If My Baby Bites

By Barbara Taylor (1990)
Revised and adapted by Nancy Jo Bykowski (1999)
Revised and updated by Danelle Frisbie (2009)


Baby teeth may loom large in the minds of expectant mothers and those who know them. When a pregnant woman talks to others about her plans for breastfeeding, it's likely she'll encounter someone who will ask, perhaps with a smirk, "But what will you do when he gets teeth?"

Some people incorrectly assume that when a baby gets teeth it's time to wean. They may believe that baby teeth make breastfeeding painful for mothers. But as long as a baby is breastfeeding correctly, breastfeeding won't hurt, even after two, or four, or a whole mouthful of teeth have poked through baby's gums. After all, there is a reason they are referred to as milk teeth.

It's important to remember that a baby who is actively breastfeeding can't bite. When properly positioned, the mother's nipple is far back in the baby's mouth. The baby's lips and gums are positioned on the areola (the darker skin surrounding the nipple) about an inch behind the base of the nipple. The baby's tongue extends over his gums, between his lower teeth and the breast. The upper teeth may leave an imprint on the areola that is harmless, but while a baby is actively sucking and swallowing, he can't clamp down on the breast tissue. Pain occurs when baby's jaws close on the nipple instead of the areola, whether baby has teeth or not. Simply put, if the baby's nursing correctly, he can't bite, and if he is biting, he's not nursing correctly. If a baby does bite, it usually happens during latch-on, during a pause in the feeding, or at the end of the feeding when he is not actively suckling (and maybe even falling asleep).

If Baby Bites

A mother's natural response to pain may discourage further biting. Many babies startle at their mother's loud exclamation and immediately release the nipple. Some may even cry. This negative reinforcement seems to make many babies stop completely. In Mothering Your Nursing Toddler, Norma Jane Bumgarner observes,

Perhaps the reason that the vast majority of children learn not to bite so quickly is that we invariably react immediately and firmly to biting at the breast. There is probably no instance in which we apply behavior modification so immediately, decisively, and consistently. Besides, our children love us and respond to the urgency and sincerity with which we insist that they must not bite.

Such prompt and direct responses occasionally backfire with sensitive babies, who may react by refusing the breast altogether. This sudden disinterest in nursing or outright rejection of the breast is called a nursing strike. A nursing strike can be distinguished from actual weaning by its sudden onset and the fact that the baby seems miserable. It may take lots of coaxing to persuade a baby who has been "on strike" that it's okay to resume nursing. Therefore, it is wise not to exaggerate your response to biting beyond what is natural for you.

Do not try to pull your baby off the breast if he clamps down on your nipple. This causes more damage to the skin than the bite itself. Instead, slip a finger between his gums or teeth to break the suction. Leave your finger between his gums while you remove him from your breast. Another strategy is to pull him in as close as possible to the breast. This will cause him to release the nipple because babies are very sensitive to any blockage of nasal breathing. Some mothers may want to try gently pinching the baby's nose to get him to open his mouth and release the nipple.

Stop the feeding, so baby is not tempted to see if he can make you jump again. As soon as a bite or "near miss" occurs, offer your baby an object such as a teething ring or toy so he will know what is acceptable to use his teeth on (he may sincerely need to bite for teething relief). At the same time, tell him, "This is for biting. You need to be gentle when you nurse."

Some mothers may want to take firmer action after a bite and quickly sit baby down on the floor. After a few seconds of distress, baby can then be comforted and should get the message that biting brings negative consequences.

When you offer to nurse again, be extra careful about positioning and give your baby lots of positive reinforcement for good latch-on and careful release of the breast. Saying "thank you" and "good baby," and offering smiles, hugs, and kisses will go a long way toward gently teaching your baby the proper way to nurse. One mother made a game of this with her five-month-old son.

We were lying down to nurse. He released gently and I praised him. He smiled, latched on again, nursed for five seconds, and released gently and I praised him. He smiled and then latched on again. This went on for a while before I decided not to press my luck and got up and did something else with him.

Even very young babies can learn proper latch-on and positioning with gentle encouragement from their mothers.

Contributing Factors

Some babies are more persistent in their experiments with biting at the breast. Identifying the underlying causes of biting can help a mother decide on her best course of action. Some common factors that contribute to biting are teething, offering artificial nipples (such as pacifiers or bottles), low milk supply (causing frustration for a hungry baby), a baby who wants more attention, or a baby with a stuffy nose (again, frustration from not being able to nurse effectively and breathe). Whatever the underlying cause, biting is most likely to occur toward the end of a nursing, when baby's hunger is mostly satisfied and he starts to focus on other things or drift off to sleep.

When a baby is teething, his gums may be sore. They may look swollen or red. If you rub your finger over baby's gums, you can often feel a tooth that is about to erupt. Teeth occasionally come in very early and a few babies are even born with a tooth or two already erupted. For teething relief ideas, see this page.

Biting can occur if baby's nose is congested. Not having a clear airway interferes with correct suckling, and the baby tends to lose his grasp on the breast. This moves the nipple to the front of his mouth and if baby's jaws are still moving to compress the breast, he may unexpectedly bite down on the nipple. A breastfeeding baby whose nose is blocked by congestion may also turn his head from side to side while at the breast because he is frustrated at being unable to breathe. This may also cause the baby's jaws to slide toward the nipple.

If your baby has a cold or congestion that is interfering with breastfeeding, you may wish to check with your health care provider for treatment suggestions. Clearing out the mucus with a nasal syringe can provide relief for a young baby who can't blow his nose and spends much of his time on his back, although many babies don't like this and it should not be used to the point of causing baby undue distress or panic. Nursing in a more upright position may allow a baby with a stuffy nose to breathe more easily, since gravity helps the sinuses to drain.

Sometimes a baby who clamps down during nursing is asking for his mother's attention. Mothers may often find that they can read, talk on the phone, or watch television while their baby nurses and these activities are fine in moderation. However, older babies may sometimes react by doing whatever they can to recapture their mothers' attention, including clamping down at the breast. Some babies get a playful gleam in their eye just before clamping down. This kind of clamping down is most likely to occur toward the end of a nursing or when the baby wasn't that interested in nursing to begin with, he just needs his mother's attention. Babies are not being 'naughty' when they do this - they are simply using the tools they have at their disposal to tell mom that they need her to pay attention and interact with them.

Offering artificial nipples or pacifiers/dummies can contribute to biting. The mouth and tongue movements a baby uses while breastfeeding are very different from those used with artificial nipples. A baby may become confused about how to suck and start to chew at the breast rather than latching on correctly. Although sucking problems associated with artificial nipples are most common in the early weeks, they can also happen with older babies. Sometimes a baby will start to chew at the breast after learning to drink out of a cup with a spout, particularly if he tends to chew on the spout.

Another way artificial nipples can contribute to biting is that bottles of water or juice (or any supplement) given regularly often lowers milk supply. A baby may clamp down in frustration if his mother's milk supply is low. Increasing your milk supply through more frequent nursing (and always offering the breast first, before any other food/drink) should help. See the resources at the end of this article for additional information and tips on milk supply.

A subsequent pregnancy can also affect a mother's milk supply. Jamie Larson, of Cape Canaveral, Florida, USA, wrote about her experience in the March-April 1997 issue of New Beginnings. Her daughter had started biting at the age of eight months. Despite Jamie's careful attention to possible reasons and her consultation with her local Leaders, she was unable to identify a cause for Uriel's biting. Three months later, after Jamie had a miscarriage, Uriel's biting stopped suddenly and Jamie's milk supply increased dramatically. She hadn't been aware that she was pregnant and she hadn't noticed that her milk supply had dropped so much. A visit to the doctor showed that Uriel hadn't gained any weight during those months. Jamie said that after her miscarriage, Uriel gained four pounds in three weeks. Pregnancy always impacts mother's milk in one way or another - either in taste, in supply, or in quality. If you wish to nurse your child for a normal duration of time, you will need to use non-hormonal means of contraception to ensure that your milk is not impacted, and unexpected pregnancy does not follow too close to the baby you already have.

