Circumcision -- Evidence-Based Information for Parents

Circumcision is a controversial topic for many parents, and it is often difficult to find unbiased, evidence-based information about the procedure, benefits, and risks. Parents rely on Facebook pages, message-board threads, and their friends for information. Unfortunately, there is no regulation over what friends and webpages can say, and a community group or a meme is not required to cite their data. Parents must be critical of all the information provided to them and check that it coming from a reliable source. We encourage you to check the data presented here as well! It is your right to have correct, reliable, evidence-based data, and it is your responsibility to make an informed decision for you and your family.

**The information provided below was gathered from peer-reviewed journals and trusted sites. If you have questions about the data presented, please contact CraftedBirth@gmail.com or speak to your pediatrician**

For a printable version of this information, please click HERE.

CIRCUMCISION

What is it?

In infant boys the foreskin is fused to the tip of the penis (like the skin is fused around a fingernail). As an intact penis grows, the foreskin begins to separate from the tip, and can usually be fully retracted by age 10. Circumcision removes the foreskin. It is usually performed within a few days of birth by a pediatric surgeon or a religious figure like a mohel. In 2010, about 58% of newborn boys in the U.S. were circumcised; the rate is about 30% in Canada, and less than 20% in Europe.1 The procedure is very common in the Jewish and Muslim faiths.

How is it done?

The baby is placed on his back and his arms and legs are restrained to prevent movement during the procedure. The baby will either have a topical anesthetic applied to the surface of the penis or have numbing agents injected into the base of the penis. The foreskin is first separated from the tip with forceps and cut with surgical scissors or a scalpel to expose the tip.

Plastibell Method: a clear plastic bulb is placed over the tip and covered with the foreskin. A suture string is tied around the foreskin, squeezing it tightly against the plastibell. The skin above the tie is cut with a scalpel surgical scissors. The ring is left on and will fall off in 3—7 days when the wound heals.

Gomco Clamp: a bulb is placed over the tip and covered with the foreskin. The clamp is placed over the bulb and tightened until the skin is squeezed tightly against the clamp. The foreskin above the clamp is then cut with a scalpel or surgical scissors.

Mogen Clamp: the foreskin is lifted through a clamp and pressed flat. The foreskin above the clamp is cut with a scalpel.2,3,4

What are the potential risks?

The overall complication rate is about 1.5% (conclusive rates for individual complications is not currently available). More complications are seen with non-medical providers, non-hospital-based procedures, “free-hand” methods, premature infants, and older children and adults.5 While death due to circumcision complication is rare, it has been reported (usually due to bleeding, infection, and shock).6,7

Pain: Doctors may use topical numbing cream and/or a numbing injection to help ease the pain, as well as a pacifier dipped in sugar. A review of studies showed that none of these interventions completely eliminated the pain response to circumcision.8 The “Ring Block” injection is the most effective at blocking pain. All interventions run the risk of complications (8-14% show skin redness, swelling, irritation from topic cream; 11% show bruising from injection).9 Circumcision without anesthesia is extremely painful, so make sure your pediatrician, obstetrician, or mohel uses anesthesia and waits at least 30 minutes after application before proceeding with the circumcision.

Bleeding: Blood loss is often minimal, but in rare cases the frenular artery bleeds and requires sutures. If this occurs at home, blood loss may be substantial and cause shock or death. Undiagnosed blood disorders, such as hemophilia, can also lead to dangerous bleeding and if there is a family history of bleeding illness, circumcision is not recommended. (Note: because infant blood volume is low, even losing 1 oz of blood can cause shock, and losing 2.3 oz of blood can be fatal.)6

Infection: The incision can become infected. The infection rate is higher with the Plastibell method, as the foreign object remains on the penis for several days.7 Infection is also a specific concern with the Orthodox Jewish metzitzah b’peh ritual, where the mohel sucks the blood away from the penis with his mouth (which can also spread other diseases like Herpes).5

Meatal Stenosis: the narrowing of the urethra which can interfere with urination and require surgery to fix.7 

Adhesions: pieces of the foreskin remain stuck to the head and must be removed surgically.

