Sterilize and Reuse or Disposable?

I was recently asked how I sterilize my equipment (answer: autoclave, except for the scalpel blades which are used once and discarded), and if I was open to the parents buying their own set of instruments for the bris for one time use to be disposed of afterwards?

Answer: I am open to it - by all means! As long as it is an expense the parents want to bear.

There are different companies outside of the USA who specialize in providing such merchandise/ equipment. It works in Europe. But I don't know how popular such an approach would be in this country.

Most people want to pay an all inclusive honorarium (however that is calculated) to a mohel, and don't want to bother with added expenses.

Of course, if a mohel wants to open such a possibility to parents, I suppose parents who want to could go the route of buying these things themselves.

Here are a couple of kits I found online. If you are interested - good luck with your purchase!

http://www.bris-milah.com/ [This one is clearly marketed to mohels... but give a call!]

http://www.brithmila.com/brith-kit/kit-brit-milah.html

News Monitor: Israel and Europe

jpost.com has a number of articles on the role Europe is taking in the modern circumcision debate.

Here is the latest.

http://www.jpost.com/Diplomacy-and-Politics/Shas-Yesh-Atid-MKs-unite-in-fighting-European-anti-circumcision-measure-334548

Shas, Yesh Atid MKs unite in fighting European anti-circumcision measure

By LAHAV HARKOV

12/10/2013 13:11

In a rare case of cooperation, Knesset members from both factions to head to Paris to battle resolution.

Baby undergoes circumcision Photo: REUTERS

In a rare case of cooperation between Shas and Yesh Atid, MKs headed to the Council of Europe’s Presidium in Paris Tuesday evening to continue battling anti-circumcision measures on the continent.

MK Reuven Rivlin (Likud Beytenu) led the delegation, which includes MKs Yitzhak Vaknin (Shas) and Ronen Hoffman (Yesh Atid), to fight a Parliamentary Assembly of the Council of Europe (PACE ) resolution protecting children’s rights to their bodies. The measure – proposed by German MP Marlene Ruprecht and passed on October 1 – could be understood as banning ritual male circumcision for children, along with female circumcision, tattoos and body piercing for those under 18.

The initiative is non-binding, but member states take PACE votes seriously. The Knesset has made significant efforts to collect signatures from European parliamentarians on a counter- resolution it seeks to pass in April, reaching 102 signatures as opposed to 77 MPs who voted for the anti-circumcision measure.

The Rivlin-led delegation will meet with leaders of four of the Council of Europe’s five factions to convince them to put the Knesset’s counter-resolution on the PACE agenda for either late January or April. The Presidium, which consists of faction chairpeople, will set the agenda for those two meetings on December 15.

According to Rivlin, the anti-circumcision measure “is not a legitimate decision, and it is a joint goal of Jews, Muslims and anyone who believes in freedom of religion and conscience to cancel it.”

Rivlin, Vaknin and Hoffman plan to meet with party leaders and members of the Council of Europe’s Presidium and present them with the 102 signatures from PACE members, aiming to show that the original measure was passed unfairly when only a small number of MPs were present.

The Likud Beytenu MK expressed concern that parliaments in Europe would adopt the resolution and expand it to other religious customs, such as kosher slaughter, which is illegal in several European states.

“We want to make it clear to the Europeans that even if it’s legitimate for them to intervene in diplomatic or regional issues, it is not legitimate for them to be involved in Judaism and freedom of religion,” Rivlin added.

In their meetings with European MPs, MKs used research by the American Pediatric Association touting the health benefits of circumcision – including halving the risk of contracting HIV through intercourse – to show that the procedure is not a danger to children. They also cited studies by ethicists showing that it is not an ethical issue for a parent to circumcise a boy for his future benefit, even if he does not have a say in the matter.

In addition, last month, The Journal of Sexual Medicine published a peer-reviewed study by researchers at the University of Sydney proving circumcision does not reduce sexual pleasure.

Rivlin, Vaknin and Hoffman will also attend a meeting of PACE ’s Diplomatic Committee on the status of the Palestinian delegation, which was declared a “partner for democracy” two years ago. In addition, they will meet with French MPs and members of the Jewish community in Paris.

Bringing Kids To A Bris

Obviously the baby...

At what age is it appropriate for a child to attend a bris?

I think any age is appropriate to be there for the celebration and party. The question is really about what they need to know and where they need to be during the circumcision portion of the event.

For whatever reason, children gravitate towards the scene of the action. While this is a good quality to have, it is probably not the best thing at a bris. The baby is crying, surgical instruments are being used, and of course, the act of circumcision itself (removal of the foreskin) is not the visual a child needs to have in his or her brain.

I always instruct kids under 12 or 13 to move back, which they typically do begrudgingly.

If they are a little older, I try to judge - in my brief interaction with them - if they are acting maturely and can stomach what will take place. If yes and yes, they can stay. If not, then I politely but firmly request that they move further back.

As far as younger children goes, parents are very creative in explaining to them what is taking place.

I personally prefer honesty, but you have to know your child and what s/he will understand.

"We are going to the party for the baby." (not enough information)
"We have a special mitzvah to remove a small piece of skin from the baby."
"A rabbi/dr/man called a "mohel" is going to do this. The baby will cry a little, but he's going to be OK."