Once women's menstrual cycles return post-birth, many mothers find that their milk supply is slightly lower during their periods. The breasts may be more tender during menstruation, too, which can make nursing uncomfortable for the mother. Hormonal birth control methods may also affect a mother's milk supply, especially if they are started in the early months after birth. Other factors may be some medications and dietary supplements. Check with your local La Leche League Leader if you have any questions about whether a medication or supplement may be affecting your milk supply and do not take artificial hormones if you wish to nurse for a normal duration of time. [Note: The copper IUD is a non-hormonal birth control option that many mothers have opted for post-birth. See information on IUDs here. Other non-hormonal options include using a combination of charting (to know the weeks you are most likely to ovulate and avoid intercourse during those weeks or use additional protection during this time), condoms, spermicide like vaginal contraceptive film (VCF), and other barrier methods like Encare, diaphrams, the Today Sponge, and cervical caps.]

Another thing to consider is your baby's personality: Some babies are just more oral than others. When they start to crawl, they may put every piece of lint they find into their mouths. They like to experience the world through their sense of taste and explore textures with their tongues.

Positioning Matters

Around the age of three or four months, a baby becomes much more interested in his surroundings. Sounds such as a sibling playing nearby may intrigue him so much that he turns his head quickly to take a look. Unfortunately, he may forget to let go of the breast first and slide down onto the nipple. At any age, a baby who falls asleep while nursing may react to the nipple being withdrawn from his mouth by clamping down (be sure to always insert your finger first to break the latch and pull your nipple out before withdrawing your finger from a sleeping baby). These behaviors are somewhat reflexive and may require different coping strategies than other kinds of biting.

Older babies and toddlers may get into positions that make breastfeeding uncomfortable for their mothers. Sometimes, a baby will lean on his mother's breast in a way that puts pressure on the nipple even though his jaws are not on the nipple itself. Some active toddlers twist around while nursing and end up in contorted positions. When a toddler's mouth turns around too much, he can exert the same kind of uncomfortable, even painful, pressure. With firm guidance from their mothers, these babies can learn to curb their gymnastic impulses while nursing and breastfeed in a way that is comfortable for both mother and child.

Preventing Biting

Careful attention can prevent one biting episode from turning into a recurring problem. It can also head off biting before it even starts. Each situation is different, so you may need to try a couple of different strategies before you find one that works for you and your baby. Here are some ideas that other mothers have found helpful.

Be ready to protect your nipple when removing your baby from your breast, particularly if he's sleeping. Insert your finger into the corner of your baby's mouth far enough to come between his gums, wrap it around your nipple, and then pull out. If baby closes his jaws in a reflexive attempt to resume nursing, he'll clamp onto your finger instead of your nipple. Women who usually support their breast with one hand during nursing may find it easiest to use the index finger of that hand. Some women prefer to use their little finger. Whichever finger you use, keep the fingernail trimmed closely to prevent scraping your nipple or your baby's mouth or tender gums.

If it seems that your baby is clamping down because he wants your attention, start giving him your undivided attention from the beginning of the nursing. Touching, talking, and making eye contact let your baby know he has your full attention. Being alert helps you notice when your baby is losing interest in nursing. Play with him often. Read to him. Go on walks and point out the world. Wear him. Engage him.

You can learn to recognize when it's time to end a nursing by watching your baby's sucking pattern. Susan Meintz Maher, in the LLLI publication An Overview of Solutions to Breastfeeding and Sucking Problems, states,

By observing her baby while nursing, the mother may notice that tension develops in his jaw before he actually bites down. This can signal her to detach him before he gets a chance to bite.

Your baby may also pull his tongue back from its normal position over the lower jaw.

Pay extra attention to good positioning and latch-on techniques to help keep your baby focused on sucking and lessen the chance of biting. Be sure your baby's mouth is open wide before pulling him close and directing your nipple to the back of his mouth. Women with large breasts should be especially careful to support the breast with their free hand while baby latches on and may need to do this during the entire nursing. Keep the baby's whole body facing yours so he does not have to turn his head to nurse. A nipple latch trick for getting a good latch for proper sucking can be viewed here.

Don't force a nursing, particularly when your baby is older. Many mothers use nursing to encourage an afternoon nap, but some toddlers resist once they figure it out. If your baby is wriggling, rolling, or pushing against you with his arms, he may not be hungry or interested in nursing. If you feel your baby is just too distracted to settle down, lying down with him in a quiet room may help remind him that it's time to nurse. Walking or rocking may soothe a small, fretful baby enough to settle down to nurse, too.

If Your Nipple Is Sore

The nipple has many nerve endings and is very sensitive. Biting causes pain, while it's happening and sometimes for a while thereafter. However, much of the soreness comes from the baby pulling off the breast (or being removed from the breast) without breaking suction. If your nipple is sore, be assured that following good latch-on techniques (ones that assure that the nipple bypasses baby's lips and gums) will protect the nipple from further damage and it will heal very quickly. If just one nipple is sore, begin nursing on the opposite side first so your baby's most vigorous nursing will be at the less sore breast.

To speed healing and soothe the pain, you may express a little of your milk, apply it gently to the nipple and areola, and allow it to dry. Modified lanolin, sold under the name Lansinoh for Breastfeeding Mothers, is hypoallergenic and safe for baby (provided neither of you are sensitive to wool). There are also other organic, healing salves made by a variety of nursing-friendly companies, including work at home moms. Many mothers have found Lansinoh or related products helpful in easing nipple pain and healing nipples with a break in the skin. Gently pat the skin dry after breastfeeding, and then apply a small amount to the nipple area.

Gaining Perspective

The prospect of being bitten by your own baby can be a bit daunting, but motherhood can be hazardous at times. An enthusiastic toddler may step on your toes or knock his head against yours while giving you a hug, but that won't make you stop hugging him. You'll just take care to protect your toes and your head. The same can be true of your nipples.

Paying attention to your baby's cues is the first step in protecting yourself. Each mother will find a strategy that works for her and her baby. In Breastfeeding Pure and Simple Gwen Gotsch says:

What you do to teach your baby not to bite again depends on his age and his temperament. An older baby may be able to understand that if he bites, mother ends the feeding immediately, and there's no more nursing for a while - perhaps twenty minutes or more. This, along with mother's sudden yell of pain, may be too much for a more sensitive baby to bear, while a younger baby cannot understand the relationship between his actions and the consequences.

Patience, persistence, thoughtful observation, and sensitivity to a child's feelings are important mothering tools at any age. If your baby goes through a biting phase, be assured that it will be short-lived and you will be able to continue nursing until he outgrows the need.

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For additional information on biting and breastfeeding see:

Mothering Your Nursing Toddler [book]

Dr Sears: Tips for Biting While Breastfeeding

La Leche League: What Should I do if Baby Bites?

Australian Breastfeeding Association: Biting and Breastfeeding

Breastfeeding Basics: Teething and Biting

KellyMom: When Baby Bites


References

Bumgarner, N. J. Mothering Your Nursing Toddler. Schaumburg, Illinois: LLLI, 1982.

Brewster, P. You Can Breastfeed Your Baby... Even in Special Situations. Emmaus, Pennsylvania: Rodale Press, 1979.

Bykowski, Nancy Jo. "If your baby bites." New Beginnings, Vol. 16 No. 2, March-April 1999; 36-39.

Gotsch, G. Breastfeeding Pure and Simple. Schaumburg, IL: LLLI, 1994.

Lawrence, Ruth A. Breastfeeding: A Guide for the Medical Profession. Fifth Edition. St. Louis: C. V. Mosby Co, 1999.

Maher, Susan M. An Overview of Solutions to Breastfeeding and Sucking Problems. Schaumburg, IL: LLLI, 1988.

Mohrbacher, N. and Stock, J. The Breastfeeding Answer Book. Schaumburg, IL: LLLI, 1997.

Taylor, Barbara. "If your baby bites." New Beginnings, November-December 1990; 163-67.


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Circumcision Information Take 3


This video compilation is not one that is exactly typical for this blog.

It was put together by an outspoken, fun-loving, male stripper who is in fact, intact. As a young intact boy growing up amidst an ocean of cut peers, Stroud was compelled early on to investigate why he was (happily!) intact while so many of the boys around him had the "best" part of their penis cut off. While still in high school, Stroud researched all that he could surrounding the prepuce organ, and the amputation of it, and became a respected and well-read intactivist at his school. After learning what had been done to them, and taken from them, most of his cut peers wished they had been granted their genital integrity at birth to remain whole and intact as teens and adults.

