I would pay a year’s salary to avoid either me or my son being circumcised.

I’ve had a UTI once (due to kidney stones) btw, and it wasn’t pleasant, but I really don’t see how being circumcised would have made any difference, and not one of the many urologists I saw ever even mentioned circumcision.

I view it like immunizing him. When I immunize while he may have short term pain and complications are possible the long term benefits are far more important and will benefit him for the rest of his life. Sometimes as parents we make choices for our children that may have some pain involved because long term benefit and honestly I don’t think any of the people who describe a UTI as no big deal have ever had one as a 3 year old.

Beijos!

Baby records are typically present shortly after birth, and in hospitals I have worked at are initially recorded as “Baby Boy **mom’s last name” during the first admission

We are not good at tracking interventions and outcomes on a national level because we do not share a common record system that would allow such tracking. Projects that do this in this country require great effort to gather data from many sources. Countries that have socialized medicine and a common system do this better than we do, in my opinion.

Fetal monitor apps are quite useful when a physician isn’t in house, in my opinion. Obsetrical driven labor and delivery is a model that integrates physician care and nursing care, with the majority of bedside care delivered by nursing. If fetal monitoring is going to be used, I’m in support of any technology that make viewing it more accessible. Problems are caused by one person telling another about a strip without the second person actually viewing it. Easy access to view strips fixes this problem.

I’ve long thought that medical record software could be much more “clever” than it is… It could even have automatized alerts to conditions that might affect treatment, like you’re already on such medication, have allergies, are trying to conceive or whatever.

I really think an open, common, model is the only way forward, something semantic and possibly xml-based, which then could be viewed in whatever way the actual doctor/hospital prefers. I wonder if there’s already some open software heading in this direction.

Hopefully we’ll see more interest in this kind of thing in the not-too-distant future.

I look forward to the day when my iphone beeps and tells me: hey, the lupus anticoagulant result you have been waiting for is finally here, oh and the nurses on the ward want you to come over and see a patient, not that urgent.

Significantly the BMJ Editor, Fiona Godlee is calling for a change in practice to delayed cord clamping.

You’re right that the literature on the topic is old. Nothing new about it has been published, as it is a pretty basic topic that is not of great interest. The matter of whether amniotic fluid ferns is pretty much settled, so there is little reason to do new research on the topic. RCTs don’t really have a role in the evaluation of a diagnostic test. RCTs are for evaluation of interventions, not tests.

Yes….and no. (or no…and yes?)

We do believe in a resurrection. One can’t really have it both ways….if one believes, upon death, you go straight to heaven or (gulp) hell, what need is there for a resurrection? One has never actually ‘died.’

So our view of the resurrection is as found in Paul’s words: “and I have hope toward God….that there is going to be a resurrection of both the righteous and the unrighteous (Acts 24:15) in which it is spoken of as a future event, not some routine process which has gone on since the beginning of time.

This is a resurrection (by and large) to the future earth as it will be when ruled over by God’s kingdom, rather than the present hodgepodge of squabbling human gov’ts. We view that God created humans and put them on earth. He didn’t put them there because he wanted them somewhere else. In the meantime, the dead are nonexistant, as if ‘asleep.’ (see Jesus’ apt metaphor in John chapt 11)

As to soul, we don’t maintain that man has a soul. We maintain that he a soul, as in how we may say that “not a soul was present.” The Bible’s first mention of ‘soul’ is found at Gen 2:7….”the LORD God formed man of the dust of the ground and breathed into his nostrils the breath of life: and the man became a living soul.” (KJV) He became one, he was not given one. (You became a doctor. You were not given a doctor) Thus, when a person dies, their soul dies, since it is essentially synonymous.

Many modern translations, perhaps recognizing that such a translation of soul runs counter to their doctrine of immortal soul, have instead translated Gen 2:7 to read ‘man’ or ‘being,’ but the Hebrew word is nephesh, a word they eslewhere translate as ‘soul.’

Hope this helps. Quite a run you’ve gotten out of this post, Doc, isn’t it? Bet you didn’t foresee it. (and no, I haven’t lurked the whole time. But I do get hits from my original comment now and again, so I come over to see how things are progressing) Good for you.

If you understand the mechanics of intercourse or mastrubation with an intact penis, you will understand why women sometimes express preference. I have had a *great* time with a fully/radically Circumcised man, but ultimately, for my breastfeeding & older years, I prefer the rolling, gliding action as it is gentler.

And I can’t resist plugging the TLCTugger. I have looked @ all the devices & this is the most efficient & affordable.

Circumcision affects only female to male STD transmission, which is the least likely route. IMHO there may be considerable reporting bias overseas considering male & male intercourse.

Regardless of whether you think the cord has done a great job or not if a baby is born flat, the reality is that the reason that baby grew and lived long enough to be born is because the placenta and the cord did a good enough job.

