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.