SUA Single Umbilical Artery

SINGLE ARTERY UMBILICAL CORD

About 30 years ago, a baby boy was born at home in a town about 90 minutes drive away from where I lived in Vancouver, BC. All was normal with the birth (first baby for the family). The baby was about 8 pounds and he seemed healthy.

I was taught to inspect every placenta carefully at some point in the hours after birth. One part of the placenta exam was to look at the cut end of the umbilical cord and make sure there were 3 little openings where the 2 arteries and one vein were. Remember, this was in the days pre-internet. Midwifery training was accessed by reading thick obstetric/midwifery text books in those days. This little boy’s umbilical cord had only 2 vessels. Oh no. Where was that third little opening for the second artery? I re-cut and peered at the end of the cord but, no, only two vessels. The only instructions in any of my textbooks about that possibility were to “call the pediatrician”. So, I did. At that time, we had a kind pediatrician who always took calls from home birth attendants. When I told him the situation, he said “Hmmmmm, I don’t know what that means. Could you go in to Children’s Hospital to the library and look it up?” I didn’t like to leave the family’s home without knowing for sure that the baby would be okay and I had that 90 mins between their home and the hospital library. I decided to call a friend who was a long time hospital nurse. She didn’t know either but thought it might have something to do with the heart. The baby wasn’t showing any signs of blueness around the mouth and was a keen breast feeder so, I didn’t see or hear any heart problem indicators. After a few hours, I headed back to town and went straight to the Hospital Library.

Vein larger than the 2 arteries

In those pre-computer days, the hospital Librarian was a God-send. She was very helpful and looked up a bunch of articles for me but they really didn’t tell me much more than “it could mean a kidney problem”. I was feeling frustrated but, then, got an idea. I could find the pathology department in the hospital and speak to a person who had seen babies with kidney problems and maybe get some useful help.

I was a bit nervous going to Pathology because I was afraid I’d see dead bodies but, no, the place was clean as could be. The Pathologist was glad to see me and have someone to talk to. (I think that’s a lonely job). I told him what was going on and the first question he asked was “How much did the baby weigh?” He then told me that babies with kidney problems tend to be very small so he doubted my finding that there were only two vessels in the umbilical cord of an 8 lb. baby. He suggested that I should bring the placenta in so he could take a look. I wasn’t relishing the 90 minute drive back and forth again but I was more than willing to be wrong about my count of the vessels if it meant I could relax about the baby.

One vein, two arteries

I returned to the family home, got the placenta from the fridge and drove it back to show the pathologist. He cut the end of the cord on his marble slab and peered at it and then said “Well, I see what you mean. There are just two but can you see that the vein, which is usually larger than the arteries, and the one other vessel are both about the same size? I think what happened here is that the two vessels grew together. If the baby is pee-ing normally and eating well, I don’t think you have anything to worry about.” He then proceeded to reach up on to his shelf and bring down a copy of a thick text book entitled “The Human Placenta”. He told me that it was a fascinating book by a pathologist who had been a veterinarian before he pursued pathology. When I expressed amazement that there was enough to say about the placenta that it could fill a whole book of its own, he said that a lot of the information was comparing the human placenta to that of zebras, gorillas, and other wild animals. Somehow, I’ve never been tempted to buy the book. . . I like to keep my placenta knowledge on a “need to know” basis.

That little boy did just fine and he’s a big man now. That’s the only 2 Vessel cord I’ve ever encountered in 1500 plus births, so it’s very rare (and, in this case, not even a real finding).
I hope this story is informative and reassuring to parents/practitioners about SUA (single umbilical artery) diagnoses in babies with normal growth.
Gloria Lemay, Vancouver BC Canada

From www.midwifethinking.com
A great blog

Breastfeeding Benefits

This is a good checklist of all the benefits that breastfeeding provides and the
risk of using any kind of subtitutes. Thanks to the California Dept of Health for
creating the poster. Gloria

Your Newborn Baby—What’s Normal?

    Parents’ Guide to the Newborn

Keep your caregiver informed of any concerns about your baby.
Phone number of dr., public health nurse, midwife, or other provider Name_______________________Phone_____________________

Your baby’s breathing

Noises such as snuffles, grunts, wheezes, etc are not a concern by themselves. Babies can be noisy breathers. They have small amounts of mucous in their airways from the birth process and they are adjusting to air breathing. It is normal for the breathing to be irregular—sometimes rapid and then followed by slow, deep breathing. When your baby cries vigorously, he/she will become redder in the face and take deep, gasping breaths. This is normal.

Concerns about breathing to notify your caregiver about are:

1. Chest retractions–if your baby draws the chest wall in noticeably when breathing and you can see the outline of the breast bone with every breath.

2. Prolonged rapid breathing–the rate of breathing in a healthy calm newborn should be about 30 to 40 breaths per minute. If the baby is doing a panting breathing when calm (60 or more breaths per minute) for more than 15 minutes, have your caregiver check.

3. If your baby seems to have worrisome breathing and blueness around the mouth, call your caregiver.

FEEDING Within 8 hours of birth, the baby should be waking to feed every two hours and latching on to the breast well. Demanding to be fed is a very good sign of health in a newborn. Your baby needs only what is in the breast, do not feed water. If baby seems lethargic and doesn’t wake to feed for 4 hours, call your caregiver immediately. This behavior might mean the baby has a serious infection.

COLOUR A small amount of blueness and coolness in the extremities (hands and feet) is normal. Some mottling of the chest and tummy is normal. Many parents are alarmed by the baby’s whole body going dark red like a strawberry, this is a normal result of changing blood circulation in the newborn. Generalized blue or gray colouring (rare) would be alarming.

