Information For ALL Parents - Bris Concerns

You are a parent of a baby boy. You're going to bring a stranger into your life who will circumcise your baby. What do you need to know?

Don't Make Any of These Mistakes [Top Ten List]

You need to know that your baby's health is paramount, and that while most babies are healthy and their bris takes place on time, if a real question comes up, better to have the bris delayed and not be on time, than put your baby in a compromised situation because of inconvenience (such as family flight plans!)

You need to know which method of circumcision your mohel uses [and what is a "shield" vs a "clamp"]

You need to know how he estimates the edge of the foreskin

You need to know if he employs a sterile technique

You need to know how he does metzitzah [See the Metzitzah Page]

You need to know if he does Milah and Priah together or separately

You need to know how he deals with a redundance of membrane

You need to know if there are ever any complications afterwards see also this - "most common issues"

You need to know how to care for your baby

In some cases, you need these Long term Care Reminders:
CHUBBY BABY Syndrome - How alot of baby fat is disheartening for a few months
Fusion Challenge

Bris: One Stage or Two?

I've heard from some people that some of my warning postings are not very positive, [see here and here].

Here is another attempt to explain what happens at a bris, and what may happen at the bris.

During the bris, the mohel attempts to remove all of the ערלה (orlah)/foreskin, and as much of the עור הפריעה (or ha''priah)/ mucosal membrane (that lines the penis below the foreskin) as possible.

With a good חיתוך (incision) the proper amount of foreskin is removed and does not need to be revisited.

Sometimes "all" of the membrane is removed in that incision. Sometimes "some of it" is removed in that initial incision. Sometimes "none of it" is removed.

If any of the membrane remains, a good mohel will do "priah" - tearing and folding back the membrane beyond the glans before bandaging everything up.

Depending on how much of that membrane remains, as well as how it sits below the glans, it may need to be revisited (ideally immediately) either because the "bris" isn't kosher, or because it will be an unsightly eyesore.

So here is the bottom line:

Sometimes the bris goes well in one stage, as the foreskin and membrane are removed in one-fell swoop (so to speak).

Sometimes the foreskin is removed completely during the ceremony, but some of the membrane remains and needs to be removed in a second stage.

Obviously we would all prefer a one-stage and everything-goes-perfect-the-first-time bris milah experience. 

But if a quick revisit, when the wound is still fresh, is necessary, especially if/not doing it could bring asthetic consequences, I make every effort to be up front, honest, and most importantly to take care of it right away so it never becomes an issue. As I've written elsewhere, I much prefer people be angry at me for five minutes than for 5 plus years.

Results matter, and I try to take all the necessary precautions so that the results are pleasing and pleasant for a very long time.

News Monitor: Hamodia Update

I'll bet some will argue that Hurricane Sandy was a sign from heaven that this hearing should never need to take place. Oy. I hope for all who suffered from the storm to get back on their feet sooner than later - with God's help they will.

Most Important Kibbudim

One of the search terms that brought someone to this site recently was "most important kibbudim," so I figured the subject is worthy of a posting.

Other than being the father or mohel, the highest honor at a bris is unquestioningly the sandak.

Beyond the sandak it really becomes a matter of opinion. 

Some might call the "standing sandak" the highest honor. Though whether it was always called that or later called that to give similar honor to the honoree (such as the grandfather who did not serve as sandak) is a question for discussion.

Some might view placing the baby on the Chair of Elijah as a great honor. After all, if the presence of the prophet is noted and invoked through the appointment of this chair to such a role, being partner in placing the baby on this holy space is surely significant.

Some might view the speaking roles as most important - the recitation of the blessings and the paragraph in which the baby is given his name. Every other role at the bris (aside from the father and mohel) is a non-speaking and holding-baby-only role. If you view a speaking role as significant, then this one is pretty important (though the dramatist in me reminds all of the old adage "there are no small roles. Only small actors.")

The catch in this latter group of roles is that the speaker must be a fluent Hebrew reader, and insofar as the blessings go (from my perspective) the one saying the blessings should be an observant Jew - at least to the best of everyone's knowledge.  These factors often leave the mohel as the default person for this role, or the community rabbi. At brisses for Orthodox families, this role might be given to a family member, or a friend who is more cantorially inclined.

My only recommendation is that whoever names the baby not be a person emotionally attached to the name being given to the baby. I have seen too many a grandfather lose control when the baby was named for a recently deceased great-grandfather. 

On the other side, as well, one grandfather with "quite the sense of humor" got up to the part when the baby is named, gave the child his "Name, son of..."  At this point, he is supposed to say the baby's father's name. When he took a longer pause, I thought in the heat of the moment he had forgotten his son's name. Turns out, he paused as if to say to his kid, "who is the REAL father?" People laughed good-naturedly (I think), but if I had to do it again, I would have had someone else name the baby.

Those kinds of jokes are not funny, and while the baby's father "laughed," I don't think he thought it was funny either. "My own father... Sheesh!" 

The Rabbi With the Great Line

On Friday, I was privileged to work with my second set of twins of the week. The difference was that Friday's twins (as opposed to Sunday's) were a boy and a girl. Which means that while the bris took place, the sister was sleeping in her crib.

Anyway, the bris took place at home, where the living room was adorned with signs that say "It's a Boy!" and "It's a Girl!"

The bris spot (meaning where the chairs were set up) happened to be under the pink sign, and before he recited the blessings over the bris, the rabbi of the community remarked, "This is the first time I have ever done this under an 'It's a Girl!' sign."

Thank God for that!

[Photo below is not from the bris in question - I found it online and doctored it for the effect.]

My Article About Bris Milah

I write a weekly column for the Jewish Star in New York - which I reproduce on my Torah/Judaism-focused blog. Last week the topic was Bris Milah - or the Covenant of Circumcision, as it appears in the Torah in Bereshit (Genesis) Chapter 17, Parshas Lekh Lekha.

Here is the link to the Jewish Star      Here is the link to my blog

And here is the text for good measure:

Front page of Sun Sentinel local (Palm Beach County) section

On Tuesday October 23, 2012

All good except the man in the white coat's first name is AVI

More twins!

Interesting Stimulus Response

I just came across this article, which includes a link at the end with a response from the "other side" (my side).

http://www.tikkun.org/nextgen/my-body-my-choice-ban-non-consensual-circumcision

And the response

http://www.tikkun.org/nextgen/becoming-a-jew-is-dangerous-circumcision-is-the-least-of-it

Were I to respond to the original author (and I might here eventually) [Update: Response Part I, and Response Part II]  I would take issue with a lot of his points. I'll just respond to one here, becomes it is brought up a lot by people who make similar arguments:

The author quotes Maimonides - and takes the same quote that many people who areanti-circumcision like to quote from "The Guide tothe Perplexed" [3.49 (118a), 609] in which Maimonides expressed how circumcisiondecreases physical sensitivity. 