To a boy some parents add, "You had a bris when you were a baby, at the same age. Do you remember it? Did you even know that you had that happen?"

Most kids don't push much more. They were curious, the question was answered - it is honest and correct, without giving too much information that might scare a child.

Of course once the circumcision is over and the baby is out of the room, no explanation is needed to enjoy a party! Cheers!

Awareness Factor

Parents of a new baby have different approaches to hiring a mohel.

Some call the mohel based on the recommendation of friends. They have no questions. Their friend had a good experience and they want the same. 

Some call many mohels, ask a few questions to each, and try to find the mohel that best fits their needs.

Parents who have been through the bris process before - whether once, twice, or more - more or less know from experience what they want the bris to be like. If they were satisfied in earlier brisses, they'll call their mohel back each time. (Unless they've moved states, or he's moved! Though I've had a number of people call me from NY, my old stomping grounds, and I still go back there on occasion for repeat customers)

In this past week alone, I've met with a couple of families dealing with their third boy (I did not do any of their previous brisses), and they articulated to me why they called me this time.

Their concerns included that a previous mohel did not and refused to wear gloves

They were unsatisfied with a previous mohel's standards of cleanliness and sterility

In their most recent bris, the bandage came off and there was blood everywhere (here's why this should not happen)

They wanted to understand metzitzah and why previous mohels insisted on doing it the way which does not conform to their sensibilities (see also here and here)

One wanted to know if I use a clamp.    I do not.

ASKING IS ALWAYS THE BEST POLICY. Here are links from the Topical Index about important questions to raise before the bris

Good Questions to Ask ANY Mohel
Prioritizing Our Questions
Wrong Attitude is NOT to Ask

FAQ - Summary (links to answers to the questions) - Shorter Answers Appear in a Link at the top of the page
Inquiries Welcome

CONCERNS - SUMMARY OF IMPORTANT LINKS

GOOD LUCK WITH EVERYTHING! Be in touch with your inquiries!

Achieving Perfection

Every mohel worth his sense tries to get a perfect circumcision every time. Some estimate the foreskin - others (I wish it were many more) use a surgical marker to note where the edge of the foreskin is (I offer for parents to see what this refers to when we meet in advance of the bris).

Any circumcision must account for a little bit of human imperfection - and I love quoting the line of the urologist grandfather who told me, "The penis is a very forgiving organ" meaning that for all the circumcisions that don't look perfect that he sees, most turn out fine on account of the way this organ heals over time.

While I have had my share of "perfect jobs," it would be dishonest for me (or any mohel, or any surgeon) to say that EVERY procedure goes perfectly without a hitch. Many do. But there are those that are a little more complicated. Thankfully, many "hitches" (when they occur) can be corrected, and I try to fix them ASAP after the bris. 

So what is referred to by "Achieving Perfection?"

It is the instruction given to Avraham at his bris! "Avraham - walk before me and become perfect" (some translate perfect as "complete." The Hebrew word is "Tamim" = תמים.)

The perspective of Jews that have always embraced circumcision as a mitzvah is that the act of circumcision makes the Jewish male complete.

[The thought process continues suggesting that women do not need a circumcision because they are created physically complete.]

Anti-circumcision people sometimes argue that a baby is born perfect. What gives us the right to do anything to the child.

It is a good argument. But it is ignorant of Jewish knowledge. Which is why we ignore it.

Parents cut umbilical cords, they cut hair, they cut fingernails, they clean out earwax, they pierce ears, they put injections, blood tests, and in some cases choose surgery as an option for either an emergency reason, or, in some cases, a cosmetic reason (yes! even on babies!). 

So we will continue to aim to achieve the perfection God spoke of in Genesis 17 (and we will not yell at anyone who cuts a "natural" umbilical cord off of its baby owner). That is our goal when we undertake the Bris Milah.

A Wise Opinion About NYC and Metzitzah

My position on metzitzah is clear. And the politics that have been going on over the practice in NYC has been a public discussion for far too long.

Here is an article from the NY Post which concludes with the following paragraph.

"This is a crucial election for New York, with many vital issues at stake. It’s tough enough to know what to do about schools, taxes, spending and crime without having our candidates have to weigh in on a Jewish ritual that never should have become a government issue in the first place."

Couldn't have said it better myself. 

Gloves Revisited

Rabbi Aryeh Leibowitz recently wrote an article/essay that explores the halakhic appropriateness of using Gloves while performing a mitzvah, with a specific focus on whether gloves (sterile, of course) should be worn when a mohel performs a bris.

I have written about gloves here. And if I did not make it clear there, I believe that once a mohel chooses to wear gloves (which all parents should INSIST upon!), the only gloves of choice are STERILE gloves - which usually come packaged in pairs.

Full disclosure is that I discussed some of these matters with Rabbi Leibowitz while he was in the draft stage, though I did not review the article before it was posted on the internet.

Here is the link to Rabbi Leibowitz's article. (link goes to the TorahMusings website)

Feel free to chime in (though only relevant and appropriate comments will be approved below)

Bris Wine and Baby

I originally wrote about giving the baby wine at the bris here

A recent experience caused me to rethink not the concept, nor the method, but the source of the wine we give to the baby.

