Your Whole Baby: A resource For Midwives
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How we help midwives
Circumcision and the midwifery model of care
Communicating with employers, colleagues, and clients
Of Episiotomies and Circumcisions: Teri Mitchell, CNM
What is Your Whole Baby's mission?
Our nonprofit organization works to reach expectant parents with gentle information about foreskin and circumcision, including the following:
How does Your Whole Baby help midwives?
In the United States, each midwife determines individually what role, if any, they should play in a client's decision to leave a baby's penis intact or have him circumcised. Your Whole Baby recognizes that not all midwives want or feel able to take a strong stand against circumcision, and we offer resources for your consideration while you develop your own policies and procedures. We also provide free materials to share with birthing families.
No major medical organization in the world recommends routine neonatal circumcision. Several European nations are moving toward increased legal protection against genital cutting of minors — male, female, and children with atypical sex characteristics. Infant circumcision rates in the United States today are at their lowest since the 1950s peak. As numbers continue to drop, we need to make sure that parents and healthcare providers have proper intact penis care information, especially if they have no prior experience with foreskin and intact boys.
What place does circumcision have in the midwifery model of care?
Every Midwife CAN...
Regardless of where a provider stands on the issue of circumcision, Your Whole Baby encourages every midwife to provide evidence-based information about normal penis/foreskin development and care to every birthing client. Boys of parents who do not receive this information are more likely to sustain iatrogenic injury from a caregiver (parent, doctor, daycare provider) who mistakenly believes it is necessary to see or clean beneath the foreskin. Sharing evidence-based intact penis care and the harms of forced foreskin retraction helps parents understand and respect their son's normal body.
Cornerstones of the midwifery model of care include:
Respect for normal physiological processes in pregnancy and birth
Respect for client autonomy
Shared decision-making & informed consent for procedures and treatments
Skills to provide appropriate interventions when necessary
To leave a male baby's normal foreskin intact, or alternately, to surgically remove it by circumcising him, is a decision that involves every one of these fundamentals:
Normal physiological processes. Foreskin is a unique and purposeful part of the human anatomy. It plays important sexual, protective, and immunological roles, and has its own timeline for development.
Client autonomy. Both the baby and the birthing parent are the clients of a midwife. In the absence of medical need, the choice to surgically remove an intimate body part can be left to its owner. Neonatal circumcision is termed "non-therapeutic" in medical literature; even American Academy of Pediatrics members admit the "benefits" previously claimed are cultural rather than medical. Talking to your clients frankly about the harms and risks of circumcision, and/or declining participation in the procedure, helps respect the baby's autonomy as a human being.
Shared decision-making and informed consent. A pregnant parent's only communication on the subject of foreskin and circumcision may be with a birth professional. Many families in the U.S. first encounter the circumcision question in the hospital, after their baby has been born — probably the worst time to make an informed decision!
We hear from many parents every day who say having their son circumcised is their biggest regret. They wish someone, anyone, had brought the topic up before it was too late. This intense regret/stress may trigger or worsen postpartum mood disorders. We also frequently hear from men who are upset about the choice having been taken from them. If a midwife opts not to share evidence-based information, this inhibits shared decision-making and informed consent. As our YWB homepage says, "We believe if you have the information necessary to see circumcision in a new light — free from cultural blinders — you will not choose it for your son. Your protective instincts will scream NO as far as the ear can hear."
Skills to provide necessary interventions. Neonatal circumcision is considered an elective procedure within the U.S. healthcare system. Non-therapeutic circumcision is never necessary, as it does not treat a disease or injury; it subjects a healthy baby with a normal, complete penis to the harms and risks of surgery on their genitals.
I would like to take a stronger stance in defense of healthy, whole male babies, but I fear backlash from my clients/co-workers/employer.
Because there are few regulations in the realm of U.S. circumcision, midwives may face challenging decisions regarding what kinds of information they provide their clients about foreskin and circumcision, and what role, if any, they play in performing, assisting in, or referring for circumcisions.
Your Whole Baby is here to help!
Read our "Common Concerns for Midwives" page.
Contact us at [email protected] to ask questions, share your experiences/concerns, and offer ideas!
Become a member our Advisory Board, which includes birth workers and healthcare professionals.
Have your midwifery practice listed as intact-friendly — parents increasingly seek midwives who distance themselves from circumcision.
Join our Facebook community of parents and healthcare professionals.
Of Episiotomies & Circumcisions: Meet Teri Mitchell, DNP RN CNM IBCLC
Owner of BundleBorn Midwifery and YWB Advisory Board Member
Teri says: As a midwife, I can largely say that we are "do-gooders." We know how disturbing it is to see birthing parents stripped of their wishes and potential and pushed through the system. We work hard to honor our clients as autonomous agents with intrinsic understanding of their own needs in pregnancy and birth. It is possible for us to view the issue of infant circumcision in the same context: doing what's right for the baby, as a vulnerable autonomous person, rather than as an extension of fulfilling the woman's wishes.
I see circumcision as very relatable to an unnecessary episiotomy. Both involve genitals. Both are unnecessary (routinely, at least). Both can happen without consent. There is no way for me to obtain consent for unnecessary genital surgery from the infant or the future adult he will become. Opting to be a conscientious objector to circumcision is simply extending to her child the respect we already afford the mother.
From the BundleBorn website:
"Well over a hundred baby boys had their penises cut to the sound of my voice and the suckle of my finger. All I could think was: If parents only knew what was happening to their babies, there is no way that they would do this. I could not continue to do this and sleep at night...I learned that I had the right to conscientiously object. I learned that there is a growing movement of people from all over the world who speak out against the cultural tradition of genital cutting in the US. I refused to further participate in circumcisions and made it my life's work to provide parents with accurate information. This is how I repent for my hand in harming baby boys."
Check out Dr. Mitchell's research into the shared decision-making conceptual model as it relates to teaching expectant parents about foreskin and circumcision:
Mitchell, T.M. & Beal, C. (2015, January). Shared Decision Making for Routine Infant Circumcision: A Pilot Study. The Journal of Perinatal Education, 24(3): 188-200.
Looking to get in touch with Teri? Email [email protected]
Violating Children's Rights: Harmful Practices Based on Tradition, Culture, Religion, or Superstition
A 2012 publication from the International NGO Council on Violence Against Children, an organization created to work with UN member states following the 2006 UN Study on Violence Against Children. From page 22:
Pages 47 & 48 discuss the role of the healthcare provider in protecting children's rights.
UN Convention on the Rights of the Child
A legally binding human rights treaty for all countries that have ratified it since its adoption in 1989. Every member nation of the UN has ratified this treaty except the United States. Article 24.3 declares,
American College of Nurse Midwives' important documents:
Nurses for the Rights of the Child tri-fold brochure on conscientious objection.
Your Whole Baby offers a variety of free printable handouts on correct intact penis care, common penis concerns, harms and risks of circumcision, and other topics. These handouts are designed to be distributed to your clients so they understand that:
foreskin is normal and functional.
forced foreskin retraction is harmful.
neonatal circumcision comes with harms and risks.
This forced retraction brochure is designed to help healthcare providers understand care of the normal penis.
Check out our shop!
Visit our Shop page to view other materials (info cards, shirts, lanyards, buttons, decals, etc.) that you may like to purchase for yourself or have on hand for your clients.
Thank you for everything you do to promote the health and well-being of new families!
Date Published: April 30, 2018