Stroud covers many of the issues surrounding the myths of circumcision and tells his own story and that of others who have shared with him. His videos include a style of humor that may rub some people the wrong way - yet he uses his personal style to drive home some very good points.

There is 'adult language' used approximately 3-4 times throughout the video, and Stroud's presentation of religion may also upset some viewers. We'd encourage him to dig a little deeper into the topic of 'cutting the blessing' among Hebrews and Jews in antiquity (something that was not done in the same way as today's U.S. prepuce amputation, or done with such severity as we do today, but was genital mutilation nonetheless). It may add to the videos if Stroud were to also dive into historical research regarding the complete lack of circumcision among Christians for most of human history, and the outright opposition of this infant mutilation by the Christian church and the majority of Christian leaders throughout history.

We'd encourage you to take a listen to what this passionate, unique, young man has to say. Amid his humor, he makes a lot of powerful and important points.


What is done to children,
They will do to society.
~ Karl Menninger




By Jamie Brendon Stroud

Unassisted Homebirth: A Father's Story

© Bob Griesemer
Photos courtesy of J&J Quesada; by Sandi Heinrich Photography
posted with permission



I have put off for a long time writing my comments for Lynn's book. She has the whole thing written now except for my input so I better write this. I guess one of the reasons it's taken so long for me to write my thoughts down about our home birth is that it was just so awesome that I feel like I can't even come up with words adequate enough to describe it. Let me try anyway.

When Lynn first mentioned the idea of giving birth to our baby at home I told her she was crazy! No way was I going to allow that. I was the man of the house and it was my responsibility to protect and watch out for the well being of the family and I just felt that giving birth at home away from the professional medical support was just plain irresponsible if not downright dangerous. Well, that was because I had bought into the prevailing notion that childbirth is inherently risky and fraught with danger that requires the constant supervision of trained medical people. Little did I know just how wrong that notion was.

Lynn does not give into me that easily so she worked and worked on me to educate me about the idea of homebirth. I am not too stubborn and will change my mind if I am presented with new information so I did some reading and listened to Lynn with an open mind. It was when I read Marilyn Moran's book Birth a Dialogue of Love that I realized we should have a homebirth.

It was Marilyn who made me realize that birth is part of a couple's love just as conception is. I concluded that I was missing something from our four prior hospital births. I was not a participant; I didn't have a role to play; I was extra. I just stood around trying to talk soothingly to Lynn and holding her hand (when she let me), but the focus of attention was on the medical surroundings and all the interventions, the constant stream of strangers into the room to check on progress, to hook up the fetal monitor, to insert the IV during one of the births. I felt so unneeded one time I went and got myself a sandwich for lunch, leaving Lynn there knowing the medical people would be watching her. I know that seems pretty cold and heartless of me, but I feel that the situation contributed to that. As I recall, it was actually the doctor who suggested I go to get some lunch.

Then we got close to delivery (still talking about the other four hospital deliveries) and that's when I really became superfluous. In all four of our hospital births there would come a time during labor when Lynn would not want to hear from me or touch me. One time she actually told a nurse she wanted to hear her, not me, and wouldn't let me touch her.

At the time I didn't think it bothered me because I'd heard all the jokes about the wife in labor who blames her husband for doing that to her and all that. I think we tell those jokes just so we won't have to seriously think about what's going on around us in that delivery room, because if you stop and think about it, which I've done now thanks to Lynn, you'll realize that in most cases the hospital delivery room is the last place you want to be to have a baby with your wife. Men, you would never let another man between your wife's legs while she's lying in bed half naked in your bedroom, right? Yet you give up that position when she's in the hospital to have a baby and you don't think twice. I think there is something wrong with that.

A baby is born and it is beautiful and wonderful and a miracle from God. In the hospital you have about a minute to contemplate that before the trained medical personnel grab the baby and whisk him off to do whatever their training says they're supposed to do with him. Once again I didn't think there was anything wrong with that because after all, they are highly trained, skilled medical professionals who know what they're doing. Well, that might be true but what they're doing is not necessarily for the good of the baby or the mother. What's best for baby and mom is for them just to be together, to start nursing, but at a minimum to be held close and to look at each other. Don't believe that talk about how newborns can't see. If you were in a dark room for nine months and then were suddenly brought out into a room with bright lights like the average hospital room and then had some eye drops put right in your eyes, you'd probably not see very well either. But, if instead, you were brought out into a room with low lighting and were left alone, like a a baby is if born at home, you'd see much better.

I thought about those four hospital births and about what I'd read in Marilyn Moran's book about birth really being a dialogue of love between husband and wife and realized that giving birth in the quiet comfort of your own home really would be much better.

The moment of Millicent's birth will be forever etched in my mind as the most significant moment of my life. I can hardly begin to describe the feelings and the emotions of the moment, to see that little purple head start emerging from my wife's body, and then the rest of her just slipping out into my waiting hands. I was the first one in the whole world to hold my baby. What a miracle from God, what a gift from my wife! Time stood still. The rest of the world ceased to exist. All that mattered was the task at hand, assisting Lynn as she labored and catching Millicent as she came out in the world. When it was all over and Mom and baby were settled down and comfortable and things were cleared up, I couldn't get back to sleep. I was on an adrenaline rush the whole time. I remember feeling like I just had four or five cups of coffee. It was such an intense experience.

Guys, if you want to gain a whole new appreciation for the miracle of life and for your wife then catch your own baby. You'll also feel more of an attachment to that child too. I feel different about Millicent than my other four that were caught by doctors in the hospital. I don't mean to say I love Millicent any more than Robby, Melanie, Hilary or Christina. I love all my children as unique and special gifts from God entrusted by him to my and Lynn's care, but there is just something there with Millicent that isn't with the others. I really believe she even reacted to my voice differently as an infant, almost as if she knew that I was the first one to hold her. I should have had that with all my children and if I had it to do over again, I would have had all of them at home.


More Q&A With Homebirth Dads at Natural Papa



Christmas Miracle: Mother & Baby Back to Life After Fatal Birth

CBN News Brief


After a Colorado mom and her baby were brought back from the brink of death after a Christmas Eve delivery, her husband says there is no other explanation except the hand of God.

On Christmas Eve, 33-year-old Tracy Hermanstorfer was admitted to Memorial Hospital in Colorado Springs, Colo. for what was supposed to be a routine delivery - but something went horribly wrong.

"About 35 seconds after I arrived in the room, she went into cardiac arrest and we started immediate preparations for cesarean section in the room," recalled Dr. Stephanie Martin, a maternal fetal medicine specialist at Memorial Hospital.

Seconds later, both mother and baby died.

"Half my family was lying right there in front of me, in my hands," her husband Mike said. "There's no other way to say it, but dead."

Tracy had no heartbeat, no blood pressure and she wasn't breathing. The baby was also limp and unresponsive.

Attempts to revive them failed. Doctors were just about to take them away when they both came back to life.

"We were never able to fully understand what happened, but we will take it," Martin laughed.

Although the couple are Christians, they said even a nonbeliever would have to admit what happened to them was the "hand of God," a Christmas miracle.

"Someone upstairs is looking after me and saying it isn't time for me to be gone," Tracy said.

Mother and baby are now perfectly healthy.


Encouraging Black Women to Embrace Breastfeeding

posted with permission

American mothers as a whole do not breast-feed their babies as much as health experts would like, but African-American moms have the lowest rates of all — by some measures, they are half as likely to nurse as whites and Hispanics.

The federal government, some hospitals and nonprofits are trying different strategies to close this nursing gap, though no one seems sure exactly why the disparity exists.


Changing Perspectives

When Kathi Barber gave birth a decade ago, she was the first in her family in generations to nurse, and was dumbfounded to realize she had no role models. Barber became obsessed with encouraging nursing among black moms, as numerous studies show that exclusive breast-feeding can reduce a baby's chances of developing diabetes, obesity, ear infections and respiratory illness.

Yet Barber was frustrated that for many new mothers, their only image of this age-old act may come from a museum or a National Geographic documentary.

"Tribal women, with elongated breasts, earrings and tribal jewelry. And let's say we're trying to promote that to a 25-year-old, mmm ..." she laughs. "I don't think that's going to do the trick."

