Maybe it’s because circumcision has become a controversial practice. Or maybe it’s the fact that there’s no scientific research linking breastfeeding and circumcision. Whatever the reason, all the breastfeeding education I had before my son’s birth was silent on the topic of circumcision. I didn’t know that circumcision could affect a newborn’s ability to breastfeed.
I know many of my readers have strong feelings about circumcision. I am not going to condemn circumcision, nor am I defending the fact that my son is circumcised. My primary focus in blogging is breastfeeding, and that remains the focus of this post on circumcision. Parents should know that breastfeeding problems are among the risks of circumcision in the first few days of life. If I had known, we would have made different choices.
My experience
My son was circumcised on his third day of life. He wasn’t breastfeeding well yet and we were reluctantly supplementing with formula as instructed by the pediatrician. While my husband accompanied him, I anxiously waited for him to return to my hospital room so I could comfort him and nurse on demand as he recovered from the procedure.
When he returned, however, he was asleep. He wouldn’t wake up to feed. An hour went by. He just slept. Far longer than he had ever slept in his short life. Hours passed. When he finally started to stir and show hunger signs, I eagerly put him to my breast. He screamed and arched his back. My doula tried to help, with no success. I dropped my few precious drops of colostrum, extracted by the breast pump, into his mouth. We were discharged from the hospital later in the day, without breastfeeding established. Eventually, we got breastfeeding on track. Circumcision wasn’t the cause of all the breastfeeding problems we had, but I couldn’t shake the suspicion that it might have contributed to them.
Researching circumcision and breastfeeding
Ever since that day, I’ve wondered if my son’s post-circumcision behavior is a common response. I’ve heard of breastfeeding problems arising after circumcision from a few of my clients. I set out to find some good, peer-reviewed published studies linking circumcision and breastfeeding, and found nothing that directly links the two. There is research establishing that circumcision is painful, which I discuss below, but the most informative resources I found came from major professional organizations and lactation consultants.
Original research on circumcision pain and infant behavior:
I was disappointed to find that most of the scientific literature on behavior and feeding response to circumcision is decades old. Many variables can change in this time, such as circumcision procedures, anesthetic measures, and feeding practices (most of the babies in those studies were bottle-fed.) What we can conclude from the published research available is that circumcision is painful to a newborn and may lead to what lactation consultants call a “shut-down” response. Circumcision results in vigorous crying, even with topical anesthetic treatments that continue to be used today, and is usually followed by prolonged, non-REM (very deep) sleep. None of the studies I found directly linked circumcision or the behavioral response to breastfeeding. I’d say we’re overdue for a study of breastfed infants that assesses latch, milk transfer, and duration of feeding in the hours post-circumcision. From here, we’ll turn to the breastfeeding and pediatric organizations for more on the stress of circumcision and it’s effects on breastfeeding.
La Leche League
La Leche League has no official policy or statement on circumcision, but I found the following warnings about circumcision:
The Breastfeeding Answer Book: When a baby undergoes a painful medical procedure, such as a heel stick, injection, spinal tap, or circumcision, he may shut down and be unreceptive to feedings until he is feeling better.
La Leche League responds to a leader’s question about addressing circumcision: “Circumcision, in and of itself, is not directly related to breastfeeding. However, like other elective surgeries, this procedure can affect the early days of breastfeeding”… “The majority of babies are sleepy at least twenty-four hours after birth. If they are already sleepy, and have not nursed well or often, the circumcision being performed early in the hospitalization may cause breastfeeding problems. As a mother and a patient, it is your choice to ask the physician to wait until the last hospital day to perform the surgery, or to ask if it could be done later.”
American Academy of Pediatrics (AAP)
The AAP’s policy statement on pain management states, “research indicates that newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward.”
The AAP’s policy on breastfeeding, while not directly mentioning circumcision, suggests that after birth, “Procedures that may interfere with breastfeeding or traumatize the infant should be avoided or minimized.”
Journal of Human Lactation
Two letters to the editor in 2000-2001 raised the issue of circumcision’s effect on breastfeeding. A well-known IBCLC notes her observation that baby boys circumcised before breastfeeding is established have more problems breastfeeding. Another lactation consultant responds in agreement: “…what I observe in the hospital again and again, with babies shocked into a stupor, some having not yet even suckled well, milk volume not yet increased, and mom not yet experienced with feeding.”
Breastfeeding Management for the Clinician: Using the Evidence (Marsha Walker, 2006)
Marsha Walker describes the effects of the prolonged hard crying associated with circumcision: “as crying progresses, infant behavior becomes more disorganized and the exhausted infant may be unable to make eye contact or breastfeed effectively.”
Why this is a big deal
The interference with breastfeeding may only be temporary, but for a baby still struggling to learn to latch, a brief unreceptive period may derail breastfeeding. A long stretch of time with no breastfeeding this early on can impact the amount of milk a mother starts to produce. Less milk removal means less milk will be made. A newborn who goes long periods without “practice” at the breast can lose the learning opportunity to develop the good sucking skills that are required for successful breastfeeding. When a newborn seems to not want to breastfeed, hospital staff are often quick to turn to a bottle of formula, another strike against learning to breastfeeding during the critical first few days.