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

TEMPERATURE Only take your baby’s temperature under the armpit. Digital thermometers can be purchased for about $12 at the pharmacy. If the temperature falls below 36.1 degrees Celsius (97 F) or goes above 37.2 degrees Celsius (99F), look to see if you have bundled the baby too warmly or if the baby needs more covering. Adjust the baby’s garments and recheck the temperature in 15 minutes. Call your caretaker if abnormal temperatures persist. The usual rule of thumb for baby covering is to look at what the adults are wearing and then add one more layer for the baby. The baby being skin to skin with the mother is a good way to help the baby have a normal temperature and breathing rate.

URINE The baby may only have one wet diaper per day for the first two days. Once the breast milk is in, the baby should have at least 6 very soaked diapers in 24 hours. Urine should be colourless. Some babies have crystals in their urine (orange staining that looks like face makeup) and this is not a concern in the first 3 days. After the third day, that orange staining can be a sign that the baby is dehydrated. Increase the time at the breast and advise your caregiver. Little girls may have a spot of blood in their diaper which is their first menstrual blood, this is normal. By the fourth day, the baby should have at least 6 very wet diapers per day (the diaper will feel heavy in your hand).

BOWEL MOVEMENTS In the first 24 hours of life, the baby will pass meconium (blackish, tarry stools). Next, the stools will be brownish, greenish and quite soft. Once the milk is fully in (around day 3 of life) the baby’s stools are the colour and consistency of yellow mustard. The baby should have two poops the size of a loonie (silver dollar) as a minimum every day. A well fed baby usually has much more than the minimum.

UMBILICAL CORD Fold diapers down away from the drying umbilical stump. The cord will be dry and blackened within 24 hours and the clamp can be removed. The stump usually rots off by 5 to 10 days after the birth. Don’t put peroxide or alcohol on the cord. It heals best if left alone. Because it is rotting flesh, there is usually a foul odor when it is ready to fall off and it can be quite goo-ey looking. If there is redness on the abdominal skin surrounding the belly button area, notify your caregiver.

EYES The policy in hospitals is to treat the baby’s eyes with an antibiotic cream called “Erythromicin”. If you do not want your baby to receive this antibiotic, let your caretaker know in advance and sign a waiver. Newborns can have plugged tear ducts which cause discharge to accumulate in their eyes. Bring any discharge concerns to the attention of your caregiver.

INTACT PENIS Keeping your son’s penis intact is now the recommended policy of physicians’ groups. There is no special cleaning that needs to be done. Simply bathe your baby in a warm bath and leave the foreskin alone. The foreskin is attached to the glans in babies (much like the fingernail is attached to the finger) and the separation process may take years to complete. Only the boy should retract his own foreskin, this should not be done by parents or medical professionals. For more info on caring for your intact son, there is a handy free brochure at this link http://www.nocirc.org/publish/pamphlet4.html

JAUNDICE Yellowing of the skin of the newborn in the first 24 hours of life is unusual and should be called to the attention of your caregiver.
After Day 2, some yellowing is normal. Usually the face and chest are the most yellow places on the body. The baby may be sleepier than normal with jaundice and you may have to wake the baby to feed every two hours. It’s important that the baby remains well hydrated in order to get rid of the yellow cells from the body. Let your caregiver know if you are having trouble waking/feeding the baby or if the yellowness extends out to the hands and feet.

Slightly jaundiced newborn

Slightly jaundiced newborn

Gloria Lemay, Vancouver, BC
March 2016

BABIES BORN IN THE CHRISTMAS SEASON–KEEP THEM HEALTHY

It’s a special thing to have a baby in North America at Christmas time. Photos of the new baby under the tree with the gifts, extra time off from work, a time of holiness joy and good cheer, . . . you would think it would be the ideal time to give birth. Unfortunately, many little newborns end up in hospital at this time due to the timing of their arrival.

No Finer Gift

No Finer Gift

Photo credit http://www.gracemogadamphotography.com/2015/05/08/newton-newborn-photography-william/

1. This is sugar time. The chocolate, cookies and candies are everywhere you look and sugar undermines the immune systems of the family members leading to colds and flu.
2. Staying up late. Parties given by neighbours, school, church, etc., tend to go late and the older kids in the family are affected and can get sick at this time by the late nights AND THE SUGAR.
3. The pregnant parent is either nesting in with the new baby or is hugely pregnant and doesn’t want to go to events, so the other parent takes the bigger kids and doesn’t pay close enough attention to the sugar or the late hours.
4. The children at school tend to be getting coughs, colds, flu and they spread it to the siblings of the new baby. Those older siblings sneezing or coughing on the new baby leads to trouble.
5. Christmas travel. A lot of pressure can be put on the family of a new baby to drive 100 miles (or more) for Christmas day family dinners. No matter how much the family thinks this is a good idea, IT IS NOT. The newborn should be kept warm and cozy at home because those long car trips are exhausting, no matter how much planning happens in advance. The nursing parent has to take care of her breasts/breast milk supply. All this is best done at home.
If the breast feeding gets thrown off at this season of the year, it can result in the newborn baby failing to thrive and/or the nursing parent getting mastitis, sore cracked nipples or a diminished production of milk.

What can you do to make sure that your new baby stays out of the hospital during this season?

