This index page contains links to documents about
circumcision versus breastfeeding, the effect of circumcision
on mother-infant bonding and interaction, and information
about breastfeeding's beneficial effect on reducing the risk
of urinary tract infection (UTI) in infancy.
See also The Birth Scene, a site having an
excellent discussion of circumcision in seven articles by
leading writers.
Circumcision's Adverse Impact on Breastfeeding
Initiation
Medical authorities agree that there are no medical
indications for circumcision in the newborn period. Male
neonatal circumcision is a non-therapeutic operation, an
unnecessary procedure that does not promote child health.
Authorities agree that male circumcision is a painful and
distressing event for a baby. Infants have fully functioning
pain sensors at birth,2 and the
pain of the surgery is severe and longlasting.3
The AAP Policy Statement on Breastfeeding
documents numerous significant benefits of breastfeeding for
both mother and baby. Breastfeeding is encouraged.
It has been established in numerous studies that
circumcision causes changes in infant brain function and
behavior. Marshall el
al. (1982)1 and Howard et
al (1994)5 have studied
the effect of the pain, stress, and trauma, of male neonatal
circumcision upon subsequent feeding behavior. They each
found that male circumcision disrupts feeding behavior.
Sometimes the infant is returned to the mother in an
exhausted and debilitated state in which he is unable to
manage the task of latching-on and feeding.5
Breastfeeding provides many health and developmental
benefits to the infant, so clearly breastfeeding failure
should be avoided. Traumatic and stressful events in infancy
interfere with breastfeeding success. The AAP Policy
statement on breastfeeding states that traumatic
procedures should be avoided lest they interfere with
breastfeeding initiation. Taddio and colleagues report that
male neonatal nontherapeutic circumcision causes an "infant
analogue of posttraumatic stress disorder."6 Rhinehart has clearly
and indisputably documented neonatal male circumcision as a
traumatic procedure.7 Parents
who intend to provide the benefits of breastfeeding should think
carefully before subjecting their new baby to
circumcision.
If parents decide to have their son circumcised despite
prevailing medical opinion, La Leche League advised that
circumcision should be deferred until after breastfeeding is
well established.11 See the
articles indexed below for more information:
Library Holdings
Medical literature
- Marshall RE, Stratton WC,
Moore JA, and Boxerman SB. Circumcision: effects upon
newborn behaviour. A controlled blind observational
study. Pediatr Res 1979;12:334.
- Marshall RE, Stratton WC,
Moore JA, et al. Circumcision I: effects
upon newborn behavior. Infant Behavior and Development
1980;3:1-14.
- Marshall RE, Porter FL, Rogers
A, et al. Circumcision II: effects
upon mother-infant interaction. Early Human
Development 1982;7:367-74.
- Anand, KJS and Hickey PR. Pain and its Effects on the
Human Neonate and Fetus. New Engl J Med
1987;317:1321-29.
- Howard CR, Howard FM, and
Weitzman ML. Acetaminophen
analgesia in neonatal circumcision: the effect on pain.
Pediatrics 1994;93(4):641-6.
- Taddio, A., Koren G. et al. Effect of neonatal
circumcision on pain response during subsequent routine
vaccination. Lancet, Vol. 349: 599-603 (March 1,
1997).
- Rhinehart J. Neonatal
circumcision reconsidered. Transactional Analysis
Journal 1999; 29(3):215-22.
- Hill G. Avoidance of circumcision plus
breastfeeding may produce lowest childhood morbidity and
mortality. BMJ 2003; Rapid Response, 5
July.
Medical Society Policy Statement
The American Academy of Pediatrics now has recognized
officially that circumcision interferes with feeding
behavior.10 The AAP advises
that painful or stressful procedures (such as circumcision)
intefere with breastfeeding initation and should be
avoided.9,11
- Work Group on Breastfeeding.
Breastfeeding and the use of human
milk. Pediatrics 1997;100(6):1035-39.
- Committee on Psychosocial
Aspects of Child and Family Health, American Academy of
Pediatrics; Task Force on Pain in Infants, Children, and
Adolescents, American Pain Society. The assessment and management
of acute pain in infants, children, and adolescents.
