Helping parents achieve safer male infant circumcision
Non-therapeutic neonatal circumcision, whether for religious or cultural reasons, is generally not available via the NHS. Tragedies can occur with unqualified practitioners, and some health-care Trusts have cooperated with local communities to provide approved services. Unfortunately, these are unevenly distributed throughout the UK and most involve cost. Midwives are well placed to help interested parents understand the procedure and contact an acceptable provider.
This article hopes to give midwives some knowledge of infant circumcision, its controversial nature, the pros and cons, the groups for whom it is important and the methods commonly used in the UK. Points are listed for patient discussion and suggestions made for examining websites. As with Scottish guidelines, were midwives to discuss neonatal circumcision with all parents in the antenatal period, it would give them time to consider the procedure and access a safe and reliable service.
Male circumcision or the removal of the foreskin holds a deep spiritual significance in Judaism and Islam. The Judaic origins are reflected in our language as no other part of the human body is afforded a negative prefix, as in ‘uncircumcised.’
A better understanding of foreskin problems and the use of steroid creams for phimosis have led to a decline in the operation for medical reasons (Naguib et al, 2012; Hutson et al, 2015). However, the development of a more ethnically diverse society has led to an increasing demand for non-therapeutic circumcision (Stringer and Brereton, 1991). Sadly, the complications caused by unregulated practitioners documented by these authors have continued, with increasing concerns regarding sterility and infection control (Paranthaman et al, 2011; Poole, 2014). In England, community-based circumcisions have resulted in two recent tragic deaths, which involved unqualified personnel, poor communication and the failure to appreciate the dangers of continued blood loss (Fogg, 2012). Scotland has attempted to resolve such problems by requiring midwives to ‘ask all parents’ about circumcision at antenatal booking, ‘rather than presume someone's religion or belief’ (The Scottish Government, 2008). Religious circumcision is then offered free of charge under a general anaesthetic between the ages of 6 and 9 months (The Scottish Government, 2008). However, most approved services in the rest of the UK usually consider local anaesthesia up to 6 months of age as perfectly safe (Hutson et al, 2015). Midwives can help significantly by ensuring that information relating to such recognised providers is widely available.
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