As discussed in the original posting on wine, the source for giving the baby wine most likely comes from the situations in which he is the ideal candidate for drinking it because everyone else is fasting, and no one else has had any of the wine. That the wine is soothing and may act as a kind of analgesic is an added benefit - but is frankly, irrelevant after the circumcision is over (which is the point in time when most of the wine is typically given to him). 

"What happened recently?" you ask.  I'll tell you.

I was about to give some wine to the baby, when the person who had just taken a sip said to me, "I'm sick! Don't give the baby any wine from that cup."

I readily complied and dipped my gauze directly into the bottle, to give the baby "untainted" wine  

After that day, it occurred to me that while the baby is highly unlikely to catch anything from the wine, especially if the drinker merely takes a sip (which is usually the case) and particularly if he does not backwash, but still... If we are trying to keep the baby safe, shouldn't the baby have a cup of wine designated for him, which is not touched by anyone?

Now, there are some rabbis who specifically do not drink from the cup.  While they say the blessings, some wine typically drips on their fingers, and they taste the wine on their fingers, leaving the cup alone.  In those cases, the cup and wine in it remains untainted, and the wine in the cup is as "safe" as the wine in the bottle. But in most cases the one reciting the blessing sips from the cup. Wouldn't it be better for baby if there were a cup of wine dedicated for his use only, so he need not share a cup with an adult who may possibly have some virus in his mouth that could possibly be transferred...?

May be extreme, but seems logical to me... especially in light of the second source quoted here!

3 Day Yom Tov Mohel Blues

This year, Rosh Hashana falls on Thursday and Friday, leading into Saturday, which creates what is called in observant circles a "Three Day Yom Tov."

It also means that anyone who gave birth naturally this past Thursday, Friday, or Saturday, who is looking for a bris to take place on time will need to get a mohel who either lives within walking distance, or who is willing to come for the 3-day period - because an observant mohel is not driving over these three days.

Of course this is not normally a concern. A mohel with a car comes and goes at his schedule during the week. And even a typical Shabbos-bris is only 1 day. But here we are talking about 3 days - 72 hours!

While in a Metropolitan area a walking-distance mohel should be fairly easy to find, in some places, this is not the case.

And finding someone willing to come for the 3-day yom tov is extremely hard. Any mohel with younger children living at home will most likely not be able to come.  And anyone with significant holiday plans will most likely not be able to make it either. In my case, I serve as a rabbi in a synagogue on Rosh Hashana and am therefore unavailable.

Who might come? A single (unmarried) mohel. Or an empty-nest mohel. The latter case may come with or without his wife.

In either case, aside from needing to arrange a place for the mohel to stay, and a seat in shul (though I am sure most shuls would be accommodating), it needs to be understood that the mohel is giving up his yom tov, in whatever way it was planned, for YOU the parents.

Now, some mohels might say, "I am not available. If you can't find anyone, I will do it Sunday." It is OK for the mohel to do this.

But the parents have a responsibility to have the bris take place on the 8th day of the baby's life. Which is probably why I got a call today from Michigan, and I was contacted a month ago by someone from Tampa who was concerned about a possible Rosh Hashana bris (and wouldn't you know it, she confirmed for me today that her fears turned out true!), and I heard from someone in Maryland about another RH bris. And I am sure there will be many brisses around the world over the 3 day yom tov.

Hopefully the parents and the mohel can come to an agreement. The mohel should come "b'simcha," and the parents should be sensitive and offer a generous compensation for the mohel putting himself out in a significant way.

Mazal Tov to all!

Maimonides on the Reasons for Circumcising II

This is not as much a blog post as it is an attempt at providing a source which has been misused, mistreated, misunderstood, etc. by people looking to sling bris milah under the bridge, and to bury it in mud. 

The previous blog post says all we need to know about Maimonides' view of circumcision. 

This excerpt includes a couple of paragraphs from Maimonides's introductions to "The Guide to the Perplexed" as well as the entirety of the passage which includes to oft-quoted segment in which Maimonides describes what the loss of the foreskin does to a man. 

Of course, as the entire book was written systematically, it is imperative that the paragraph in question NOT be read alone and out of context. It MUST be read in the context of the section being presented here: 3:49 of The Guide - interestingly, this section is entitled "Marriage Laws." 

Maimonides warned in his Introduction that he is talking to the religious person, and to the, in some cases, one intelligent person amongst ten thousand fools. Translation: Not everyone who reads The Guide will understand it. And people who misunderstand it (or who take it out of context) might be included in the group of ten thousand. 

The point of sharing this is simply to be intellectually honest. People who read what they want, and become Maimonideans for an out-of-context quote are not intellectually honest. You can't pick and choose. At least an attempt at consistency is warranted. And to use Maimoindes to bolster your argument, you MUST ALSO KNOW WHAT HE IS TALKING ABOUT, and understand the point he is trying to make, in its totality. What Maimonides says about circumcision is to benefit marriages. And he was preaching to the choir. So, once again, if you don't like circumcision in general, please vent your frustrations elsewhere. 

