Break The Ice About Circumcision: For Birth/Medical Workers & Their Clients

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Gather Your Bravery

Whether you’re a midwife, OB/Gyn, doula, childbirth educator, nurse, or pediatrician, you need to have this talk. You need to bring up circumcision and facilitate an honest, complete, educational discussion about it, just as you would any other birth or newborn procedure.

You routinely provide updated information about, say, epidurals and exclusive breastfeeding, right? Then you must give as much attention to this other elective birth ‘option’ of neonatal genital cutting.

I’m sure it can be difficult to balance the various aspects of your job description: unconditional support of a mother’s choices, preserving her and her baby’s well-being, matter-of-factly offering guidance with minimal personal bias.

Though it may seem that a neutral stance of ‘pro-parent’s choice’ (PPC) is the path of least resistance here, it is certainly not ‘pro-baby.’ As a birth worker, your responsibility of care covers a client’s child as well.

Think about this: Would you discourage a parent from circumcising a daughter if they expressed interest to do so? Or would you refer a pro- female circumcision parent to someone who’s willing to perform the procedure, locally or overseas?

Many PPC birth workers refer pro-male circumcision clients who are expecting sons to what they nickname ‘holistic circumcisers’ (though the very definition of circumcision absolutely defies the concept of holism), which deprives these parents the support and encouragement they need to make a better choice — that is, the choice to give their son HIS own choice.

Remember you might be the only person to ever bring this up with your client during her pregnancy. If she cannot count on her care provider to open up this relevant discussion, who can she count on?

Ideas For Breaking The Ice

  • Keep pro-intact brochures and info cards in your waiting area/office.
  • Insert an info card (available at SavingSons.org and Etsy) into all New Client packets and Birth packets — or consider cute freebies like info stickers or “Do Not Retract” bands.
  • Include circumcision risk resources with Breastfeeding and Episiotomy information (circumcision can negatively affect breastfeeding success; an episiotomy is also genital cutting birth procedure).
  • Keep intact-friendly books on all birth topics in your lending library.
  • Host a screening of ‘Elephant in the Hospital’ and invite your clients.
  • Don’t ask “if” they plan to circumcise — ask for their thoughts on circumcision. Frame your language as though you assume they are on the same page as the majority of the world when it comes to accepting normal, whole bodies.
  • Teach clients about the benefits of foreskin and the simplicity of proper intact care — BEFORE asking their thoughts on circumcision.
  • This should be obvious, but it’s an important note: avoid referring to genitalia with crude terms (like ‘manhood,’ ‘weenie,’ ‘junk,’ etc), infantile terms (‘thingy,’ ‘pee-pee,’ ‘wee-wee,’ etc) or slang terms (‘boy parts,’ ‘privates,’ etc) — anatomical accuracy is best. A penis is a penis; foreskin is foreskin or prepuce; genitals are genitals. Also, the proper term for a penis that has not been circumcised is ‘intact,’ ‘whole’, ‘natural,’ or simply ‘normal penis’ — discourage use of the term ‘uncircumcised’ (learn why here).
  • For parents who still wish to circumcise, require they read and sign a circumcision consent form that lists all risks and circumcision care (a consent form provided by those performing the circumcision will be incomplete and often lists the presence of foreskin as a “condition”).
  • If you don’t feel comfortable with extended discourse on the topic, direct at-risk parents to educational pages so they can learn on their own (see resources below).
  • Refer to foreskin-friendly pediatricians if your client asks for suggestions.

Need To Know Basics

Abandon your expectations regarding your client’s initial reactions, otherwise you may find yourself prematurely disheartened. It often takes a few separate dialogues to fully inform a client about circumcision. A little bit at a time is best. Let your clients know you’re there to listen to their feelings and concerns and will not judge them — you want to help them become fully informed.

To do this, you’ll need to have a wide scope of knowledge on the topic. You don’t need to worry about having all the details memorized, but you’ll need to know where to refer your clients if they have questions you cannot answer.

You may also be responsible for assessing and treating your clients’ babies, so it’s important to know the differences in care for an intact and circumcised baby as well as normal development.

The Basics To Share With Clients:

  • Anatomy of the natural penis, especially from birth to childhood
  • Proper intact care (no retraction)
  • Functions/benefits of foreskin
  • Debunk common myths (try this Psychology Today series)
  • Religious vs Medical vs Cultural excuses to circumcise (or reasons to keep intact)
  • Types of surgery most likely encountered in your area (Plastibell, Gomco, Mogen methods)
  • Short-term and long-term risks
  • Worldwide prevalence

The Basics For You To Learn:

  • Ethical concerns
  • Informed consent
  • National medical organization statements
  • Local network of intact-friendly care providers
  • How to broach the topic with your client
  • Individualize the discussion
  • Blind cathing/clean catch bag for UTIs

Approaches That Work To Gently Inform

Know your audience! To what will they respond best? What will pique their curiosity? It’s also helpful to be aware of your client’s religious and cultural background to better highlight areas that are more likely influencing their current opinion.

Emotional Appeals:

  • Circumcision is painful, risky, and traumatic.
  • Suggest videos that speak to a general audience without alienating.
  • Appeal to the father with resources tailored to men.
  • Regret parents are not alone — know better, do better.

Logical Appeals:

  • The facts speak for themselves! Explain how to sift through reliable research.
  • Intact children today will be in good company among peers.
  • Foreskin is beneficial and vital.
  • Who profits from promotion of circumcision? Who profits from promotion of the normal, intact body?
  • Intact care is easy. Circumcision wound care requires more attention, multiple steps, and continued pain management.
  • Fathers/sons/brothers don’t need to match.

Approaches That Rarely Work

  • Everything all at once.
  • Graphic images and details first (instead of as a last resort).
  • Detailing sexual risks (with father present, if applicable), without context to the bigger picture first.
  • Using a blatant bait-and-switch (surprising your clients about circumcision for the first time when discussing an unrelated topic), because they will see right through this. Instead of bringing circumcision into other birth care topics, hold a separate conversation about circumcision and tie in those topics. For example, when discussing circumcision as genital cutting, you can mention how an episiotomy is also a form of genital cutting. It’s understood that episiotomy consent should ideally be provided by the owner of the affected genitals, and the procedure is no longer routinely recommended as it’s only medically necessary in rare situations… just like circumcision. Then you have an opportunity to explain how circumcision is different, such as that it permanently removes vital tissue.
  • Referring parents to an extremist site/organization that bullies/shames.
  • Broaching the topic during an unrelated emotionally charged moment (Timing!)
  • …most importantly, what’s guaranteed to not work: avoiding the topic completely.

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Resources

For birth/medical workers:

For expecting parents:

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