Short and Sweet Article on Infant Sleep

Now that we will have a new baby joining us on the outside in September, I am sure I will get to hear that typical question beginning pretty soon after the baby is born: "Is he/she a good sleeper?" Or the other most common question of, "Is he/she sleeping through the night yet?" Ah, if only it was common knowledge that babies are not supposed to sleep through the night, and "good" sleep for a baby does not mean that he sleeps in long stretches, uninterrupted, like an adult or a much older child sleeps.

So, if you have a baby or toddler or preschooler who does not "sleep through the night," then don't let the question get you down! Remind yourself, "My baby is NORMAL! And that is a good thing!"

Here's the article. Of course, it's by James McKenna - who else? ;)

Reconciling Expectations with Biological Norms

As I have looked through advertising, books, and media in general on the topic of new babies and parenting, I have developed a critical eye in picking out information that is, shall we say, "sugar-coated" and unrealistic. I volunteer as a breastfeeding support counselor, and so I have to be aware of all things baby-related as I may have a mom come to me with questions, and I like to know what she is talking about if she brings up any topics that are baby-related but not directly breastfeeding-related.

Media in our culture presents us with these ideas of what newborns, babies, and young children are like. Often, these ideas are not based in biology, but rather, cultural expectations. Parents over the past few generations have come to expect certain things of their babies due to these non-biologically imposed ideas. As many first-time parents have not spent much, if any, time at all in observation of babies, they turn to parenting magazines and books, most of these presenting mainstream ideas of how babies "should" be.

So I thought I'd come up with a list of the many expectations that are presented to new parents and how they don't always mesh with biology, with how a "real-life" baby will be. Unfortunately, even with knowledge of what a baby is like biologically, there is still enough pressure to conform to societal norms that many parents will still try to go against these biological norms. We are a society of control, and often parents will feel out-of-control when going along with the biological norms of their babies. If their baby is not doing things "the way the book says they should," then parents can feel betrayed, helpless, out-of-control, and as if they are failing. My wish is that all parents could feel confident that not following the mainstream baby-raising advice won't result in ruin for their children. The biological facts were enough to convince me that society's idea of a "good baby" was not accurate and based more on social norms than biology. I don't know what it is about me that made it so that I don't care about being "different" from the norms as portrayed by the media... if it was, I would share it with the parents who want to follow their instincts and the biology of babies but feel pressured by family, friends, and society in general. Self-confidence is part of it, but there has to be more to it than that, because I was never too terribly self-confident as I was growing up.

So, some of the expectations parents may have based on how babies are presented by our media, and the biological realities which cause frustration when babies fail to meet those expectations:

* Culturally-imposed expectation: Young babies eat every 3 hours and sleep in a crib/bassinette contentedly in between feedings.

Biological reality: Newborns have tiny tummies, about the size of their fists. They need to eat frequently, especially in the early weeks if nursing, in order to get enough milk as well as to ensure that there is an adequate supply of milk in the future. Breastmilk digests quickly by design, to ensure that babies eat often. Breastmilk is the biological norm for feeding infants. Babies also are used to being in constant contact with the mother in her womb. Many babies object to being laid down alone frequently and for long periods. Frequent nursing provies frequent skin-to-skin contact, which babies expect biologically.

*Culturally-imposed expectation: Babies need to learn to be independent, to "self-soothe," and to play on their own. They will become "spoiled" if they don't learn this at a young age.

Biological reality: The American culture sees independence as an important trait in adults, and it seems that has carried over into how we treat children from the beginning of their lives. Many parenting magazines and books portray babies as being able to put themselves to sleep, play with their own toys alone, and sit contentedly in various baby devices. However, babies come into this world more helpless than any other mammal. Even baby apes can cling to their mothers' fur, and our babies can't even do that! Babies' brains do about 90% of their growing in the first three years. New connections are being formed constantly. Science tells us that meeting babies' needs consistently helps with the normal wiring of the brain. Babies who are left to "cry it out" alone, which many parents do in trying to get the baby to "sleep better" (more on "sleeping better" in a moment), experience higher levels of the stress hormone cortisol. High levels of cortisol can be damaging to the baby (reference).

Often, mainstream parenting advice says, "But if you hold your baby every time he starts crying, he will control you." But an infant cannot seek to control anyone. He only knows that he is a social creature who feels "right" when he is being held. His biology dictates that he cry when alone - it is a survival mechanism. True, we don't have to worry about a tiger coming after the baby if we set him down in another room, but he doesn't know that we now live in a civilized society where there is no threat of wild animals! His biological makeup remains the same.

When people advise new parents to get their babies to play independently, this is often presented as "entertaining himself." There are mobiles and crib toys and "baby gyms" for babies who cannot yet pick up and manipulate objects. They cannot even pick things up but are expected to "play" by themselves! This can lead to the over-purchase of multiple baby entertainment devices and toys. The thought behind this is that the parents shouldn't set themselves up as the entertainer of the baby, so they should teach babies to do it independently. But biologically, babies don't need to be "entertained" nor do they need to entertain themselves at a young age! Babies learn best when they are allowed to experience in-arms passive observation. The parent can hold the baby or wear him in a sling as he goes about his daily adult tasks - this does not tie him up in "entertaining" the baby, but it serves a valuable purpose: the baby IS "entertained" by this, and in the process he learns what adults do, what life is all about. He learns how things happen in day-to-day life. He is not the center of attention. More information on this can be found in Jean Liedloff's book, The Continuum Concept. Some information about it, as well as two great articles, can be found here. Another excellent read about biological norms of infants is Our Babies, Ourselves by Meredith Small.

* Culturally-imposed expectation: Babies should be able to sleep through the night at a certain age or milestone (such as by 8 weeks, or as soon as they double their birth weight, for instance).

Biological reality: Babies do not sleep like adults. They are designed to wake frequently as a survival mechanism! Not only do they need to eat frequently, but they need to go through shorter sleep cycles to ensure they do not go into too deep a sleep, which is dangerous for babies. If a baby begins sleeping 8-12 hours straight in the early weeks or months, then he is getting less nutrition and is not stimulating his mother's milk supply as frequently, which can lead to too little milk a few months down the road in many instances. Babies are particularly vulnerable during the first six months (especially 2-4 months) to difficulties in rousing themselves from a deep sleep - they are designed to sleep near an adult, whose breathing regulates theirs and keeps them in a lighter sleep state. This is preventative against SIDS. Biologically, a parent should not want their baby to sleep alone for an 8 hour stretch prior to six months of age! Sleeping long stretches is often seen as a baby sleeping "well" or being "a good sleeper." But biologically, it is actually good for the baby to sleep for short stretches! The question of, "Is he a good sleeper?" is so commonly used, and in the wrong context, in our society. Read more at Dr. McKenna's Notre Dame Sleep Laboratory.

* Culturally-imposed expectation: Babies should sleep in cribs on their backs and alone. This is the only safe way for a baby to sleep.

Biological reality: Again, there is the assumption that "good" sleep is done alone. A baby is often given a quiet, separate sleeping space. But as mentioned above, babies who sleep alongside their parents are better able to regulate their breathing and able to nurse more frequently. Sleeping alone is not safer, yet it is sometimes portrayed this way. A nursing mother sleeping next to her baby will not roll over on him unless she is under the influence of drugs or alcohol or has some sort of severe sleep disorder. This of course does not mean that most babies sleeping alone will succumb to SIDS, nor does it mean that a baby sleeping with its mother will never die from SIDS, but the biological makeup of the mother-baby dyad is such that we were designed to sleep in this way. Babies who sleep alongside their mothers nurse often, keeping them in a lighter sleep state for a prolonged period. Have you heard the suggestion from the American Academy of Pediatrics to put a baby to bed with a pacifier to decrease the risk of SIDS? Biologically, the baby has a "pacifier," the mother's breast, for this very reason! Babies nursing in the night alongside their mother often go from back to side frequently during the night, which not only solves the question of which position to put the baby to sleep in, but it prevents against a relatively new issue of "flat-head syndrome," where a baby develops a flattened spot on the back of his head due to lying on his back all night (and this can be exacerbated by use of car seat, infant swings, and not being carried often in an upright position). Biological norms of infant sleep can alleviate the need for many modern-day devices: cribs, pacifiers, helmets to correct severe flat-head syndrome... Putting babies to sleep alone in a separate room is a relatively new experiment in the history of humankind.

* Culturally-imposed expectation: You need to purchase various baby gear items because they will be used frequently and are essential to raising a baby. Some of these items may include: bucket car seat, stroller, baby swing, exersaucer, jumper, crib, pacifiers, bottles...

