week 6: Proposal Essay- Circumcision: A violation of human rights

 Well, my teacher wanted controversy so I picked the most hush-hush 'hot button' topic I knew.

I enjoyed  the research and really solidified my own view on the subject. Every day I am amazed more and more when it comes to the social norms that we as a society mainly leave unquestioned. I have to say that until a few years ago I did not question male circumcision but after researching I have difficulty separating the ethics of male circumcision from those of female circumcision. If one violates a person's right to body integrity don't both of them?  Anyway, this is the conclusion I came to.

  Circumcision: A violation of human rights

 In the 19^th Century the American medical establishment began utilizing a surgical procedure it deemed a cure for everything from epilepsy and fever to idiocy and masturbation (Gollaher DL. From Ritual to Science). To no one’s amazement this ‘cure’ did not cure anything. What is surprising, though, is that the American medical establishment of today still performs this surgery, only now the unconfirmed claims include preventing urinary tract infections, sexually transmitted diseases, cancer of the penis, prostate, and cervix, even HIV/AIDS (Mothering.com). Yet in light of all the false claims, in the year 2000 this procedure, a procedure with no demonstrated medical benefit, was completed 94 million times (infocirc.org). This common procedure is what is medically referred to as routine male infant circumcision.

           

Most people in the United States view circumcision as a choice that parents have the right to make when concerning their newly birthed baby boy.  Some defend their right by stating social status quos, some revert to religious reasoning and some will simply state that it is no one’s business how they raise their son.

These popular arguments attempt to defend an action but fail to address one very important issue - that the lack of consent from the infant violates the basic human right to body integrity. As such, routine infant circumcision should be banned.

To fully understand what is at the core of this issue we first need to find out who is being circumcised. Worldwide only 10-15 percent of men are cut. The procedure is almost unheard of in Europe, South America and Non-Muslim Asia. In fact the vast majority of circumcised men throughout the world are Muslim (mothering.com). So why does the United States, with a comparatively low Muslim population, retain a circumcision rate of 34 percent? Statistics show that the United States is the only country in the world to circumcise newborn males for non-religious reasons (mothering.com). It would seem that if religion is not the driving cause of our high rate then the reasons must be medical… right? No. According to the medical definition of intervention, the term “indicated” applies to a treatment or intervention that is required because a particular condition is present. Due to the high risk of the procedure infant circumcision is only performed on healthy infants and is considered both “cosmetic” and “prophylactic” meaning that 0 percent of routine infant circumcisions are medically indicated (infocirc.org). When American parents are asked why they circumcised their baby boys the two most common answers are ‘So he will not be teased’ and ‘We want him to look like his father.’ Social concerns are more important than medical ones (Tiemstra JD. Factors in the circumcision decision).

The risks and consequences of the procedure are also rarely taken into consideration. Along with a reported death rate of 1 in 500,000 there is a complication rate of 1 in 500 (nocirc.org). Complications can range from staphylococcus infections to gangrene, uncontrollable bleeding and penile loss.  Infant feeding patterns are also disrupted. Circumcised infants may refuse to nurse immediately after the procedure or at night leading to a failure to breast-feed and the infant may exhibit signs of trauma such as inconsolability, unexplained crying and lack of maternal-infant eye contact (Rickwood AMK, Kenny SE, Donnell SC. Towards evidence based circumcision of English boys). These repercussions can last for days or weeks but new studies are beginning to show that the perception centers of the neonate’s brain are permanently and adversely altered by the procedure, although these findings are very new and the medical community does not yet fully understand their implications. Dr. James Prescott suggests that circumcision can cause deeper and more disturbing levels of neurological damage (Lewis, Van. Nobel Laureates for Genital Integrity).

On the other hand, some parents have claimed that the practice must be painless, as their baby did not make a single whimper, in fact some claim that the child simply slept through the procedure. The reality is that the circumcision causes severe, persistent pain that many times results in shock - not a peaceful sleep. No matter how you look at it the fact remains that both the body and brains of these baby boys are being altered without their consent and often times without anesthesia.

In 1995, the American Academy of Pediatrics Committee on Bioethics stated that informed consent may only be given by a competent person. Infants, being unable to give permission, are included in the concept of informed parental decision, meaning that permission can be giving regarding the infant’s wellbeing in the case of immediate medical necessity only, such as disease, trauma, or disfigurement (mothering.com). The human penis in its natural state does not fall under any of these requirements. According to this committee’s statement obstetricians have a moral duty to refuse routine circumcision.

