessly the whole time we were gone, not because he was hungry, but because he was so freaked out that we left him. Needless to say, we didn't try leaving him again for a really long time, and by then bottles had become useless. Did we learn from this experience? Not really. Kaylee came along, and I pulled out my breastpump. Thought I'd teach her how to take the bottle in case I ever needed some time to myself, or go on a date with my husband, or something. Kaylee was such a needy baby, however, that I quickly dumped the pump, and just resigned myself to the fact that she wasn't getting bottles because there was no way I was ever going to be able to leave her. And breasts make the perfect food, after all. Always the right temperature, always ready to go, nothing to clean up afterwards. :o)

I always think about this when we're in Germany. If you told someone about routine infant circumcision here, they'd look at you like you're crazy. They'd think you've gone mad. They may even call the police on you, and accuse you of violating human rights and mutilating a baby. Seriously. I'm not even kidding. So then I think about this topic, and why we practice RIC in the United States. And I always end with the same conculsion - I don't understand why it's done. Cleanliness, tradition, so father and son look alike? Those seem like pretty weak arguments to me, considering what's happening is surgery. It's purely cosmetic. Whoever performs cosmetic surgery on a little baby boy who has nothing wrong with him? How is that ethical? Then there is the argument citing research that shows a smaller risk of UTI's for boys who were circumcised. That's gotta be a good thing, right? No, not when you look at how small the risk is for a baby boy to get a UTI to begin with. Does that warrant surgery on a day-old baby? I mean, we don't routinely perform tonsillectomies on babies because they may develop strep throat at some point in life. We don't routinely put tubes in their ears because they may develop an ear infection. We also don't perform routine appendectomies because, hey, you may get appendicitis one day and it could save your life. Doctors would look at you and declare you crazy if you as much as suggested such a thing. Yet they go on cutting day-old baby boys, in the name of what? Whatever way I look at it, it doesn't make sense to me. Just wish I would have started thinking about it 7 years ago...


scienceteachermommy said...

I need to email you AJ's birth story. I have Dave's email, but not yours. I can send it to Dave and have him forward it. It was very therapeutic for me to write it. It was important for me to understand why I hadn't been able to have a "natural" experience though I had desperately wanted to.

On the breastfeeding . . . because of my difficult birth with AJ, my milk didn't come in for about five days. I was also quite anemic. I didn't realize what the problem was, but after we had him home for about 12 hours, he started screaming and would not stop. I had no idea if such a thing was normal or not. He seemed hot, we took his temperature and it was very high.

Long story short, AJ had a spinal tap when he was less than 72 hours old (they worry about meningitis with such a high fever at such an early age) and was readmitted to the hospital with an IV in his newborn arm for two days. Not good. And you think mommy was having a difficult recovery before . . .

Anyway, nothing was ever found to be wrong with him. As I came to know Ammon and looked back on the experience, I am quite convinced that his high fever was a direct result of dehydration. Many newborns are just sleepy and not that concerned if Mom's milk hasn't really come in. I was clueless about nursing and had nobody to help me (even my midwife hadn't been much help on that score and the LeLeche woman I talked to was so mean and condescending and critical that my modest self nearly burst into tears while she watched me nurse.) He was probably two or three weeks old before I had a real let down reflex, and while the books will tell you this doesn't matter, with both my subsequent pregnancies, I've had this reflex from the very FIRST nursing period, and many times in between.

A bottle or two during AJ's first week would have made a night and day difference to us. Even as better as it has gone with the other two kids, low milk supply is always my biggest concern.

And yes, while breast milk is absolutely the perfect food for baby and the first preference, I am glad to live in a day and age when women have choices. It is true that choices should not be entered into lightly and without education, but formula can be a huge blessing for many women. And truthfully, there are days when hooking myself up to the pump is just too humiliating and it is worth it to have Jeff give him two ounces of formula.