Biological reality: Advertisers often push these items as essentials when many babies don't care for them at all (much to chagrin of tired/overwhelmed parents who think the baby gadgets might be the key to saving their sanity, and then the gadgets fail to help - how frustrating!). Because of the expectations we have, we think that babies really will like these items, and that there is something "wrong" with them if they don't! The pressure to buy various things for the baby is deeply ingrained: registry lists, baby showers, ads coming to your mailbox (how do they know you are pregnant or have a new baby??), friends who have these items for their babies... Sometimes it is helpful to have a space to safely set the baby, so these items can have their place. But when over-used, babies are passed from station to station to "entertain" them as a substitute for being in the arms of parents. They are not biologically programmed to expect this. Further, most of these devices are only able to be used for a few months before the baby outgrows them.

* Culturally-imposed expectation: Babies must sleep alone and have to "cry-it-out" in order to learn this necessary skill. If they don't, they will never be able to sleep well and alone.

Biological reality: Babies don't sleep like adults. They go through much shorter sleep cycles, and they wake frequently, as mentioned before, as a survival mechanism, because deep sleep is not safe for infants. All children (unless they actually have a medical condition of some sort) will develop more advanced, adult-like sleep habits as they age. Both of mine did. They both slept in my bed, and then in my room, and both now sleep in another room, all night long, and rarely wake up in the night. They just got to that point, and there was no forcing and training and leaving them to cry. I know others who have had the same experience. As much as magazine articles want us to believe that we are "starting a bad habit" and it will never be able to be broken (does "never" mean a few years, or is it actually literal?), it is simply not the case. The sleep development of a baby or toddler will grow and unfold the same way their development will in any other area: talking, walking, etc. Above, there was a link to a Dr. Sears webpage which listed the potential dangers of the "cry it out" method of sleep "training." This method, which most authors and doctors who do advocate for it will at least say to wait until the baby is six months, has no biological basis. The reason it "works" is because babies just give up. They don't "learn" to sleep "better," they just stop trying to get anyone to respond because they know it is hopeless. Parents sometimes hear that you have to leave a baby to "cry it out" so they will develop "good sleep habits," and they assume this just means to leave the baby, as young as a couple weeks old in some cases, to cry for prolonged periods. They don't realize - or don't want to realize, perhaps - that babies are biologically programmed to be near their mothers, day and night. It is okay to be the "sleep aid" for your baby, and it is natural! Cry-it-out, cribs, "loveys," etc. aren't natural, so why is it sometimes assumed that it is healthier for babies to go to sleep in these ways than it is for their mothers to nurse them or their fathers to lay next to them and rub their backs? In fact, babies who are parented to sleep this way are adaptable to different situations - they don't have to be in their own cribs in their own bedrooms in order to fall asleep, nor do they have to "cry it out" in a strange new environment such as a hotel room. Babies who know mom as the way of going to sleep are much easier to travel with. Travelling with my babies has been a joy (well, except the driving with babies who hate the car seat part! ;).

* Culturally-imposed expectation: Babies need to eat jarred baby food purees before they can begin to eat finger foods. Nutritionally, babies also need rice cereal as their first food.

Biological reality: I have done an extensive post on this in the past. Biologically, babies are designed to be fully sustained on their mothers' milk for at least six months to a year. Only after a year does solid food begin to be needed nutritionally. This does not mean that babies cannot try food prior to a year, but that they don't need much of it for nutrition, and it should not be replacing much of their diet of breastmilk. Spoon-feeding of purees does just this. Purees were designed so babies could eat solids earlier than when they'd otherwise be ready developmentally. Babies who can pick up small bits of foods and put it in their own mouths are in control of their own appetite, and they learn how real food smells, feels, and tastes. Solid foods are about learning in this case, not for filling the baby up and replacing breastmilk. It is as easy to throw a banana in the diaper bag as it is to throw in a jar of baby food and a spoon. And the eating process is easier - the adults can enjoy their own food, modelling social and eating behaviors for the baby, rather than having to feed the baby first and then eat later, once their hands are free. This is the way babies were fed for thousands of years, before baby food was introduced.

* Culturally-imposed expectation: Nursing babies must be weaned actively by their mother or they will never wean on their own and will be "mamas boys (or girls)."

Biological reality: All children wean eventually. I don't think there's a case on record of a teenager who was still nursing, much less an adult! ;) As toddlers get older, mothers do add to the weaning process in a natural way, by asking the child who can understand to wait a few minutes to nurse, for instance. The child gradually finds other things that are interesting, tasty, and comforting. In a natural weaning, there is no horror story of the terribly engorged breasts as is sometimes the case in a more abrupt weaning. There is no lamenting the angry outbursts from the young toddler who doesn't understand why he can no longer nurse. If a mother needs to wean earlier than her child would, it can be done gradually over several weeks so as to minimize these uncomfortable possible side effects. Toddler and preschool-aged nursing is biologically normal: worldwide, the average weaning age is somewhere between 2-4 years, and that is even with our low weaning age averaged in!

* Culturally-imposed expectation: Babies have to be on a schedule.

Biological reality: Babies need to eat when hungry, as was stated previously. There is new evidence that women may have different breast capacities, meaning that some women will have to nurse more often in order for their baby to grow and thrive. Just because so-and-so's neighbor's baby only nurses every three or four hours (and sleeps all night and still weighs a ton!), it doesn't mean this will be the case for all mothers and babies. With scheduling of feeding and sleeping (and even "playing!"), it is often times more frustrating to try to do this in the first place. If the baby won't sleep when it is "naptime," or he "doesn't eat enough" at one feeding and so the mother makes him wait until the next scheduled time to "teach him to eat a full meal," then there can be crying and frustration on all ends! Many pieces of advice say that if you don't get your baby on a schedule, he will "control" you. He needs to be on a schedule so you can "get your life back." But talk about being controlled - how is not being able to leave the house at the expense of "the schedule" going to give a parent a feeling of being "in control" anyway? At some point, the schedule can control the parent. And for the baby who does not conform to a schedule despite his parents' efforts, the result is disappointment, resentment, and feelings of failure. But an infant does not have to be on a schedule. If he wakes at night crying a lot due to illness or teething one night, then letting him fall asleep nursing before "naptime" the next day may be quite beneficial to him. Wearing the baby around in a sling allows him to nurse and nap whenever his body urges him to do so. Now, at some point this does get to the point where an older baby or a toddler can benefit from a sleep schedule, in that he doesn't stay up til midnight one day and go to bed at 7 another day... once an older baby becomes distractable and cannot nap easily on the go, then he may need a set "naptime." But for infants, for babies under six months in particular, a sleep schedule is not necessary. Nursing on a schedule also prevents comfort nursing, which is important to babies, who have a biological sucking instinct and do it for comfort.

* Culturally-imposed expectation: You and your baby must spend face-to-face time playing "learning games" using "learning toys." This is the best use of your time spent interacting, and the rest of the time, baby will be in some device such as a swing or crib.

Biological reality: This is one I have picked up on lately, which the fisher-price ads and Pampers/Huggies parenting newsletters (I mean ads) would lead us to believe... that our babies will suffer developmentally if we don't use learning toys and games with them. Biologically, does a baby need a toy that will spout off the ABCs with the touch of a button? Does a child need to experience learning time in order to learn cause and effect? Biologically, a child will learn best by interacting with his natural environment, by hearing adults speaking (because they are near the adults and not in another part of the house with "learning toys"), by observing life happening around him. Yes, we need to interact with our babies to a certain extent, but this is most naturally done by singing and holding and moving and talking, not by sitting on the floor with some Baby Einstein toy. It has become popular to have learning games and DVDs for babies and toddlers, but biologically, these things are not essential - if they were, would our species have made it this far intellectually?

*Culturally-imposed expectation: Babies and toddlers have to have things "done to" them in order for them to learn independence in acquiring new skills. This includes sleeping, eating, toilet training, and others.

Biological reality: This is one reason why we have so many parenting books and magazines. Our society is such that we can't just leave a child to develop, but we have to do it for him. We have to push, or it will "never happen." I am not sure where this idea came from, but biologically, a baby and young child will sleep alone when ready, will eat when hungry, and will stop soiling himself when he develops to the point of finding it unpleasant and inconvenient. When pushed, there may be resistance, so that it no longer becomes about what the child would have done naturally, but a power struggle. And there are children who may have medical or emotional issues which could slow the normal biological development in these areas, such as a child who has sensory issues and certain foods feel wrong to him, causing him to gag and refuse a variety of foods. In these cases, yes, the children may need some adult interference, but not in a forcing way. For the normally-developing child, he will master all these tasks on his own one day. Toileting, eating, dressing himself, weaning... all he needs is the example of older people around him and his natural development will unfold.

