IS CIRCUMCISION TRAUMATIC FOR A NEWBORN BABY?
Circumcision was often deliberately intended to be a means of torture during primitive initiation rites. Today circumcision is always performed under anesthesia if the patient is an adult or child past early infancy. Yet when the same operation is performed on a newborn infant it is almost always done without anesthesia. Why ?!
Does the newborn baby feel any fear or discomfort as he is strapped into the plastic circumcision board? Does he register pain when his genitals are pinched, cut, clamped, or sliced? Does he feel soreness during the following days as his freshly‑cut penis heals? Or is he not sufficiently developed enough to be aware of anything?
In many of the personal accounts in this book it was obvious to those involved that the infant underwent a severe amount of pain. It would seem that simple common sense and basic knowledge of the feelings and responses of infants in other respects would plainly indicate that the newborn infant is sensitive and aware and is just as capable of feeling pain as any other person at any other age.
However, many people, both lay and medical professionals, insist that the infant feels little or nothing when he undergoes this operation. There are people who have dismissed me as a neurotic, overly‑sensitive mother for my heartfelt concern about this matter.
One father, after watching his infant son being circumcised, assured me that the operation could not possibly have been traumatic for the baby because all he heard was “one tiny little cry!” One doctor has tried to tell me that he is able to circumcise a baby “so gently that the baby just goes to sleep during the operation.” An acquaintance who is a child psychiatrist has labeled my efforts as “struggling with minutiae.”
The textbook for a class on “Marriage and Parenthood” that my husband and I took during college, tells future parents the following about the newborn:
“For the most part, the neonate is blankly unemotional, although he may smile when contented, whether he is awake or asleep. There is no indication that the neonate feels affection toward anybody or anything, although such affection develops quickly in the first few months.
“The neonate is also relatively insensitive to pain, but his sensitivity picks up rapidly in the first few days. Circumcision can be performed a few days after birth with no anesthetic and with apparently very little discomfort.”1
“It would seem that simple common sense and basic knowledge of the feelings and responses of infants in other respects would plainly indicate that the newborn infant is sensitive and aware and is just as capable of feeling pain as any other person at any other age.”
While some people insist that the infant feels nothing, others attempt to justify neonatal circumcision by claiming that perhaps the baby feels some pain, but it is much more traumatic for an older child or an adult. For example Katz states:
“Circumcision can be done at any time, but the amount of post‑operative pain and irritability is proportional to the age. Up to three weeks of age, pain and irritability virtually occur only at the time of the operation. From four weeks to three months of age the baby is irritable for a night or two and an analgesic is recommended. From three months to a year the pain and irritability last three or four days, and from a year onwards the response varies with the individual. The average adult experiences pain and discomfort for seven to ten days.
“While functional development does not necessarily parallel the progress of nerve myelination, it is certain [?] that not all tracts and pathways in the nervous system are fully functional at birth. No anesthetic is necessary during the first 2 1/2 to 3 months after birth.”2
It is curious that Katz is “certain” of what he states, because absolutely no studies have been conducted that support the belief that infants feel little or no pain.
Statements informing people that babies feel nothing while undergoing circumcision arouse anger and disgust among those of us who are opposed to infant circumcision. However, my own experiences when my first two sons were circumcised seemed to bear this out. Neither experience left me with any impression that the baby had undergone anything traumatic.
Eric’s foreskin was cut off the morning after he was born. He was brought to me several times that day for feedings. During those feedings he was never crying, fussing, or showing any outward indication that he was in pain.
Jason underwent the same operation the morning after his birth. We had “rooming‑in” and I knew exactly when it was done. I recall the doctor taking Jason in his bassinet to another room about 30 feet away and bringing him back to me about 15 minutes later. Although I was within earshot I did not hear any crying. After he was back with me the day continued as usual with Jason sleeping and nursing as before. It did not appear to me that circumcision had traumatized the baby.
Why then did Ryan’s circumcision seem to be such a horrible, traumatic experience? The answer will be made clear further on in this chapter.
Others who have witnessed infant circumcision describe the event in terms of extreme trauma and incredible cruelty, For example, according to Foley:
“The circumcision of a newborn is a spectacle so appalling and revolting in its cruelty that, on their first encounter with the ordeal, many robust medical students faint. The infant is tied down securely to a circumcision board, with his genitals exposed. Next, the entire foreskin and much of the penile skin is pulled through a clamp, and as the clamp’s screw is tightened the skin is crushed off. As much as 80% of the total penile skin is removed. In this country anesthetics are rarely used. The infant struggles and screams, and often vomits and defecates, before lapsing into unconsciousness.”3
The psychiatrist Dr. Rene Spitz has been quoted as saying:
“I find it difficult to believe that circumcision, as practiced in our hospitals … would not represent stress and shock of some kind. Nobody who has witnessed the way these infants are operated on without anesthesia … the infant screaming … in manifest pain, can reasonably deny that such treatment is likely to leave traces of some kind on the personality…. This is one of the cruelties the medical profession thoughtlessly inflicts on infants, just because these cannot tell what they suffer….”4
Why do some people perceive infant circumcision as a trifling, momentary event of which the baby is scarcely aware, while others describe it as severe torture? Can people really be talking about the same occurrence?
Witnessing and describing what one believes another person feels in any given situation is a highly subjective endeavor. One’s own personality and involvement in the situation influence one’s perception. Almost all parents who have ever had a son circumcised, or medical professionals who have ever performed or assisted with the operation – if presented with the idea that circumcision hurts babies‑react with a certain amount of defensiveness. For circumcision is not done out of deliberate intent to harm the infant. No one wants to believe that what he or she is doing or advocating inflicts a great deal of pain on helpless babies! If one is to accept such a belief, then he/she would either have to recognize in himself or herself an element of cruelty and sadism, or he/she would have to admit that he/she was wrong in the past and quit performing or authorizing circumcisions. It is difficult for most people to admit that they have been wrong. It is difficult for many doctors to learn from lay people.
Circumcision of infants is a culturally accepted event in our society. The context has somehow made people fail to question this act. In most situations if someone were to forcibly restrain a child and do something to hurt his genitals, people would consider that child abuse. But we have accepted the same action within hospital nurseries! If some doctor were to cut off the little fingers of all the newborns in a hospital or to slash the vaginas of all the infant girls he would quickly be thrown in jail! Everyone would be horrified! But somehow we are inconsistent and do not give infant boys the same consideration. A few years ago a sexual psychopath was tried and convicted for the rape and murder of a two‑year‑old girl. People were especially aghast when they learned that he had applied vise grips to the child’s tiny nipples! Yet we believe that it is okay to apply clamps to infant foreskins! Of course we as adults know that the intention is different. We assume that a doctor who circumcises babies is not a sexual psychopath or sadist. But, his motive makes no difference to the baby!
