Wednesday, December 23, 2009

Why Can't the Baby Eat Before the Bris?

I generally recommend that the last pre-bris feeding take place 90 minutes before the bris.

For babies who drink formula, this usually does not present a problem, as they are usually on a schedule.

But for babies who nurse (I am happy to report that the number of nursing moms is on the rise), this presents a bit of a problem. My wife likes to call herself "Mommy's 24-hour open bar," so I understand very well how nursing moms like to provide when baby asks. And this is a wonderful thing. One might argue that the only downside of nursing is that babies love it! and don't want to give mommy a break.

Before a bris, however, the problem is twofold.
A: Nursing during the bris is impossible - for obvious reasons.
B: The baby's system needs to be cleaned out in anticipation of the bris.

I assume I don't have to explain the first reason, so here is the explanation for reason "B."

The baby will be crying in a way he might not be consolable while the bris or bandage change is taking place, and if he happens to have recent food in his system, there is a good chance he'll spit it up. "Spitting up baby + crying and can't be moved due to position he is in when caring for his circumcision wound" is not an equation we want to deal with.

The best I can recommend if the 90 minute window does not work for you is to try to estimate how much time he can handle, so he'll be ready for a good feeding (nice and hungry) 15 minutes after the bris is scheduled to begin.

After the bris he can eat all he wants.

But it is not worth risking a spit up during the bris or when I am checking his bandage right after the bris. Choking baby is much worse than crying baby.

I hope you will agree.

Tuesday, December 22, 2009

Prioritizing our questions

I've received a number of calls in the last couple of weeks, from people who are doing their research before baby arrives. I mean this with all sincerity - kudos to you! It it so important to do proper research before the baby arrives.

The question I hear most often is about the "cost." Let me assure you this is not an issue - I graciously accept whatever you offer. [Note from 1/2/11 - here is a new posting on the subject] [And yet another posting on why Costs should not be a determining factor - August 2011]

While it is most understandable that this is a top question, at the same time, I feel that other questions which should be at the top are not asked at all.

Are there ever complications?
What is the healing process like?
What are your methods for maintaining sterility? (See the second half of the link)
How will you treat our baby and how will you treat us?

More examples of Important questions can be found here and here (this second one is the same as the link above, but the questions in it focus more on things you ought to be asking yourself - to help you decide what you want out of the bris experience).

Let's talk!

Thursday, December 17, 2009

What is a "Kvatter"?

The role of the "kvatter" is to bring the baby from the mom to the dad at the start of the bris ceremony.

The term is Yiddish, and probably comes from the term "K'fater" which means "like the father." Those of Germanic descent might pronounce the word "g'fotter" with an "umlaut" over the "e" (the "e" should be pronounced like the "e" in "yes," as opposed to rolled over as it is in "fodder").

[Update 11/2014 - In the book "Minhagei Worms" (customs of the city of Worms), the author notes a custom that the woman who would take the baby from the mother (who is called the "Sandeket") would give the mother a gift called the "גיפאטר שאפט" (Gifater Shoft) in order to distract the mother from the pain her child is about to go through as she enjoys her new gift. I don't know what the literal translation of the term is (though "שאפט/shoft" seems to mean "community"), but clearly "G'fater" relates to our word in question.]

The word may also come from a diminutive or derivative of "Godfather."

There are different customs related to who is honored to play this role, particularly as pertains to what is called a "segulah" - a special merit to achieve a certain result.

This is not the place to discuss the general benefits of "segulah"s - but there is a nice list of segulahs at the "In the Pink" blog - you can read it here. [I don't recommend the last one for "getting pregnant" - and I happen to think it is a mistake. There is no way that anyone "really" ever did that. At least I hope I am correct]

The major "segulah" of this role is for people who are not yet parents to merit to become parents. Just as they are participating in the bris, just as the woman and man are "like" the mother and father of the baby in the way they are bringing him to his bris, they should merit to have a child, and if he's a boy, to bring him to his bris.

Brief History

Before the age of the mega-mom and the DIY ladies of today, whom we admire very much, by the way, women would not attend a bris in the way they do now. The mother might be in a different room or building, possibly being forced to rest by all her relatives or attendants after having given birth, and the baby would be brought to his bris.

Who would bring the baby? A woman who is trustworthy to the mother.
Who would she give the baby to? The baby's father, surely, except that it was considered immodest for a woman to hand something to a man, who is not her husband, in a public ceremony. So she would give the baby to her husband, who would bring the baby to his (baby's) father.

Present Day

I have not yet met a mother who chose to hide in a room somewhere while the bris takes place elsewhere. So why do we still have the kvatter? Let the mother bring her son to his bris!

There are a few reasons why the kvatter is still used, and other thoughts to consider when choosing a kvatter.

1. Married couples who observe the laws of "niddah" are not supposed to pass things to each other, on account of rules which limit certain practices between husband and wife during the niddah period. While "niddah" status is usually a private affair, a woman who has given birth is known to be in the status of "niddah" on account of her having given birth, so in a public Jewish ceremony, we help them follow the rules by having the "kvatter" couple as their go-between.

2. Some situations and circumstances do not make the mother's entrance possible, such as in certain synagogues or smaller rooms which have limited space. As such, the male half of the kvatter is in the room anyway and he'll take the baby from his wife to bring him to the ceremony.

3. The segulah to have a child is something that some people put a lot of stock in. Why not give them the opportunity, if it would be meaningful to them?

