“Hey, baby: just bite down on this stick.”

by Lillian Dell’Aquila Cannon

55% of circumcising doctors do not use anesthesia during circumcisions, and often the only “anesthesia” a newborn gets during circumcision is a pacifier dipped in sugar-water.  What does this say about our culture and ourselves?

In a study of doctors who perform neonatal circumcisions, only 45% of them used any anesthesia or analgesia.  Pediatricians, family practice physicians and OBs all perform circumcisions, but OBs were the least likely to use any pain relief (only 25% used anything.)  This is especially sad in my area of the country, where OBs are the main circumcisers, despite male genitals NOT being their specialty.  Even sadder: “Of physicians surveyed, 44% do not use anesthesia because they feel the procedure does not warrant its use.”  What other amputative surgery does not require anesthesia?  What body part would you consent to have removed without anesthesia?

A common type of anesthesia is a sugar-water solution called Sweet-Ease.  A pacifier is dipped into it and given to the baby.  Based on studies that showed that babies cried less and their facial expressions appeared less painful with the sugar water, they thought that this was an effective type of anesthesia.  To the uninitiated, sugar water is intuitively NOT effective – would you consent to be cut with only a lollipop for anesthesia?  I certainly would not, but amazingly, parents convince themselves that it worked.  This recent study from The Lancet showed via brain scan that they felt just as much pain – the only difference was that they didn’t make the same facial expressions.  To the observer, the baby appeared to feel less pain, but the baby felt just as much pain as those without a pacifier.  Sugar-water pacifiers are only for the adults’ comfort and self-deception – they don’t do anything for the baby.

One of the other interesting findings of the paper was that “physicians in the western states were significantly more likely to use anesthesia than were other physicians from the rest of the United States.”  The western states also have the lowest circumcision rates (see this lovely map.)  These two facts are connected.  When circumcision ceases to be normal, it can be seen as what it is: painful and unnecessary.  The study also showed that pediatricians were the most likely to use anesthesia.  This is likely due to two factors: they are taught about this more in their residency, and all their patients are children, thus they are more likely to see children as people.

There is a long history of doctors objectifying their patients, seeing them as problems and puzzles, but not as people.  For example, up until the mid-20th century, doctors performed open-heart surgery on babies with no anesthesia, just a paralytic agent.  That meant that the babies were awake and felt everything – they just couldn’t move.  The low usage of anesthesia in routine infant circumcision is a remnant of this attitude.  Medical students learn to keep a certain emotional remove from their patients in order to function effectively, but this cannot include ignoring patients’ pain.  Babies cannot speak or resist (much), but that does not make them less human.  In our culture, however, many people have the idea that babies and children are less human, and that adults have rights over them.  This is a moral mistake – the fact that adults have greater agency and power over children does not mean that children are less human or have fewer rights.  Might does not make right.  The truth is, because of their special needs and asymmetry of the power relationship between adults and children, adults have a duty to act in the child’s best interest.  True, babies and children are not as powerful as adults, but only an immoral person would take advantage of this fact to perform painful and unnecessary surgery.


This entry was posted in Circumcision, Human Rights, Medical Anthropology and tagged , , . Bookmark the permalink.

9 Responses to “Hey, baby: just bite down on this stick.”

  1. Ashley says:

    So disturbing. A few weeks ago I sent this same Lancet article to a friend of mine who is a pediatrician. When she did circumcisions she used the sugar water pacifier along with a dorsal penile nerve block. She doesn’t do them now, though, because where she lives OB’s do them, and she did confirm that in her experience OB’s are less likely to use anesthesia. Ugh.

  2. roger desmoulins says:

    A good post about an important part of the social evil that is routine infant circumcision.

    What is the percentage of doctors who use analgesia other than sugar water?

    Lewis Sayre began advocating routine childhood circumcision in 1870 (see Gollaher 2000 for the history of circumcision in the USA). Atthat time, general anesthesia was the only option, and maybe 1 patient in 100-500 died under anesthesia. The death rate was higher among young children. So the doctors of the era dispensed with anesthesia for circumcisions. This was of course traumatic for boys, so the operation was shifted to the neonatal period, where the trauma cannot be remembered. The option of reconsidering circumcision itself was not entertained.

    Routine circ without anesthesia was so well anchored in American medicine, that when novocaine was introduced in 1920, circumcisers ignored it. When lidocaine was introduced in 1950, circumcisers ignored that as well. RIC without anesthesia finally fell into official disrepute after the JAMA published a study in 1998 conclusively proving that RIC was intensely painful. (Before then, much of the evidence of excruciating pain was rationalised away.)

    I have been told that American doctors dislike injecting lidocaine because it has to be given 15-20 minutes to take full effect, and obgyns very much have the “time is money” outlook. Also, quite a few doctors believe that lidocaine causes swelling that interferes with surgical precision.

    Finally, the reason why doctors west of the Rockies are more likely to use lidocaine is that they fear that if they did not, the number of circs they do would be even lower than it already is. They are responding to market forces!

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