This page is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

This is an archive of past discussions. Do not edit the contents of this page. If you wish to start a new discussion or revive an old one, please do so on the current talk page.

Archive 1

Archive 2

Archive 3

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Archive 5

Lactation without pregnancy

I removed the time period for the commencement of lactation in males and non-pregnant women. As far as I've researched and heard, the time frame varies widely from person to person and also depends on the amount of stimulation the nipples receive. Joele Gilbert

Unknown content of breast milk

The following seems unlikely, or a non sequitur, or something. Surely human milk has been analyzed.

"The exact content of breast milk is unknown, but the nutrient content after this period is consistent"

Have you seen the dreadful things said about wet nurses over in the Infanticide article?

Ortolan88 21:52 Jul 29, 2002 (PDT)

Human milk has been analysed to the extreme. It's not that we don't know a lot of what is in breast milk; it's that we keep discovering more and more ingredients. For one thing, breast milk is a living food; so it more than an issue of what the nutrient list is, it is a matter of cells interacting with cells. We just don't really understand everything about breast milk that makes it the best for a baby. We just know that it is impossible to duplicate by artificial means. I'm not a medical expert (just a mom who is interested), so I'll try to find a more technical explanation.

As for infanticide article... yikes!

Joele Gilbert

Joele, I changed "the exact content of breast milk is unknown" to "the exact interactive properties of breast milk are unknown" because I think this is more what you are getting at. I also removed marijuana from your list of potential dangers, because there is NO documented suggestion that this is the case. I think it shows bias to include marijuana just because it is illegal ... it's very different from caffeine or crack. Sara Parks Ricker

The US FDA says marijuana in breast milk can be harmful to infants.[1] The American Academy of Pediatrics says cannabis is contraindicated during breastfeeding. In Canada, where marijuana use is not criminal and possession of a few joints is legal, the Canadian Paediatrics Association says that use of marijuana during pregnancy can be a cause of SIDS.[2] Can anyone else find medical association statemens on the subject? --Westendgirl 02:31, 22 Oct 2004 (UTC)

Image

A comment on the image: I like it. It's very clinical and informative. I only have one minor criticism: it is a bit low-res. Is there a chance of getting a slightly higher resolution image? On the current image, some of the labels are almost unreadable. The ones that are discernable are very muddled. —Frecklefoot 13:48 13 Jun 2003 (UTC)

I'll try and find a better copy, but I got this from the fda's website, and I don't know if they have a higher res one. I tried making it bigger, but of course it just looked worse. MB 14:12 13 Jun 2003 (UTC)

Breastfeeding in public

I think the article needs some discussion of breastfeeding in public. I'm not sure about other countries but in the UK it is illegal to stop a woman from breastfeeding publicly. In the Royal College of Midwifery journal (August 2004) there is an article about The National Gallery in London admitting a mistake after banning a breastfeeding mother from one of its exhibition rooms. violet/riga 09:11, 20 Aug 2004 (UTC)

I've added a section but could only find details about US law - I'll try to find the UK laws but I doubt I'll be able to contribute to other countries. violet/riga 09:47, 20 Aug 2004 (UTC)

I looked up on whether there is any law on breastfeeding in public spaces in Japan. I came up empty as I expected because I have never heard of an attempt to limit this practice anywhere in Japan. Revth 16:25, 19 Sep 2004 (UTC)

A bill [[3]] safeguarding the freedom of women to breastfeed in public is currently making progress [[4]] in the Scottish Parliament. Adambisset 00:55, 22 Oct 2004 (UTC)

Mozzerati added this, but there were significant grammatical errors. I took the opportunity to rewrite it. ——Daelin 18:01, 7 Nov 2004 (UTC)

Letdown Reflex and Thirst

I'll leave the details to the expert authors, but I couldn't see any reference to the letdown reflex, and how in many women it triggers an immediate thirst. Dunstan 10:44, 21 Sep 2004 (UTC)

Circumcision and Breastfeeding

Circumcision disrupts breastfeeding. Circumcision is very painful. Circumcision causes a huge spike in stress-hormones. Circumcision drives infants into catatonic states. Needless to state, circumcision disrupts breastfeeding If anyone doubts this, they can run a search. Expectant mothers should consider this before cutting off pieces of their babies, if they plan to breastfeed. I believe that we should have one informative link about this subject.

Ŭalabio 05:29, 2004 Sep 23 (UTC)

I'm sure it is quite a trauma for the child, but such views have not been proven either way. I've reworded the entry and hope it sounds good enough now. violet/riga (t) 07:18, 23 Sep 2004 (UTC)

I met Tina Kimmel in meatspace. She explained what I did not understand (which is most of the subject). Basically, this is it:

Sexual mutilation drives the baby into a catatonic state
After coming out of the catatonic state, the baby is usually too irritable to nurse
When the baby can nurse, placing the baby firmly against the body of the mother as the baby requires for a good latch, puts pressure on the genitals, causing excruciating pain, making nursing impossible
In order to keep babies from starving and dehydrating, mothers often bottlefeed the babies, which often leads to the babies getting used to bottlefeedind
By the time the baby can nurse comfortably again, the amount of milk the mother makes is much lower, leading to more bottlefeeding for preventing dehydration and starvation.

Tina Kimmel stated that La Leche League International refuses to condemn sexual mutilation because of the objection of a few religiously motivated women in the leadership.

I take full responsibility for errors (this is all from memory). You may write to Tina Kimmel thus:

"Tinna Kimmel " < Tinakimmel @T Motherlove . D . O . T . Org >

The address is spamproofed. Some assembly required.

Ŭalabio 03:27, 2004 Oct 18 (UTC)

I suggest that until you have some scientifically proven evidence to present you desist from pushing your POV anti-circumcision agenda in this regard. It should be clear that parents who choose to circumcise their sons should insist on the use of the best pain relief available, both during and post the procedure. Your scare tactic only works where pain relief is not used. The more people begin to insist on its use the less your scare tactic will work. - Robert the Bruce 05:33, 18 Oct 2004 (UTC)

Pain relief does not stop it entirely. Circumcision does have a negative effect on breastfeeding, no doubt, but as this is difficult to handle NPOVly then I think the article covers it well enough as is. violet/riga (t) 07:17, 18 Oct 2004 (UTC)

The sentence seems kinda added on and out of place. Does a topic like circumcision really need a whole subtopic in breast feeding? It should be integrated or eliminated instead of added as an addendum. 04:51, 22 Oct 2004 (UTC)

I have now integrated the topic as a reason for Breast Refusal which is where it should of been in the first place.

(summarized & expanded) I have changed the bullet on circumcision to reference infant surgery and medical procedures, circumcision being a member of the later. I googled and asked a pair of nurses about this. This edit covers more material under "discomfort", and properly notes that circumcision is neither a unique source of discomfort nor surgery (treatment of disease via incision). Circumcision is the one of the most common medical procedure which can cause discomfort, so its inclusion does not require a qualifier (e.g., frequently), as extra attention is already drawn by noting it. IMO, the correct descriptor for circumcision is ritual body modification, however (1) this term is likely to incite violence in peace-loving devout Christians, and (2) a criticism of circumsion is not necessary in this article, but it's prevalence warrants noting its effects on breastfeeding. The amount of notation this requires above and beyond other medical procedures, in an article on Breastfeeding, is a matter for debate.—Daelin 13:38, 23 Oct 2004 (UTC)

No criticism is intended in the article, but then again one cannot hide scientific knowledge and research. Effects of circumcision are related to breastfeeding in some people's minds, and not in others. There is no reason both views cannot be respected. Are we to add breastfeeding information to the circumcision article to appease the puritanical anti-sexual POV? Please remember that circumcision is not medically-indicated surgery to treat disease or injury, so blur that line deliberately is POV. I believe this can be presented in some neutral way. DanP 18:36, 26 Oct 2004 (UTC)

DanP had added back a paragraph on circumcision three times to the section on maternal bonding. I think the most recent version is the best:

Research has also found that the act of circumcision may have a negative effect on the feeding habits of the baby [5]. The topic of circumcision itself is controversial, and some parents who have breastfed babies believe circumcision may be detrimental to maternal bonding.

However, given that the section on maternal bonding is about the benefits of breastfeeding for bonding, not vice versa, and that the effects of surgery, such as circumcision, on breastfeeding is already mentioned in the section on breast refusal, I don't think this is necessary and have removed it twice (Theresa knott did once too). If pushed, I guess I could live with:

Research shows that circumcision can have a detrimental effect on maternal bonding, which may reduce the chances of successful breastfeeding; the topic of circumcision itself is controversial.

However, I still don't think this is really required either. Anyone else have views? -- ALoan (Talk) 19:08, 26 Oct 2004 (UTC)

I think we shouldn't compromise on this at all. I think the section should go. It's not relavent here. Theresa Knott (Not the skater)

I thought you might say that :) But "circumcision → pain → possible breast refusal" is already mentioned; why not "circumcision → detriment to maternal bonding → possible failure of breastfeeding"? -- ALoan (Talk) 19:27, 26 Oct 2004 (UTC)

Give me time to check the references and I might push to have the first scrubbed as well. Look at the reference that Dan is linking to. It only mentions breast feeding. There is no mention of bonding at all. What's more, the paper is not research, it's a pov statement in itself. The paper says words to the effect of "circumcision causes children to be unable to breastfeed" it backs this claim up by a reference to a research paper. However that research paper says "Feeding behavior deteriorated in breast- and bottle-fed infants in both groups, and acetaminophen did not seem to influence this deterioration." I.e. the research paper is talking about both sorts of feeding, not breatfeeding in particluar.Therefore it is off topic here. What's more despite wqhat Dan says below, adding it in here does not NPOV the topic, it merely adds complete speculation to it. Theresa Knott (Not the skater) 19:51, 26 Oct 2004 (UTC)

Well, I haven't checked the references, but I trust violet/riga's opinion on that one. But I remain open to being convinced otherwise. -- ALoan (Talk) 20:01, 26 Oct 2004 (UTC)

(EDIT CONFLICT) Talking to Dan, I don't understand your question. If circumcision causes pain, and this affects feeding then by all means add that fact to the circumcision article. But it's off topic here. This article is about breast feeding. You can't just go down the cirp list and say to yourself "Oh look this article is about breastfeeding, I'll stick on wikipedia's breastfeeding page, this articles about sexual intercourse, I'll stick it on wikipedias sexual intercourse page, this ones about infant circumcision i'll stick it on Wikipedia's infant page. You said above "Please remember that circumcision is not medically-indicated surgery to treat disease or injury" Now what on earth has that got to do with breastfeeding? Theresa Knott (Not the skater) 19:18, 26 Oct 2004 (UTC)

I completely agree with your last comment - the only relevant points are the effects (if any) that circumcision has on breastfeeding. We mention one already; I could just be persuaded to mention another one, but it looks a bit like overkill. -- ALoan (Talk) 19:27, 26 Oct 2004 (UTC)

Breastfeeding is impacted. Look at the article - there is a big section on nicotine, tobacco smoking, and alcohol consumption. If those have impacts, so does circumcision. I ask only for NPOV here, not for personal attack or judgement. If we are to relocate breastfeeding into the circumcision article, should we do the same for cigarettes and alcohol. As you said, what on earth do those have to do with breastfeeding? Personally, I believe it's better to just leave every potential negative here and let the reader judge. That is NPOV, I believe. DanP 19:27, 26 Oct 2004 (UTC)

I think we are NPOV already - unless you can justify it, a second mention of the negative impact of circumcision on breastfeeding looks to me like banging a drum. -- ALoan (Talk) 19:30, 26 Oct 2004 (UTC)

No drum intended - I agree that one mention of potential negative is perfectly adequate. Please find a way to make the article neutral though. As I said, the is research there, and circumcision is usually not medically-indicated as the article hints. The pro-mutilation slant should be taken out, and the controversial nature of circumcision should at least be mentioned in connection to bonding. We did not hide nicotine or tobacco, they are stated blatantly. DanP 19:40, 26 Oct 2004 (UTC)

So let us be clear:

you want a mention of the detrimental effects (if any) of circumcision on maternal bonding in this article on breastfeeding, and
you object to "discomfort, possibly due to surgery or medical procedure" including circumcision because you don't think circumcision is surgery or medical and this is "pro-mutilation slant".

Would you care to suggest some wording here that would satisfy these points so we can discuss it. (It seems to be that the first is about bonding, not breastfeeding, and the second is just terminology - I would define circumcision as a form of surgery - but you can try to convince me otherwise :) ).

Anything else? -- ALoan (Talk) 20:01, 26 Oct 2004 (UTC)

Thanks for responding. Wikipedia distinguishes between surgery and plastic surgery (the former is to treat disease or injury). Even voluntary adult circumcision is plastic surgery, not surgery proper without some diagnosis. I do not wish to say "there are detrimental effects to breastfeeding" -- only that some studies indicate it, and the reader can judge negative or not without the article pressing one way or the other. This is more NPOV than the strong anti-alcohol and anti-tobacco slant in the article, and the tenuous mention of marijuana which has little or no research. NPOV requires that no viewpoint be advocated. DanP 20:44, 26 Oct 2004 (UTC)

The anti-alcohol, anti-tobacco slant is not POV at all, it's factual and common sense. Circumcision is covered perfectly well in the article already. violet/riga (t) 21:27, 26 Oct 2004 (UTC)

(drop indent)

There should be some mention of circumcision - it is a common procedure (yes, procedure) that does cause problems for breastfeeding women. Problems it causes for maternal bonding should be mentioned in the maternal bond article. It is fine as a point in the breast refusal section, as far as I am concerned. violet/riga (t) 21:11, 26 Oct 2004 (UTC)

DanP - correct me if I am wrong, but isn't plastic surgery a form of surgery? I agree with violet/riga, subject to the caveat that effects on maternal bonding that affect breastfeeding could legitimately be mentioned too. -- ALoan (Talk) 21:36, 26 Oct 2004 (UTC)

Plastic (or cosmetic) surgery isn't true surgery which by many medical definitions is usually some kind of repair or a treatment of a disease. But some loose definition, all mutilation is surgery -- ear piercing is too probably. But this is an encyclopedia, and we should expect some scientific accuracy with our words. With regard to maternal bonding, I thought my edit did just that. The totally unproven POV is that circumcision is unrelated to breastfeeding problems. There is zero evidence to prove that, yet such slanted POV is asserted so emotionally. The article already has anti-tobacco and anti-alcohol POV in there without a shred of scientific research cited. Seems like there's work to do there. So it doesn't seem at all unreasonable to mention the Marshall study [6] which covers both feeding and bonding, just to say some research exists and any parents planning to breastfeed can make up their own minds on circumcision. DanP 23:13, 26 Oct 2004 (UTC)

There isn't POV in the article and everything is researched. Just because it doesn't link to a website doesn't me that it isn't fully researched - that's the point of the references section. Circumcision is mentioned enough already. violet/riga (t) 09:54, 27 Oct 2004 (UTC)

The anti-alcohol and anti-tobacco slant is still there. Why are those presented as "harmful", instead of leaving that value-loaded opinion up to the reader? NPOV says we should not advocate a position. If circumcision is censored as to its potential harmful effects, even though there is scientific evidence of bonding problems, why are cigarettes and alcohol opposed so blatantly? That judgemental stuff should all be taken out, and the relevance research simply cited. With regard to breastfeeding, the effects of circumcision on bonding are not even presented as a parental choice in this article, despite the fact that parents can choose to prevent it. Instead, other parental choices (smoking and drinking) are judged as "harmful". How can you say that isn't POV when it judges one activity as "bad", and the other is not even mentioned as a choice? DanP 17:55, 28 Oct 2004 (UTC)

DanP --

Circumcision is already mentioned in a negative light as a potential issue with respect to breast refusal, which is directly relevant to this article, which is about breastfeeding.
The maternal bonding section is about the effects of breadfeeding on maternal bonding; it is not about other things that can influence maternal bonding. If circumcision has negative effects on maternal bonding then the article on maternal bonding should say so, not this one - this article is about breastfeeding not maternal bonding.
The section "Negative effects upon the infant" explains that breastfeeding can be harmful to the infant in certain circumstances. Circumcision is not one of those circumstances - unless there is some other issue at play, breastfeeding does not have harmful effects on a circumcised child (irrespective of whether circumcision is a good thing or a bad thing). There are peer reviewed and published academic articles saying that alcohol and nicotine can be harmful in any event (find me someone who thinks they are not) and some of those articles say the same thing in the specific context of breastfeeding. Hence, this is mentioned as one of the potentially harmful circumstances mentioned in that section.

You still haven't responded to my two questions above - I don't see why this article on breastfeeding should mention the detrimental effects (if any) of circumcision on maternal bonding, rather than those effects being mentioned in the article on maternal bonding, and you have not suggested any language to change the reference to surgery (including circumcision) - for what it is worth, I still think circumcision is a form of surgery. -- ALoan (Talk) 18:23, 28 Oct 2004 (UTC)

You have my full support with that excellent argument, ALoan. violet/riga (t) 18:37, 28 Oct 2004 (UTC)

ALoan, you make several good points. The POV slant is not exactly what you say, but is this:

Circumcision is not presented as a choice in this article, but only hinted as happening somehow, as though it blames the doctor or the hospital. These days, it is parental choice. Drinking and smoking are clearly implied as being choices (and condemned as bad ones too).
Circumcision is mentioned as surgery instead of cosmetic. There is no birth defect, no injury, no disease. The procedure should be listed without that connotation, and the word "discomfort" (not even in Wikipedia) is purely a euphemism for pain and trauma (which are articles in Wikipedia). The word is POV to weaken what is stated by research.
This issue is related mainly to breastfeeding and bonding. But maternal bonding lasts throughout childhood. Maternal bonding is a significantly broader context than just breastfeeding, and much of the research focuses on feeding habits of babies.

I believe the line on breast refusal could be changed from "Discomfort, possibly due to recent surgery or medical procedures (for example, circumcision)" to "Pain, possibly due to surgery or circumcision procedures" which leaves the judgement of medical necessity in neutral territory.

I don't think it's hard to put this in NPOV format in the bonding section. "Some people believe breastfeeding and bonding is impacted negatively by the choice of circumcising a child, and research supports this. Circumcision is common in the United States, and parents should take this into consideration before making this decision." Any objections? DanP 19:18, 28 Oct 2004 (UTC)

Thanks for the response. On the surgery point, how about "Discomfort or pain, possibly due to recent surgery or medical procedures (for example, circumcision)". Note that the only 'prcedure' (avoiding the controversy over whether circumcision is medical or surgical or not - note again that I think most people would think that it was surgical, even if not medically indicated)mentioned is circumcision. Would that be acceptable to everyone?