Too much/too little/uneven skin removal: If too much skin is removed, a man may not have enough skin for an erection, and the skin may split. If too little skin is removed, the excess skin can slide back over the tip and scar, causing phimosis (when the foreskin cannot be retracted). If the skin removal is uneven, the penis may curve to one side. This is called Chordee, and may be treated with additional surgery. Note: some penile curvature is natural.7

What are the potential benefits?

HIV/AIDS: African studies have shown a decrease in HIV/AIDS infection when heterosexual men are circumcised. The theory is that the underside of the foreskin is more susceptible to infection (it contains more “target cells” for bacteria and disease).5 Circumcision would remove this susceptible skin. However, these studies are criticized because of the methods used and because the results cannot be duplicated in the United States and other developed countries (discussed below). The American Academy of Pediatrics states that circumcision is most beneficial in populations of very high HIV rates.10

Urinary Tract Infection (UTI): Only for boys with recurrent UTIs, circumcision can reduce the number of infections. The rate of UTI for healthy infants is about 1% for both circumcised and intact boys, and this rate declines as the boy ages.9

Why the controversy?

Disease:

- HIV/AIDS: Many disagree on the reliability of the African HIV studies. The circumcised men were put into different environments than their intact peers, with acess to clean water and soap, and the results have not been duplicated in the United States or other developed countries.11,12 Additionally, many believe that the studies have actually done more harm in Africa, as they may have instilled a false belief that circumcision alone prevents the spread of HIV. An alternate view states that instead of preventing sexually-transmitted diseases with surgery, men and women should be encouraged to use condoms and other safer-sex practices.

- Human Papillomavirus (HPV) & Penile Cancer: Similar to the HIV studies, results show a decrease in HPV infection in circumcised African men, but these results have not been duplicated in the U.S. Again, an alternate view states that condoms and the HPV vaccine is just a good at preventing HPV in men and women, and Penile Cancer in men (which can be caused by HPV).5

Ethics:

- Autonomy: Many parents believe that it is wrong to permanently alter a boy’s body when he cannot consent; however others argue that parents make medical decisions for their children all the time (for example, vaccination or medications).

- Tradition and Culture: Some equate male circumcision with female-genital-mutilation, which is illegal is many countries, including the U.S.; however many people believe circumcision to be a valuable and important part of their religion and culture.

- Elective Surgery: Some liken circumcision to elective cosmetic surgery, something that would never be allowed on an infant.

Official Recommendations: The American Academy of Pediatrics’ statement about circumcision is ambiguous:

“Although health benefits are not great enough to recommend routine circumcision for all male newborns, the benefits of circumcision are sufficient to justify access to this procedure for families choosing it and to warrant third-party payment for circumcision of male newborns.”12

Thought Starters:

Do you believe the benefits of circumcision outweigh the risks? 

Do you believe it is your job as a parent to make this decision for your son? 

Are there any other positive factors to consider? 

Do those factors outweigh the risks? 

Are there any other negative factors to consider? 

Do those factors outweigh the benefits? 

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Like what you've read? Pregnant and looking for a class in Western/Central Massachusetts?
Check out our current class schedule here.

Questions? I'm never very far away from my email.

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Sources:

1.   Wikipedia contributors. "Circumcision." Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 23 Jan. 2014. Web. 26 Jan. 2014, http://en.wikipedia.org/wiki/Circumcision

2.   Morris, B. J. “Circumcision—The Procedure Itself” 2013, http://www.circinfo.net/the_procedure_itself.html

3.   Scheve, Tom.  "How Circumcision Works"  20 January 2009.  HowStuffWorks.com. 26 January 2014,  http://people.howstuffworks.com/circumcision4.htm

4.   Wikipedia contributors. "Circumcision surgical procedure." Wikipedia, The Free Encyclopedia. Wikipedia, The Free Encyclopedia, 19 Oct. 2013. Web. 26 Jan. 2014, http://en.wikipedia.org/wiki/Circumcision_surgical_procedure

