The Cost of the Cut: Reflections on Infant Circumcision

by Jeanne Denney

I remember the day after my first child was born. A well-known “OB to the Stars” in New York City who delivered my son came in to see what we wanted to do about circumcision. “This is completely up to you,” she said with authority. “But it only takes a minute and he won’t remember a thing. I do it myself. It is absolutely not a big deal.” I trusted her judgment in a New York nanosecond as I had trusted her throughout the labor. She was beyond confident. I, on the other hand, was 27 years old and quite without confidence. I was unprepared for mothering and comforted by the idea that  the medical establishment had the answers. Still, I had the good sense to turn to my husband, saying simply, “This is up to you.” Nick declined the procedure for Michael, and later for Peter and Gil, our two twin boys even though, or perhaps because, he himself had been circumcised at birth.

Later on, I was surprised to discover the emotions our choice triggered in my father. Not having been circumcised after his home birth on an Iowa  farm, he had it done in the Navy and found it a brutal experience, one he did not want his grandchild to go through. “Best to just get it over and done with early,” he said, never questioning the ultimate need for it, the timing of doing it with a newborn, the humanity of the procedure itself or its ultimate side effects on body or psyche. Dad’s conclusion that it would never be remembered still seems to be the norm in America. Though circumcision rates in the United States have declined from 90% to 57% in the past 40 years, it is still much more common here than in Europe, Australia or Canada where rates are usually well under 20%.

Traumatic Learning

Because of this pervasive lack of public dialogue on this subject, it was probably fifteen years before I discovered literature on trauma while I was studying and practicing body psychotherapy. I learned that, far from never remembering traumas of this nature, a baby’s nervous system registers events such as birth, early bonding and circumcision with a strong neural imprint. In these imprints are messages about the safety and kindness of the world that often lasts a lifetime. Further, I began to notice that circumcision was an experience that exerted a significant influence on the psyches of my male clients. It was certainly far from the innocuous, small procedure, assumed forgotten, I had been assured about after Michael’s birth. I began to ask myself: “Where  had my OB’s authoritative certainty that it would be ‘no big deal’ to my baby come from?” It certainly did not appear to come from sound medical or psychological research.

The idea that babies and children are not significantly influenced by harsh experiences because they do not  have conscious recall of them later, is the greatest distortion of truth I have had to witness as a doula, therapist and mother, one that seems to live on in hospitals and within medical personnel despite their often very good conscious intentions. It is an idea that should, in my opinion, be challenged loudly and at every possible opportunity by many voices, good research and common sense.

Rachel’s Story

Challenging such thinking is just what my friend Rachel did a couple of years ago, however it was not without a price. As a new nurse on a labor and delivery floor in a large New York City hospital, Rachel was given circumcision support duty as one of her first assignments. She had no idea where this duty would take her. When I talked with her after her first few months she was visibly distraught by her job and the suffering she was witnessing. She also worried that she might lose her job for complaining loudly and often about something that seemed unnecessarily cruel. The circumcisions Rachel was assisting were generally administered with no anesthesia to babies. This is a traditional practice still in common use despite the fact that the American Association of Pediatrics does not consider circumcision  medically necessary and has advocated for the use of anesthesia since 1999. (A compelling, but graphic description of what Rachel was witnessing can be read in this description offered by then nursing student, Marilyn Milos who eventually founded NOCIRC).

Being naturally empathic, Rachel’s  experience of the agony of infants during this procedure was nearly more than her nervous system could bear. She was forthright in her complaints to doctors about not using the anesthesia, and assertive in requesting that they follow APA recommendations. She even counseled parents to request the anesthesia, and advised them this would probably not happen without their active intervention (a practice that did not make her popular with colleagues). Indeed, she once witnessed a doctor blatantly ignore a parent’s request for local anesthesia for their child’s circumcision (don’t, and say you did!), unilaterally deciding that it was unnecessary. I am sure that Rachel’s  empathic presence helped many babies she comforted post-operatively, but the toll this compassion took on her own mind and body was extreme. Being new, young and not yet numb to the experience of suffering before her, her own nervous system was at risk. She began to lose both weight and hair as symptoms of what is now recognized as “vicarious trauma.”

Awakening Direct Awareness

I am not saying here that it is necessarily unethical to circumcise infants or intending in any way to impose guilt about choices families make. Certainly if my husband had answered, “Yes, please, let’s have the circumcision,” I would have complied without thought and would have known little about my child’s experience. Circumcision is a world-wide, cross-cultural practice often associated with the initiation of males and religious rites. It has been around a long time and is likely to  be with us for a long time to come. There are undoubtedly arguments in its favor that must be weighed. However, there seems to be ample and growing evidence from places like Circumcision Information and Resource Pages   http://www.cirp.org/, the National Organization of Circumcision Information Resource Centers  http://www.nocirc.org/, or advocacy organizations such as Intact America www.intactamerica.org that circumcision as we often do it, is an unnecessary surgery which is significantly traumatizing to infants and may be associated with later sexual problems such as impotence, premature ejaculation, and erection dysfunction. Advocates often note the ethical problem of permanently disfiguring the body of someone else without their consent. Perhaps most importantly, most circumcisions happen without loving parents present to comfort and reassure the baby, and often without the basic courtesy of anesthesia that any one of us would demand if the most delicate part of our body was to be ritually modified.

I recall Mark’s “Big Brain Question” here. A newborn getting a circumcision alone with strangers has got to be screaming, “Are you there for me?!” and “What kind of painful world is this!?,” and not getting very good answers. At least that is what Rachel and other witnesses to live circumcisions tell me (even with anesthesia). Surely if we can put newborns through it, we should be willing to go through such an initiation ourselves, even if only as witnesses and empaths. I have a feeling that directly observing this experience might change a lot of our unexamined views on the subject.