So Barber founded the African-American Breastfeeding Alliance and wrote The Black Woman's Guide to Breastfeeding. As a lactation consultant, she travels the country putting on workshops and training sessions, and encouraging hospitals and family clinics to reach out to this community.


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Nursing Rates And Demographics

For children born in 2006, a smaller percentage of African-American women exclusively breast-fed for three months.

Nursing Rates And Demographics

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Partnership And Peer Counseling

"People tell me it hurts," says 16-year-old Dijonna Hunter, due with her first child in February. But at the Developing Families Center in northeast Washington, D.C., where she's come for her maternal care, Hunter has learned about the health benefits of nursing. Hunter says she's determined to try it despite what her friends and mother tell her.

Experts say a supportive partner is key for successful breast-feeding, and Hunter's boyfriend, Anthony Frost, is trying. He's even taken to watching baby shows on television. But when asked if his mother nursed him, Frost makes clear that he finds the very notion disgusting. Angela Ewing-Boyd, the center's program manager, says she hears that a lot, even from women.

People say, "I can't imagine doing that to my child, and that's just nasty," she says. "It's like the primary function of the breast is one-dimensional."

So Ewing-Boyd has organized weekly peer-counseling sessions for pregnant women. On a recent afternoon, about a dozen of them sat in a circle, shifting to find a comfortable position on their folding chairs.

"I have a car," said counselor Joan Brickhouse, holding up a matchbox racer. "What does this have to do with breast-feeding?" She sent the car zooming across the floor as the women tossed out guesses — some sincere, a few snarky.

Brickhouse then told them, "You can take your breasts with you anywhere. On the airplane, you know, you can just whip it out!"

Other objects in this educational pop quiz stressed the health benefits of nursing and the economic advantage: breast milk, of course, is free, while formula can easily run $150 and more a month, which makes it all the more baffling why lower-income mothers of all races are more likely to choose formula.

In fact, the older, more educated and higher-income a mother is, the more likely she is to breast-feed. But experts say the disparity for African-Americans is so great it transcends socio-economics.

Barber says work is clearly a huge barrier, and black moms may be more likely to hold lower-wage jobs with no breaks allowed for nursing. African-Americans have also had to earn money since long before the women's liberation movement.

In fact, Barber thinks you can trace part of the problem all the way back to the breakup of families under slavery, and the enduring, negative image of so-called mammies — slaves made to serve as wet nurses for their master's white children.

That practice continued for domestic servants well past the end of slavery, and for Barber, it helps explain the ironies that played out later. In the 20th century, it was white, wealthy women who led the march to formula feeding, and minorities followed. But when white elites backtracked and made breast-feeding hip, most African-Americans didn't buy it.

"Infant formula became a thing of prestige," says Barber. "Breast-feeding was thought to be something that lower-class women did. So, if you can think of it as a political issue, it really is."


From Formula To Breast

Barber and others say another factor in low breast-feeding rates is aggressive marketing by the multibillion-dollar baby formula industry, which has convinced hospitals to hand out its products for free.

Barbara Philipp is medical director of the Birth Place at Boston Medical Center, and says numerous studies have looked at this.

"When I, as a physician in a white coat, or when a staff nurse with her hospital badge on, hand out that diaper bag that we get for free from the formula company," she says, "that mom and baby will go on to exclusively breast-feed for a shorter period of time."

A decade ago, Boston Medical Center launched a broad campaign to promote breast-feeding. It educated both its staff and clients. It started putting newborns in the same room with their mothers instead of carting them off to the nursery. And it stopped handing out free formula, something Philipp says caused a ruckus.

"It was seen as denying a free gift to poor women," she says.

But the number of mothers at the center who start out nursing has shot up to 90 percent, well above the national average for black mothers.

In fact, national rates have been rising for African-Americans — a study last year found that the number initiating breast-feeding had jumped from 36 percent in 1993-1994 to 65 percent in 2005-2006.

But that number still lags far behind whites and Hispanics, and figures from the Centers for Disease Control and Prevention show the proportion who continues nursing exclusively soon plunges into single digits. Washington's Developing Families Center tries to stem this drop with follow-up visits to new moms.


Home Visit Lends Support

Counselor Tina Pangelinan steps into Kala Blue's small apartment five days after Blue delivered baby Kamya.

For the past two days, an exhausted Blue has struggled to get Kamya to latch on, and has instead been using the free formula the hospital gave her. The women sit side by side on the love seat as Pangelinan offers tips and suggestions, and Blue tries again and again, holding her frustrated baby first one way and then another.

Finally, after 20 long minutes, she succeeds. But Blue admits it just doesn't feel right. Pangelinan offers to come back tomorrow with a breast pump, so Blue can express her milk into a bottle.

"We're here for you," she tells Blue.

Whatever it takes to keep one more African-American baby getting mother's milk.


Lisa Uncles, a certified nurse-midwife who is the acting clinical director of the Family Health and Birth Center in Washington, D.C., visits a new mother a day after she gave birth. Clients of the center have fewer premature births, low birth weights and cesarean sections as compared with the D.C.'s African-American population overall.


Nurse-Midwife: The Way We Work


The U.S. has set 2010 targets for increased breast-feeding rates, but experts say they will largely go unmet.

Public health officials have waged two campaigns to promote breast-feeding in the U.S. The first was a century ago, when infant deaths from diarrhea were linked to spoiled, diluted or unpasteurized cow's milk in baby formula. The other was earlier this decade, when the Health and Human Services Department called for a mass-marketing effort to promote not just the benefits of breast-feeding, but the dangers of formula feeding. That led to two U.S. television ads.


BREASTFEEDING PUBLIC SERVICE ANNOUNCEMENTS

RESOURCES FOR THE BREASTFEEDING MOTHER

Exclusive Breastfeeding Protects Against Urinary Tract Infection

Acta Paediatr. 2004 Feb;93(2):164-8.

Protective effect of breastfeeding against urinary tract infection

Marild S, Hansson S, Jodal U, Oden A, Svedberg K.
Department of Paediatrics, The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Goteborg, Sweden.

Contact: staffan.marild@pediat.gu.se

[Editor's Note: These babies and children would have all been intact, being born in Sweden. In other words, none were circumcised.]


OBJECTIVE: To assess the possible protective effect of exclusive breastfeeding against first-time febrile [feverish] urinary tract infection (UTI) in children.

METHODS: Two children's hospitals and local child health centres in the Goteborg area, Sweden, participated in a prospective case-control study.

In total, 200 consecutive cases (89M, 111F), aged 0-6y, presenting with first-time febrile UTI were enrolled. The mean +/- SD age was 0.98 +/- 1.15 y. As control subjects, 336 children (147M, 189F) were recruited from the child health centre of the case, matched for age and gender and included consecutively for each case during the first days after diagnosis. The duration of exclusive breastfeeding was obtained from the case and controls by a standardized procedure.

RESULTS: Ongoing exclusive breastfeeding gave a significantly lower risk of infection. A longer duration of breastfeeding gave a lower risk of infection after weaning, indicating a long-term mechanism. The protective role of breastfeeding was strongest directly after birth, then decreased until 7 mo of age, after which age no effect was demonstrated.