“In most situations if someone were for forcefully restrain a child and do something to hurt his genitals – people would consider that as child abuse. But we have accepted the same action within hospital nurseries!”
It is also true that for medical professionals a certain amount of callousness develops as a result of working in an environment where they deal with so many people and see an unusual amount of suffering. Compared to the serious surgery, horrible injuries and life‑threatening diseases that they constantly witness, infant circumcision to them may appear trivial.
Some people are simply not particularly attuned or sensitive to the feelings of others. Some consider any sentiment about babies as maudlin or silly. Even some anti‑circumcision activists are primarily concerned about unnecessary surgery and the rights of males to keep their foreskins and consider trauma to infants an extremely minor matter.
Much of the focus of the medical profession is on objective, “scientific” emotionless facts. This perspective is certainly expedient and necessary for conducting much research. It is also true that any medical professional has to maintain some level of emotional detachment in order to effectively carry out his or her responsibilities, particularly because they witness an incredible amount of injury, trauma, and tragedy. Unfortunately many medical professionals have become geared to think only along those lines. It is sad indeed that the people whose role is to cure the sick and attend birth in our society have so frequently fallen into the trap of being detached instead of caring about the feelings of others.
However, there are certain characteristics of the newborn and his response to the operation that have even led some basically sensitive and caring adults to believe that circumcision is not traumatic for him.
With rare exceptions no one can consciously remember being an infant. In a sense, infancy is a “natural amnesiac.” Therefore, some people believe that since events in infancy can only rarely be recalled, nothing that happens in infancy is truly important. Sometimes men who have been circumcised as infants will say “It was done to me and I don’t remember it, so it must not have hurt.” The concept that events during birth, infancy, or early childhood are perceived, are remembered, can be recalled through therapy, and can have an effect on the rest of that individual’s life is too “out in left field” for many people to accept. It is plausible that for some people their own traumas during birth and infancy, and the subsequent repression of feelings, causes them in turn to reject this concept and to fail to sympathize with the feelings of others.
It is true that newborn infants do heal rapidly from any type of injury. Usually, a circumcised infant’s penis, is healed within about a week. Also, stitches are not normally required following infant circumcision, but are necessary when an older child or adult undergoes the same operation. Yet another factor is that infant circumcision takes very little time. Unless complications occur, the operation should take only about 5-10 minutes. The short amount of time involved, the absence of stitches, and rapid healing process have all led some people to believe that infant circumcision is less traumatic than for someone older.
However, time as perceived by infants is undoubtedly different than what adults perceive. Most adults could stand a five minute painful procedure without being traumatized. But for an infant five minutes under a circumcision clamp must seem tremendously long! Also, a week’s worth of healing undoubtedly is a tremendous amount of suffering for someone who has only been in this world for a few days. To further the contrast between infant and adult circumcision: Many lay people are unaware that the newborn’s foreskin is sealed to the glans. Therefore, when the foreskin is cut off, one layer of skin has literally been torn away from another. The freshly exposed infant’s glans is raw, extremely sensitive skin like new skin beneath a blister. When an adult is circumcised, in most cases his foreskin has long since freed itself from the glans. Also, the freshly‑circumcised adult penis is not in constant contact with feces or urine‑soaked diapers! But most importantly, the older individual is able to understand what is being done to his body!
As has been stated elsewhere, for many parents their babies’ circumcision has been such a “behind the scenes” procedure that they are simply not aware of it. Perhaps bonding has not been allowed to take place, or perhaps the mother is still too sore, exhausted, or drugged from giving birth to be concerned over what is happening to her baby. If she does not change diapers in the hospital, she will not even see her son’s penis until they both go home. By this time his circumcision is nearly healed and she simply never realizes that he underwent a traumatic operation.
How trauma and pain affect a person is a highly individual matter. Some people are not particularly bothered by pain. Two individuals, each given the same stimuli, may respond to it differently, one perceiving it as extremely unpleasant, the other hardly noticing it. Witness the incredible gamut of women’s reactions to labor and birth -‑ ranging from “there was nothing to it” to “it was the most horrible torture I have ever imagined!” While it is true that earlier traumas influence our perceptions during later experiences, some differences in pain perception may be inborn. It is reasonable to assume that such differences also exist in newborns. (Although I doubt that there has ever been any infant who felt no pain as his foreskin was severed.) This could be yet another explanation as to why witnesses of circumcision report such conflicting views.
A final, important consideration is that adults expect a vocal response to be the appropriate indicator of pain. Some infants do actively scream as they undergo circumcision. But other babies cry only a little or not at all during the procedure. If a baby does not make much noise in response to the operation, frequently adult observers conclude “It must not have hurt him because he did not cry.” Also, babies, characteristically fall into a deep sleep following circumcision. This has caused some people to conclude “Look! It didn’t hurt him! He just went to sleep!” The significance of both absence of crying and deep sleep manifested by babies in response to circumcision will be explored in greater depth.
“There is no documented evidence or scientific study that supports the belief that infants do not feel pain.”
It is clear that the wide range of opinions about the infant’s response to circumcision reflects selective perception on the part of observers. Simple common sense would support the fact that the infant does indeed feel pain. Recent scientifically conducted studies also indicate that the infant feels more pain from circumcision than most people would like to believe. There is no documented evidence or scientific study that supports the belief that infants do not feel pain. Therefore it is curious that medical professionals have so frequently clung to this belief. Usually doctors are quick to dismiss lay people’s ideas as being “not valid,” “unscientific,” or “unproven.” Yet the idea that circumcision is not painful for babies is equally “unproven” and “unscientific.”
Interestingly, the earlier medical writings about infant circumcision unquestioningly state that the operation is indeed extremely painful for an infant.
In 1904, DeLee wrote:
“It is cruel to subject the helpless tiny patient to unnecessary pain. Mild anesthetics are used….”5
According to Valentine in 1901:
“Ordinary humanitarian sentiment prevents consideration of circumcision without anesthesia. I do not believe … that any physician would rend a mother’s heart by so torturing her babe. It is specious to hold that an infant’s sensibilities are not sufficiently developed to permit it to perceive pain. If so, why does the infant cry when a maladjusted pin pricks it, or when its delicate skin is irritated by a badly folded or moistened diaper? Is it logical to assume that its shrieks of agony, when a foreskin is cut or torn off, are but reflex?”6
Scientific Investigations in Regard to the Infant’s Reaction to Circumcision
Relatively few scientific studies have been conducted in regard to this matter. The only studies that I found worth noting during the original writing of this book all took place during the 1970’s. In some of these studies the researchers’ primary concern was not circumcision. They simply wanted to study infant response to a stressful procedure. In one study the intent was to observe gender differences among newborns and it was found that circumcision distorted the results.