I know that there is a lot of overlap in the areas mentioned above. If there was a specific "child-rearing norm" as presented by the popular culture which I have missed, feel free to comment and let me know. I wrote this list in part as I thought back at my first child's babyhood... how I knew she needed to be close to me, instinctually, yet I felt that I needed her to nap alone. "All babies nap alone," the parenting magazines told me. So why couldn't mine? Why did her eyes fly open and the crying begin as soon as she hit the mattress? And she wouldn't lay contentedly alone, so forget about the "put your baby down to nap when she is drowsy but awake" nonsense! But if only parents knew that this is not normal baby behavior - that they don't just sleep and eat whenever and wherever you want them to and fit conveniently into your pre-baby life as if they aren't there to begin with, like the soap opera I used to watch in high school would lead you to believe (in which the young children and babies would make brief appearances so their parents could acknowledge them and then life would go on as if they didn't exist, because they were "sleeping" or "with the nanny"). New parents would be better off if informed that they don't have to "do" things to their infants, that life will be very different than before children, and that the baby will just learn things as life progresses. No need to get neurotic over it, yet this is what I sometimes felt like in the early days with a baby! So, if any future first-time parent is reading this, know that yes, it will be a difficult adjustment. It is hard to let go of the preconceptions and myths and stereotypes and expectations you may have had ahead of time. Your baby may not make his biological needs known as loudly as others, but then again, he might. Knowing what to expect developmentally and biologically can put you at ease so that your expectations don't rule your new life with baby. And he will grow up - it will happen, and faster than you could know. Certainly faster than I thought it would when my first was a baby... I literally sometimes had the illogical thought that nothing would change, that she would never grow into different ways of sleep, eating, etc. But I learned more and more about what babies need and what they are like biologically, and I let it all go and began to relax and to embrace the closeness with my babies. They will grow up and be gone all too soon.

What is Biologically Normal?

Why does our culture try to cache what was meant to be carried? This article on the "species-normal experience" for babies discusses what is biologically normal for an infant. It is a bit lengthy, but I would highly recommend reading it if you have a baby or may have a baby one day. It discusses what human infants expect, biologically... and that's not to be left in a room alone for 12 hours a day and fed artificial baby milk! ;)

What do I mean by "cache" and "carry?" Well, looking at animals (humans being animals as well), there are "cache" animals, which hide their babies somewhere and go off for hours at a time to hunt or graze or whatnot. Deer would be an example. The milk of these mammals is high in fat and protein and is designed so that the babies will stay fuller longer and thus stay safely hidden while their mothers go out for extended periods. The "carry" species are those animals whose young are carried all the time - the mothers do not leave their babies at all, and their milk is of a lower fat and protein content. Human beings are among this group. Our babies cannot follow behind us as do fawns. They are helpless when it comes to being able to move about freely. Our milk is digested rapidly so that our babies will require frequent feedings.

I am not going to rehash the whole article, but just get the thoughts moving here... Many might say that, sure, biology dictates that human babies stay with their mothers, but now we have technology that allows us to change this: bottles, formula, breast pumps, sleep training books and cribs, baby monitors, pacifiers... in other words, mother substitutes, or tools for otherwise distancing mothers from their babies.

But can an increase in technology actually change basic biological norms? Do human infants understand that technology has made for these allowances? Can technology really change the expected biological experience, the norm, the standard, for a baby? Do human babies somehow know that, "Yes, if I was left alone from my mother for a half hour 5,000 years ago, then a wolf might eat me, but now that it is the year 2010 and we have technology, I am safe here in this crib in my own room... so I don't need to cry." Human babies were designed to be with their mothers because they are totally helpless and defenseless - they cannot run away from wolves! Just because the wolves are no longer a threat in our culture, does this mean that the hard-wiring in the infant's brain has changed? That he will feel less of an urgent need to be with his mother?

It's Not Really about the Milk

While reading the latest New Beginnings magazine, I came across a story submitted by a mother who was writing about nursing her twins through infancy and toddlerhood. She spoke of how she didn't nurse her first child in the same way or for as long, and she quoted a bit from this Diane Wiessinger article: It's Not Really about the Milk.

"You won't 'get it' at first. At first it's all about technique, and position, and time, and swallowing, and soreness, and feeling as if your whole world has narrowed to Feeding The Baby. Those of us who have enjoyed nursing our children are on the other side of a great emotional gulf from you. We can't explain it, we can only try to help you across the bridge, to where you can see for yourself. If you stay caught up in this as a feeding method, you may never get all the way across the bridge. But oh, the view from the other side!"

This article actually comes as close to explaining it as I have come across, even though the author herself claims that we can't explain it.

"I wish I could convey to you the simple, thought-less, vast, delicious pleasure of nursing my children. Once I "got it," I didn't "feed" them, didn't worry about intervals, didn't hold back."

This is certainly hard to see when you are nursing your first-born child and don't have the gift of hindsight in advance! Many women today struggle with breastfeeding in the early days - sore nipples, worry about weight gain, and more. Personally, I had to struggle through sore nipples with my first and also digestive issues that were quite concerning to me (although they didn't have any detrimental effects, it was still worrisome to me at the time). In the beginning, it does just feel like going through some sort of routine, but less so to me once I knew where to look for support and encouragement - namely, La Leche League and many of the publications that they list on their bibliography. Checking out a book from our group's library each month was an incredible source of strength for me. I learned through experience and encouragement from these sources that breastfeeding is not about a scientific process, it is not about measuring input and counting ounces... it is about the relationship.

"Breastfeeding is a newborn's first relationship, designed to continue throughout a child's early years. As a culture, we tell ourselves - without evidence - that the absence of this fundamental human relationship has no longterm implications for mother or child or family or society."

This really spoke to me - a great way to explain it. It is a relationship - a primary, biological relationship. Therefore, when somebody disputes the nursing of a toddler, it can be helpful to explain that it is also about the relationship. Sure, a toddler no longer "needs" breastmilk nutritionally (although they do continue to receive nutritional benefits from it), but it is about more than just the milk. This article does a great job of communicating my thoughts about nursing my own children: even if it were proven that formula actually was equivalent to breastmilk, or even if they found some additive to put in formula to generate "smarter" children or some such (which is not likely to happen, but hypothetically speaking here), I would still breastfeed, because the act of nursing, with it being the biological norm and having all the relationship-building benefits (the skin-to-skin contact, the ability to nurse as comfort, the hormonal state of the lactating mother), is the key for me.

The whole article is extremely short... a three minute read, maybe. Well worth those few minutes, I think!

Ooh, and this one is good, too!

Discovered Recently...

This blog, which contains lots of good posts on parenting and baby-related issues. Looks to be a relatively new blog with lots of traffic!

Some highlights, which go along nicely with my "Why Do I" series:

On "extended" breastfeeding:

http://womanuncensored.blogspot.com/2010/01/theres-no-such-thing-as-extended.html

"Premature weaning," ha ha! I like it. :)

On nursing in public:

http://womanuncensored.blogspot.com/2010/01/why-you-need-to-stfu-about-nip.html

I also appreciate the tribute to PoWM.

On routine infant circumcision:

http://womanuncensored.blogspot.com/2010/01/rationalizing-harm-doesnt-make-it-less.html

Short, to the point, and unabashedly straightforward.

http://womanuncensored.blogspot.com/2010/01/circumcision-is-for-weiners.html

Ha ha on the title of that one... I told you she's straightforward!

http://womanuncensored.blogspot.com/2010/01/what-have-i-done-voices-of-circumcision.html

People regretting their choice... because they made the one that cannot be undone.

http://womanuncensored.blogspot.com/2009/12/would-you-circumcise-your-daughter.html

An interesting twist.

And speaking of the "Why Do I" series, if there is a topic I have not covered that anyone is interested in, please let me know and I will try to get to it soon!

Did you know...

... that it is possible that the American Academy of Pediatrics is considering actually recommending routine infant circumcision to - get this - prevent HIV? As if babies are going to be contracting STDs? As if flawed studies conducted in Africa on adult males who were circumcised as adults have anything to do with American babies? As if circumcision were a "cure" to HIV and a "free pass" to have promiscuous sex? As if it is ethically permissible to recommend surgery - even if it were proven to be beneficial to future health, which it has NOT - on infants as a preventative measure against a potential future illness that they would contract based on their lifestyle choices? As if the high percentage of circumcised adults in the USA with its relatively high HIV rate for an industrialized nation compares favorably to the low percentage of European circumcised males and its relatively LOW rate of HIV infection?

This is madness. If the AAP goes forward with this recommendation, it will be the only medical association worldwide to recommend routine male infant circumcision. And the reporting on the topic is largely biased... for example, this brief article from the WSJ website. Where is the depth? Where are the pros and cons examined? Where is the fact that more infants are permanently injured or even die as a result of their "routine" circumcision surgeries than are "saved" down the road as result of their circumcision (nobody has ever died as a result of being left intact!)? When did it become okay to sacrifice some children in the name of potential STD protection for adults? And why is it still abhorrent to us to even consider circumcising our infant daughters? The link above is actually to the comments on the article (because overall they are thought-provoking and contain some very valid points), and at least it appears from the comments that the public isn't buying this recommendation... at least, some of us are not buying it. But what about those whose doctors simply say, "There is medical benefit to this procedure," and they nod and consent with no further thought or research?

