Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum

Mary Kroeger with Linda J. Smith.

Jones and Bartlett Publishers, 2003, pp. 197-198.



According to the Council on Scientific Affairs of the American Medical Association, circumcision is a non-therapeutic procedure without documented benefit for the infant. Hill has raised concerns in a letter to a lactation journal about how little the matter of possible negative effects on breastfeeding from circumcision is addressed in the literature or in parental counseling. Circumcision is a traumatic and painful procedure that induces hard crying and that will continue to cause postoperative pain to the newborn. Anesthetic is used in less than half of the procedures done, according to one survey. This is despite the fact that the American Academy of Pediatrics (AAP) has called for the use of anesthetic.

In his letter, Hill notes 25 years of studies documenting breastfeeding difficulties in infant males who have been circumcised. Howard et al. studied 44 infants after circumcision and found less-frequent feeding and withdrawn, subdued, less-interactive behavior. Howard cautions that because many babies are discharged on the day the circumcision is performed, they are lost to immediate follow-up for subsequent breastfeeding problems. Breastfeeding newborns in this study required supplementation due to their mother's perception that the baby could not breastfeed or had true difficulties with feeding. Early supplementation before the onset of lactogenesis is known to be associated with breastfeeding failure. Given the strong arguments for protecting a calm, safe, pain-free environment for the newborn to transition to life outside the warmth and cushion of the uterus, Hill argues that successful breastfeeding should be given absolute priority over neonatal circumcision. The work group on breastfeeding in the AAP has also called for avoidance of painful procedures like circumcision.

Fleiss has written extensively on the initial and long-term trauma to infants from circumcision. He writes: The radical practice of routinely circumcising babies did not begin until the Cold War era. This institutionalization of what amounted to compulsory circumcision was part of the same movement that pathologized and medicalized birth and actively discouraged breastfeeding.


  1. American Medical Association, Council on Scientific Affairs. 1999. Report 10: Neonatal circumcision. Chicago IL: American Medical Association.
  2. Hill G. 2003. Breastfeeding must be given priority over circumcision. Letter in J Human Lact 19(1):21.
  3. Stang HJ, Snellman LW. 1998. External link Circumcision practice patterns in the United States. Pediatrics 101:e5.
  4. Marshall RE, Porter FL, Rogers AG, et al. 1982. Circumcision II: Effects on mother-infant interaction. Early Hum Dev 7:367-374.
  5. Howard CR, Howard FM, Weitzman ML. 1994. Acetaminophen analgesia in neonatal circumcision: The effect of pain. Pediatrics 93:641-646.
  6. Academy of Pediatrics, Workgroup on Breastfeeding. 1997. External link Breastfeeding and the use of human milk. Pediatrics 100:1035-1039.
  7. Fleiss P. 1997. The case against circumcision. Mothering Magazine Winter 1997:36-45.

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