Just Say No: Issues of Empowerment

By Elizabeth Noble

Presented at The Second International Symposium on Circumcision, San Francisco, California, April 30-May 3, 1991.

       I have been interested in issues of empowerment for over 20 years. I am interested in how parents say no to the epidural, to the cesarean, and so forth, and I counsel women who have a lot of grief because they did say yes, and always under an emergency and a time of crisis. Circumcision is a decision which normally is not made under duress, or at least not in haste. I come to see how circumcision is very much linked to my other interests, which are prenatal psychology and the ability to identify and empathize with the infant. I have received a tremendous response from people. A lot of them would say things like, "Please contact I have interviewed people who were put under pressure to circumcise their sons. If they had no problems keeping their sons intact and were not under pressure, I was not interested. I was interested in how one "just says no." I was not interested in talking to the parents who circumcised their sons because of religious issues, but I was amazed at the number of Jewish people who called me.

       It is still a very prevalent myth in Australia that when the Australian soldiers, the Anzacs, went to Gallipoli, or were in the desert, they had a hell of a time and ever since then every good Australian has been circumcised. I grew up in Australia and had never seen an intact penis until I went abroad. When I was living in the Netherlands, my fiance at the time, who was, of course, intact, would wash, performing what we Australians used to joking call an "APC:" armpit and crotch. Even though the Dutch did not have bathrooms, they did have sinks in their rooms and they fastidiously washed their perineums every day. It is possible to keep clean "down there" even with a little bit of water. When I returned to Australia, and was working in a maternity hospital, I asked to see a circumcision because it was coming up as an issue in childbirth classes. A Dr. Harry Cohen was performing the circumcisions that day. He pulled a very long face and said to me, "And the Jews celebrate this?"

       This comment came from, obviously, a Jew. I could hardly stay and watch the surgery to the end. Ever since the, in my childbirth classes, I always said two things if the issue of circumcision came up: "Just go up to the nursery on the postpartum floor and see if you can hear, from the cries, which babies in the room have been circumcised. I guarantee you you will be able to pick them out. If that does not convince you just ask, as I did, to see a circumcision.

       Around that time, circumcision fell out of vogue in Australia - this is was in Perth, in Western Australia - and a group of the most socially prominent obstetricians decided they would not do it and they put up a sign in their offices to the effect: "Don't ask, we don't do it." I was of the opinion that it ended then and there, because I moved to the United States a couple of years later and have been here ever since. I was very surprised when my cousin, who is a pediatrician in Geelong, (a town outside Melbourne) faxed me some information a couple of weeks ago in preparation for this presentation that the circumcision rate in Australia is 24 percent - about the same as the cesarean rate. They are both about 14 percent.

       As I worked at my Maternal and Child Health Center in Cambridge, Massachusetts over the past eleven years, I have had the opportunity and privilege of teaching prenatal exercise and childbirth classes to hundreds of pregnant women. The issue of circumcision would come up. The Jewish people in particular would often hope that their child would be a girl. One of the childbirth educators who worked for me said to me once, "How can I present the issue of circumcision objectively in class." I replied: "Why do you need to be objective? None of us is objective. Be opinionated." We do not need to be objective about rape and spouse battering and child abuse. Just give them the brown bread philosophy. I have developed what I call "the white bread philosophy" and my analogy is that brown bread is really hard to get. We all know that whole grain bread is better for us, but it is difficult to find. Restaurants often do not serve it. Hospitals virtually never do. You have to hunt around in special shops and health food stores to try to get it. Since it is so difficult and we do not to want make people feel guilty that they somehow missed out, let us tell them that the white bread is acceptable and it is really just the same.

       This analogy holds for childbirth preparation, breathing patterns, bottle feeding versus breast feeding, natural childbirth versus cesarean birth and, of course, circumcision. It is time to stand up and say, "the emperor is not wearing any clothes." I am very adamant about that. I speak for the newborn and the unborn in every situation. Other things happened that disturbed me. I found that members of my staff, many of whom were highly educated Jews, some of whom were married to Jews, and felt as I did about circumcision, actually allowed their sons to be circumcised. This is where education has its limits. We have a large and important library at the Center. We receive almost every journal on maternal and child health issues. I started a circumcision file years ago, before there was even a book on the subject.