On the bonding point, this article is about breastfeeding not about maternal bonding. Why should circumcision be mentioned as a factor in maternal bonding when other factors are not? -- ALoan (Talk) 10:39, 29 Oct 2004 (UTC)

Circumcision and the affect it has should be mentioned in the circumcision article. It does not have a significant enough affect on breastfeeding (when compared to bottle feeding) that warrants greater mention than there already is. The affect it has on the maternal bond should be mentioned further in other articles, yes, but not here. Sorry but I feel that objections to these changes have been made clear enough now and I don't see any need for them to go ahead. violet/riga (t) 19:56, 28 Oct 2004 (UTC)

I'm not clear what factual objection you have. The disruption of bonding is relevant to breastfeeding -- a bond is essential, and any likely source of concern is warranted. If your opinion is that it's not in the right place, then how about relocating the anti-alcohol and anti-smoking propaganda to the right article? Those relate to the harm the substance might cause, not the actual act of breastfeeding itself. I'm only asking for you to formulate a neutral view on this, and not erase valid causes of problems. Is your opinion that only female babies are worth breastfeeding? DanP 20:16, 28 Oct 2004 (UTC)

Circumcision has an affect on the feeding habits of babies – not just breastfeeding but bottle-feeding too. The problems it causes for feeding and bonding should be discussed in the circumcision article. The present status of the article is NPOV and passes through wp:pr and wp:fac as such – it does not need changing. Please note that if you say anything else like your final comment I'll not reply to you again. violet/riga (t) 20:25, 28 Oct 2004 (UTC)

As someone who is strongly opposed to non-therapeutic circumcision of children I agree with ALoan and violet/riga regarding DanP's comments. Circumcision is already mentioned in the breast refusal section of the article in an appropriate way. The controversy over whether circumcision should be called "surgery" or "permanent body modification" belongs in the circumcision article, not the breastfeeding article. Health care professionals and society in general view circumcision as surgery. -- DanBlackham 20:40, 28 Oct 2004 (UTC)

OK, that's fine. I wasn't trying to add controversy, but just wanting to leave out any value-judgements either way (which is NPOV). Relocating this issue to the circumcision article is agreeable with me. But again, why is the prejudice against smokers and drinkers in this article? That should be toned down just a bit, as there are some who breastfeed without quitting those activities. NPOV is supposed to be non-negotiable, and the marijuana reference is about as irrelevant as outer space in this article. DanP 21:01, 28 Oct 2004 (UTC)

Nicotine and alcohol cause problems for breastfeeding infants. It is better for breastfeeding women not to smoke or drink excessively. That is an undisputed fact and should be discussed in the article, just like it is. Yes, many women still do it but if they think it has no negative effects then, frankly, they're wrong and no pedia should pander to them. As for marijuana please refer to this statement as linked to at the relevant section of the article:

The Committee on Drugs strongly believes that nursing mothers should not ingest drugs of abuse, because they are hazardous to the nursing infant and to the health of the mother. – American Academy of Pediatrics, [7]

violet/riga (t) 21:14, 28 Oct 2004 (UTC)

Almost by definition, a fact cannot start with the words "it is better that". That is a matter of degree and opinion. "Better" is a comparison and an opinion. Whether it is opinion backed by the AAP, Congress, or all of humanity, it is still opinion. Saying "no pedia should pander to them" is simply POV -- how can it not be? NPOV is to state both sides without claiming one is right. If the article says it is a fact that alcohol/tobbacco causes some problems, that is fine with me. But to judge the act as "harmful" is not magically more justfiable than judging the signature of consent to leave a boy scarred and it's impact on breastfeeding (bottle feeding is easier, so please don't blur them together with regard to bonding). I respect your opinion and mostly agree with it, but this is an encyclopedia. I guess we now have opinionpedia. DanP 21:29, 28 Oct 2004 (UTC)

I'm sorry but virtually everything you just said is incorrect.

Facts can start with "it is better that"
Next you'll be saying we should pander to the people that think murder is a good idea (it's their opinion after all)
Bottle feeding is not easier than breastfeeding
Everything in the article is based on fact, not opinion

violet/riga (t) 21:37, 28 Oct 2004 (UTC)

It is actually the case that "murder is bad" is a point of view, and should not be espoused by WP Lethe | Talk

Funny – at no point do I see the discussion of murder being a good thing in the murder article, hence my point. violet/riga (t) 10:30, 29 Oct 2004 (UTC)

However, it is a fact that "most people hold the opinion that murder is bad". Similarly, it is a fact that medical research shows, and most medical opinion holds, that alcohol and nicotine intake by nursing mothers is potentially harmful for their infants.

Where does the article say "it is better that..."? It says " Breastfeeding can be harmful to the infant if the mother ...", "Breastfeeding mothers must use caution if they regularly consume nicotine..." and "Heavy alcohol consumption is known to be harmful to the infant...". Are these not facts? -- ALoan (Talk) 10:39, 29 Oct 2004 (UTC)

No disagreement there from me personally on those issues ("it is better" was violetriga's assertion labelled as fact, even though it's still opinion by definition) But it's still not NPOV to use Wikipedia as a tool to stigmatize smoking, or to imply that smoking mothers are harming their babies everytime they breastfeed them. But do whatever you want, misrepresent scientific facts if needed -- smoking mothers are as bad as murderers now -- I just don't agree with the attack angle there. DanP 18:05, 29 Oct 2004 (UTC)

I feel totally justified in disagreeing with you when you clearly have no idea about interpreting written English. Sorry but you clearly have a circumcision agenda and don't fully understand NPOV. violet/riga (t) 18:31, 29 Oct 2004 (UTC)

We can hash English out on your talk page. You win here, right or wrong. So what more is there to say. DanP 18:44, 29 Oct 2004 (UTC)

Well, whatever violet/riga says here, the article says "Breastfeeding can be harmful to the infant if the mother ... uses potentially harmful substances such as caffeine, tobacco, alcohol, cocaine, heroin and amphetamines" (emphasis added) - surely you can agree that (i) caffeine, tobacco, alcohol, cocaine, heroin and amphetamines are potentially harmful and (ii) they can be harmful to a breastfed infant if used by the nursing mother? -- ALoan (Talk) 21:26, 29 Oct 2004 (UTC)

Indeed, if we were to say circumcision was potentially harmful (which even I don't push for just on grounds of POV) and then cite sources where babies have died, babies were in severe pain and didn't breastfeed with articles to support that, that is twisted by advocates of circumcision. "Harmful" is a cheap shot at smoking mothers, whether potential consequences are there or not. I can certainly respect the opinions and research behind it, but the selective bias on both issues is obvious. In any case, Violetriga's latest addition is good enough for me. DanP 22:24, 29 Oct 2004 (UTC)

I wrote to " Tina Kimmel " < Tina @T Motherlove . Org > who referred me to " Amber Craig " < Ambercraig @T Nc . Rr . Com > who referred me to " Norm Cohen " < NormCohen @T NOCIRCofMI . org > who sent me this:

October 2004

Suffering at the Breast is Not Best

La Leche League Censors While Mothers and Sons Suffer

To La Leche League Board of Directors, Staff, Leaders, Members, and Alumnae:

In a shocking display of mixing with religious causes, La Leche League’s Board of Directors has let a small group of women defeat the free exchange of information on circumcision’s negative impact on breastfeeding success.

In April of 2003, NOCIRC signed a contract with La Leche League International as an exhibitor and paid for exhibit space for their international conference held in July 2003. Shortly before the event, the board of directors vetoed our admission as exhibitors. Word of our attendance had spread to a minority of Jewish women in the organization who objected to our very presence.

NOCIRC has exhibited successfully at literally hundreds of conferences locally, regionally, and nationally. We are asked back year after year. Without religious prejudice, we provide information about the traumatic effects of circumcision. We hand out our information pamphlets in a non-confrontational manner to those who approach our table because they are interested in learning about the issue. Each year, we have a well-received exhibit booth for physicians attending the American Academy of Pediatrics national conference.

NOCIRC already counts among its supporters hundreds of LLL members and former members. The silent majority of leaders within League are already on our side. Attendees who were interested would have appreciated our information; those who were not interested would have just walked on by.

The vast majority of boys who are circumcised in the United States are not sons of Jewish or Muslim parents. Preventing these non-religious circumcisions has always been the primary focus for NOCIRC. This painful surgery, the most common procedure that baby boys are forced to experience, puts breastfeeding success at risk. Good chest-to-chest positioning requires mom to press her son’s wounded penis up against her body, and the pain makes him unable or unwilling to nurse.

La Leche League reported problems with breastfeeding by circumcised infants in their 1981 edition of The Womanly Art of Breastfeeding. In 1996, LLL ratified the Mother-Friendly Childbirth Initiative, along with 25 other organizations. The organization accepted ten basic principles for mother-friendly care, including the requirement that service providers must “discourage non-religious circumcision of the newborn.” (on-line at [8]).

The breastfeeding relationship does not begin in a vacuum. In 2002, NOCIRC issued its position statement, “The Effects of Circumcision on Breastfeeding,” available at [9]. Researchers have found that some male babies are unable to suckle the mother’s breast after circumcision. The circumcised infant is in pain and is in an exhausted, weakened, and debilitated condition. The circumcision procedure frequently causes the newborn to withdraw from his environment, interfering with his process of bonding and breastfeeding.

La Leche League claims it is a non-sectarian organization. However, when it comes to circumcision, it is a religious organization. A few powerful members are keeping clinical data regarding breastfeeding obstacles out of the hands of all members in order to further their personal religious viewpoint. For six years now they have systematically excluded NOCIRC from simply having a table at their area and national conferences.

The Board of Directors has placed a higher priority on protecting religious circumcision than on breastfeeding success for the 94% of non-Jewish, non-Muslim moms. Jewish boys have seven days to establish breastfeeding before undergoing surgery; non-Jewish boys do not because they are circumcised at birth, and thus they are at a greater risk.

The Board’s action is hypocritical in light of LLL’s own struggle with those who block the promotion of breastfeeding benefits for fear of upsetting parents. LLL has itself been accused of producing guilt when they describe the advantages of breastfeeding in much the same way that NOCIRC is now being accused by LLL.

LLL has an obligation to its members to make available information on how circumcision affects breastfeeding. New and expectant moms need this information ASAP in order to nurture a successful breastfeeding relationship with their sons. NOCIRC can help to insure that this happens.

NOCIRC is not asking for an endorsement from LLL nor are we asking for leaders to discuss circumcision during meetings. We are simply asking to be one of the many outside organizations and merchants not directly involved in breastfeeding that exhibit each year at their excellent conferences.

Are you surprised by the League’s lack of courage on this issue? If so, then write to the board at [10]. Demand that they stop this petty censorship and trust conference attendees to make their own informed choice about circumcision. On behalf of babies yet to be born and parents yet to be educated, demand that they take the moral high road and let NOCIRC be a participant in breastfeeding success.

On behalf of all the children, thanks!

"Norm Cohen"

Director

NOCIRC of Michigan

< NormCohen @T NOCIRCofMI . org >

(248) 642-5703

Original document was plain text. Links wikified. Email-addresses spam-proofed.

Ŭalabio 07:19, 2004 Nov 8 (UTC)

Hepatitis B

"There is also a small statistical correlation between the Hepatitis B vaccination given at birth and difficulty establishing breastfeeding. This difficulty is manifested as a slight delay in the ability of the baby to correctly establishing feeding, so the immediate administration of the Hepatitis B vaccine is usually recommended."

Removed the above until an external link or the statistical evidance can be added. violet/riga (t) 07:18, 23 Sep 2004 (UTC)

Lactation as contraception?

A naive male writes: I'm told that ovulation ceases while a woman is actively breastfeeding. Presumably an evolutionary reason for this would be to ensure that an infant was properly weaned before its mother gave birth to another child, but the article mentions that a woman can breastfeed children of different ages. Is there any truth in what I was told? Don't worry - I'm not so naive that I'd want to rely on it as a form of birth control!! :-) Adambisset 00:54, 22 Oct 2004 (UTC)

Yes it can. A very good page at Dr Sears [11] explains it well. Basically the hormones given out during breastfeeding help to cease ovulation, but you have to feed very often. I think I'll integrate this into the article soon, thanks. violet/riga (t) 08:31, 22 Oct 2004 (UTC)

I took a course about Women in Western Civilization. The course was not about famous women, but about the history of the treatment, conditions, and liberty of women. As a side note, the professor spent part of a class talking about historical contraceptives. She said that her doctor had told her, incorrectly, that breastfeeding could prevent conception, or at least full term pregancy. Historically this was true, however modern women are too well fed for this to work. The contraception works somehow because a woman, historically, could not nourish a growing fetus and breast feed at the same time, and the breast feeding took priority. Daelin 11:55, 22 Oct 2004 (UTC)

Thanks for the information Adambisset 12:59, 22 Oct 2004 (UTC) :-)

Ideas on splitting the article

Now this article is in excess of 41k I think it needs breaking down a little. I'm thinking of creating a Benefits, contraindications and complications of breastfeeding article to take those two large sections out, but the article name is hardly great. The other idea was for a History of breastfeeding article, but I think the content works well in this one and the former idea is better. So, can anyone think of a better article title than that first one? Or another way of splitting this, perhaps.

Erotic aspects

I have read some articles discussing the sexual arousal sometimes associated with breastfeeding, and discussed it with my wife, and am surprised to see nothing here on this topic. Are there any objections to my writing it up here, despite my constitutional lack of experience? Haiduc 03:43, 19 Feb 2005 (UTC)

I do worry about the fact that so many articles can have the erotic aspects discussed (cucumber?) but it may be appropriate for this one. Not sure what references and sources you will be able to find about it though. violet/riga (t) 11:19, 19 Feb 2005 (UTC)

Just noticed an anon added Milk fetishism to the see also section - that covers it I think. violet/riga (t) 12:21, 20 Feb 2005 (UTC)

Bottle Introduction

Is it necessary to introduce a bottle to a baby? SOme people say that a bottle should be introduced by 6 weeks or the baby will never take one. If the mother became ill when the baby was older and a bottle became necessary, would the child not take it? This seems ludicrous to me.--Westendgirl 06:03, 19 Mar 2005 (UTC)

While the sucking method is different between the nipple and a bottle the baby will learn to switch whenever necessary. violet/riga (t) 10:36, 19 Mar 2005 (UTC)

Thanks. Do you have any references for this? I can find tons of non-scientific claims that say a baby must have the bottle at 3-6 weeks. Any researched-based references that say a baby will learn to switch? --Westendgirl 22:46, 19 Mar 2005 (UTC)

I've been looking but to no success yes - it all seems rather anecdotal. violet/riga (t) 10:09, 21 Mar 2005 (UTC)

What constitutes "necessary" can be subjective. A mom who is home with her baby can decide for herself what would make using a bottle "necessary", it isn't a set-in-stone rule. If a bottle is introduced too early, nipple preference can cause huge breastfeeding difficulties. In real life some babies switch back and forth no problem but a few have trouble. In real life it can be extremely difficult to get an older baby to accept a bottle, but the fact is, a bottle is not the only option for an older baby,(sippy cups become a possibility after the baby is sitting up) so it is less of an issue. I too am interested in seeing if any studies have been done in this area. Maybe if people are coming into this section asking questions about the topic the section needs to include clearer explanation and/or options.

Neutral POV

This article appears to have a bias against breastfeeding, ignoring evidence-based medicine. Also, many good-faith recent edits attempting to neutralize some of the bias have been removed with no explanation. I'd like my suggestion that this page be up for discussion of its neutrality to at least be discussed and not summarily dismissed as vandalism. Suggested reading: http://www.het.brown.edu/people/kjp/stuff/watch_your_language.htm

I think it's already NPOV and has actually been mostly written by someone with a pro-breastfeeding bias. The recent edits have introduced far too much bias along with unnecessary content (such as information that should be included in paternal bond instead of here. Where you think there is a POV against breastfeeding please let me know and I will review it - for now I will remove the notice because no specific issues have been raised and I have checked it for bias myself. violet/riga (t) 06:54, 20 Mar 2005 (UTC)

Further, one recent problem has been information that is too centred around the US and La Leche. violet/riga (t) 06:55, 20 Mar 2005 (UTC)

Could you provide specific examples of the bias you see? This might help us see what you mean. --Westendgirl 05:48, 21 Mar 2005 (UTC)

Not sure if that one is to me or the anon, but I was referring to the new additions being US and LLL-centred. violet/riga (t) 11:34, 21 Mar 2005 (UTC)

Statements from the article that subtly or not-so-subtly make breastfeeding seem difficult and impossible to achieve. See below. Reading these make it seem like in order to breastfeed, a mother must eat a perfect diet, be serenely relaxed, be prepared for embarassing leakage, expect problems with her partner, experience excrutiating pain, and even harm her infant.

"The thought of nursing or the sound of any baby can stimulate the process, causing unexpected leakage." (caution! you might leak! how embarassing!)

A statement of fact that does not give any POV. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

How is stating the fact of the let-down process embarassing? I found it far more comforting to have learned in advance that this could happen. --Westendgirl 05:15, 24 Mar 2005 (UTC)

"Commonly both breasts can give out milk when one infant is feeding, but this and other problems often settle after two weeks of feeding." exactly what problem are you talking about here?

Other problems in general, though I agree it is too vague. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"One major cause of difficulties during breastfeeding is when the mother is in a stressed or anxious state of mind." (proof? why not blame the mother for not being relaxed enough.)

A stressed mother can have difficulties breastfeeding - that's true. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"While some partners may feel left out when the mother is feeding the baby," not sure why this is in an enclopedia article, sounds more like a marital problem, and a weaselly one at that

Some fathers can as they want the chance to breastfeed - again a fact and not a slur against breastfeeding! violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"Breastfeeding, possibly alongside birth-related health problems, takes a lot of time." -- nothing to do with BFing. Same situation applies for formula feeding.

It is slower to breastfeed than give a formula feed especially when the woman is poorly. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"This may add pressure to the partner and the family, with them having to work harder, caring for the mother and performing tasks she would otherwise do. " again weaselly and hardly reference material fodder

I'll look at that in context to see if it should be removed. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"If looking after the child while the mother is away, the father may find it impractical or inappropriate to feed expressed breast milk to the infant. This may remove the choice of the mother of whether to breastfeed her child or not." huh? impractical or inappropriate in what way? nothing to do with BFing. Same situation applies for formula feeding.