 All the translations here come from the Friedlander translation, which is available online over here: http://www.sacred-texts.com/jud/gfp/gfp003.htm 

 Anything in bold or italicized from here on is my emphasis. With the exception of a very rare comment here and there, the rest of this very lengthy treatise is Maimonides' words (translated) 

Maimonides on the Reasons For Circumcising

There is one reason why we circumcise our sons: Because it is a mitzvah in the Torah.

We don't do it because Abraham did it. He certainly set a precedent and we follow his example. But

as the Rambam (Maimonides) explains in his commentary to the Mishnah Hullin at the end of Chapter 7, EVERY MITZVAH STEMS FROM WHAT MOSES TAUGHT AT SINAI BASED ON GOD'S COMMAND.

פירוש המשנה לרמב"ם מסכת חולין פרק ז 

[ו] לדעת ר' יהודה האוכל כזית מגיד הנשה של בהמה טמאה חייב שתי מלקיות משום בהמה טמאה ומשום גיד הנשה. ואין הלכה כר' יהודה. ושים לבך לכלל הגדול הזה המובא במשנה זו והוא אמרם מסיני נאסר, והוא, שאתה צריך לדעת שכל מה שאנו נזהרים ממנו או עושים אותו היום אין אנו עושים זאת אלא מפני צווי ה' על ידי משה, לא מפני שה' צוה בכך לנביאים שקדמוהו, דוגמא לכך, אין אנו אוכלים אבר מן החי לא מפני שה' אסר על בני נח אבר מן החי, אלא מפני שמשה אסר עלינו אבר מן החי במה שנצטווה בסיני שישאר אבר מן החי אסור. וכן אין אנו מלים בגלל שאברהם מל את עצמו ואנשי ביתו, אלא מפני שה' צונו על ידי משה להמול כמו שמל אברהם עליו השלום, וכן גיד הנשה אין אנו נמשכים בו אחרי אסור יעקב אבינו אלא צווי משה רבינו, הלא תראה אמרם שש מאות ושלש עשרה מצות נאמרו לו למשה בסיני, וכל אלה מכלל המצות. 

Translation of the two bolded statements:

"You must know that everything we are careful about or do today, we only do it because of a commandment of God [delivered] through the hand of Moshe."
"And we do not circumcise because Abraham circumcised himself and the men of his household. But because God commanded us, through Moshe's hand, to circumcise, just as Avraham, Peace upon him, circumcised..."

So Maimonides makes it quite clear that we have a mitzvah to circumcise. And that the only reason we do so is because of the mitzvah.  

This is an important set up to the next posting, which will specifically target the Jews who are anti-circumcision, who like to take a quote of Maimonides out of context to argue why we should not circumcise.

They do not listen to anything else Maimonides says. They don't read Maimonides at all. And they don't understand what Maimonides writes. But they champion him as the anti-circumcision advocate because of something he wrote, when applying such a moniker to him could not be any further from the truth - stay tuned... for part II

Looks Swell - Doesn't it?

In the "milah" (circumcision) component of the Bris Milah, the intent is to remove the foreskin and the underlying mucosal membrane from atop the glans.

No two circumcisions turn out exactly alike. In some cases more foreskin is removed, in some cases less. In some cases more membrane is removed, in some cases less. The angle of the incision as well as the amount of membrane removed (or left behind) will determine what the final look will be once all is healed.

Which brings us to the swelling. If the membrane and the frenulum didn't swell after the bris, most circumcisions would look awesome immediately. Alas, there is sometimes swelling. And depending on the degree of swelling, things might not look as nice as we want them to for perhaps even a few weeks.

I don't put pictures of this nature in my website, because I don't take pictures of before and after. Nor would I post them anyway. But I found this pdf file online that has pictures (on page 16) of the few days process (between 2-3 days to 2-3 weeks) of post-circ swelling. Hopefully it does not get more extreme than this.

http://www.brismilah.com/bris.pdf

Some of my colleagues suggest waiting three months before getting all excited. 

But then you run into the Chubby Baby Syndrome and the Fusion Challenge

Swelling isn't swell, but at least it doesn't last forever.

Born Without a Foreskin - Anything Done Differently?

The male organ develops differently for every (male) child in utero. In some cases it even develops without a foreskin, or with barely any foreskin - it develops in a manner that is described in Halakhic works as either "Mahul" (a fully circumcised look) or "Chatzi Mahul" (a partially circumcised look).

I have seen this a handful of times in my fifteen years in the business. The procedure for removing the "partial foreskin" is obviously quite different than a run of the mill circumcision - for what I hope are obvious reasons.

When there is a partial foreskin, the circumcision "cleans up" the extra skin that is preventing the circumcised look. While not a full circumcision, it is nonetheless a surgical procedure and should be treated the same way a circumcision is, insofar as that if the baby is ill, we would delay the bris 7 days until he is completely healthy.

But when there is no foreskin at all, and the child only needs "Hatafat Dam," which is a (mostly symbolic) minimal drawing of blood, will the same rule of waiting apply?

Here is from "Bris Avos" - same chapter (see previous blog post), paragraph 4.

In the Responsa "She'eilat Shalom" the question was asked whether a child born without a developed foreskin ("Mahul") [who cannot be circumcised, but would need "hatafat dam"] can have the hatafat dam on the 8^th day if he became ill. [Hatafat Dam is a ritual which does not require follow up medical care]. The answer he gave is that it is not only forbidden to do anything to him while he is ill, but one would need to wait the same requisite 7 days after he is healed in order to do the Hatafat Dam, just as one would wait the requisite seven days before doing a full circumcision.