       My staff had access to every bit of information and yet they would miserably and reluctantly admit they had caved in to the family pressure. If my own staff cannot say no, who can? This is why I set about to try and find some of those people who did say no - despite pressure. I might add that I had only one negative response. I got a very long letter from an orthodox Jew, who accused me of anti-Semitism, insensitivity, and so forth. She is a new employee at my Center, which I no longer direct. It is interesting how challenges are right under our noses, so to speak. I am very concerned that she not sabotage the efforts of the Center to empower women. I say not to have a choice in circumcision, but to make the right, the only decision. I do not even like to teach infant massage anymore because when the mothers start to take the diapers off and I see the circumcised babies I really tend to get upset, and I notice that often it is the circumcised babies who will cry when their diaper is taken off and I wish that I had thought to look at this a few years ago to see what happened when circumcised babies have their diapers removed. They do not cry every time, of course, because there are plenty of circumcised babies who enjoy a massage, but I often intuit that the baby is re-experiencing some violation of his body.

       Three years ago, when I became the mother of a son, who, needless to say, like his father, is intact, the issue of circumcision became more pertinent. Every time I looked at him I thought, "How could anybody cut this of?" How could someone purposely force such an experience on their precious child?"

       We live in a society where people like to cut things out. Episiotomy is more common than circumcision. It is probably about 90 percent. It is yet another cut to another genital orifice. We live in a society where if you do not like your nose, you cut a bit of it off; if you do not want to go on a diet, cut away some of your intestines. It is the "cut-it-out" solution.

       The pressures on the parents whom I interviewed were incredible. I might add they were men and women, about equal in number. Certainly this is not a formal study; I am not that kind of a left-brained researcher. I was just interested in trying to understand a little bit more about a phenomenon, and to take a very positive point of view about how people become empowered to stand up against stupidity, ignorance, pressure, etc.

       The pressure was spousal, familial, it came from brothers-in-law, sisters-in-law, doctors, and others. A lot of women were unfortunate enough to have more than one of the above circumcision advocates in their family. A typical response was, "My father is both Jewish and a physician," or "Three of my brothers are physicians. The extra medical pressure is very difficult to reject. Physicians do not like to have their opinion questioned or to be refuted. One woman said, "The doctor asked me, `Why didn't you circumcise'? "Well, I couldn't find any evidence to do it." And he said, "Well, you didn't ask the right people, did you?" As one couple pointed out, "These are hard issues, it's an all-or-none situation, you can't compromise on half a penis." "It's hard to say no, it's much easier to say yes to such a little procedure." Or "It's so visible. I'm aware," one woman said, "but I don't let my son run around naked as much as I allow my daughter to be naked." So the pressure was varied. Listen to these non-specific examples:

"It's automatic."

"You're supposed to do it."

"It's like violating a custom.

"It's like not putting up the Christmas tree."

"It's so routine you feel funny saying no."

"It's not a decision of choice."

"Of course you're going to circumcise."

"It's expected."

"It's something you do."

"It's normal."

"How could you ever think of not getting him circumcised?"

"What is the matter with you that you didn't circumcise?"

       Some people thought it was a state law. A lot of people said that the older generation was, of course, no help for two reasons: they did not want to feel their guilt, and, secondly, in those days women tended to lie in the hospital for a couple of weeks and do very little newborn care whereas today the mother is likely to be handed her traumatized infant very soon after the surgery even though they are generally not encouraged to accompany the baby to the circumcision room which is often as far away as you can get from the actual nursery because if mothers really knew what went on it really would not happen. The pressure some of the parents described was tremendous:

"The worst thing in my whole life."



"I cried every day for weeks."

"I felt ostracized."

"I felt all alone."

"People think we're crazy."

"We're treated like someone from outer space."

"I had to fight really hard with everyone I thought I could trust."

       A lot of them still remained worried, still feeling that the are courting disaster, that down the road there's going to be retribution. Some people were appalled when their sons were left intact:

"You're kidding?"

"Why not?"