4. In a ceremony with limited participation - most of the honors consist of holding the baby briefly - it provides an opportunity to have more people hold the baby. Many people like to get additional "kvatter people" involved to give additional grandmothers, great aunts, friends and the like the opportunity to participate. It also provides more opportunities for photographs.

My rule in this respect (#4) is simple. Let the women pass the baby first, and the last woman gives the baby to her husband before other men pick up the hand-offs.

What if I don't have any childless married friends? Do I need to find such a couple? (Or - Who else could serve as kvatter?)

No. The couple should ideally be married to one another. Some people give it to the baby's aunt and uncle, or a great-aunt and great-uncle, or even the baby's grandparents. In the case that a married couple is not available, or they are being utilized for something else, the honor can also be given to a male-female team whose contact with one another would not be considered "immodest" in a public Jewish ceremony: for example, a mother/son or a father/daughter team. I guess a brother/sister team could also work.

What if the couple I want to include as kvatter are expecting - in other words, the wife is currently pregnant?

It really depends. Technically they don't have a baby yet, so the "segulah" could still apply. Some who are superstitious might view their being kvatter as a curse on their unborn baby (I believe this to be nonsense). Some feel that an expectant couple don't "need" to play this role.
May they be kvatters? Yes. Is it commonly done? No.

What if there is a couple with no kids that have been kvatter many times?

If they do believe in the segulah and want to play the role again, it is appropriate to give it to them as many times as possible.

BUT... be sensitive!

If they seem to be remorseful, or if it seems to be embarrassing to them because "everyone" knows they are "always" the kvatter couple, and "everyone" sees every time that they "still don't have kids" - which, of course, is nobody's business, then give the honor to somebody else.

Bottom Line

Follow the rules of a couple or appropriate tag-team, and give the honor to someone you care about and/or love.

p.s. Afterthought question

For those who follow the laws of niddah, what happens if the kvatter couple themselves are in a state of niddah?

There are two approaches:

1. This is nobody's business, and as it is a public ceremony, it does not matter. You should not be asking them, and they certainly should not be offering such information.

2. In some circles and some communities, the wife bring the baby in on two pillows, and the husband takes the baby and only the top pillow. In this way, the possibility of the wife handing the husband the baby is taken away. And as "everyone" does it this way, it removes any uncomfortable situations or needs for explaining.

Tuesday, December 15, 2009

Methods of Circumcision

Most parents looking to have their son circumcised just want it to be done as efficiently as possible, as speedily as possible, with minimal pain to the baby.

Of course they'd prefer the circumcision be aesthetically pleasing, and that the circumcision heals sooner than later with no complications.

When doing research about ANY mohel, the end results are important. (I've written elsewhere about the demeanor and the ceremony and the need for things to be done at your speed.) And most people leave the method to achieving those end results up to the mohel, and how he feels most comfortable getting there.

However, there is not "only" one way to circumcise. And if it is important to you, it is important to ask about methods, and to inquire if the mohel can accomodate your desires.

There are some methods which are questionable according to some (in some cases, many) rabbinic opinions. There are others which are standard - even if the "innovation" in them is "only" hundreds of years old. And there is old-school, bare bones (literally), which is advocated by few.

Sadly, those who advocate the latter method often knock everyone else, even going so far as to declare other circumcisions "unkosher" and requiring hatafat dam brit - a ceremonial drawing of blood from the circumcision scar that would "kosherize" the bris. This is not only a form of lashon hara and rechilut (talebearing), but is a lie, a form of fear-mongering, and does nothing but increase hatred amongst Jews.

Hmmmmm. That last paragraph was a mouthful. Take a deep breath and let's move on to methods:

INTRODUCTION

Bris Milah has three steps:
1. Milah - the removal of the foreskin
2. Priah - the removal of the membrane that is found between the foreskin and the glans
3. Metzitzah - drawing of "distant" blood

The foreskin is drawn forward and removed. The membrane is often removed with the foreskin. If it is not completely removed, then it is torn and folded back beyond the glans. Finally, blood is drawn from the wound.

In the interest of space, the methods described will not include metzitzah, which will be the subject of different posts.

And I will leave the issue of whether the mohel is wearing gloves up to you, the parents, as well. I've addressed this in a number of posts already. [Search "sterility" in the keywords]

Method #1. Clamp





The foreskin and membrane are grasped with a hemostat and a clamp is applied to the foreskin. There are two kinds of clamps that have been utilized by mohels over the last sixty years. The first is the Gomco (on the right in the photo), which is often the method of choice for doctors in hospitals, but is not largely used by mohels. The second is the Mogen or Bronstein clamp (on the left), which is the method of choice for many mohels in the US (though most Orthodox mohels, including me, do NOT use it). The foreskin and membrane are then removed together in one incision, with a scalpel or bris knife.

Method #2. Shield


The foreskin and membrane are grasped either with a hemostat (as in method #1) or skillfully with the fingers. A metal plate with a thin slit is applied to the foreskin, leaving the foreskin resting above the plate, with the glans safely shielded below. A scalpel or bris knife is used to excise the foreskin.

If the membrane is removed along with the foreskin, metzitzah follows.
If the membrane is not completely removed along with the foreskin, it will either be cut with scissors, or the mohel will tear it with his sharpened thumbnails - in both cases to reveal the entire glans.

Method #3. Free hand


Without using any device other than a blade, the mohel will estimate the length of the foreskin, grasp it with the thumb and forefinger of one hand and excise the foreskin with the knife in his other hand.

Membrane removal will follow that of method #2. Metzitzah will follow.