Pediatrics 2001;108(3):793-7.
- Section on Breastfeeding. Breastfeeding and the use of human
milk. Pediatrics 2005;115(2):496-506.
La Leche League International (LLLI)
- Elective Surgery for You or
Baby. In: The Womanly Art of Breastfeeding, 3rd
ed. (Franklin Park, IL: La Leche League International,
1981), 92-93. (ISBN 0-912500-10-7)
- [Breastfeeding Problems
After Circumcision]. Leaven, September-October
1994:78. (Published by La Leche League International (LLLI)
for the training of Leaders)
- Frank L. Circumcision and Breastfeeding.
Leaven: La Leche League Journal For Leaders
2000:36,(5):94-95.
- Mohrbacher N, Stock J. The Breastfeeding
Answer Book. Schaumburg: La Leche League
International, 2003: pp.27,259.
Journal of Human Lactation, (Official Journal of the
International Lactation Consultant Association)
Two mothers and lactation consultants report their
observations about the effect of circumcision on
breastfeeding initiation in letters to the Journal of
Human Lactation.16,17 Hill
advises that lactation consultants should tell mothers about
the adverse effects of circumcision and that breastfeeding
should be given priority over circumcision.18
- Lee N. Circumcision and
Breastfeeding. [Letter] J Hum Lact
2000;16(4):295.
- Caplan L. Circumcision and
breastfeeding: a response to Nikki Lee's letter.
[Letter] J Hum Lact 2001;17(1):7.
- Hill G. Breastfeeding must be given
priority over circumcision. J Hum Lact
2003;19(1):21.
Testimonial Letter
The problem of breastfeeding failure due to circumcision
is more than theoretical. It is very real as this poignant
testimonial letter substantiates:
- Beth Long. Testimonial Letter. March
1, 2000.
NOCIRC Position Statement
The National Organization of Circumcision Information
Resource Centers has released a position statement on
breastfeeding.
- Anonymous. The Effects of Circumcision on
Breastfeeding. San Anselmo, CA, National
Organization of Circumcision Information Resource Centers:
2002.
See also: Circumcision and Breastfeeding (link to
www.circumstitions.com)
Circumcision and Mother-Infant Bonding
Generally, the post circumcision infant, who is in pain,
traumatized, and exhausted post-circumcision infant, may be
less available for mother-child interaction for a period of
several days to a week. The following indexed articles
discuss the effect of the stress and trauma of circumcision
on the infant and on mother-infant bonding:
- Emde RN, Harmon RJ et al. Stress and neonatal sleep.
Psychosomatic Medicine, Vol 33, No. 6
(November-December 1971), Pages 491-497.
- Anders TF, Chalemian RJ. The effects of circumcision
on sleep-wake states in human neonates.
Psychosomatic Medicine, Vol. 36, No. 2 (March-April
1974), 174-179.
- Richards MPM, Bernal JF,
Brackbill Y (1976). Early behavioral
differences: gender or circumcision? Developmental
Psychobiology 9: 89-95.
- Marshall RE, Stratton WC,
Moore JA, Boxerman SB. Circumcision I: effects
upon newborn behavior. Infant Behav Dev
1980;3:1-14.
- Marshall RE, Porter FL,
Rogers A, et al. Circumcision II: effects
upon mother-infant interaction. Early Human
Development 1982;7:367-74.
- Anand KJS, Hickey PR. Pain and its Effects on the
Human Neonate and Fetus. New Engl J of Med
1987;317:1321-1329.
- Laibow R. Circumcision:
Relationship Attachment Impairment. Second Int'l Symp. on
Circumcision., San Francisco April 1991:14
- Taddio A, Koren G. et al. Effect of Neonatal
Circumcision on Pain Responses at Vaccination in Boys.
Lancet, Feb. 1995;345:291-292.
- Taddio A, Koren G. et al. Effect of neonatal
circumcision on pain response during subsequent routine
vaccination. Lancet, Vol. 349: 599-603 (March 1,
1997).