"It's the wrong thing to do."

"Just wait, he'll have a lot of trouble."

       One woman was trying to recover from a cesarean. All the family kept calling up and saying, "When's the baby going to get circumcised?" For her, the pressure was basically over. There was still some covert pressure, some snide remarks, some whispering by the nurse - "She's not going to get the baby circumcised" - and that kind of thing. For most parents, the pressure was very overt. It was just simply for social and cosmetic reasons and that not to do it made for accusations of being different and odd:

"Your kid'll be a freak."

"You're the only one on the maternity floor that hasn't done it."

       There was stigma attached sometimes, as in this comment:

"The only people who do it are low class or 'Mexicans'"
were comments I heard. Then, there is the deficient hygiene argument and the idea about deserts. It was not only in Australia I found the desert phobia. There are plenty of Americans who think:
"Well, we haven't heard back from the latest batch in the Persian Gulf."

       Other people say, "Now, when the male becomes elderly and is unable to care for himself, he's a bother for his caretakers." "If so, then we should say, 'Let's pull out all his teeth too,'" retorted one parent. There are also all the other phobias - fear of infection, cancer, AIDS, unnamed 'future' problems. The most comment attitude of pediatricians and obstetricians was, "Might as well get it done now," as a kind of reassuring resignation to otherwise inevitable problems. There is also the old idea about pain, and, of course, we now know that the younger the baby, (especially premature babies) the more pain they feel. Pediatricians and obstetricians often told couples that the nervous system was not completely formed, that it began at the head and took a while to get down to the toes, so at least the babies never felt anything.

       Incidentally, it is often the medical profession's dismissal of the seriousness of the pain dimensions that actually turned couples against the procedure. Some of them said them, "Well, I know at least the Jews have made it less painful, and it's ethically, spiritually, morally, whatever, a Jewish thing to do, but they do not try to pretend it is not painful." One father said to me: "When the doctors said that infants feel no pain, that clinched it. The doctor continued: 'It's nothing, he'll forget. It's only like one-two-three.' Such statements came across as dishonest and nonchalant. It insulted my intelligence. I would have been more convinced if he had said, 'Yes, it's painful, but....' So this had the reverse effect on me." The identity-similarity-with-father argument of course came up and one woman was furious that her doctor said that you should do it for psychological reasons, suggesting that the mental health of her child was at risk if she did not agree to letting her child be circumcised, so she changed doctors! Then there are the issues of masturbation, armed services, and our idea that friends, brothers and fathers compare genitalia and say, "Well, look at me, I'm okay, no problems. It's more comfortable, more cosmetic," and so forth. In spite of all these so-called reasons it is interesting that the literature shows that many parents will still favor the operation even if they do not know any of these claimed justifications. Circumcision is very deeply ingrained.

       I just want to run through some of the "close shaves," and there are many people who almost did it, who literally had somebody say to them as they were about to sign the consent form, "Take it home and read it," or else they told me, "Just that week I received the NOCIRC literature." Sick babies usually escaped the procedures. If the baby was at risk, the parents felt, "Oh, I couldn't put him through another intervention," or "Yes, we were going to circumcise; when I saw him with all those tubes in him, I just couldn't do it."

       It is a contradiction when physicians will warn that it is too much for a sick baby to withstand a circumcision while still claiming that circumicsion is such "a little deal" and "babies do not feel pain." For many couples the pressure was continuous; it did not end just when they made the decision. Mothers-in-law and relatives would say, "There's still time to have him fixed," or "I still think that looks strange," or "I just can't get used to how he looks." It would continue until the child reached puberty and by that time people seemed to think a boy's penis was his own business. The Jewish parents had the hardest time, often not having the family visit for two, four or six months and often the issue was still not resolved even then, it just was never mentioned again. One Jewish couple told me that the biggest problem was that the circumcision is so symbolic and that if they had been more observant it would have been easier for them. They even called the rabbi from the labor room and he said, yes, he would take an intact Jew in the synagogue and accept the covenant. Then the hospital rabbi came around and kept ignoring their questions and telling them to circumcise, resulting in more continuous pressure. Ultimately, the Jewish people I talked to came to peace with their decision and felt quite strongly that it was right. One of them said: "Is my religion at the tip of my penis? If so, where does that put Jewish women?" Another one said, "Spirituality is not governed by rituals. You can be a very good Jew without being mutilated, stupid, and dangerous." One Jewish doctor told me how he had circumcised his first two sons and for the third son, he made a symbolic cut, after which he turned to his wife and said, "We are insane," and he did not circumcise his next two sons. Incidentally, one of his sons was born at home and shared a house with two babies who were gentiles. The two gentiles were circumcised. One baby had to have general anesthesia for complications before he was one month old. The two Jews in the house did not circumcise!

