Newborn Circumcision In The UAE: What Parents Should Ask

Whichever clinic or hospital you choose, a few clear questions before you book will tell you a great deal. Here is a checklist you can take to any provider.

Many UAE families plan a circumcision for their baby boy, and the choice of where often gets made in a hurry, in the sleepless weeks after the birth. It is easier to ask questions during pregnancy, when you have time to compare answers. As a paediatric surgeon, I'd encourage parents to put these to any provider, mine included.

1. Who will perform it?

Ask for the name of the doctor who will carry out the procedure, not only the clinic's name. Then ask:

- What are their qualifications, and are they licensed by the health authority where they work? In Dubai that is the Dubai Health Authority (DHA), and you can ask for the licence number.

- How often do they circumcise newborns?

- Will they examine your baby beforehand?

Experience matters. A global review by UNAIDS and the World Health Organization found that complications were more common when the procedure was carried out by inexperienced or poorly trained providers.

If your son arrived early, needed neonatal care or has jaundice, say so when you book, and listen for a provider who will tell you honestly when waiting is the sensible choice.

2. Which technique, and why?

The American Academy of Pediatrics describes several methods in common use, including the Gomco clamp, the Mogen clamp and the Plastibell, a plastic ring that stays on while the area heals and then falls off. Clinics use other techniques too. Ask:

- Which technique do you use, and why?

- Will there be a ring, stitches or a dressing, and what will I need to look after at home?

You don't need to become an expert in methods. Listen for a clear, unhurried explanation of what healing should look like with their approach.

3. What anaesthetic, and what pain relief?

The American Academy of Pediatrics says that newborns having a circumcision should be given procedural pain relief. Ask:

- Is it a local anaesthetic, which numbs only the area, or a general anaesthetic?

- How is the local anaesthetic given, for example as a nerve block, a ring block or a numbing cream, and how long do you wait for it to work?

- What pain relief will he have afterwards?

Baby medicine doses are worked out by weight, so ask for a written plan, and don't give him anything that isn't on it.

4. Can I stay with him?

Some parents want to hold their baby's hand throughout. Others would rather wait outside. Both are fine, and the choice should be yours. Ask whether you can be in the room, whether you can feed and cuddle him straight afterwards, and how long the whole visit takes, from arrival to going home.

5. What aftercare and follow-up are included?

Ask:

- Will I get written aftercare instructions, in a language I read comfortably?

- Who do I contact if I'm worried, how, and at what hours?

- Is there a follow-up check, is it included in the fee, and is it in person, by phone or by photograph?

The written instructions should set out the warning signs and what to do about each. Look for advice along these lines:

- Bleeding: press firmly with clean gauze for 3 minutes without lifting to check, and repeat up to 3 times. If it still hasn't stopped, call 998 or go to the nearest emergency department, then let your clinic know.

- Fever: in a baby under three months, a fever of 38.0°C or higher means calling 998 or going straight to the nearest emergency department, then letting your clinic know. The same applies if he seems seriously unwell, floppy, hard to wake or is struggling to breathe.

- Contact your clinic or doctor about: bleeding more than a dirham-sized spot, poor feeding, dry diapers for over 8 hours, redness spreading up the shaft, or swelling getting worse after Day 3.

6. What does the fee include?

Ask whether the fee covers the consultation, the anaesthetic, medicines, dressings and follow-up, and whether there is a charge if the date moves. Cover for circumcision varies, so check with your insurer early.

Your checklist

- Who performs it, what are their qualifications and licence, and how often do they do it?

- Which technique do you use, and why?

- Which anaesthetic, and what pain relief afterwards?

- Can I stay with my baby?

- What written aftercare, follow-up and contact details will I get?

- What does the fee cover?

A provider who answers each of these clearly, and puts the aftercare in writing before the day, is giving you what you need to decide. No good clinic minds a parent's question.

// Dr Brian MacCormack, Consultant Paediatric Surgeon

About the author:

Dr Brian MacCormack is a Consultant Paediatric Surgeon and Medical Director of Gentle Procedures Clinic, Dubai (DHA licence 62903517-001). He has cared for more than 5,000 newborns during circumcision.