Amazing chiddush! I would have thought since Hatafat Dam is really "no big deal" it wouldn't matter, and it could be done right away. But he says it is treated like a regular Bris Milah, and the requisite seven day waiting period would apply were the baby to become ill before the eighth day of his life.

Health Concerns? Priority #1

Bris Milah is performed only on a completely healthy baby. We have discussed here and here, in general terms, what would delay a bris. In these next few blog posts, I intend to translate portions from the book Bris Avos (Shabtai Lifshitz), Chapter 9, "The Law of a Baby Who is Ready to be Circumcised, and Which is Not Ready to be Circumcised." The book was first published in Elul 5673 - a few months shy of 100 years ago (it is now Tammuz 5773). It was reprinted by the author's grandson in 1969.

Paragraph 1:
            We do not circumcise a child who has even the slightest indication of illness, on account of our concern for life (Maimonides – chapter one, laws of Milah, as well as the Tur 263:1). They were careful to say even the "slightest indication" (חשש), even if it's not completely apparent. For example, even if he cries excessively, we would not circumcise him yet. The Pischei Teshuvah wrote that even if the baby's belly button was not cared for properly, and it bleeds, we do not circumcise him until he has strengthened, healed and has recovered the lost blood from the bellybutton. In my humble opinion, the baby is not to be circumcised without asking doctors or experts [if he is ready].

The author is making our concern for the baby's health paramount. Obviously the bris milah carries its own risks, but this is the price of this mitzvah.

Having said that, when the bris milah is performed properly on a completely healthy baby, the procedure is usually a smooth one, and baby returns to his normal routine once he is in his parents' arms. Anything out of the ordinary can be a cause for delay. [Normal physiological jaundice need not necessarily be a cause for delay... See here]

A grandparents record! - Traveling For A Bris in New York

Mazel Tov! Heading to New York today for another bris in New York.

For one set of grandparents, this will be their seventh grandson for which I will have had the privilege to serve as mohel. And I only missed another one of their grandsons because one of my best friends was getting married in Montreal on the same day that the baby's bris was taking place.

The most I have with other grandparents is 6 (I missed #7 for them because I was in Denver for shabbos and they had a Sunday bris in NY).

A few fives and fours (from multiple sets of their children), and very many threes and twos.

Kein Yirbu! B'mazal uv'simcha!

Communication... Will They Lead to A Bris?

When I lived in New York, the traffic of brisses came from a very simple formula.

A couple had a baby, and they called me. They had heard of me, seen me, had friends, knew what they wanted for months, etc. It was VERY rare that someone would call in advance of their son's birth to interview me or to "inquire."

In Florida, I find a very different clientele. I get calls or emails MONTHS in advance. In some cases people are doing research. Asking all the right questions (see links in this post), trying to find the right match.

Some people are getting the lay of the land - perhaps even thinking if they want to go the Mohel route or the Doctor route (see the previous posting!).

Some people are just looking for the best price. (Which is hard to determine in my case, because I don't really have a price)

Some people call when baby is born. Some do not. I am told by some of my colleagues that they have similar experiences all the time.

Other than the calls that will come out of the blue, I have somewhere close to 10 people who have called about my availability over the next few months. We shall see if they call when baby arrives!

God should only bless them with healthy babies.

News monitor: botched circ, not botched bris!

It's not a bris story, but it is a circumcision story.

See here or keep reading

CHICAGO FAMILY WINS $1.3M JUDGMENT FOR SON'S BOTCHED CIRCUMCISION

In 2007, one Chicago family underwent a nightmare at Northwestern hospital: their newborn son’s circumcision went awry, with a doctor amputating the tip of the boy’s penis. According to a lawyer for the family, Dan Kotin, the doctor missed three safety procedures that should have been followed. According to Kotin, the boy lost “the top 40 percent of the head of his penis.”

The doctor’s attorney argued that this was a predictable complication of circumcision, to which Kotin responded, “If that were a known complication to a circumcision procedure, I suggest to you that nobody would dare have a circumcision done because it would be too risky.”

The jury awarded the family $1.3 million in damages.

**************************************

Someone recently told me that a certain doctor (pediatric urologist) claims to hear of one case like this a year when a mohel does a circumcision with the traditional shield.

I've spoken to mohels and doctors and all agree this is likely untrue. If the mohel (or any operator) is using any kid of clamp, however, the chances are significantly greater that this could happen.

The person who told me of this doctor said it makes the doctor really angry. If it's true, it should. But the above article is a case in point to the surveyed opinion I have heard from doctors who do touch up work, that errors in circs are more often committed by doctors - OB-GYNs and pediatricians. So I wonder if the doctor from the conversation is anti-Semitic, hates mohels, is making things up, or if he actually has proof.

Are mohels perfect? Who is? But the competent mohels remove the right amount of foreskin and certainly protect the glans.

For clarification as to the differences between a traditional shield v the Mogen Clamp, see this posting.

Honesty From Your Mohel

Please note: This is not "confessions of a mohel." This is sharing of information, in which I try to be realistic about the pluses and minuses of the bris experience - with whichever mohel you may one day hire.