       Leboyer, in his book Birth Without Violence, says: "No monsters, no sadists. Ordinary people, like you and me, but with their minds elsewhere." I might add, their hearts. The conspiracy of silence in the hospitals is another factor in the circumcision problem. Nurses and doctors will be very aggressive in favor of circumcision, but they will say nothing or have absolutely a blank face when asked for arguments against it." This is very hypocritical.

       As one father said: "Neutrality can be a sin of omission, and I mistrust the medical community for promoting a procedure that's unnecessary." The nursing staff are often involved in the promotion of circumcision, and just like they are often unpaid salespersons for formula companies, they tend also to be unpaid salespersons for circumcisions. There may be repercussions if they do not comply. I know what kind of pressure nurses are under. A friend of mine was suspended from the Mercy Hospital in San Diego for three months without pay, not for even discussing the pros and cons of doing a circumcision, but for simply recommending to the mother that she talk to the baby and explain that it will be painful. Another nurse reported, "I have been reprimanded and the fact sheet on circumcision has now disappeared from the hospital. If parents want to ask questions they have to ask the obstetrician, who, incidentally, is the one who gets paid for performing the circumcisions." What often happened was that when couples did refuse, the same nurse whose mouth had been gaffed, so to speak, would go up to them the next day and say, "Oh, I'm so glad you didn't do it, now I can tell you what really happens." Or "What made you decide not to do it? Oh, good for you." But nurses often do not dare say anything for fear of dismissal. We have to empower these nurses.

       Another problem is that the medical profession is often very ignorant. Firstly, they are ignorant of the statistics. One woman had her son circumcised because she was told the rate was 85 percent. She presumed that her son would want to be among the majority. Then she found out that in her community, the circumcision rate was actually only 43 percent (almost half). She was very angry with the doctor. Many medical staff are not even aware that this is a controversial issue. Another problem is that most physicians have no idea how to care for the foreskin, so that these brave strong people who did "just say no" face the next dilemma: What are they supposed to do with this intact penis? The art and the literature show circumcised penises. There are no nude beaches like there are in Europe, so Americans have no opportunity to get acquainted with intact penises. The pediatricians were often as unhelpful as the obstetricians. If some of the pediatricians only knew how many people left their office because of misleading advice on what I call "the big problem with the little hole." It is astounding that doctors In the United States know so little about the anatomy, physiology, and development of the foreskin. In the United States there was a study that found that only 22 percent of pediatricians knew anything about the age at which retractability of the foreskin occurs. In a very recent study in Australia it was a little bit better. Fifty percent of the GP's were informed, but that is certainly not the majority. Most physicians are into "preventive measures:" "We got to get under there" - "As much as possible get under there" - stretch it," and so on. Many mothers had the experience of going to the pediatrician, watching him stretching the boy's foreskin painfully and his not letting her be involved. The doctors often said things like: "Well, this has to be done and you're not doing it right." One woman, who had just been through everything to avoid circumcision, with a Jewish husband and three physicians in her family, including a urologist and a gynecologist, went to the doctor who was trying to pull her son's foreskin back and when it would not retract he said, "You'll have to have a dorsal slit." She replied, "Oh, no, we just avoided circumcision and now we'll have to have more surgery?" She went to another pediatrician and was told her nonretractability was normal. She was very angry at the first doctor, exclaiming, "I came for education, not a lecture, not an opinion." If she had not been rescued by NOCIRC she would have been extremely upset.