But their quotation of Maimonides is always incomplete, and therefore intellectually dishonest. Maimonides is coming from the perspective that there is a lot more to life than "running like chickens to one's bedroom."

In the part they don't quote, Maimonides outlines why we circumcise. Avraham was the first to recognize the power of the male "drive" and the need to have other pursuits in life [see Hilchot De'ot 3:2]. More importantly, in his day (certainly before any notion of routine circumcision that exists in the United States today), circumcision gave our people a common physical sign of our peoplehood, along with the faith that this is what God has asked of us. 

The covenant forged with Avraham, in which God agreed "to be a God for you and for your children after you" [as described in Bereshit 17] is the source for declaring God's oneness.

[As to Maimonides' real reason for why we circumcise, see here]

Maimonides states unequivocally that the Torah cannot be properly fulfilled without circumcision. He shares three points of wisdom in the process of circumcising at this age: 1. Were we to leave it for the child to do when he grows older, there's a great chance that he wouldn't do it. 2. The long-term pain experienced by an older person, who will add emotional stress to the ordeal, does not compare to the when-it's-over-it's-done experience of a newborn 3. Submitting a newborn to circumcision is much easier than an older child, for whom our love only grows over time, who experiences pain differently and who might remember it.

To Maimonides first point here, the author of the first "Tikkun" article quoted above might say, "That's exactly my point!" But to a Jew who has faith in God and appreciates that life itself is a gift from God, and that our bodies are given to us to house our souls, circumcision is a non-question. [See a discussion on the subject of God's creation versus Man's intervention here]

To the second point (which follows, once we assume circumcision will be taking place), Maimonides is essentially arguing that when a child is newly born, circumcision is not as traumatic as it might be at a later age. As a mohel, my experience echoes such a sentiment. Most babies are calm and cooing minutes after their circumcision, if not resting quite peacefully, and no worse the wear. Contrast this with the father of a baby, who was born in Russia, and told me how grateful he was that this was being taken care of in infancy while he personally was circumcised at age 18 and remembers the pain of the experience as one of the most difficult times in his life ("Couldn't walk for weeks!").

These days, even many Muslims have switched from the older practice of circumcising at 13 or a younger age of childhood, opting for the newborn period, which is far less traumatic and entirely forgettable.

CONCLUSION

I readily admit that in the general culture the to circ or not to circ question is a legitimate one that people can debate. But for Jews who observe this commandment, there is no question, need for further rationale, or discussion to be had (aside from "which mohel," "where will the party take place" and "who is catering").

With blessings for happy occasions and many celebrations of the births of Jewish children, and the occasional bris (on the boys only), may we continue to fulfill God's commandments until the end of time.

Should the Father DO the Circumcision?

Most fathers (and certainly most mothers) will answer "NO!"

For this reason, I've outlined the Father's Role here, and also told the story of a father who got lost in the moment when circumcising his son (don't worry - everything turned out OK). I've also addressed the emotional downside that may accompany the first time a person does the circumcision act (see here, most notably paragraphs 6-9).

When I did the bris that was the inspiration for this blog post, the father of the baby wanted his own father to do the circumcision. When the father saw me set everything up and observed his father make the incision, he spontaneously remarked, "That's IT? I'M doing it next time!" [Once the moment of the incision has arrived, if the mohel has set things up properly, it is a simple matter of sliding a scalpel across a metal shield, literally like cutting soft butter.]

The simple answer to the title question is if you know what you are doing, you have an awareness of the anatomy, and can maintain poise in the heat of the moment, then you can do the bris. Nonetheless, you don't have to do it yourself, because appointing a mohel to serve as your "Shaliach" (Agent) on your behalf fulfills your responsibility adequately.

But the Torah says, וימל אברהם את יצחק בנו בן שמונת ימים כאשר צוה אותו א-לקים, that Avraham circumcised his son when Yitzchak was 8 days old. He did it himself, without an agent.

The Shulchan Arukh expresses, in the first of the Laws of Milah (Circumcision) (Yoreh Deah 260):

מצות עשה לאב למול את בנו, וגדולה מצוה זו משאר מצות עשה.
"It is a positive commandment for the father to circumcise his son. And this mitzvah is greater than every other positive commandment."

To be fair, the "greatness" of this mitzvah lies in the fact that if the mitzvah is not done there's a significant (and quite serious) spiritual consequence. But this could mean that "if the father does not see to the circumcision being taken care" i.e. through a person trained to do so, that such a consequence would come into play.

Bottom line is that the mitzvah is the father's to do. Most fathers are not trained and are happy to have the mohel do the brit milah on their behalf. But if this is something which is of interest to you, even remotely, and baby's mommy is cool with the possibility of your playing this role, I am happy to have the conversation and see if it will work. I have done set it up for many fathers, with an excellent track record.

IT ISN'T FOR EVERYBODY, CERTAINLY NOT THE FAINT OF HEART.
But if you are interested in at least exploring or finding out more, there's no harm in having a conversation.

My Metzitzah Article in the Jewish Week

In the heat of the Metzitzah Debate raging in New York City in the Summer of 2012, I wrote this opinion piece which was published by the Jewish Week. Here is the link to my article (text follows below)

http://www.thejewishweek.com/editorial-opinion/opinion/metzitzah-changes-require-rabbinic-leadership-0

The sources that needed to be left out of the article due to space limitations will follow the text of the article below.

Metzitzah Changes Require Rabbinic Leadership

Tue, 09/25/2012

Avi Billet

Special To The Jewish Week

Rabbi Moshe Mordechai Epstein (1866-1934) was widely considered to be one of the more impressive Talmud scholars of his generation. In his “Levush Mordechai” (Ch. 30) he writes, “If anyone were to suggest doing metzitzah with the mouth, we would say the worst things about him because there is nothing more disgusting [than] placing a wounded [bleeding] organ into the mouth. Especially that organ.” His conclusion, however, is that “since it is a mitzvah, there is justification.”

He compares metzitzah b’peh to circumcision itself, arguing that we only do both — against, perhaps, what logic might dictate — because they are mitzvot.

That circumcision is a mitzvah is clear from Genesis 17 and Leviticus 12:3.

But Rabbi Epstein view represents only one side of the debate about metzitzah — it, unlike circumision, isn’t in the Bible. It first appears in the Talmud (Shabbat 133a), but the method and mitzvah-status is absent from the Talmud and most sources until the Middle Ages. Even Maimonides and the Shulchan Aruch mention metzitzah but leave out any mention of putting the mouth directly on the wound.

The question is, does the Talmud view metzitzah as a requirement or as a medical suggestion?

According to the Talmud (Shabbat 137b), removing the foreskin but leaving the membrane [“milah” without “priah”] is an incomplete circumcision: it will need to be redone.