So why, then, are there some people pushing for this recommendation? Perhaps they really believe it will help prevent HIV and that providing this procedure will enable males to have sex with whomever they please without consequence? Perhaps, the more likely issue, that they are set in their ways and since the status quo in the USA is circumcision, they don't want that changed. They are afraid of redefining "normal" in their minds in reference to male anatomy. They are grasping at straws to make circumcision a medical issue because they are noticing the fact that Americans are beginning to wise up to the issue, less are choosing cosmetic surgery for their newborn sons, and so they have to turn it into a therapeutic surgery. But since when is preventative surgery on infants considered therapeutic, anyway? Do we amputate baby girls' breasts because they have a 1 in 8 risk of developing breast cancer as adults? NO!

All I ask for is some logic here. Does this get anyone else as fired up as it gets me?? Even if you are Jewish and thus circ for a religious and not medical or cosmetic reason... isn't the recommendation of surgery on a baby for made-up reasons just ethically wrong?

As a side note, I think I read this in the comments of the above link, or else it was another similar article... as far as Jewish/Biblical circumcision goes, if babies in Jesus's time were circumcised the way they are today in a hospital routine circ, they would have all died. they would have bled to death and contracted infections. The circs of Biblical times must have been radically different, removing much less skin. In facts, some Jews in history would, in some cases, pull down the remaining foreskin in attempts to look like and fit in with the Greeks. Since this was considered to be denial of their own faith and roots, circumcisions began to be done more radically, more like the hospital circs in the US today. Interesting.

Oh, and just for fun: The Circumcision Decision-Maker. It belongs in my previous Why Do I post on circumcision, but nobody would see it if I put it there now that I have discovered it. ;)

We interrupt the Christmas photos...

...with a link to an article on infant sleep, including a comprehensive list of books and articles regarding sleep, "sleep training," and babies. If you have been following my "Why Do I" series, check it out!

Why do I...

leave my babies intact? Why don't I have them circumcised?

Short answer: Because they are girls. Ha ha... okay, so that isn't really funny, as I will explain later...

I would not have them circumcised, male or female. This is something I looked into heavily while pregnant with my second baby before finding out the gender. With Caroline, we'd already found out she was a girl long before anyone even mentioned circumcision, and so it wasn't given much thought - and zero research - until early in my second pregnancy.

This post is not for Jews... I understand Jews have religious reasons for circumcision and it is done in a religious ceremony by a mohel and not in the hospital. This post is also not intended to make people feel bad for circumcising their sons. If the research was done and the parents are confident in their decision, then okay. This post is primarily for those who do not yet have a son and haven't given much thought to the issue, and to those who may already have a circumcised son and are re-thinking this decision for future sons. If you regret your son's circumcision, please, do not feel badly. We do the best we can with the information we have at the time. So I want to give the future moms who read this blog the information, so they can make a fully informed decision and not have to feel regret.

I wasn't even going to touch this topic as it tends to be even more controversial than the breastfeeding/formula feeding debate... but in light of women reading this blog who don't yet have children - and after having heard from moms who say they wish somebody had talked to them about circumcision before they'd consented to having it done to their sons - I thought I would put it out here. So I bring up this topic not to judge, but to inform, so that other parents have the information and may not have to live with regret as many moms do whose stories I have heard.

Another thing to keep in mind - there is much more information currently available on this topic than there was years ago. Of the males born around the time I was (1979), about 80-90% were circumcised. It was simply not questioned much, and people generally accepted it as a necessary thing that is done to all baby boys. Currently, the nationwide numbers are closer to even: almost half of boys born currently remain intact. This percentage varies from region to region, of course.

First of all, some basics and vocabulary words, because most people don't go around discussing circumcision daily and especially if you have never had a son before, then these terms might not be familiar. So, a brief glossary, and trying to use technical and accurate terminology (so if you don't want to see words that refer to genitals, please skip this post. I promise to not be too graphic ;) :

circumcision: the surgical removal of the foreskin of the penis
foreskin: the fold of skin which covers the head (the glans) of the penis. Also called the prepuce. It is a continuation of the skin on the shaft of the penis and is not a seperate anatomical structure.
intact: term used to describe the unaltered male. Use of this term is intended to show that "uncircumcised" is not the opposite of being circumcised (the opposite of circumcise would be "restored," technically). "Intact" is meant to describe the natural and biological norm, and it does not make sense to use a word which has at its root a surgical procedure that was not performed - is that as clear as mud? ;)
RIC: routine infant circumcision, the term which refers to this procedure when done on a baby for non-therapuetic or non-religious reasons (a newborn hospital circumcision)
circ: shorthand for circumcision
retract: to pull the foreskin back, exposing the glans

Probably everyone knows that circumcision is the removal of the foreskin. Here's the basics of the procedure: It is usually done with a scalpel and a device that is made to fit over the glans to protect it during the procedure. The procedure takes around 15 minutes typically. Sometimes local anesthetics are used and sometimes they are not. To perform the circumcision, the baby is placed in a device called a Circumstraint (I couldn't make that up! - here's a photo) where his arms and legs are secured and he is immobilized. The foreskin, which is fused to the glans on the penis in infants (much like a fingernail is adhered to the skin beneath it), is physically separated from the glans using surgical instruments. After it is torn from the glans, it is cut off. Here is a video clip of an infant circumcision that shows it being done step by step (be warned, this does not make for pleasant viewing - you may want to mute your speakers. I have not been able to watch it all the way through with the sound turned up! There are reasons why parents are not typically invited to watch their babies' circumcisions!). The same video can be found larger here.

So, now that we have the terms defined and the basics of the procedure, what are the reasons that people choose to circumcise their male infants?

Religious reasons:
As I mentioned before, Orthodox Jews believe in circumcision as a religious rite. They are following Old Testament Law. While today's Jewish religious circumcisions are similar to hospital circs, they are done as a part of a religious ceremony and not by a doctor in a hospital. I believe Muslims also circumcise on religious grounds. I am sure other religions may as well, but I am most familiar with the Jewish traditions.

As far as Christianity goes, I cannot speak o the positions of all the subsets of Christianity, but I can say what I know about the Catholic teachings. the Catholic Church, as far as I can tell, has no position on circumcision directly. As Paul wrote in the New Testament, it is not necessary for our salvation. Whether a Christian circumcises or not has no bearing on his salvation because it is no longer a requirement under the New Law. In other words, his genital status has no bearing on whether or not he gets into heaven! However, for those who continued to circumcise because of a belief that it was tied to their salvation, and for those who tried to "uncircumcise" or restore their foreskin, this was problematic and Paul warned against it:

Was someone called after he had been circumcised? He should not try to undo his circumcision. Was an uncircumcised person called? He should not be circumcised.

Circumcision means nothing, and uncircumcision means nothing; what matters is keeping God's commandments.

Everyone should remain in the state in which he was called. (1 Cor. 7:17b-20)

Based on the New Testament, it would appear that no Christians are mandated to be circumcised, then. And speaking as a Catholic, there is nothing in official Church teaching regarding circumcision of male infants (correct me if I'm wrong, Seminarian Tim). The only thing I could find that might be applied to circumcision is this (which I came across by chance when looking for something else awhile back), found in the Catechism of the Catholic Church, paragraph 2297: "Except when performed for strictly therapeutic medical reasons, directly intended amputations, mutilations, and sterilizations performed on innocent persons are against the moral law." (Italics theirs, not mine)

RICs are performed for non-medical, non-therapeutic reasons, as I will discuss in a few moments. I would think a baby qualifies as an innocent person. And circumcision is certainly an amputation of a healthy part of the body. It seems to me that RIC could fall into this category. Any Catholic theologians want to weigh in on this (after reading below to find that circumcisions are not medically necessary)? I did find this info from fisheaters.com which makes good sense, although it is not necessarily official Church doctrine, although it may very well be...

There are some interesting points to ponder regarding the New Testament and circumcision at this link. I cannot vouch for the theological soundness because I really don't know the source other than the author's name, but she does make some valid points and bring up some interesting information. And some more interesting thoughts about the Bible and circumcision here.

Which leads us to the next reason to circumcise an infant...

Personal preference for the appearance of the circumcised penis:
When stated this way, it sounds almost petty. "I just think it looks better, so that is why I had my son circumcised." Sometimes it is said this way, too, as if it is okay to surgically alter a baby's body so that its appearance fits the parents' norm. If they are not used to seeing the intact penis, then sometimes parents are uncomfortable with it and base their decisions on what they know.

This often comes across in statements such as:
"We want him to look like his father."
"We want him to look like his peers so he won't be teased in the locker room."
"We want him to look normal."
"His older brother(s) is circumcised, and we want them to look the same."

But should it really be someone else's choice as to how his anatomy looks?

