Before I delve into explaining why circumcision harms breastfeeding, I thought I would take the time to thoroughly define what circumcision is. Circumcision is the surgical removal of the prepuce, also known as the foreskin. The foreskin is protective tissue that covers the glans of the penis. This prevents the glans from becoming hard and keratinized as it is meant to be an internal, self-cleaning organ. It also serves several other functions, to learn more about the functions of foreskin click here. Circumcision is most often times done in the hospital, sometimes just hours after birth, or done for religious reasons on the 8th day of life. It can also be performed later in childhood for cultural reasons or as an adult for medical reasons, which is pretty rare.
“The penile foreskin is a natural and integral part of the normal male genitalia. The foreskin has a number of important protective and sexual functions. It protects the penile glans against trauma and contributes to the natural functioning of the penis during sexual activity.”
Circumcision is a painful procedure (even with anesthetic) and begins with the foreskin being grasped with forceps and the opening being forcefully stretched open. Then a metal probe is inserted into the foreskin opening which tears the foreskin away from the glans which is adhered to the glans like your nail is on your finger or toe. After that a cut it made down the middle of the foreskin with scissors. Then the foreskin is crushed, clamped (if using gomco), and cut off by a scalpel.
To see a video of a circumcision click here.
Could you imagine just being born (or even as an older baby or child) and then being subjected to this treatment? Even with anesthetic this procedure is extremely traumatic for a baby to go through. So how does this directly relate to breastfeeding? Let me explain…
There is a physiologic process that your body goes through in order to successfully begin and maintain lactation. How you manage breastfeeding can make or break your chances of meeting your breastfeeding goals. Breastfeeding already can get off to a rocky start depending on how the labor and birth went. The longer an epidural is in place the greater chance that hormones necessary to start lactogenesis stage 2 will be diluted and not function as effectively. Because epidural medication lowers blood pressure, intravenous fluids must be given to maintain blood pressure. This can cause fluid volume over load which leads to 3rd spacing. This causes your feet, legs, nipples, and other parts of your body to become swollen. This can make it really hard for baby to latch on correctly to feed, leading to nipple trauma, pain, and ineffective milk transfer. Epidural rates in America are really high, so this is already a potential “bump” in the road to a good start at breastfeeding.
Milk volume begins to increase between days 3-5 after birth. This will happen regardless if a mother chooses to nurse her baby or not. The important factor here for a breastfed baby is keeping that baby on the breast as frequently as possible. Ideally the baby should nurse 10+ times per day, and this is for multiple reasons.
- Babies are born with a high suck need, which serves two main functions. Recall, “My baby is using me for a pacifier!” I’m sure you’ve heard that said a lot. It’s normal. The more the baby sucks on the breast and consumes that protein rich colostrum, the faster the baby will conjugate their excess bilirubin, preventing pathologic levels of bilirubin, which, if left to accumulate turns into jaundice. Sucking causes peristalsis which helps to excrete the newborn’s meconium, which is full of bilirubin, and is a process necessary to avoid jaundice.
- Frequent nursing (10+ times in 24hrs) during lactogenesis stage 1 (the time period before milk increases in volume) helps to ensure a healthy long-term milk supply. Prolactin is a hormone that circulates in your body (that can be diluted by excess fluid volumes during labor) that helps stimulate milk production. Stimulation of your nipples and breasts tell prolactin to plug into prolactin receptor sites located in the breast. The more early and effective nursing that the baby does, the more this hormone will go to the right place within the breast. And this is essential for having a good long-term milk supply.
Now that you’re familiar with the physiologic process of the beginning stages of breastfeeding, and what circumcision is, I will connect the two in the following list…
- Circumcision requires time spent away from the mother. Usually an hour before the procedure, and 2 hours after to monitor the baby for excessive bleeding. When a newborn is not breastfeeding they should be skin to skin with mom or dad. This enhances the bond between baby and parents and helps to establish their delicate and new microbiome. It also helps milk increase in volume faster.
- Circumcision is a traumatic event that compromises the bond between mother and child.
- Some facilities require fasting before the procedure to prevent aspiration from vomiting due to severe pain. This keeps the baby from breastfeeding as much as they should be.
- Most baby boys that are circumcised are very hard to wake after the procedure. Sometimes they will not eat for 6-8 hours!
- Urination on the raw open wound in the diaper causes extreme pain which can disrupt breastfeeding due to pain.
- Research has clearly demonstrated that pain adversely affects breastfeeding during the early stages.
- Most of the time doctors will give the baby a pacifier to cope with the pain of circumcision, and pacifiers should be avoided in the early weeks, until breastfeeding has been established.
- Pumping in place of the baby nursing is not as effective.
- Ineffective nursing can lead to decreased milk volume.
- The baby depends on minuscule, consistent feedings of colostrum in order to thrive in the early days. Inadequate caloric intake can cause the baby to be too sleepy to eat, which can lead weight loss of greater than 10%.
“Newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward.” – American Academy of Pediatrics
A breastfed newborn baby should be breastfeeding 10 or more times per day. This is best practice to ensure an adequate long-term milk supply and to prevent hyperbilirubinemia, hypernatremia, and hypoglycemia.
“The pain of circumcision causes breastfeeding problems in some babies. After this procedure, a baby may have trouble settling in at the breast, may refuse the breast, or may shut down and be unresponsive.”
Mohrbacher, Nancy. Breastfeeding Answers Made Simple: A Guide for Helping Mothers. Plano: Hale, 2010.
If a baby is not nursing for 6-8 hours because they are exhausted from going through the pain of circumcision…
If a baby is not stimulating the breast helping the milk to increase in volume…
If a baby is not nursing they are not causing peristalsis within their gut to get rid of meconium…
If a baby is not eating it can lead to dehydration and hypoglycemia…
Not only does circumcision harm breastfeeding, it harms the child.