Emde and his associates investigated the sleep patterns of newborns. People experience two types of sleep. Sleep cycles usually begin with a period of active, rapid eye movement called “REM” sleep. Dreams take place during this phase of sleep. Later in the sleep cycle people usually experience a deeper, inactive type of sleep without rapid eye movements called “non‑REM” sleep.
They investigated how stressful stimulation (provided by circumcision) would affect the sleep cycles of newborns. One theory predicted that the stress of circumcision would result in an increased amount of active, restless sleep. The second theory predicted that infants would exhibit “conservation‑withdrawal” behavior. In their technical language: “…a reduction of incoming stimuli by alteration of sensory thresholds with a decline of activity.” In plain English, babies would withdraw into an abnormally deep sleep in response to pain and trauma.
Six normal, full‑term newborn male infants were observed continuously over a 24‑hour period. Midway through the observation period they all underwent circumcision with a Plasti‑bell device. Four of the six infants evinced increased amounts of non‑REM sleep of 28%, 72%, 76%, and 80% during the 12 hours following the operation. One infant was kept awake by his father and the other was clearly an exception. Three other infants of the same age who did not undergo circumcision were also observed for 24 hours. They showed no increase in non‑REM sleep during the second 12 hours.
They then studied 20 normal, full‑term male infants, 10 of whom were circumcised and 10 who were not circumcised. They used an electro‑encephalograph polygraph machine to record sleep patterns and other behavior in more detail. They were studied on two successive nights beginning at 24 hours of age. Eight of the ten circumcised infants showed an increase in non‑REM sleep, with increases ranging from 41%‑121%. The amount of non‑REM sleep varied little from the first night to the second among the infants who were not circumcised.7
It is reasonable to conclude that this abnormal sleeping pattern on the part of the infant is a withdrawal, a self‑protective reaction to the trauma.
Anders and Chalemian attempted to repeat Emde’s study, but theirs differed in a number of ways and produced different results.
They observed 11 normal, 3‑day‑old, full‑term male infants for 3 separate 1‑hour periods, 1 hour prior to circumcision immediately following a feeding, a stress-circumcision hour immediately following the operation, and a recovery hour after the next feeding following circumcision. They classed the state of the infants in four categories of wakefulness and two types of sleep: Fussy Cry; Wakeful Activity; Alert Inactivity; and Drowsy; and Active REM Sleep and Quiet non‑REM Sleep.
They found that total wakefulness increased during the stress‑circumcision period characterized by fussy crying. The recovery hour was characterized by drowsiness. No significant changes in active REM or quiet non‑REM sleep were noted in any period.
However, they do point out that Emde’s study observed the infants over longer periods of time. This may account for the differences in their observations. Additionally the infants in Emde’s study were circumcised with the Plasti‑bell, while the infants in Anders and Chalemian’s study had it done by a clamp device. The plastic ring and ligature is probably more painful for the infant because the device remains in place. The difference in methods may also account for the differences in behavior.8
Talbert, Kraybill, and Potter investigated infants’ internal chemical responses to the stress of circumcision. Serum cortisol and cortisone are secreted by the hypothalamic, pituitary, and adrenal glands, and are generally produced in greater amounts following stressful situations.
Five normal newborn male infants were studied. Before 6 hours of age, heel stick and then circumcision with a Gomco clamp took place. Blood was again obtained at 20 minutes and 40 minutes after circumcision. Cortisol and cortisone levels were measured in all three samples. The average levels prior to circumcision were 5.8 ug/100 ml. of cortisol and 7.3 ug/100 ml. for cortisone. 20 minutes after the operation the respective mean levels rose to 14.7 and 8.5 for the infants. 40 minutes afterwards the levels remained significantly higher.
They conclude that neonates respond to stress with increased output of adrenal corticoids.9
Heel sticks are also painful for babies. Therefore one is led to question how might three heel sticks create additional trauma for the infant or affect the results of their study. Also, while I question the ethics of neonatal circumcision, I also question the ethics of using infants as “guinea pigs” in studies like this even if parental consent is obtained.
Richards, Bernal and Brackbill set out to investigate possible gender differences between male and female babies. Such studies when conducted in the United States found newborn boys to be more active and restless, while similar investigations conducted in Europe found no such sex differences. Since infant circumcision is widespread in the U.S. but is rarely done in Europe, they postulated that circumcision, not gender, was responsible for the differences in behavior.
“…circumcision requires more study in its own right and that it requires description if not control in all neonatal and infancy studies. Our purpose here is to examine the possibility that … physical insult in the form of male circumcision, has both behavioral and physiological consequences that may have been uniformly misinterpreted by developmental scientists.”10
More recently Brackbill and Schroder conducted a follow‑up investigation of the correlation between neonatal circumcision and gender differences. They researched 38 other studies which were concerned with gender differences among newborns and included circumcision as a variable. Interestingly the data revealed few significant differences among newborns in any of a large number of categories. Some of the different studies yielded conflicting results.
Brackbill and Schroder do not state what methods of circumcision were employed in these different studies, nor when the operation was performed in relation to birth or to the study itself, nor what other potentially traumatic variables had been recently performed on both male and female infants (such as heel sticks) which could similarly alter their behavior.
A single, more controlled study (if such studies on newborn infants are indeed ethical) accounting for many variables such as the above listed, would reveal more conclusive answers.11
If Richard’s, Bernal’s and Brackbill’s first hypothesis is valid this raises yet another question. Could another “complication” of circumcision be less affection, attention, or positive feelings on the part of parents toward their infant? Some have suggested that injury to the infant can stimulate an instinctive rejection reaction by the mother, similar to the way a mother animal is likely to kill or reject her infant if it has been injured. More plausibly and less directly, circumcision may produce a fussier, crankier, less appealing baby who will in turn inspire less parental affection.
The Awareness and Consciousness of the Newborn
Books and publications about infants frequently expound on the sensitivity and awareness of newborns. Ironically these are often the same books that ignore the subject of circumcision or state that the infant feels little or nothing while this part of his body is cut off. Circumcision has truly been a “blind spot” in our thinking.
According to an American Baby Magazine publication:
“The newborn can also avoid pain. If you hurt any part of him, he will withdraw from you if he can. Stroking one leg will make the other cross and push your hand away. If you poke the upper part of his body, his hand comes over to grasp yours. Then he will try to push you away.
“These reflexes are not just immediately useful. Your baby’s brain stores and learns from all these reflex experiences, building for the future….
“Even more exciting, your baby is a thinking, feeling, being….