CONCLUSION: A protective role of breastfeeding against UTI was demonstrated. The study provides statistical support to the view that breast milk is a part of the natural defence against UTI.

~~~~

Breastfeeding Baby Jesus

By Danelle Frisbie © 2009

The video [bottom of page] is a glimpse into my current collection of breastfeeding baby Jesus images - paintings, statues, carvings, etc. We have about a hundred of them here in our Birth and Babies library that I've collected from around the world, but you can view 3 minutes worth in this clip. Somehow in my addiction to education I ended up with degrees in Human Health and Development (emphasis on birth and breastfeeding), Human Sexuality, and Religion. Mix those degrees, and you simply must study the subject of a breastfeeding baby Jesus at some point [as well as the fact that a Jewish-born Jesus was regularly depicted with what we would today call intact genitalia... but I'll save that for a later post].

Images of Mary breastfeeding Jesus were once ubiquitous in churches around the world. But eventually in North America, as the artificial feeding of babies became more popular, and the plastic bottle replaced the breast, our nipplephobia got the best of us and these sacred images all but disappeared from churches and art galleries in North America.

The first image in the collection is a mosaic made up of breastfeeding Jesus images. I'll highlight a few others here as well. I'd love to take you on an online 'tour' of all the images and stories behind them...but I still have my own mothering duties to perform for the day, so that will have to wait.

If you have an additional breastfeeding Mary image to share, I would love to add it to our collection.


This is just one of my favorites. Maybe because Mary is riding a donkey while breastfeeding Jesus. No hands! That takes some mighty fine balance. I'm not sure if I could accomplish the same. ;)


If you note during the song (video below), this image comes up with the words "heaven's perfect lamb." The image is one that is carved into the bottom of wooden pews at a church in South America. It is Mary nursing the perfect lamb coming down from Heaven.


Here, Mary nurses Jesus on one breast and a Saint on the other


This breastfeeding image is an Egyptian pantheon carving of the goddess, Isis and her son, Horan, that had the face of Mary carved into it by Christians who moved into the area, and then scratched out again centuries later.


This is the oldest known depiction of Mary and Jesus. It was found on the Catacomb of Priscilla in Rome. Jesus is nursing at Mary's breast.


In this painting Mary is about to nurse Jesus, and Saint Bernard prays asking her to “Show that you are a human mother" ~ Monstra te esse matrem. It was readily accepted that Jesus was divine at this point in history, what needed to be 'proven' was that he was also human. This comes up in a lot of the art surrounding Jesus and Mary -- that he was not only divine, but also needed her milk for substance and that she was a 'regular' mother as any other. In this image, Mary responds to St. Bernard's prayer by squirting milk into his mouth. This painting is often called, "The Miracle of Lactation" and several images of this story exist.

The following is another example:


Breastmilk was seen as healing (which it is!) and miraculous in nature (which it also is!). In this painting (La Virgen dando su leche a las almas del purgatorio) by Pedro Machua, Jesus is at one breast while Mary feeds the souls in purgatory with her other breast. Those who drank her milk are redeemed and ascend into heaven.


I would love to have this nativity.
Anyone good with wood?


This statue is located above the Milk Grotto in Bethlehem ~ one of the many stops I plan to make on my lactivist pilgrimage around the world.


Jesus must have been at that easily-distracted age here ;)


Jesus as a red head?! And super pale skin...
I've always found it interesting how he is portrayed according to the norms within the culture that he is depicted within. I guess that is one beauty of art -- it can take form for the purposes that it needs to serve.


Imagine if we posted photos like this on Facebook! Not only breastfeeding our babes, but showing nipple AND momma's milk. And here we thought we were living in an 'emancipated' time...


Another favorite of mine




The following video is set to one of my favorite Christmas songs, "Mary, Did You Know?"


~~~~


UK fails to halt female genital mutilation

As horrific as this is, as quickly as it MUST be brought to an end, don't get too hypocritical in your assessment of the situation. This article could just as easily read, "US fails to halt male genital mutilation."

Bodily integrity is a basic human right that boys and girls, men and women are equally deserving of. It is a damaging form of sexism to cut any baby or child, no matter their genital makeup or their location in the world.


Women in Somalia being educated about the dangers of female circumcision.
Intactivists in the UK are angry that there have been no prosecutions of practitioners


By Nina Lakhani


Girls are still at risk this Christmas as 'cutters' are flown in from abroad to perform the illegal procedure in the UK.

Hundreds of British schoolgirls are facing the terrifying prospect of female genital mutilation (FGM) over the Christmas holidays as experts warn the practice continues to flourish across the country. Parents typically take their daughters back to their country of origin for FGM during school holidays, but The Independent on Sunday has been told that "cutters" are being flown to the UK to carry out the mutilation at "parties" involving up to 20 girls to save money.

The police face growing criticism for failing to prosecute a single person for carrying out FGM in 25 years; new legislation from 2003 which prohibits taking a girl overseas for FGM has also failed to secure a conviction.

Experts say the lack of convictions, combined with the Government's failure to invest enough money in education and prevention strategies, mean the practice continues to thrive. Knowledge of the health risks and of the legislation remains patchy among practising communities, while beliefs about the supposed benefits for girls remain firm, according to research by the Foundation for Women's Health, Research and Development (Forward).

As a result, specialist doctors and midwives are struggling to cope with increasing numbers of women suffering from long-term health problems, including complications during pregnancy and childbirth.

Campaigners are urging ministers to take co-ordinated steps to work with communities here and overseas to change deep-seated cultural attitudes and stamp out this extreme form of violence against women.

The author and life peer Ruth Rendell, who has campaigned against FGM for 10 years, said: "When I helped take the Bill through Parliament seven years ago, I was very hopeful that we'd get convictions and that would then act as a deterrent for other people. But that has never happened and my heart bleeds for these girls. This mutilation is forever; nothing can be done to restore the clitoris, and that is just very sad for them. I have repeatedly asked questions of ministers from all departments about why there has never been a prosecution and why we still do not have a register of cases. But while they are always very sympathetic, nothing ever seems to get done. Teachers must not be squeamish and must talk to their girls so we can try and prevent it from happening."

FGM is classified into four types, of varying severity; type 3 is the most mutilating and involves total removal of the clitoris, labia and a narrowing of the whole vagina.

An estimated 70,000 women living in the UK have undergone FGM, and 20,000 girls remain at risk, according to Forward. The practice is common in 28 African countries, including Somalia, Sudan and Nigeria, as well as some Middle Eastern and Asian countries such as Malaysia and Yemen. It is generally considered to be an essential rite of passage to suppress sexual pleasure, preserve girls' purity and cleanliness, and is necessary for marriage in many communities even now. It has no religious significance.

The most common age for the procedure is between eight and 11 but it can be carried out just after birth or just before marriage. It carries the risk of death from bleeding or tetanus, and long-term problems include urinary incontinence, recurrent infections and chronic pain. Reversal procedures are necessary in order to avoid major problems for a woman and baby during childbirth.

In the UK, some women have to travel hundreds of miles to one of 15 specialist clinics because services and training are so patchy. There are no specialist clinics at all in Scotland, or Wales, and student doctors, midwives and social workers are not routinely taught to recognise or deal with FGM.

A DVD, paid for by Baroness Rendell, which shows health workers how to reverse FGM will be launched in January. She hopes the next generation of health professionals will be better equipped to help affected women, many of whom suffer from long-term psychological effects such as flashbacks, anxiety and nightmares.

Amina, 55, originally from Somalia, underwent type 3 FGM, with no anaesthetic, when she was 11. One of the lucky ones, she suffered no long-term physical health problems but still carries psychological scars.

She has been vilified by practising communities for campaigning against FGM and for refusing to allow four of her daughters to be mutilated; the fifth suffered the procedure while in the care of her grandmother. The government funding that allowed Amina to work with families in Yorkshire, going door to door, to schools and community centres, talking about legal and health risks, ran out in March.

The Somali model Waris Dirie was mutilated at the age of five. She set up the Waris Dirie Foundation in 2002 to help eradicate FGM. She said: "I am worried about the situation in Europe and the US, as FGM seems to be on the rise in these places. In the 21st century, a crime this cruel should not be accepted in a society as developed as England. No one can undo the trauma that is caused by this horrible crime; it stays in your head for ever. So what we should focus on is that there won't be another victim."

Jackie Mathers, a nurse from the Bristol Safeguarding Children Board, said: "These families do not do this out of spite or hatred; they believe this will give their daughters the best opportunities in life. We would like a conviction, not against the parents, but against a cutter, someone who makes a living from this. We have anecdotal information that the credit crunch means people can't go home, so they're getting cutters over for 'FGM parties'. It is hard for people to speak out because they are from communities that are already vilified as asylum seekers, so to stand up against their communities is to risk being ostracised. But we have to empower girls and women to address this, along with teachers, school nurses and social workers. We can't ignore it; it is mutilation."

A Home Office spokesman said: "We have appointed an FGM co-ordinator to drive forward a co-ordinated government response to this appalling crime and make recommendations for future work."


Further Reading:

History of female circumcision in the United States

CUT: female genital cutting documentary

CUT: male genital cutting documentary

Important purposes of the prepuce (foreskin/hood)

Protecting your baby

Like Father Like Son?