1. Screen all visitors by asking them “Are you sure you are completely well? We don’t want any bugs around the new baby.”
2. Buy lots of grapefruit, kiwi fruit and oranges and make them the whole family’s dessert through this time. Keep a big bowl of this healthy Vitamin C-packed fruit out and visible. Keep stocking it up. Don’t bring sugar-y foods into the house.
3. If you have older kids in school, pay close attention to their diet and sleep. Keep them healthy. Both parents need to be responsible and communicate with each other about this.
4. Both parents need to watch their own health. Stay away from alcohol, take your vitamins, keep your schedule calm, have afternoon naps, avoid annoying people, etc.
4. Take a year off from the hype and pretend you’re in a stable with cattle lowing. In the big scheme of things, you’ll be glad you did. Have a really peaceful Christmas giving thanks for the miracle of your very own healthy newborn Christ child.Christmas warmth

6 Point Recipe for Making New Parenthood as Difficult as Possible

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

4 Days old and the milk is in. Continuous skin to skin in bed with mother.

1. Start with giving the birthing woman antibiotics in high doses so that the baby develops candida (thrush) and colic. Then mix in a lot of stitches, either to repair the perineum or the lower belly/uterus.

2. Separate the mother and newborn. Make the mother walk a long distance (with her stitched body) to be able to see/feed her newborn.

3. Teach her that the best (and only) way to feed her baby is to sit upright in a chair

4. Discourage sleeping together as a family. Don’t let her know that lying down to nurse will enable her (and her partner) to get much more sleep.

5. Tell her that the baby is not getting enough milk and don’t give her the tools to increase her supply.

6. Scare her into thinking that her instincts about caring for her baby are not to be trusted and that she should listen to professionals for all things to do with her baby’s health.

Vaccines and babies in NICU

Journal of the American Medical Association

JAMA Original Investigation | June 01, 2015
Adverse Events After Routine Immunization of Extremely Low-Birth-Weight Infants FREE ONLINE FIRST
Stephen D. DeMeo, DO1; Sudha R. Raman, PhD2; Christoph P. Hornik, MD, MPH1,2; Catherine C. Wilson, DNP, NNP-BC, FNP-BC3; Reese Clark, MD4; P. Brian Smith, MD, MPH, MHS1,2
[+] Author Affiliations
JAMA Pediatr. Published online June 01, 2015. doi:10.1001/jamapediatrics.2015.0418

Importance Immunization of extremely low-birth-weight (ELBW) infants in the neonatal intensive care unit (NICU) is associated with adverse events, including fever and apnea or bradycardia, in the immediate postimmunization period. These adverse events present a diagnostic dilemma for physicians, leading to the potential for immunization delay and sepsis evaluations.

Objective To compare the incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death among immunized ELBW infants in the 3 days before and after immunization.

Design, Setting, and Participants In this multicenter retrospective cohort study, we studied 13 926 ELBW infants born at 28 weeks’ gestation or less who were discharged from January 1, 2007, through December 31, 2012, from 348 NICUs managed by the Pediatrix Medical Group.

Exposures At least one immunization between the ages of 53 and 110 days.

Main Outcomes and Measures Incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death.

Results Most of the 13 926 infants (91.2%) received 3 or more immunizations. The incidence of sepsis evaluations increased from 5.4 per 1000 patient-days in the preimmunization period to 19.3 per 1000 patient-days in the postimmunization period (adjusted rate ratio [ARR], 3.7; 95% CI, 3.2-4.4). The need for increased respiratory support increased from 6.6 per 1000 patient-days in the preimmunization period to 14.0 per 1000 patient-days in the postimmunization period (ARR, 2.1; 95% CI, 1.9-2.5), and intubation increased from 2.0 per 1000 patient-days to 3.6 per 1000 patient-days (ARR, 1.7; 95% CI, 1.3-2.2). The postimmunization incidence of adverse events was similar across immunization types, including combination vaccines when compared with single-dose vaccines. Infants who were born at 23 to 24 weeks’ gestation had a higher risk of sepsis evaluation and intubation after immunization. A prior history of sepsis was associated with higher risk of sepsis evaluation after immunization.


Conclusions and Relevance
All ELBW infants in the NICU had an increased incidence of sepsis evaluations and increased respiratory support and intubation after routine immunization. Our findings provide no evidence to suggest that physicians should not use combination vaccines in ELBW infants. Further studies are needed to determine whether timing or spacing of immunization administrations confers risk for
the developing adverse events and whether a prior history of sepsis confers risk for an altered immune response in ELBW infants. http://archpedi.jamanetwork.com/article.aspx?articleid=2300376&utm_source=silverchair+information+systems&utm_medium=email&utm_
campaign=jamapediatrics%3aonlinefirst06%2f01%2f2015

____________________________________________________________________
Source: this blogpost http://www.jeffereyjaxen.com/
blog/new-jama-study-confirms-nurse-whistleblowing-routine-hospital-vaccine-damage-happening-to-infants

Q & A: Caring for my son’s intact penis

    Question from a mother:

Obviously our little guy is not getting circumcised (unless he decides he wants to when he’s older and can make that decision independently) but I was wondering how to go about cleaning him, moreso when he is a bit bigger, but like I have heard you are not supposed to pull the foreskin back, but surely at some point that will need to happen to clean in there right? I don’t want to hurt/harm him, but i want to make sure that area doesn’t get full of bacteria. What is your advice on this?

    Answer from Gloria:

Oh, so glad you asked, Karin. Right now, and until he is about 4 years old, his foreskin is actually attached to the glans just as the fingernails are attached to the nail beds. You only clean what is seen. Never retract the foreskin or you could damage that natural attachment and don’t let any medical professionals do it either.