“They are also very sensitive to touch and pressure. Touch is almost a language for infants. Skin contact and warmth, especially from mother’s body are probably the most potent stimulation for infants in the first few months of life. Like a radar screen picking up vibrations, your baby soaks in your feelings about him from your handling. He can sense rough, inappropriate, or insufficient handling, and he appreciates touch suited to his style.”12
During the mid‑1970s ‘ (i.e. 1970’s) Dr. Frederick Leboyer’s book and film about “Birth Without Violence” have revolutionized our understanding about the feelings and perceptions of infants at the time of birth. Until his ideas became popular people rarely considered the baby’s perspective.
Babies were expected to cry and scream when they were born. Lusty, vigorous crying meant a healthy baby and made everyone happy! Although spanking the baby or holding him upside down is less common today than in the past, that has been the standard “Hollywood” image of birth.
” ‘Touch is almost a language for infants. Like a radar screen picking up vibrations, your baby soaks in your feelings about him from your handling. He can sense rough, inappropriate, or insufficient handling, and he appreciates touch suited to his style.’ “
With the advent of natural childbirth and husband participation, birth has become a time of celebration. Doctors and delivery room nurses have frequently joined in the festive mood. People would shout out the sex of the baby as soon as it was apparent. The delivery room, which is somewhat of an “echo chamber” to begin with, became full of people cheering and talking noisily. Meanwhile, people are unwrapping equipment and clanging metal things around. It never occurred to anyone that all this racket was frightening or assaulting to the baby.
Delivery rooms have always been filled with bright lights! (After all, the doctor has to see what he is doing!) No one questioned silver nitrate, the caustic burning substance that is placed in baby’s eyes in case the mother has gonorrhea. And babies “had” to be washed up, weighed, and roughly jostled around by the nursery personnel!
” ‘Arent cries always an expression of pain? Isn’t it conceivable that the baby is in anguish? What makes us assume that birth is less painful for the child than it is for the mother? And if it is, does anyone care?’ ” – Dr. Frederick Leboyer
Leboyer has raised our consciousness by telling us:
“Aren’t cries always an expression of pain? Isn’t it conceivable that the baby is in anguish? What makes us assume that birth is less painful for the child than it is for the mother? And if it is, does anyone care?
“That tragic expression, those tight‑shut eyes, those twitching eyebrows…. That howling mouth, that squirming head trying desperately to find refuge…. Those hands stretching out to us, imploring, begging, then retreating to shield the face‑that gesture of dread.
“Those furiously kicking feet, those arms that suddenly pull downward to protect the stomach. The flesh that is one great shudder….
“Has there ever been a more heartrending appeal?
“And yet this appeal -‑ as old as birth itself -‑ has been misunderstood, has been ignored, has simply gone unheard….
“What makes being born so frightful is the intensity, the boundless scope and variety of the experience, its suffocating richness.
“People say‑and believe‑that a newborn baby feels nothing. He feels everything. Everything ‑ utterly, without choice or filter or discrimination.
“Birth is a tidal wave of sensation, surpassing anything we can imagine. A sensory experience so vast we can barely conceive of it…. The baby’s senses are at work. Totally.
“They are sharp and open – new…. These sensations are not yet organized into integrated, coherent perceptions. Which makes them all the stronger, all the more violent, unbearable – literally maddening….
“What about its sense of touch?
“Its skin‑thin, fine, almost without a protective surface layer‑is as exposed and raw as tissue that has suffered a burn. The slightest touch makes it quiver…. Newborn babies arrive in our world as if on a carpet of thorns. They’ll adapt to it. By withdrawing into themselves, by deadening their senses. But when they first land on these thorns, they howl. Naturally. And idiots that we are, we laugh….
“Unhappiness is so ingrained in most babies by this time that they can hope for nothing else. If someone approaches, they tremble even more.
“And then we see an extraordinary thing: when the tears and the gasping and the pain become too much, the infant flees…. The baby disappears into itself. Doubles up again … symbolically, it has taken itself back into the womb…. When it is no longer able to cry, it collapses. Sinks into sleep. Its only refuge. Its only friend.”13
Leboyer has essentially made the same observation that was made by Emde and his associates, but in a different manner.
Leboyer advocates treating the infant with a great deal of gentleness and respect immediately following birth. He replaces the harsh glaring light with dim lighting, and the typical loud noises during birth are replaced with soft voices and as little sound as possible. Following birth the infant is placed on its mother’s abdomen and gently massaged.
” ‘People say – and believe – that a newborn baby feels nothing. He feels everything. Everything – utterly, without choice of filter or discrimination.’ ” – Dr. Frederick Leboyer
Prior to Leboyer’s philosophy no one had ever given any thought to when the cord was cut. But Leboyer advocates delaying cutting of the cord:
“If the cord is severed as soon as the baby is born, this brutally deprives the brain of oxygen. The alarm system thus alerted, the baby’s entire organism reacts. Respiration is thrown into high gear as a response to aggression. Everything in the body‑language of the infant‑the immensity of its panic and its efforts to escape … the act of breathing for a newborn baby, is a desperate last resort.”14
” ‘The newborn baby’s skin has an intelligence, a sensitivity that we can only begin to imagine.’ ” – Dr. Frederick Leboyer
He explains his philosophy behind massaging the infant as follows:
“It is through our hands that we speak to the child, that we communicate. Touching is the primary language….
“Immediately we sense how important such contact is, just how important is the way we hold a child. It is a language of skin‑to‑skin‑the skin from which emerge all our sensory organs. And these organs in turn are like window‑openings in the wall of skin that both contains and holds us separate from the world. The newborn baby’s skin has an intelligence, a sensitivity that we can only begin to imagine.”15
Finally he eloquently describes the differences between the baby born to harsh conventional birthing techniques and the baby born non‑violently.
“… Our adventurer is free of fear. He or she has gone from change to change, from one discovery to the next, so slowly, so surrounded and enveloped in love and attention, that everything that happens is accepted with confidence and happiness….
“We are touching on mysteries now. This is a grace which radiates in silence that crowns with a halo every child who arrives among us….
“Curiously, during the final moments, all newborn babies are alike. For a brief period, it is still as if they had no identity at all…. It is simply that they all wear the same mask. The depersonalizing mask of terror. And it is only when this mask falls away that we discover the individual beneath … there are no ugly babies. Only those deformed by fear….
“The baby has a miraculous sureness in understanding us. The baby knows everything. Feels everything.
“The baby sees into the bottom of our hearts, knows the color of our thoughts. All without language.
“The newborn baby is a mirror reflecting our image. It is for us to make its entrance into the world a joy.”16
Leboyer’s book has sold widely. During the 1970’s and 80’s many parents have attempted to use his techniques when giving birth. Unfortunately many parents have been interested in Leboyer techniques only to find their doctors and local hospitals indifferent about it and unwilling to change.