Let's look at the first statement, wanting the boy to look like his father. Sometimes people are concerned that the son will notice a difference and ask questions. Often situations are imagined where father and son would be comparing their anatomy. Well, I don't have any sons yet, but I do have three little brothers and a father, and I can honestly say that none of them ever compared anatomy with their dad. If a child did notice a difference, a simple answer of, "When Daddy was born, they thought it was better/healthier to cut off a part of the penis. We now know that it is not healthier, so we did not have a doctor do that to you when you were a baby." Furthermore, if a son is comparing his genitals to his dad's, circumcised or not, he is likely to notice differences. A grown man and a five year old have many bodily differences and I don't think I have to go into any details here because I am sure the readers can come up with some differences on their own. There are many parts of the anatomy that don't always look just the same - if a father had lost his finger to amputation, we certainly wouldn't have his son's finger removed so they could look alike, would we? And the difference in the fingers would be far more visible than the differences in the genitals!

The second part, about being teased in the locker room... of course, nobody wants their child to be teased. But how likely is this to happen? In the midwest, where the circumcision rate is still very high, I would say it may be likely to happen. However, the percentage of male infants being circumcised is now close to half, so it is really quite likely that there will be nearly as many intact boys as circumcised ones in the locker room. I have heard from males that yes, locker room teasing did happen, and I have heard from others that no, it didn't because you'd get teased if you were caught looking at another boy's genitals! Teasing or not - bottom line is that some kids will always find something to tease about, and should that be the justification for whether we have surgery performed on our sons? Would we allow a seven year old girl to shave her legs and wear makeup to avoid being teased by peers? Would we allow a 13 year old to get nipple rings and tattoos? If a boy was being teased about the size of his genitals, would we allow him to have surgery or take steroids to remedy his being teased? If a daughter were to be slower in developing and was being teased for being flat-chested, would we give her breast implants? Another thing to keep in mind... if a boy is teased about his intact penis so much that he wishes he were circumcised, then he can always get circumcised (if his parents will take him to have it done, or once he becomes of age and can go have the surgery done as an adult). If a boy is teased or otherwise unhappy about being circumcised, he cannot just go get his foreskin restored. (of note: some men do try to "restore" their foreskins, but this is just stretching the skin that is left and is thus not the same as having the original foreskin)

As for wanting him to "look normal," this again goes back to the growing number of intact boys nowadays. Circumcised is no longer necessarily "normal." In fact, the norm worldwide is not circumcision. It is rare in most countries, including European countries. It is most common in Jewish and Muslim-populated areas, but this is for religious reasons and is not the same as how circumcision is relatively common in the US as a non-religious procedure. However, I have heard of people saying/writing that leaving the baby intact is just "gross" or "ugly" or "weird-looking." I am trying to write this in as tasteful and respectful way as possible, but to this reasoning I say - how shallow! How ignorant! To alter a baby's natural, healthy body because of a misguided perception of appearance... this baffles me. Who is to say that any natural, normal part of the body is ugly or gross-looking? Are girls' ears "ugly" until they are pierced? No, of course not - they just look different before they are pierced (different AND normal!). Just as some people think breastfeeding is "weird" or "gross" because they are used to seeing babies fed with bottles, some people also think this about intact boys - for the same reason, because they are only used to seeing circumcised boys. As the percentages change, hopefully this perception will follow suit.

So, what about having an older child who is circumcised and then re-thinking this decision once the second (or third or beyond) son is on the way? Many parents feel like once the first one is done, then they all have to be done - like it would be hurtful to their circumcised child to not be the same as his younger brother. Again, in that case, if it even comes up as an issue between the boys, "When you were born, we thought that circumcision was best for you. We got some new information by the time your brother was born, and we realized that it is not necessary to do. We are sorry we didn't have that knowledge when you were a baby." Siblings don't all look exactly the same... it is okay if they have some physical differences! Off the top of my head, I can think of two families I know personally where the older sons were circumcised and the younger sons left intact. There are many more stories I have read. It has not created any issues for these families.

Perceived hygiene reasons:
This one is sited relatively frequently. Unfortunately, it is mostly perpetuated by the myth that you have to clean under the foreskin of an infant. Not true!!! Remember what I said earlier about the foreskin being fused to the glans at birth? For several years, the foreskin does not retract naturally because of this. It is made this way for a reason - protection. Also, the boy is not ready to use his penis for sexual functions, so there is really no need for the glans to be visible at all. Some boys do not have retractable foreskins until late adolescence.

Therefore, the cleaning instructions for an intact infant are: clean what is seen. Don't try to force the foreskin back - this is painful and can cause damage! The urine is sterile when it leaves the body and thus causes no hygiene issues for the boy - it is not poor hygiene to not clean the glans when it cannot even be seen yet. Once the foreskin becomes retractable, a boy can be instructed to pull it back and rinse it with water when he takes a shower. No other cleaning is required.

Some people argue that it might be hard for a boy to keep himself clean once his foreskin becomes retractable. This argument never seems to be given for girls... the female anatomy would be easier to clean also if it were circumcised (and yes, some cultures practice female circumcision). It is also hard to clean one's own back, under the fingernails, and in the navel. But we don't routinely amputate these body parts for reasons of it being difficult to care for properly!

Perceived health benefits:
This is the reason which is most controversial. Currently, no health organization in the world recommends RIC. The health benefits of circumcision are slim to nil. The only one that seems to hold true is that intact boys are at a very slightly increased risk of UTIs in the first year of life only than their circumcised counterparts. Likewise, baby girls who are circumcised have a lower risk of UTIs in the first year (and this risk is actually larger for females - yet we don't routinely circumcise them here, and in fact, it is illegal!).

There are some studies which claim that circumcised men have a lower risk of HIV/AIDS. These studies were done in Africa, where AIDS is very prevalent. However, these studies were done on men who were circumcised as adults and not infants. There were many issues with the studies which may have skewed the results as well, such as the circumcised men in the study being told to abstain from sexual relations for longer period of time than the intact men. Also looking at the relatively high rate of AIDS in the US along with the relatively high rate of circumcision among the current adult males here... and the lower AIDS rate in many other countries who have lower rates of circumcision... see the point? Circumcision may not really reduce the rate of AIDS infection at all. Here is another link full of studies and how their flaws.

Now, even if the studies showed beyond a shadow of a doubt that circumcision was directly related to a reduced AIDS transmission rate in adult Africans, would that justify performing RICs on American infants? That would be akin to giving the controversial HPV vaccine to all infant girls in an effort to protect them from some STDs. Baby boys are at an extremely low risk of getting AIDS through sexual means. So even if circumcision afforded them with some protection against AIS, it would not be until much later in life!

There is also some evidence that removal of the foreskin can be linked to a very, very slight decreased risk in penile cancer (which is a rare form of cancer). However, studies again may have been flawed. Even if the very slight reduction in risk was able to be proven, penile cancer is so incredibly rare to begin with (more males get breast cancer than penile cancer) that the risks associated with circumcision are not worth it.

The clincher on this for me was the following: Why perform surgery to remove a healthy, functioning part of the body, even if done as a preventative measure for something that could potentially occur in the future? The percentage of men who have medical problems related to their foreskins is very small... well over 90% of intact men have no problems with it at all, ever. However: do you know what the breast cancer rate is for females? One in eight women will develop breast cancer - one in eight. Breast cancer is a serious cancer, too... it kills, and it is common. But do we routinely amputate the breast tissue from young girls in an effort to reduce their risk of developing breast cancer later in life? No! We wouldn't even do this in infant girls whose families have a high incidence of breast cancer. To do so would be considered unethical. So why, then, do we justify removal of a part of the baby boy by saying that it might be decreasing his risk for some sort of health issue later in life?? This is the big "aha" to me... the number one reason to leave a baby intact. There is no other healthy body part on a newborn baby which we amputate for the reason of slim potential health reasons down the road.

This leads us right into the next reason given for circumcision...

Because it is better to do it now when he can't remember than to have to have it done later in life:
This reason is cited often by people who know somebody who had to undergo circumcision as an older child or an adult because of some problem with the foreskin. Their rationale is that it is better to perform the surgery on a baby who can't consciously remember it than on an older child or adult who will have lasting memories of a uncomfortable surgery. In fact, it used to be thought that newborns felt no pain, and thus needed no anesthesia during a circumcision (and sometimes they are still not given pain relief during the procedure to this day!).

So, are there really a whole bunch of males who had to undergo circumcision later in life? It seems like many people at least know the horror story from a friend of a friend on this topic.

If left alone, the intact penis will develop normally and will rarely have any issues which need to be treated medically. However, since circumcision was so common in years past, many doctors didn't know how to care for their intact patients. Many parents didn't know either and thought that the foreskin had to be pulled back from an early age in order to properly clean the area. When young boys are forcibly retracted, damage can be done which can cause scarring and lead to later problems. Sometimes these problems are so great that circumcision is necessary. This problem could be prevented if more people knew how to care for intact infants. Many parents today are hyper-vigilant about this, making sure that their doctors and any caregivers of the baby know not to try to pull back the foreskin at all. How many of these older boys and adults had to be circumcised due to damage done by early forced retraction??