PROS AND CONS OF THE METHODS

Obviously, the "con" of the baby having skin tissue removed and being subject to the pain of circumcision, and any bleeding are a given. If you are having your baby circumcised, it is assumed you understand that this is the down side (if you even view it as a downside) of the spiritual, national and Jewish significance attached to this procedure - which is the fulfillment of a commandment.

The pro: Baby bears the mark of the covenant established between God and Abraham, and all of the Jewish people, which established God as our only God, and we, the Jewish people, as His firstborn, the chosen people who have a mission on this earth to spread monotheism and ethics to as many people as we can.

Pros and Cons of #1 (Clamp)

Benefits include:
* Usually a bloodless circumcision.
* The mohel may not even need to use a bandage.
* If applied correctly, the glans is protected.

Cons:
* Usually a bloodless circumcision. (Blood is an essential element of the bris)
* Estimating the end of the foreskin along the shaft is inexact
* The FDA has issued severe warnings about the use of the clamp, as it could grasp and amputate the glans or the tip of the glans.
* The pain of the crushing of the foreskin is immense
* Once the clamping mechanism is applied, the estimation of the foreskin is irreversible. Even if one were to remove the clamp and then reapply it correctly before excising the skin, the skin tissue that remains would be dead, and would liekly either become the equivalent of a growth or fall off on its own.
* In order to achieve its desired effect, the clamp usually needs to be on for a significant amount of time - from 30 seconds to five or ten minutes. This is significantly longer than the next methods which take 3-4 seconds.
* Rabbinic approval is scant.

While Reform and Conservative mohels will often use this device, Orthodox mohels who use it usually do not have rabbinic dispensation to do so. Many will use it out of their own convenience (in other words, not because they have the baby's best interests in mind) so they need not come back and check the baby. This is not nice - every baby should be checked after the bris. No matter the method used.
Those who use it usually swear by it. I think they feel this way because of the lack of necessity to follow-up. But I may be wrong.

Pros and Cons of #2 (Shield)

Pros:
Quick procedure
* There is blood (necessary component of the bris)
* No chance of anything happening to the glans
* Until the actual incision is made, nothing is irreversible

Cons:
* Estimating the end of the foreskin along the shaft is inexact
* While the foreskin is not crushed, it is squeezed tightly for a few seconds.

The shield is an innovation which dates back at least four hundred years. It's purpose was (and remains) to protect the glans which is at great risk of being cut or amputated when a bris is done by anyone other than an extremely skilled operator. Like in the previous method, once the shield is in place, the actual removal of the foreskin - cutting along the shield, is the easiest part of the job.

Pros and Cons of #3 (Free-hand)

Pros:
* Quickest procedure
* Relatively painless

Cons:
* Estimating the end of the foreskin along the shaft is inexact
* There is no chance to second guess because the mohel never gives himself a chance to double check before excising the foreskin
* The possibility exists that the blade might cut the glans
* If done by anyone other than a skilled operator, the outcomes could be disastrous

The only people who still do brisses this way are some Chassidic Jews. While each person is entitled to have an opinion, those who do it this way are the most outspoken about - and against - any other form of circumcision.

THEREFORE

You may have noticed that the con that reads "Estimating the end of the foreskin along the shaft is inexact" was on every "con list." This is because many mohels were never taught to use a surgical pen to mark the edge of the foreskin before beginning the procedure. If the mohel's initial estimation is marked with a pen or marker, the "con" is removed from each list, as long as the mohel makes sure to cut along the mark.

I wrote about pain in the last few sections of this post. In simple terms, I think it is important to numb the area before the bris, but I think injections are not the way to go about doing it. There are topical methods out there that do just as good a job, and don't cause the baby pain from three "shots."

My Method

In addition to marking the end of the foreskin, I use Method #2 for a host of reasons. While I personally do not agree with methods #1 and #3, I believe that the bris is kosher if the operator is fit to be a mohel. I also think that parents should know what they are getting in to when hiring a mohel, and that the method which best suits your needs should be employed for your son.

When I circumcise, I aim to remove the foreskin and membrane at the same time, to minimize pain to the baby and the need to bother him too much. I always check the baby later, either a few hours after, the evening after, or the day after the bris. I wear gloves. I package all my instruments and bandages and sterilize everything in an autoclave machine - unless it is sterile in its packaging, e.g. gloves and drapes.

I hope this has been helpful to you. As always, feel free to contact me by email with any questions, or call me

Friday, November 27, 2009

Putting Your Mind At Ease

When a new baby arrives, there is so much to do.

Take care of older siblings, take care of mommy, take care of new baby.

If there's a Shalom Zachar: arrange the logistics of the Friday night party, tables and chairs, food and drinks, who will speak, and (if it's being done out of the house) arranging the location.

In the week leading up to the bris: the location needs to be booked, the caterer or food needs to be arranged, and the mohel needs to be called.

Many people are blessed to have family and friends take care of many of these things. Even calling the mohel can be done by someone other than the parents (though it's a good idea for everyone to know who is arranging the mohel so only one is hired).

Most of the things that need to be done can be done per your style, based exactly on what you want.

When it comes to the actual circumcision, however, most people do not know enough about the field to know there are differences in the way mohels may operate or work, in terms of technical procedural details.

I try very hard to give the baby's parents the forum to have the bris "how you want."

So whether you want a meaningful ceremony, a quick procedure, interactive with crowd participation, more of a show, or just a simple, dignified bris, give me a call! Let's talk about what fits your needs, and make the bris out to be all that you wish for yourselves, your baby, and this moment in your lives.

Mazal tov!