       I might add that author Jane Brody, Mothering Magazine, NOCIRC and the "Donahue Show" were the four sources of educational information which people cited. They never cited their childbirth class, their midwife, their obstetrician, or anything quasi-medical. Mishaps were very influential. The lay people are very scared of accidents during the procedure and it is a shame that the press does not report them. One man said, "Oh, the neighbor had a real mishap, it was what you would call a botched job." The little boy would get these erections and then, of course, the skin couldn't heal and it would hurt. (Erections are not always necessarily related to pleasure. Even when men are hanged they get erections.) That story stopped one couple from circumcision.

       In Alberta, Canada an article described how the circumcision rate dropped from 40 percent to 19 percent when two infants suffered circumcision complications requiring plastic surgery. This event was deliberately kept from the public, but it had a very big impact on the physicians. The double standard presents the procedure not only as benign, but it is actively trivialized:

"Just a little squeal, just like cutting the cord."
"No big deal, it's over, it's easy, it's painless."
As somebody commented, "If it's no big deal, then let the child decide. Let's wait."
"The childbirth books, the way they describe it, it couldn't be that bad because if it were that bad nobody would do it."

       Couples are in a double bind regarding what they can believe. As one man said to me: "When there are accidents and problems, no one says, `The heck with this.' They rationalize it with: `These little things happen occasionally.' `Just because one little boy has a problem, it's just one in a million, don't let it change your mind.' Instead of saying: "Wow, let's stand back and look closely at this."

       There is also the argument that: "Well, Jews want everybody to look the same for fear of another holocaust." Well, by the same token, if everybody were intact you would not be able single out the Jews either! So for every one of these arguments there is a flip side, usually a double standard. The other irony is the enormous degree to which we have gone to measure fetal distress in labor: we have electronic fetal monitoring, external and internal leads, electrodes, on the baby's scalp. We are so concerned ababout fetal distress, but what about neonatal distress?

       I would like to emphasize the terminology used around circumcision. We must stop using the word uncircumcised, which suggests that circumcision is normal. We must use the word 'intact.' Defining an intact male as uncircumcised is like defining an intact woman as 'unclitoridectomized.' We need to admit and describe the change in sexual functioning caused by circumcision. Sexuality is not adequately considered: Circumcision is always "a medical reason," "a religious reason," or "a cosmetic one." A lot of men called me. In fact, I found myself being in the position of giving advice to intact adult males about the health and vitality and function of their foreskin because - (and I was amazed that men who, obviously, were fathers because they were talking about how to avoid a circumcision for their sons) would say, "Is it normal that the foreskin stretches like this?" or "Is it normal it does this and that?" These questions indicate the extent to which our culture divorces normal anatomy and the appreciation of it. Other men who were intact would point out that other men just do not know what they are missing. Then, of course, those who were circumcised would say things like: "I was 19 before I realized I was any different and, you know, I'm very upset to have lost my foreskin, but I can't blame my parents, everybody did it in those days, all the doctor had to do was mention the word cancer."

       If mothers really knew what was going on, they would not allow circumcision. One mother of identical twin boys, after witnessing the circumcision of the first boy would not let the doctor circumcise the second twin. The doctor said, "But identical twin boys, I mean, this is the ultimate in look alike male identity." The mother replied: "But the question is, how could I ever, knowing what has happened to one, ever allow a second one to suffer in the same way too?" For some respondents, "Just the sight of the circumcision tray, just the thought of the straps with no anesthesia was enough."

       So what I found, in conclusion, about this dilemma was that the people broke down into various groups. I cannot say there was one common thread between these respondents except that they were all very strong people. They had courage, and courage comes from the French word "the heart." They basically sounded well-educated. However, I remember one guy from Arkansas called me and I would not have said from his speech that he was educated. The only common thread was breast feeding. Every mother had breast fed. But, of course, we know plenty of breast-fed babies are circumcised. So I divided the respondents into several groups. And this is important to note when we decide how we direct our propaganda. There were some people who were just cerebral - rational about circumcision. "It's not necessary. There is no reason." They weren't emotional about this issue at all. Some excuses were mild:

"Checked it out with religion; no problem."