Then there is also the issue of doctors recommending circumcision before trying less invasive measures. If a doctor is much more familiar with circumcised patients, then he may not know of alternative ways to try to solve problem with the intact foreskin. A doctor may go straight for a circumcision recomendation rather than trying, say, a topical steroid cream first.

All in all... the number of older males actually requiring circumcision is smaller than what is seen. It could be made a very small number indeed if people would learn more about caring for the intact penis properly - just clean what is seen and never forcibly retract!


So...................................

What reasons are there then to leave male infants intact?

Because the procedure is painful
Sometimes infants are given pain relief, but often they are not. Some people say that circumcision is not a big deal to the baby because, after all, some actually fall asleep during the procedure. In truth, falling asleep during a painful procedure is an escape response, a shutting down. When infants have trouble coping with a stressful situation, sometimes they fall asleep to "escape." Even with effective pain relief, the raw wound is still there when the drugs wear off. Remember that the foreskin is fused to the glans and had to be torn from it before it can be cut off. Ouch! Often, babies scream when urinating for several days because of the burning sensation on the fresh skin of what was intended to be an internal organ.

Because the procedure causes early separation of baby from mother
As with any medical procedures, early separation of mother and baby has the potential to interfere with bonding. The early days are important for establishing breastfeeding and in the baby becoming acclimated to life outside the womb. His mother is all he has ever known. So, whenever possible, I feel that those early days should not have any unnecessary interference.

Because circumcision is a cosmetic surgery
Neonatal circumcision is the most common surgery done in the US. Most people do not think of it this way, but circumcision is actually a cosmetic surgery. When it is not done for medical or religious reasons, then cosmetic is the only thing left. I would guess that nearly all people would answer "no!" to the question, "Would you agree to having cosmetic surgery done on your newborn before he leaves the hospital?" Looking at the words separately: cosmetic has to do with the outward appearance. Newborn babies are beautiful and created in God's own image. Their looks need no alterations - they are already perfectly made this way! Many people tend to describe their newborn babies as "perfect" when they look at them for the first time. So thinking about their appearance being anything less than perfect is a bit odd to me. Then the second word, surgery... this is not a word that parents want to think about in relation to their new baby! Surgery means that something is wrong and needs to be fixed. And no parent wants their newborn to undergo unneeded surgery, and even when surgery is necessary, parents feel concerned and worried about it. Most people do not think of circumcision as surgery. However, it is clearly a surgical procedure - it is an amputation. And it is not just a tiny piece of skin as many people believe. The foreskin makes up a large percentage of the skin of the penis (anyone have a link to the approximate percentage which I cannot remember offhand?).

Because circumcision carries risks
This follows the discussion of surgery well. As with any medical procedure, circumcision carries risks which range from discomfort and poor healing all the way up to accidental amputation of the penis and death! Every year there are a few deaths of infant boys as a result of complications of their circumcisions. Deaths! How could even the perceived benefits outweigh this risk? Nobody has ever died as a result of remaining intact! There are also cases of boys having so much damage done from botched circumcisions that they are permanently disfigured or lose part or all of their genitals! Just a few examples.

Because the foreskin is a healthy, functioning part of the body, not a birth defect
There are some myths about the intact penis - that it is not healthy and that it serves no function anyway, so what is the big deal about cutting it off? Well, we don't remove the appendix of infants unless it becomes infected and unhealthy, even though it serves no purpose. Many people think the foreskin is like the appendix and is unnecessary and serves no purpose. In truth, the foreskin is a protective body part, causing the glans to be an internal organ. Further, the foreskin is full of very sensitive nerves that are designed to aid in sexual intercourse. The glans of the circumcised penis is constantly exposed to the elements, to having clothing rub against it, which causes callousing and desensitizing. More details on this can be found here.

So.............
We have explored the arguments for and against circumcision. But what about other issues that may come up when deciding whether or not to circumcise a son?

When one parent disagrees
It is typically the father who disagrees and wants his son circumcised - usually because he was circumcised and so he thinks his sons should be as well. Sometimes it is the mother though who wants the circumcision and the father wants his son to remain intact. Either way, this can be a very difficult thing when the parents are in opposite camps. Obviously, the ideal thing to do would be to discuss and research this ahead of time, early on in the pregnancy (which is why I have looked into it so much - I researched before I knew that Cecilia was a girl!). Of course, this is not always possible, especially when many people don't even think about circumcision as a decision... they view it as just "what is done" and don't even consider that they have a choice. I hope that in my writing this, somebody is able to read it and decide to think about and read up on circumcision well ahead of time and be able to discuss it with the other parent and hopefully come to an agreement.

For people who are in this tough situation of disagreement, I can say first that I am sorry and that it must be difficult to feel so torn between wanting unity in the relationship while also wanting to do what you feel is best for your child. Perhaps if both parents agree to do some research and thinking on it, they can have discussion on what they see as the reasoning and rationale behind their choice. I have read of some parents who come to the decision to leave their son intact since it is the default - it is not really making a choice because it is just doing nothing, leaving it alone, whereas circumcising is actually taking a physical action. remember, circumcision can always be performed later in life, but you can never get your foreskin back once the decision is made for it to be cut off! For the parent who opposes the circumcision, it may be a better approach to take to be neutral than opposed: "I think we should just let it be. I don't think anything should be done."

If anyone has struggled with disagreement between spouses over this and would like to share your perspective, please do feel free to do so.

You may be wondering, why did circumcision become so popular as a medical procedure in the US anyway? What is the history? Well, just briefly, circumcision was thought by doctors in the 1800s to cure a variety of ailments, from cancer to insanity. It was also done in an effort to deter boys from masturbating. At one point it was done for status (the wealthiest people could afford circumcisions). Of course, it didn't cure the medical issues that doctors claimed it did over 100 years ago, and so it has never really had medical benefit. But the trend continued nonetheless. For more info on the history of circumcision in the US, click here.

I said I would say a bit about why my "short answer" at the beginning of this post was actually not humorous... and that is because female circumcision is performed in many parts of the world. It is a common tribal practice in many places. Most Americans would be aghast at the thought of females having their genitals mutilated in tribal ceremonies. However, female circumcision - often referred to as "female genital mutilation" - is illegal in our country. Perhaps male circumcision should also be illegal then? Why are girl infants protected and boys are not? Why is circumcision of males not referred to as "male genital mutilation"? I cannot say that I would agree to RIC of males becoming illegal... but I am pretty darn close. Because it is done as a Jewish religious rite, I have trouble saying that it should be outright illegal, but then I also think... some religious practices say that it is acceptable to have multiple wives, yet polygamy is illegal in this country. That is not because we are discriminating against a religious belief. And so neither would outlawing RIC be discriminating. I am pretty much as conservative as you can go on protecting individual freedoms and such, including parental rights (like the right to home-educate our children!)... but what about the baby's rights? Like I said, I am really, really close on this one...

I will close with this: leaving a baby intact is the default and the norm. By choosing to do nothing, nothing has been changed, no harm has been done, there is nothing done that cannot be reversed or changed in the future. I think this is a topic that has far too little attention by doctors and parents alike. It needs to be brought to the attention of parents-to-be so that they can make informed decisions. So please, encourage people to do their research and to consider this before making an irreversible decision. I hope that something here has been useful for a future parent of a baby boy. And if you made it all the way to the end, then wow! Thanks! ;) And as always, if I have missed anything or left questions, feel free to ask away!

For additional reading:

The Case Against Circumcision
This one is excellent. If there is only one link you read, make it this one.

Daddy, Why is Your Penis Different from Mine?

The Unkindest Cut (a video - contains good historical info)

Circumcision Choices (shows the differences between Old Testament Biblical circumcision and the newer methods)

A Catholic Priest's words on circumcision

Penn & Teller on Circumcision (FYI, they are crude and use vulgar language, but their message is good)
Part 1
Part 2
Part 3

And a short clip from one of the above segments regarding to what happens to the foreskin after it is cut off... I didn't even go into this, but it is unethical and a money-maker:
Who Buys Foreskin Cut Off from Babies?

Protect Your Uncircumcised Sons

Why do I...

...nurse in public? Why don't I avoid nursing my children in public by waiting until I am in a private place, or by trying to schedule nursings so they don't happen when I am away from home? Or why can't I just use a bottle while out?

This has been a much-debated subject. I am not sure why it evokes such controversial debates among people... I can think of much more controversial subjects myself! The arguments typically go like this: One person speaks about the right to nurse in public, and the other starts talking about women "whipping it out" to feed their children. Then we get into the "I don't want my kids to see that!"and the "why can't you just go into another room/the bathroom/your car/somewhere isolated?" Then it gets really ugly when people begin comparing nursing to other bodily functions such as urinating.