Another reason to leave the cord intact, besides oxygen and blood stores from the placenta, is that the cord attached to the placenta (which is usually still inside the mother) makes it impossible to remove the baby from the mother, at least not very far. See Dr. Nils Bergman’s work at http://www.skintoskincontact.com for an explanation as to why it is especially important for compromised babies to stay with their mothers: in a nutshell, the mother is the baby’s safe place, and when the baby is removed from the mother’s presence, the baby goes into despair-distress mode, which negatively affects heart rate and oxygenation.

Midwife Thinking’s blog has a post on the topic of resuscitating with the cord intact: http://midwifethinking.com/2010/08/26/the-placenta-essential-resuscitation-equipment/

Also, see this website for photos and description of a baby being resuscitated in mother’s arms: http://www.homebirth.net.au/2008/04/resuscitation-of-newborn.html

It can be done.

Let’s start to assume, as the first rule of medicine requires, that any intervention is harmful until proven safe (First, do no harm). Including the intervention of cutting the cord so you can resuscitate a baby. Use the cord and the placenta, don’t sever them. How long would it take to retrain any one medical professional in resuscitating a baby on a board on their lap or with the baby in the mother’s arms? Strictly technically speaking, I don’t think it would take very long. Skills are the same. It’s the attitudes that need to change.

Cutting the cord at any time should be assumed harmful until proven safe. The physiological process is that the placenta & cord separates from the baby when the cord dries. Let’s put the onus on the INTERVENTION to prove itself, not the other way around.

Mothers of Change is doing a series on cord clamping right now: http://www.mothersofchange.com

Nicholas Fogelson :
After all, at a fundamental level circumcision either reduces the risk of HIV transmission or it doesn’t – I wouldn’t think it would matter which country it was in.
Thanks for the data!

Dr. Fogelson,
I do not know much about culture and socio-economic situation and traditions in African countries. However, I would say that theoretically it could matter which country or which part of the country, and it could affect results in either direction. For example, if in particular country or region people tend to believe that circumcision protects an individual and condoms are not necessarily it could make HIV rates higher among circumcised men. On the other hand, if circumcision in a region is performed more among wealthier men, who have money to pay for it, and who are more educated – educated to know to use condoms, HIV rates could be observed to be higher among uncircumcised. I am sure there can be many more causes of similar biases. Of course, biases introduced during data collection and analysis could also be present.

Given this data, I’m not sure what the real answer is. I’ve always held that when we have this type of disparity in data, it is often due to the method of data analysis in each study, or statistical variance. After all, at a fundamental level circumcision either reduces the risk of HIV transmission or it doesn’t – I wouldn’t think it would matter which country it was in. Some of the countries show a pretty strong association between circ. and lower HIV rates (Kenya most strongly), but as these data are observational there is certainly plenty of room for bias to creep in.

Thanks for the data!

I’d rather lose a hand than be HIV+ too, but there isn’t a link between losing a hand and HIV, just as there isn’t a link between losing a foreskin and a lower risk of HIV.

At the risk of repeating myself:
From the USAID report “LEVELS AND SPREAD OF HIV SEROPREVALENCE AND ASSOCIATED FACTORS: EVIDENCE FROM NATIONAL HOUSEHOLD SURVEYS”
“There appears no clear pattern of association between male circumcision and HIV prevalence—in 8 of 18 countries with data, HIV prevalence is lower among circumcised men, while in the remaining 10 countries it is higher.”
http://www.measuredhs.com/pubs/pdf/CR22/CR22.pdf

The South African National Communication Survey on HIV/AIDS, 2009 found that 15% of adults across age groups “believe that circumcised men do not need to use condoms”.
http://www.info.gov.za/issues/hiv/survey_2009.htm

From the committee of the South African Medical Association Human Rights, Law & Ethics Committee :
“the Committee expressed serious concern that not enough scientifically-based evidence was available to confirm that circumcisions prevented HIV contraction and that the public at large was influenced by incorrect and misrepresented information. The Committee reiterated its view that it did not support circumcision to prevent HIV transmission.”

The one randomized controlled trial into male-to-female transmission showed a 54% higher rate in the group where the men had been circumcised btw:
http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(09)60998-3/abstract

ABC (Abstinence, Being faithful, and especially Condoms) is the way forward. Promoting genital surgery will cost African lives, not save them.

That thing about perspective: that’s a good example. If I had a choice between losing a hand and being HIV positive, I’d lose my hand. Hopefully, none of us (people, the world-over) will have to face that kind of decision. Still, how can someone look at the situation with HIV/AIDS in Africa, and think that voluntary circ by adult males is an issue.

I recently wrote to Dr. David Odd (UK) to discuss his work (re: resuscitation at birth and cognition at 8 years of age: a cohort study) and in his reply he stated: “At present we don’t know if early cord clamping is good OR bad for compromised infants at birth: but I am aware of research being planned in this area so we may have an answer in a few years”. Sounds promising.
The implementation of the B.A.S.I.Cs trolley in the UK may be able to begin generating data but it would also be good to have longer term studies that track outcomes.