When a non-medically indicated circumcision is performed not only are the OB’s violating their ethical committee they are also going against the policy statements of health organizations around the world. In truth, no medical organization in the world recommends routine circumcision of male infants. The official position of the American Academy of Pediatrics is that “Existing scientific evidence … [is] not sufficient to recommend routine neonatal circumcision.” In 2002, the American Academy of Family Physicians stated “Evidence from the literature is often conflicting or inconclusive… A physician performing a procedure for other than medical reasons on a non-consenting patient raises ethical concerns.” These two American health organizations join the World Health Organization, the British Medical Association, the College of Physicians and Surgeons of British Columbia, the Royal Australasian College of Physicians, the Canadian Pediatric Society, the Australian Medical Association, and the Australasian Association of Pediatric Surgeons. Together they raise ethical concerns of and retract any support of therapeutic, neonatal circumcision (nocirc.org).

In spite of the mounting evidence that routine infant circumcision is unnecessary, immoral and dangerous, the practice continues. This we should not stand for. Denver is urged to follow the lead of San Francisco and propose a bill akin to the San Francisco Male Genital Mutilation Bill (SFMGM Bill). This bill states, “it is unlawful to circumcise, excise, cut, or mutilate the whole or any part of the foreskin, testicles, or penis of another person who has not attained the age of 18 years” The bill deems the mutilation of a minor a misdemeanor punishable by a fine that will not exceed $1,000 and or imprisonment that will not exceed one year. Exceptions are made if the operation is necessary to the physical health of the person on whom it is performed because of a clear, compelling, and immediate medical need with no less-destructive alternative treatment available (sfmgmbill.org). We are also urged to support San Francisco in their effort to end male genital mutilation please contact www.sfmgmbill.com to support their movement. To begin the effort in Colorado contact www.coloradonocirc.org and let them know that Colorado will not be know as a state that does not protect the basic human rights of our sons.

If a ban of routine infant circumcision was enacted we, as a community, would be providing babies with their best chance of establishing continuing and benefiting from nursing, maintaining each maternal infant bond as nature intended and most importantly giving our baby boys back their innate right of body integrity. For it is only when our male babies are afforded the same rights and protections as our female babies that our children will be allowed to live knowing that only they retain the right to permanently alter their bodies.

  

"Circumcision Fact Sheet." Circumcision Information Resource Centre. Web. 14 Feb. 2011. www.infocirc.org/factsheet

Circumcision Position Statements of Medical Societes in English-Speaking Countries. Nocirc.org. Colorado No Circ. Web. 12 Feb. 2011.

Fleiss, Paul M. "The Case Against Circumcision." Mothering: The Magazine of Natural Family Living. Web. 14 Feb. 2011.

Gollaher DL. From ritual to science: the medical transformation of circumcision in America. Journal of Social History 1994;28(1):5-36

Lewis, Van. "Nobel Laureates for Genital Integrity." Stop Infant Circumcision. Web. 14 Feb. 2011. www.stopinfantcircumcision.org/crick-wald.htm

"Male Genital Mutilation Bill." San Francisco MGM Bill. Web. 22 Feb. 2011.

Rickwood AMK, Kenny SE, Donnell SC. Towards evidence based circumcision of English boys: survey of trends in practice BMJ 2000;321:792-793

Tiemstra JD. Factors the circumcision decision. J Am Board Fam Pract 1999;12:16-20

Stop Picking on Breast Feeding Moms!

I really must admit that I am getting incredibly tired of people labeling women who choose to nurse or talk about the benefits of nursing as extremists.


Does caring and informing equal extremism? 


Or are the people attacking breast-feeding advocates practicing exactly what they preach against?


Case in point: Michelle Obama.


"Let's Move!" is a comprehensive initiative, launched by the First Lady, dedicated to solving the challenge of childhood obesity within a generation, so that children born today will grow up healthier and able to pursue their dreams. Combining comprehensive strategies with common sense, Let's Move! is about putting children on the path to a healthy future during their earliest months and years. Giving parents helpful information and fostering environments that support healthy choices. Providing healthier foods in our schools. Ensuring that every family has access to healthy, affordable food. And, helping kids become more physically active. (www.letsmove.gov)


According to Politics Daily, as part of the programs second year the first lady is gently encouraging   breastfeeding -- including working to make workplaces more pumping friendly and qualifying breast pumps as medical equipment to qualify them for a tax deduction. Just last week the IRS ruled in favor of the breast pump tax deduction along with over-the-counter medical items such as pain relievers, bandages, and contact supplies. 