Circumcision doesn’t impair breastfeeding for every baby. What the evidence above shows is that it’s particularly a risk for newborn babies who have not yet learned to breastfeed well- often the case when circumcision is done prior to hospital discharge. Interestingly, the traditional Jewish ceremony of circumcision is performed on the 8th day, by which time most babies have learned to breastfeed well and their mothers are making plenty of milk.
Circumcision is a common birth-related practice in U.S. hospitals. Rates are dropping, with recent U.S. average rate of 56% of baby boys (rates are much lower outside the U.S.) but in some areas of the country, the rate is higher than 80%. If only a fraction of these procedures leads to breastfeeding complications, that’s still a lot of baby boys whose mothers don’t meet their breastfeeding goals. But without more research, it’s hard to say how commonly circumcision leads to breastfeeding problems.
My questions for you: Did you know breastfeeding problems were a risk of circumcision? If you circumcised, did your baby’s response affect the breastfeeding pattern in any way? Please be respectful of readers whose feelings about circumcision may differ from yours.
I had no idea there could be a correlation; very interesting. As per traditional Judaism, we circumcised our son at 8 days old–long enough that breastfeeding was established. (He was also our 2nd, so it wasn’t as difficult to figure breastfeeding out.)
Kosher-thanks for stopping by. I’d love to hear more about the traditional Jewish circumcision since I’ve heard it’s less painful than what’s done in the hospital. . . true?
Thank you for posting this and excellent blog. I’ll be back. I did not circumcise my son due to the research I read about it being painful and, I decided, unnecessary. This post makes me all the more sure I made the right decision. I’m so glad he and I had a very strong bf’ing relationship from day one, which was never interrupted (he very rarely left my side in the hospital).
I have heard that there is some kind of optimal blood flow (or is it pain resistance?) that is established by the eighth day as well. God knew what he was doing when he prescribed that time period.
Stasi, thanks for stopping by and for your comments. I’m glad you had a great start to breastfeeding! Another note about the timing of circumcision. . . although it is painful at any age, I found some research articiles that indictaed it starts getting more painful later in infancy and childhood. So for those who circumcise for religious or cultural beliefs, 8 days really seems to be the best timing.
I don’t know about that. An adult can be put under anesthesia and express how much pain relief (Tylenol or stronger) they need afterwards. Infants have neither of those options and usually don’t even get much pain relief during or after the procedure. If your religion states to do it on the 8th day, I guess that is best, but if you’re doing it for cultural reasons alone, I think waiting until adulthood is best.
Thank you!! My son is not circumcised and we STILL had BF drama due to jaundice and low supply. I can only imagine what a circumcision would have done in our case. I probably would have given up.
While BFing was not part of why we chose against cir, I am now thankful in hindsight since our BF has been drama anyway. Staci M pointed me here- she mentioned you have a connection with Fuller? My hubbs and I both have degrees from Fuller as well.
I’ll be back!!! Thank you again!
Michelle- glad you did not circumcise and that you didn’t give up! Yes, my husband is a Fuller grad. Thanks for stopping by here – hope to hear more from you
We did not circumsize and had no trouble breastfeeding. I didn’t know that circumcision was a risk; we made our decision independent of that info. Although my husand has performed circumcisions at work, he does not feel comfortale with it. Good for you to doing so much precious research! Very interesting!
Thanks, Jemila! ouch, I would not want that responsibility as a doctor. I would love to hear his observations on circumcisions, pain and breastfeeding sometime.
You can add me to the list as someone whose baby was circumcised and then had trouble breastfeeding. I was against circumcision from the beginning, but my husband (who isn’t circumcised) wanted it for personal reasons and I agreed, figuring that I don’t have the equipment, so who am I to say anything? But the circumcision was performed early, and that combined with problems latching and poor lactation support at the hospital left me with low milk supply. My baby couldn’t latch until 2 months and I had to give up BF at 6 months because I couldn’t meet his needs anymore, even with a supplemental device.
I sought out information and STILL wasn’t prepared for the BF problems I encountered, nor were the healthcare professionals I had access to at the hospital able to give the info I need. I just wish there was more support for women out there who try to BF, because most feel crushing guilt (like me) when it doesn’t work, as I have seen on the La Leche forms. There is definitely more research that needs to be done!
Marie- that’s terrible, but unfortunately all too common, that they just didn’t help you enough in the hospital to get breastfeeding off to a good start. Circumcision is yet another strike against mothers and babies trying to make it work. I applaud your efforts to keep working at breastfeeding even when it took so long to get your baby to latch! I hope that time that you were able to breastfeed was rewarding to you.
Great post–something i have definitely been thinking about. I have two boys that are both circumcised. My oldest did struggle with BF but also had a more traumatic birth (forceps). My second son had a very gentle birth and was a natural at BF. If i have another son I still want to circumcise but after reading your post I am having second thoughts about WHEN to circumcise. I did not know that about Jewish tradition to wait 8 days. I am doing a home birth with my third so we will probably wait at least a week to make sure BF is well established. Thanks for your post again!!!