Leboyer presents his ideas as a poet and not as a scientist. Because what he says is not presented as cold, hard statistics, documented “facts,” and research involving thousands, many medical professionals have not been able to relate to it. Also, doctors have not been able to observe any concrete, measurable, long‑term health or developmental differences among babies born by the Leboyer method. (At least among those born to hospital “token” Leboyer techniques.) Therefore many consider it of no value. Why can’t the practice of treating babies with gentleness and respect be of value in and of itself?!
What has been even more disturbing is that a number of doctors and hospitals have tried to “do” the Leboyer “method,” without approaching it out of true consciousness and caring for the feelings of the infant. When “The Leboyer Method” was still a novel idea it proved to be a great source of publicity for a hospital. Newspapers did features on it. Hospital staff did public presentations on it for their clientele. For many it became a fad. In some hospitals the people involved would dim the lights, massage the baby, perhaps immerse the infant in a warm bath, and follow this peaceful routine for about 15 minutes. It made a great show – the latest “in” thing to do. But after that, the baby was whisked off to the nursery where he/she was jostled around, weighed, measured, exposed to bright lights, silver nitrate placed in his/her eyes, and if male his foreskin was cut off. Many doctors who have gained a lot of public recognition for offering “the Leboyer method” were regularly circumcising the same babies that they had helped into the world by “non-violent techniques!” Many parents were requesting the Leboyer method and signing circumcision papers at the same time! Where is our consciousness and awareness? We have not learned anything about the nature and well being of the infant. We have merely adopted another fad! Leboyer techniques are worthless if they are done without sensitivity, caring, and genuine concern for the baby’s feelings. We must apply that same consciousness and caring for choosing to leave our sons intact. For as modern day intactivism progresses, for many parents, not having one’s son circumcised sometimes has also become the next “fad,” the next “in thing to do.” Although as intactivists we consider each infant boy with an intact penis a “victory” in our cause, it must be seen that as advantageous as a foreskin may be, the choice will be worth little if it is not chosen out of love and genuine concern for the infant’s well being.
Joseph Chilton Pearce in his magnificent, eye‑opening book Magical Child, presents more ideas which complement Leboyer’s message, giving us further insight into what the infant experiences following conventional birth:
” ‘… In early all cases, the doctors circumcise the male infant on the second or third day of life. After all, the infant – suffering excessive stress, in a state of shock, and all to often with a crippled reticular formation – seems to be a vegetable, so why not treat him as one? … If the infant is not already in a complete state of shock before the operation, he certainly will be afterward, as parents would be if they were to observe and comprehend what is happening.’ ” – Joseph Chilton Pearce
“The semi-drugged, overstressed, and exhausted infant is, of course, generally unable to get his/her breath, even if given ample time to do so. The many new, unused coordinates of muscles are confused and malfunctioning. His/her body is reacting only; all synchronous interactions have long since been destroyed. In addition to his/her prolonged body fear of oxygen deprivation, when s/he is finally sucked or clawed out of the mother, his/her entry is into a noisy, brilliantly lit arena of masked creatures and humming machines. (The hum of fluorescent lighting alone is an overload, much less fluorescence itself, which, as the world’s greatest authority on lighting, John Ott, makes perfectly clear, is disastrous to infants.) Suction devices are rammed into the mouth and nose, the eyelids peeled back to that blinding, painful light and far more painful chemicals dropped into the open eyes. S/he is held by the heels and beaten on the back or subjected to a mechanical respirator; at this critical oxygen-short period, the umbilical cord has been cut. S/he is cleaned up a bit from the blood of the episiotomy … placed on cold, hard scales to be weighed like any other piece of meat in a factory; wrapped up … ; bundled off to a nursery crib, screaming in pain and terror if s/he is lucky; or rushed semiconscious and half dead to an incubator, far worse fate than a crib, if s/he is less lucky.
“What the infant actually learns at birth is what the process of learning is like. S/he has moved from a soft, warm, dark, quiet and totally nourishing place into a harsh sensory overload. S/he is physically abused, violated in a variety of ways, subjected to specific pain and insult, all of which could still be overcome, but s/he is then isolated from his/her mother…. The failure to return to the known matrix sets into process a chain reaction from which that organism never fully recovers. All future learning is affected. The infant body goes into shock. The absorbant mind shuts down. There will be little absorption again because there is only trauma and pain to be absorbed. The infant then surely exhibits only two states…, ‘quiescence,’ which means semi‑ to full unconsciousness, and ‘unpleasure.’ If awakened from his/her survival retreat from consciousness, s/he is propelled back into a state of unresolved high stress. S/he cries him/herself to sleep again…. Pleasure and smiling will surely be much later in appearing, just about two and a half months later, because it will take that long for this unstimulated and isolated body to compensate if it is to survive at all. The infant’s body must manage slowly to bring its own sensory system to life, get that reticular formation functioning, and come fully alive through whatever occasional physical nurturing it gets. Stage‑specific processes, once missed, must be laboriously rebuilt.
“…In nearly all cases, the doctors circumcise the male infant on the second or third day of life. They cut off the foreskin of his penis, nearly always without anesthetic. After all, the infant‑suffering excessive stress, in a state of shock, and all too often with a crippled reticular formation‑seems to be a vegetable, so why not treat him as one? … If the infant is not already in a complete state of shock before the operation, he certainly will be afterward, as parents would be if they were to observe and comprehend what is happening…. Ask your doctor, though, and he will scathingly dismiss criticisms, reassure you that it’s perfectly all right, and make you feel rather stupid for even asking.”17
Much of this is, of course, speculative. No one has any way of definitely knowing what an infant truly feels. But much of what is now being learned about the infant’s perception during birth has been based on people’s own recollections that surface during regressive sessions such as primal therapy. Others who refute its validity claim that one may not be re-experiencing events the way they actually happened, or that people are simply fabricating what they tell. However, critics of such findings are probably defensive about their own involvement in birth or infant circumcision.
Anyone who has only experienced or observed conventional birth within a hospital might readily dismiss these ideas presented by Leboyer or Pierce as too “fantastic” or “strange” to be considered. “But this is a perfectly nice, cute little baby! There’s nothing wrong with him!” Following the births of my first two sons in hospitals I didn’t go out the door thinking “Wow! This baby is really traumatized!”
But, after having given birth at home using dim lighting, soft voices, immediate body contact, and treating the baby with only gentleness and love, I can verify that there is a profound and dramatic difference in the nature of the baby born in this manner, compared to the baby born by conventional techniques. The baby is more peaceful and contented and will smile blissfully during his first few days of life when he has been welcomed into the world knowing only warmth and gentleness. His eyes will open and look around immediately after birth when they are not assaulted with glaring lights or burning chemicals.