So what is the problem?  The problem is that right-winged tea-partiers like Michele Bachmann and Sarah Palin are considering this new IRS development and Mrs. Obama's encouragement of breast feeding 'breaking news' and part of the 'liberal agenda' but never once mention the addition of  tax deductions for contacts. For bandages. The only item that is under attack is the breast pump. What makes the breast pump so special?


First of all there is nothing wrong with encouraging breast feeding for health reasons or considering breast pumps medical equipment. The IRS is simply allowing nursing mothers the same right that other people who purchase and use medical supplies have. People still have the option to choose to breast feed or to choose to formula feed. Lets face it, there will always be people who will choose not to nurse their kids for reasons that are none of my business but that does not expunge the fact that it is accepted scientific knowledge that breast feeding is both natural and expected by the neonate. There is nothing wrong with pointing this out to a public that may be ill informed.


Secondly, when have tea partiers been against tax cuts and the reduction of medicaid or overall medical expenses? Isn't one of their main stances that health care is too expensive? Here are the facts: If 90 percent of Americans breasfed their babies for the first six months of life the US would save 13 billion dollars a year and prevent 1,000 related deaths. As a family you save roughly 600 dollars  by exclusively breast feeding for six months.


Here is how I break it down.  These 'mama bears' don't want:
-to provide equal rights for nursing mothers
-are against tax breaks
-are against  providing accurate medical information to people 
-are against encouraging (not forcing!) a practice that could save the country 13 billion dollars a year


Why coin the term 'mama bear' for yourself if you are not really interested in representing what is best for mothers and families?  Not surprisingly it sure seems that these family-first ladies are more concerned with political images then the mothers they claim to represent. 


Props to Michelle Obama for providing and encouraging a program that could only improve the childhood obesity rate and for providing pumping moms the tax break they deserve.

A comparison of infant death rate by model of care

Week three of classes brought a lab of choice assignment. After much debate I choose to compare the neonatal outcomes of CNM-based care against MD-based care.  I compiled the statistics from over 12.5 million singleton (1 baby), vertex (head down),vaginal births from 35-42 weeks of gestational age over the six year span of 1999-2005. 

Question:

What is the safest model of care for a prospective low-risk mother and her child?

Background:

There are two main models of care regarding the pre-natal and birth period: the nurse midwife-led model of care and the medical doctor–led model of care. Throughout most of the world midwifes are the primary caregivers for low-risk mothers. In the United States M.D.-based care has become the standard.

Hypothesis:

The midwife-led model of care provides maternal and neonatal outcomes that are equal to or exceed that of other models of care.

Procedure:

Data stating infant death rates in the United States was collected from the Centers for Disease Control and was then filtered by controlling for type of birth attendant, gestational age at live birth, and delivery method.

In total, the statistics from 12,589,251 singleton, vertex, vaginal births of newborns from 35 - 42 weeks gestation were compared, with the variable being the type of attendant that supervised the birth. Statistics concerning births overseen by doctors of osteopathy or direct entry midwives, births before 35 weeks, births after 42 weeks and births ending in cesarean deliveries were dismissed.

Data:

CNM Attended Births from 1999-2005

Medical Attendant	Delivery method	Gestational age in weeks	Births	Infant death rate per 1,000
Certified Nurse Midwife	Vaginal	35 weeks	25,237	5.36
Certified Nurse Midwife	Vaginal	36 weeks	49,951	4.35
Certified Nurse Midwife	Vaginal	37 weeks	105,442	2.96
Certified Nurse Midwife	Vaginal	38 weeks	224,156	2.18
Certified Nurse Midwife	Vaginal	39 weeks	151,988	1.79
Certified Nurse Midwife	Vaginal	40 weeks	360,871	1.66
Certified Nurse Midwife	Vaginal	41 weeks	192,273	1.72
Certified Nurse Midwife	Vaginal	42 weeks	61,663	2.59

CDC (2010)

MD Attended Births from 1999-2005

Medical Attendant	Delivery method	Gestational age in weeks	Births	Infant death rate per 1,000
Doctor of Medicine	Vaginal	35 weeks	292,614	6.7
Doctor of Medicine	Vaginal	36 weeks	530,446	4.88
Doctor of Medicine	Vaginal	37 weeks	1,062,320	3.43
Doctor of Medicine	Vaginal	38 weeks	2,144,586	2.49
Doctor of Medicine	Vaginal	39 weeks	3,145,543	2.0
Doctor of Medicine	Vaginal	40 weeks	2,754,870	1.82
Doctor of Medicine	Vaginal	41 weeks	1,292,051	1.95
Doctor of Medicine	Vaginal	42 weeks	419,396	2.59

CDC (2010)

Results:

Medical Attendant	# of births from 1999-2005	Average Infant death rate per 1,000
Certified Nurse Midwife	947,425	2.82
Doctor of Medicine	11,641,826	3.23

Infant death rates from births supervised by certified nurse midwifes are lower at every stage of gestational age except for at 42 weeks, where both CNMs and MDs have an infant death rate of 2.59. Overall, CNMs have a lower average infant death rate of 2.28 compared to the MDs rate of 3.23.