5.   Meilke, R. T. “Counseling Parents Who are Considering Newborn Male Circumcision” J. Midwifery Womens Health, 2013;58:671-682

6.   Frisbie, D. “Death from Circumcision” The Male Infant Circumcision Information Site, 2010, http://www.circinfosite.com/45.html

7.   Newborn Nursery at Lucile Packard Children's Hospital , “Complications of Circumcision” Stanford School of Medicine, 2014, http://newborns.stanford.edu/CircComplications.html

8.   Brady-Fryer B, Wiebe N, Lander JA. “Pain relief for neonatal circumcision” Cochrane Database of Systematic Reviews 2004, Issue 4,   http://summaries.cochrane.org/CD004217/pain-relief-for-neonatal-circumcision#sthash.t0sibvLf.dpuf

9.   American Academy of Pediatrics Task Force on Circumcision, “Technical Report: Male Circumcision” Pediatrics 2012; 130:3 e756-e785, http://pediatrics.aappublications.org/content/130/3/e756.full

10. Young, M.R, et al. “Factors Associated With Uptake of Infant Male Circumcision for HIV Prevention in Western Kenya.” Pediatrics 2012; 130:1 e175-e182

11. Frisch, M. et al. “Cultural Bias in the AAP’s 2012 Technical Report and Policy Statement on Male Circumcision” Pediatrics 2013; 131:4 796-800, http://pediatrics.aappublications.org/content/early/2013/03/12/peds.2012-2896

12. American Academy of Pediatrics, “Circumcision Policy Statement. Task Force on Circumcision” Pediatrics, 2012; 130:3, 585 -586. http://pediatrics.aappublications.org/content/130/3/585.full

Just show me numbers

(from one of my favorite episodes of The West Wing, "Two Cathedrals")

I've yelled this a few times in the past few weeks. I've been spending my free time navigating through peer-reviewed journals (as well a few other less-reliable websites) trying to gather evidence about some of the more controversial topics for parents. 

One-sheets about Circumcision, Vaccines, maybe Bed-Sharing/Co-Sleeping will find their way to this blog (and to my classes) eventually (oh, and by One-Sheet, and I mean 2 or 3 pages, because I cannot seem to condense it all onto one page). It's surprisingly difficult to find reliable information about these topics online -- I now have much more sympathy for parents who are debating these decisions and end up relying on Facebook groups, BabyCenter threads, and their friends for information. Unfortunately, there is no regulation on what a Facebook group can post, a BabyCenter mom can share, or where your friends' opinions come from. Even medical research sites like the American Academy of Pediatrics, the Center of Disease Control and Prevention, and the World Health Organization make statements without any citations, so it is incredibly difficult to understand where all the "data" comes from. For example, one site may say "Adverse reactions to this vaccine are extremely rare", while another says "Your child can have a serious adverse reaction to this vaccine"; both statements might be correct, but neither tells you what the adverse reaction is or the likelihood that it may happen. That is what we're going to try to fix.

Over the next few months Crafted Birth will delve into these topics for you, pulling out the best information and giving you NUMBERS to help you make the best decisions for yourselves and your baby. Stay tuned ...

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Like what you've read? Pregnant and looking for a class in Western/Central Massachusetts?
Check out our current class schedule here.

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We've moved!

Big news over here at Crafted Birth! At the end of November, my husband, son, and I moved from Queens, New York to Northampton, Massachusetts! I'm excited for our family to put down roots in this great community!

I spent December trying to get us all settled in our new apartment (and celebrating the holidays with my family, who are now only an hour away!). I'm now looking forward to meeting other educators and doulas in the area, as well as learning about all the different birth options here in the Pioneer Valley.

It was a crazy 2013, and I can't wait to see what this year brings. Happy New Year, everyone!

Hospital Tour Questions | Childbirth Classes in Western Mass

When I was pregnant with my son, I was the most prepared pregnant person. Ever. Even before I got pregnant, I was the most prepared non-pregnant person. Ever.