Explained in another section and reworded completely. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"It is not uncommon for a mother and child to have difficulties breastfeeding, with some women unable to feed their child at all." put this in the complications section

It is the intro to the "Contraindications and complications" section and explains what the section will look at. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"Others find it too problematic or choose not to attempt or continue breastfeeding for personal reasons." maybe there should be a "choosing to breastfeed" section?

That's a possibility but I can't think of what it would cover over and above what exists in the article. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

(The contraindications and complications section should be separated. Mixing the two makes things like masitis seem like a contraindication.)

Maybe, but there is an overlap. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"Negative effects upon the infant Breastfeeding can be harmful to the infant if the mother:" (we need proof for this -- harmful how? is it more harmful to receive formula, or to received breastmilk with medication in it???? need clear proof of harm before this is stated)

This is about breastfeeding, not about the relative merits of breastfeeding compared to alternatives. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"is taking certain medications which may be passed onto the child through the milk and are found to be harmful. However, the vast majority of medications are compatible with breastfeeding. has had excessive exposure to heavy metals such as mercury" (again proof?)

There should be a reference for it - I'll attempt to find one. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"If the baby is large and grows quickly, the fat stores gained by the mother during pregnancy can be quickly depleted, and she may have trouble eating well enough to keep developing sufficient milk." proof?

Many textbooks say so, including some referenced here. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"The diet usually involves a high calorie, high nutrition diet which follows on from that in pregnancy. " proof?

Many textbooks say so, including some referenced here. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"Breastfeeding mothers must use caution if they regularly consume nicotine through tobacco smoking. In addition to reducing the milk supply, heavy use of cigarettes by the mother (more than 20 per day) has been shown to cause vomiting, diarrhea, rapid heart rate, and restlessness in breastfeeding infants. Research is ongoing to determine whether the benefits of breastfeeding out-weigh the potential harm of nicotine in breast milk. "(Actually, we need to know whether nicotine in breastmilk is more risky than formula since that is what is subtly being recommended here)

No, we need to state that nicotine gets into breastmilk not compare it with alternatives. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"One criticism of breastfeeding is the difficulty in accurately monitoring the amount of food taken by the baby." criticism by who? how is this relevant?

A criticism by people against it. It states a slight problem that mothers may face. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

But why is it ok to include criticisms by people against breastfeeding if it is not ok to include benefits by people for breastfeeding? If we include criticisms, how is that balanced if no benefits opposite the criticism is presented. Saying, "One criticism of breastfeeding is..." is basically the same as saying "some mothers think..." or "some people believe..." Those types of statements have been disallowed previously.

"Expressed milk can also be used to assist a mother who is experiencing difficulty breastfeeding, in the later stages because of a newborn causing grazing and bruising or because of an older baby growing teeth and biting." proof? never heard of grazing or bruising

Usually through improper latch or removing the baby incorrectly, as stated previously in the article. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"Though some dislike the idea of feeding their own child with another person's milk, others appreciate the ability to give their baby the benefits of breast milk." some = weasel

Find a statistic and put it in. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"It is not necessarily the case, however, that the appetite and feeding habits of both babies are the same. This leads to the complication of trying to feed each baby according to their individual requirements while also trying to breastfeed them both at the same time. In cases of multiple births with three or more children it is extremely difficult for the mother to organise feeding around the appetites of all of the babies. " Not relevant to breastfeeding. Same issue exists with FFing.

True - this may be better off in infant or a separate infant feeding habits article. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"Although some may find it controversial, some women breastfeed their offspring for as many as three to seven years from birth." some = weasel

Again, find statistics and put them in. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

" Breastfeeding can make the mother thirsty and can last for up to an hour (usually in the early days, when both mother and baby are inexperienced) – it is therefore common for the mother to require a drink during the process." proof? never heard of this

Definately true and the references back it up. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

"Incorrect positioning is one of the main reasons for unsuccessful feeding and can easily cause pain in the nipple or breast." wait, i thought the mother's uptight attititude was the main reason for unsuccessful feeding

No need for that. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

Breast and nipple pain -- this whole section should be part of "complications" and not a separate section.

Agreed that the section could be moved there. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

Nutrition

"Since the nutritional requirements of the baby must be satisfied solely by the breast milk in exclusive breastfeeding it is important for the mother to maintain a healthy lifestyle, especially with regards to her diet" proof? i thought the opposite was true, that even malnourished mothers produce adequate milk

An adequate supply yes, but not milk that is nutritious enough. There should be a reference for this one. violet/riga (t) 12:16, 21 Mar 2005 (UTC)

La Leche League says women produce nutritionally adequate milk even in famine conditions.[12] And it appears that, in famine conditions, breastmilk is fine, except for somewhat-weaned toddlers (who rely on food, not just breastmilk) and babies born too close together for the mother to produce adequate milk.breastfeedingbirthspacing.pdf--Westendgirl 23:02, 21 Mar 2005 (UTC)

The Subcommittee on Nutrition during Lactation seems to suggest that nutrition is an important thing and backs up the high calorie statement:

"A malnourished mother may have inadequate levels of vitamins A, D, B6 and B12 in her milk, and may risk decreased milk supply."

"The Subcommittee on Nutrition during Lactation advises breastfeeding mothers to take in 1500-1800 calories per day." [13]

I'm going to add this now. violet/riga (t) 23:38, 21 Mar 2005 (UTC)

I'm waaaaaaaayyyy late to this particular party, and am just kibbitzing here, not suggesting any changes to the article, but: La Leche League is absolutely wrong if they believe that malnourished mothers magically produce nutrition out of thin air. This is part of the American fantasy of pregnancy and childbirth. The fantasy is that Motherhood is so special and sacred that a mother's body will (and should!) sacrifice itself to keep her baby healthy. In actuality, women's bodies — just like the bodies of all other female mammals — will take care of their own nutritional needs first, and the babies second. Just my $0.02. Nandesuka 05:40, 1 September 2005 (UTC)

I think I know the source of the confusion. The mother will produce milk, yes, but if they don't have any vitamins to give they can't give them. However, it is considered safer to breastfeed than to use formula made with contaminated water, which is a common problem in famine-stricken areas. Russia Moore 00:46, 30 April 2006 (UTC)

Omega 3

"Nutrition for the breastfeeding mom" at BellaOnline.com discusses essential fatty acids, particularly omega-3. While very interesting and well-written it doesn't make any citations and I don't really consider BellaOnline.com to be a strong voice on the subject. Perhaps it's a starting point and could be added until better references can back it up. violet/riga (t) 00:31, 22 Mar 2005 (UTC)

Health Canada (official Canadian government site) says that Omega 3 occurs naturally in breast milk.[14] We can include this information. However, it doesn't say whether this varies according to the diet of the mother. For example, do fish-eating Scandinavians have higher levels than Canadians? --Westendgirl 20:33, 14 Apr 2005 (UTC)

Fathers' effect on breastfeeding choice?

"If looking after the child while the mother is away, the father may find it impractical or inappropriate to feed expressed breast milk to the infant. This may remove the choice of the mother of whether to breastfeed her child or not."

What does this mean? What would be more practical, a bottle of formula would have to be fed the same way; and what is meant by "inappropriate"? Is this a reference to the family dynamics or social beliefs in some cultures? I would like to see some clarification of how a father's discomfort with feeding expressed milk could possibly "remove the choice of the mother". Can it be reworded to show both sides of the theoretical situation - it is referring to the idea that a father's discomfort with feeding the baby would be an insurmountable problem and make a woman give up the thought of nursing her baby? Can we see some references to the father's needs being the priority, and then balance them by including some possible solutions to the problem? I think both could be presented briefly, those few sentences as it stands make it appear as though the father has the absolute power to take away a mother's choice. And maybe in some places they do, but to say so and not mention any alternative seems unbalanced.

I take it that "impractical" refers to the fact that the mother must express her milk and leave it, perhaps therefore being impractical for the mother more than the father. "Inappropriate" would refer to men feeling odd at feeding the mother's milk to the child, especially if the couple are separated. This would remove the choice of the mother if the father has access rights but refuses to give the child breast milk. Perhaps it could be slightly reworded to better reflect this. violet/riga (t) 10:02, 21 Mar 2005 (UTC)

If the father has visitation with his child and refuses to feed expressed milk, it does not remove the mother's choice to breastfeed. That is an opinion statement and should be reworded. The mother can pump while the baby is with the father and resume nursing when the baby is returned home. With an older baby, she may choose to cease pumping and just nurse whenever mother and baby are together. It is simply untrue that if a father doesn't like feeding expressed milk, the mother has no choices. She does. She may not like them and they may make life more complicated for a while, but those subjective issues are not typically addressed in a reference article. It would be more accurate to say that a father's discomfort with feeding expressed milk can have an affect on breastfeeding management choices made by the mother.

Hence the rewording which I believe, and I hope everyone agrees, is better. violet/riga (t) 20:09, 21 Mar 2005 (UTC)

Physiological and Historical Oversights

This article overlooks the physiological fact that a healthy new mother will automatically produce breast milk after childbirth, whether she wants to or not. Modern medicine does have the capability to artificially curb the lactation process, but the POV of the article ignores the fact that her developed lactation and the breastfeeding of her newborn is the natural, healthy course of events. The POV takes the position that breastfeeding is a chosen alternative to formula feeding; when in fact it is the opposite that is true.

The “History of Breastfeeding” barely touches on mothers who actually breastfed their own children, moving quickly to alternative methods and the employment of wet nurses. There is no discussion of the inherent advantages of breastfeeding for a woman and child in the wilderness, or in a similar primitive setting, as compared to the modern world. This would more accurately titled as the “History of Breastfeeding Alternatives”.

There is no discussion of how life in a primitive setting favors breastfeeding and lactation development as a survival tool for her family (and/or tribe) to help ensure their strength and survival under extreme conditions such as seasonal or winter famine, or recovery from illness or injury, both of which were commonplace in the primitive wilderness environment. A woman’s inherent ability to induce lactation and release her internal stores as food for others increases her value to a mate or to the tribe, thus ensuring her protection and survival in the harshness of the wilderness. This supports the theory that during early development of the human species women nursed their mates as well as their young and maintained their milk supply for most of their adult lives.

While this article is overall very good, it appears to look at breastfeeding as an oddity of human nature instead of the natural and normal human function that it is. It also leaves a vast area of related material unexplored. See "Roman Charity" to learn more. Mlklvr 18:45, 8 May 2006 (UTC)

Accuracy Issues

"Mothers can also buy or hire breast pumps to extract the milk, if nipple pain becomes unbearable."

While this is not an untrue statement (yes, mothers can get a pump and use it when they have sore nipples) it is based on the incorrect assumption that the use of the pump is a solution to the problem of sore nipples. It gives the impression that a mother can simply switch to pumping instead of nursing from the breast, give her baby the expressed milk, and all will be well. That is not the case. I have never seen pumping offered as a first choice solution for soreness in any reputable breastfeeding resource, nor was that a solution in the eyes of the lactation consultants I saw after my son was born. I have seen it offered merely as a very short term way to obtain a brief respite from difficulties, while in the process of solving the problem, but with the caveat that pumping and bottlefeeding have their own drawbacks and possible complications that would be better avoided.

Most breastfeeding experts agree that the main cause of soreness is incorrect latch which can have various causes. Pumping does nothing to remove the cause of the problem, and in some cases can itself be painful. A breastfeeding mother with sore nipples must seek help to determine the cause of the problem so that it may be solved. I would like to see this sentence replaced with a fact based, expert supported statement about what a mother can do if she has sore nipples.

If the latch is the problem then expression can be used as a short-term solution to allow the nipples to become less sore and then, having taken advice regarding proper latch, give the mother the chance to start breastfeeding again. The sentence does not say that it is a good thing to stop breastfeeding and change over to EBM. violet/riga (t) 10:08, 21 Mar 2005 (UTC)

In addition, the extremely negative use of descriptions of pain make it easy to see why some parts of this article are being seen as biased. Referring to breastfeeding as something that has to be "endured" and can cause "unbearable" pain seems less than neutral. We can surely describe the very real problems some breastfeeding mothers have in a truly neutral way, without resorting to descriptives that seem designed to evoke negative reaction.

Nowhere does it say that it happens to everyone. We should avoid weasel terms such as "some women" and "a small amount of" but I'm not aware of any published statistics regarding the number of women that have sore nipples. The word "unbearable" is fine in this situation because the woman should only turn to expressing if she can no longer bear the pain. violet/riga (t) 10:08, 21 Mar 2005 (UTC)

I agree that the use of "endured" is loaded. I've reworded this statement. I also added several statements about sources of pain -- including breast pumps. While breast pumps are not a first choice for dealing with pain, women can turn to them if they want to continue to feed their child (expressed) breastmilk while allowing nipples to heal and learning to latch better. --Westendgirl 05:44, 22 Mar 2005 (UTC)

POV

Once again I've just had to revert changes to this article because an unregistered user has introduced biased wording. This time it changed the lead, which is supposed to give a summary of the article rather than present a one-sided view.

I wholeheartedly agree that breastfeeding is the correct thing to do, but we must reflect that some people choose not to. Yes, it is recommended by WHO and most other organisations but the rewrites keep adding a wording bias which almost implies that you're an unfit mother if you don't breastfeed your child.

Please can these changes be discussed here before changing the article, just like the above two sections are working to a solution. violet/riga (t) 11:40, 21 Mar 2005 (UTC)

I read the change and felt it was 100% appropriate. This article is about breastfeeding, not about people who choose not to. You are projecting your own guilt or something by removing neutral POV edits.

"Breast milk is the standard for infant feeding -- all others forms of nutrition have been shown to be inferior to the nutrition provided from breast milk. " this statement should not have been removed. It is scientifically and neutral in value. If someone feels it is talking about unfit mothers, that person is reading something into it that doesn't appear.

That's an absurd accusation. The changes made did not reflect Wikipedia policy on lead sections. I've added to it to present a better way of what I think you were trying to say. violet/riga (t) 11:55, 21 Mar 2005 (UTC)

Just quoting you where you said "adding a wording bias which almost implies that you're an unfit mother if you don't breastfeed your child." -- hardly an absurd accusation when it's there in your own words. Scientific *fact* is that all other feeding methods are inferior. Says nothng about fitness as a mother as you seem to feel it implies. Or are you trying to say that you believe that formula is just as good?

Why on Earth would you think I was talking about my inner feelings when I said that?! As I've already said I agree that it is better for the infant but there are many women that choose (or are forced or even advised in some countries in history) not to breastfeed. violet/riga (t) 12:20, 21 Mar 2005 (UTC)

Your statement is also true, but it does not invalidate the truth or the validity or the neutrality of the statement you deleted.

This article is supposed to be a description of Breastfeeding, not a vehicle for promoting the practice. Please note Wikipedia:What Wikipedia is not: "Wikipedia articles are not... advocacy of any kind. Of course, an article can report objectively about such things, as long as an attempt is made to approach a neutral point of view. You might wish to go to Usenet or start a blog if you want to convince people of the merits of your favorite views." Jayjg ^(talk) 19:32, 21 Mar 2005 (UTC)

"Breast milk is the standard for infant feeding -- all others forms of nutrition have been shown to be inferior to the nutrition provided from breast milk. " It would be helpful to consider whether it is a statement supported by experts in the field or a statement of opinion which has no place here. I have explored the following sources looking for information that contradicts this statement or identifies it as subjective or controversial. I am also searching through my copy of “Breastfeeding, Biocultural Perspectives”. American Academy of Pediatrics: [15] World Health Organization: [16] American Academy of Family Physicians: [17] American Dietetic Association: [18] Dr. Palmer’s research and findings: [www.babyreference.com]

In reading through the breastfeeding information offered by these sources, so far I find nothing to indicate that medical professionals consider any other form of nutrition equal to breastmilk. The statement above certainly does appear to be expert supported and in no way a misrepresentation of the current best scientific information. There is no valid reason to remove it from the article unless it can be shown to be a subjective statement rather than an accurate portrayal of the current information on the topic of infant nutrition.

Uh huh. Well, the information about the specific benefits of Breast milk, if properly cited and expressed in a NPOV way, can certainly added to the Breast milk article. Broad handwaving statements are great for pamphlets but of little use in an encyclopedia. Jayjg ^(talk) 20:40, 21 Mar 2005 (UTC)

I would like to challenge the references used for the article. Ive read that you are refereing to textbooks for your information, but not citing the texts used. The following are texts acknowledge by nursing professionals for the accurate information regarding lactation. Whle the the books cited by the royal College of Midwives and LLL are excellent books, I'm dissapointed that not more texts have been cited as reference material. The following are additonal sources that can be used:

Riordan, j. Breastfeeding and Human Lactation. Boston; London: Jones & Bartlett, Third editon, 2004

Lawrence, R. Breastfeeding: A Guide for the Medical Profession. St. Louis, MO: CV Mosby, fith edition

Wilson-Clay, B. and Hoover, K. The Breastfeeding Atlas. Austin, TX: Lactnews Press, Second Edition

Journal of Human Lactation.

I would be happy to continue to post reference material for your use.

looks like the mothing.com forums are involved with theis one [19]

That was a very interesting read, thanks for that. violet/riga (t) 18:35, 9 Jun 2005 (UTC)

Anthropomorphism?