Thursday, November 19, 2009

A Note on Jews, Religion and Observance

According to the oldest understanding of Jewish law, a person is a Jew either through having being born to a Jewish mother, or through undergoing a rigorous, intense conversion. (Please Note - conversion in general is a hotbed for all kinds of issues which cross the borderline of politics. I generally try to avoid dealing with it as I am not an expert in the laws of conversion.)

Every mohel, when asked to perform a bris, will ascertain that the mother of the baby is Jewish either by birth or through conversion. This would automatically make the baby born to her Jewish, and fit to have a bris in its proper time.

The mohel will not ask about personal observance or religiosity, because it is irrelevant to his job (unless he is thinking of grabbing a bagel or danish to go, in which case he may want to know if the food is kosher.)

When the mother or baby is a convert, some mohels deal with this regularly, while some shy away from it unless they work with the first hand guidance of a rabbi who will help them through the steps of the conversion process.

The main thing to do is have an open conversation with the mohel. Recognize where he is coming from, where you are coming from, and understand that the mohel knows as well as you know, that this is a sensitive issue.

Wednesday, November 18, 2009

The Right to Choose

You're a young parent. You are about to have your first son (or your second, or your third, etc). You know you're going to be making a bris. You'd like to do research and hire the person you want to do the job. Then mom or dad call and say "Use our friend. He was good enough for you back then." You're thinking, "I don't want a guy who is old enough to be my parent (or grandparent). I want someone who can relate to my experience." Not that the person being recommended is not a good mohel. But your needs are different.

He's your baby. You have the right to choose.

Getting Ahead Means Constant Education - Static is a Formula for Mediocrity

In order to get to the top of one's field, every professional has an obligation to continue one's education. As one mohel put it to me after I had observed him work, "Please tell me what I am doing wrong. I am always learning." Mind you, this man has been a mohel for over 25 years. So I admire him for being able to say this.

When you're put on the spot like that, it is hard to be honest. Especially when you don't really know the guy.

So I told him, "Here are the things I would have done differently. I would wear sterile gloves (as opposed to your method of wearing no gloves and using your bare hands). I would have a wastebasket under the table."

What I did not say was, "I would make sure the wine and all materials are there before I begin. I would know who all the key players are (i.e. who is the father, and who are the grandparents) before I begin the ceremony. And I would not delay the start of the ceremony twenty minutes because I am not ready."

I once mentioned to my father that a person who had been reading the megillah on Purim for thirty years must really know it well. My father said, "Yes. Except he's been making the same mistakes for thirty years."

The World of Competition or 'Why Settle for Mediocrity?'It is amazing to me that people settle for mediocrity just because that is what they are used to.

Imagine this scene: There is one kosher restaurant in town. The food is OK (not great), the service is borderline (leaning towards lousy), and the prices are a little higher than reasonable (bordering on ridiculous). You go there only because you don't know anything else, and because you like to eat out every once in a while, but mostly because there are no other options

But don't you think you'd be checking circulars, ads, newspapers, yellow pages, the internet to see if a different kosher restaurant is opening? Let's say this mediocre restaurant is "all you ever knew." Can't you imagine that a different option might be an improvement? Especially if it is looking to compete with what has been, until now, the "only show in town?"

That is a depiction of restaurants.

Why I Prefer to Promote the Finer Qualities of A New Age Mohel

When I was a younger (not as busy) mohel, a friend of mine once said to me in commiseration "Does it really matter if a sixty year old [makes the cut] or if you do it?" His point was that the cosmetic result will be the same. The sixty+ year old in question (a certain mohel in NY), has a reputation and an endless supply of clients. Does it really matter to a young family if they get the thirty year veteran or the (then) five year veteran? All they want is for the bris to go well and for the baby to heal nicely!

Not really.

The New Age Mohel is in tune to modern sensitivities and sensibilities. He uses the most up to date methods of sterilization. He is neat and polished He is extremely aware of the clients he serves, their particular needs, and the needs of their guests who join in their celebration.

And he knows what new parents really want to get out of the bris experience.

What Do Parents Really Want?

New parents want to be treated with dignity and respect. They want the mohel to give them the time of day. They want a person who will sit with them and talk to them, and address their concerns. They want a person who will explain to them the process, who will raise and discuss important issues, who will give them the information they need to feel most comfortable with the process of the bris. They want a mohel who will help guide them and show them different options, to help them understand and find what they want.

They want to see that the mohel practices with a sterile technique. They want to see that he works in a clean space. They want to see that he treats their baby gently. They want to see that they and their baby are not just a number - that they are treated like human beings, like parents who have just had the amazing experience of birth, and who want to have an equally meaningful experience with the bris.

They want follow up. They want the mohel to visit the baby after the bris. To see that everything is OK. To give clear instructions. To call. To be in touch. To care.

See here for a list of good questions to ask a mohel

WARNINGS

Too many people go into the bris experience with too little information. You would never choose a surgeon for yourself without doing research: why pick a mohel for your newborn without doing research?

The bad stories and experiences are usually swept under the rug.

People are embarrassed to talk about their son's penis and his bris.I have heard the following statements from (too many) people who did no research before hiring someone for their son's bris. No one is perfect. But these statements should never have to be said after your son's bris.