This blog was born after years of looking at different mohels' websites and finding them to be largely the same. Of course every mohel has a different style, and (obviously) a different web designer, but between explaining the "Order of the Bris," the "Honors/Kibbudim" and, every now and then a "Frequently Asked Questions" page, most of the websites offered little to no information beyond what the particular mohel wants people to know.

But over the years I have been asked MANY questions. Some are fairly simple and common, and some are much more complicated. Because as much as circumcision is a relatively minor surgery, the organ upon which it is done is not "minor," the nature of the procedure in question is quite sensitive - physically AND emotionally, and, perhaps most importantly, the results of the procedure (NOT the ceremony) will last a lifetime, and will be something parents will encounter every day, until the child realizes what privacy is, and from then on HE will encounter the results every day.

[Some people only realize afterwards how much the personality of the mohel, and perhaps how the way he personally experiences his Judaism informs how he runs the ceremony and perhaps relates to people, is also important to them!]

I have met many men who have confided in me that they are not sure if their mohel did a good job. Everything usually "works" but they don't like how it looks or think something is awry. But because it's embarrassing to discuss or address (who really wants to have a cosmetic touch up?), most do nothing about it. Except mention it in confidence to a friendly mohel - who is in the field, but is not interested in rendering an opinion nor is he in a position to do anything about it.

Some mohels have communicated with me how helpful they find this website to be. Others have communicated their opinion that I offer too much information and scare parents away.

To the former I say thank you, and to the latter I respectfully disagree. We live in the Information Age when people find whatever they need to know with a few clicks on a keyboard. And so I have tried to provide information on both extremes, and everywhere in between, so people can have a good understanding of how things can go perfectly, how there could be a few bumps on the road (including this error that some mohels are not careful to avoid) and how much care and thought people need to put into their research and decision making.

And if people choose not to hire me because I am honest and say I am imperfect, so be it.

When I lived in NY, a pediatric surgeon told me he had done touch up work on babies circumcised by every mohel in NY. Even the BEST of the BEST. Here in Florida, a pediatrician and a pediatric surgeon (2 different people) have shared similar statistics. 

NOONE is perfect. And parents, who are often doing research for their mohel on a very limited time frame (too often people wait until after the baby is born, at which time they have only 7 days until the bris), don't have the time to ask ALL the important questions to make sure the mohel they are talking to is exactly what they are looking for. Sometimes, they don't even know what that means.

I take the precautions to make sure I can deliver as close-to-perfect a job as I can. I double check afterwards to make sure everything looks as good as I can get it to look. I try to be as sensitive to your baby as I can, and to give you as much respect, courtesy, and straightforward information as I can. I want you to know what is happening and what has happened to your baby. The ceremony is flexible, depending on your background, your crowd, the setting, your level of observance, and any number of factors that weigh into your personal situation.

And the results show. I meet many babies months after their bris, and their parents are happy, and the babies don't remember a thing. They smile at me, coo at me, and have no ill will.

With the exception of one case where an anatomical abnormality was uncovered once the foreskin was removed (it was not evident while the foreskin was present), I am unaware of any touch-up surgeries that followed my brisses, on account of the precautions I take (the case I mentioned needed a surgery irrespective of the circumcision). Does it mean every circumcision turns out the same? No. And that I am unaware of touch-ups does not mean they never happened. I simply don't know. But most mohels will not say that "it sometimes happens." It's actually a lot more common when an OB-GYN does the circumcision, but it does happen to mohels too. Nobody is perfect.

There you have it. Up front and straight. Everything on the table. From a mohel who is honest with you, who will communicate with you, and who will do the best he can to give you and your baby a positively memorable experience - with the main positive memory being a satisfactory result that you and baby will be happy with for the rest of his life.

May A Bris Take Place At Night?

I've addressed this question in simple terms over here, when we discussed how to time when the bris will take place, along with the notion that the bris should take place while the sun is out.

But I came across the question in Yossele Wesiberg's magnum opus on Bris Milah (Volume I page 154), where he records 4 possible answers:

1. One would not fulfill the mitzvah and there would be a requirement to draw out blood for the covenant (Hatafas dam)

2. One does not fulfill the mitzvah and even Hatafas Dam would not change any status. It is an error that cannot be corrected.

3. One has nonetheless fulfilled one's obligation, with no requirement at all for Hatafas Dam

4. If it was on the night of the eighth day, no Hatafas Dam is required. Any other night would require Hatafas Dam.

Generally speaking, however, we follow the first approach if the circumcision happened to take place at night. But we do not schedule the circumcison to take place after sunset.

The celebratory meal, on the other hand, can go for as long as you like into the evening.

Amazing Bris Experience

I posted this on Facebook, right after the fact, but here is the account of last week's bris: 

Most amazing bris experience today! The father of the baby recently converted to Judaism (Orthodox), and while the baby today is his third son (Jewish mother, of course!), it is the first time he participated in the mitzvah of bris milah as a Jewish father who has the mitzvah to circumcise his son as per our Covenant. 

Easy to say he was the most emotional person in the room, "This is BIG, Rabbi. Isn't it?"