So... I nurse my babies in public because that is how I feed them, comfort them, and mother them. I do in public the same as I do in private (although I tend to be less discrete when in the privacy of my home). Nursing is how I feed my babies. If I happen to be grocery shopping or dining out or at a park where my older child is playing when the baby gets hungry, then I nurse. Babies get hungry fairly often... and breastmilk is designed to digest quickly, so a breastfed baby may get hungry every two hours whereas infant formula is designed to fill a baby up for longer - it is made of cow's milk, which contains different proteins that are not as rapidly digested. So, especially with babies who are not eating much solid food (ie, babies under a year old in many cases), they will often need to nurse if mom has more than one or two errands to run or needs to be out for a few hours or more.

Mothers who bottle-feed their children in public are never questioned about this... nor are mothers who give their babies pacifiers in public in order to comfort them. Breastfeeding mothers are actually protected by law in most states so they will not be able to be charged with indecent exposure for breastfeeding. Frankly, I think that is sad that we have to have laws to protect a mother's right to feed her baby in a restaurant! Bottle-fed babies don't need such a law... nor do people who are fed through feeding tubes. It is recognized that they must eat, and so it is obvious that it must be legal for them to eat in "alternative" ways - by this I mean rather thn eating solid foods with a fork and spoon. But a breastfeeding baby is seen as different - why? Because breasts are seen as purely sexual body parts. Their functional main purpose is overlooked and all some people can see is, "Oh my goodness, I see some skin!!"

Most mothers who nurse in public are so discreet that you'd not even notice them unless you knew what to look for. A lifted shirt covers the top of the breast, the baby's head covers most of the rest of the breast, and the baby's body covers the rest. I have had people come up and say, "Oh, how sweet, she's sleeping!" when my baby was actually breastfeeding - and they didn't even notice I was nursing, or they only noticed once they leaned over closely and were two feet away from my baby's head. Often these people will say, "Oh, I didn't even know you were nursing her!!" They will sometimes apologize, thinking they have invaded my personal space - it doesn't bother me, though, because all they saw was a sliver of skin. Contrary to some belief (media-induced in many cases), one does not see nipples when women breastfeed in public... unless one happens to be looking very, very closely or happens to glance over at a mom who is having a brief fumbling moment, perhaps with a new baby and she is still learning the ins and outs of nursing.

So, the baby is just eating. Therefore, this should be allowed in all places a bottle-fed baby is permitted to eat. This should especially be permitted in a restaurant, where everyone is eating! This tends to be a place where women are often confronted with complaints about their babies nursing. I find this very strange, especially when it is suggested that they go to the bathroom to nurse... who would want to eat in a stinky bathroom? Who would think it's a good idea to bottle-feed a baby while sitting on a public restroom toilet? So then why should a breastfed baby have to eat in that way?

So, here's where we get into the part about bodily functions... often people who oppose nursing in public (NIP) will say something along the lines of, "Sure, it is the natural way to feed a baby, but there are lots of natural things that we don't do in public. I wouldn't urinate or defecate or have sex in public!" To compare breastfeeding to any of these things shows some ignorance on the subject. First off, on the bathroom functions - the reason those are done in private is because of sanitation. It would be unsanitary to urinate or defecate in the middle of a shopping mall, would it not be?? It would also smell awful! Breastfeeding a baby does not smell bad (although formula-feeding one does!), nor does it present a health issue... it is perfectly sanitary to nurse a baby in public as no milk comes in contact with other people... it is directly transferred to the baby's mouth! Even if some breastmilk were to spill somehow (perhaps likely if expressed and in a bottle but much more unlikely for it to spill onto the floor out of the breast!), it is not along the sames lines as urine or feces... it is not unsanitary. It doesn't carry diseases like blood could, it is not unclean like it would be if somebody defecated on the floor... human milk has actually been used to kill cancer cells! It has many, many properties, but being unsanitary is certainly not one of them!

So, what about the people whose sensibilities are offended by the possibility of seeing a little bit of cleavage or something while a mother nurses her baby in public? Or people who "don't want their children to see that"? Well, what if I don't want my kids to see bottle feeding? Or public displys of affection? Or people cussing at their children in Wal-Mart? Or people smacking their kids in the grocery store? Or people whose underwear is showing because their pants are down almost to their knees? Or girls whose shirts reveal a lot of cleavage (for no purpose other than to show it, I might add, and not to perform some function such as nourishing a baby)? My point is, people do lots of things in public, and maybe some of them are things we'd rather not see. I would rather my children don't see parents cussing at their children in Wal-Mart (And so I avoid taking my children to Wal-Mart!), but it is not something within my control. If people who are uncomfortable with nursing in public (because they have been taught indirectly to view breasts as merely sexual and therefore inappropriate to show at all in public - or even to use in public, as the case may be, since they are rarely showing while a mother nurses; it's just the knowledge that they are uncovered and being used nearby!) could understand that a mother is just innocently feeding and comforting her baby, and she is not intending to be gawked at or make a scene, then perhaps this would not be an issue. It would also not be an issue if breastfeeding were more common in general in this country. If people grew up around breastfeeding, with it just being a normal part of life that is seen regularly, then they would expect it rather than be shocked by it.

So another reason I NIP - rather than trying to go hide in another room - is because I want it to become seen as the norm. I want people to see breastfeeding more often so it doesn't seem so foreign to them when they have their own children! I have seen two people ever nursing in public in my town since I became a mother... only two. I cannot count how many babies I have seen how were given bottles in public, because that number would literally be in the thousands. So people think bottle-feeding is normal, and the proper way to feed a baby, because that is what they see so often. Believe it or not, this can be part of what influences them to breastfeed their own babies or not.

This also causes people to be much less understanding of a breastfeeding mother - why she can't just leave her baby at home, why she can't just bring a bottle either of expressed breastmilk or formula for when she is out, why she can't just make the baby wait a bit or go to a secluded spot... I will try to cover these one by one below:

Why can't a mom just leave her baby at home while she goes out for awhile? Mostly, this is due to supply and demand. A mother has to nurse her baby frequently - especially in the early weeks - in order to produce and maintain an adequate supply of milk to meet her baby's nutritional needs. If a mother skips feeding her baby and somebody at home is giving the baby a bottle instead, then her milk supply can suffer, particularly if this happens more often than just occasionally. Also, mothers who are breastfeeding do have hormonal factors at play... the hormones present can cause strong emotions about being with the baby. It is not easy for a breastfeeding mother to leave her baby - physically or emotionally!!

Why can't a mother just bring a bottle to feed her baby when she is in public? Well, part of this can be answered with the above paragraph. If she gives the baby a bottle in place of nursing him, then a mother may compromise her milk supply, especially if the baby needs to eat several times while they are out and the mother gives him bottles each time. The mother can also become painfully engorged due to not removing milk frequently, and this can lead to health problems in the woman - namely, breast infections. I actually read one person's thoughts that a mother should bring bottles for the baby and a breast pump for herself when out in public - that she should feed the baby a bottle first and then find someplace private to pump while out in order to maintain her milk supply and not become engorged. How over-complicated is that??? It is just one of the sacrifices of choosing to be a parent, this woman wrote. Sure, there are many sacrifices involved with becoming a parent, but I think this is one that is societally-imposed. People from other cultures in which breastfeeding is a common sight would probably not even be able to understand the rationale behind doing something like this!

Another thing about mothers just bringing a bottle... this may just not be what they want to or are able to do. Mothers have the right to feed their babies only with bottles, so how about it going the otherway, where mothers have the right o only feed their babies at the breast? There are many reasons a mother may want to do this... we hear a lot about possible toxins in plastics, so a mother may want to avoid using bottles for this concern. She may want to avoid them because the bottle nipple has been shown to cause tooth alignment problems in some cases, particularly in older babies and young toddlers. Perhaps a mother cannot afford bottles and a breast pump. Perhaps the mother has had problems maintaining her milk supply in the past and would not want to risk anything else that might lessen her supply? Perhaps the baby wouldn't take a bottle at all and the only way he will eat is at the breast? There are babies out there who completely reject bottles!

Why can't the mother just wait a bit to feed the baby? This is hard for a mother who is feeding on-demand or on-cue. When a mother does this, she is reading her baby's hunger cues and feeds him when he first gets a little hungry so he doesn't get so very hungry that he is inconsolable. Crying is a late hunger cue. Often a baby who has only begun to fuss a little can be consoled by being fed right away, whereas waiting another five minutes could result in a full-scale meltdown. Nobody likes to hear a wailing baby in the store or a restaurant, although the sound is quite common. A baby who is given the breast is typically consoled... his appetite is satisfied, he is comforted and "pacified" by the breast... so he is quieter, draws less attention to himself and that his mother is nursing... and other people can enjoy their shopping or dining with minimal disturbance from crying. Of course breastfed babies may cry at times too, but most are quickly silenced when given the breast... often they will nurse to sleep! So, most patrons of a restaurant would be inclined to support a mother breastfeeding her baby, right? And when the bottle is empty, that is that... but a baby can continue to suckle at the breast for comfort after he is full, and he can remain content.