When he’s about 4, he’ll reach into his pants and find that “toy” and then he will start playing with it. (They continue that till about age 80). That is the only way that the foreskin should come back—the boy doing it himself. Most boys/men simply retract their own foreskin in the shower and rinse with plain water and replace the foreskin. That is all the cleaning that is needed. It’s very easy.

This is a link to the brochure that I give out to mother’s of boys as a pdf. http://www.nocirc.org/publish/4pam.pdf Congratulations on your new little son. Love, Gloria

sonandmom

Additional comment, June 12,2015 Bodies are designed for pleasure. Only a big meanie would deprive anyone of having fun with their own body. Part of my education on boys having fun with their toy came from my brothers. When we were little, my mom would plunk all 5 of us kids (we were 18 months apart in age) in the bathtub. My brothers would do very impressive tricks with their toys,– popping out the shiny purple surprise from inside the foreskin. There was no need for my mom to clean anything, All that bathtub play took care of things. Gloria

Paul M. Fleiss, M.D., M.P.T.

In Loving Memory
Paul M. Fleiss, MD, MPT
Sept. 18, 1933 to July 19, 2014

Paul Fleiss 1933 - 2014

Paul Fleiss 1933 – 2014

Dr. Fleiss was a father of 6 children and a much-loved and respected Pediatrician for 50 years in the Los Angeles, CA area.
He spoke up for babies and was a voice of reason about the importance of breastfeeding, attachment parenting and keeping boys intact. He genuinely loved babies and wanted them to have the best health possible. In 1997, Dr. Fleiss wrote an article for Mothering Magazine called “The Case Against Circumcision”. Peggy O’Mara, the founder of the magazine adopted that title for the forum on her website on the subject of ending circumcision. Peggy would not permit any discussion that endorsed male genital cutting and the name of the forum was self-explanatory. To read Dr. Fleiss’ article go to this reprint. http://www.mothersagainstcirc.org/fleiss.html

I met Dr. Fleiss when we both attended the International Symposium for Genital Integrity in Seattle, Washington; August 24–26, 2006. I was thrilled to meet him and be able to thank him for all his efforts to make life better and healthier for children.

Dr. Paul Fleiss, Gloria Lemay, Gillian Longley, Jenn Beaman and other intactivists in Seattle.

Dr. Paul Fleiss, Gloria Lemay, Gillian Longley, Jenn Beaman and other intactivists in Seattle.

Carla Hartley of Ancient Art Midwifery Institute brought us together again at a Trust Birth Conference in 2008 in California. I will remember him as a warm and happy man who made a big difference in the lives of those who were fortunate enough to read his books/articles, meet him professionally or use his services. He provided leadership to many physicians who have joined him in urging the abolition of male genital mutilation.

Jay Gordon, M.D. wrote about his memories of training with Paul Fleiss at http://drjaygordon.com/in-the-news/paul-fleiss-md-1933-2014.html

I offer deepest condolences to the family and close friends of Paul Fleiss. This fine man will be remembered with love and appreciation by doulas, midwives, lactation consultants, nurses and parents who will benefit from his work for a long time into the future. Gloria Lemay, Vancouver, BC Canada

Vitamin K

Routine procedures in neonatal care are questioned by parents and rightly so.  The first question is “does the benefit outweigh the risk?”  The next question is “is there really a problem?” and the third question is “Who is making a big money profit from this routine?”  Anytime we are giving a system-wide medication, there’s big money to be made.

A newborn baby has as much blood volume as can be contained in a soda pop can.  This is why the umbilical cord must be securely clamped after cutting because it wouldn’t take much to lose the whole blood supply.  It’s also a reason why many baby boys have died after circumcision–they can lose most of their blood volume into a diaper.  What are other ways that the baby can lose blood?  The most common is internal bleeding due to severe bruising.  When a baby is hauled out of the mother by forceps, vacuum extractor or through a cesarean (and, yes, many cesareans also involve forceps on the head or a vacuum extractor in addition to rough handling) the bruises on the baby can be so massive that  blood pools in those internal bruised areas and is not available for the function of vital organs. Giving the baby Vitamin K in order to boost the body’s ability to clot and stop that internal bleeding could be prudent.

What does this mean for the baby who is born without bruising and trauma?  It could mean that the baby is in even more danger of a medication error (giving the wrong drug, giving the drug in the wrong way, other human error) or sepsis from the skin protection being broken.  The preservatives in the Vitamin K could be causing harm as well.

gently born at home and kept intact

gently born at home and kept intact

Someone who has done some thinking and research about the Vitamin K subject is Michel Odent, a physician originally from France who now resides in Britain.

Michel Odent, M. D.

Question: What are the risks/benefits to letting your baby have a shot of vitamin K after birth?

Today there are many reasons to de-dramatize the topic and to reassure at the same time the parents who are inclined to refuse the shot and also those who prefer to do it.

To the parents who refuse the injection, we can say that they don’t take a great risk, since the chances of their breastfed baby having a hemorrhagic disease related to vitamin K deficiency is in the region of one in 15,000. It is even probable that the risks are still lower if the birth and the initiation of lactation were undisturbed. My view is that vitamin K deficiency of breastfed babies is probably no more physiological than the weight loss in newborn babies. After thousands of years of culturally controlled childbirth and lactation, we usually underestimate the amount of ‘colostral milk’, and therefore of vitamin K, a human baby has been programmed to consume during the first days following birth.

A well-constructed Japanese study showed that babies who consume 350 ml of breast milk in the first three days following birth are protected against vitamin K deficiency. Let us also remember that vitamin K deficiency is unheard of among formula fed babies.