I feel that the current article covers only the Human POV. Is it that the name is not applied to other animals? -- Sundar (talk · contribs) 11:25, Mar 28, 2005 (UTC)

The term is usually just used for humans - animals just "feed" their young - though I agree there is certainly a lack of animal feeding information that could do well in another article. violet/riga (t) 12:02, 28 Mar 2005 (UTC)

Thanks for clarifying. -- Sundar (talk · contribs) 12:07, Mar 28, 2005 (UTC)

Wasn't that lactation or suckling (both now redirect here)? Animals do not have breasts - they have udders and teats. JFW | T@lk 12:14, 28 Mar 2005 (UTC)

While I agree that the article is human-centric, it is true that some animals have breasts, such as gorillas and elephants

Negative effects upon the infant

Is this the best title for this section? The effects cited only occur if the mother is engaging in negative activities, such as drugs. Thus, it's not that breastfeeding has a negative effect, but that there can be negative outcomes if the mother engages in negative activities. I'm not able to offer a better term, but I think the current title is misleading. If breastfeeding itself has negative effects, then those should be included -- but they aren't right now. --Westendgirl 06:55, 29 Mar 2005 (UTC)

We could put "Potential" in front of it? violet/riga (t) 10:19, 29 Mar 2005 (UTC)

I see where you're coming from, but it's still not the breastfeeding that has a negative effect. How about "Contraindicated maternal activities"? That's the real issue. --Westendgirl 00:47, 2 Apr 2005 (UTC)

"Things not to do when breastfeeding" ? Mozzerati 06:59, 2005 Apr 2 (UTC)

"Potential infant harm due to maternal health issues" Or something... I agree, though, I saw the header for that and was confused. "What problems could the milk cause itself?" But all of these are valid, and need to be mentioned. Just not labeled so strangely... Russia Moore 00:53, 30 April 2006 (UTC)

Breast Refusal

Teething is not a problem for breastfeeding. Source: http://www.lalecheleague.org/NB/NBMarApr99p36.html

Agreed, and the edits you have made are good ones. I think that many mothers see teething as an appropriate time to wean because most tend to not want to continue after a few months of feeding. Yes, you should breastfeed for six months or so but I think many look at teething as an excuse - it does complicate things (if not the teeth then the gum pain) even if only slightly. violet/riga (t) 23:39, 30 Mar 2005 (UTC)

Request page protection for article I have requested page protection for the article as Violetriga's unilateral reverting of my adding a balanced view is against policy. It is not allowed to revert such an edit, rather adding the balanced opposing view to an article is good policy. Also Violetriga has abused the 3 revert rule here and also broken the policy of starting an edit war rather than discussion.Kreen

Your statement that "Violetriga has abused the 3 revert rule here" is false. According to the page history, Violetriga reverted your edit once. Do not make false accusations. — Matt Crypto 20:27, 4 Apr 2005 (UTC)

Kreen, if you are right you have to back up your claim. Stating that feeding in public should be allowed under European law, and that the UK law is "illegal", is original research unless you can support this. Protection will not help you; VioletRiga is an administrator, and you are not. This means that she can edit the article, and you cannot. I'd go for a request for comment if you're desperate. JFW | T@lk 20:28, 4 Apr 2005 (UTC)

sagging concerns

there's concerns of breast feeding to sagging. Though, the article doesn't mention it? Xah Lee 23:17, 2005 Apr 4 (UTC)

Could be a good topic to touch on in a "breastfeeding myths" section. It comes up freqently among mothers in conversation. Hormones like relaxin soften tissues during pregnancy, and engorgement happens when the milk comes in whether a mother breastfeeds or not. Genetics also plays a part.

Article disparity

I think this article should take into account the information presented in male lactation and breast. In particular the addition to ,or re-wording of, the initial paragraph that takes into account that 'breastfeeding' is a word that applies to the feeding of a baby with human milk and only strictly applies to the breast because that feeding is assumed to take place by women. I feel that the emphasis on breastfeeding relating strictly to the breasts as opposed to the act of feeding could be considered an anachonistic POV. --219.88.188.28 23:08, 1 Jun 2005 (UTC)

Indeed, more men should breastfeed. JFW | T@lk 00:55, 2 Jun 2005 (UTC)

Weaning should not redirect here

I find it rather irritating that weaning redirects here. The top of the breastfeeding article makes no mention of weaning. Weaning gets only a 2nd-level section, buried way down near the bottom. AlbertCahalan 04:42, 26 Jun 2005 (UTC)

Given the current content regarding weaning I think it's the best way, really. If you can think of how to make a worthwhile separate article, however, then go for it. violet/riga (t) 10:07, 26 Jun 2005 (UTC)

Marijuana NPOV

Does it seem to anyone else as if the paragraph on marijuana is hinting at defending the use of marijuana during pregnancy? unsigned comment by User:68.18.105.26.

Yes, nice catch. I've rewritten that paragraph to more accurately summarize what the AAP report said and remove original research or commentary. I've also added a cite to the research article the AAP report was based on in the References section. Nandesuka 19:35, 28 July 2005 (UTC)

supplemental nursing system

I just noticed today that there was no Wikipedia entry for Supplemental Nursing System, so I wrote a stub... anyone who would like to go add to it would be welcome. Also, as I wrote it up, I made reference to the advice available from a lactation consultant only to discover that there is no article on that topic yet. Would anyone be willing to get that started? Thanks in advance! Mamawrites 17:44, 25 August 2005 (UTC)

Circumcision

I am aware that this topic has been controversial in the past. However, I felt it necessary to make some minor changes to the article.

I removed the link to CIRP, on grounds that an advocacy site is not a reliable source.
I clarified that the study found this problem in cases of inadequate anaesthesia (as the study concluded). To generalise from it to circumcision in general is original research.

I hope that everyone will agree. - Jakew 13:37, August 27, 2005 (UTC)

Cirp.Org is unbiased. It even has your biased studies like that one out of Africa. I am certain that those men were sexually active while they healed. I am sure that they celebrated their præpucectomies by going to the bordello the night of they day they were mutilated. I among others pointed out the methodological flaws over a year ago and told them that destroying the controlgroup would make followup impossible. They did it anyway. ¿Do you believe that if the researchers would not have destroyed the controlgroup we would test everyone in study on 2006-01-01, eliminate all HIV-positive people people and then would retest the remainder of the participants on 2007-01-01, the difference between the two groups would be so extreme?

All of your studies are biased such as that study Wiswell (a foreskin is 125 dollars to me) did. Before you write it, this is what you call the Lexis-Theory. Well, I stand by it: Ob/Gyns mutilate the genitals of mothers and babies with unnecessary Episiotomies, Circumcisions, and Cæsarian Sections just so they can add the fees to the bill. That is why Ob/Gyns are sued so much. I would not let an Ob/Gyn near my wife; I would insist on a Midwife.

If you do not like Cirp.Org, ¿why do not you link to Circs.Org, the Cirp.Org-Clone you created? ¡Oh! ¡That is right! ¡Circs.Org is a joke! ¡None take it seriously because it only lists studies favorable to your side! Let us take Wiswell and UTIs as an example:

Wiswell did his so called study in the 1980s and published in 1987. He did his study in the US-Army. The military, in order to function, has to standardize, sometimes arbitrarily. The Doctors circumcised all boys except those who were underweight, sick, premature, and/or had congenital abnormalities of the urinary track. To top it all off, the sick babies were isolated from their mothers who could not give them their antibody-rich milk — none can say this thread is offtopic now. Army-doctors, in order to justify the standard Army-Circumcision later, would forcibly retract the præpuce for irritating it, so that they tell the parents that the præpuce is diseased and has to go. Frankly, the study was methodologically flawed.

Followup studies done with proper methodology consistently failed to find protective effects of circumcision against UTIs. Indeed, an Israeli study found the opposite. [20]

Unfortunately, this ignores little things like pain and suffering, the reduction in sexual pleasure, complications like meatal stenosis (over 10 times greater than the supposed benefits), or cost (using the finding of Wiswell, it takes about 198 circumcisions to prevent a single UTI, and given that treating a UTI with antibiotics costs about 100 dollars while a circumcision costs about 400 dollars, using Wiswells own numbers, circumsing is about 800 times more expensive than not circumcising).

Comparing Cirp.Org with Circs.Org on UTI, one finds that Circs.Org has 13 articles while Cirp.Org has Cirp.Org has 98. You only include articles in your favor because you know the bulk of the evidence is against you while we include everything because the bulk of the evidence is with us.

¿What do third parties have to say?:

Cirp.Org has endorsements from:

Healthyway™, Best of the Web
ParentWeb.Com, Select Parenting Site
Luckman 4 Star Award
Links2go Key Resource
BioMed Link
NetGuide Gold Site
LookSmart editor's choice
Listed in the British Medical

All of those thirdparties think highly of Cirp.Org.  ¿What do people think about Circs.Org?  Not one third party has endorsed Circs.Org.  Before I restore the link to the unbiased site which publishes both side because it knows the truth is on its side, let us compare Cirp.Org and Circs.Org on breastfeeding

Cirp.Org: 47 articles

Circs.Org: 0 articles

Circs.Org seems about as Fair and Balanced as FoxNews.Com, while Cirp.Org is full of articles published in peerreviewed Journals listing both the good and the bad because we know that the truth is on our side.

—

— Ŭalabio‽ 21:01:38, 2005-08-27 (UTC)

That a site has a lot of articles does not make it a reliable source, Walabio, except for the articles themselves. Their summary pages are definitely not reliable. Please see WP:RS and also Talk:Circumcision#CIRP_links. - Jakew 21:06, August 27, 2005 (UTC)

Editorial and the republished articles are clearly separated. Even peerreviewed journals have editorials, but they clearly separate it for the published studies. Cirp.Org does not try to be what it is not. The webmasters know that involuntary sexual mutilation of nonconsenting adults and all minors without medical necessity is wrong, but they also know that the truth is on their side. They publish everything. At talk:circumcision, we established that the republished reports are not changed and that if Cirp.Org fails to republish a paper, a gentle reminder will get it on the site quickly. ¿Can you say the same about Circs.Org? It is not like it would be hard for Circs.Org to be more comprehensive, since it gets most of its articles from Cirp.Org. If Cirp.Org is so biased, then ¿why does Cirp.Org have articles on it worthy of republish by Circs.Org? This brings up another point:

Cirp.Org does not hide that it is run by Intactivists. It just presents every study and lets people read the studies. Circs.Org pretends to be totally unbiased, while giving only the subset of studies most strongly supporting its position. Going back to the example of UTIs, Cirp.Org republishes 98 studies. Circs.Org republishes 13. I would not be surprised if at least 10 came from Cirp.Org. For our purposes, let us suppose that all 13 come from Cirp.Org. While pretending to be neutral. Circs.Org only republishes the one seventh of studies which support circumcision. That seems misleading to me.

You site Talk:Circumcision#CIRP_links. The conclusion was it is okay to use them. Even you could not find any signs of altering the republished articles. Anyone can verify this by creating a personal sandbox and saving the Cirp.Org-version and the version from another site and running a Dif.

—

— Ŭalabio‽ 22:51:51, 2005-08-27 (UTC)

Gentlemen, can we please keep the circumcision holy war from metastasizing into the Breastfeeding article? Whoever is wrong and whoever is right, you must be able to see that this is an awful lot of text to be spending on what, in context of breastfeeding, is little more than a footnote. My personal belief is that one sentence and one reference is entirely adequate to cover the entire issue; of the two references proposed, the nih.gov one is more clearly a reliable source. Nandesuka 22:29, 27 August 2005 (UTC)

Walabio, I disagree with several things you've written above, but as they are not relevant to breastfeeding, I will not respond here. If you wish, I will gladly discuss these issues over at Talk:Circumcision. I do not object to linking to (republished) articles at CIRP, only the editorials. Please look carefully at what I removed from this page - it was an editorial.

This particular editorial cites only two studies in support of their assertion that circumcision affects breastfeeding. One (by Marshall et al.) doesn't actually mention breastfeeding, and the other (by Howard et al.) we cite. What, exactly, is the problem? - Jakew 10:13, August 28, 2005 (UTC)

¿What is wrong? is wellpoisoning. I established here that the republished articles on Cirp.Org are reliable and that Cirp.Org is much more neutral and complete than Circs.Org. Circumcision vs. Child Health, Breastfeeding and Maternal Bonding is a metapage, not an editorial. ¿What is the problem? If you prefer, I could directly link Breastfeeding to a few dozen of those articles and nix the link to the metapage. ¿Would you prefer a few dozen links from Breastfeeding to Cirp.Org instead of one link? Understandably, more data would be useful:

La Leche League International flat out refuses to help us study this or for that matter refuses to educate expectant mothers with what it knows already. Some religiously motivated women block education and research about circumcision at la Leche League International.

—

— Ŭalabio‽ 20:16:06, 2005-08-28 (UTC)

It contains content that is original to CIRP, Walabio. If it were just an index of pages, I wouldn't object to it so much.

If you would like to add any peer-reviewed studies directly addressing breastfeeding and circumcision, please go ahead. I don't mind if they are at CIRP now, as long as they have previously been published in a peer-reviewed scientific journal. Please stick to primary sources.

Since Circs.org doesn't contain anything related to breastfeeding, and I haven't proposed linking to it, I don't understand why you keep referring to it.

- Jakew 21:03, August 28, 2005 (UTC)

For goodness' sake, I've removed the Howard reference. There are many problems with the whole issue, and I think a small study of 44 infants which looked only into paracetamol (as opposed to e.g. prilocaine) and only addressed Gomco clamp circumcions is not really encyclopedia material. The findings cannot possibly be extended to daily practice. In my personal experience, I've never seen an infant breastfeed as good as in the hours after a non-anaesthetised circumcision! JFW | T@lk 21:27, 28 August 2005 (UTC)

Oh, anyone for sucrose (PMID 15266438)? JFW | T@lk 21:27, 28 August 2005 (UTC)

The article states that the pain of sexual mutilation is to extreme. Let me use an analogy:

When donating blood, one looks away and thinks about something else.  ¿Is looking away and thinking about something else sufficient for surgery, or does one need anæsthesia?

Your personal experience with Jewish religious circumcision on the eighth day after a successful pattern of breastfeeding has been established does not translate well to the experience of boys who are circumcised in the hospital before a successful pattern of breastfeeding has been established. Please see the letter by Linda Caplan. -- DanBlackham 03:06, 29 August 2005 (UTC)

What makes you think this concerns Jewish circumcision and an established breastfeeding routine? JFW | T@lk 07:58, 29 August 2005 (UTC)

Linda Caplan, RN, IBCLC wrote, "I agree with Nikki Lee (2000;16:295) that baby boys are at lower risk for breastfeeding difficulties when circumcision is delayed and breastfeeding is more established. Case in point: my own three sons were all circumcised at home at 8 days at the traditional Brith Milah. Breastfeeding was well established, my milk supply was ample, and the babies had a full week to perfect their skills. As soon as the mohel was finished, the baby was whisked back to mom's breast for a comforting feed, with no problems at all! This is so unlike what I observe in the hospital again and again, with babies shocked into a stupor, some having not yet even suckled well, milk volume not yet increased, and mom not yet experienced with feeding." -- DanBlackham 09:54, 29 August 2005 (UTC)

Many lactation consultants are aware of the fact that infant circumcision may be a factor in breastfeeding failure.[1] Boys who are circumcised in the hospital before a successful pattern of breastfeeding has been established are at greater risk for breastfeeding failure than boys who are circumcised several days after birth when a successful pattern of breastfeeding has been established.[2] In their book Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum Mary Kroeger and Linda J. Smith discuss circumcision as a possible cause for breastfeeding failure.[3]

Anesthesia used during the surgery does not reduce the post-operative pain caused by pressure on the circumcision wound during breastfeeding.  If a lactation consultant is aware that pain from the circumcision wound may be a factor in a boy refusing to breastfeed, she can suggest ways for the mother to hold her son to reduce the pressure on the circumcision wound.

The article on the CIRP web site contains information that is relevant to the breastfeeding article including a list of 52 references related to circumcision and breastfeeding.

1. Lee N. Circumcision and Breastfeeding. [Letter] J Hum Lact 2000;16(4):295. http://cirp.org/library/birth/lee1/

2. Caplan L. Circumcision and breastfeeding: a response to Nikki Lee's letter. [Letter] J Hum Lact 2001;17(1):7. http://www.cirp.org/library/birth/caplan1/

3. Mary Kroeger with Linda J. Smith. Impact of Birthing Practices on Breastfeeding: Protecting the Mother and Baby Continuum. Sudbury, Massachusetts: Jones and Bartlett Publishers, 2003: pp. 197-8. (ISBN 0-7637-2481-5). http://www.cirp.org/library/birth/kroeger1/

DanBlackham 02:54, 29 August 2005 (UTC)

Dan, please read my response to Violet below. JFW | T@lk 07:58, 29 August 2005 (UTC)

Dan, most of those references are general information about breastfeeding, and do not address circumcision directly. You've cited three letters, giving no objective data. One of them cites the Howard article mentioned above. These are hardly noteworthy, and certainly not encyclopaedic. If you can find some objective studies, rather than opinion pieces, please list them. - Jakew 09:50, August 29, 2005 (UTC)

No Jake, I cited two letters by International Board Certified Lactation Consultants which were published in the Journal of Human Lactation and a quote from the book by Mary Kroeger and Linda J. Smith who are recognized experts in the field of breastfeeding.  The book by Kroeger and Smith is an important reference book for lactation consultants. The quote from Kroeger and Smith's book is definitely noteworthy because they are recognized experts in the field of human lactation. -- DanBlackham 10:18, 29 August 2005 (UTC)

My apologies. Two letters providing no new data plus an extract from a book providing no new data. Jakew 10:29, August 29, 2005 (UTC)

The letters and the quote from the book support the fact that infant circumcision may be a factor in breast refusal. -- DanBlackham 10:45, 29 August 2005 (UTC)

They do provide circumstantial support for the hypothesis, yes, Dan. But how many letters were actually published on the subject, I wonder. The problem with anecdotal evidence is that it is fundamentally subjective, and often misleading. When assessing it, it's wise to be aware of the fallacy of the striking instance (superficially, "I walked across the road and got hit by a bus" supports the hypothesis that every time you cross the road you will be involved in an accident. Only empirical data can address the matter objectively, though common sense reasoning and reductio ad absurdum are a good substitute).

By the way, take a look at appeal to authority. - Jakew 11:00, August 29, 2005 (UTC)

Surely we can agree that medical procedures have some impact on the feeding habits of a newborn? Giving circumcision as an example is acceptable seeing as it is the most common medical procedure. Going in-depth would be wrong, but saying "such as circumcision" is not too bad. violet/riga (t) 11:05, 29 August 2005 (UTC)

It's certainly possible, but it isn't an established fact. As you can see, I originally reworded it to say "such as circumcision with ineffective anaesthesia", which was supported by the link. I don't strongly object to including circumcision with that qualification, though I think it is unnecessary - after all, it is blindingly obvious that circumcision is a medical procedure. However, as Jfd and one of the letters noted, it may be necessary to craft a further exception for circumcisions performed later on. These caveats, combined with the fact that the evidence is so tentative, suggest that perhaps the article would be better off without. - Jakew 11:16, August 29, 2005 (UTC)

The qualification you added is misleading because anesthesia used during the surgery does not reduce the post-operative pain caused by pressure on the circumcision wound during breastfeeding. It is the discomfort from pressure on the circumcision wound that may cause breast refusal. -- DanBlackham 09:29, 30 August 2005 (UTC)

Interesting hypothesis. Any evidence supporting it? - Jakew 09:50, August 30, 2005 (UTC)

My opinion

The article explicitly states that "Pain or discomfort; for example, due to recent surgery or medical procedures" can be a cause of breast refusal.  It does not state that there is a direct link whereby all newborns having a medical procedure will have feeding difficulties.  Circumcision can cause problems, mainly discomfort, and that can lead to feeding troubles.