This explains why in my experience, my first two sons circumcisions shortly after their births in hospitals did not impress me as being traumatic, while the same operation performed on my third son following his peaceful home birth was so horrible! The baby born to conventional birthing procedures is in a state of trauma anyway — whether he is circumcised or not!
This explains why some babies do not cry or appear to react when their foreskins are clamped and sliced off. The baby is already in a state of withdrawal, simply from other common traumatic procedures associated with conventional birth. (An analogy can be drawn by the experience of having one’s blood drawn ‑ generally an unpleasant sensation for most people. If one is to have one’s blood drawn when one is healthy, such as during a routine check‑up, the experience usually stands out as extremely painful. The same person, while recovering from surgery or following a severe injury, may only be scarcely aware of someone drawing his blood.) Also, in some cases infants have still been under sedation from drugs given to the mother during labor, and therefore have been partially anesthetized for circumcision.
Another explanation for the absence of crying during circumcision is that for some babies the shock of the assault is so intense that they cannot cry! (A personal experience supporting this is based on my husband’s past experience as a lab technologist. One of his most unpleasant tasks was to do routine PKU heel sticks on newborns. A heel stick is painful although less intense than circumcision. He has done hundreds of heel sticks on newborns and has never seen a case in which the infant did not cry!)
Medical professionals have simply not been “tuned in” to the feelings of newborns. They work day in and day out, seeing hundreds of parents and babies every year, and forgetting about most of them. Most births are “routine” (if birth should ever be “routine!”) and the mothers and babies go home healthy. The constant turnover of patients quickly fades into a blur.
I have repeatedly tried to direct the concept of the consciousness and awareness of newborn babies and the significance of trauma to medical professionals and to other parents only to receive looks of uncomprehension. For most people have never seen an untraumatized newborn and have no understanding of what this means. They fail to perceive their babies in the hospital nursery, under the glaring lights with eyes burned by silver nitrate and recently cut genitals as traumatized because this is the only type of baby that they have ever seen. They have no basis for comparison. For the truly untraumatized newborn infant is something truly precious and rare.
Is There a Relationship Between Circumcision and Sudden infant Death Syndrome?
Every year thousands of apparently healthy infants are put to bed and never wake up. This tragedy is called Sudden Infant Death Syndrome, abbreviated as “SIDS,” and commonly called “Crib Death.” The parents are wrought with severe grief and guilt. The cause of SIDS is still uncertain. A plethora of theories have been proposed.
More male infants than female infants succumb to SIDS. For this reason, some anti‑circumcision activists have suggested that perhaps circumcision leads to SIDS. Could the trauma of circumcision as remembered in the infant brain, be the reason, or a contributing factor, that would make a small percentage of babies give up and stop living? If this theory were to be proven true, dramatic results would follow. Few parents would choose circumcision for their infants if there was a strong possibility that the operation would endanger his life. Potential victims would be spared by virtue of not having experienced circumcision. However, considerable research is necessary before the answers will be known. Although numerous detailed studies have attempted to solve the tragedy of SIDS, to the best of my knowledge none have ever considered circumcision as a variable. It is hoped that researchers will investigate this in the future.
The following information is worthy of noting:
SIDS rarely occurs during the immediate recovery period following circumcision. Most circumcised infants undergo the operation during the first few days of life, but SIDS rarely occurs before age 1‑2 months, and is most frequent between the ages of 2 and 4 months. Perhaps what has given some people the idea that circumcision may cause SIDS is the fact that there have been infants who have bled to death or succumbed to severe infections following circumcision. These tragedies, however, are not SIDS.
Although more male than female infants do succumb to SIDS, many girl infants are also victims of the tragedy. According to Valdes‑Dapena, approximately 58‑59% of SIDS victims are male and 41‑42% are female. Therefore, circumcision cannot be isolated as a sole cause of the tragedy.18
If circumcision were a significant factor in SIDS it would stand to reason that the rates of its occurrence would be dramatically higher in countries such as the United States or Israel where infant circumcision is common than in other countries where the operation is not practiced. However, the distribution of the various rates of SIDS throughout various parts of the world shows no apparent correlation.
According to Valdes‑Dapena, specific studies of the occurrence of SIDS report that the lowest rates have appeared in Sweden – 0.06 per 1,000; Israel ‑ 0.31 per 1,000; Netherlands – 0.42; and Czechoslovakia – 0.8. While circumcision is not practiced in Sweden, the Netherlands, or Czechoslovakia, the operation has been nearly universal for infant males born in Israel.
The middle rates on the list ranged from 1.55 per 1,000 in California to 2.32 in King County, Washington. The areas represented include various U.S. cities (with most males circumcised), Great Britain (with very few circumcised), and Australia and New Zealand (with less than 50 % circumcised).18
The highest rates appear in Western Australia‑2.5 per 1,000 (less than half circumcised); Great Britain‑2.78 (very few circumcised); Ireland‑2.8 (almost none circumcised); and Ontario, Canada‑3.0 (about half circumcised).
The above studies can only be considered estimates. The individual circumcision status of the victims involved, and even the male‑female ratio, are not noted. Studies making note of the above statistics are confined to specific places and times. The data was collected during the early 1970s and was usually confined to one year. Statistics revealing the continuous rates of SIDS in specific areas over a period of years would be more informative.
The breakdown of the rates of SIDS among various ethnic/racial groups within the United States appears not to indicate a correlation with circumcision, for the rates are considerably higher among our racial “minority” groups than among the “white middle class” although the latter tend to choose circumcision to a greater extent than the former. SIDS occurs at a rate of 5.93/1,000 among Native Americans; 2.92 among Blacks; 1.74 among Hispanics, 1.32 among whites, and .51 among Orientals. 17. Again, however, specific data for the circumcision status of the victims may reveal different findings.
Positive correlations have been noted between SIDS and many other factors. The tragedy occurs more frequently among infants of younger mothers, single mothers, and mothers seeking no prenatal care. Bottle-fed babies, babies born prematurely, and babies of mothers who smoke are all at somewhat greater risk. Prenatal nutrition and general health of the mother appear to be important factors. However, babies who have been full term, breastfed, and born to healthy, non‑smoking mothers have also been SIDS victims. No one factor appears to be universal.
Many believe that some infants are somehow born susceptible to SIDS. The question is posed that the trauma of circumcision, as remembered in the infant brain, could be a factor that could “tip the scale” for an infant who is already vulnerable to SIDS. If this is true, perhaps leaving that infant intact could mean the difference between life and death.