"I read the pregnancy books. Nobody ever said why we should circumcise. Once we heard the facts and got the cons - until then we had only heard the pros and now we heard the cons, they made more sense."

Such people simply made a cerebral decision. Then there was the emotional group:
"Sometimes I feel like shaking them to see if they can focus on the logic of it all."

"It's worse than rape. It's how wars get started."

"My son had been born perfect. How could I subject him to something I see as barbaric?"

"It makes me feel sick. Right now I know some little boy somewhere is being circumcised....Right now."

"I want to release the pent-up energy and remorse I have from doing my first son on the wrong information I got from the doctor."

And one person said:
"All I needed was a sentence."
The moralistic group would say:
"Do no harm."

"Do nothing that can't be undone."

"Let the child choose."

"Support those who have questions."

"Two wrongs don't make a right."

"Hold onto your ideals." "The people you live with can change. First I have to live with me."

"This is like consenting to have a child molested."

"We don't know what it entails. We have no right to interfere with another's body."

Then there were the naturalists:
"We use medicine and technology as little as possible."

"No reason to fix something if it's not wrong."

"God, our creator made it so. Nature doesn't make mistakes."

"We tried everything natural. We don't want anything invasive or intrusive."

"Our family had already given up on us. We had a mid-wife, a home birth,"

and so forth. The humanistic ones would make remarks such as:

"How can you inflict that pain?"

"Be humanistic."

"Explore new options." "Question rather than follow."

And so forth.

       But, basically, I would say it boiled down to the ability to identify with a newborn, to really identify with the baby. Education is important. Almost everybody stressed that there was never a pamphlet in the doctor's office or in the hospital, but I do want to point out that Johns Hopkins in 1978 put out a form on which they emphasized all the risks, and the American Academy of Pediatrics' statement is known among professionals. But their statement, which is a lifetime commitment to genital hygiene, I think is rather frightening because nobody else would say to you about your baby,

"Do you wash between the fingers? "Do you wash its ears?"

"What's happening with the anal skin folds?"

I mean, these questions are never asked. And, of course, the AAP recommended, but never developed, an educational program. A Canadian study suggested that 20 percent is the level at which circumcision will prevail when physicians oppose circumcision. So we must persuade all the health care providers to "just say no" - and some of them have. My husband's an obstetrician; he does not do them. I know a pediatrician who said she even refused in a residency to do them. There are some providers who just say no. But will it still be a rate of 20 percent? In fact, my cousin, the pediatrician, said, "I get the feeling there are just some people who will never budge." And that's the group we have to be concerned about. But I believe that it's the ability to identify with the baby, and I would like to say that this bonding starts prenatally. And I was interested in Lisa Moss' presentation - she's also written this too - that she considers it is the "Unnatural indifference to the newborn that allows us to not have developed a bond sufficiently enough with the baby to put his suffering and concern before some other pressure." So the challenge is, how can we develop that bond before birth? Michel Odent suggests, "If they have a lovely birth and you leave the mother and baby alone, they won't circumcise." I wish that were true. I can't tell you how many people I know who have had home births, Leboyer births and went right on to have the baby circumcised. Education and change have to start prenatally - birth is too late. But, unfortunately, women - or the infant - are violated earlier and earlier in the childbearing year.