Cleanse Your Children! A Parody

By Guggie Daly
Read more from Daly at The Guggie Daily

Thank you to Michelle Richardson for bringing this link up in our intactivist discussion.


"When a lie, especially the sordid, asinine lies,
are said over and over and over again
by the members within a society,
it becomes difficult to hear what is wrong with them.
The words become
normative,
even if they do not become any less remarkably stupid."


A good way to get your hearing recalibrated is to replace the repeated terms and alter the analogy. The mind will hear new words, allowing your brain to function. When this is done, some people will have a return to sanity and recognize logical fallacies within the argument.

This is actually a basic learning exercise in law school. There is a fancy Latin name for this technique that I should...I bet my old professor is spinning in his grave right now.

So here is a bit of a twist on the comments from the link Richardson shared [above]. Misspelling and grammatical errors have been left in place as they were written by commentators in the original thread. DH = 'dear husband'; DD = 'dear daughter'; DS = 'dear son'




Lauralkemp:
Ok I know we have about half a dozen boys or so in this group and I was on another forum talking about fingernail removal. Joseph has all his fingernails removed. I believe it is cleaner and DH says that he is happy and has never had a problem with loss of tactile sensation anything like that. Plus DH is so in charge of writing so no awkward questions about looking different then daddy. So I was wondering how many of the other boys here had their fingernails removed at birth? If you decided for it was it just a religious or hygiene thing or was there another reason? If you decided against it will you support your son if he decides he wants it later because he's a minority in English class or whatever? I know that this is becoming less of a rarity but still. Those who have girls this year but have boys and those that are planning to have more babies please chime in on your feelings too.

Rudolphia:
I have two boys and removed the eyelids on both. I honestly was ambivalent about it. I'd read opinions on both sides, and wasn't swayed either way, so I left it up to dh, since he was the one with experience in that area. Dh had his eyelids removed and wanted the boys the same too, so that's the direction we went. I know plenty of people who have passed on eyelid removal, and I respect that.

Dopey406:
We're pretty much in the same boat as Rudi. I was also pretty ambivilent and had no opinions either way. DH had a Cholecystectomy and thought that Alex should have one, too, so we went with that. I talked to my OB about it and she said that SHE would be the one doing the procedure because it's considered "surgery" so only a surgeon could do it. They don't let just anybody perform Cholecystectomies at that hospital so I felt very comfortable with her handling him. But I also know plenty of moms who opted to pass on the gallbladder removal and that's fine, too. To each his own--literally.

Lynn012:
Both of my boys are missing ears. I took off their ears for both of them because I felt that it is cleaner, and I never had any other thoughts of keeping ears on my children.

Keepers:
We decided both girls would be circ'd too. The wife is too. We actually never even questioned having it done. Our peds did both girls.

Brandimichelle:
(all I have to say is it’s supposed to be the 8th day!)

Qteach333:
My girls are circ'ed which caused a mini-stir in my family because the women in my family are not. I remember as a kid my half sisters having trouble keeping it clean, getting sand in there when they went to the beach, etc, but ultimately left it up to my wife who wanted it to be done. I also talked to my sister about it, and she said if she had a daughter, she was going to get her circ'ed. That sealed the deal for me, since my sister isn't circ'ed.

MrsS1stbaby:
I don't have a daughter, but if we ever do we will get her's removed. No religious or any other reasons other than that is what we are used to. And If I am completely honest, I had an ex-girlfriend that wasn't, and it was a little umm, different. I was scared the first time, lol! So, to save any daughters from having embarassing moments, I think we will go ahead and do it!

LMB2007:
Both of my boys had their eyelids removed. I did it for cleanliness and because I just felt it was the right thing for them. DH is missing his eyelids and we both felt that the boys should be too.

Valleygirl:
My daughter is circumsized. The usual wife is it seems cleaner looks like everyone else reasons. But a huge deciding factor for us was that right before we had Michaela Dh's grandma who was like 89 at the time and hadn't been circumsized had the skin growing closed over her vagina, she could hardly urinate. So at 89 years old she had to have a partial circumcision and she had to envolve her daughter in the matter which I am sure was very humiliating for her.


Further Reading:


Male and Female Circumcision

History of female circumcision in the United States

CUT: female genital cutting documentary

CUT: male genital cutting documentary

Important purposes of the prepuce (foreskin/hood)

Protecting your baby

Like Father Like Son?



Circumcision Increases Urinary Tract Infection Among Baby Boys in Israel

Is ritual circumcision a risk factor for neonatal urinary tract infections?

Authors:
1) Dario Prais
Contact: prais@post.tau.ac.il
2) Jacob Amir
Contact: amirj@clalit.org.il
3) Rachel Shoov-Furman


Abstract: http://adc.bmj.com/content/early/2008/10/06/adc.2008.144063.abstract?rss=1


Objective: Although circumcision is commonly believed to protect against urinary tract infection (UTI), it is not unusual in neonates in Israel, where almost all male infants are circumcised. The aim of the study was to evaluate the burden of neonatal UTI in Israel and its relationship to circumcision.

Design: Medical records of neonates (≤T2 months old) hospitalized with UTI were reviewed and demographic and clinical data were collected. The second part of the study consisting of a telephone survey to assess timing and details concerning the circumcision, included two groups: the study group consisting of parents of male infants, aged 8-30 days, hospitalized with UTI and a control group consisting of healthy neonates.

Results: 162 neonates (108 males, 54 females) were hospitalized with UTI. Mean age at admission was significantly lower in males (27.5 vs 37.7 days, p=0.0002). The incidence of UTI in males peaked at 2-4 weeks of age, i.e. the period immediately following circumcision. In females, the incidence tended to rise with age. Accordingly, male predominance disappeared at 7 weeks and the male-to-female ratio reversed. In the second part of the study, 111 males (≤T1 month old) were included: 48 post-UTI and 63 as a control group. While evaluating the impact of circumcision technique, we found that UTI occurred in 6 of the 24 infants circumcised by a physician (25%), and in 42 of the 87 infants (48%) circumcised by a religious authority; the calculated odds ratio for contracting UTI was 2.8 (95% CI: 1-9.4).

Conclusions: There was a higher preponderance of UTI among male neonates. Its incidence peaked during the early post-circumcision period, as opposed to the age-related rise in females. UTI seems to occur more frequently after traditional circumcision than after physician performed circumcision. We speculate that changes in the hemostasis technique or shortening the duration of the shaft wrapping might decrease the rate of infection after Jewish ritual circumcision.

~~~~

Urinary Tract Infections Higher Among Circumcised Men in Australia

Prevalence of urinary symptoms in urban Australian men aged 40-69
Abstract: http://www.ncbi.nlm.nih.gov/pubmed/11434500

J Epidemiol Biostat 2001;6(2):211-8 (ISSN: 1359-5229) McCredie M; Staples M; Johnson W; English DR; Giles GG. Department of Preventive and Social Medicine, Dunedin Medical School, University of Otago, New Zealand.


BACKGROUND: This study was devised to determine the prevalence of urinary symptoms among men living in the Australian cities of Melbourne, Sydney or Perth, and to identify factors associated with the presence of moderate-to-severe urinary symptoms.

METHODS: The study comprised a population-based sample of 1,216 men, aged 40-69 years, whose names were obtained through electoral rolls and who participated as controls in a case-control study of risk factors for prostate cancer. As part of a structured face-to-face interview, the men completed the International Prostate Symptom Score (IPSS). Men with moderate (IPSS = 8-19) or severe (IPSS > or = 20) urinary symptoms were compared with those with mild or no symptoms (IPSS < 8) using unconditional logistic regression.

RESULTS: The age-specific prevalence of moderate-to-severe urinary symptoms (IPSS > or = 8) in men aged 40-49, 50-59, 60-69 years was 16%, 23% and 28%, respectively. Compared with men with no or mild urinary symptoms (IPSS < 8), men with moderate-to-severe symptoms were more likely to report not currently living as married [odds ratio (OR) = 1.5; 95% confidence interval (CI) 1.1-2.0] and being circumcised (OR = 1.5; 95% Cl 1.2-2.0).

The increased likelihood associated with drinking an average of > 60g per day of alcohol in the 2 years before interview was of marginal statistical significance (OR = 1.6; 1.0-2.6). There were no significant differences between men with IPSS > or = 8 and those with IPSS < 8 with respect to body mass index, education level, having had a vasectomy, or cigarette smoking.

CONCLUSION: Among Australian men, being circumcised, or not currently living as married, were associated with increased prevalence of urinary symptoms.