I'm sure that some of you have checked the archive about this, but the inclusion of any mention of circumcision was based on a compromise.  The article used to have a much bigger chunk of text about the two things, but that was certainly not appropriate.  I personally don't think it needs a mention over and above it being hinted at with "recent surgery or medical procedures", but to maintain the previous peace I lean towards keeping a small reference to it.

I don't want this to fall into the trap of being decided by a poll, so please do continue the discussion, and don't edit war in the article.  violet/riga (t) 07:14, 29 August 2005 (UTC)

Circumcision falls under "recent surgery". Mentioning it seperately, as distinct from the repear of duodenal atresia, resection for necrosing enterocolitis, open closure of a patent ductus arteriosus, orchidopexy etc etc sounds to me like undue coverage just because there are anti-circ activists on Wikipedia. JFW | T@lk 07:58, 29 August 2005 (UTC)

You might have a point if infant circumcision in the United States were as uncommon as it is in Europe. However in the United States infant circumcision is the most common form of surgery performed on infants. Approximately half of all boys born in the United States are circumcised before they are discharged from the hospital after birth. Boys who are circumcised in the hospital before a regular pattern of breastfeeding has been established have a greater risk for breastfeeding failure than boys who are circumcised after a regular pattern of breastfeeding has been established and boys who are not circumcised.

Circumcision should be specifically mentioned in the article because it is by far the most common form of surgery performed on infants in the United States. The level of coverage of circumcision in the article before the recent changes was appropriate. -- DanBlackham 09:44, 29 August 2005 (UTC)

I don't think that anyone will disagree on grounds of prevalence, Dan. However, relevance is questionable. The evidence for the purported link is one small-scale study using Tylenol (aka paracetamol for those of us in the UK) plus two opinion pieces in letter form and a book noting the study previously mentioned. In contrast, consider the evidence for other statements in the article. As an example, consider the statement that breastfeeding helps prevent diabetes. Searching PubMed for "breastfeeding diabetes" returns 212 articles (not all relevant, of course, but what a difference)! - Jakew 11:09, August 29, 2005 (UTC)

I am not opposed to the "such as circumcision" reference; it seems that the recent bout of edit-warring was in fact centered around Jake's fairly conservative link-tweaking. His edit removed the link to the advocacy site, cirp.org (can I call it an advocacy site without upsetting people?), but left in a link to the actual study at nih.gov. I think the follow-on edit war was a result of people getting sick of the issue. I suspect that Jfdwolff's surgical removal of the entire reference (pun intended) was mostly due to frustration at seeing the amount of bickering that was going on over what is essentially, in the context of this article, a mostly unimportant sideshow. My personal opinion is that the "right" balance is for circumcision to be mentioned, and the nih.gov link to be provided as a reliable, neutral, non-advocate source. But, frankly, if the various parties involved here can't get themselves under control and insist on making the article about breastfeeding a proxy war for their own personal feelings about male genitalia, I am not above forcing the issue by removing the mention and reference entirely until the warring editors have settled their differences and both share the exact same position on male circumscision, sometime after the heat-death of the universe. Nandesuka 12:31, 29 August 2005 (UTC)

LOL your psychoanalysis of us all. I removed it because it was a distraction. I suggest the proposal below is followed. JFW | T@lk 21:24, 29 August 2005 (UTC)

JFW, you listed several other surgeries performed on infants. What percentage of infants born in the United States has those surgeries during the first or second day of their life? -- DanBlackham 09:37, 30 August 2005 (UTC)

I for one am fairly sick of activists trying to push their agendas in barely relevant articles. In my view, it doesn't belong here, as it is already covered by "recent surgery". This article should be left to La Leche and infant formula activists, so that they can have relevant edit wars. Jayjg ^(talk) 22:14, 29 August 2005 (UTC)

The information that infant circumcision may be a factor in breast refusal is both important and relevant to the article on breastfeeding. It is pro-circumcision activists who are pushing their POV by deleting relevant information from the article. -- DanBlackham 09:38, 30 August 2005 (UTC)

Such information is already provided in the form of "Pain or discomfort; for example, due to recent surgery or medical procedures". A true pro-circumcision activist POV-pusher would want to delete that. The only purpose served by mentioning circumcision explicitly is to promote the anti-circumcision agenda.

Consider a hypothetical Pepsi employeee editing an article on avoiding dehydration. "Drinking water or soft drinks regularly helps avoid dehydration" includes Pepsi. However, he wants to promote Pepsi, so he edits it to read "Drinking water or soft drinks (eg., Pepsi Cola or all-new Caffeine-Free Diet Pepsi) regularly helps avoid dehydration." Another editor removes this. Is it because he is an anti-Pepsi activist, or because it makes the encyclopaedia worse? - Jakew 12:00, August 30, 2005 (UTC)

It is important to mention circumcision in the section on breast refusal because circumcision is by far the most common form of surgery perform on infants during the first few days of life in the United States. Some contributors to this discussion with a pro-circumcision POV want to delete any mention of circumcision from the section on breast refusal. The only purpose served by deleting the reference to circumcision is to protect a cultural and religious practice from the unpleasant, but relevant, fact that infant circumcision may be a factor in breast refusal. -- DanBlackham 07:47, 31 August 2005 (UTC)

So you would support our Pepsi employee saying "It is important to mention Pepsi because it is by far the most common soft drink"? - Jakew 11:11, August 31, 2005 (UTC)

A more relevant hypothetical scenario would be if an article on caffeine said, "Caffeinated beverages, including caffeinated soda, may cause health problems in children" and a Pepsi salesman removed "including caffeinated soda" because he did not want anything to reflect negatively on his product. -- DanBlackham 21:33, 7 September 2005 (UTC)

Your hypothetical scenario is entertaining, but it is not relevant to the discussion of infant circumcision as a factor in breast refusal. -- DanBlackham 23:02, 4 September 2005 (UTC)

I've been lurking here for a bit... Thought I'd add my $0.02... I am against routine infant circumcision. Let me first get that out on the table so no one can accuse me of having a pro-circ bias. However, I think Jakew's analogy is very apt. When a category is listed, to then point out one specific item in that category is to emphasize that one. Unless there is good reason to emphasize that particular item, it shouldn't be specifically pointed out. I'm open to hearing suggestions as to why circumcision does merit emphasis above other forms of surgery (I'll throw two out onto the table right now for anyone who wants to debate them:1) to remind people that circumcision is indeed surgery, when it's prevalence leads to some people thinking that it's status as a surgical procedure is a mere technicality and 2) it's the most commonly performed surgical procedure, so if any specific procedure is mentioned it makes sense that this would be the one), but until and unless some sort of consensus is reached, it should be assumed to already be covered in the general category of "recent surgeries". --Icarus 03:25, 5 September 2005 (UTC)

I agree. Circumcision should be mentioned for the reasons you cited: (1) many people do not think of circumcision as surgery and (2) it is the most common surgery performed on infants. Circumcision should also be mentioned because it is an elective, non-therapeutic procedure that can easily be delayed until after a successful pattern of breastfeeding has been established. -- DanBlackham 21:23, 7 September 2005 (UTC)

A good reason exists for singling out sexual genital mutilation:

Not only is it a painful medical procedure, it is both totally unnecessary and harmful Indeed, since it is both medically unnecessary and harmful, it is not a medical procedure at all, but a barbaric ritual. If the fad pseudomedical procedure would be earamputation , the article would be right to single it out as not only bad for breastfeeding, but also unnecessary, wrong, to be avoided, et cetera. — — Ŭalabio‽ 04:14:06, 2005-09-05 (UTC)

Please recall that Wikipedia is not a soapbox. Jayjg ^(talk) 04:30, 5 September 2005 (UTC)

I just state things the way they are.

—

— Ŭalabio‽ 05:06:49, 2005-09-05 (UTC)

Sigh. I am getting sick and tired of this.

Why is it that there is this ongoing battle? Why can people not understand that this, Wikipedia, is an encyclopaedia, not a platform for their views? Why can people not grasp the simple concept that fact is different from opinion, and that we are supposed to write from a neutral point of view, putting aside their own?

Nothing whatsoever is stopping you from forking Wikipedia and creating your own encyclopaedia with a different editorial policy. Intactivpedia could have a stated policy that circumcision ought to be mentioned in every single article, from serial killer to jet engine, along with a forceful statement about how awful it all is. Go ahead.

But this is Wikipedia, not Intactivpedia. For goodness sake, will you just read the damn policies and try to abide by them? - Jakew 10:01, September 5, 2005 (UTC)

Proposal to move discussion

To avoid boring those uninterested in the circumcision topic, I propose to move the preceding discussion to Talk:Breastfeeding/circumcision. Comments? - Jakew 09:55, August 29, 2005 (UTC)

This talk page is the appropriate place for the discussion. I am opposed to moving it anywhere else. -- DanBlackham 10:23, 29 August 2005 (UTC)

Proposed rewrite

I believe I have a way to rewrite the paragraph:

Painful medical procedures can interfere with establishment of breastfeeding. [21] Therefore one should therefore use anæsthesia for necessary medical procedures, and avoid all unnecessary procedures, whether medical or not, such as branding, circumcision, piercing, tatooing, et cetera. The unnecessary procedure of circumcision is especially to be avoided because not only does does the unnecessary procedure of circumcision cause unjustifiable torturous pain, but in order to latch properly, the baby must place his genitals against his mother, causing excruciating pain just as the baby starts feeding.

It seems like this version above says it all.  It is accurate.  I belive we should add it to the article.

—

— Ŭalabio‽ 04:51:50, 2005-08-30 (UTC)

LOL! Please review WP:NPOV. Jayjg ^(talk) 04:57, 30 August 2005 (UTC)

Seconded. It's a shame there isn't an NPOV exam... - Jakew 09:50, August 30, 2005 (UTC)

I don't want to be involved in the lawsuit for dispensing bad medical advice (such as "give an infant anaesthesia for all medical procedures"). And thirded Jayjg's point. Nandesuka 11:38, 30 August 2005 (UTC)

You know perfectly well that I meant painful medical procedures. I know that the paragraph needs wordsmithing. ¿Does anyone argue that branding, circumcision, tattooing, piercing, et cetera are medically necessary for the average healthy babies?

I'm having trouble believing that you're actually serious, but...

Painful medical procedures can interfere with establishment of breastfeeding. so far so good

[22] not a WP:RS reliable source (discussed above)

Therefore one should is a WP:NPOV POV. since the rest of the sentence is predicated on acceptance of this POV, it is unacceptable. Nevertheless, let's continue...

therefore use anæsthesia for necessary medical procedures (except when contraindicated)

and avoid all unnecessary procedures (unless, of course, they are beneficial)

whether medical or not, such as branding, circumcision, piercing, tatooing, et cetera. vaccinations, heel pricking...

The unnecessary procedure of circumcision is especially to be avoided because not only does does the unnecessary procedure of circumcision cause unjustifiable torturous pain (unjustifiable is POV, torturous is POV)

but in order to latch properly, the baby must place his genitals against his mother, causing excruciating pain just as the baby starts feeding. (speculative, WP:NOR) - Jakew 11:09, August 31, 2005 (UTC)

Proposal Intactivists and Circumcisionactivists to voluntarily withdraw to just talk:breastfeeding, leaving the editing of breastfeeding to its regular contributers

I cannot speak for anyone but myself, but if the circumcisionadvocates will leave the main article alone, so shall I.  Michael Glass did some excellent wordsmithing of the introduction, so I would like an exception for all sections not involving, pain and medical procedures.  As a sign of goodfaith, I shall withdraw to the talkpage firstly.  I ask that you look at my proposed rewrite when you rewrite the section (it still needs wordsmithing).  I shall now voluntarily withdraw to just the talkpage.  I shall not edit the sections about pain and medical procedures unless circumcisionadvocates force mine hand.

— Ŭalabio‽ 21:36:10, 2005-08-30 (UTC)

Simpler language

I have noted that 'Breastfeeding' is a featured article. Therefore I hesitate to make changes. However, I feel that it would be better with simpler wording.

For example: the opening paragraphs could read as follows:

Breastfeeding is when a woman feeds an infant (or sometimes a toddler or a young child) with milk produced from her breasts, usually directly from the nipples. Babies have a sucking instinct that enables them to take in the milk.

While many mothers breastfeed their children, some do not, either for personal or medical reasons. Breast milk has been shown to be the best nourishment for a child. As with other bodily fluids, some diseases, such as HIV and HTLV-1 can be passed through breast milk and some medications may also transfer in this way. However, most medications are transferred in very small amounts and are considered safe to take during breastfeeding.

Many governmental strategies and international initiatives have promoted breastfeeding as the best method of feeding a child in its first year – this supports recommendations by the World Health Organization (WHO) and the American Academy of Pediatrics (AAP) amongst others.

The idea of such changes is not to introduce bias or spin, but to make the article easier to read. This is helpful to everyone. What do others think? Michael Glass 10:51, 29 August 2005 (UTC)

There doesn't seem to be too many changes there, and so I don't really have a particular problem with most of the changes. The one objection I would have, however, is that breastfeeding is not just about nutrition and is the most "beneficial feeding method", not just "the best nourishment". violet/riga (t) 10:59, 29 August 2005 (UTC)

OK. I'll make the changes with that amendment. Michael Glass 13:02, 29 August 2005 (UTC)

I hope the further changes that I have made help to clarify the meaning of the passages concerned and simplify the wording. I believe we should always strive to write as simply and clearly as possible. Michael Glass 14:32, 29 August 2005 (UTC)

Evidence on the effect of Circumcision on Breastfeeding

I believe the following links have evidence that should be considered:

1 AAP Policy Statement - The Assessment and management of Acute Pain in Infants, Children and Adolescents This says:

Some common painful minor procedures, such as circumcision, do not always receive the warranted attention to comfort issues. Available research indicates that newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward.9-11 Opportunities for alleviating pain exist before, during, and after the procedure, and many interventions are effective.12-17

2 The following comments from the Journal of Human Lactation are also worth pondering:

I have noticed that boys who are circumcised before breastfeeding has been established have more problems with breastfeeding. Conversely, boys who are recovering from a traumatic birth but are left intact have fewer breastfeeding difficulties. Could we recommend that circumcision be delayed in cases of traumatic birth until the boy is feeding well? What do readers think?

Nikki Lee, RN [23]

I agree with Nikki Lee (2000;16:295) that baby boys are at lower risk for breastfeeding difficulties when circumcision is delayed and breastfeeding is more established. Case in point: my own three sons were all circumcised at home at 8 days at the traditional Brith Milah. Breastfeeding was well established, my milk supply was ample, and the babies had a full week to perfect their skills. As soon as the mohel was finished, the baby was whisked back to mom's breast for a comforting feed, with no problems at all! This is so unlike what I observe in the hospital again and again, with babies shocked into a stupor, some having not yet even suckled well, milk volume not yet increased, and mom not yet experienced with feeding.

Linda Caplan, RN, [24]

3 A randomised, controlled study of pain relief for circumcision had this to say:

Objective. Recognizing the concerns about the use of local anesthesia in neonatal circumcision, a painful procedure usually performed without analgesia or anesthesia, we undertook a study of acetaminophen for pain management of this procedure.

Design. A prospective, randomized, double blind, placebo-controlled, clinical trial of acetaminophen analgesia in 44 healthy full term neonates undergoing circumcision was conducted. Beginning two hours before Gomco circumcision, neonates received either acetaminophen (15 mg/kg per dose, 0.15 mL/kg per dose) or placebo (0.15 mL/kg per dose) every six hours for 24 hours. Neonates were monitored intraoperatively for changes in heart rate, respiratory rate, and crying time. Postoperative pain was assessed at 30, 60, 90, 120, 360 minutes and 24 hours using a standardized postoperative comfort scoring system. Feeding behavior was also assessed before and after circumcision by nursing observation.

Results. Neonates in both groups showed significant increases in heart rate, respiratory rate, and crying during circumcision with no clinically significant differences between the groups. Postoperative comfort scores showed no significant differences between the groups until the 360-minute postoperative assessment, at which time the acetaminophen group had significantly improved scores. (P<.05). Feeding behavior deteriorated in breast- and bottle-fed infants in both groups, and acetaminophen did not seem to influence this deterioration.

Conclusions. This study confirms that circumcision of the newborn causes severe and persistent pain. Acetaminophen was not found to ameliorate either the intra-operative or the immediate postoperative pain of circumcision, although it seems that it may provide some benefit after the postoperative period. Pediatrics 1994;93:641-646; [25]

With evidence such as this it is not surprising that the Breastfeeding Answeer Book contains statements like this:

When a baby undergoes a painful medical procedure, such as a heel stick, injection, spinal tap, or circumcision, he may shut down and be unreceptive to feedings until he is feeling better. Vigorous suctioning of a baby's mouth can also cause a sore throat and injured vocal cords, which can cause a baby to reject anything by mouth for a time.

Research indicates, however, that if a baby is breastfed during a painful procedure, such as a heel stick, that breastfeeding is "a potent analgesic" that essentially eliminates the symptoms of pain, such as crying and grimacing, and prevents a marked rise in heart rate (Gray 2002). Previous research has found that three components of a potent reliever [sic] for the newborn are: skin-to-skin contact, suckling, and a sweet taste (Gray 2000). Breastfeeding provides all three. [26]

In the light of all this I think it is in order to include a carefully worded statement in the article on breastfeeding about the likely disruptive effect of circumcision on breastfeeding, and suggesting ways to ameliorate the situation. Michael Glass 13:54, 31 August 2005 (UTC)

We've already been over this, Michael. See above. - Jakew 14:42, August 31, 2005 (UTC)

You're right, except that whole thread seemed to be a pack of red herrings, with far too much heat and not nearly enough light. What I was hoping to do was to find reasonably objective and balanced evidence and then write something reasonable, balanced and NPOV on the question that would be broadly acceptable to reasonable people, whatever their views on infant circumcision. Although this endeavour might appear to be quixotic, I have a feeling we might be able to bring it off. Michael Glass 01:06, 1 September 2005 (UTC)

Already covered. Please take circumcision related activism back to the circumcision pages. Jayjg ^(talk) 04:53, 1 September 2005 (UTC)

I would like to make two points:

All of this is here on the talkpage as a courtesy to the editors. Michael Glass has left the agreed-upon sections alone. This is more concise than the above section for the editors. This does no harm. It is complete with references. One could just cut and paste directly into the article; while the above section is more of a debate.
Pot meet kettle. You are a circumcisionadvocate Confucius once commented that those in glasshouses should not throw stones, less others throw stones back.