Nicole- blessings on your homebirth! I hope to go that route, too, next time around. I’m no expert, but I’ve heard that you can hire a mohel to come do the circumcision on the 8th day as they do for Jewish baby boys and it’s gentler than the typical procedure done in hospitals. I’m not sure whether we will circumcise again, but if we do, that’s how I’d want it done.
If you’re interested in hiring a mohel you should be able to get recommendations from a local Orthodox synagogue (just call and ask–you don’t have to explain to the person answering the phone that you aren’t Jewish) or if you know an Orthodox Jew, you can ask them as well. Even for a mohel, however, I suggest you act on recommendations, as like with anything there are those who are better and those who aren’t as good.
One of the best things about a mohel, though, is that they will come by to check on the baby the day before (to make sure he isn’t jaundice), they will check on the baby and mother the day after, and then a few days after, all the while looking for any signs of infection, making sure that mom/dad know how to change the dressing on the incision, etc. And they are available via phone if you have questions or concerns.
interesting, I was just talking to my coworker who is Jewish and had a mohel on the 8th day for her first son, and the second was done in the hospital, and she said the mohel did a MUCH better job than the ob/gyn. Not surprising that he would provide much more care to the infant, since that’s his specialty.
our experience:
i had done extensive research on breastfeeding and natural parenting before the birth of our first child. up until our (now 10m old) son was born, i worked in surgery at our local hospital, and was hyperaware of risks/complications/anethesia/surgical practices – i did know that breastfeeding problems were a risk of circumcision, and these were two of many reasons why i did not want to circumcise our baby if we had a boy; my husband, for reasons of his own, very strongly wanted to circumcise, and i ultimately deferred to him.
our small town medical community did not allow us the option of having our baby circ’d on the 8th day after birth (which was one of my conditions in accepting my husband’s decision). i, too, do not blame all of our breastfeeding problems on the circumcision, but i definitely think that it contributed. my baby was also sleepy when they brought him back after the procedure, and fought nursing later. he didn’t latch well and would only nurse for the briefest period. we never established breastfeeding in the hospital; my milk didn’t come in for a week. my 8 lb 4 oz baby lost down to 6#15 by his fifth day with us, and we were forced to supplement. we finger-fed him (with the syringes) for 6 weeks while attending a weekly lactation support group. he was never a good nurser and i never produced more than a half ounce each side per pumping session (and that was at the most), despite the supplements and reglan. we even purchased an SNS (like adoptive moms use) but all my efforts were to no avail. i gave up on nursing at 4 months, but continued to pump for two more weeks. it was so frustrating and depressing.
i can’t help but feel a little resentful; i know the trauma of the circumcision didn’t help. now, pregnant with baby#2 due in three months, i am almost hoping for a girl, just so that i am not faced with the same situation. i dread the trauma my baby will endure if he is a boy, because i will again defer to my husband – i even spoke the Archbishop about it, and i believe this is what is right for our family. i don’t want to feel sad and guilty every time i change a diaper those first weeks. i don’t want us to struggle with breastfeeding, which should be such a natural and enjoyable, nurturing time for us.
we are roman-catholic, but i am planning on seeking advice from the Temple in our town, and seeing if they can point me in the direction of a good mohel (in the event we are blessed with another son). our pediatrician performed the circumcision in the hospital, and he did a wonderful job and was also very thorough in his follow-up, but i think i will have to insist that the procedure be delayed the traditional eight days this time. i believe that God implemented the eighth day rule for very good reasons (blood-clotting factors, breastfeeding) and i would prefer to follow the Jewish custom if we have another boy.
this was our experience, and i pray that it is not repeated.
great non-biased article; i will be back for more … you have been bookmarked!
I am one of those with “strong feelings” about circumcision, I guess. Most moms don’t realize that the chance of circumcision interfering with breastfeeding is yet another way that circumcision endangers their child’s life, health, and well-being.
Alexis, sorry to hear about your troubles breastfeeding your last child. It sound hard, too, to be at a disagreement with your husband about it.
As a fellow Christian, I found it interesting when making my decision about this, that as well as the 8-day custom, early Jewish ritual circumcision was much less invasive than current medical circumcision. It was a ritual shedding of a few drops of blood, the Hebrew word used to institute circumcision is “clip” or “to cut shorter”, not “remove” or “amputate”. Regardless of it’s extensiveness, I’m so thankful that circumcision, for Christians, is made obsolete by Christ’s sacrifice on the cross and replaced by the sign of baptism. We no longer need the shedding of blood (circumcision and animal sacrifices) to point forward to Christ, because he has already come and paid the price once and for all!
Wow! This is the first time that I am finding out about a correlation between bf problems and circumcision. I was reluctant to have my first son circumcised. I did not know if I should or shouldn’t. I called my husband and he said that it was ok. I was heartbroken by how upset my son was after the procedure. I was already having latch problems and my milk was not letting down. To make things worse, I had a visit from my in-laws that day. They kept blaming his tears on breastfeeding and told me to just give him a bottle. I now think that the circumcision only made things worse. I am 9 months pregnant. I will not have my second son circumcised!