~~~~

The Effects of Circumcision on Breastfeeding

Review of research between The National Organization of Circumcision Information Resource Centers and La Leache League International



It is the human right of every baby
to have the
opportunity to be breast or breastmilk fed.
~ Australian Breastfeeding Association


Advantages of Breastfeeding
Medical societies in Australia,1 Canada,2 and the United States3 concur that breastmilk is the optimum food for infants. The National Organization of Circumcision Information Resource Centers agrees with this conclusion. Breastfeeding provides nutritional, emotional, developmental, immunological, and economic benefits that are not equaled by any substitute.3 Studies show that breastfed babies exhibit improved neurodevelopment and greater cognitive ability.1,4-6 Breastfeeding may contribute to improved mother-infant bonding and to lessened tendency for violence in adult life.6 One study finds that breastfeeding protects against childhood asthma.7 Another study finds that breastfeeding reduces infant mortality.8 Early initiation of breastfeeding reduces the incidence of diarrhea.3,9 Breastfeeding protects against otitis media (middle ear infection)3,10 and urinary tract infection (see below).
Breastfeeding also improves the mother's health because it provides increased levels of oxytocin with several important benefits, including reduced post-partum bleeding, more rapid return to pre-pregnant weight, improved bone remineralization with fewer hip fractures, and reduced risk of ovarian and breast cancer.3 Moreover, a recent study suggests that breastfeeding protects mothers from postpartum stress.11 Only mothers who breastfeed enjoy these benefits.

How Breastfeeding Replaces Circumcision as a Prophylactic Measure Against UTI
Breastfeeding now is documented to dramatically reduce the incidence of urinary tract infection (UTI).
In the early 1980s, Thomas E. Wiswell, M.D., a vociferous advocate for routine circumcision, opined that lack of male circumcision might be the cause of UTI, and he set out to prove it with two retrospective studies that were published in 1985 and 1986.12,13 The studies, carried out by searching through old medical records maintained by the United States Army on children of Army personnel, failed to examine an existing clinical population. The study purported to show that the incidence of UTI in circumcised and intact infants were 1.4 and 0.14, respectively. The difference of 1.26 percent is not clinically significant. Wiswell's studies suffered severe methodological flaws, including lack of control for confounding factors,14 such as maternal infection, perinatal anoxia, low or high birthweight,15 breastfeeding, socio-economic status, urogenital deformities, and the nature of infant hygienic care.
Escherichia coli, bacteria present in feces, is the most frequent etiologic agent of acute uncomplicated urinary tract infection (UTI) in infants and children, accounting for 85 to 90% of all pathogens recovered from urine cultures.16
After Wiswell's studies were published, Coppa et al. discovered that human milk contains oligosaccharides that are excreted in infant urine and inhibit the adhesion of E. coli to the tissue of the urinary tract.17 This protective effect was quickly confirmed in a preliminary report in 1990 by another group of Italian scientists, headed by Pisacane,18 and further confirmed by Swedish researchers.19 The Pisacane group then produced a prospective case-control study, published in 1992,20 that found breastfed infants have only 38% as many UTIs as non-breastfed infants.20
A recent study that tried to correct for some of the deficiencies in Wiswell's studies found that 195 circumcisions would be necessary to prevent one hospitalization for UTI.21
Wiswell could not have known about the significant effect of breastfeeding protection against UTI because these studies17-20 had not been published at the time he conducted his studies,12,13 which do not control for breastfeeding. The number of breastfed infants in his studies is unknown. Consequently, his data is inconclusive and inaccurate.
Even if one were to accept Wiswell's data, breastfeeding has an additional advantage that male circumcision could never provide: breastfeeding reduces UTI in both male and female infants.3,22 Females have a four times greater incidence of UTI than males,16 which may be because females lack the protective effect of the preputial sphincter (see box). Breastfeeding actually delivers the protection against UTI infection that has been touted for circumcision.3,18,19,20 Circumcision is an inappropriate and ineffective way to reduce the risk of UTI in infants.

Postoperative Pain, Stress, and Exhaustion
Human milk is the best food for babies.1,3 Babies who are breastfed are more likely to experience optimum health and well-being throughout life than babies who are given a substitute for mother's milk. It is imperative, therefore, that nothing be done that would interfere with successful initiation and completion of breastfeeding during, at least, the first year of life. Mothers need full information, well in advance of birth, so that they may avoid the pitfalls and snares that prevent success in breastfeeding.
We now know that newborn babies are born with fully functioning pain pathways.23 Infants exhibit greater physiologic responses to pain than do adult subjects.23 Male neonatal circumcision has been documented to be an extremely painful, distressing, traumatic, and exhausting experience for a newborn male infant.24-28 Circumcision disrupts the baby's normal sleep patterns.25,27 Post-operatively, the circumcised infant is in pain and is in an exhausted, weakened, and debilitated condition.28 Most importantly, the circumcision procedure frequently causes the newborn to withdraw from his environment,25 thus interfering with his process of bonding and breastfeeding.28
La Leche League International (LLLI) first reported problems with breastfeeding by circumcised male infants in 1981.30 Circumcision has long-lasting postoperative pain that continues for days after the surgical event.29 Howard et al. found that some male babies are unable to suckle the mother's breast after circumcision,29 thus confirming the LLLI report.30
The Workgroup on Breastfeeding of the American Academy of Pediatrics (AAP) recommends that stressful procedures that interfere with breastfeeding be avoided.3
Breastfeeding problems among circumcised male infants have been verified by lactation consultants.31,32 Parents may avoid creating this problem simply by refusing to consent to the circumcision of their baby boy. In doing so, they would also be adopting the recommendations of the AAP and LLLI to avoid stressful procedures.3,30 Mothers who protect their new baby from circumcision are more likely, therefore, to be successful in breastfeeding and less likely to have to resort to providing breast milk substitute.3,29,30

The Relative Value of Breastfeeding and Circumcision
When it comes time for parents to make decisions about circumcision and breastfeeding, the choice is clear. Medical societies agree that no medical benefit from circumcision exists and "potential [alleged] benefits" cannot be proven. The Canadian Paediatric Society says that male neonatal circumcision should not routinely (i.e., in the absence of medical indication) be performed.33 The American Medical Association calls male neonatal circumcision a non-therapeutic procedure.34 The American Academy of Family Physicians equates male neonatal circumcision to a "cosmetic procedure."35 Male neonatal circumcision now is regarded as a non-therapeutic procedure that is totally unnecessary for a child's health and well-being. Furthermore, male neonatal non-therapeutic circumcision has significant risks and complications.36 Circumcision increases infant mortality because some babies die from complications of circumcision.37 Studies show that intact boys have better penile health during the first three years of life.39,40 Other drawbacks and disadvantages include psychological and sexual problems in adult life.40 Non-therapeutic circumcision, therefore, provides no discernible health benefit to the child, while there are numerous documented significant risks, complications, and adverse sexual and psychological sequellae. Chessare found that non-circumcision produced the highest "utility" (or, in other words, the highest state of health).41
Pain in young babies presently is believed to permanently affect development of the immature nervous system.40 The AAP and the Evidence Based Group for Neonatal Pain now emphasize prevention of pain by avoidance of painful procedures in infancy in preference to the use of anesthesia.42,43 Neonatal circumcision is the most common painful procedure to which young children are subjected. Neonatal circumcision, therefore, should be avoided.
Breastfeeding, on the other hand, offers all of the benefits described above without any significant risk, complication, disadvantage, or drawback. Certainly, responsible parents will favor breastfeeding over circumcision for male infants. If parents are adamantly insistent on a circumcision of their male infant, the circumcision should be deferred until after breastfeeding is well established.
Breastfeeding, like non-circumcision or "intactness," is natural and healthy. Bottlefeeding, like circumcision, is unnatural and unhealthy. Male neonatal circumcision should never be allowed to compromise the successful initiation of breastfeeding.