Okay, last issue and then I PROMISE to be done commenting for a few days. This is, after all, your blog! :) I think there is something to be said for boys looking like dad. The whole penis thing is a sensitive enough issue for a young man without trying to understand all this other stuff. I read a lot of research on this before making the decision with my first boy. There really is a significant lessening of infection (not just UTIs) with the foreskin gone because, truthfully, young men are just not very hygenic. During those awkward years when mom is not allowed in the bathroom and boys haven't quite got it figured out yet, the whole keeping the foreskin clean thing is just difficult for some kids. (Maybe this is why God gave the Jews the commandment anciently. Like the Word of Wisdom, it was done to keep their temporal bodies healthy.)

Again, it all comes down to choice, but I think women need to be really careful about forming opinions about such personal decisions that can seem so accusing. Aka using a word like "mutilation." This is a far cry from what they still do to young girls in many parts of Africa. The process there can affect a woman's fertility and lead to infection after infection that can result in death.

Doreen said...

doreen1999 at yahoo dot com :o)

You need to know that when I talk about birth and natural birth, I generally talk about normal birth. I realize that sometimes, things don't go as planned. Emergencies happen, sometimes babies don't cooperate. That's what hospitals and doctors are for, and I'm grateful we have them available. What gets me going is how normal birth is "managed", how badly birthing moms are often treated, and the problems that can, and do, arise from too many (unecessary) interventions. :o)

As for breastfeeding, I wasn't (in this case) condemning the use of formula. Just sharing my experience with trying to give babies bottles when they are generally breastfed. I realize that formula is a necessity for some women, but I do also believe that it is very much over-used, and used too lightly. What many women don't realize is that supplementing with formula can actively sabotage breastfeeding. Some women do struggle with low milk supply, and the more they supplement with formula, the more their supply goes down. It's often a difficult to break cycle.

Now to the sensitive issue. Do we not teach girls to clean up down south each time they shower? How is this different for boys? All they have to do is retract the forskin and rinse with warm water while in the shower. That's all. I wouldn't think it would be so difficult to teach someone, boys are pretty good at playing and exploring down there, I'm sure they could even figure it out themselves. ;o) Don't you think that if cutting off the foreskin was really so revolutionary for men's health, more countries in this world would have caught on during the last century and introduced RIC? The opposite is the case, actually. England, for example, used to have a high RIC rate. They don't anymore. I think hygiene is mostly used as an excuse. Yes, it takes less work to keep a circ'ed penis clean, but not really that much less... As for God giving the Jews the commandment to circumcise, it was given as a sign of the covenant. It was used to set Jews apart from Gentiles. The law of circumcision was fulfilled with the Atonement. We are no longer required to circumcise, as you know (there is plenty of scripture to back this up). If circumcision really was so beneficial to our health (as is the Word of Wisdom), don't you think it would still be a commandment? Honestly, the only time hygiene was ever a problem was during times of war, when men didn't have a chance to shower or bathe for weeks on end. That's when circumcision became widespread among soldiers, and eventually passed on to RIC (besides the fanatics who thought RIC would keep boys from masturbating, obviously not the case). And yes, the word mutilation is strong. I still don't think it's misused, though. After all, what circumcision does is amputate a part of a man's body that is perfectly healthy and functioning well. There is not usually any medical indication for this procedure in a day old infant. Sure, sometimes problems do occur later in life, but does that warrant RIC? There are babies who have died as a direct result of RIC, there are also babies who have been permanently damaged. Granted, this is very rare, but it does happen. When Bryan was 5 days old, he got a really high fever, and we ended up in the hospital for 3 days (yep, I know what that's like). We shared a room with a little boy (about 5 months old or so) who had just had surgery to correct hypospadias. As part of the surgery, circumcision was performed. It was supposed to be an outpatient procedure, but the little boy wouldn't stop bleeding. He was still there when we left, and they still hadn't figured out what the problem was. Of course, in his case the circ was medically indicated, but what is to say this couldn't happen in an otherwise normal infant? Some boys do have lasting problems from being circ'ed, be it from scar tissue, adhesions from what foreskin was left, painful erections from too much foreskin taken off... Bryan's circ looked really messy because his glans was too big for the bell. It ended up really bruised and took a long time to heal. It got me thinking about the reasons why we continue to do this to boys, and my conclusions were obviously different from yours. :o)

Oh, and please feel free to comment all you want, it makes blogging more fun. :o)

Meems said...

