According to the American Academy of Pediatrics’ 2012 guidelines, “the true incidence of complications after newborn circumcision is unknown,...

But according to the Canadian Paediatric Society’s own document, the complication rate linked to circumcision is relatively low – a median of 1.5 per cent, according to one study – so the absence of formal training doesn’t appear to be taking a major toll, right?

Not necessarily. The true rate of infections, bleeding, skin adhesions and more serious complications may be higher than believed because the few studies that have looked at this area may underestimate the number of adverse events. For instance, some studies may look only for complications a few days postprocedure, while it could take longer for problems to appear. In some cases, parents aren’t happy with the cosmetic appearance after the surgery, which likely wouldn’t be counted as a complication, but may well be in the eyes of the family.

In 2013, Dr. DeMaria and his colleagues published a study that revealed just how great the disconnect is between best practices and reality. They surveyed a group of 62 physicians and surgeons in southwestern Ontario who perform circumcisions. None of the respondents said he had learned how to perform circumcisions in a structured training course. Nearly half of the non-surgeons said they learned how to do the procedure from a colleague. About one-third said they would perform a circumcision on an infant with a concealed penis – a condition in which the penis is hidden beneath excess skin – despite the fact the surgery is not recommended in those babies.

In 2013, the CBC reported on a Montreal doctor with more than 30 complaints made to the provincial medical regulator relating to botched circumcisions. The doctor in question still advertises his services online, with a website that states he has travelled throughout North America to identify the best way to perform circumcisions.

So what can parents do?