Conclusion
Breastfeeding contributes significantly to the health and well-being of both baby and mother. We recommend that babies be breastfed, except in those few rare circumstances when a particular mother may have a medical condition that contraindicates breastfeeding.1-3
Studies have proven that circumcision impairs the health and well-being of the child.24,33,36-41 Doctors and parents should protect children from the complications, risks, and unavoidable surgical trauma inherent in circumcision.44
Psychological studies show that some circumcised fathers adamantly insist on having a child circumcised in opposition to current informed medical opinion.45 In that case, it is the mother’s job to protect the baby. When she does so. she is teaching her husband to protect the child, not to wound him. In any event, the operation should be deferred until breastfeeding is well established. Furthermore, the Section on Urology of the AAP recommends that no genital surgery should be performed during the first six weeks of life while the bonding process is occuring.46 The Australasian Association of Paediatric Surgeons recommends, if a circumcision is to be performed, then it should be deferred until the child is at least six months of age when general anesthesia may be used.47 If a circumcision is performed, it should be carried out by a skillful surgeon in a setting that provides all necessary emergency equipment to handle possible complications and emergencies. Ring block anesthesia (the most effective available type of local anesthesia for infant circumcision24) should be used to reduce the pain. No local anesthesia can totally protect an infant from the pain of circumcision. While more dangerous, after six months, general anesthesia can be used. Circumcised babies should be given post-operative analgesia for the post-operative pain for seven to ten days.33,48
The information provided to parents prior to obtaining permission for circumcision must include all material and relevant information about circumcision, the known risks, and the benefits of non-circumcision necessary for a parent to make an informed decision.49 Breastfeeding failure is a known and documented risk of circumcision. Doctors who perform circumcision, therefore, have a responsibility and a legal obligation to inform parents about the adverse effects of circumcision and the beneficial effects of non-circumcision upon breastfeeding.
Breastfeeding educational material for mothers should include information about the adverse effects of male circumcision on breastfeeding. Mothers need to learn "how the choices parents make about the birth experience can affect breastfeeding in the early days."50 Organizations that promote breastfeeding have an ethical and moral responsibility to provide this information to parents well in advance of delivery so that they can make a truly informed decision about circumcision.1,3

For more information on circumcision and breastfeeding see:

References
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  2. Anonymous. Breastfeeding. Ottawa: Canadian Paediatric Society, 1998.
  3. Work Group on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 1997;100(6):1035-39.
  4. Horwood J, Fergusson DM. Breastfeeding and Later Cognitive and Academic Outcomes. Pediatrics 1998;101(1):e9.
  5. Angelsen NK, Vik T, Jacobsen G, Bakke L S. Breast feeding and cognitive development at age 1 and 5 years. Arch Dis Child 2001;85:183-188.
  6. Prescott JW. Brain nutrients in brain development for human love and peace. Touch the Future Newsletter, Spring 1997.
  7. Oddy WH, Holt PG, Sly PD, et al. Association between breast feeding and asthma in 6 year old children: findings of a prospective birth cohort study. BMJ 1999;319:815-819.
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  12. Wiswell TE, Smith FR, Bass JW. Decreased incidence of urinary tract infections in circumcised male infants. Pediatrics 1985, 75: 901-903.
  13. Wiswell TE, Roscelli JD. Corroborative evidence for the decreased incidence of urinary tract infection in circumcised male infants. Pediatrics 1986;78:96-99.
  14. Altschul MS. The circumcision controversy (editorial). Am Fam Physician 1990;41:817-820.
  15. Littlewood JM. 66 infants with urinary tract infection in first month of life Arch Dis Child 1972;47(252):218-2.
  16. McCracken G. Options in antimicrobial management of urinary tract infections in infants and children. Pediatr Infect Dis J 1989;8(8):552-555.
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  18. Pisacane A, Graziano L, Zona G. Breastfeeding and urinary-tract infection (Letter). Lancet 1990;336:50.
  19. Maarild S, Jodal U, Hansen AL. Breastfeeding and urinary tract infection. Lancet 1990;336:942.
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  24. Lander J, Brady-Freyer B, Metcalfe JB, et al. Comparison of ring block, dorsal penile nerve block, and topical anesthesia for neonatal circumcision. JAMA 1997; 278:2158-62.
  25. Emde RN, Harmon RJ, Metcalf D, et al. Stress and neonatal sleep. Psychosom Med 1971;33(6):491-7.
  26. Gunnar MR, Fisch RO, Korsvik S, Donhowe JM. The effects of circumcision on serum cortisol and behavior. Psychoneuroendocrinology 1981; 6(3)269-275.
  27. Anders TF, Chalemian RJ. The effects of circumcision on sleep-wake states in human neonates. Psychosom Med 1974;36(2):174-179.
  28. Marshall RE, Porter FL, Rogers AG, et al. Circumcision: II effects upon mother-infant interaction. Early Hum Dev 1982; 7(4):367-374.
  29. Howard CR, Howard FM, and Weitzman ML. Acetaminophen analgesia in neonatal circumcision: the effect on pain. Pediatrics 1994;93(4):641-646.
  30. Anonymous. Elective Surgery for You or Baby. In: The Womanly Art of Breastfeeding, 3rd ed. Franklin Park, IL: La Leche League International, 1981: 92-93. (ISBN 0-912500-10-7)
  31. Lee N. Circumcision and Breastfeeding [Letter]. J Hum Lact 2000;16(4):295.
  32. Caplan L. Circumcision and breastfeeding: a response to Nikki Lee's letter [Letter]. J Hum Lact 2001;17(1):7.
  33. Fetus and Newborn Committee, Canadian Paediatric Society. Neonatal circumcision revisited. (CPS) Can Med Assoc J 1996; 154(6): 769-780.
  34. Council on Scientific Affairs, American Medical Association. Report 10: Neonatal circumcision. Chicago: American Medical Association, 1999.
  35. AAFP Commission on Clinical Policies and Research. Position Paper on Neonatal Circumcision. Leawood, Kansas: American Academy of Family Physicians, 2002.
  36. Williams N, Kapila L. Complications of circumcision. Brit J Surg 1993; 80: 1231-1236.
  37. Baker RL. Newborn male circumcision: needless and dangerous. Sexual Medicine Today 1979;3(11):35-36.
  38. Fergusson DM, Lawton JM, Shannon FT. Neonatal circumcision and penile problems: an 8-year longitudinal study. Pediatrics 1988;81(4):537-541.
  39. Van Howe RS. Variability in penile appearance and penile findings: a prospective study. Brit J Urol 1997;80:776-782.
  40. Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychology 2002;7(3):329-43.
  41. Chessare JB. Circumcision: Is the risk of urinary tract infection really the pivotal issue? Clinical Pediatrics 1992;31(2):100-4.
  42. American Academy of Pediatrics. Committee on Fetus and Newborn, Committee on Drugs, Section on Anesthesiology, Section on Surgery. Prevention and Management of Pain and Stress in the Neonate. Pediatrics 2000;105(2):454-461.
  43. Anand KJS, International Evidence-Based Group for Neonatal Pain. Consensus statement for the prevention and management of pain in the newborn. Arch Pediatr Adolesc Med 2001;155:173-180.
  44. Kendel DA. Caution Against Routine Circumcision of Newborn Male Infants (Memorandum to physicians and surgeons of Saskatchewan). Saskatoon: College of Physicians and Surgeons of Saskatchewan, February 20, 2002. Photocopy.
  45. Boyle GJ, Goldman R, Svoboda JS, Fernandez E. Male circumcision: pain, trauma and psychosexual sequelae. J Health Psychology 2002;7(3):329-43.
  46. Section on Urology, American Academy of Pediatrics. Timing of Elective Surgery on the Genitalia of Male Children With Particular Reference to the Risks, Benefits, and Psychological Effects of Surgery and Anesthesia (RE9610). Pediatrics 1996;97(4):590-4.
  47. J. Fred Leditsche. Guidelines for Circumcision. Australasian Association of Paediatric Surgeons. Herston, QLD: 1996
  48. Geyer J, Ellbury D, Kleiber C, et al. An Evidence-Based Multidisciplinary Protocol for Neonatal Circumcision Pain Management. JOGNN 2002 31, 403-410.
  49. Hill G. Informed consent for circumcision. South Med J 2002;95(8):946.
  50. La Leche League. [Breastfeeding problems after circumcision]. Leaven 1994; September-October:78.

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