This data supports but does not prove the hypotheses that the midwife-led model of care provides maternal and neonatal outcomes that are equal to or exceed that of other models of care. In order to solidify results intervention rates, cesarean rates, infant Apgar scores as well as maternal mortality and morbidity would also have to be studied.

Conclusion:

When comparing the infant death rates of Certified Nurse Midwives and Doctors of Medicine in the United States from 1999-2005, adjusting for gestational age at live birth and delivery method it has been concluded that the results support the hypotheses that the midwife-led model of care provides maternal and neonatal outcomes that are equal to or exceed that of other models of care. For births that occurred during the gestational age weeks 35-41 CNMs had lower infant death rates when compared to the infant death rates of MDs. For births that occurred during the 42^nd week, both CNMs and MDs had infant death rates of 2.59.

References:

Declercq, E., Sakala, C., Corry, M., Applebaum, S. (2006, October). Listening Mothers II: Report of the second national U.S. survey of women’s childbearing experiences. Retrieved from: http://www.childbirthconnection.org

Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models ofcare for childbearing women. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD004667. DOI: 10.1002/14651858.CD004667.pub2

United States Department of Health and Human Services (US DHHS), Center for Disease             Control and Prevention (CDC), National Center for Health Statistics (NCHS), Office of Analysis and Epidemiology (OAE), Division of Vital Statistics (DVS), Linked Birth / Infant Death Records 1999-2002 on CDC WONDER On-line Database. Accessed at http://wonder.cdc.gov/lbd-v2002.html

 on Feb 5 2011          4:32:18 PM

United States Department of Health and Human Services (US DHHS), Center for Disease             Control and Prevention (CDC), National Center for Health Statistics (NCHS),  Office of Analysis and Epidemiology (OAE), Division of Vital Statistics (DVS), Linked Birth / Infant Death Records 2003-2005 on CDC WONDER On-line Database. Accessed at http://wonder.cdc.gov/lbd-current.html

 on Feb 5 2011             4:33:02 PM

Back With A Purpose

Well, the day has come, after three years of diligently preparing I have taken the next step and began the formal education that will eventually lead me to a masters in midwifery.  It is such a relief to have the financial and class planning aspects out of the way, I now have room to breath and  focus completely on my studies. 


I finally feel the relief.


I have to admit that it feels as bit awkward to be the non-traditional student in the classroom. I feel overly mature and responsible which, I must admit, are traits I am not exactly accustomed to. I am happy however that I did choose to take one of my three classes (my just-for-fun creative writing class) in the classic classroom format.  It is nice to be out of the house alone and with purpose.  It also gives me the opportunity to meet face to face with the variety of people involved in the nursing program. Building relationships can never hurt when the nursing program is selective entry.


That brings me to one of my biggest concerns: the selective entry process. This last week I attended an open house for the nursing program lead by the program director who went over the entire entry process including the program qualifications.  It sounds as if the school's decision to change the nursing program from wait-list to competitive entry (a fairly recent change) has had a huge affect and increased the amount of applicants therefor increasing competition.  I get the feeling that you must have a near 4.0 average and very high test scores to even have a chance. This information is sure to make this year a very stressful year indeed.


Anyway, I am very excited to be this much closer to my end goal.  After years of talk, research, and decisions I am moving forward with the support of a wonderful family and friends with whom I could not make my goals a reality.  A huge thank you to everyone who have given me support, direction, advise, offered childcare or help with studies.  I am truly a very blessed person to be surrounded by such inspiring and helpful people.

A Sensitive Subject

Male Infant Circumcision for Non-Medical Reasons 

With so many people relying on the show The Doctors to get accurate health information I am a bit horrified over the amount of misinformation given in the episode talking about the ban on non-medical infant circumcision that San Fransisco has proposed.  I get that, as a talk show, we are bound to get personal opinion and that is great.  Everyone has the right to express their opinion, but no one has the right so spread misinformation, especially when your job is specifically to inform the public!  