THESE ARE ACTUAL QUOTES FROM PEOPLE I HAVE MET, WHO TOLD ME THE STORY OF THEIR EXPERIENCE AFTER LEARNING I AM A MOHEL (WHO DOES THINGS VERY DIFFERENTLY THAN THESE COMMENTS INDICATE ABOUT OTHERS' BRIS EXPERIENCES)

"The diaper was a mess after the bris."
"The mohel did not give us clear instructions."
"There was a bleeding problem."
"The baby got an infection from the bris." [THIS SHOULD NEVER HAPPEN]
"The mohel was not in touch."
"The mohel did not practice good personal hygiene, or in the way he conducted the bris."
"The mohel told us how to take off the bandage, and instructed us over the phone."
"The mohel was insensitive to our needs."
"I wish I had done more research."
"I wish I had even explored other options."

Feel free to contact me if you have any questions.

Sunday, November 15, 2009

Putting Parents At Ease - More Considerations

Over the weekend, I attended a presentation/discussion in which one person mentioned her impression that bris turns some people off from Judaism. Almost as an aside she said "They think it is barbaric."

It wasn't my forum, so I kept quiet. I have a lot to say on the subject, but it's for a different place. My blog, for example.

Firstly, I don't believe the bris turns people off from Judaism. It's a big world out there. People who are unhappy with Judaism will find any excuse they want.

As far as circumcision being barbaric, that statement is a hard sell in the United States when over 60% of the newborn male population is circumcised - either routinely with a clamp (with or without a local anesthetic), in the O.R. under general anesthesia, or as part of a religious or holistic ceremony - and until relatively recently, over 90% of the newborn male population of this country was circumcised.

The American Choice

In American culture, people have all kinds of reasons for circumcising their sons. I learned about this recently when our son was born, when my wife and I were handed a pamphlet about circumcision which boiled the choices down to two: "to circumcise or not to circumcise; that is the question."

They have a number of reasons why people may opt to circumcise.
* Medical suggestions that urinary tract infections, penile cancer, and other penile illnesses (including STDs) are less common and the penis is less susceptible when circumcised.
* It is easier to clean.
* Family - father and brothers are circumcised
* Cultural - everyone else does it
* Aesthetics - You like the circumcised "look" better than not.
* And, of course, religious reasons.

Reasons not to circumcise include:
* It is healthy tissue which guards a very sensitive area of the body
* No medical benefits if the child is taught how to clean under the foreskin
* Why subject a child to such surgery, which may be unnecessary?

The "barbaric" nature of circumcision is not raised, even if people may personally feel it to be such.

Why Jews Circumcise Their Sons

While the religious reason is most obvious, the best verbal explanation I have heard of late was in the documentary "Partly Private" - a film made by a secular Israeli woman living in NY, who was researching whether or not to circumcise her as-yet-unborn son (they had circumcised his older brother, but were displeased with the experience).

When a number of her Israeli friends gathered to be a sounding board for her deliberations, one of her friends who had become observant said, "If you are deliberating circumcision because you think it is 'barbaric' - you are right. Don't circumcise. But if you have faith in God and understand that this is what God asked of the Jewish people, as this is a mark of the covenant He forged with Abraham, then this is not barbaric. This is an act of love: for your child, for your people, for your God."

He is so right. The reason we circumcise is FAITH.

But it's still BARBARIC, Right?

It really depends on your perspective.

Most medical authorities who deal strictly from a medical perspective (in other words, who do not have an agenda), will argue the benefits versus the risks, the pros versus the cons. Very few will call it a barbaric procedure.

Most people who call it barbaric have an agenda, have an obsession, and find it hard to not think about how life (read "sex") would be different if the parents had not chosen to "make the cut" on them.

And they'll usually show a picture of a red, screaming baby to show the kind of pain a baby feels when undergoing a circumcision.

Before we continue, it is important to understand that there are different kinds of circumcision procedures, and all kinds of situations that can make a baby cry and scream bloody murder.

Setting the record straight

Babies cry. They scream. They can be in all kinds of discomfort. And sometimes there is not much we can do to ease their pain.

Babies who have blood tests, shots, raw diaper rashes, or sometimes just have colic may very well be inconsolable. Would you not have your baby have the necessary blood test or innoculation just so your baby won't ever cry?

Sometimes benefits outweigh the downsides. And sometimes not.

There are some who will argue that babies nerve endings are underdeveloped and so they don't feel the circumcision.

This is a lie.

Babies absolutely feel pain. But they only feel the pain to which they are subjected - and that, only if nothing is done to numb them from the pain. Which brings us to two points worthy of consideration when considering the difference between what is known as "routine circumcision" and a bris (A circ in an O.R. is a completely different story, because once the baby is under general anasthesia, all bets of pain and discomfort are off.)

SPEED OF PROCEDURE and NUMBING

Click this line to read the article in which it appears: "A mohel does not usually use anesthetic, because his anesthetic is the speed with which he does the circumcision. "

Most routine circumcisions are done elaborately, painstakingly, with a clamp that crushes the skin in order to achieve hemostasis. Since the skin is essentially dead when it is excised, there is usually no bleeding by the time the last skin is removed. Kudos.

Meanwhile, the baby has been in excruciating pain throughout the procedure (which usually takes between 5 and 20 minutes), unless the circumciser has used a penile block (3 injections around the circumference of the penis, along the lower base of the abdomen), to numb the area during the procedure.

3 injections = 3 shots. If your kid screams during one shot, imagine THREE, even if their outcome is a numbing. The shots themselves are painful!

A good mohel is usually done with the procedure, start to finish, in between 5 and 10 seconds. That's less time than it takes to administer the injections. Yes, there is usually a little more blood at a bris (only a little), but the drawing of blood is (like it or not) a necessity for the procedure according to Jewish law. The covenant was forged over blood. (If you like movies, you can see how a covenant is forged over blood in Kevin Costner's "Robin Hood" when he swears to avenge his father's murder in the first quarter of the film - I used to have a link to youtube here, but the video was taken down.)