—

— Ŭalabio‽ 06:50:56, 2005-09-01 (UTC)

Walabio, please focus on article content, and please avoid making unfounded and demonstrably false personal attacks. Jayjg ^(talk) 06:56, 1 September 2005 (UTC)

Agree with Jay. Furthermore, the above is completely inappropriate for inclusion in the article as-is. Not only is it in a different form, but there are approx. ten paragraphs of it! This is way, way out of proportion.

Michael, we have actually discussed most, if not all, of this evidence already. I would suggest that if you want to reach an agreement, I would tentatively suggest that dismissing what has already been said and essentially repeating what was said in the first place might not be the best approach. - Jakew 09:10, September 1, 2005 (UTC)

Because of the adverse impact of infant circumcision on successful breastfeeding of boys circumcised in the hospital soon after birth a case can made that more than a passing reference to infant circumcision should be included in the section on breast refusal. I agree that ten paragraphs would be too much, but the passing reference in the article before the recent changes may have been too little. -- DanBlackham 00:47, 2 September 2005 (UTC)

Dan, we have 1) a policy statement citing other evidence, 2) two letter-length opinion pieces, 3) a small study concluding that the anaesthesia used was inadequate and suggesting research with more appropriate anaesthesia, and 4) another opinion piece. This is inadequate for even asserting that such an adverse impact exists! At most, a passing reference is warranted, but nothing more. - Jakew 10:24, September 2, 2005 (UTC)

Responding to your points: (1) The AAP policy statement on pain management does not cite evidence that disproves that infant circumcision may be a factor in breast refusal. (2) The two "letter-length opinion pieces" are letters from International Board Certified Lactation Consultants published in the Journal of Human Lactation. (4) It seems rather odd that you would refer to a quote from the The Breastfeeding Answer Book published by La Leche League International as "another opinion piece". The Breastfeeding Answer Book is a reference book in the field of breastfeeding. It is definitely not just "another opinion piece". -- DanBlackham 21:17, 7 September 2005 (UTC)

1) True enough. 2) I couldn't care less if the letters are stone tablets personally carved by God. They are still opinion pieces. Journals publish letters all the time, typically from professionals in their field. That does not make them absolute fact. 4) Just because it is a book does not magically stop it being an opinion. It is, specifically, Nancy Mohrbacher's opinion. I can't help noticing that it is not included in the references. - Jakew 11:35, September 8, 2005 (UTC)

Jayjg, please follow your own advice and take your pro-circumcision activism back to the circumcision pages. The current controversy began when a pro-circumcision activist started pushing his pro-circumcision agenda. -- DanBlackham 00:14, 2 September 2005 (UTC)

I suggest that you read Wikipedia:No personal attacks - Jakew 10:24, September 2, 2005 (UTC)

Without wishing to spoil the bunfight over circumcision, I would like to get back to the effect of circumcision on the establishment of breastfeeding. I believe that something like the following could be inserted into the article.

There is some evidence that if a baby is circumcised without pain relief before breastfeeding is firmly established, this can disrupt the breastfeeding process. [27] [28] This may be ameliorated by delaying the circumcision until a week after the birth, as in a traditional Jewish circumcision [29]. It should also be noted that breastfeeding can itself have a calming and analgesic effect on babies who are undergoing painful procedures [30].

I believe that this statement is a fair summary of the evidence that I have seen. I would be interested in others' opinions about it. Michael Glass 06:27, 4 September 2005 (UTC)

Two problems, Michael:

It interferes with the flow of the article, and the style is inconsistent with that already there. There are currently nine single sentences describing causes of failure. None have links. Introducing a whole link-heavy paragraph is inconsistent.
It is redundant. We already have "Pain or discomfort; for example, due to recent surgery or medical procedures" in the article. Circumcision clearly falls into these categories. Read my Pepsi scenario above. If any mention of circumcision is justified (which is frankly dubious), it should be as a short parenthetical example. - Jakew 11:11, September 4, 2005 (UTC)

Your Pepsi scenario is entertaining, but it is not relevant. -- 16:41, 4 September 2005 (UTC)

On the contrary, it is highly relevant, because, like this, it is a case of making an unnecessary and redundant example simply to promote an agenda. - Jakew 17:51, September 4, 2005 (UTC)

Exactly. Jayjg ^(talk) 04:27, 5 September 2005 (UTC)

Thanks for your feedback, Jake. Here are my responses:

Flow: Most of the article is written in paragraphs and only a few parts are written in dot points. I believe that the paragraph I proposed could be inserted without interrupting the flow of the article.
Style: If you have problems with the style of what I have written I would welcome your suggested amendments. However, I am puzzled that you should find its style a problem. Perhaps you could elaborate on this point.
Links: I agree that the rest of the article has very few links. However, I would see this as a defect to be remedied rather than a point of style to be copied. In any case, it is appropriate that any point made about circumcision should be very carefully documented because it is such a contentious area. Also, though it is heavily linked, it is done with numbers which shouldn't cause too much of a problem for the average reader. If, however, you believe that linked words would serve the article better, that would be fine with me. Please comment.
Redundancy: The reference to 'recent surgery or medical procedures' in the article is not clear. For instance, it wouldn't occur to me to think of circumcision when reading such a reference. This could be remedied by a passing reference to circumcision. However, this would generalise the criticism of circumcision to all such procedures when the evidence documents the disruptive effect of circumcision on those who were circumcised before breast feeding had been firmly established.
Lack of Necessity: I can understand that you may feel that a reference to circumcision is not necessary. However, as a husband and father I know from experience that a woman who is breastfeeding can need a great deal of support and understanding. Disruptions to the process of breastfeeding need to be minimised.

The above were simply responses to what you have written. However, there are other points that should be made.

Critical comments on circumcisions done on babies before breastfeeding is properly established should not be taken as a criticism of circumcision as a whole. One of the links, remember, was of Linda Caplan, who had three sons ritually circumcised on the eighth day [31]. Her comments, critical though they were of the timing of hospital circumcisions, could hardly be construed as an attack on circumcision as a whole.
It is one thing to support circumcision and quite another to feel that one has to support every custom that surrounds this practice. Examples that spring to mind include circumcisions performed in unsanitary conditions, and dangerout traditional practices such as using the mouth to suck the blood from the circumcision wound.
All in all, Jake, I believe that the wording that I proposed can form the basis of a moderately worded comment on the disruptive effect circumcision can have when it takes place before breastfeeding has been firmly established. I believe that the evidence justifies such a reference. Michael Glass 12:16, 5 September 2005 (UTC)

It seems to me that if anything is to be included, one or two sentence summarising the AAP's above statement would probably be the most suitable. Having considered the matter, and given that the AAP cite suitable sources themselves, I see little need to cite any other sources. Perhaps we could try to find some appropriate wording? - Jakew 19:03, September 6, 2005 (UTC)

I will insert a quotation from the AAP on pain management, together with a reference to the Jewish and Gentile lactation consultants. I hope that this will satisfy most people that the issue has been dealt with fairly. Michael Glass 13:52, 7 September 2005 (UTC)

I've removed the letters. The AAP should be good enough. We don't need to clutter the article with opinion pieces. - Jakew 15:02, September 7, 2005 (UTC)

Opinion pieces! Jayjg ^(talk) 20:40, 7 September 2005 (UTC)

The letters are from International Board Certified Lactation Consultants and were published in the Journal of Human Lactation. -- DanBlackham 21:10, 7 September 2005 (UTC)

Is this what passes for scientific studies these days? Jayjg ^(talk) 21:44, 7 September 2005 (UTC)

Why is there an AAP citation about medical procedures and not about infant colic (extremely common, very difficult to deal with), inebriation of the mother (sadly only too common), sore bottom from diarrhoea (not uncommon) and other things? I think that unless this becomes more balanced, the AAP cite doesn't actually add anything. It's blooming common sense that pain requires analgesia (although I still need to tell too many of my patients that their pain will not go away until they actually take their painkillers). I'd say it should stay out, actually. JFW | T@lk 21:37, 7 September 2005 (UTC)

Agreed. Jayjg ^(talk) 21:44, 7 September 2005 (UTC)

No objection to its removal. -Jakew 11:35, September 8, 2005 (UTC)

The important point is that infant circumcision performed before a successful pattern of breastfeeding has been established increases the risk of breast refusal. JFW, earlier you listed several other surgeries in addition to circumcision performed on infants. What percentage of infants born in the United States has those surgeries during the first or second day of their life? -- DanBlackham 23:14, 7 September 2005 (UTC)

From The Womanly Art of Breastfeeding. 3rd edition. La Leche League International. Franklin Park, IL. 1981. pages 92-93

"ELECTIVE SURGERY FOR YOU OR BABY If you are going to be in the hospital anyway for the birth of your baby, you or your doctor may suggest that you have some other medical matter attended to. Examples of elective surgery for the mother include stripping the legs of varicose veins or typing the fallopian tubes (tubal ligation). As for the baby, it may be considered almost routine to circumcise boy babies when they are only a few hours or days old. But circumcision is elective surgery and you have a choice of whether or not to have your baby circumcised. You can also choose to wait a while before having this done. We bring these subjects up because, physically and emotionally, these procedures all take their toll on mother and child. Since they represent elective surgery, their appropriateness at this critical time must be questioned."

DanBlackham 23:22, 7 September 2005 (UTC)

Another opinion piece! - Jakew 11:35, September 8, 2005 (UTC)

No Jake, The Womanly Art of Breastfeeding published by La Leche League International is an authoritative reference on breastfeeding, not just "another opinion piece" as you call it. -- DanBlackham 07:46, 22 September 2005 (UTC)

Opinion Piece

I am interested to note the use of the term opinion piece. It seems to be a very convenient way of branding, discounting and discarding invonvenient evidence. For instance, when two lactation consultants say that very early circumcision has a disruptive effect on the establishment of breast feeding [32] [33], all you have to do is say opinion piece! press the delete button, and presto! there's an edit that claims to be as NPOV as can be.

In this case, I find the two word argument rather light on reason and logic. I would be grateful if those who have used this term would explain how the opinion of two lactation consultants can be discounted almost without argument.

Could it have anything to do with the fact that they are women?
Could it have anything to do with the fact that they question a common medical practice?
Do those who have argued in favour of this edit have any particular axe to grind on breastfeeding or circumcision?

I would suggest that the letters of the two lactation consultants should be given some weight because:

They are consistent with the AAP's statement: Available research indicates that newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward.
Because both women are lactation consultants their opinion carries some weight.
As one of the women is Jewish, her opinion cannot be discounted as anti-circ prejudice.
As neither woman argued against circumcision it is hard to discount either opinion as anti-circ prejudice.

Of course it is possible that there are other factors that we should consider. If so, I would be interested to be informed of them. Michael Glass 14:05, 8 September 2005 (UTC)

Michael, are you familiar with the forms of evidence, and their relative merits?

Both of the letters are anecdotal evidence, which is the least valuable.

Appeal to authority is a logical fallacy. Anecdotal evidence from a "lactation consultant" (I'm sorry; I couldn't keep a straight face using the term "urination consultant", either) is anecdotal evidence.

The AAP's statement is itself referenced and does not appear to need confirmation.

Primary sources are preferable to secondary sources. The AAP's statement (secondary) is a compromise, but is at least peer-reviewed. Please review reliable sources.

The fact that they are women and have a POV is not relevant. Questioning the grinding of axes violates assume good faith.

-Jakew 14:29, September 8, 2005 (UTC)

Jake, I take your point about anectdotal evidence being weaker than some other forms of evidence. However, this form of evidence has repeatedly led to previously unrecognised facts. In this case, the opinions of the women have some value because they are registered nurses who work in the field of human lactation. This isn't just a question of an appeal to authority. Indeed your reaction = of laughter = suggests that they have little authority, at least in your eyes. It is that their knowledge and expertise give their opinions some value.

There is a story, perhaps apocryphical = that Mohammed was once asked a question about the artificial insemination of date palms. His response was to immediately defer to the farmers, saying that they knew their business. Now date farmers mightn't know everything even about date palms. However, only a fool would discount their opinions altogether.

In the case in question, the women are both qualified nurses who work in the area of lactation. It strikes me as quite arrogant to airily dismiss their opinions as if they don't count.

Finally, we all have biases, prejudices and blind spots. It's part of the human condition. Drawing attention to this fact isn't to suggest bad faith on the part of others but to ask the others to consider whether the opinions of the two nurses have been too hastily cast aside. Michael Glass 15:13, 8 September 2005 (UTC)

Michael, please remember that this is an encyclopaedia. I do take your point about the possibility of leading to revealing information at a later time, but those working at the cutting edge of research have different information needs than the typical encyclopaedia user.

Incidentally, you're mistaken in your interpretation. My amusement is at the pretentious title, rather than the work that these people do. - Jakew 17:18, September 8, 2005 (UTC)

Jake, I have reviewed both letters and there is nothing in them to indicate the term lactation consultant. I'm sorry that I used a term that made you see them in a poor light. I think these points should be noted:

The women are both registered nurses who work in the area of lactation.
The first of the women [34] reports an observation that she has made about breastfeeding difficulties in boys.
Far from pushing any point of view on others she asks for confirmation from other observers.
She asks whether it would be desirable to delay the circumcision of boys who had suffered a traumatic birth until breastfeeding was well established and calls for comments of others.
The second woman confirms the observation that the first woman had made [35].
She points out that her three sons were ritually circumcised on the 8th day, and because breastfeeding was well established it did not cause her difficulties in breastfeeding them.
She contrasts this with what she had observed "again and again" with hospital circumcisions.
The observation of both registered nurses is confirmed by the finding of the AAP, which was included in the article.

Therefore a careful reading of the letters confirms that both nurses observed something that is confirmed in the AAP policy document, that the pain of circumcision could disrupt breastfeeding. In fact, the only substantial difference that I could observe between the AAP policy document and the letters of the two nurses is in the remedy that both suggest. The AAP suggests using pain relief; the nurses suggest that circumcision be delayed until breastfeeding is well established. These different approaches, of course, are not mutually exclusive.

Therefore I believe this exchange of views between us has established two things:

The letters recorded observations. I believe it is inaccurate and demeaning to label them as opinion pieces.
Referring to the nurses as lactation consultants is also demeaning, because of the negative connotations that this can have for readers.

Now I am not arguing that the nurses' observations are as rigorous as a double blind trial. Nevertheless, I believe that it is inappropriate and unfair to dismiss their observations as of no consequence. I believe that a short reference to their observations would be of interest to readers, as it confirms what the article already says but it suggests a different way of minimising the disruption to breastfeeding. Michael Glass 12:01, 9 September 2005 (UTC)

Michael, why are you so desperate to push these letters? They are anecdotal, far too weak to warrant inclusion. Think for a moment: how would you feel about inclusion of a letter (elsewhere, obviously) from a doctor stating that most of his heart disease patients were uncircumcised? Would you be so keen to include them? I think - I hope that you'd oppose it. I would, for the same reasons I've stated here. Jakew 12:46, September 9, 2005 (UTC) As a further note, the AAP reviewed existing evidence, rather than finding new data. Jakew 12:50, September 9, 2005 (UTC)

Now then, Jake. Remember your advice to me to assume good faith? I once again state that a reference to these letters serves a good purpose because it confirms something that is already in the article and it suggests that one solution could be to delay the circumcision of boys until breastfeeding was firmly established. I think your argument above is a "straw man". because heart disease and circumcision are, to the best of my knowledge, unrelated whereas the disruptive effect of circumcision on infant feeding is well accepted.

I am puzzled by your reference to "new data" in relation to the nurses' observation. How can their observation be new data when they observed something that you have accepted when the AAP says :"Available research indicates that newborn circumcisions ... are associated with irritability and feeding disturbances during the days afterward." [36] Could your ready acceptance of the AAP and determined rejection of the nurses, even though they are in essential agreement, have an element of an appeal to authority in it? Michael Glass 14:48, 9 September 2005 (UTC)

Michael, firstly, any disruptive effect of circumcision is far from well accepted. Secondly, I neither accept the AAP nor reject the nurses'. My personal opinion doesn't come into it. I am simply arguing that it is inappropriate for an encyclopaedia to reference a letter giving anecdotal evidence. Yes, citing the AAP is indeed an appeal to authority, but it was intended as a compromise. I'm wondering if it might be better just to delete the lot. Jakew 16:35, September 9, 2005 (UTC)

No Jake, the disruptive effect of circumcision on breastfeeding is well accepted. It may not be as well documented as you would like, but it is well accepted by people familiar with problems of breast refusal. It is only questioned by people with a strong pro-circumcision point of view. -- DanBlackham 20:04, 9 September 2005 (UTC)

Michael, I think your analysis is accurate. The use of the term "opinion piece" is a convenient way of branding, discounting and discarding evidence that does not support a particular POV. -- DanBlackham 20:04, 9 September 2005 (UTC)

Cite credible, peer-reviewed medical studies and you will have no difficulties. Jayjg ^(talk) 21:30, 9 September 2005 (UTC)

Good point, Jay. If you look at [37] you will find a report of a prospective, randomized, double blind, placebo-controlled, clinical trial. I have added this reference to the article. Michael Glass 22:52, 9 September 2005 (UTC)

Lactation Consultants

"Lactation Consultant" is a professional title like "Registered Nurse" or "Medical Doctor".

"Professional Standard for Lactation Consultation"

"International Board Certified Lactation Consultants (IBCLC), Registered Lactation Consultants (RLC) help mothers breastfeed their babies, in challenging situations. By gaining the experience and education necessary to pass the International Board Certification Examination, Board Certified specialists in lactation management prove to their patients and colleagues on the healthcare team that they are competent practitioners - committed to the health and well-being of breastfeeding mothers and babies in their care." [38]

-- DanBlackham 19:58, 9 September 2005 (UTC)

The Breastfeeding Answer Book

I am interested in the opinions of people familiar with breastfeeding who are not part of the circumcision discussion. Jake says The Breastfeeding Answer Book published by La Leche League International is an "opinion piece". He claims it is Nancy Mohrbacher's opinion and her opinion should not be given much weight.