All the best,
Kate

Sure, like a man with two working eyes do not know what it is to be blind, and so cannot tell if he would like it or not.
Seriously…

My first son suffered severe head trauma (cephalhematoma) at birth. His developmental delays were evident from the beginning. I did survive to have three more sons. My second son’s birth was even more traumatic (a face presentation). for years I believed he was stillborn, brought back to life after many tense minutes of resuscitation. At 8 pounds 14 ounces he looked fine within a day or two. He had no developmental delays and was precocious in learning to speak. Sadly at age 3 he was diagnosed as having autism. His speech was clear but consisted only of phrase fragments (echolalia).

Who am I, to suggest birth injury as cause of his autism?

1. I returned to school to study biochemistry and neuroscience, and am well-trained in interpretation of medical research, which I have followed for more than 4 decades now.
2. I chose family over pursuing a career in research, and am viewed as just a mother.
3. I have no platform from which to express an opinion that could be taken seriously.
4. However, I will keep trying to point out that ischemic injury at birth affects the brain in a very clear-cut pattern of damage that could interfere with normal language development, and I only hope someday this will be recognized:

In 1959 Ranck and Windle published their surprise finding of subcortical damage caused by “asphyxia” at birth, with most prominent ischemic lesions in nuclei of the auditory pathway. See Ranck JB, Windle WF. Brain damage in the monkey, Macaca mulatta, by asphyxia neonatorum. Exp Neurol. 1959 Jun;1(2):130-54.

In 1962 Kety published results of his work on blood-flow in the brain with the surprise finding that nuclei of the brainstem auditory pathway have higher blood flow than any other area of the brain, which explains their greater vulnerability to ischemic impairment. See Kety SS. Regional neurochemistry and its application to brain function. Bull N Y Acad Med. 1962 Dec;38:799-812. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1804882/?tool=pubmed.

In 1969 Faro and Windle published their finding that brain maturation does not follow a normal course in monkeys subjected to “asphyxia” at birth. See Faro MD, Windle WF. Transneuronal degeneration in brains of monkeys asphyxiated at birth. Exp Neurol. 1969 May;24(1):38-53.

In 1940 William Windle stated, “. . . the rather common practice of promptly clamping the cord at birth should be condemned. Of course this will make it impossible to salvage placental blood for ‘blood banks.’ However, the collection of usable quantities of placental blood robs the newborn infant of blood which belongs to him and which he retrieves under natural conditions.” See Windle WF. Round table discussion on anemias of infancy (from the proceedings of the tenth annual meeting of the American Academy of Pediatrics Nov18-20, 1940) Journal of Pediatrics 1941 Apr; 18(4):538-547.

You point out that “human beings born at term clearly thrive no matter what is done.  One only needs to deliver a few hundred infants, clamp their cords immediately after birth, and watch them go home apparently healthy to know this.”

My stillborn son was resuscitated, came home apparently healthy, and appeared to develop normally for about 3 years. However, abnormalities of the auditory system in victims of autism have recently been reported. See Kulesza RJ Jr, et al. Malformation of the human superior olive in autistic spectrum disorders. Brain Res. 2011 Jan 7;1367:360-71.

Clearly most infants suffer no harm from clamping the cord immediately at birth. However, the developmental course of these infants should be followed into the school years, and into their teens. Schizophrenic decline becomes apparent sometimes as late as a person’s 30s, and includes auditory system dysfunction.

I wish my son could have been resuscitated without clamping the cord. I realize now that he was not stillborn, and at 8 pounds 14 ounces had been well nourished and oxygenated from the placenta. Allowing placental blood-flow to continue during ventilation of his lungs would have been healthier, but I realize that in earlier generations we might both have died in childbirth.

Thank you, Dr Fogelson, for continuing to advocate delayed clamping of the cord at birth. I do hope Drs. Weeks’ and Hutchon’s BASICS trolley can soon come into routine use for depressed babies.

ThatsNotHowScienceWorks :
I hit post too soon, or maybe not soon enough.
I would ask any serious intactivist why they are not involved in helping children who suffer from ongoing pain from poverty or neglect or illness. I can’t fathom being so concerned about theoretical future babies’ potential pain and potential imagined PTSD. I’m sure that the children in your area could really benefit from your volunteering at a public library or helping with homework over the phone.

This is just an elaborate version of “Let’s talk about something else.” Sure there are more important issues. There always are. You have your priorities and I have mine.

I don’t care who circs as long as it’s legal
That’s why part of Intactivism is about making it illegal – or as lawyer Peter Adler argues here, establishing that it is already illegal.

Nicholas Fogelson :
I’d just do what feels right to you.

What about just leaving the baby’s genitals alone so that in due course he can just do what feels right to him – probably nothing.