Yes it is. I haven't seen people dance at a bris in a long time, but the men in the room grabbed him (he was sandak as well!) and danced in circles singing "Siman Tov UMazal Tov."

It was AWESOME - this is what Bris Milah is all about. It's a little sad that we need these kinds of reminders of why we celebrate and how to celebrate, but we all got it today.

Truly a special bris. Honored to have been a part of it.

You want to know what Metzitzah is? (VIDEO)

See also the Metzitzah page

Here is a video I just found on youtube that depicts the two methods out there. (Link provided in case the video doesn't show up on a mobile device)  I believe both of these are from brisses in Israel. Note that in neither case is the mohel wearing gloves. They surely washed their hands, but the "traditional" way was not to use gloves because sterile gloves are a relatively new invention, and some people believe that priah cannot be done when wearing gloves (which is actually  not true if one uses thin gloves).

The video briefly describes then demonstrates the sterile tube method (at the 19-20 seconds), and then the direct oral contact method (aka MBP or "metzitzah b'peh") (at the 38-41 seconds). You'll note that both are done "b'peh" (with the mouth) though the first does not involve the mohel's mouth contacting the baby, and the second one does involve this kind of contact. 

My main objection is to the use of the words "more traditional" for the second one. I would call it "more cultic" than "more traditional" because the only tradition it reflects is living in an ancient world.

Having said that, the track record is relatively good. But as I say each time, if ONE baby gets infected from the second method (and that seems to be the reality out there), then it shouldn't be done.

Metzitzah in the News Again

It's been about a year since I set up the Metzitzah Page, and things have been relatively quiet.

Until the last few weeks.

First Rav Herschel Schachter was chastized for claiming there are 15 cases a year, most of which go unreported.

And this week, another report has come forward, claiming that two children have been infected with Herpes in NY, post brisses which included Metzitzah (Fox News originally mistakenly said HIV, but they meant HSV - Herpes Simplex Virus)

Here are a few links:

http://www.examiner.com/article/some-new-york-city-infants-contract-herpes-after-ritual-circumcision-1

http://www.dailymail.co.uk/news/article-2304793/Two-babies-stricken-HERPES-ritual-oral-blood-sucking-circumcision-New-York-City.html

The radio showman Michael Savage (nee Wiener) spent an hour talking about this subject - here is the youtube link: http://www.youtube.com/watch?v=RPLh36XYolc

Suffice it to say, the man knows nothing about bris milah and is a bumbling buffoon on this subject. The only thing I'll agree with him on is that the Metzitzah with direct oral suction needs to be stopped. And that the people who say "If it were dangerous we would stop" are not telling the truth. Yes, the numbers don't reflect it being an overwhelming danger, but as I've written before - if ONE baby gets infected or dies from this practice, that is ONE WAY TOO MANY!


It is an irresponsible practice in 21st century. Chazal would not approve if they knew what we know.
It's not a mitzvah. And the argument that it's been practiced for 4000 years is a lie.

It's a chillul Hashem (desecration of God's name). Plain and simple. 

A Mohel in South Florida

There are many cities in Florida that do not have a local mohel. There may be some people who will opt to have a physician play the role on the traditional eighth day, and there are some who will bypass tradition opting for a hospital circumcision in the hospital on day 1 or day 2 of their baby's life. [I don't recommend this path because I believe that a bris milah is incomplete unless it is done by the right person on the eighth day - or afterwards, if delayed for medical reasons.] If a person chooses this latter method, the procedure described here Hatafat Dam Brit, would be needed to turn the circ into a bris.

For those who are looking for the traditional method, a bris done with a mohel, the difficulty comes in finding the right person for your needs, as well as someone willing to travel. 

These are the things that make me - and therefore your bris experience - different than with a different mohel.

The travel expenses are sometimes the biggest deterrent for people contemplating the traditional route. But if you think of bringing in a mohel as a one-time expense which, in most cases, doesn't repeat itself for at least two or three years (if not more, if there's a girl somewhere in the mix), then it becomes a little easier to stomach.

So whether you are looking for a mohel, moyle, moil, moyel, in Naples, in Fort (Ft.) Myers, in Sarasota, in Tampa, in Western Florida, or in Kendall, in Miami, in North Miami, in North Miami Beach, in Ft. Lauderdale, in Hollywood, in Boca Raton, in Delray Beach, in Pompano Beach, in Plantation, in Cooper City, in Palm Beach, in West Palm Beach, in Boynton Beach, in Aventura, in Weston, in Pembroke Pines, in Margate, in Deerfield Beach, in Lake Worth, or in Wellington (not to mention Jupiter, Stuart, Port St Lucie, or Orlando) - or even Gainesville, Jacksonville, Tallahassee or Pensacola, to which I am accessible by plane, be in touch! I'd be honored to join your family for the bris of your son!

CONTACT INFORMATION

Calcium Alginate

New delivery arrived!

I love using calcium alginate as a bandage post-bris. It contains the blood very well and comes off so easily on account of the way it gels when it comes in contact with the bris-wound.

My supply was running low, so my friend Mr. JG from NY hooked me up with the latest supply.

Good for a year of brisses! And loving it

Metzitzah Tubes - Approved by Arukh HaShulchan

The two short letters were composed by Rabbi Yechiel Michel HaLevi Epstein, author of the Arukh HaShulchan on The Friday of Parshas Chukas 5659 a.k.a. 1899.