Not so if metzitzah were skipped. Rav Pappa says, in Shabbat 133b, “One who skips metzitzah must be removed: he is putting the baby in danger.” Note how “no metzitzah” does not produce an invalid bris. It reflects badly on the operator, not the operation.

Conclusion: metzitzah was more a medical suggestion than a mitzvah requirement.

Rabbi Moshe Feinstein, the leading 20th-century American Orthodox decisor, certainly supported the act of metzitzah. But he wrote that metzitzah is not part of the mitzvah, and a bris without it is kosher. There is, therefore, no conclusive obligation to do it in any specific way.

The polemics favoring direct-contact oral suction are relatively new (mid-1800s), typically attributed to a reaction to the Reform movement’s efforts to abolish Jewish practices that did not conform to modern sensibilities.

Early Reformers certainly saw metzitzah (and circumcision) as barbaric. The “Orthodox establishment” reacted quite strongly, upholding the practice of metzitzah specifically with the direct oral contact method (MbP), to take the strongest stand against the destruction of Judaism as they knew it.

I believe this mid-1800s attitude guides the defenders of MbP today. If they had the common sense of Rabbi Epstein, they would scream from every hilltop that MBP is a disgusting practice to be abolished. Combining this approach with Rabbi Feinstein’s “obvious” understanding, would demonstrate that metzitzah in any form is not even considered part of the mitzvah.

MbP made sense in a medicine world defined by the Hippocratic method. But in our world, with knowledge of germs and bacteria, the practice is unacceptable.

Those arguing against the proposed law in New York State claim that if MbP is outlawed, bris milah will be next. I strongly disagree because I don’t believe bris milah is in danger in the United States of America.

The American Academy of Pediatrics recently issued a report [see policy statement and press release and some links on their website] stating that there are clear medical benefits to circumcision that outweigh the risks of the procedure. They don’t endorse the practice, but they don’t discourage it either. Most U.S. hospitals offer circumcision as an option, and parents make the choice for their sons.

Furthermore, there is no need to defend bris milah from the Reform movement — there is a Reform Berit Milah Board!

I agree, however, that government should keep out of regulating this religious practice. Government does a fine job of warning smokers not to smoke, without mandating waivers. Along with doctors, medical professionals and rabbinic leaders, government can issue similar warnings regarding the dangers and risks of MbP. This should not come at the cost of a fine or legal action by the state.

I am a mohel, and I practice metzitzah in a halachically approved manner, using a sterile tube powered by the mouth (which makes it “b’peh”). It fulfills the needs of those who require metzitzah and has the added benefit of providing zero risk to the baby. It also elevates the mitzvah of bris milah and makes it appealing even to Jews who are not observant.

Three final thoughts:

First: A father who insists on MbP should do it himself. Bris is his mitzvah, he shares his baby’s DNA, and he may run the risk of infecting his baby or himself if he and his wife agree to the procedure. What makes any mohel’s mouth, no matter how pure and holy the man is, a bastion of germ-free saliva?

Second: Government intervention will not stop people from doing what they think their religion tells them to do. A law against the practice will push people undercover where they will do it anyway. This too is unacceptable — the United States is not Czarist Russia.

Third: Change must come from within. Rabbis and yeshiva leaders in these communities must ignore the insistence of their followers that this practice be maintained. Rather, these leaders must teach that metzitzah with a sterile tube is not only an acceptable option (Rabbi Elyashiv, the Israeli sage, said it is acceptable in 1989), but should really be the only option.

Without the rabbis preaching a different tune, nothing will change. And while the babies who die from metzitzah are rare, fortunately, the only acceptable number of metzitzah-related infections or deaths is zero. As long as direct-oral-contact metzitzah continues, any rabbi who does not ban the practice is partly responsible for negative metzitzah outcomes.

Avi Billet is a traveling mohel who blogs about bris milah at www.mohelinsouthflorida.com

Levush Mordechai – can be found here - http://hebrewbooks.org/pdfpager.aspx?req=978&st=&pgnum=82&hilite=

Talmudic mention of Metzitzah - Shabbat 133a

Maimonides - Laws of Milah 2:6

Rabbi Yosef Cairo - Shulchan Arukh O"C 331:1 and YD 264:3

Milah and Priah as requirements - Shabbat 137b; and Shulchan Arukh Y"D 264:5

No Metzitzah = Bad operator - Shabbat 133b

Rabbi Moshe Feinstein that metzitzah is not part of the mitzvah - YD I:223, last paragraph

Rabbi Yosef Shalom Elyashiv saying tube is acceptable - Kuntres Shaarei Halachos 16, page 30, edited by Rabbi Menashe Klein, 1989 – which can be found here: http://hebrewbooks.org/pdfpager.aspx?req=4427&st=&pgnum=32

Amazing Story

At a recent bris, the baby was named "Refael Pinchas Zev."

Giving a baby one or two names is common. Giving three names is far less common. When I expressed interest in "why 3 names?" I was told by the baby's father, that the baby was being named after his [the baby's] grandfather, a young grandfather who passed away a couple of years ago in his early 60s.

Refael Pinchas Zev's dad then told me his father's story.

"When my father was 44, he suffered a major [malady] which sent him to the hospital. I was a young kid. My sister and I were told "Go say goodbye to your father. He is either going to die; or, if he survives, he'll be a vegetable."

As you can imagine, this was a very difficult thing for young kids to hear.

The family's rabbi was there as well, and he suggested they add a name. This follows an ancient custom that essentially argues that if God has made a decree on "Shmuel," He has not made the decree on "Chaim Shmuel." The hope is that changing the person's name will help give the person a different chance in the workings of the heavens.

But the family did not want to add the word "Chaim" - meaning "Life" - because the doctors had said that if he lives, he'll be a vegetable. Instead, they chose to add the name "Refael" which means "God heals." If the name change "works" we pray that he is healed and gets better.

The catch to the story is that the sick man's mother was involved in saving some member[s?] of the Belzer Rebbe's family during the Holocaust. It was proposed to contact the Belzer Rebbe. Perhaps, in the merit of the deeds of the sick man's mother for the Belzer Rebbe's family, perhaps the Belzer Rebbe could participate in the prayers on behalf of her son.

Contact was made, and the Belzer Rebbe recited the prayer at the Western Wall, changing the name from Pinchas Zev to REFAEL PINCHAS ZEV.

"At the moment that the Belzer Rebbe changed my father's name," Baby RPZ's father says, "my father's vitals improved. He had a complete recovery and was out of the hospital in a fairly short amount of time. And he lived another 19 years."

In general, I am wary of stories like this that come from third party individuals, or from people who heard a story once... But this story is amazing because it comes from a person who witnessed and experienced it. AND it really makes you wonder "coincidence? or power of prayer?" My vote is on the latter.

Of course they gave the baby the grandfather's three-name name. Pinchas Zev no longer existed. It was Refael Pinchas Zev who had the new lease on life. And we certainly wish the new Refael Pinchas Zev to have a very long life, with good health!, bringing joy and nachas to his parents, grandparents, great grandparents, etc.