Some parents who accepted the injection might feel guilty or anxious afterwards when hearing about two British studies suggesting that vitamin K injected at birth (not vitamin K given orally) is a risk factor for cancer in childhood. These parents must be reassured as well because the British findings have not been confirmed by other studies, particularly a huge authoritative Swedish study involving more than one million children. However one cannot hide the fact that the routine injection of 1 mg of vitamin K at birth is always associated with the injection of 10 mg propylene glycol and 5 mg phenol, the effects of which are unknown.

Source:  UPDATE ON DEC 30, 2013 The quoted material by Dr Odent was taken (by me) from a website called “Ways of Wise Woman” which has since been taken down. I’m happy that I was able to copy some of the information here before that happened. For more reading on the dangers of Vitamin K and links to the studies mentioned by Dr. Odent see this website http://legaljustice4john.com/jaundiceVitKshotNewborns.htm

UPDATE ON DEC 31, 2013. Dr. Odent has sent me this explanatory letter about the breastfeeding optimization which leads to Vitamin K natural coverage. Quote: “Since 1967 it is well accepted that breastfeeding is a ‘necessary factor’ in the pathogenesis of the hemorrhagic disease of the newborn (Sutherland JM, et al. Hemorrhagic disease of the newborn: Breastfeeding as a necessary factor in the pathogenesis. Am J Dis Child 1967; 113: 524-530).
My point of view is that that the vitamin K deficiency of breastfed babies is not more physiological than the weight loss of the newborn baby. In fact I wrote about the newborn weight loss in Mothering (Odent M. Newborn weight loss. Mothering. Winter 1989: 72-73). When a woman gave birth at home, in complete privacy, without feeling observed or guided (in conditions with make a ‘fetus ejection reflex’ possible), when the first contact between mother and baby in a very warm place has been undisturbed by distractions (such as somebody observing, guiding, talking or cutting the cord), and when mother and baby could maintain a quasi continuous day and night skin-to-skin contact during the first two days, one third of babies do not lose weight at all. In other words we usually underestimate the amount of colostral milk a human baby has been programmed to consume. All human cultural milieus routinely disturb the physiological processes. Most breastfed babies are not correctly breastfed.
These are important considerations when taking account a Japanese study which found that babies who consume 350 ml of breast milk during the first three days are protected against vitamin K deficiency (Motohara K, et al. Relationship of milk intake and vitamin K supplementation to vitamin K status in newborn. Pediatrics 1989; 84: 90-93). The Japanese researchers used a biological marker in order to detect vitamin K deficiencies without clinical expression. I summarized my point of view in the summer 1997 of the Primal Health Research newsletter (vol 5. no1).
In conclusion the vitamin K deficiency of breastfed babies might be an effect of culturally controlled childbirth and lactation. All societies have disturbed the physiological processes and particularly the first hour following birth via beliefs (e.g. the colostrum is harmful) or rituals. For that reason we have not known for a long time that the human baby is as if programmed to find the breast during the hour following birth. When I said that 25 years ago obstetricians and pediatricians could not believe me (Odent M. The early expression of the rooting reflex. Proceedings of the 5th International Congress of Psychosomatic Obstetrics and Gynecology, Rome 1977. London: Academic Press 1977: 1117-19). Today we must readjust all our observations and interpretations by taking account the usual deviations from the physiological model.

Warmest regards
Michel Odent” end of quote

The reference for the large Japanese study mentioned by Dr. Odent is:
Motohara K, et al. Relationship of milk intake and vitamin K supplementation to vitamin K status in newborn. Pediatrics 1989; 84:
90-93.

Added April 2015: Pharmaceutical information on Vitamin K with precautions http://www.rxmed.com/b.main/b2.pharmaceutical/b2.1.monographs/CPS-%20Monographs/CPS-%20%28General%20Monographs-%20V%29/VITAMIN%20K.html

Pediatric Response by Petrina Fadel

Part 1 : Dear AAP Board Members and AAP Task Force on Circumcision:

I am writing to you to request that you withdraw or rescind the newest
2012 AAP Circumcision Policy Statement. Below I have critiqued for you some of the serious problems with this new statement.

The Abstract states on page 585 that “health benefits are not great enough to recommend routine circumcision for all male newborns”, but this is not repeated even once in the long text on pages 758-785.
Other long columns favoring circumcision are repeated over and over again, on pages 761-762, 770, 775-776, and 778. The 1999 AAP Statement was 8 pages long (pages 686-693), but this diatribe against living with a foreskin goes on for 28 pages. There is almost the feeling that AAP physicians hope that if they repeat something over and over again, eventually it might become true.

The AAP concludes on page 778 that “the health benefits of newborn male circumcision outweigh the risks”, and yet on page 772 the AAP admits that “the true incidence of complications after newborn circumcision is unknown”. If one doesn’t know how often complications occur, then one can’t make the judgment that the benefits outweigh the risks! The AAP lacks the evidence it needs to make such a claim.

The 1999 Statement studied 40 years’ worth of research, and the 2012 studied only selective research since 1999. Only 1031 of 1388 studies were accepted to look at. Balance might have been found in the 357 studies that were omitted, but the AAP was not seeking balance. The AAP statement goes on ad nauseum about alleged “benefits”, to the point of fear-mongering that something will go wrong if an infant isn’t circumcised. It’s a high pressure sales pitch to try to get the American public to buy the circumcisions that AAP and ACOG doctors are selling. This is in direct contrast to Europe, where circumcision is uncommon and the health of European children equals or surpasses that of American children.