He blessese those who have innovated the glass tube for Metzitzah, expressing how the merit of the mitzvah (not clear if he's referring to the mitzvah of circumcision or the "mitzvah" of metzitzah) should protect those who made it and use it.

O the Irony!

A Hebrew Name for Brooks

Last Sunday I presided over the bris of a baby who had been given the English name Brooks. His parents asked me if I have any recommendations for a Hebrew name, as they noted that one of the baby's grandfather's has the name Baruch.

I immediately thought of one of the great heroes of the Bible, who is actually mentioned in the Haftorah read the Shabbat of the bris - Barak ben Avinoam - ברק! (Judges, Chapters 4-5) I was not yet aware of the family's political leanings, and I told his mother that the name has been around a lot longer than it has been made famous by the current president.

The baby's mother said to me, "O dear God no. My father hates Obama, and that just won't be possible."

So they named him "Berel." Which is ironic, all things considered, because the President was known as Barry for most of his US formative years. Barry, of course, is a very common English diminutive for Berel.

I have met many Israeli "Barak"s – never been unimpressed. One of the great characters in Leon Uris' "Exodus" was named Barak. It's a great name.

Unless you don't like the President. O well.

Interesting Conversation About Clamps

I received a phone call today from Rabbi Yaron Amit. He is an Israeli mohel who maintains a presence in South Florida, who has an organization that provides free bris services to Jews around the world. He told me they do 28 brisses a day.

He called because I wrote a blog post in response to an article which appeared in IsraPost a few years ago in his name. As it turns out, my response was more against the way the article was translated than against the points he made. My original post has been removed - at his request, and in respect of the clarification - but I would like to share the points he made in our conversation, along with my own commentary.

Rabbi Amit's main issue is that brisses done with a clamp are not kosher. He says there is never blood from such circumcisions and that even when there is blood in the procedure it is blood which emanates from handling an open incision, which is different blood than "dam milah" - the blood of circumcision. He also referred to realities that changed for people - which he witnessed - after their circumcisions-by-clamp were corrected, such as a change in parnasah, finding a mate, and general shift in life turning positive - what he refers to as "spiritual benefits" (my translation - we spoke in Hebrew).

He maintains that any bris done by such a method is unacceptable and needs hatafat dam bris. And that a mohel who uses such a device is unfit to be a mohel, and is unfit for anyone to hire as a mohel.

He shared with me stories of surgical corrections that needed to be done to brisses done through this method, as well as horror stories of amputations of the glans that he has witnessed on account of the use of clamps.

I agree with him on almost all points. I have long advised against the use of clamps:
* For halakhic reasons: Rabbinic approval is scant        Mistake #4
* For practical reasons: Danger        Arrogance (here I outline another practice, which the Rabbi agreed should not be done - "Freehand")
* In addition, in the "methods of circumcision" I have described here (for education purposes), I have made it clear that while there are some mohels who opt to use the clamp, this practice has been forbidden by many many great rabbis and poskim


The points in which we might disagree are:
I maintain that according to Rabbi Moshe Feinstein, if there is minimal blood at the time of circumcision, the bris is valid b'dieved, as long as there was blood. Rabbi Amit believes there is never blood when a clamp is used, and any blood is not "dam brit" as I explained above. Rabbi Feinstein also makes it clear that the clamp is not to be used (Iggerot Moshe Yoreh Deah 3:99).

I am not a fan of telling thousands of people that their bris is unkosher and needs a touch-up, even if it is "merely" Hatafat Dam. With this Rabbi Amit and I will have to agree to disagree.

CONCLUSION: FIND A MOHEL WHO DOES NOT USE A CLAMP (WHO DOES USE A SHIELD) IF YOU WANT THE SAFEST RESULTS, AND NO HALAKHIC COMPLICATIONS FROM THE BRIS MILAH PROCESS. ASTHETIC RESULTS - IN ALL CASES - ARE DETERMINED BY THE SKILL OF THE MOHEL, IRRESPECTIVE OF THE METHOD. ALL MOHELS ARE HUMAN. ALL HUMANS ARE IMPERFECT. EVERY MOHEL SHOULD DO HIS BEST, AND SHOULD TAKE EVERY NECESSARY PRECAUTION TO ASSURE THE BEST ASTHETIC RESULTS HE CAN.

Rabbi Howard Jachter has penned an article in which he talks about the clamp. I don't believe all the responsa he quotes are being portrayed accurately. I also don't understand what he means when he says "As long as the clamp is used properly." The clamp being used properly happens when the clamping arm is closed. This is what all the rabbis wrote against! The clamp being used "improperly" is when the clamping arm is not utilized. If one is not closing the clamp, why not just use the more traditional shield?

The deleted post (that inspired this one) concluded with these links.
He's YOUR baby, you have a right to choose whom you'll hire.
You have the responsibility to ask all the right questions to every mohel you interview before you settle on the one you want
And you also must take care to know what you are looking for to have the right kind of experience for your needs.  Always remember that the wrong attitude is not to ask.

REMEMBER - IMPORTANT REMINDERS (similar links), as well as THE MISTAKES YOU WANT TO AVOID