Consider the hospital tour. Most parents take their tour with a hospital's admission class or towards the end of their pregnancy, as a formality. I took mine before I was ever pregnant. And here's why.

In my own childbirth ed class there was a couple. They arrived at our second-to-last class looking very upset. They explained that they had been on their hospital tour the previous week. There they had learned that mom would have an IV placed as soon as she was admitted, would be on continuous Electronic Fetal Monitoring, would not be allowed to eat or drink, and would be confined to a bed the whole time. In our class we had learned many techniques for dealing with labor pain, and almost all of them required being up and moving around. The couple checked with their doctor, who had previously agreed to their preferences for a non-medicated birth, lots of moving around, and as few interventions as possible. "Oh, right, but yeah, we have to follow the hospital's rules," he said when they confronted him about all the restrictions.

This mom was 38 weeks pregnant, so it was pretty much too late to switch care providers. Now, I don't know if their doctor actually DID tell them they wouldn't be able to have an intervention-free birth at their hospital and they just didn't hear it, or if he actively misled them. I went home that night and was so upset for them. "Why did they wait so long to go on their tour?!?!" I cried at my husband. "Um ..." he answered, in his best I'm-trying-to-say-this-in-the-nicest-way-possible voice, "because you're the only one who goes on hospital tours for fun."

If this couple had gone on their tour even a few weeks earlier, they would have had more options: they could have tried to switch to another care provider with privileges at a different hospital; they could have spent time negotiating with their current care provider or another doctor at that hospital for more flexible rules; they could have met with the nurse manager or head nurse at the hospital to discuss the hospital policies (and see if there actually WAS a hospital policy about laboring in bed); or they could have taken time to adjust their expectations for a non-medicated birth and prepared themselves for laboring in bed. And if this couple had gone on their tour MONTHS earlier, they would have definitely had timed to switch care providers and plan their birth at a hospital where their wishes would be respected.

So go on your tour. Now. Even if you're not pregnant yet. Ask lots of questions, and really listen to their answers. Listen to the kind of information they volunteer, vs the information that you have to request (e.g. if they are super excited to talk about all the TV channels they get in the rooms but are confused when you ask about pushing positions, then they are probably used to moms spending a lot of "alone time" chilling in bed). If anything sounds like it conflicts with what your doctor has told you or has agreed to, ask for clarification -- it may be "policy" to give an IV to every patient, except when a doctor has specified other arrangements in writing. Then negotiate where you can -- you may need to make a special appointment with a nurse or a member of the hospital staff to sit down and go through things in detail. Finally, if you really get a bad feeling from the tour, look into changing hospitals -- but be prepared that changing hospitals will mostly likely mean changing care providers as well.

Don't know what to ask? I've put together a (very) long list of questions for your hospital tour (and for your care provider -- make sure their answers match!).

For a printable version, click HERE. 

Hospital / Birth Center Tour Questions

Name of Hospital / Birth Center:  

Address: 

Main Phone Number: 

Maternity Dept Extension:

Date of Tour: 

Tour Guide’s Name: 

Arriving at the Hospital in Labor

Can I pre-register or take home the paperwork I will need now, so admitting will be easier/faster?

Is there a Triage process before admission (observation on Fetal Monitor)?

How many people can be with me during Triage?

Do I need to be in Active Labor to be admitted? Is there a minimum I have to be dilated?

Labor and Delivery

Are there separate labor/delivery/recovery rooms, or just one room throughout stay? 

If separate, when does mom move from one room to another?

How many Labor rooms are there? ___ Delivery Rooms? ___ Postpartum Rooms? ____

Are they private? Shared?

How many people can I have with me during labor? During pushing?

How many people can I have with me during a Cesarean birth? Can my doula stay in the OR with us?

Can I wear my own clothes? Or is a hospital gown required?

If my partner/support person/doula is with me during labor/birth, does he/she have to wear anything special?