Chubby Baby Syndrome

Thank God, most brisses I do look pretty nice after the bandage comes off. Even when there is some swelling and things don't look "amazing" immediately, time usually corrects things and within a week or two swelling goes down and the look "fills in" and "evens out."

In some cases, a few months down the road I'll get either a phone call, email, or chance encounter when the question of "why is his penis disappearing into the shaft?" comes up.

I've blogged about this before. Suffice it to say, my initial reaction is always, "Does your baby have a lot of baby fat?" 100% of the time the answer is, "Yes! His legs are nice big pulkies" (or some similar euphemism for 'quite large').

THIS is the reason behind the "look" which was not apparent when I finished with my care of the baby post bris. With the exception of some newborns who are born larger, most newborns are born between 6-8 pounds, perfectly apportioned with no significant baby fat.

But once they've been around for 2-6 months, and their bodies have discovered food, it deposits most of the baby fat quite significantly into the legs and groin area. Compound that with the constriction of the diaper, plus a lot of time on the back, and a chubby baby may very well have a tip of the penis (the glans) finding itself squashed with nowhere to go but to sink into the shaft, or, worse, to have the skin of the shaft climb up and adhere itself to the rim of the glans giving the penis a partially circumcised look. Parents will understandably be concerned.

This is why I try to remind everyone of what "may" happen in the event your baby becomes chubby.[Of course, some people never experience this at all.] Therefore - nip it in the bud! Be vigilant! Make sure the glans is always separate and distinct every time you open your baby's diaper. Sometimes the diaper is as much at fault as the baby fat. Neither of these are a "fault," per se, as both are really par for the course. But if parents are aware and know to keep the glans separate from the shaft, most of these "problems" will never come up.

Call if you have a question. I am always happy to come and take a look to tell you what you are seeing. And remember it is better to call earlier, when baby is 2-3 months old, than later, such as from 6-12 months old. In either case you can be shown what to do to train the skin the right direction. But the more it drags on, the more uncomfortable it can be for the baby.

Another Funny Exchange

Right before the bris, I always remind the father that he must appoint me as his agent to do his son's bris on his behalf.

Today, the father said in response, "I appoint you to do my bris."

Not expecting THAT, I told him I'd be happy to do his SON'S bris.

After a loving chuckle circled the room, the error was corrected and everything proceeded according to original plan!

The Footnote

I recently received an email from a journalist who wrote "[I] am working on a story about the decline in circumcision rates in the U.S., pegged to a new study released today by researchers at Johns Hopkins. I’m curious to know whether or not you and other mohels have been affected by this “decline” and would love to include your input in the piece."

In addition to offering to speak and continue the conversation, I wrote back to her "Those declines are probably more in the hospital arena. Mohels typically service clientele who are circumcising their sons for religious reasons, as opposed to for medical reasons. The anti-circumcision movement (as well as medical opinion) has little to no influence on Jewish people. Jews who choose not to circumcise are a very small minority, and, in my opinion, are generally further from Jewish observance and Jewish life" (the last sentence might not be fair, but I am entitled to an opinion.)

To back what I said, an article came out this week which - following the leadership of several doctors - declared that benefits of circumcision outweigh the risks of the procedure.

http://www.vosizneias.com/112438/2012/08/27/chicago-us-pediatricians-benefits-of-circumcision-are-outweigh-risks/
http://www.huffingtonpost.com/2012/08/27/new-circumcision-guidelin_n_1826069.html?utm_hp_ref=email_share

I once articulated the Jewish perspective on this, concluding with a wonderful quote from Herman Wouk's "This is My God." Enjoy

Afterthought to anti-circumcision groups

            Jews who choose to have their sons circumcised do so either because they believe in the Biblical mandate of Genesis 17 or because they believe the bris to be an important ingredient for the continuity of the Jewish people. No matter how much anyone will argue of the needlessness or barbarism of this male “genital mutilation” the Jewish people as a whole will not be swayed and will continue to practice this rite.

[F]or Jews circumcision … is not a detail of hygiene, [but] the seal of the pledge between Abraham and his Creator… The Jews have followed the Mosaic law with a confidence which modern medicine progressively ratifies.  The medical endorsement is not, however, the glory of Judaism.  It is a footnote.

-         Herman Wouk, “This is My God”

News Monitor: Germany (positive and negative)

Hat tip to vosizneias.com for keeping us all up to date on what's going on in Germany with regard to circumcision - and of course how it translates.
Here are two links to recent articles (today being 8/21/2012):

http://www.vosizneias.com/112103/2012/08/21/berlin-israel-chief-rabbi-in-germany-over-circumcision-talks
http://www.vosizneias.com/112126/2012/08/21/bavaria-germany-report-for-the-first-time-german-rabbi-criminally-charged-for-performing-circumcisions

Read them at your leisure, weep or enjoy.

A Metzitzah Appeal - guest posted

A friend forwards a weekly email sent out by Rabbi Dr. Ronnie Hasson. The Rabbi Dr. is a Sephardi, and his perspective here is one all Jews should take heed to and follow. What he advocates is my personal practice (as I have advocated in my postings regarding Metzitzah), and I post it here because his arguments are sound, and, as a doctor, he writes from experience about the things he has seen in cases when metzitzah does not go "as planned."

Share with everyone you know who may be the parents of a baby boy in the future!

Protecting our children

Our children are our most valuable and precious assets.  It is our responsibility as parents to do everything we can to protect them.  This is why we buy car seats,  choose the best doctors for our children’s health, only leave them under the care of responsible adults that we know and trust, etc.  There seems to be one exception to this rule.  When it comes to the Berit Mila, many parents don’t understand how dangerous it can be and that it is a serious medical procedure.  If the child had hypospadias we would look online, do background checks, see what school the doctor went too, etc.   We would do everything to find out exactly what procedure the doctor is planning on performing on our child.  We would ask him to do it in the best hospital with the utmost sterile technique, etc.  Now imagine yourself in the observation room, watching this expert doctor correct your child’s hypospadias.  There are several doctor’s and nurses in the room.  They dress each other meticulously in sterile gowns, with sterile gloves (not just the ordinary gloves used day to day), they clean the area very carefully and have a completely sterile field.  Now imagine in the middle of the procedure the sterile field was compromised.  Someone touched the area with their bare hand, or worse spit on the exact area where the incision was made with their bacteria and virus filled mouth.  Not only would the doctors immediately re-sterilize the field in panic, but you would jump out of your seat and run down to the operating room yourself, that person would certainly lose his job and most likely face criminal charges which might include jail time, etc. 