       Let's, for example, talk about amniocentesis. Barbara Katz Rothman did an interesting study on 50 women who had amnios and 50 women who didn't. She found that in those who had amnios there was delayed experience of fetal movement. We all know that if you ask women what is the gender of the child they want to deliver, most of them, even today with feminism, will say a boy child. And that's what they told Rothman. But when they found they were carrying a boy child in the prenatal phase, most of them were disappointed. Now, Rothman did not go into the implications of this, but I can tell you from my work with Graham Farrant, an Australia psychiatrist, the way he puts it is, "It's very hard for some women to walk around for nine months with a penis inside." Women have real issues about the male, about the other, about the alien. I know this. I've held workshops at my own center for gender issues in new and expectant parents. I have not got time to go into those issues, but I just want to throw out to you the whole idea of the male/female psyche and sexual agendas. Many people - psychologists, anthropologists, et cetera - have come to watch my mother and baby classes and pointed out that the mothers behave differently toward male compared with female infants. I have asked the mothers about how they relate to their male children, and many of them will say, "Well, I don't hug and kiss him quite the way I did with my little girl because I'm scared he'll turn out to be gay." I'm sure you know people who don't think like this, but for some mothers and fathers there is a belief that too much affection, too much bonding, is somehow going to warp the male. Perhaps pain - circumcision even - is good for manliness. So we have to work with the emotions as well as the intellect. All the knowledge in the world doesn't give one that inner knowing when there is no choice, because true freedom means no choice. And I'm not talking now about legal choice which, of course, I defend. Sometimes a parent considers: Should we have a home birth? Should we have a hospital birth? Should she breast feed? Should we bottle feed? Should we circumcise? Should we not? We need people so secure in their inner knowing, so connected with their babies, that there is no equivocation and thus no dilemma of choice. These questions, like circumcision, won't arise. As one of my friends said the other day, when I told her I was coming to this congress, she said, "I never thought about circumcision. I never thought about breast feeding; to me it's like urinating, it's something normal that my body does."

       I would like to mention briefly the continuum concept. The primal period extends until about three years. When a baby comes out of the uterus it wants to live a similar kind of existence; it's just the other side of the mother's abdominal wall. I suggest the family bed and the family bath to parents - but again we get into the cleanliness and the cut-it-out issues. I guess the last thing I want to say is that couples have to know that it is their baby, it does not belong to the hospital or to the doctor; at any time you can say, "Stop." The minute they get the clamp on the penis you can say "Stop, you've done too much already," and take it off before it's cut right through. You can walk out of the hospital and say, "Enough." But the issue is, to whom do we surrender? Do we surrender to the staff? To the family mores? To the culture? Or to our inner knowing and to our baby. Because to be a real mother and a father is to surrender to the child. If you are really going to meet your child's needs, pick it up when it cries, nurse on demand, have it with you day and night. That is total surrender. The culture and demands of the work-place make it hard to do that, let me tell you; as a mother who just weaned my almost-three-year-old last month. And why is it so problematical? Why don't we surrender? Many of you have said, "The cry, that's what got me into this movement, I saw a video and I heard that baby's cry." So how is it that the health care professionals hear that cry all the time; they hear it, but they don't listen to it. And that's because of their own primal pain, their own inner child, their own denied needs that are represented along with their response. And I would just suggest to you in closing that we think about healing, healing our own inner child. There's the Association for Pre- and Perinatal Psychology Association from which you can learn more about this, and you can attend experiential workshops that will enable you to take these steps. My book, Primal Connections has an appendix listing everybody I could find around the country and the world who will hold people's hands as they go through a process that will take them back to their own vulnerability, be it primal therapy, be it hypnosis, rebirthing, shamanism, or whatever suits the individual. I'd like to point out that David Chamberlain is in the audience. He lives in San Diego. David Cheek is in Santa Barbara. William Emerson is in Petaluma; he does terrific work helping traumatized infants. Barbara Findeisen is in Healdsburg. Right here there are so many people, and so many adults need to individually heal our own pain so they can stand back to hear the baby's cry and come forward and respond. And if the baby's cry doesn't always work, and we know from neurolinguistic programming we're not all auditory, I think this particular photograph is very moving. It was in Mothering Magazine. We must find whatever helps us to identify with the baby so that we'll have the strength to help others to "JUST SAY NO."

Elizabeth Noble was born and raised in Australia where she received degrees in physiotherapy, philosophy and anthropology. In 1977 she founded the Obstetrics and Gynecology Section of the American Physical Therapy Association, now called the Section on Women's Health. The author of many books, videos and audiotapes, she offers consulting, lecturing, and treatment of OB-GYN disorders as well as the establishment of wellness programs. Her courses provide training for physical therapists and other health care professionals. During the past thirty years, Noble has presented lectures, workshops, media appearances across the USA and abroad, on the physical, psychological, and philosophical dimensions of reproduction, birth, and health through the lifecycle. Several thousand instructors in prenatal and postpartum exercise have been trained by her.

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