One opponent of infant circumcision has speculated the following on the subject:
“During the trauma of the circumcision operation the infant often stops breathing because of the extreme pain. This lack of oxygen, though not fatal at the time, does damage the lowermost part of the brain that controls the semi‑automatic functions such as heartbeat, breathing and swallowing. For several months after the operation the baby will often stop breathing for as long as 30 seconds while asleep. The medical term for this temporary suspension of breathing is called “apnea” and these apnea episodes cause further damage to the breathing control mechanism. Finally the infant stops breathing altogether and he dies.”19
It must be emphasized that these ideas are not proven. Further research must be done in this area. (I am in no way presenting any claim here that circumcision and SIDS are at all related. No evidence so far has proven or disproven this possibility.)
Parents who lose an infant to SIDS experience incredible grief and remorse. Frequently they torment themselves by painstakingly going over every detail of the baby’s life, agonizing over what they may have done wrong. Often such parents need professional therapy to recover from the tragedy. Such parents, if their child happened to be a circumcised baby boy, may, upon hearing our speculations, blame themselves for having allowed him to undergo the operation. Therefore, intactivists are admonished to be careful so as not to needlessly add to these parents’ grief. It is easy to become so caught up in one cause as to ignore people’s feelings in other areas. SIDS parents can, of course, consider leaving a future son intact for any of the known advantages of not circumcising. But if they are in the throes of grief, they must be reassured that it is not known whether or not circumcision contributes to SIDS.
In the years since this book was originally published, some newer studies have taken place.
In Paul D. Tinari’s study at Kingston General Hospital (Kingston, Ontario, Canada in 1998), infants were strapped into Circumstraints and then placed into an MRI chamber while the lower part of the infant’s body was accessible to the doctor performing the circumcision.
“The baby was kept in the machine for several minutes to generate baseline data of the normal metabolic activity in the brain. This was used to compare the data gathered during and after the surgery. Analysis of the MRI data indicated that the surgery subjected the infant to significant trauma. The greatest changes occurred in the limbic system concentrating in the amigdala and in the frontal and temporal lobes.
“A neurologist who saw the results postulated that the data indicated that circumcision affected most intensely the portions of the victim’s brain associated with reasoning, perception and emotions. Follow up tests on the infant one day, one week and one month after the surgery indicated that the child’s brain never returned to its baseline configuration. In other words, the evidence generated by this research indicated that the brain of the circumcised infant was permanently changed by the surgery.”
(The reactions on the part of the medical system bears witness to the conscious attempt on the part of medical hierarchy to silence all questioning of infant circumcision [aka male genital mutilation]: Upon attempts to publish their findings in the open medical literature – “All of the participants in the research … were called before the hospital discipline committee and were severely reprimanded. We were told that while male circumcision was legal under all circumstances in Canada, according to their dubious interpretation of the ethical regulations, any attempt to study the adverse effects of circumcision was prohibited. Not only could we not publish the results of our research, but we also had to destroy all of our results. If we refused to comply we were all threatened with immediate dismissal and legal action.”)
Paul D. Tinari, Ph.D., Director, Pacific Institute for Advanced Study
(from Circumcision Resource Center, http://www.circumcision.org/brain.htm)
A more recent report by James McIntosh in 2015 (Oxford University, England) shows similar results and has been published in medical media.
“The researchers examined the brains of 10 healthy infants aged 1-6 days old and 10 healthy adults aged 23-36 years. … the babies were placed inside an MRI scanner where the bottoms of their feet were poked with a special retracting rod. …
“The researchers observed significant brain activity in 18 of the 20 brain regions that are active in adults when experiencing pain. The babies’ brains responded in the same way to a poke (force 128mN) as adults did to a stimulus that was four times stronger (512mN).
“Dr. Slater states that their findings stand in contrast with previous understandings of infant pain. ‘In fact, some people have argued that babies’ brains are not developed enough for them to really ‘feel’ pain, any reaction being just a reflex,’ she says. ‘Our study provides the first really strong evidence that this is not the case.'”
McIntosh, James, “World-first MRI Study Shows Babies Experience Pain ‘Like Adults'”, Medical News Today, April 2015, http://www.medicalnewstoday.com/articles/292717.php
“What did the researcher’s find? Eighteen out of the 20 brain regions activated in the adults when experiencing pain were also activated in the infants. This suggests that infants not only feel pain the way adults do, but also that they have a lower pain threshold.”
MRI scans reveal brain activity in response to a painful stimulus in infants and adults.
(These findings were published online in the journal eLife.)
Another study set out to find out whether neonatal circumcision (with and without Emla cream as a numbing agent) altered pain response from vaccinations given at 4 or 6 months in comparison to infants who had not undergone circumcision. Infants were videotaped during vaccination done at the primary care physician’s clinic. Videotapes were scored without knowledge or circumcision or treatment status by a research assistant who had been trained to measure infant facial action, cry duration, and visual analogue scale pain scores. Differences between the groups were assessed in regards to facial action, crying time and assessments of pain. The boys who had been circumcised without any type of anesthesia demonstrated far greater sensitivity to injection pain. Pain reaction from boys for whom the numbing agent had been used during circumcision was somewhat less, while those who had not undergone circumcision demonstrated significantly greater tolerance to the pain of injections.
Taddio, A., et al., “Effect of Neonatal Circumcision on Pain Response During Subsequent Routine Vaccination”, The Lancet, Vol. 349, No. 9052, p. 599-603, March, 1997
Goldman summarizes this by stating: “The authors believe that ‘neonatal circumcision may induce long-lasting changes in infant pain behavior because of alterations in the infant’s central neural processing of painful stimuli.’ They also write that ‘the long-term consequences of surgery done without anesthesia are likely to include post-traumatic stress as well as pain. It is therefore possible that the greater vaccination response in the infants circumcised without anesthesia may represent an infant analogue of a post-traumatic stress disorder triggered by a traumatic and painful event and re-experienced under similar circumstances of pain during vaccination.'”
Goldman, Ronald, Ph.D., “Infant Responses to Circumcision” (adapted from his book Circumcision: The Hidden Trauma, pages 20-26.) c. 1997. http://www.circumcision.org/response.htm
A Possible Link Between Infant Circumcision and Autism
The typical baby, by the time he or she is several months old, will giggle, grin, laugh and babble in response to interaction with those who are familiar to him/her. A normal child is learning words by his/her second year of life, knows how to express his/her needs, and readily forms friendships with others. But there are others who, from early infancy on, have great difficulty communicating with other people or responding normally to the world around them. As babies they may not respond to expected smiles, games and other interactions. As children they may have difficulty learning language, forming friendships, or developing large motor skills. They may exhibit unusual, repetitive behaviors, experience mood disorders, or have sensory processing difficulties. The symptoms listed here describe the child with autism. There is no single standard definition of autism. Each individual is different. There are varying degrees of severity along the autism spectrum. Some people eventually outgrow symptoms of autism and lead relatively normal adult lives, while others remain imprisoned, life long in their limitations. Most autistic people have normal intelligence. Some are even geniuses. Whether or not autism is truly on the rise in recent years is still questionable. In years past some autistic children have undoubtedly been misdiagnosed as “retarded” or “demented.” Today autism is generally more recognized, treated, and better understood than in previous times.