Dr Sears, the pediatrician on the show,  does an alright job with providing a more well-rounded view but he does fail to counter some important points.  This video, does what Dr Sears could not and accurately breaks down the false arguments that the other hosts make. If you ignore the obnoxious editing and comment about rape and roofies I would say that this is a great informative video that really dives into  many of the myths that surround male circumcision.

How I Became a Natural Birth Advocate

If you would have met me five years ago and talked to me about my plans for birth you most likely would have heard me say "I'm going to get an epidural as soon as I find out I'm pregnant."  Yes, I did used to say that and quite often.  You see I do not have a high pain tolerance. In fact I am really terrible with pain.  The first time my now husband took me backpacking I cried out in agony when I had to walk through an ice cold stream. 

our first backpacking trip (before I cried)

Tears and all.

I also just assumed that my babies would be born in a hospital.  I mean, where else are babies born? I had no idea midwifes existed and I am a bit embarrassed to admit that my first exposure to them was through a foreign thriller movie.




I had always pictured myself being driven to the hospital in a mad rush, screaming from the pain and cursing Mark for doing this to me. When in the labor and delivery room I would get my epidural and chat with friends and family until it was time to push.  Then, after the baby was seamlessly born I would give the baby a bottle and simply enjoy my stay in the hotel hospital.  I would be so content in the postpartum  room that they would literally have to push me out of there.


It was not until I googled the term 'midwife' while watching said foreign film that my curosity about a career in the birth field would spark a passion that would lead to me becoming a student midwife, natural birth advocate, lactivist and intactavist. It is strange when you look back on your life and can pin point the exact moment of when your life takes a dramatic turn and leads you to your current mission.  The first time you are exposed to a health and human rites issue that makes you want to spend your life raising awareness and educating others about is truly a life changing event and I will always remember that not-so-great foreign film that introduced me to this world of activism.


After watching the film I did a little research and thought  'I could do that'.  And so it began.  I ordered a few books off Amazon.com including one by Ina May and one by Henci Goer in hopes to learn a little more about this new (to me) and very different kind of birth: birth without doctors.


I certainly got more then I bargained for!


Not only did I learn about the midwife's model of care and how it differs from the techno-medical model of care that hospitals use and the importance of breastfeeding but I learned about the regular use of a counter-indicated (not just off-label!) abortion drug 

note the pregnant lady with the line crossing through her!

that is used to induce labor in hospitals, the lack of informed consent and the sky-high cesarean rate.


I was shocked.  Never in my life have my opinions turned 360 degrees on an issue in so little time (and anyone that knows me knows I am a very passionate and opinionated person. My mind is not swayed easily).


 I was furious.  How could I have not known this information.


I was betrayed.  By the system and by society for giving me a false sense of comfort and perpetuating the illusion that hospitals are the safest place to birth.


I went from the feeling that only crazies and hippies birthed at home to felling that homebirth was the best option. I now understood the women who wanted to so badly to birth without drugs.  The same women that I previously thought to be a bit extreme I now knew were just educated. I am also positive that if every expectant woman read Pushed by Jennifer Block, The Thinking Woman's Guide to a Better Birth by Henci Goer, and Ina May's Guide To Childbirth or watched The Business of Being Born and  Pregnant in America 100% of women would view birth differently and maybe feel just as betrayed by the system as I did.


I am incredibly thankful that I stumbled onto this knowledge before I became pregnant with out first born for I do not think I would have taken the time to search out a care provider that had statistics I could trust and employed women that I could bond with. I also would have not done everything in my power to avoid medical induction, augmentations and a cesarean.  Unfortunately, plans don't always turn out they way we like and I did end up being transfered to a hospital, augmented with an IV, epidural analgesia and pitocin and ended up at part of the birth center's 7% cesarean rate. 


I have suffered from birth trauma over the fact that the birth of my daughter turned out being the exact experience I did everything in my power to avoid; the only way I have been able to move past this trauma has been healing through writing, birth circles, good friends, the best husband and the fact that I do feel confident that I did give it my best.

my precious daughter after a cesarean delivery

 Ignorance may be bliss but the curse of knowledge is that you can't ignore what you know. Having the birth experience I did allowed me to experience birth center care and hospital care in a single birth.  Walking away with both experienced has fueled my desire to advocate for natural birth and midwifery care even more. I will spend my life trying to change the system and inform women of the facts and obstacles they face so even when births do not go as planned the woman and baby will rest assured that the care they will receive from me will be evidence based and will not be fueled by birth politics.