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Circumcision and Breastfeeding


Medical benefits of breastfeeding . Effects of circumcision on breastfeeding . Conclusions. Additional sources on breastfeeding

Starting in the late 19th century many changes in the way childbirth is viewed took place, which had taken wide effect by the 1950s. The birthing procedure was taken over by male obstetricians and childbirth was being treated as a medical condition. During this time women were pumped full of drugs to give birth, subjected to shaving, enemas, episiotomies, they were encouraged not to breastfeed and if the baby was a boy, chances are he would be circumcised whether it was asked for or not.

Today, more and more women are going back to doing things the natural way. It can be good to use modern medicine to aid in childbirth, especially if you're high risk, but that doesn't mean you have to completely medicalise it. Mother Nature usually knows what's best. Even when it was frowned upon for some time breastfeeding has now made a comeback. It is now largely embraced by the medical community and most places allow women to breastfeed in public, even if special laws were required to make this so. Although it hasn't quite become universally excepted around the country yet, breastfeeding has come close to becoming a mainstream practice.

Breastfeeding and circumcision has almost been treated the opposite by the medical community. Circumcision was claimed to be beneficial and encouraged/forced while breastfeeding was said to offer no benefits. Today most of the benefits of circumcision are being shown to be without merit and not high enough to justify recommending the procedure, while new benefits of breastfeeding are being found all the time. Circumcision is no longer recommended by any medical society, while breastfeeding is almost universally recommended. The American Academy of Pediatrics (AAP) now says that babies should be breastfed exclusively for the first 12 months of life (up from 6 months previously) while the World Health Organization (WHO) says it should be done for the first 2 years of life at least. But unfortunately in some places circumcision still remains more common than breastfeeding. Only 22% of babies in the United States are breast at 5 months of age and the figure drops to 10% by 12 months. About 60% of males born in the U.S. are circumcised.

Medical benefits of breastfeeding

According to the AAP, "human milk feeding decreases the incidence and/or severity of diarrhea, lower respiratory infection, otitis media, bacteremia, bacterial meningitis, botulism, urinary tract infection, and necrotizing enterocolitis infant death syndrome, insulin-dependent diabetes mellitus, Crohn's disease, ulcerative colitis, lymphoma, allergic diseases."1 It should be noted that reduction of urinary tract infections (UTIs), which have been shown by several studies to be reduced by breastfeeding2,3 are also said to be a benefit of circumcision (for the first year of life only), and usually claimed to be the most convincing benefit. Now that we know UTIs can be reduced by breastfeeding and the baby rooming in with the mother these should be used instead, because they unlike circumcision they don't permanently alter the body there are other health reasons for them as well.

Babies who have been fed formula instead of from the breast have been shown to have higher cases of various infections, increased risk of allergies and a greater intensity of problems from allergies, higher rates of cancer (including increased childhood lymphomas and increased breast cancer in women were not breastfed as infants), adult intestinal disorders, and they have been shown to score lower on tests of neurological development.4,5 Formulas clearly do not offer the same nutritional value of breast milk, and formula fed infants have been shown to suffer higher rates of mortality but the issue is being ignored while formula feeding is commonly portrayed as a safe alternative to breastfeeding.5

Effects of circumcision on breastfeeding

The AAP also says in its policy on breastfeeding "Except under special circumstances, the newborn infant should remain with the mother throughout the recovery period. Procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized."1 Circumcision is the most commonly performed traumatic and painful procedure done on infants today and is usually done in the first 48 hours of life.

The claim that circumcision can interfere with breastfeeding is also backed up by studies. Dixon et al did a study about pain from circumcision and behavioral differences with and without anesthesia Brazelton Neonatal Assessment Scale (BNAS), a series of stimuli designed to elicit measured response from infants and found that;
"Behavioral differences were still evident on the day following the procedure. This report adds to the growing body of data that indicate that circumcision is a painful procedure that disrupts the course of behavioral recovery following birth"7
Marshall et al performed a study on how circumcision effects mother-infant interaction. This study also used the BNAS and was double blind, where one group of babies were circumcised at two days and the other at three weeks. They found that infant behavior changes after circumcision in 90% of cases and that it can have "brief and transitory effects on mother-infant interactions observed during hospital feeding sessions." It was also found that mothers attempted to feed their infants 62% of the time, while "the infants eyes were typically closed (71%), had neutral facial expressions (91%), did little vocalizing (8%), clinging (13%), or even feeding (40%)."8

Howard et al did a randomized, double blind and placebo controlled study on acetaminophen analgesia for pain management with circumcision. Among their results they found;
"Neonates in both groups showed significant increases in heart rate, respiratory rate, and crying during circumcision with no clinically significant differences between the groups. Postoperative comfort scores showed no significant differences between the groups until the 360-minute postoperative assessment, at which time the acetaminophen group had significantly improved scores. Feeding behavior deteriorated in breast- and bottle-fed infants in both groups, and acetaminophen did not seem to influence this deterioration."9
Conclusions:

Circumcision and breastfeeding both represent areas that too many parents are simply uninformed in. Just as parents aren't aware that circumcision is not recommended by any national medical organisation they don't know that breastfeeding is recommended, and that WHO recommends it be done for at least the first two years of life. Just as parents aren't aware of all the side effects that may result from circumcision they're not aware of the types of health problems that may result from formula feeding. People think of circumcision as having so many benefits but they're not aware of all the benefits of breastfeeding, that do not require children to be put through pain and trauma and permanently lose a body part. Historically breastfeeding and non-circumcising have both been discouraged, and to a certain extent they still are today. Advocates of both breastfeeding and not circumcising (or lactivists and intactivists) both have common ground in their missions, and we can work together to help children receive the best care that they deserve.
> References:

1.) American Academy of Pediatrics - Breastfeeding and the Use of Human Milk (RE9729)

2.) Pisacane A et al. Breastfeeding and urinary tract infection. The Lancet, July 7, 1990, p50.

3.) Marild S. Breastfeeding and Urinary Tract Infections. The Lancet 1990;336:942.

4.) A full list of medical benefits of breastfeeding with citations from medical journals to back them up can be found at http://www.promom.org/why_bf.htm

5.) James W. Prescott, Breastfeeding: Brain Nutrients in Brain Development for Human Love and Peace. Touch The Future Newsletter, Spring 1997

6.) Katie Allison Granju. Infant Formula: What Every Parent Should Know. Minnesota Parent 1997

7.) Dixon S, Snyder J, Holve R, Bromberger P. Behavioral effects of circumcision with and without anesthesia. Journal of Developmental Behavioral Pediatrics 1984; 5(5): 246-50.

8.) Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Human Development 1982; 7:367-374.

9.) Howard CR, Howard FM, and Weitzman ML. Acetominophen analgesia in neonatal circumcision: the effect on pain. Pediatrics 1994;93(4): 641-646.
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