Is The Breastfeeding Answer Book just an "opinion piece" or is it an authoritative reference book in the field of breastfeeding? -- DanBlackham 20:14, 9 September 2005 (UTC)

I consider it an authoritative reference. Unless there are more recently published studies contradicting a conclusion in the answer book, I would consider something from the book worthy of inclusion in the encyclopedia. Mamawrites 10:07, 10 September 2005 (UTC)

BAB is considered an authoritative reference. Workshops and such produced by LLLI qualify for CME credits for doctors and nurses, so the organization carries weight in the medical community as well. This book is a compilation of over 46 years of evidence-based research and caring for breastfeeding mothers, and is overseen by a medical advisory board. When Jake breastfeeds a child of his own for at least nine months he can re-read the book (He HAS read it, right?) and decide how many inaccuracies it has or doesn't have. When he then goes on to log 5,000 patient contact hours under medical supervision, 45 hours of medical courses specific to human lactation and pass an hours-long board exam, he can continue to deride "lactation consultants" at his leisure. (Although I admit, these are only requirements for an IBCLC. There are complete morons out there who can complete only a two-day workshop on breastfeeding basics and are allowed to call themselves "lactation consultant." From what I have seen, these people are just about as useful as "urination consultants.")

Breast refusal and circumcision continued

An authoritative reference

Once upon a time a man had the temerity to claim that the world is round.

'Show us your evidence!' said his peers.

He replied, 'But everybody knows that the world is round!'

They retorted 'That's not evidence. That's only an opinion about an opinion. You have committed a logical fallacy '.

The man went away and thought about this. He then read a book or two, and they also said that the world was round. So, being a little more cautious this time, he took the biggest, oldest and most authoritative book he could find and showed it to his critics. 'See' he said, 'The world is indeed round.'

'Another logical fallacy!' replied his critics. This is an appeal to authority. You'll have to do a lot better than that!'

That stumped him. Then he realised that there would soon be an eclipse of the moon. He arranged for his critics to see the eclipse, where the shadow of the round earth covered the moon. However, when they saw the eclipse they said, 'Appearances can be deceptive. We need a photograph and a diagram.'

The man searched the internet and found a photo and a diagram and showed them to his critics. 'Ah, yes,' they said. 'This is an American internet site. You'll have to do better than that!'

He then found a British site and showed them that. 'Yes, but ' said his critics, 'This is still an English-speaking country. What about an Islamic website? What about a Russian website? What about a Christian website?'

He went away again and after much time and labour and expense came back with an Islamic website, a Russian website and a Christian website that all said that the world was round. He even had translations of the website to ensure that he had got it right.

'Aha!' said his critics. 'But are the translators accredited?'

At this point the man decided that he had better things to do with his time. So he decided to go to Wikipedia and do a little editing.

Have a nice day, everybody. Michael Glass 23:22, 9 September 2005 (UTC)

Consensus

I find it unacceptable that circumcision is the only medical procedure mentioned specifically as a cause for breast refusal. Together with the CIRP link (why not put a full reference to the Howard article in the "reference" section?) is it an ugly scar on the article that there has been a war of words between circumcision activists. I do not deny that a freshly cut baby may be harder to feed or that they sometimes have hypotylenolaemia (it's up to y'all to decipher this one), but this just bears out that there are no other procedures newborns could undergo - quod non. JFW | T@lk 21:04, 10 September 2005 (UTC)

It's a battle between those who want to emphasise that the pain of circumcision can disrupt breastfeeding and those who want to minimise or discount this point. Perhaps restoring the statement of the AAP will make the point about pain in a way that isn't seen as implying that circumcision is the only source of pain for newborns. By the way, which CIRP link are you referring to? Michael Glass 23:11, 10 September 2005 (UTC)

Those who want to emphasise the point might care to remember that Wikipedia is not a soapbox. Jakew 10:18, September 11, 2005 (UTC)

JFW, earlier you listed several other surgeries performed on infants. What percentage of infants born in the United States has those surgeries during the first or second day of their life? -- DanBlackham 07:41, 19 September 2005 (UTC)

Nor is Wikipedia a place where information should be suppressed simply because others disagree with it. Of course, propaganda is something that should not be a part of Wikipedia, but at least propaganda is upfront and in your face. A much more serious problem is the inadvertent or deliberate suppression of a point of view, just because some people find it confronting, offensive or wrong.

In this case there is some evidence that circumcision can disrupt the establishment of breastfeeding. Some people find anything that seems to criticise circumcision as too confronting, so they want to censor or suppress any mention of this issue. I believe that this is profoundly wrong. I believe that it is better for all of us to work together to get this information across in a fair and balanced way. Michael Glass 10:50, 13 September 2005 (UTC)

If anyone truly wanted to censor that from the article, they would have removed the mention of surgery altogether. The fact that noone has done so ought to tell you something. Jakew 11:07, 13 September 2005 (UTC)

Yes. It tells me that some people don't mind mentioning recent surgery, as long as you don't mention circumcision. Now as circumcision is the most common surgery on infants, that's a bit like describing a room but ignoring the elephant in it.

Circumcision can disrupt breastfeeding. Because of this, it should be mentioned. Now I don't mind discussing how it can best be mentioned. However, it should not be censored out of the article altogether. I invite those who may not be inclined to agree with me to discuss how we can do this best. Michael Glass 12:49, 13 September 2005 (UTC)

If you mention X, you do not need to mention a special case of X. It is already covered by the wider statement. Jakew 14:56, 13 September 2005 (UTC)

Come on! There is a problem here, and it is only tangentially connected to the rights and wrongs of circumcision itself. There is clear evidence that circumcision may disrupt breastfeeding, and this is especially the case if the circumcision happens before breastfeeding has been established. This needs to be stated clearly and frankly in the article. Hints, and obscure links in rreference section are simply not good enough.

What is going on is a determined effort to stifle information and I object to it. Michael Glass 21:03, 13 September 2005 (UTC)

I agree that there appears to be a determined effort to stifle information and I also object to it. -- DanBlackham 07:53, 19 September 2005 (UTC)

The CIRP page on circumcision and breastfeeding

I believe that this page is valuable because of the links it provides [ttp://cirp.org/library/birth/] I am sensitive to the concerns of those who feel it is biased. That is why I suggest we have a NPOV note to alert people to its point of view. Then those who find it unacceptable will have fair warning. Despite this the link has been removed. The reason given is:

non-encyclopedic OK, but is any other link encyclopedic?

partisan source This is a partisan way of describing a source of information that the writer objects to.

source only peripherally related to breastfeeding Really? Let's look at some of the headings:

Circumcision's adverse impact on breastfeeding initiation

Avoidance of circumcision plus breastfeeding may produce lowest childhood morbidity and mortality.

Breastfeeding Problems After Circumcision. (La Leche League International)

Circumcision and Breastfeeding (La Leche League International)

I don't think I need to go on. Surely this shows that the charge of being peripherally related to breastfeeding simply cannot be sustained. So let's work on adding accurate and unbiased information, not deleting and censoring it. Michael Glass 12:42, 13 September 2005 (UTC)

Yes, many other links are encyclopaedic (or suitable as a source for an encyclopaedia). For example, links to peer-reviewed studies (such as Howard's).

Partisan source is a fair description for an agenda-pushing website that does not respond to notification of errors. Jakew 15:01, 13 September 2005 (UTC)

Of course it has a strong point of view. Yes it does have its own agenda and, like all of us, it is perhaps not as willing to respond to cirticism as it should be. Nevertheless, the links are useful and the point of view is worth considering. That's why I think that a link from the article is in order.

What I find much more concerning is the determination of a couple of people to downplay or suppress information or links about circumcision and breastfeeding problems. This is far more worrying. Michael Glass 20:39, 13 September 2005 (UTC)

The point of view is expressed, if in more reasoned tones and with fewer sweeping generalisations, in some of the links it provides (indeed, as far as I can tell, many of them are based in some way or other on Howard's study). Why not link to a few of those instead (preferably the more credible ones, and please exclude articles which solely cite Howard - they add nothing but bulk)? Jakew 20:49, 13 September 2005 (UTC)

It's not a question of suppressing information. The information is in the article already, in the form of the mention of surgery and the links to the AAP and Howard's study in the references.

If I might be so bold (not to mention arrogant) as to speak on behalf of those of us that you accuse, we (ok - give up - I) feel that the article a) does not need to explicitly mention circumcision explicitly, and b) would be less balanced with explicit mention. I see no reason to include CIRP's pages, which tend to overstate and exaggerate their case, and thus mislead the reader, when the more useful source documents can be included in the references instead. Jakew 20:49, 13 September 2005 (UTC)

You're not the only editor who feels this way; so far four editors have expressed support for this position. Jayjg ^(talk) 22:12, 13 September 2005 (UTC)

Only Jay and Jake appear to have expressed support for this position here. Michael Glass 11:38, 14 September 2005 (UTC)

Don't forget JFW. Jakew 12:21, 14 September 2005 (UTC)

You're right, it's only 3. Jayjg ^(talk) 21:02, 14 September 2005 (UTC)

I find the denial of suppressing information to be disingenuous. I have tried my best to ensure that the article on breastfeeding has balanced and fair information on some possible effects of circumcision on breastfeeding. Virtually every attempt has been suppressed. Even links to articles have been routinely rejected on flimsy grounds. The one or two links that were finally let stand were placed in a list of references so long that it almost guarantees that they are overlooked. Despite the evidence that circumcision can disrupt breastfeeding, any direct reference to this is removed. Then the people who do this turn round and claim that they are protecting the article from bias! Michael Glass 11:38, 14 September 2005 (UTC)

Mushroom Edit

I respect Jake's intelligence and his ability to consider other people's arguments. However, I must object to the way he did the edit on the link to surgery. The link I provided was about the effect on breastfeeding of recent surgery, including circumcision. The replacement link said nothing about circumcision and nothing about breastfeeding, so it was quite irrelevant. The only reason I can see for doing this was to suppress a point of view that Jake objected to. If Jake had voiced some objection to the link that would have been fair. However, changing the link in a way that could be taken to imply that the same or similar information was elsewhere on Wikipedia is disappointing. Michael Glass 11:38, 14 September 2005 (UTC)

There was nothing wrong with linking to surgery. If you look, you'll see that most articles link to others to provide more information about a topic. Providing more information about surgery is not 'bad'.

Now I see that Jake has replaced a bad link with a good link on breastfeeding and surgery. This is an asset to the article. However, as circumcision is the most common procedure on infant boys it deserves its own reference. Michael Glass 12:01, 14 September 2005 (UTC)

It is covered under 'surgery'. Discussed above. Jakew 12:18, 14 September 2005 (UTC)

Yes, Jake, is is covered, cloaked and concealed by the use of the word 'surgery'. I think it is disingenuous to pretend otherwise.

Please look again at what I am aiming for: a short, simple statement that points out that circumcision can disrupt breastfeeding and a link to further information that would explain how to minimise this problem.

If we can come to some kind of consensus on other edits I believe we can do the same here. We already accept that surgery of any kind can disrupt the establishment of breastfeeding. We would both agree that circumcision is the most common form of surgery on newborn boys. Our only area of contention is in how to present the evidence fairly. It shouldn't take much more to bridge the gap. Michael Glass 13:04, 14 September 2005 (UTC)

There is no gap to bridge. By your own admission, circumcision is a form of surgery. Your argument is equivalent to the following:

There is a gap in the following: "Drinks that help relieve thirst include water, fruit juices, soft drinks, and hot drinks." Since Pepsi Cola is the most common soft drink, it ought to read: "Drinks that help relieve thirst include water, fruit juices, soft drinks, Pepsi Cola, and hot drinks."

No gaps there, either. Just no needless advertising or activism. Jakew 13:41, 14 September 2005 (UTC)

Unsurprisingly, I completely agree. Jayjg ^(talk) 21:02, 14 September 2005 (UTC)

Please see a more relevant Pepsi analogy below. [39] -- DanBlackham 06:58, 24 September 2005 (UTC)

A response to both Jake and Jayig

Jake, a charge of activism from you is laughable. You are the author of the pro-circumcision website, circs.org, and your edits and comments on your own user page make it clear that you have a very great interest and involvement in circumcision. While I respect your intelligence and value many of your contributions to Wikipedia, please don't come the raw prawn.

You say: I am neither in favour of or against neonatal circumcision. Rather, I am in favour of parents making an informed decision. An informed decision requires accurate and honest information, so I am opposed to attempts to mislead. All I ask is that you live up to your own ideals.

Jayig, what is evidence of activism: arguing for relevant, documented information to be put in an article or making every effort to minimise or remove that information? If both are evidence of activism, why have you chosen to support suppression and censorship? Michael Glass 20:56, 15 September 2005 (UTC)

Wikipedia has a whole article explaining what pain is. Cirp is a site devoted anti-circumcision activitism, and presents a decidedly one-sided (and often edited and distorted) view on the subject. Attempts to turn a page about breastfeeding into an anti-circumcision page may well be acceptable (and expected) on Cirp, but not on Wikipedia. And when non-encyclopedic and inappropriate links are removed from articles, the first cry is always "suppression and censorship", it's as inevitable as the sun rising in the east. Jayjg ^(talk) 21:12, 15 September 2005 (UTC)

I know that Jayig has made a great contribution to Wikipedia but I am disappointed at the intemperate tone of the comment above and his apparent assumption of bad faith on my part. However, I am most disappointed that an Administrator of Wikipedia should make a misleading description of his edit.

He said: restore proper Wikipedia link, remove link to one-topic and biased activist site. What he did was to remove a link. Therefore the first part of his description is demonstrably false. Now about the second part of his description. The link was to a policy statement of the American Academy of Pediatrics entitled The Assessment and Management of Acute Pain in Infants, Children, and Adolescents. It was a link to this article that Jayig chose to describe as a link to one-topic and biased activist site because it was published on the CIRP website. I leave it to the reader to decide if this was fair dealing.

I, for one, expect more of an Administrator of Wikipedia. Michael Glass 11:53, 16 September 2005 (UTC)

Vitamin D supplements

I found this article via one of the links at the bottom of the article: Do exclusively breast-fed infants need vitamin D supplements? The discussion in that article dovetails the recommendations I've heard given by several breastfeeding-advocate pediatricians. I'm thinking a couple of sentences about the possibility of rickets and vitamin D deficiency, and when supplementing is appropriate (and when it is not needed) would be a good addition to the article. Anyone else have an opinion on this? Nandesuka 12:06, 15 September 2005 (UTC)

Good idea, but the link is perhaps not the most credible of sources. How about these? [40] [41] [42] Jakew 11:15, 16 September 2005 (UTC)

I agree with both Jake and Nandesuka that the Vitamin D question is important to mention and discuss. i also agree with Jake that his links are a better source of primary information about the rickets/Vitamin D question than the Geocities site. Nevertheless, the issues that are raised in the Geocities article are certainly worth pondering. Michael Glass 12:44, 19 September 2005 (UTC)

The management of pain in infants and children

I have added a link to an important policy statement about the control of pain in infants and children. I have chosen the CIRP reprint for the following reasons:

the typeface is clear and well-presented.
Parts of relevance to the question of circumcision and breastfeeding are highlighted.

I hope that those who are dedicated to providing clear, accurate and unbiased information to parents will bear this in mind. Michael Glass 21:14, 15 September 2005 (UTC)

Um, you don't think the highlighting of the parts about circumcision introduces bias, and shows clear activisim? If the AAP had wanted to highlight those sections, they certainly could have done so themselves. Jayjg ^(talk) 21:18, 15 September 2005 (UTC)

Oh  Jayjg, ¿could you please explain your removal of this link  to the  AAP Policy Statement - The Assessment and Management of Acute Pain in Infants, Children, and Adolescents  in the edit “remove link to one-topic and biased activist site”?  I can see nothing wrong with the paper.  ¿Is the AAP an one-topic activistic site?  Marking the relevant text in a long paper does not seem a very good reason for calling a policystatement biased.  ¿Who other than  Jayjg  and  maybe  (he has not yet chimed into this conversation yet)  user  Jakew  has a problem with this source?

—

— Ŭalabio‽ 03:46, 16 September 2005 (UTC)

Walabio, it is quite obvious from Jay's comment that he refers to CIRP, not the AAP. The original article would be preferable (indeed I would argue that we should always prefer the original to a reprint). It would be preferable not only because of the risk of introducing errors during republication, but also because highlighting a few passages to make a point subtly alters the apparent meaning of a document.

Secondly, while the original is preferable, it is still not appropriate. That article discusses surgery and pain in general, but only mentions breastfeeding once, in passing. It is not even general information, since they only discuss this in connection with circumcision. As stated previously, there is no need to single out circumcision. If we want to link to general information on pain, we should prefer Wikipedia's article. Jakew 11:10, 16 September 2005 (UTC)

First of all, I would like to commend both Walabio and Jake for their measured comments. I especially appreciate the fact that Jake took the trouble to trace the original policy. I chose the link to the CIRP reprint because it was better set out and relevant parts were highlighted. The best way to judge the effect of the highlighted parts is to reprint the paragraphs with highlighting. The parts highlighted by CIRP are bolded. The conclusion is reproduced in full:

A major aim of pain treatment is to eliminate pain-associated suffering. Pain is an inherently subjective experience and should be assessed and treated as such. Pain has sensory, emotional, cognitive, and behavioral components that are interrelated with environmental, developmental, sociocultural, and contextual factors. Suffering occurs when the pain leads the person to feel out of control, when the pain is overwhelming, when the source of the pain is unknown, when the meaning of the pain is perceived to be dire, and when the pain is chronic.2 The concepts of pain and suffering go well beyond that of a simple sensory experience.

Local anesthetics and strategies to soothe and minimize distress should be considered even for simple procedures, such as venipuncture. Some common painful minor procedures, such as circumcision, do not always receive the warranted attention to comfort issues. Available research indicates that newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward.9-11 Opportunities for alleviating pain exist before, during, and after the procedure, and many interventions are effective.12-17

CONCLUSION

Ample knowledge about pediatric pain exists to treat children humanely and effectively, but it is not universally applied. Multiple sources of information are available, and it is important that pediatricians expand their knowledge base and advocate for the appropriate treatment of pain in children. This may include the institution of and adherence to educational requirements and quality improvement guidelines for the treatment of pediatric pain. Pediatricians are encouraged to advocate for and facilitate the use of services offered through child life programs that can have a dramatic effect in improving psychologic and physical comfort. In many treatment centers, pain is a continuous quality improvement measure and included as a fifth vital sign.