No studies on ethics were included in this statement, and it is clear that the rights of the child and how a grown man might feel about HIS foreskin being stripped from him were never given any consideration at all by the AAP. These are major issues, and even more important than many of the other minor issues the AAP discusses. Material was provided to the AAP to study this aspect of circumcision, but it was ignored. With one bioethicist on the panel, you would have thought that the AAP might at least have given the ethics of circumcision a cursory examination, considering that they were provided with many sources showing the emotional distress many men feel. Ethics and mental health, however, nowhere enter the picture for the AAP. Respect for the bodily integrity of another person were not included, and medical ethics were thrown out the window as infants were thrown under the bus.

Financing studies weren’t included in the studies, but the AAP did its best to push financing repeatedly for third-party reimbursement of non-therapeutic circumcision, at the expense of taxpayers during a time of budget crises. Those with private insurance would see premiums and medical costs rise. The cost for circumcision on page 777 ranges from
$216 to $601 per circumcision in the U.S. In 2010, the in-hospital U.S. circumcision rate was 54.7%. Thus, 45.3% of newborn males left
the hospital genitally intact. If the AAP were to convince parents of
these 45.3% to circumcise (as they are attempting to do in this 2012 statement), then there would be 45.3% of roughly 2.1 million baby boys that could be an additional income source for physicians. (Remember, don’t consider the ethics!) This would be an additional 951,300 male infants to profit from. At prices the AAP quotes, this could mean an additional $205,480,800 to $571,731,300 for doctors who circumcise.
This is no small sum, and as Thomas Wiswell, M.D. stated on June 22,
1987 in the Boston Globe, “I have some good friends who are obstetricians outside the military, and they look at a foreskin and almost see a $125 price tag on it. Each one is that much money. Heck, if you do 10 a week, that’s over $1,000 a week, and they don’t take
that much time. “(Lehman 1987) Money like that would certainly help
doctors make their mortgage payments and their car payments, pay for vacations, etc. – a “benefit” that the AAP failed to mention. Under Literature Search Overview, it is understandable why AAP physicians might consider it important to investigate “What are the trends in financing and payment for elective circumcision?”

No studies on the anatomy and functions of the foreskin were included.
This is surprising, since it would seem like common sense to consider what the functions of any healthy body part are before amputating it.
Probably since the male AAP Task Force members are all circumcised, this idea was difficult for them to grasp. Only one study on the sexual impact of circumcision was included, and this from Africa.
Other studies were ignored or discounted. “The effect of male circumcision on the sexual enjoyment of the female partner”, which appeared in BJU INTERNATIONAL, Volume 83, Supplement 1, Pages 79-84, January 1, 1999, is not mentioned. Nor is the newest Danish study that was publicized on November 14, 2011 – “Male circumcision leads to a bad sex life” – “Circumcised men have more difficulties reaching orgasm, and their female partners experience more vaginal pains and an inferior sex life, a new study shows.” See:
http://sciencenordic.com/male-circumcision-leads-bad-sex-life The AAP had time to include this study, but it was ignored. Others sent material to the AAP about CIRCUMserum, Senslip, foreskin restoration that men are undergoing to undo some of the damages of circumcision and how this improves the sexual experience for both men and women. It didn’t fit the AAP’s pro-circumcision agenda, so it was ignored. The Policy Statement is totally lacking in ethics, anatomy, and foreskin functions. Instead, the Task Force is more concerned with how to train more doctors to circumcise, and how to do so with different devices and various forms of anesthesia.

The physical and sexual harms from circumcision are minimized or dismissed outright. Deaths from circumcision and botched circumcisions are considered “case studies”, and the children horribly damaged from circumcision don’t merit the AAP’s consideration, even though the AAP’s alleged mission is that it is “Dedicated to the Health of All Children”. When cribs are faulty or car seats aren’t safe, the AAP becomes concerned and warns the public. When physicians botch circumcisions and are at fault, children don’t matter. After one botched circumcision lawsuit and a large settlement, the company that manufactured the Mogen clamp went out of business. The AAP report should have advised physicians to NOT use the Mogen clamp because of the botched circumcisions that have resulted with this device. If still in use, no doubt there will be future tragedies with the Mogen clamp, but parents will only be able to sue the doctor and hospital and not the manufacturer.

There was so much reliance on studies from Africa in this statement, that it seemed like the AAP should change its name to the African Academy of Pediatrics. In contrast to the AAP, the American Association of Family Physicians (AAFP) has stated: “…the association between having a sexually transmitted disease (STD) – excluding human immunodeficiency virus (HIV) and being circumcised are inconclusive…
most of the studies [of the effect of circumcision on HIV] …have been conducted in developing countries, particularly those in Africa.
Because of the challenges with maintaining good hygiene and access to condoms, these results are probably not generalizable to the U.S.
population”. But generalize the AAP did! In addition, the AAP listed page after page of STDs that allegedly circumcision would prevent, and wrote conflicting statements about syphilis. A recent study in Puerto Rico found that circumcised men have HIGHER rates of STDs and HIV. The 60% reduced risk of HIV following circumcision is the relative risk reduction, not the absolute risk reduction. There’s a huge difference.
Across all three female-to-male trials, of the 5,411 men subjected to male circumcision, 64 (1.18%) became HIV-positive. Among the 5,497 controls, 137 (2.49%) became HIV-positive”, so the absolute decrease in HIV infection was only 1.31%, which is not statistically significant.”
(Boyle GJ, Hill G. Sub-Saharan African randomised clinical trials into male circumcision and HIV transmission: Methodological, ethical and legal concerns. J Law Med 2011; 19:316-34.)