What is your Nurse-to-Patient ratio during Labor?

During Delivery?

During Postpartum?

What will the nurse do to help me during labor?

Can I eat and drink while in labor? Before/after epidural?

Is an IV required for everyone?

If IV is required, can a Hep-Lock be placed instead?

What kind of fetal monitoring is allowed/required? Continuous/Intermittent? Electronic Fetal Monitoring (EFM) or hand-held Doppler monitor?

Can I move around freely during labor? Walk in the halls? Or will I be confined to bed?

What things does the hospital have than can help with labor pain? Shower? Tub? Birth Ball?

Is there any reason these things would not be available to me when I arrive? (Restrictions? Complications? How many balls/showers/tubs are there for everyone?)

Will I be able to push in any position that feels good? Or will I be confined to bed?

What things does the hospital have than can help with pushing? Swat bar? Birthing stool?

Is there any reason these things would not be available to me when I arrive? (Restrictions? Complications? How many balls/showers/tubs are there for everyone?)

Newborn Care:

What immediate newborn procedures are required (Vitamin K, Eye Ointment, weighing)?

Can these be delayed, and for how long?

When/where are these done?

What other newborn tests or procedures are required before discharge (hearing tests, PKU test, regular weighing, bathing).

When/where are they done?

Do babies usually room-in or stay in the nursery?

Is there a NICU (Neonatal Intensive-Care Unit)?

What level (I, II, or III)?

If not, where is the nearest hospital with a NICU?

Is there a Lactation Consultant on staff? How are the nurses trained in breastfeeding?

What is your breastfeeding rate? At discharge? At 6 weeks? At 6 months?

Postpartum

How long is the average stay after an uncomplicated vaginal birth?

After a C-section?

Can partners/Dads stay over?

When can other children visit/stay over?

Other visitors?

Other Statistics/Information

Are most deliveries performed by OBs? Midwives?

What groups (OB offices, midwifery practices, etc.) have delivery privileges here?

What is your Cesarean rate?

Epidural rate?

Induction rate?

Augmentation/Pitocin (speed up labor) rate?

For a printable version, click HERE. 

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Like what you've read? Pregnant and looking for a class in Western/Central Massachusetts?
Check out our current class schedule here.

Questions? I'm never very far away from my email.

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Book Review: "Expecting Better" by Emily Oster

There is no lack of pregnancy books out there, so when I heard about one more book expounding on the "newest" recommendations for prenatal health, I was skeptical. When I saw the post on Slate.com that it was about debunking myths about eating sushi and drinking alcohol and coffee, I scoffed - doesn't EVERYONE know that it's ok to drink alcohol once in a while, a few cups of coffee won't hurt, and sushi won’t make you any sicker than it would for a non-pregnant person? Then my dear husband had to remind me, as he so often does, "Babe. No, they don't. No one else reads pregnancy books for fun like you do." He had a point. And when I went on to actually READ the post on Slate, I learned that the author, Emily Oster, is an economist, not a doctor or a childbirth educator, and the book was about the actual studies that lead to the common recommendations about food, drugs, and general health during pregnancy. I was intrigued -- I do so love evidence-based care.

I picked up Expecting Better from the library when it was released. Again, I was surprised to find my name at the top of the list for it -- weren't other people as excited as me to find out the methodology that went into studying the effects of deli meat on pregnant stomachs?! Apparently not. Their loss, because this book was wonderful.

The author takes the reader through the story of her own pregnancy -- from stopping birth control through delivery day -- and discusses the research behind many of the common recommendations she received. For example, when asking her doctor when she would expect to resume a normal menstrual cycle after stopping hormonal birth control, the doctor gave her “vague reassurance” that it would not take long. Ms. Oster, a planner like myself, found phrases like "a little while" and “everyone is different” to be inadequate answers. She used her training as an economist to pull the studies associated with this “data”, dissect them, interpret them, and (lucky for us) explain them in simple, easy-to-digest language. (Turns out, 60% of women have a normal period the first month off the pill, and nearly 100% of women will have resumed normal cycles by nine months).