I have to comment on the "doing research" part. Routine circumcisions cost money. Who would do research and do test if it would be a free procedure? Of course medical professionals do research on how IRC is beneficial to your boys' health. I don't trust research nearly as much when there is money involved.

Odd question. Does a boy's penis always look like the dads' or could it get some genes from the mom and look like her family's side penises? (Oh man, did that make sense?)

btw, in the United States the cost of routine circumcisions ranges from $150 Million to $270 Million each year. Nothing to sneeze at. Who would advertise the fact that intact penises are better off health wise? What in the world is the plural of penis? Peni?

Meems said...

Happy vacation! We'll be joining the world of intact males in less than a week.

Keith and Nicci said...

Just have to defend myself as well - it was mommy's milk in the bottle, and by the way, he's taken it beautifully the past few days. I have loved being able to get out for a couple of hours a few times already :). I love pumps!

Doreen said...

Aw, Nicci, you don't need to defend yourself. Your post simply brought back some memories that made me smile. I'm glad it's working for you. Even if it was formula, I wouldn't come after you and condemn you or anything. After all, I'm not the breastfeeding police (or formula police, or whatever :p). It would have been nice if it had worked for me, it just didn't. And I decided, that for me, it just wasn't worth the hassle. :o)

Mimi, you're too funny, world of intact males! You're right, there is a lot of money involved in the whole RIC debate. Ever wonder what all those cut off foreskins are used for? I've heard interesting stories, should look into that some more. Hm...

Keith and Nicci said...

It's all good - just thought I'd share the good news for me - I get to play basketball twice a week now and go to a D-backs game in a few weeks with Keith - yipee!

Kermit~the~Frog said...

Well, you know I don't disagree with anything you said. I have one circ'd son and one non-circ'd son, and each comes with its own set of problems. My older son's circ was very well done according to another ped, but he ends up with some periodic itching and needs a steroid cream. Younger son isn't retracted yet, so there aren't any real problems there yet, of course.

I was talking to my SIL about this several years ago. She is older than I am, and her youngest boy is 5. She recoiled in horror at the thought of NOT circ-ing a child, because retracting and cleaning the poop out of the infant penis is such a pain. In the late 80s and 90s (when she did child care), nobody knew that you just needed to leave the penis alone. Don't force it to retract, and you never have to clean anything other than the surface, exactly as you do on a circ'd child.

I love to breastfeed. Oldest was bottle-fed and it was awful. Washing, filling, mixing, washing again. Blech. The spit-up smelled foul and the stains were impossible. I own exactly one bottle, and I never use it. Don't care to. This could change if I ever get a high-needs infant, but my kids are very laid back. (Just jinxed myself, I know.)

As for birth, I've done induced/epi, induced/no epi, and natural/no epi/no IV/birth ball/occasional fentanyl injection. The last birth rocked. Rocked. Birth is power, physical and spiritual.

Lari said...

Oh my goodness, I'm so glad I just came across this entry. I've been thinking a lot about routine infant circumcision lately. I've also been planning on writing about it in my blog as well... but I think I need to wait until I'm in the right frame of mind. I never thought anything was wrong with it until a few months ago. Being pregnant has caused me to read a lot about pregnancy and childbirth and babies, and it ultimately led me to an online video of a circumcision being performed on an infant boy. That was when I realized something was wrong with it. I just had a sick feeling in my stomach after watching the video. That was when I decided to do some research about it, and I have now decided that my future sons will not be circumcised. After reading the pros and cons, the research, and everything else when it comes to circumcision, I have decided that it's purely cosmetic and a "cultural" practice.