Infants are not at risk of STDs or HIV through sexual contact, so this speculation about their future risk is foolhardy. Infants can also be at risk for many other diseases, but surgical amputation of healthy body parts is a foolhardy approach for prevention and treatment of disease. If an infant is at risk of an STD, then it is probably safe to say that an adult is perpetrating a crime against the child and needs to be arrested and charged.

Judaism and Islam are mentioned as religions that practice religious circumcisions. Once again, the statement ignores Christianity, which teaches that circumcision is unnecessary. Christianity is the largest religion in the U.S., but its teachings don’t even get a mention by the AAP, which is rather insulting! With an over-representation of members on the Task Force who have a religious bias favoring circumcision, this is not surprising.

The AAP promotes parents choosing medically unnecessary circumcision for their male children, completely contradicting what it said in PEDIATRICS, Volume 95 Number 2, Pages 314-317, February 1995. It said then, “Thus “proxy consent” poses serious problems for pediatric health care providers. Such providers have legal and ethical duties to their child patients to render competent medical care based on what the patient needs, not what someone else expresses. . . the pediatrician’s responsibilities to his or her patient exist independent of parental desires or proxy consent.”

Parents deserve factual information about circumcision, but they won’t find it in the new AAP Statement. In fact, the AAP wrongly advises parents of intact baby boys to retract the foreskin and wash it with soap and water. (page 763) Soap can alter the good bacteria under the foreskin, potentially causing infections that should then be treated with liquid acidophilus to restore the good bacteria. Water is sufficient for cleansing. Circumcised doctors with circumcised sons probably don’t know this.

On page 764, the AAP speculates that the foreskin contains a high density of Langerhans cells, “which facilitates HIV infection of host cells.” Actually, the exact opposite is true. “Langerin is a natural barrier to HIV-1 transmission by Langerhans cells” (Nature Medicine- 4 March 2007). This study states, “Langerhans cells (LCs) specifically express Langerin . . . LCs reside in the epidermis of the skin and in most mucosal epithelia, such as the ectocervix, vagina and foreskin.”

UTIs can be prevented through breastfeeding, which the AAP allegedly supports. This is nowhere mentioned under “Male Circumcision and UTIs”
on page 767. HPV can be prevented with a vaccine for both boys and girls, but it is not mentioned on that same page. A recent study reporting on the large number of re-circumcisions done following infant
circumcisions is also not even mentioned. On page 770, EMLA is
mentioned as a possible anesthetic, but EMLA is not supposed to be used on infants. The fact remains that unnecessary surgery performed with anesthesia is still unnecessary surgery.

There is so much wrong with this new statement that it should immediately be withdrawn before it is presented on Monday. The AAP should either start all over again (with new, unbiased Task Force members), or renew its 1999 statement which attempted to at least give a more balanced view of circumcision. The 1999 circumcision statement certainly had its flaws by ignoring ethics and the anatomy and functions of the foreskin, but it wasn’t as atrocious as this new statement is.

If the AAP wants to be regarded as a credible organization, it will look to the judgment of other foreign medical associations who recognize that circumcision is medically unnecessary and has serious ethical problems underlying its practice. American parents should look to these foreign medical associations for good advice, since the AAP is not providing it in its new statement.

Sincerely,
Petrina Fadel, Director
Catholics Against Circumcision

Part 2 : Sent to the AAP Board of Directors and the AAP Task Force Members on Aug 24, 2012 :

After rereading the AAP’s new Circumcision Statement, several more problems have emerged with this statement. This statement needs to be rescinded and withdrawn immediately! Others are becoming aware of this matter as well.

Under “Ethical Issues” (pages 758-759), two of the references for this opinion come from Dr. Douglas Diekema (AAP’s bioethicist), who signed his name to this statement. The rights of the child are totally ignored in this section, from an organization that claims to be concerned with the welfare of children but in this case isn’t. This is Diekema’s own personal opinion that the Task Force has bought into, based on what he wrote before. References are also taken from M.
Benatar and D. Benatar (both Jewish circumcision supporters), as well as from AR Fleishman (whom I suspect has a religious bias favoring circumcision). Under “Ethical Issues” (page 759), there’s an interesting choice of words by the AAP. “In cases, such as the decision to perform a circumcision in the newborn period, … and where the procedure is not essential to the child’s immediate well-being …” , the AAP admits here that circumcision “is not essential”. It even calls circumcision “elective” in several other places, but it then proceeds to do a massive sales pitch for this unnecessary surgery.

Under Ethics, Reference #14 comes from the British Medical Association- “The law and ethics of male circumcision: guidance for doctors: J. Med Ethics 2004. The BMA did not print a favorable piece on circumcision, but the AAP cherry-picked something from it on page 760. Medical associations in other countries, like the British Medical Association, do not promote circumcision as the AAP has so foolishly chosen to do.

On page 760, the AAP states, “The Task Force’s evidence review was supplemented by an independent, AAP-contracted physician and doctoral-level epidemiologist who was also part of the entire evidence review process.” Who was this? The AAP should reveal the name of this physician.

Several times in the report, the AAP states (page 762), “For parents to receive nonbiased information about male circumcision in time to inform their decisions…clinicians need to provide this information at least before conception, and/or early in the pregnancy, probably as a
curriculum item in childbirth classes.” There is absolutely no way
doctors can do this before conception, and “Inform their decisions” is code for brainwashing parents as early as possible. This is mind control at its worst, supported by the AAP!