There is need for more research to elucidate further the strategies for optimal pain management and the effect of the pain experience. It is unacceptable that almost no potent analgesics have received approval from the Food and Drug Administration for use in children. Children deserve the benefit of systematic research on the clinical efficacy and adverse effects of such medications.

Treatment of children will improve as pain management education expands and as the issue of pediatric pain is brought into greater public awareness. Education of parents and others in the community who deal with children in pain is an important pediatric issue. When pediatricians consistently make comfort a priority for their patients and help others to treat pain more effectively, the treatment of pain in children will improve.

The effect of the highlighting is to stress those parts of the paper that are directly relevant to infant circumcision. By reprinting them in this way the reader can see that the policy does say that the pain has serious consequences, that the pain of circumcision does interfere with feeding, that knowledge of pain relief is not universally applied and that almost no powerful analgesics have received official approval. I appreciate the point that Jake made about subtle distortion. However, contrary to what Jake has suggested above, I think that these quotations demonstrate that the policy on pain does have something relevant to say about the pain of circumcision and its control. It is for this reason that the policy should be linked to the article.

Now Jake has stated that it would be better to link the article to the Wikipedia article on pain. I do not think this would serve any really useful purpose. The Wiki article has no standing whereas the AAP article speaks with real authority. The Wiki article says nothing about infant feeding or circumcision; the AAP article deals with both issues. Finally, whereas the AAP article is current until the next update, the Wiki article is inherently unstable.

I prefer the article as published by CIRP because it is well set out and parts relevant to breastfeeding and pain are highlighted. However, if the article on the AAP website was linked, the same information on feeding and pain would still be there, even though the AAP's layout is not quite as clear and the parts relevant to breastfeeding and circumcision tend to get lost in the details of the policy as a whole. Michael Glass 13:17, 16 September 2005 (UTC)

The effect of the highlighting is to stress those parts of the paper that are directly relevant to infant circumcision. The negative parts, anyway. This is part of the problem. The text of the link was 'pain', not 'circumcision'. The reader will thus rightly expect it to be about pain, not circumcision. If he or she clicks on it, it will be because he or she wishes to learn more about pain, much the same as those wanting to learn about infants will likely click on infant at the beginning of the article (and you may care to note that it links to Wikipedia's article, rather than elsewhere).

If the link text were 'circumcision', you might have a better point, but since that is covered by the more general terms, and the only point to mentioning circumcision is to advance an activist agenda, and Wikipedia is not a soapbox, we should concentrate on general matters.

and that almost no powerful analgesics have received official approval. How exactly did you read the AAP's pain management committee's words that "Opportunities for alleviating pain exist before, during, and after the procedure, and many interventions are effective.12-17"? If that isn't official approval, what is?

You object to preferring Wikipedia articles to external sources, despite the fact that this is actually Wikipedia policy (as I remember), on the apparent grounds that you dislike the open source Wiki way. Your preferences are your own business, I suppose.

Finally, one can only presume that if the parts relevant to breastfeeding and circumcision tend to get lost in the details, that is perhaps because the AAP's committee chose to let it be that way. One can only speculate why, but the possibility does occur that they wanted to write something serious and important on the subject of pain, and didn't feel that it was necessary to use this as an opportunity to push an anti-circumcision agenda. Jakew 14:30, 16 September 2005 (UTC)

You made some good points, Jake. However, before I want a reference to the CIRP reprint, I would prefer to have the following paragraph quoted in the article:

Some common painful minor procedures, such as circumcision, do not always receive the warranted attention to comfort issues. Available research indicates that newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward. Opportunities for alleviating pain exist before, during, and after the procedure, and many interventions are effective.

Please note that I quoted more than CIRP highlighted, to give a more balanced picture of what the AAP wrote. Despite your charge of pushing an agenda, this is not my intention.

I agree that the article should be read as a whole because it is an important paper about the importance of managing pain in a humane manner. A short quotation in the text and a link to the AAP website would be ideal.

I am surprised at the spin you have put on what I wrote above. The AAP policy says It is unacceptable that almost no potent analgesics have received approval from the Food and Drug Administration for use in children. My summary of this read almost no powerful analgesics have received official approval.I quoted both this and the other statement you alluded to,

A preference to using authoritative sources, where appropriate, is consistent with Wikipedia policy to cite sources. It is perverse to assert that this means I favour other sites over Wikipedia. They simply serve different purposes.

Finally, the text of the link was pain, and that was what the whole article was about. Therefore the link was accurately described. Michael Glass 15:26, 16 September 2005 (UTC)

Edits to the second and third paragraphs

I have edited the second paragraph to:

Put the chief reason for preferring breastfeedding - being best for the baby - first.
Simplify the language in several places.
Expand other points to make them clearer.
Point out that most women are not precluded from breastfeeding and that governments and doctors are keen to promote the practice.

I have edited the third paragraph to:

make two simple sentences rather than one longer sentence
simplify the wording very slightly

As this is near the beginning of the article it's important that it reads well and is NPOV. I hope that others will look at these paragraphs closely to see if there are other ways in which they can be improved. Michael Glass 00:56, 18 September 2005 (UTC)

I improved your edits by linking to the Wikipedia articles. Jayjg ^(talk) 07:45, 18 September 2005 (UTC)

Why did you remove these links?'

Jayig, under the heading, "Edits to the second and third paragraphs (above) you wrote:

I improved your edits by linking to the Wikipedia articles.

This may give others a false impression of what you did. Your edit had nothing to do with the second and third paragraphs. Your edit was to a dot point about breast refusal which reads:

Causes of breast refusal include:...

Pain or discomfort from recent surgery or other procedures

You removed the links to two articles:

AMERICAN ACADEMY OF PEDIATRICS:The Assessment and Management of Acute Pain in Infants, Children, and Adolescents

and

University Health Care: Surgery and the Breastfeeding Baby

You then replaced these links with Wiki links to pain and surgery, neither of which said anything about infant feeding.

Why did you remove relevant links and replace them with less relevant links?

Michael Glass 11:53, 19 September 2005 (UTC)

If a reader needs to understand what pain and surgery are, then he or she should be directed to the relevant Wikipedia articles about them. If you want to include those links in the list of links at the end of the article, I have no objection. Jayjg ^(talk) 17:55, 19 September 2005 (UTC)

Fine. In other cases when I have added direct links to information, they have not been challenged. Why the double standard? Michael Glass 21:16, 19 September 2005 (UTC)

You didn't add them the same way; instead, you added them in place of Wikipedia links. Why the double standard? Jayjg ^(talk) 21:40, 19 September 2005 (UTC)

Simple. The links I added are more relevant. However, I'm quite content to have both Wiki links and the more relevant links in the text. Any objections? Michael Glass 08:37, 20 September 2005 (UTC)

None, if you put them at the end of the sentence, as has been done with the others. Jayjg ^(talk) 20:19, 20 September 2005 (UTC)

I have now added those links, and I expect them to be left in place. However, I still feel that it is quite unsatisfactory that mention of the disruptive effect that painful procedures such as circumcision can have on the establishment of breastfeeding is still excluded from the text of the article. I believe that this short passage from the AAP policy that follows would be appropriate.

Local anesthetics and strategies to soothe and minimize distress should be considered even for simple procedures, such as venipuncture. Some common painful minor procedures, such as circumcision, do not always receive the warranted attention to comfort issues. Available research indicates that newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward. Opportunities for alleviating pain exist before, during, and after the procedure, and many interventions are effective.

What do others think? Michael Glass 21:42, 20 September 2005 (UTC)

You don't really need to ask, Michael. Furthermore, the disruptive effect of painful procedures is explicitly included: "Pain or discomfort from recent surgery or other procedures [43] [44]" Jakew 08:46, 21 September 2005 (UTC)

No. It's not explicit about circumcision. No explicit reference to the effect of circumcision on breastfeeding has been allowed to stand. In fact, your last edit to the article was to remove an explicit reference to the disruptive effect of circumcision on breastfeeding from the list of references! That is a measure of the length that you will go to remove any explicit reference to a well documented cause of problems in breastfeeding.

Why is there such resistance to including any such comment? Why?

i am not asking for a diatribe against circumcision. All I want to see is something short, factual, frank and moderate abnout this issue This statement would serve that purpose well.

Local anesthetics and strategies to soothe and minimize distress should be considered even for simple procedures, such as venipuncture. Some common painful minor procedures, such as circumcision, do not always receive the warranted attention to comfort issues. Available research indicates that newborn circumcisions are a significant source of pain during the procedure and are associated with irritability and feeding disturbances during the days afterward. Opportunities for alleviating pain exist before, during, and after the procedure, and many interventions are effective.

What about it? .Michael Glass 12:15, 21 September 2005 (UTC)

You are repeating the same arguments that have been made before. This is neither short nor moderate; in fact, it is unecessary activism. Pain from recent surgery is included, as are the links you wanted. That is more than enough. Jayjg ^(talk) 01:51, 22 September 2005 (UTC)

The adverse affect of infant circumcision on breastfeeding is well documented by people familiar with problems of breast refusal. The determined effort by supporters of infant circumcision to remove any mention of circumcision from the article is a form of activism that is contrary to the spirit of Wikipedia. Please recall that Wikipedia is not a soapbox. -- DanBlackham 07:36, 22 September 2005 (UTC)

Jayig, I am puzzled that you would describe an 80 word paragraph as not short, not moderate and unnecessary activism. What do you find immoderate about the language the American Association of Pediatrics uses? Finally, if inserting this passage is a form of activism, then so are the activities of those who are determined to keep this passage out of the article. Michael Glass 13:26, 22 September 2005 (UTC)

80 words is a lot when the topic is already covered, and trying to focus this article about breastfeeding on circumcision is undoubtedly immoderate activism. Please recall that Wikipedia is not a soapbox. Jayjg ^(talk) 16:18, 22 September 2005 (UTC)

Precisely.

And don't forget: mothers who help save the dolphins can breastfeed too! ;-) Jakew 20:24, 22 September 2005 (UTC)

If 80 words is a problem, how about just a couple of words? Like this:

Causes of breast refusal include:

Formula feeding, sometimes without the knowledge of the mother.
The use of artificial teats leading to "nipple confusion"
Poor feeding technique
Over-handling after birth
Thrush in the baby's mouth
Distractions or interruptions during feeds
Long separations from the mother
Breathing difficulties, often caused by a common cold [45]
Pain or discomfort from surgery, e.g. circumcision, or other painful procedures [46] [47]

Now to say that e.g., circumcision focuses the whole article on circumcision is a complete nonsense. Michael Glass 12:26, 23 September 2005 (UTC)

Please see the Pepsi comments above. Jakew 13:35, 23 September 2005 (UTC)

Irrelevant. Michael Glass 15:09, 23 September 2005 (UTC)

Obviously, not all editors agree. Nandesuka 15:17, 23 September 2005 (UTC)

A more relevant Pepsi analogy would be if an article on caffeine said, "Caffeinated beverages, including caffeinated soda, may cause health problems in children" and a Pepsi salesman and members of a Pepsi Club removed "including caffeinated soda" because they did not want anything in the article to reflect negatively on Pepsi. -- DanBlackham 06:52, 24 September 2005 (UTC)

More relevant would be an anti-Pepsi (Coke marketeer?) editor changing "Caffeinated beverages may cause health problems in children" to read "Caffeinated beverages, including Pepsi, may cause health problems in children." Anyone removing this unnecessary detail that only serves the anti-Pepsi cause would then be accused of being pro-Pepsi. Jakew 10:24, 24 September 2005 (UTC)

True. I'll try another way to explain why it is important to mention circumcision explicitly in the article.

Pain from surgery and other painful procedures can disrupt breastfeeding. [48]
The American Academy of Pediatrics specifically mentions pain from circumcision as affecting infant feeding.
If the AAP finds it appropriate to mention this, then attempts to censor, remove or even downplay this finding must be trreated as suspect.
If the AAP finds it appropriate to mention this, then attempts to censor, remove or downplay this finding must be regarded as POV pushing.
Most infants do not receive surgery. Male circumcision is the great exception. If it is done without pain relief or it is done so early that it disrupts the establishment of breastfeeding, then people have a right to know.

However, there are flow-on issues that also impinge on this question.

There is evidence that the pain from circumcision can sensitise babies to later painful procedures [49].This is another reason for facing up to this issue and not shying away from it.
There is also evidence that proper pain relief can make a difference. Anna Taddio said:

Hospitalized newborn infants undergo many painful procedures without the benefits of analgesia. In previous studies, my colleagues and I demonstrated safety and efficacy of pharmacologic interventions aimed at minimizing procedural pain in newborn infants.(1) We have also found that untreated newborn circumcision pain can alter sensitivity to pain 4 to 6 months after the procedure and that these changes can be minimized by using local anaesthesia to decrease pain from circumcision.(2) In addition, we have demonstrated that newborn infants exposed to repeated painful procedures can learn to anticipate pain.(3) Our current studies continue to investigate safety and efficacy of analgesics and the long-term effects of pain in this population. We have prepared position statements on the prevention and management of pain and stress in the newborn that have been endorsed by the American Academy of Pediatrics, Canadian Paediatric Society, Fetus and Newborn Committee, and the International Group of Pain Researchers.(4,5)

Finally, a moderate and responsible position on the question of infant pain and its its prevention and relief is totally compatible with a neutral point of view on the rights and wrongs of infant circumcision. Michael Glass 02:15, 24 September 2005 (UTC)

Is already stated in the article.
The AAP specifically mentions this in an article on pain. Their article on breastfeeding makes no mention of circumcision.
It is ludicrous to expect this article to cover the contents of policy statements on other topics.
Since the AAP's breastfeeding policy statement (link given above) does not mention circumcision, this is a poor argument.
We have already stated that surgery may cause difficulties.
Taddio is cited in the appropriate article. There is no indication that it is relevant to breastfeeding.
Finally, discussion of circumcision belongs in that constellation of articles, not here. Jakew 10:39, 24 September 2005 (UTC)

Jay's suggestion that Michael is "trying to focus this article about breastfeeding on circumcision" is absurd. One paragraph on the negative effect of infant circumcision on breastfeeding is reasonable and appropriate. One paragraph on the relationship between infant circumcision and breast refusal does not "focus" the article on circumcision. -- DanBlackham 07:15, 24 September 2005 (UTC)

Discussion of circumcision, including pain relief, certainly belongs in the appropriate article. This one, however, is on breastfeeding. Jakew 10:29, 24 September 2005 (UTC)

Jake is certainly right in stating that pain relief and circumcision should be discussed in the appropriate article. However, the effect of circumcision on the establishment of breastfeeding is obviously of relevance to articles on both circumcision and breastfeeding. It's absurd to suggest otherwise.

In point 2 (above) Jake states that the AAP mentions the impact of circumcision on breastfeeding in their article on pain but not in their article on breastfeeding. To imply that this means we can ignore the impact of circumcision on breastfeeding strikes me as an absurd piece of rationalisation.

It is ludicrous to expect us to ignore other policies of the AAP that have relevance to breastfeeding.

Of course, Taddio's findings apply to the article on circumcision, rather than breastfeeding. However, when circumcision affects breastfeeding, it is also relevant to the breastfeeding article.

The AAP policy on breastfeeding says: Delay weighing, measuring, bathing, needle-sticks, and eye prophylaxis until after the first feeding is completed. [50] If even eye prophylaxis is to be postponed until after the baby's first feed, then this stresses the importance of a peaceful entry into the world to assist the establishment of breastfeeding.

Finally, Jake is quite right in his suggestion that the question of breastfeeding and circumcision should be discussed in the articles on circumcision. This is true, and I look forward to working with him to include more of such material in Medical analysis of circumcision. Michael Glass 12:56, 24 September 2005 (UTC)

We already mention pain and surgery, Michael. Howard is already cited in medical analysis of circumcision, however. Jakew 16:34, 24 September 2005 (UTC)

True. Therefore I will link this section of [Breastfeeding] to that part of [Medical analysis of circumcision], like this:

Pain or discomfort from recent surgery or other procedures [51] [52] [53]

Michael Glass 21:53, 24 September 2005 (UTC)

Jake, why did you remove this link?

Jake, I see that you've removed a link to a Wiki article. Why did you remove the link to Medical Analysis of Circumcision # Pain, stress, trauma and interference with breastfeeding? Trying to hide something? Michael Glass 15:50, 25 September 2005 (UTC)

I see you've removed that link again. You really do look as if you're trying to hide something. Michael Glass 16:15, 25 September 2005 (UTC)

For the same reason that myself and others have been removing links to other links that specifically address circumcision while ignoring others forms of pain and surgery. This link would not be okay in the Pepsi analogy on the sole grounds that the destination lies within Wikipedia, would it? Jakew 19:53, 25 September 2005 (UTC)

See Jakew's response. Also, Wikipedia does not link to its own articles that way, that is used for external sources. Jayjg ^(talk) 20:51, 25 September 2005 (UTC)

One link is to the pain of surgery. The other link is to pain in general, but specifically mentions the disruptive effect that circumcision can have on breastfeeding. A proper discussion of circumcision and breastfeeding would address the issue squarely and would mention the following:

Circumcision can disrupt breastfeeding.
This can be mitigaged by proper pain relief.
This can be mitigated by ensuring that breastfeeding is properly established before the circumcision takes place.

Instead of delete, delete, delete, censor, censor, censor I expect your co-operation in getting these facts across in a moderate and responsible way. Michael Glass 23:08, 25 September 2005 (UTC)

While other forms of pain and surgery shouldn't be ignored, I think we need to keep things in perspective. Generally speaking, especially with a baby surgery would only be carried out if there is something considered abnormal that needs fairly immediate correction. Pain would also usually be avoided whenever possible. Circumscion is somewhat unique in that it is primarily done for cultural and religious regions. While there may be some medical reasons, these are hotly disputed. In any case, circumscion is by and large not considered to be the equivalent of other surgeries that may need to be performed when something is considered abnormal that needs correction. Therefore, circumscion is unique in this regard and we cannot ignore it Nil Einne 04:55, 2 June 2006 (UTC)