NUMBING [See this posting - in which I revised what I wrote below - AB, 2012]

I happen to be a fan of numbing the foreskin, but not with injections. I prefer a topical analgesic with a dose of 30% lidocaine + 70% acid mantel cream base, to be applied to the penis at least a half hour before the bris. It doesn't hurt the baby at all in its application, and it does the same thing for the small amount of time it is helpful. Most of the discomfort at the bris comes from being handled, not from the pain of the bris (proof is that the baby usually stops crying once he is no longer being touched).

And even without it, the bris speed is, as mentioned above, its own form of anesthesia.

In Conclusion

If I were not Jewish, would I circumcise my son? Knowing what I know about circumcision, I probably would. My wife would probably not, just because she would not want to subject the baby to a painful experience - even a fleeting one.

As we are Jewish, we agree that we do it because the Torah commands it of us.

I don't think it is a barbaric custom, and I think those who do it properly have a tremendous sense of satisfaction that the baby is well and that the chapter of bris is behind them.

Consider the method and you have your answer. (Clamps, injections, drawn out, hospital v home, physician, resident, mohel, surgery v bris)

And hopefully, if you call me, you'll find what you're looking for in a mohel and you'll uncover the answers to more questions through our conversations.

Monday, November 2, 2009

When The Mohel's Wife Gives Birth to a Boy

My wife gave birth to a little boy on Shabbos morning! Really!

We are so excited and so blessed.

When our oldest was born, a girl, people asked me if I was disappointed. Of course I wasn't disappointed. (In the fifty percent chance of the child being a boy, I was excited about the prospect of a bris until the doctor said "It's a girl," and she was (and is) beautiful, healthy, and the joy of our lives.) Becoming a father is one of the most altering moments in a man's life. Any remaining ego in one's marriage disappears as your life becomes one of complete focus on doing everything for the sake of the child.

At the same time, I called my mohel teacher, Rabbi Sasson, to tell him my wife gave birth to a girl and he said, ".תמיד זה כחה. למוהלים נולדות בנות" - "It's always that way. Mohels always have daughters."

Two Things Everyone is Saying

1. Everyone's a comedian. "I can recommend a good mohel." "Who's going to be doing the bris?" "Have you called the mohel yet?" "We had a great experience with so-and-so. You might want to call him." "I guess we all know who the mohel is!"

Do people make such a fuss over the identity of the mohel before their other friends' brisses?

2. Many people ask: "Will you be doing the bris yourself?" I don't know what the source of this question is... unless people are thinking that doctors don't operate on their kids or immediate family.

To answer the question - Yes. I will be doing the bris.

The Ideal Mitzvah of Bris

The reason I will be doing the bris is because that is the ideal mitzvah. Every father is supposed to do the bris himself.
(Genesis 17:10-12: It's worth reading the whole chapter) But since most fathers are not trained to do it, it is much safer to have a mohel do it.

In this case, since the father is a mohel, the father will do the bris.

The first baby to be circumcised in the Jewish tradition was Yitzchak, who was circumcised by his father Abraham on the eighth day of his life. (See chapter 21, verse 4)

In an ironic twist, our son was born on the day we read the Torah portion describing the origin of the covenant - the Bris Milah (Genesis 17), and his bris will, please God, take place on the morning when we read the Torah portion describing the birth and bris of Yitzchak.

Pretty cool, no?

A number of years ago, my wife wrote an article about being the mohel's wife, and her impressions of anticipating the birth of our first child.

Now we will joyfully bring our son through this reaffirmation of our commitment to the covenant, as we continue to celebrate his arrival and the joy he brings to us, our family, our friends, our community, and the collective nation of Israel.

Thursday, October 29, 2009

Why we stand at a bris

The mishnah in Bikkurim 3:3 says that when the first fruits were brought to Jerusalem during the holiday season in the times of Temple, workers would stop what they were doing to greet those carrying the fruit.

Rabbi Ovadiah of Bartenura asks why they did this. While there is a custom/law to stand out of respect for scholars, the rule is inapplicable to workers who are busy at their trade. If one need not stand for scholars, one certainly should not have to interrupt work to stand for regular people carrying fruit!

He answers that we are not standing out of respect for the persons or for the fruits. We are standing because at the moment the actual mitzvah is being performed, it is beloved. Thus we stand out of respect for the loving feeling we have for the mitzvah at the time it is being fulfilled.

This is why there is also a custom to stand for the pallbearers who carry the deceased past us and [on the opposite end of the circle of life] to stand for those who carry a baby into his bris.

Those who participate in a bris know the joy of the moment, the special feeling in the room. Emotions run extremely high when those attending have a deep understanding of the special significance of the bris, and have a feeling that the mitzvah being fulfilled is indeed beloved to all who are present.

One way to express respect garnered from the love emotion is to stand when subject of that love, the item or person, passes by.

As this is certainly the case for the baby at a bris, and hopefully for the mitzvah being fulfilled through the baby, we have the custom to stand for the bris itself.

Wednesday, October 28, 2009

Funny story? You decide...

Part I

At a bris of a family I knew well, I knew one set of the baby's grandparents, who lived in my community, but not the other set of grandparents. When I met the mother-of-the-baby's father for the first time and figured out who he was in relation to the baby, I made the mistake of saying to him, "O! You must be the other grandfather."

I meant no harm - simply that I knew one grandfather already, and since the baby has another one, I've now identified him.