The author does a great job breaking down statistical theories in an easy way. For those of us who have forgotten (or blocked out) our last high school or college statistics class, she explains concepts such as false-negative and false-positive, how researchers arrive at those numbers, and why they are important when calculating your own risks. She also explains some of the more complex reasoning behind certain medical recommendations. For example, she briefly explains the different classes of drug restrictions, including how the Class C classification is pretty un-helpful. This information is a particularly useful nugget for a mother to have in her arsenal, even after the birth. Imagine a doctor prescribes a nursing mom a drug and says "This is a Class C drug, so you have to wean immediately." Wouldn't it be nice to know before going to the doctor that a Class C means there have not been any well-controlled human studies for this drug, instead of thinking it means it will immediately harm your baby?

Ms. Oster walks a fine line between giving us the data we need and making any true recommendations herself. She makes a good effort to explain HOW one would go about making a decision with all the facts, and gives examples of the decision SHE made vs. the decision her friend made with the same data and the same risk factors. While her personal interpretations come out at times (for example during the discussion on home birth), she stay mostly neutral on "controversial" topics, such as breastfeeding and pain management. To her credit, she guides the reader through the problems with the study responsible for the standard (negative) recommendation about home birth from the American Congress of Obstetricians and Gynecologists, pointing out where the flaws are and how their published infant mortality rate may not be accurate. Overall, the author’s tone is one of respect – mothers CAN be trusted to make informed decisions as long as they have the correct information.

My one issue with the author’s interpretation of the data is regarding epidural use and breastfeeding. Though it hard to argue with her data analysis (since that’s her job), I feel like perhaps she did not extend her analysis far enough. She states convincingly that getting an epidural does not delay the onset of lactation or cause babies to be lethargic (there is some anecdotal evidence that babies born after epidurals do not latch as well, though according to Ms. Oster there is not enough randomized data to conclude this). However, her conclusion that “there is no affirmative evidence that nursing is impacted by the epidural” is simply not accurate – lactation does not automatically equal breastfeeding success. She goes on to describe that a major complication of getting an epidural is maternal fever, and that the standard care for an infant in that case is to be given antibiotics. In addition, the infant is usually SEPARATED from his or her mother and placed in the NICU for observation. The simple act of separating a baby from its mother directly impacts their ability to breastfeed. So while an epidural may not keep a mother’s milk from coming in, it may lead directly to a practice that damages the breastfeeding relationship – a huge factor for many moms contemplating their pain management.

Overall, this book is a great resource and one that should be on any educator’s bookshelf (not to mention in a gift-bag to your newly pregnant friend). The studies used are current and well-interpreted, and Ms. Oster’s writing style is friendly and accessible. In order to give informed consent, one first needs to be informed. This book is a great way to get your questions answered and begin the process of making well-informed decisions about your care.

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Like what you've read? Pregnant and looking for a class in Western/Central Massachusetts?
Check out our current class schedule here.

Questions? I'm never very far away from my email.

Follow Crafted Birth on Facebook for updates and birth-related resources.

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Link Party: Postpartum Recovery

A great article about some culture's "lying-in" practices for new mothers, comparing them with in the U.S. model of a "functional" postpartum period.

Why Are America's Postpartum Practices So Rough On New Mothers?

Book Review: "Mother's Milk: Breastfeeding Controversy in American Culture" by Bernice Hausman

Synopsis: (via Amazon.com)

    Mother's Milk examines why nursing a baby is an ideologically charged experience in contemporary culture. Drawing upon medical studies, feminist scholarship, anthropological literature, and an intimate knowledge of breastfeeding itself, Bernice Hausman demonstrates what is at stake in mothers' infant feeding choices--economically, socially, and in terms of women's rights. Breastfeeding controversies, she argues, reveal social tensions around the meaning of women's bodies, the authority of science, and the value of maternity in American culture. A provocative and multi-faceted work, Mother's Milk will be of interest to anyone concerned with the politics of women's embodiment.