The AAP on page 763 uses the term “Uncircumcised” under “Care of the Circumcised Versus Uncircumcised Penis”, and later the term “non-circumcised” when saying, “The non-circumcised penis should be washed with soap and water.” The correct terminology is intact penis, or normal or natural penis. We don’t say “uncircumcised” female or “non-circumcised” female.

The APP on page 764 states, “Mathematical modeling by the CDC shows that, taking an average efficacy of 60% from the African trials, [Note:
This is the relative risk, not absolute risk, which is 1.31%.) and assuming that protective effect of circumcision applies only to heterosexually acquired HIV” …” The AAP states here that they are assuming, which means to “suppose to be the case, without proof.”
There’s a saying that if you “assume” anything, it makes an ass out of u and me. Assumptions are not evidence, and since when should the AAP be relying upon or making assumptions? “Sexual Satisfaction and Sensitivity” (page 769) never once mentions or considers how circumcision impacts the sexual experience for females. The AAP gets it totally wrong about males, while then totally ignoring females! A Danish study by Morten Frisch (whom the AAP uses as a reference in
#118) revealed late last year that circumcised men have more difficulties reaching orgasm, and their female partners experience more vaginal pains and an inferior sex life.

“Analgesia and Anesthesia for a Circumcision After the Newborn Period”
(page 771) states, “Additional concerns associated with surgical circumcision in older infants include time lost by parents and patients from work and/or school.” The AAP is promoting newborn circumcision so parents don’t have to miss work? Parents miss work all the time when their kids get sick as toddlers or later on as young children. Now, all of a sudden, the AAP is concerned about parents missing work, but not concerned about the rights of the child.

Under “Complications and Adverse Events” (page 772), the AAP twice mentions how circumcision risks are lower in hospitals with trained personnel than those performed by untrained practitioners in developing countries. U.S. parents don’t live in a developing country, and this doesn’t even belong in an AAP statement!

“The true incidence of complications after newborn circumcision is unknown …” (page 772) “Two large US hospital-based studies with good evidence estimate the risk of significant acute circumcision complications … ” “(T)here are no adequate studies of late complications in boys undergoing circumcision in the post-newborn
period; this area requires more study.” (page 773) “There are not
adequate analytic studies of late complications in boys undergoing circumcision in the post-newborn period.” (page 774) Under “Stratification of Risks” the AAP says, “Based on the data reviewed, it is difficult, if not impossible, to adequately assess the total impact of complications, because the data are scant and inconsistent regarding the severity of complications.” After admitting that the true incidence of complications is unknown (i.e. the risks), the AAP then has the audacity to state that “the health benefits of newborn male circumcision outweigh the risks”. (page 756). Under “Task Force Recommendations” (page 775), the AAP says, “Physicians counseling families about elective male circumcision should assist parents by explaining, in a nonbiased manner, the potential benefits and risks …” The AAP doesn’t know the incidence of risks, so how do they expect physicians to know that?

The AAP sings its own praises under “Medical Versus Traditional Providers”. “Physicians in a hospital setting generally have fewer complications than traditional providers in the community setting.”
Was this the AAP saying that doctors are safer than mohels? I don’t think they’ll like that!

In 2009, ten years after the AAP did not recommend circumcision (and still doesn’t apparently, doesn’t on its words on page 585, but which one would never know after wading through this rubbish), their own survey of AAP members found that “18% responded recommending to all or most of their patients’ parents that circumcision be performed.” (page
776) I don’t find that surprising that AAP doctors would recommend a surgery that means more money for them. On pages 777-778 the AAP wants to know about the effectiveness of their new 2012 statement to mislead parents. “The Task Force recommends additional studies to better understand … The impact of the AAP Male Circumcision policy on newborn male circumcision practices in the United States and elsewhere.” In other words, how effective are we in deceiving American parents and people in other countries?

The AAP wants to work with the ACOG, AAFP, American Society of Anesthesiologists, and American College of Nurse Midwives to develop a plan about which groups are best suited to perform newborn male circumcisions. (page 777) In other words, how is the AAP going to divvy up the money it so eagerly wants?

The AAP targets blacks and Hispanics in the U.S. for unnecessary circumcisions. “African-American and Hispanic males in the United States are disproportionately affected by HIV and other STIs, and thus would derive the greatest benefit from circumcision.” (page 777) But then, under Areas for Future Research, the AAP says, “The Task Force recommends additional studies to better understand … The impact of male circumcision on transmission of HIV and other STDS in the United States because key studies to date have been performed in African populations with HIV burdens that are epidemiologically different from HIV in the United States.” The AAP just spent several pages before this promoting newborn circumcision to allegedly prevent STDs and HIV based on African studies, but now it’s admitting that more studies are needed because the results could be different in the U.S. Was this put in to help with the solicitation for more funding for pro-circumcision researchers at Johns Hopkins and elsewhere, to keep them going? Maybe these researchers are tired of Africa and want to come home?

The AAP did actually say ONE good thing, but only ONE good thing in this whole statement. On page 760 the AAP says, “The Task Force advises against the practice of mouth-to-penis contact during circumcision, which is part of some religious practices, because it poses serious infectious risk to the child.” If I were to guess, I’d say that perhaps Dr. Susan Blank put that in. While working for the New York City Health Department, Dr. Blank has done nothing to ban metzitah b’peh, so as not to offend the Orthodox Jews who practice it.
Babies have died of herpes from metzitzah b’peh under her watch.

This atrocious AAP Statement needs to be rescinded immediately. I suggest that the AAP use good judgment and do precisely that.

Sincerely,
Petrina Fadel, Director
Catholics Against Circumcision

Male genital mutilation is ending