In a half-joking but half-extremely-serious tone he said to me, "The other grandfather? I am not the other grandfather! I am the baby's grandfather. There are two grandfathers. Neither one is the other."

At least he was fair to his mechutan (is there a word in English for your kid's in-laws?).

Even though I meant no harm, I learned my lesson. Now I tell the story of how I learned not to call any grandfather the "other grandfather."

Part II

At a different bris, the family kept on calling up "the baby's grandfather" to participate in the ceremony - except that there were four of them! Grandfathers, I mean.

Finally, when the last grandfather was called up to serve as the sandak, who holds the baby during the bris, as I was positioning the baby on his lap, I told him the story (Part I).

I said, "I once made a mistake, so I never call any grandfather 'the other' anymore."

Without missing a beat, he said, "Well there were a lot of mistakes made here. And that is why there are four grandfathers."

Tuesday, October 27, 2009

Bris Humor

Here is a quote from Rabbi Joseph Telushkin's "Jewish Wisdom," p. 141 (William Morrow, 1994)

“My friend Rabbi Jack Riemer of Miami likewise expresses great exasperation at the obscene jokes that frequently are told by people attending a circumcision. Turning the sacred ceremony through which a male Jewish baby enters the covenant into a source for ribald humor demonstrates how obscenity can desecrate the sense of the sacred. For if entering the covenant is turned into a source of jokes, then the covenant itself eventually will be treated as a joke.”

The sentiment is so true. (I only disagree in that I believe the boy enters the covenant when he emerges from his Jewish mother, as does a baby girl who will never be circumcised, when she emerges from her Jewish mother. The boy bears the mark of the covenant, the sign of the bris (אות ברית) at his circumcision.)

The covenant is critical to the definition of the Jewish people. If we disregard or make light of it, it will become meaningless.

At just about every bris at least one person will approach me to see if I've "ever heard this one." One of my colleagues likes to say, "I have respect for that joke, because it's older than you and me combined."

It is a rare occasion when someone tells a joke related to bris that I have not heard.

It is even more rare if the joke I am told is appropriate and worthy of being repeated.

Let us save our inappropriate humor for a night on the town, and minimally preserve our dignity when we have the chance to show the utmost respect for our tradition and heritage.

Why not?

Wednesday, October 21, 2009

What to Prepare for a Bris

Every mohel has a similar list of items you'll need for the bris and for caring for the baby after the bris.

Here is my list:
  • 2 pillows (to hold the baby before, during and after the bris)
  • 1 small wastebasket (for packagings, bandages, and the occasional dirty diaper)
  • 5 disposable diapers with wipes (in case baby soils more than his share...)
  • 5 hospital-style receiving blankets (not expensive blankets) (see previous)
  • 1 large tube of A&D Ointment (with the gold label) (NOT the "cream") (to lubricate the bandage)
  • 1 box of 25 individually wrapped 3"x3" gauze pads (to put on top of the dressing)
  • 2 tubes of polysporin (ointment) (or polybacitracin) (For after the dressing is removed)
  • 1 bottle of sweet kosher red wine (for the blessings which accompany the bris)
  • 1 kiddush cup (to hold the wine :) )
Italicized items can be purchased at any pharmacy, and the ointments can be generic


The setup of the room can be found at this link (or http://www.mohelinsouthflorida.com/2009/10/typical-bris-set-up.html)

Covenants in the Torah

In the weekly Torah portion, we have entered the territory in which most of the covenants between God and humans were forged.

The first covenant is forged using the rainbow as a sign: Genesis 9:12, 15
The rainbow serves as a reminder that all of humanity will never again be destroyed with water. This covenant is between God and all of humanity

The second covenant is made over the mark of circumcision: Genesis 17:10-11 (read the whole chapter!)
This is between God and Abraham's descendants and household (Abraham passes on the tradition of this covenant to his son in Genesis 21)

The third covenant is created through the Shabbat: Exodus 31:13-17
This covenant is between God and the Children of Israel.

The rainbow, circumcision and Shabbat serve as a sign (אות) of God's role and involvement in the world. Circumcision and Shabbat serve as a mark of the special connection the Jewish people have with God.

On one hand, this is a very cursory view of these covenants, but on the other hand, for the God-fearing believer, these are very deep concepts.

The rainbow is external - it is for all of humanity.
Circumcision (as a covenant) is a one time deal which is difficult when it happens, but you don't really notice it beyond that. It is for Abraham's descendants and his household, not as general as the covenant of the rainbow.
Shabbat is, for the uninitiated, more difficult, more taxing, more long-term commitments, and it involves the entire body, on a weekly basis, and is exclusively for the Children of Israel.

We go from very general to very specific. What does this say about God? What does it say about different peoples?

Monday, October 19, 2009

Sterility and Cleanliness - Can't Emphasize Enough

Circumcision as Surgery - An Observation

Today I accompanied a pediatric surgeon friend of mine to the O.R. where he performed a circumcision on a three month old baby.

Those who do circumcisions strictly for non religious reasons have many options for how to do it. They can do it in the doctor's office, in their home, in the hospital with local anesthetic, or in an Operating Room, under general anesthesia.

It is a different kind of experience, watching a procedure I knew so well, and a result I am so familiar with, done in a completely different way. Surgeons have the luxury of all the time in the world. There is no crying baby, no nervous mother who only wants the baby to stop crying and for the mohel to leave him alone. And just about any error in the course of the procedure can be corrected right away without anyone being the wiser.

