Infant and newborn circumcision in Birmingham: NHS position, consent and choosing a provider

Circumcision is the removal of part or all of the foreskin. The BMA calls it non-therapeutic (sometimes ritual) circumcision when it is done for any reason other than a current physical clinical need. That covers most circumcisions of baby boys, which parents request because of faith, family identity or community practice. The BMA notes that Jewish tradition places circumcision at 8 days old and that Islamic tradition places it within 4 weeks or in young boyhood, while cautioning that a family born into a practising community should not be assumed to want it.

Medical circumcision in infancy is uncommon. The NHS explains that a tight foreskin is normal in babies and boys: most boys' foreskins do not pull back before the age of 5, sometimes not until 10 or older, and the foreskin may balloon when a boy passes urine as it begins to separate. The NHS says never to force a child's foreskin back. Guidance from the Academy of Medical Royal Colleges states that medical circumcision is rarely indicated as a primary treatment under the age of 16 and that most boys need only reassurance. The same guidance says phimosis is normal in babies because the foreskin and glans start out fused.

This page covers the first year of life. For older children with a medical reason, see the separate Birmingham guide on circumcision in children.

There is no statute specifically about non-therapeutic male circumcision in England and Wales. The BMA says a body of case law confirms it is lawful when it is in the child's best interests, there is valid consent from both parents (or a court has authorised it) and it is performed competently. It quotes the GMC's 0 to 18 years guidance, which permits procedures without an immediate therapeutic benefit when they are in the child's best interests and carried out with consent.

The BMA says a parental request alone is not enough for a doctor to proceed. Parents may be asked to explain why the benefits outweigh the risks for their particular child, and doctors are expected to discuss irreversibility and whether circumcision could wait until the child can make his own decision. Religious timing is recognised as a real factor, and so is the harm of removing a child's chance to choose. Where two people hold parental responsibility, the BMA says doctors must be satisfied that both have given valid consent, and that written consent is advisable. If parents disagree, a court order may be needed, and the courts cannot require a doctor to perform the procedure against professional judgement.

The Birmingham and Solihull ICB leaflet says the same in plain terms: both parents or carers with parental responsibility must give consent, and the procedure and its risks must have been explained.

The ICB website states that the local NHS does not commission male circumcision for cultural, social and religious reasons, and its leaflet for parents says the NHS only pays for medically necessary circumcisions, which are rare. That means most families who choose circumcision for a baby son pay a provider directly. The leaflet is explicit that you will most likely need to pay and should agree the total price in writing before the procedure. Prices are not given here because none were found in the sources read, and they vary.

Medical circumcision, where it applies, follows the ICB male circumcision policy, which funds circumcision for pathological phimosis, three documented episodes of balanoposthitis and a short list of related indications such as recurrent paraphimosis, injury and abnormalities from birth. The policy document is written for the former clinical commissioning groups, so confirm the current position with a GP.

The ICB leaflet for parents and the BMA toolkit give a consistent set of checks. The BMA notes that there is no legal requirement for the person performing circumcision to be a doctor and urges parents to confirm that the practitioner has relevant training and proven experience. It adds that doctors who perform non-therapeutic circumcision in England must be registered with the CQC.

• Registration: the leaflet says to check that doctors are on the GMC register, nurses on the NMC register, and that the service is registered with the CQC, which you can search by location.

• Experience: the leaflet suggests asking how many circumcisions the practitioner performs each year; it states a minimum of 20 a year and says more is better. This is a local guide, not a national rule.

• Setting: the place should be clean, with sterile, single-use instruments.

• Pain relief: you should be told how pain will be managed during the procedure and at home.

• Aftercare: the leaflet says your son should stay at the premises for at least 30 minutes after bleeding stops, and that you should leave with written aftercare advice and an out-of-hours number.

• Presence: if you wish to be in the room, raise this early, as the leaflet notes that some practitioners allow it and some do not.

• Pausing: the leaflet says you do not need to go ahead if you are worried on the day, and a good practitioner will rearrange or cancel.

• Cost and paperwork: ask for fees in writing, whether complications are covered, how the bill is paid and how health information is stored.

The sources read do not give risk percentages specific to babies. BAUS publishes figures for adult circumcision, and the NHS says the procedure itself is the same in adults and children, but the figures were not written for infants and are not repeated here. The ICB leaflet says most boys recover well but that, like any operation, circumcision carries a risk of harm. The Academy of Medical Royal Colleges notes that major illness or death after medical circumcision is very rare but could be reduced if indications were applied more strictly.

The NHS lists general recovery points that apply to children: loose clothing and underwear, paracetamol or ibuprofen as directed on the leaflet, gentle washing and patting dry, about a week off school, and no aspirin for children under 16. It says healing takes 4 to 6 weeks and that swelling, bruising and minor bleeding are normal for 1 to 2 weeks. A baby in nappies needs frequent changes while the area heals; ask the practitioner for specific nappy-care instructions.

The ICB leaflet says that if you are worried after the circumcision you should contact the practitioner straight away, and if you cannot reach them or are unhappy with the advice, ring NHS 111 or go to A&E. The NHS says always to call 111 for a child under 5, and to seek urgent help for bleeding that does not stop, a high temperature or feeling hot, cold or shivery, a red or warm wound, blood in the urine, severe pain, or great difficulty passing urine. It says to call 999 or go to A&E if he cannot pass urine at all. See a GP if there is pus, discharge, a smell, a re-opened wound, new bruising or bleeding, or if the tip of the penis looks narrower or urine comes out slowly.

Male circumcision and female genital mutilation are treated differently in law. The ICB leaflet states that female genital cutting is illegal under the Female Genital Mutilation Act 2003, has no medical benefit, and carries a maximum prison sentence of 14 years, whether arranged in the UK or abroad. The BMA quotes a High Court judge describing a clear distinction in family law between FGM and male circumcision, while noting that both involve significant harm.

If you are worried about the safety or welfare of any child, the ICB leaflet directs people to the local authority children's services in Birmingham or Solihull, with an emergency duty team out of hours, and NHS 111 or A&E for urgent medical concerns.