- LeBoyer, Frederic. Birth
Without Violence: The Book That Revolutionized the Way We
Bring Our Children Into the World. Inner Traditions
International, Ltd. (ISBN 089281540). 1995 Reprint of
1975 Classic.
- Birth Scene http://www.birthpsychology.com/
- Pyterek AV. Circumcision: The Roof of
Misogyny.
- Mary Kroeger with Linda J.
Smith. Circumcision.
In: Impact of Birthing Practices on Breastfeeding:
Protecting the Mother and Baby Continuum. Sudbury,
Massachusetts: Jones and Bartlett Publishers, 2003: pp.
197-8. (ISBN 0-7637-2481-5)
Breastfeeding and UTI reduction
Some methodologically-flawed studies that were published
in the mid-1980s suggested that male neonatal circumcision
may provide some protection against urinary tract
infection.
Later information that was published in 1990-1992 show
that breastfeeding provides a three-fold reduction in the
incidence of urinary tract infection (UTI) in the first year
of life as compared with bottlefeeding. The earlier studies
had no control for the variable of bottlefeeding or
breastfeeding (amongst other methodological problems) so they
have become invalidated by the later information. There is
now no reliable evidence that male circumcision offers any
protection against UTI.
The following articles indicate that breastfeeding can
protect infant boys from urinary tract infections:
- Coppa GV, et al. Preliminary study of
breastfeeding and bacterial adhesion to uroepithelial
cells. Lancet 335 (March 1990), 569-571.
- Mårild S. Breastfeeding and
Urinary Tract Infections. Lancet, 336 (October
1990), p. 942
- Pisacane A, Graziano L, Zona
G. Breastfeeding
and urinary tract infection. Lancet
1990;336:50.
- Pisacane A, Graziano L,
Mazzarella G, et al. Breast-feeding
and urinary tract infection. J Pediatr
1992;120:87-89.
- AAP Workgroup on
Breastfeeding. Breastfeeding and the use of human
milk. Pediatrics 1997;100: 1035-39. (link to
AAP website)
- Outerbridge EW. Decreasing the
risk of urinary tract infections. (Letter). Paediatr
Child Health 1998; 3(1):19.
- American Academy of
Pediatrics Task Force on Circumcision. Circumcision Policy
Statement. Pediatrics 1999;103(3):686-693.
- Anonymous. The Effects of Circumcision on
Breastfeeding. San Anselmo, CA, National
Organization of Circumcision Information Resource Centers:
2002.
- Mårild S, Hansson S,
Jodal U, Oden A, Svedberg K. Protective effect of
breastfeeding against urinary tract infection. Acta
Paediatr 2004;93(2):164-8.
- Hanson LÅ. Protective effects of
breastfeeding against urinary tract infection. Acta
Paediatr Scand 2004;93(2);154-6.
- Section on Breastfeeding. Breastfeeding and the use of human
milk. Pediatrics 2005;115(2):496-506.
See also: Circumcision and Breastfeeding (link to
www.circumstitions.com)
General Information About Breastfeeding
A general discussion of breastfeeding is outside the scope
of this website. For more information on breastfeeding the
following links are provided:
- ProMom
(Link to www.promom.org)
- The
Compleat Mother (Link to www.compleatmother.com)
- La
Leche League International
- Australian Breastfeeding Association
(Link to www.breastfeeding.asn.au/)
- INFACT
Canada (Link to www.infactcanada.ca)
- Prescott, JW. Breastfeeding: Brain Nutrients in Brain
Development for Human Love and Peace. Touch the
Future Newsletter, Spring 1997. (Link to
www.violence.de)
- Health Policy Unit. Breastfeeding. Sydney: Royal
Australasian College of Physicians. April 2001.
- Breastfeeding, Canadian Paediatric
Society. 2204 Walkley Road, Suite 100, Ottawa, Ontario K1G
4G8 (link to www.cps.ca) Phone: 613-526-9397, fax:
613-526-3332.
- A Woman's Guide to Breastfeeding. The
American Academy of Pediatrics, 2000. (Link to
parentingthoughts.org)