Yet we still allow this to happen every single day in our own communities.   It is so sad to see rabbis stand by idly, community members and doctors just sit there, when a mohel takes his mouth to the baby’s berit mila site and suck on it and spit because he believes that medieval (otherwise known as mid-evil) medicine is the best medicine.  It is absurd, it is dangerous, it is literally killing Jewish babies and almost no one is doing anything to stop it.  No one except the governments of the places we leave.  With thanks to God, the politicians who we all love to hate, are doing more to save Jewish babies then any rabbi, community leader, or doctor has been doing. 

In New York City, Mayor Michael Bloomberg (Hashem yehyehu ve’yishmerehu) said: ““There are certain practices that doctors say are not safe and we will not permit those practices to the extent that we can stop them…You don’t have a right to put any child’s life in danger, and this clearly does.” The Dept of health added: “There is no safe way to perform oral suction on any open wound in a newborn. To protect infant health, parents considering ritual Jewish circumcision need to know that circumcision should only be performed under sterile conditions, like any other procedures that create open cuts, whether by mohelim or medical professionals.”

Dov Hikind of course was quick to criticize the mayor for trying to save Jewish lives.  It is understandable, that Jews, and especially Esheknazim, would be very worried when they see governments begin to make policies regarding Jewish ritual and practice.  We have too often in our history seen this as a form of anti-Semitism to ban Jewish practice in the region.   What Dov Hikind failed to notice is that Michael Bloomberg and NYC are not anti-Semitic and are not creating these policies to harass Jews rather to protect them.  If the rabbis and Jewish community leaders did their job and controlled the mohalim from their dangerous and outrageous practices, then the city would have not had to step in.  Bloomberg gave more than ample time and warnings to the rabbis to put a stop to the practice themselves so that the government would not need to step in, but time and time again they refused to do what was necessary to protect our children.  Dov Hikind asked where is the respect for our traditions? I would ask Dov Hikind to show us what tradition he is referring to.  There is absolutely nowhere in our tradition that states that a Mohel needs to put his mouth on the babies berit site.  NOWHERE!! I challenge anyone to find any traditional Jewish source that says so.  There is absolutely no reason why a gauze or a glass pipette can’t be placed as a barrier to protect the baby.  For God’s sake, when we see a man dying in the street, we find a barrier, such as a mask, to place between our mouth and his before performing life saving procedures.  But our most delicate and sensitive newborns, for them we can’t do the same.  It is absurd, it is criminal, it is irresponsible, it is simply murder and it must not be tolerated not one more day.  Reports show that from 2000-2011, there has been at least 1 baby every year that contracted herpes from this procedure, 2 of which died, and many of which suffered with the disease that can be incurable.  At 3-4 babies in Israel are infected every year.

Some Mohalim try to convince parents that it is safe and that they were tested and disease free, blah blah blah.  There is only one correct answer to that – please do not put your mouth directly on my child’s berit mila site or I will call the police. It doesn’t matter how safe the mohel thinks it is, there is simply no reason to do it since no Jewish sources say it must be done without using a barrier, so why not be healthy safe and clean and use it?

Inspired by the push by Bloomberg to protect Jewish babies the Israel Ambulatory Pediatric Association (IAPA) has followed suit and has called for the discontinuation of the practice of metzitza without a barrier. IAPA wants Israel’s Health Ministry to require maternity wards and clinics to advise parents that metzitza b’peh is not necessary. It is one thing to bicker about exactly how much matza you have to eat and what a kezayit really is or if you are allowed to carry in an eruv, it is another thing to use this pilpul and silliness to defend dangerous practices on our children.  There are many articles both in Hebrew and in English written, both in Israel and elsewhere, that prove and show without a shadow of a doubt that there is absolutely no reason in the Jewish tradition to perform Metzitza without a barrier to protect the child.  We can not allow not even one more child to die or worse suffer the devastating herpes encephalitis that I have seen destroy not just the babies’ lives but the lives of the entire family that have to spend the rest of this child’s life watching him suffer with this most horrific preventable disease.  I have also written an article explaining all there is to know on this topic and am happy to forward it to anyone who is interested (email me at parasha@hassonmd.com).  

Next time you are at a berit milah, ask the parents if they spoke to the mohel about this and if he assured them he will use a barrier (or simply avoid the procedure all together).   If they have not do not let the mohel anywhere near the baby till he guarantees that.  According to Jewish Law, even if the parents forgot and now it is the morning of the berit, one should excuse the mohel of his duties if he refuses to use a barrier and I would argue this is the case even if there is no other mohel available and the berit would have to be postponed.  Safek Pikuach Nefesh dohe – a possible risk to life is more important than performing it on the 8^th day.  Those who have not worked in a hospital taking care of these children simply do not understand the dangers and the terrible disease this procedure can cause.  I have seen it with my own eyes as have many physicians that take care of these children.  I would suggest that one of the community organizations sets up a task force to call the mohalim and publish which ones are approved that they use a barrier and which ones should not be used so that parents are better informed.  The community should send a representative to every berit milah to supervise and assure that our children’s safety is being protected.  We do this by bringing in police to talk to the community about bike helmets, and pool safety, why not on Berit Mila safety as well. There are many mohalim in Brooklyn and even in the Syrian community that have gotten caught up in the Hasidic nonsense of not using a barrier and it is time we eradicate the practice today. May Hashem protect all our children so that they grow up healthy, but He can’t do it without our help

We'll Call Him... (A Tale)

This is a humorous tale about a bris that I heard second-hand from a friend many years ago (please note that it does sound a lot better when I tell it). On account of this week's Torah portion being Pinchas, my brother reminded me how much he liked the tale. Inspired, I share it here.

The rabbi/mohel was hired to do the bris for a non-observant family. Apparently, he neglected to discuss the baby's Hebrew name - which is always given at the bris, unless the bris is delayed a significant length of time such as for medical reasons.

It is the moment of truth. They are up to the paragraph in which the baby's Hebrew name is announced, and the mohel turns to the parents and says, "What name have you chosen for your son?"

They mention his English name. "Very nice. But what Hebrew name are you giving him?"

They hadn't discussed it. So they have a very quick conference. And they come back with "Esau."

Anybody hear crickets? Esau - עשו - or Eisav (in the traditional pronunciation), the traditionally villainous brother of Jacob.

The mohel hesitates. And then a voice comes from the balcony in the synagogue. "No. No. Pinchas."

The mohel pauses - a voice of reason! The parents say, "Don't listen to her."

Mohel: Who is she?
Parents: She's the baby's great grandmother.  [Apparently the family's only connection to the old country and traditional Judaism]
Mohel: Who is Pinchas?
Parents: It doesn't matter. Just give him the name we gave you.
Great-G: Pinchas Pinchas.

The mohel, in a bind between giving the baby a name that just doesn't smell right (he'll be called to the Torah at his bar mitzvah with this name, and it will be written on any legal Jewish document he ever has his name on) and a sensible Biblical name being presented by a woman who is definitely not the baby's mother, comes up with the plan to save face and bring our tale to its dramatic conclusion.

