Local Anesthesia

“WHAT ABOUT LOCAL ANESTHESIA?”

My earliest work on infant circumcision focused heavily on the infant’s pain and trauma. Only slowly did I realize that the topic involved a myriad of other issues as well.

Back then the medical establishment was the “enemy.” The goal: to make all new parents aware of exactly what happens when a baby is circumcised, and to feel the terror and agony that he feels. Parental protective instincts would then intervene and soon all Gomco clamps and Circumstraints would be thrown in the trash as everyone would quickly learn to accept the body in its natural state.

Many parents have made the decision against circumcision on the basis of pain alone. But for many others, our voices have only been partly heard. Instead of throwing away their Gomco clamps, many doctors have simply pulled out hypodermics filled with local anesthetic.

I cannot fully condemn its use. Local anesthesia probably does at least numb the initial impact of the clamp and blade. But too many people think that this has solved the problem. Use of local anesthesia for infant circumcision has been used by many as an excuse to sweep the other issues under the rug.

I always point out that strapping an infant down and working on him is, in itself, stressful and traumatic for an infant. Injections themselves (directly into the penis) are painful. Local anesthetics such as xylocaine cause a sharp burning sensation when they enter body tissues. Some babies scream and cry just as much when local anesthesia is used. And the wound will be raw and sore for several days, especially when the baby urinates.

I always detail the other facets too important to ignore: the function and purpose of the foreskin, the medical non-necessity of the operation, and the human rights issue of allowing a child to keep all normally occurring body structures. No dorsal nerve block can obliterate those issues!

Pain is only one facet of circumcision. Pain is also only one facet of the concern over trauma. From my own experience as a mother, two cases in point:

Our oldest son, Eric, as a 22 month old toddler grabbed a boiling hot pot of tea and spilled it all over his legs. He sustained horrible first and second degree burns from his thighs to his ankles. We spent the morning in the pediatrician’s office. Eric’s screams were devastating but I did remain with him the entire time.  Eric’s legs were fully bandaged. He was given a shot of Demerol for the pain. I brought him home and he slept all afternoon.

Burns are among the most intense types of pain. I expected Eric’s recovering days to be challenging. Surely he wouldn’t even want to walk for some time. We would have to handle him with much care and gentleness. But much to my astonishment, that evening Eric was running around the house, climbing all over the furniture, laughing and giggling. His resiliency was amazing.

The pain Eric felt was certainly tremendous, but I never saw any change in his happy, outgoing nature following that ordeal.

Our second son, Jason, was also a 22 month old toddler when he fell against a window ledge making a deep gash over his right eyebrow. We rushed him to the hospital emergency room for stitching. Soon, the impact of his fall forgotten, Jason was busily exploring every nook and cranny of the treatment room. Finally the doctor came into the repair the wound. I had assumed that I would stay in there holding Jason during the stitching. Instead the nurse picked Jason up and began strapping him into a “Papooser” (an immobilizing device used for small children during medical procedures.) Jason screamed in terror at the prospect of suddenly being restrained. The doctor ordered me out of the room saying, “If you are in here, Jason will associate you with the pain, and be angry at you for not rescuing him.”

I sat out in the hall for about 15 minutes listening to Jason’s screams. (An almost two year old can really howl!) I was in early pregnancy with Ryan when this happened, and this experience was the dawning of my concern over traumatic medical events and how they ultimately effect the nature of the child. (This, and not circumcision per se, was my original concern.)

Jason was given a local injection for the stitching. What he experienced was not, in and of itself, all that painful. But it was devastating to him from a psychological standpoint. The doctor was a skilled technician. The scar is barely visible. But the procedure was not handled humanely in regards to Jason’s mental health.

Over the next several months I observed many distinct personality changes in my formerly happy-go-lucky child. He was much more fearful — deeply suspicious that someone might do something to him. None of my other children have ever had any particular attachment to an object or needed to suck on anything but my breast. But Jason, although still nursing, constantly sucked his finger, and was intensely dependent on his “favorite blankie” that accompanied him everywhere. A subsequent visit to a photographer was a disaster. Jason screamed at the prospect of being placed on the platform for a portrait.  An attempt to visit Santa Claus was equally terrifying. Over the next few years new challenges such as potty training, new places, amusement park rides and new friends all were approached with tremendous fear and reluctance. Jason eventually became a happy, confident and high achieving older child and adult, but it took him years to adjust to life’s everyday conquests.

Because of these two incidents, I wonder if the experience of being forcibly restrained and worked on (for a child who cannot understand) is more significantly traumatic and damaging than the pain itself.

The local anesthetic did not prevent Jason’s traumatized reaction to his experience. Similarly, a local injection for infant circumcision is missing the point.

My feelings today about my baby boys having undergone circumcision are no different than had someone taken one of my daughters away from me, tied down her arms and legs, taken a knife and slashed her genitals. (Remember, it was not that long ago that even rape was not taken seriously!) Had something like that happened to one of my daughters, and had she been given a shot of local anesthetic as well, would my horror have been any less?

Come on people, THINK!

By Rosemary Romberg
Originally printed in Peaceful Beginnings’ Summer/Fall 1988 Newsletter.
(Revised – 2012, edited 2013 )


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