Autism is believed to be related to early brain development, both in utero and during the early months of life. In the United States autism occurs more than 4 times as frequently in boys – 1 in 42, as it does in girls – 1 in 189. Possible causes mentioned have included genetic predisposition, prenatal exposure to environmental contaminants including pesticides and air pollution, advanced parental age, maternal illness during pregnancy (particularly diabetes), low birth weight, extreme prematurity, birth complications that have involved oxygen deprivation, and mercury poisoning from Thimerosal in vaccines.
The results of a recent 19 year study has found higher rates of autism among boys who were circumcised as infants compared to boys who were left intact. The researches have post that the extreme pain and trauma of genital cutting in infancy impacts the brain and may hamper how the individual responds to stress. The study took place in Denmark where 342,877 boys born between 1994 and 2003 were followed until their 9th birthdays. In addition to autism spectrum disorder (asd), the outcomes of hyperkinetic disorder and asthma was also observed. Out of the total of boys studied, 4,986 showed symptoms of asd. The abstract reads as follows
Objective: Based on converging observations in animal,clinical and ecological studies, we hypothesized a possible impact of ritual circumcision on the subsequent risk of autism spectrum disorder (ASD) in young boys.
Design: National, register-based cohort study.
Participants: A total of 342,877 boys born between 1994 and 2003 and followed in the age span 0–9 years between 1994 and 2013.
Main outcome measures: Information about cohort members’ ritual circumcisions, confounders and ASD outcomes,as well as two supplementary outcomes, hyperkinetic disorder and asthma, was obtained from national registers. Hazard ratios (Hrs) with 95% confidence intervals (CIs) associated with foreskin status were obtained using Cox proportional hazards regression analyses.
Results: With a total of 4986 ASD cases, our study showed that regardless of cultural background circumcised boys were more likely than intact boys to develop ASD before age 10 years (HR¼1.46; 95% CI: 1.11–1.93). Risk was particularly high for infantile autism before age five years (HR¼2.06; 95% CI: 1.36–3.13). Circumcised boys in non-Muslim families were also more likely to develop hyperkinetic disorder (HR¼1.81; 95% CI: 1.11–2.96). Associations with asthma were consistently inconspicuous (HR¼0.96; 95% CI: 0.84–1.10).
Conclusions: We confirmed our hypothesis that boys who undergo ritual circumcision may run a greater risk of developing ASD. This finding, and the unexpected observation of an increased risk of hyperactivity disorder among circumcised boys in non-Muslim families, need attention, particularly because data limitations most likely rendered our HR estimates conservative. Considering the widespread practice of non-therapeutic circumcision in infancy and childhood around the world, confirmatory studies should be given priority.
Deciphering the above statistics into plain English, this study found that among the boys that were observed, those who had undergone circumcision displayed a 1 1/2 to 2 times the development of autism spectrum disorder. I wish to add, what we now know of changes made in the infant brain due to stressful events, including painful genital cutting and recovery, it stands to reason that in some cases the trauma for some could lead to eventual difficulties on communication and interaction with others and the surrounding environment.
- The Individual, Marriage, and the Family Wadsworth Publishing Co., Inc., Belmont, CA., c. 1968, p. 426.
- Katz, Joseph, M.B. “The Question of Circumcision” International Surgery, Vol. 62, No. 9, Sept. 1977, p. 491.
- Foley, John M., M.D. “The Unkindest Cut of All” Fact Magazine, July 1966, p. 309.
- Weiss, Charles, Ph.D., M.D. “Circumcision in Infancy” Clinical Pediatrics, Vol. 3, No. 9, Sept. 1964, p. 561‑562.
- DeLee, Joseph B., M.D. Obstetrics for Nurses W.B. Saunders Company, Philadelphia, c. 1924 (1st ed. 1904), p. 437.
- Valentine, Ferd C., M.D. “Surgical Circumcision” Jour. A.M.A., March 16,1901, p. 712.
- Emde, Robert N., M.D.; Harmon, Robert J., M.D.; Metcalf, David, M.D.; Koenig, Kenneth L., M.D.; and Wagonfeld, Samuel, M.D. “Stress and Neonatal Sleep” Psychosomatic Medicine, Vol. 33, No. 6, Nov.‑Dec. 1971, p. 491‑493.
- Anders, Thomas F., M.D. and Chalemian, Robert J., M.D. “The Effects of Circumcision on Sleep‑Wake States in Human Neonates” Psychosomatic Medicine, Vol. 36, No. 2, March‑April 1974, p, 174‑175.
- Talbert, Luther M., M.D.; Kraybill, Ernest N., M.D.; & Potter, H.D. “Adrenal Cortical Response to Circumcision in the Neonate” Obstetrics and Gynecology, Vol. 48, No. 2, Aug. 1976, p. 208‑210.
- Richards, M.P.M.; Bernal, J.F.; and Brackbill, Yvonne “Early Behavioral differences: Gender or Circumcision?” Developmental Psychobiology, Vol. 9, No. 1, p. 89‑95, 1976.
- Brackbill, Yvonne & Schroder, Kerri “Circumcision, Gender Differences, and Neonatal Behavior: An Update” Developmental Psychobiology, Vol. 13, No. 6, Nov. 1980, p. 607‑614.
- American Baby Magazine The First 12 Months of Life, 1979 Ed. “The First Week of Life,” p. 23‑24.
- Leboyer, Frederick, M.D. Birth Without Violence Alfred A. Knopf, Inc., c. 1975, p. 5, 6, 8, 15,16,19, & 29.
- Ibid., p. 51.
- Ibid., p. 59.
- Ibid., p. 94, 95, 97,107,108,112.
- Pearce, Joseph Chilton Magical Child E.P. Dutton, New York, c.1977, p. 57‑59.
- Valdes‑Dapena, Marie A., M.D. Sudden Unexplained Infant Death 1970 through 1975. U.S. Dept. of Health, Education & Welfare, Rockville, MD, c.1978, p. 7, 10.
- “Before You Decide to Circumcise” Department of Family and Community Welfare, div. of The Remain Intact Organization, Larchwood, IA. (informational brochure)* (*Their source of information is not stated.)