In a voice booming with authority he asks, "Alright. Who is paying for the bris?"

The parents sheepishly pointed at Great Grandma: "She is."

Mohel: And let his name be PINCHAS.

News Monitor: Germany - Anti-Semitic or Uber-Liberal?

[UPDATE: Here is the follow up article to what I blogged about below - the 'Outraged Jews Respond']

The Times of Israel reported today that a German court declared circumcision illegal, barring out of medical necessity.

The article states "The case that prompted the ruling took place in Cologne, when a 4-year-old boy, circumcised by a Muslim doctor, began bleeding two days after the surgery and needed to be brought into the emergency room."

If the "Muslim doctor" is really a physician (as opposed to someone like a mohel who is often not a physician), then saying that he is Muslim is really irrelevant. This was a medical procedure and either the operator (if indeed the physician is at fault), or the patient (who may have clotting issues), or the parents (who did not care for the circumcision wound properly) are at fault. And this is to be chalked up as one of the more uncommon statistics. [The doctor was apparently acquitted in the suit - it was the judges who took the case a step further to outlaw circumcision]

I am not saying circumcision is comparable with cosmetic surgery, but elective surgery often brings the desired results, and sometimes it does not. [I am also not raising the argument of whether parents "have the right" to do this to their children. There are enough voices in the medical community arguing that circumcision is either beneficial, good, or not harmful to make the pro-circumcision side a legitimate opinion.]

The article also says "The recent landmark decision will likely draw the condemnation of Jewish and Muslim communities, although official representatives have refrained from commenting so far, saying they first want to study the reasons given for the judgment." Which, I guess, is reasonable. Certainly more reasonable than the judges taking one case and deciding on national policy.

"... the district court rule[d] that the circumcision was a “severe and irreversible interference into physical integrity.”

Physical integrity? There are literally hundreds of millions of males in the world who are circumcised. None of them have "physical integrity?" What on earth are they talking about?

Smoking causes lung cancer: has smoking been banned?
Tanning salons cause skin cancer: has tanning been banned?
Elective plastic surgery can go horribly awry: has it been banned? (talk about "physical integrity"...)
Earrings? Any piercings? Tattoos? Braces? Cavity fillings? catheters? Ear tubes for ear infections? Cochlear implants?

If you live in a world in which people enjoy freedoms and there is officially religious freedom, then responsible circumcision falls into the category of untouchables. As I have written in my "Bris: Not Barbaric" posting - most circumcised people do not put a moment's thought during the day, during any given week, or much at all during any given year to the fact that they are circumcised. There are many women in the anti-circumcision camp, and there are men as well (circumcised and uncircumcised) who play a role in the anti-circumcision camp. And, in general, I think they have a little too much time on their hands.

But governments and courts should stay out of telling people what they can and cannot do. We're not talking about the amputation of a limb. The removal of the foreskin does not change the way the penis functions. It may remove nerve endings and alter the appearance. But it gets rid of phimosis (which ends of helping many babies finally urinate properly), it makes the cleaning of the penis very easy, it removes the possibility of growing smegma, and, down the road, it significantly lowers the incidence of certain STDs and other penile-related diseases. And, of course, a circumcised male can enjoy intercourse and father a child just fine, all without a foreskin.

It's not for everybody, and that's OK. But to "ban it" as official "law of the land" on account of one incident is uber-liberal thinking. I find it ironic that all the people who claim "God made you this way" are usually the ones who have no concept of God, religion, etc who smear religions, religious individuals, and religious choices. But when God is convenient, they use God to bolster an argument, not appreciating the rights of others to understand God the way religions have taught for centuries and millenia.

To ban circumcision otherwise in the 21st century (which usually stems from anti-religious thinking) - this is a 200-years step backwards into the realm of feudal lords, czarist regimes, and fanatical irrational despots who had nothing better to do than impose their own will on the people, or make a religious life that conflicted with the despot's view into a very very difficult undertaking.

Shame on these judges.

Does the Baby need a Kippah/ yarmulke?

It depends who you ask. Bubby or Grandma will tell you "YES WHAT'S THE QUESTION HOW COULD YOU EVER THINK OTHERWISE?!?!??"

If you ask me, I'll tell you the baby doesn't need it. A head covering of this style is for a person who is saying blessings, who is personally demonstrating or who needs a reminder that God is above him.


As a baby makes no such conscious choice in his demonstrations, and certain isn't giving himself any reminders - and he's not saying any blessings, he does not need a Kippah. 


To compound this point, recall that most kippahs made for babies do not sit on the head without being tied by a string. The string goes around baby's neck. That makes me a lot more nervous than his not having a kippah on his head. 


In conclusion, I don't recommend it for the bris itself. If people want to put it on the baby when he is calm (not having his bris) for photos and the like, you are of course welcome to do so. 


But during the bris when the baby has enough stress to deal without our potchkering over whether his kippah is staying on his head, I vote for NO KIPPAH. (Sorry Bubby)

Not Understanding the Bris

Hat tip to Susanne Goldstone-Rosenhouse who brought this to my attention. The link she shared was here, though I have linked to the video on YouTube below

In this day and age, much credit goes to all Jews who continue Jewish traditions. Those who are entrenched in them and understand the reasons for what we do probably have an easier time with it, while those who are either traditional, less observant, or unaffiliated get credit for maintaining traditions - especially when the connection to what is called the "Mesorah" (heritage) is not as ingrained as it is for those with a Yeshiva education and upbringing.

So this video, coming out of Israel, is - in a sense - not a shock. At the same time, it completely misses the point of what this is all about.

The parents of this baby certainly get the "bad taste of the year" award. But seriously, how dare you not "bring" the baby (as in, carry him) to his bris? The bris is about kedusha - holiness - and while I randomly get emails and facebook notifications from the anti-circumcision wackos who clearly do not understand why we do this - if this is the image of what leads into a bris, I too want no part in it.

We circumcise our sons because we were commanded to by God. Abraham circumcised himself and the people in his household. He circumcised his son Yitzchak, when the baby was 8 days old. He forged a covenant with God which was transmitted to his descendants through this mark in the flesh. And the promises, which have sustained the Jewish people, are enumerated in Genesis 17

At Sinai it became more than a tradition for the Abrahamic family - it became a commandment for the Children of Israel forever (as per the interpretation of where all mitzvot come from, even those seemingly given before Sinai, according to Maimonides).

The "kedusha" (holiness) aspect is why we continue to submit our sons to this, what thousands of pages about bris milah have been written to underscore, and what the bris experience should be all about. And holiness requires reverence, and good taste, and, in the context of a newborn, loving and caring hands.