And why can't the mother go to a secluded place to nurse? There are times when a mother may choose to do this... when it is more convenient to nurse in her car, when the baby is less distracted if she goes to nurse in a dressing room in the mall, if the mother is unsure of herself in those early months of nursing and desires a little more privacy while she is figuring out how to nurse - these are some reasons mothers may choose to leave busier public areas. But what about mothers who have more than one child? This argument often comes from people with few or no children. They do not understand that if you are eating in the mall food court with your baby and two older children that you cannot just pack up the kids and all their food and hike off to the bathrooms to nurse because your baby is about to have a screaming meltdown. Likewise, if your older children are on a playground, you have to stay nearby while nursing so you can supervise them. If an older child is in some sort of performance or sporting event, then a nursing mother may have to feed her baby while she cheers on her older child.

Personally, I would find it difficult to bear if the people I was around asked me to go into another room to nurse. We are social creatures and are designed to be in the company of other people. When we get together for social events with family and friends and then are made to spend half of our time alone in a back bedroom rather than out socializing and enjoying the merriment, then that can be very difficult. I don't want to miss out on the Thanksgiving meal, the opening of Christmas gifts, the story-telling and reminiscing of family members, the quality family and friend time. I can nurse while I talk, play a board game, open Christmas gifts... I can remain a part of the family. Many women quit nursing because they feel isolated... not only do they not know many other nursing moms, but they are isolated in that they feel like they have to go hide every time they nurse, even in front of their own parents or children - or even in front of their husbands, which I have heard of happening (rarely, fortunately!).

Disapproval of NIP is just another hindrance to mothers' success in nursing their babies. When they are made to feel guilty or dirty about it, when they are inconvenienced and isolated, then they are less likely to stick with it. Babies deserve to eat and be comforted no matter where they are and what other people think! And babies usually can't "just wait!" They have no idea of the societal views - they just want to be fed and held close!

I am not sure I covered all the aspects of this much-debated topic, so feel free to leave a comment if I missed something!

Update: More comments on being discreet and covering with a blanket in the comments...

Why do I...

... let my babies feed themselves solid foods? Why don't I buy, or at least make, baby food? Don't babies need to start with purees? Don't babies need the extra nutrition from baby food, and how will they get enough by self-feeding?

Short answer: Because I'm lazy and cheap. ;)


Okay, so letting a baby self-feed really is much easier, that is for sure. You don't have to spoon-feed the baby first and then feed yourself, or alternate between the two. Everybody eats together, in a social family setting. I like that aspect of it.

The main reasoning for me is this: breastmilk should be the main source of nutrition for at least 12 months - that's right, 12 months! - of a child's life. If a baby is being formula-fed, it should also provide the bulk of the calories received in the first year. Solid food is for learning, for experimentation, and for a bit of nutrition. But it should not be replacing large amounts of nursing time. Breastmilk still provides the most crucial, specially tailored nutrients and immunological factors for a baby. Breastmilk can easily sustain a child completely for his first year of life... it sure did for my first child, who didn't eat hardly any solid food until she was over 13 months old!

In our culture, it is considered the norm to begin solids at either four or six months, regardless of baby's readiness signs. Parents are often made to feel that their baby must eat purees right at this age, and that if they do not, their baby might not get enough nutrition. Many people recommend rice cereal at age 4 months - which really has little to no nutritional value and is just a filler than can actually cause constipation issues for babies.

If you walk down the baby food aisle in a grocery store, you will see all the foods: purees, chunkier jarred foods, finger foods marketed specifically towards babies, juices, and now even toddler meals and snacks. Don't even get me started on the toddler snacks - why can't a toddler just eat crackers and rice cakes and diced fruit that older children and adults eat? Anything to make money, I guess... I have even seen juice containing "less sugar" marketed to young children - and guess what, it is half water, and it costs more than the full concentrated equivalent! Why not just water down your own juice at home? Again, it's all in the marketing... it says "For Kids" on it, so it must be more appropriate for them and we'd better buy it!

So... following biological norms, a baby is breastfed on demand, meaning whenever he is hungry or wants to nurse for comfort or whatever, and this continues at least until he is well into solids at age 12 months or older. The baby then is assured of getting the proper nutrients he requires before too many of them are replaced by solid foods. His system can gradually get used to the new foods while he is still nourished in the best way.

So, some of the readiness signs for solids: baby can sit unassisted or with little support, can hold up his head well; baby is approximately six months old; baby is developing the pincer grasp - that is, the ability to pick up small objects between thumb and forefinger, and baby can bring objects to his mouth; baby has lost the "tongue-thrust reflex" in which he involuntarily pushes foreign objects out of his mouth; baby has the ability to turn his head away to show he is full or uninterested in the food; baby has gotten a tooth or two.

I was so glad to know that last one... when Caroline still had no teeth at age one, I could still rest assured that her digestive system was going to be a little slower to develop, and I didn't have to worry that she would "never eat." Other people tended to be amazed (in a bad way!) that she wasn't eating anything once she was over six months old. I would have been concerned as well if it hadn't been for the support from La Leche League and our pediatrician not being worried about it.

At first glance, purees seem developmentally appropriate... a baby hasn't eaten any solids before, so you wouldn't want to start with a huge hunk of parmesan cheese, right? Of course not. But it is possible to skip most or all of the purees if you wait until the baby is over six months. Once the baby is able to pick up foods and bring them to his mouth, you can start finger foods. These must be small and mushy at first... ripe banana and avocado are great first foods. They can even be mashed a bit if baby seems to have trouble with small chunks. There is even one line of thinking that babies can be given large chunks and can nibble off small bites, as long as they are watched closely in case of choking. I gave my second child large pieces at about eight months old and she handled them well. I also gave her small pieces, and she was able to practice fine motor coordination while picking them up.

I love the idea of the baby being able to control how much he eats. This can happen with spoon feeding as well, but it is easier to overfeed a baby by spoon than it is to overfeed him by letting him feed himself! Especially with a baby under six months old, he may not indicate when he is feeling full. Parents sometimes feel the urge to get the baby to finish off a jar of food or to eat "just one more bite," especially if they have been feeding out of the jar (because you are supposed to throw the rest away if you have been spooning directly out of the jar).

With self-feeding, the baby can begin to experience the family's "real" food rather than purees that nobody else is eating. The baby can take part in the family act of eating the meal, and he can have bits and pieces that are appropriate for his age, or he can have some plain fruits and veggies taken from the main meal if he cannot eat all the foods offered (such as dairy products, which are not recommended until ages 9-12 months). The baby gets used to the form of the foods and how they look and taste rather than to the feel and taste of pureed foods.

I think the baby food market really got into the swing of things when infant formula became popular. Measuring and accounting for what baby took in was seen as the "scientific" way of doing things. Also, with the idea of trying to get babies to become more independent sooner, feeding them "meals" at earlier ages has become common. They do not need solid food purees for nutrition, yet much money is spent on these things by many. I bought one jar of pureed prunes once (Cecilia had eaten a lot of banana as one of her first solids and was a bit constipated!), and that is all the baby food i have had to buy, ever, for two children. I love that I have not had to spend the money - it just hasn't been necessary! Many things that are marketed for babies and toddlers just isn't necessary - and if babies don't need any nutrition from solids until they are old enough to eat actual foods rather than purees, then they are not necessary. They can just earn about foods and learn about feeding themselves by experimenting with bits of real food. A banana, an avocado, a little container of peas, some O cereal - all can easily be tossed into the diaper bag for convenience for a baby who might need to a little food to play and learn with while the big people are eating a meal out.

Now, I don't mean to sound like people should never spoon-feed their babies... if the child is lunging for your applesauce or yogurt at age 9 months, it is probably a good idea to hold the spoon for him at first. There are some foods that adults eat in pureed form, after all, and we require a spoon to do so! Once a baby is close to a year, he really can control a spoon decently if given the chance to practice a bit, especially with something thick like yogurt before moving on to watery soups.

Self-feeding encourages a baby to move toward independence, but at his own pace - not in an effort to fill him up on solids, but in a way in which he can control what he is eating - just as he does when he nurses. Breasts do not have lines on them marking how many ounces the baby consumed... so in the same way a baby regulates how much he takes in at the breast, he can do the same if allowed to self-feed.

I really like the above-linked article for good info on this topic... it is what first opened my eyes to this way of baby-feeding. As with many things for me, I am skeptical of the cultural way of doing things and of marketing techniques for more products than just baby-related ones... I tend toward the "is this really the way nature intended it to be?" and "is this necessary, or can I use my money better somewhere else?" when it comes to choices I make about my babies. I try to stick to doing things as close to naturally as possible overall, and baby self-feeding seems to fit in line with that.

photos are of Cecilia's first self-feeding attempts around seven months of age