Review:
    The author described the conflicting attitudes of breastfeeding advocates and feminist critics very well, highlighting how this poses a problem for everyday women and leads to "Mommy Wars", something very topical in today's media. According to Hausman, the only vocal breastfeeding advocate group is La Leche League, whose continuing ephasis on "immersion mothering" and not working outside the house is off-putting and unrealistic for many families. Conversely, feminist critics, who so readily discuss pregnancy and birth and fight for better treatment of laboring mothers, do not support breastfeeding, as it serves to encourage domesticity and exacerbate the gender differences between parents. When these two groups fight against each other, there is no one fighting for the everyday nursing mother (especially one who works outside the home). The author (eventually) made an excellent point about bridging the gap between breastfeeding advocates and feminist critics by encouraging "Health Advocacy" instead of breastfeeding advocacy. This perspective will help to keep the health benefits of breastfeeding part of the discussion, encourage practical advice, and reduce the judgement of women who choose not to breastfeed. Hausman quotes from Penny Van Esterik's Beyond the Breast-Bottle Controversy, and I think this nicely sums up the goals most breastfeeding advocates and educators: 

"The trajectory goal becomes not to have every woman breastfeed her infant, but to create conditions in individuals, households, communities, and nations so that every woman could. The first step is to create conditions that make breastfeeding possible, successful, and valued in a given society."

    Hausman touched on many different points regarding how women make the decision to breastfeed or not, including physician authority, popular texts for pregnant women, formula marketing, mass understanding of evolutionary theory, and race and class. Her overall theme seemed to be that women do not make this decision "in a vacuum", that the constant collision of culture, medical expertise, and personal beliefs make this decision so much more complicated that "what should I feed my child?" I appreciated her respect for women who choose to formula-feed, stating that they choose to not breastfeed not because they are uneducated or ignorant, but because they have taken into consideration their own circumstances and decided it's better for themselves, their baby, and their family to formula-feed. Hausman also made a nice attempt to deconstruct the bottle-feeding paradigm that women see every day. Her analysis of pregnancy books and formula marketing was eye-opening and a concrete example of how culture affects breastfeeding choices.

    While the author's overall point was well-taken, I found her tone and writing style very difficult to read, especially in the early chapters. It took until the end of the over 200-page book to understand her overall message; her initial thesis was written in such abstract terms, it took a complete deconstruction of the sentence to understand her point -- and even then, it did not seem to match her overall argument once I had finished the book. She claimed the book was for mothers (as well as for doctors, educators, advocates, etc.), but I would be surprised if most mothers would find her style accessible. The book seemed aimed more for educators and advocates than for breastfeeding mothers. As she states herself, mothers need practical advice and real social support from doctors, other mothers, and the workforce; mothers do not need ideology. As this book is mainly focused on discussions of culture and the ideological meaning of women's bodies, it seems as the book itself is an example of what would be unhelpful to an everyday nursing mother.

Hausman clearly did her research on feminist theory and breastfeeding benefits; however she seems to only site a few sources. She also has a clear bias towards La Leche League, and implies that they are the only breastfeeding advocates out there. It would have been nice to see an analysis of other advocates' texts as well. Also, while the author made a good attempt at an overall flow of the book (chapter one discussed public media, chapter two physicians, chapter three texts for parents, etc.), there were times when her discussions seemed random and not fitting to the chapter as a whole (for example, the discussion of the sexuality of motherhood and breastfeeding in the chapter about physicians, authority, and scientific motherhood seemed, while interesting on its own, a bit out of place).

Overall, this book was helpful to me as an educator and breastfeeding advocate, but it would not serve to help a nursing mother feed her baby or even help her to make an informed decision about feeding, as the book is so dense and difficult to digest.

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Like what you've read? Pregnant and looking for a class in Western/Central Massachusetts?
Check out our current class schedule here.

Questions? I'm never very far away from my email.

Follow Crafted Birth on Facebook for updates and birth-related resources.

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