[As to the question of whether a bris can be done without a kvatter - the answer is Yes. Every aspect of the ceremony we have today, with the exception of the circumcision itself, is a custom that does not make or break the bris. If parents were to want to have the bris done privately, without anyone present but themselves and the mohel, that is fine, and the bris is good.]

ps. The over the top part reminds me of this. But the fireworks and the music (which we thankfully can't hear in the video) takes this to a whole new level.

News Monitor: Metzitzah Update

This report was just issued by the Centers for Disease Control and Prevention:

The report includes text and charts and essentially concludes what has been said on this website all along.

Metzitzah with direct oral contact does not always cause an infection. It may even be considered fairly uncommon. But it CAN happen. Babies are at risk of infection with this "ritual."

On the other hand, and while the report does not say this, I will say that metzitzah with an alternative method in which the sterility factor can be controlled and measured will not cause an infection. Ever.

For an objective (albeit lengthy) explanation of why metzitzah is done and the methods some utilize, see here.

For more on Metzitzah, see the Metzitzah Page (linked above)

A Skilled Operator

Many of the people involved in yesterday's bris are medical people. The baby's mother, and both of his grandfathers (to name three). One grandfather was sandak, and the other (the oral surgeon) was standing alongside watching carefully.

Both had very complimentary things to say (full disclosure: they both know me forever and this is the third bris I've done for the family), but my genuine impression was that they were impressed.

The sandak grandfather told me twice how much he enjoyed watching me work.

The "watchful" grandfather told me "I can recognize when a person is good at his craft. There is another mohel, I won't tell you who, who takes too long, has the baby crying too much, and there's too much blood."

It happened that the baby yesterday barely cried, which was unique. However, I appreciate the fact that I can work relatively quickly and that things can go as smoothly as they did yesterday.

It's not always the case - things do sometimes happen - but the smooth and easy days are the ones that are the most enjoyable.

Getting Around Florida

On Friday I was in Gainesville for a bris.
Today (Sunday) I was in Orlando for a bris.

One-day trips are fun - the trip in and trip out require me to be at the top of my game (so to speak), because it is much harder to make follow up visits to these distant places.  I wrote about the limited time span and attention I give the baby here.

But in these last two trips (as in other cases I have not blogged about - or mentioned in this context), I rechecked the baby either an hour after the bris, or right after the bris, and found that he could be left with either a tiny bandage or NO bandage, and everything worked out beautifully.

No bleeding and simple care instructions for parents are the best results I could hope for.

I thank God these experiences went so smoothly. 

And, as always, I am grateful to the parents who put their trust in me, who seek me out even though I am not local.

Books About Bris

Three years ago, the seforim blog posted about Milah Books and Manuals, most of which are in Hebrew and have spanned all kinds of ranges of subject matter and target audiences. The blog post may be of interest to some people. So here is the link.

Bris: Not Barbaric

Someone sent me a message on Facebook which said something along the lines of "What kind of person harms the integrity of the genitals? How do you live with yourself?" As I have mentioned here, this is not the forum to respond to the anti-circumcision people. This is a pro-bris website. So I choose to ignore (as in, not respond) to comments like this, because they serve no purpose. But in the event that an anti circumcision person comes across this discussion, I will try to explain here what I believe you (the anti-circumcision person) might not be able to understand.

Denuding the Shaft

I have written about this before, in the context of a discussion about arrogant mohels, and in the context of a bad story I was told by a baby nurse I worked with, and I hinted to it when I recounted a conversation I had with a urologist-grandfather with whom I worked directly. And I mentioned here why I would personally do my research in this regard were I to look for a mohel myself. Alas, being a mohel, I knew who was going to circumcise my sons.

But now I am calling it what it is.

A List of Brisses

My brother sent me this photo (taken with a smart phone - as I think the shadow indicates) of a list that is described as part of a "letter [which] lists twenty-one people circumcised by Moses Mendel Seixas between 1775 and 1796."

I hope the short list of a 21 year period is indicative of a small Jewish population at that time - and not the particular skills of the mohel in question. Although I am quite curious as to what the word that seems to say "dead" after 3/4 of the dates would indicate.

Another Article on Metzitzah

This time in the Jewish Press

The author is the same Dr. Gary Gelbfish, whose article I posted over here.

In it, he sort of responds to this article by Dr. Daniel Berman (I have not linked to this article until now)

Essentially, he suggests that a complete panel of physicians gather to weigh in on their perspectives to the rabbis - with facts and opinions about the efficacy of mixing the germs and bacteria of the mouth with an open wound (knowing what we know about all these things)

News Monitor: Metzitzah and Herpes

This from the Jewish Week.

There are those who may call the Jewish Week all kinds of names, and may disagree with their at-times slanted approach. But I don't think they are off on this one. I think sensible people want to protect babies, and don't believe that any part of the bris should "possibly" put the baby in danger (with the exception of the Biblically mandated circumcision itself - which is only done on healthy babies, and, when done properly, is a safe procedure - with a very good track record).

How to Find a Mohel

Like the medical field in general, the Bris Milah field prides itself on reputation building and reputation maintenance. While people may appreciate how nice you are, most people really (should) want to know if you do a good job. And the way they find out is by asking their friends who have had similar experiences, "Who did you go to? Were you pleased with the experience?"

No matter what the other person's experience, it is important to interview the person you may be interested in hiring. Just as every doctor has a personality and a style that needs to work for you, this is certainly the case for every mohel.

People find a mohel either by word of mouth, through a physician referral  (or mohel referral, if your first choice is not available), or on the Internet - through a Google search followed by research through various websites, most likely including the website of the mohel you end up choosing.

If you've done this before and had a good experience, you will likely call your mohel again.

If you did not have a good experience

A word about this blog

This blog consists of practical information for those looking into bris milah and circumcision, as well as observations and thoughts about the subject in question, including some philosophical comments and reactions to news stories. Of course everything is from my perspective, based on the things I have learned, studied, been taught, and experienced through my years of training and hands-on practice as a mohel.

Over the years I've had this blog, the audience has been expanding – and for that I am grateful. Grateful that I can play a role in educating people about bris milah, and that the perspective I have to offer (which, of course, is not the only perspective out there) has an audience.

On account of the sensitive nature of this blog, I have chosen to heavily monitor the comments that come through. To bring a few examples:

• This is a pro-bris blog, not a pro-circumcision blog. Comments from those who are anti-circumcision have no place here.

Nissan - When one Perk is Irrelevant

Every day at shacharis someone will ask me "Are you working today?" meaning, "Do you have a bris?"

The reason they are asking is because when a mohel is present in shul on a day when he is performing a bris, since it is considered to be a Yom Tov/holiday for him, the "tachanun" prayer is omitted in celebration of the special occasion. After all, who needs to beseech God with supplications when such good news is taking place? [That's not exactly the thought process, but it's a start.]

Anyway, the custom is for the entire Jewish community to omit Tachanun during all of the Hebrew month of Nissan on account of the fact that 20 days of the month (Biblically speaking) have a special event attached to them. The rabbis taught, once more than half the month is free from tachanun, we'll just apply the celebrations to the entire month..

During Nissan, bris or no bris, I am reminded "we don't need you."

I got it.

Milah U'Priah B'Vas Achas

The title refers to removing the foreskin and the membrane below it in one action. There are different ways to do this:

• My teacher, Rabbi Mordechai Sasson, would often grab the foreskin with his fingers and remove all of the membrane along with it, alleviating any need to tear the membrane or otherwise remove it.
• Others accomplish the same task with the help of an instrument called a "hemostat"
• Still others do what Rabbi Sasson did, except they only remove part of the membrane. The remaining membrane is then torn apart with the fingernails (which can be gloved, if the gloves are thin) and folded back beyond the corona of the glans. This third approach does not completely remove the membrane as do the first two methods described.

Rabbi Kaminetzky Clarifies His Statement

See here where Rabbi Kaminetzky "clarifies" what he said in the comments I noted here.

Having read the Rosh Yeshiva's brother's book about the response to his (Rav Nosson Kaminetzky's) book "Making of a Godol," I can only surmise that the zhulikehs are at it again.

I love the 3500 years line. It follows along with the "2000 years of a perfect record" which appears here.

The link will do the best justice - here is part of it. One of the commenters claims that the Jewish Week, which orginally quoted Rabbi Kamenetzky, lied. But the Rosh Yeshiva never said he was misquoted. He just clarified what he was quoted as having said.

Postponing a Bris

I was asked recently about jaundice, and whether it might delay a bris.

In my experience, jaundice rarely causes a bris to be delayed.

 In simple terms, a delay of a bris will come about if a baby has a condition, which, if untreated, could bring about the baby's death. Typically if the baby needs to go on antibiotics to treat something (as opposed to as a preventive measure), the bris will be delayed.

For very small babies, see this posting

For a systemic issue, we'll typically wait 7 complete days (7 twenty-four hour periods) from the time the danger passes and the baby is medically cleared.

For something which is not systemic, or even regular physiological jaundice that DOES cause a delay, the bris can be done as soon as the specific issue heals or is resolved.

Being Up Front and Straight

This posting is designed to address all the concerns that have been brought to my attention by a Mr. Anonymous who comments on some of the postings of mohelinsouthflorida.com, bringing up questions and "challenges" that are irrelevant to the post at hand.

If you want to have a conversation, feel free to call or email me. If you want to comment or ask a question that is on topic - that furthers the point in any direction - such a response will be approved. Inasmuch as you are looking for consistency, I ask the same for the conversations here.

Metzitzah Follow Up - Common Sense from a Highly Respected Rabbi

See the comments of Rabbi Shmuel Kaminetzky in this article from Vosizneias

The following quote is a direct cut and paste from the middle three paragraphs of the article:

When asked if there were those who believe that metitza cannot be performed using a tube, R’ Kaminetzky stating unequivocally, “Nobody holds likes that” and expressed disbelief when told that there are rabbis who insist that metitza must be done by mouth saying, “I don’t think there is any response to them.”

R’ Kaminetzky expressed surprise that any Mohel would perform metitzah b’peh, given the links between the practice and transmission of certain diseases to infants, saying that under the circumstances, performing metitzah b’peh would run counter to halacha.

“Chas V’shalom, if [children are] getting sick [from oral suction, you] wouldn’t do it,” under Jewish law, ruled R’ Kaminetzky, saying that since the act of doing metzitza via a sterile tube is completely risk free, the suctioning should clearly be performed in this fashion.

See the update - as per 3/31/2012

So.... Do you use a Clamp?

I get this question a lot, and I think it's time to clarify what the tools of the trade are. 

[The following links were added to the post below at a later date (based on when I blogged about them). While the links below address the "tools"/Bris Milah instruments that I use, what follows after the links is not addressed in the "SHIELD" blog post linked immediately below, so the remaining content of this blog post is still quite informative, even if you choose to follow the specific links that immediately follow]

The links to the specific "tools of the trade blog posts" are here - each which will give you a great overview of each item and how it is utilized.

SHIELD              TUBE               KNIFE              PROBE             HEMOSTATS 

MARKER              GLOVES             NUMBING

continuing the original blog post here....

I have blogged about the different methods utilized in bringing about the coveted circumcision result.

Here I will simply distinguish between the largely rabbinically approved, lauded and recommended device which is called a מגן - a Magen - a shield (in Hebrew).  And the "Mogen Clamp" developed by the mohel, Rabbi Harry Bronstein in the 50s (or thereabouts).

Here is a link to photos of shields. The basic gist is that a shield is a solid metal plate (once made of silver, but now more often made of steel) with a thin slit that divides the shield in half.

The foreskin is grasped with the thumb and index finger, and the shield is applied so that only the foreskin is drawn out - while the glans remains protected below the metal, and the foreskin is excised along the shield.

THIS IS THE ONLY KIND OF SHIELD FOR THE GLANS THAT I USE. 

I DO NOT OWN ANY OF THE FOLLOWING DEVICES

The Father's Role

Bris milah qualifies as one of the commandments incumbent upon a specific individual (in this case the baby's father) who can opt out in the event he feels unqualified or inadequately trained to perform it.

He can't shirk the responsibility completely, but he can hire someone else, in this case a mohel, to serve as his agent to accomplish the mitzvah on his behalf. Which most fathers opt to do. [here's a story of a father who opted to do the bris]

What is the father's role at the bris?

Top Referring Searches and some stats

This website is a blog which has seen much traffic in the two and a half years it has been up. Blogger recently changed its interface and my ability to navigate it. I have just discovered that the top "search terms" which send people this way are the following: "jewish moyle" "moyle Jewish" and "moil Jewish."

The Hebrew term for this profession is מוהל "MOHEL" - though the "H" is dropped in some Yiddish pronunciations (or at least sounds like it is dropped) which has somehow influenced the American perception of the title. [Here is the top visited page, and here is the second highest visited page]

[Though I think this should be the most visited page]

I suppose the Seinfeld episode has a lot to do with it too.

Here are the countries hosting some of those looking to mohelinsouthflorida.com:
United States, Ukraine, Israel, Russia, Germany, United Kingdom, Canada, Netherlands, Luxembourg, China.

I am so flattered and glad that mohelinsouthflorida.com is reaching such a diverse audience. For those seeking from far and wide - I do travel and would love to participate in your family's bris. And if you have someone local, I am happy to play the small role I get to play through the information shared here.

In Talking to a Urologist

At today's bris, the mohel was actually the baby's grandfather, a Urologist by profession. I served as the facilitator and the bandager, setting things up and taking care of the baby afterwards [see here, where I describe what is done when I play this role, in the context of a father who "blanked" in the heat of the moment].

Just a few observations from a Urologist who has been around the block a few times, with whom I chatted for a few minutes afterwards.