Emphasis on Sterility

There is no compromising on the sterility of the procedure in the operating room. Sterile drapes are put all around the surgical field. All instruments have the same level of sterility as for open-heart surgery. The surgeon and his assistant do a full scrub before donning their surgical robes and sterile gloves.

And why should they act any differently? They have a responsibility to assure that the risk of infection is minimized under their watch. At all costs.

The beef

I understand that the nature of a bris makes the sterility degree of an operating room nearly impossible to achieve. And thankfully, the bris usually heals without complications and without problems.

But...
  • I see too many mohels operate without gloves.
  • I see too many mohels who wash their hands and then touch everything from the baby's clothes to a briefcase on the floor before starting the bris.
  • I see too many mohels operate after putting their "sterilized" instruments onto a laundered diaper cloth handed to them by the baby's mother five minutes earlier.
  • I see too many mohels who have no regard for sterility, and explain their ways by virtue of their unverifiable track record and their inability to change their ways after having done things this way for decades.

There should be no tolerance for anyone treating your baby and his fresh wound any differently than how a fresh wound would be treated by medical personnel in a doctor's office or under close to O.R. conditions. Mohels are not perfect, but they can be much better.

While infections are uncommon (rare), they should be non-existent. And infections in a baby which come from the bris can be life-altering if not deadly.

Sunday, October 18, 2009

Important Lesson I've Learned on the Job

Over the years, I have been privileged to serve as mohel for parents at all stages of parenthood. First timers, Second timers, etc. up to tenth-timers. I've worked with parents of twins (a number of times) and triplets (twice).

Thankfully, most births are without complication, or with minimal complication.

But I once had the sad role of being the mohel for a premature twin who lived only one day. (There is a custom to circumcise baby boys who do not survive, so their body may bear the mark of the covenant. You may or may not agree with it, but for the parents who lose a baby so soon after birth, this can be very comforting.)

And I've been the mohel for babies who came against all odds, after their parents experienced numerous miscarriages, or many years of infertility - treated and untreated.

I was once called to do the bris on a baby whose parents - both of them - are cancer survivors. I did not know this about them until after the bris. The husband/father gave the most emotionally packed speech I have ever heard at a bris, and I kid you not when I say there was not a dry eye in the room. Their friends and family all know their story, and they all celebrated the birth and bris of that baby in a way I hadn't seen and haven't seen since.

So here is the lesson:

You never know what people go through before having or in order to have a baby. One father put it to me this way: "People keep saying to us, 'why are you waiting? Don't you know it's better to have the kids closer in age?' We have one daughter, and we've had nine miscarriages. We'll take 'em when we can get 'em."

Obviously he won't say that to people. But it just goes to show that people can be really dumb in the things they say.

Those who are blessed to have babies, whether without difficulty, or with difficulty and with help, are truly blessed.

And those who seem to "wait" a long time before having their first, or their second, etc. - they are blessed in a different way (perhaps moreso) when they have their babies.

And those who don't have any children - you never know why it is so.

Wish those who become pregnant the best of wishes. And if they don't become pregnant, do what you can to help only when they reach out to you. Otherwise, don't say anything.

You have no idea what they're going through.

Tuesday, October 13, 2009

Why I Love Being a Mohel

People ask me all the time why I decided to become a mohel.

Have you ever known you wanted to do something so badly? Some people know they want to be doctors from a very young age. Some know they want to be laborers. Some are destined to become teachers or clergy.

The First Reason - Why I Became a Mohel

I grew up in a home and an environment in which Judaism was very important to me. As I entered adulthood, it occurred to me that a well-rounded Jew knows how to do a few things. [In other words, somebody shared this passage from the Talmud with me, from Hullin 9a:]

ואמר רב יהודה אמר רב תלמיד חכם צריך שילמוד ג' דברים כתב שחיטה ומילה ורב חנניא בר שלמיא משמיה דרב אמר אף קשר של תפילין וברכת חתנים וציצית

"And Rabbi Judah said in the name of Rav, a wise student needs to learn three things: how to write (some say this means 'to be a scribe' while others define it as 'to be literate'), how to ritually slaughter (to make kosher animals fit for consumption: inaccurate slaughtering renders even kosher animals such as cows, sheep, goats, chickens, ducks to be unkosher), and how to circumcise. Rabbi Chananya son of Shelamya said in the name of Rav: Even how to tie the knot of the tefillin, how to recite the blessing of the groom (to conduct a wedding), and how to tie tzitzit."

I had observed many circumcisions, and had gotten over the natural squeamishness that sometimes comes when watching such things without knowing exactly what is going on. It was the right time and the right place for me to train and learn this skill.**

Reason #2

I love meeting new parents. Whether this is a first baby or a tenth child (I've done brisses for both ends, and all points in between), the joy that accompanies the arrival of a new baby is a classic example of something that unites the human condition.

It is a privilege to be invited into the inner circle so early, and an honor to bring what I hope is perceived as a calming presence to what can be the stressful (and meaningful!) ordeal of the bris.

Reason #3 & #4

I love newborns.

#3 - To my mind, there is no better evidence to the existence of God than witnessing the miracle of birth. Obviously I don't watch actual births, but I do get to see the result of (hopefully) nine months of gestation, and the constant renewal of the miracle of life.

There is a tradition that God continues to renew the world every day. Seeing newborns on a regular basis is an affirmation of God's continued role in Creation.

#4 - Newborns are so innocent, so sweet, so delightful to behold. It is true that most of my job consists of bothering them, but I also get to calm them and soothe them. I enjoy sharing with new parents some tricks to calm a baby that I've picked up over the years: fast diaper change, how to swaddle, how to avoid the ever-threatening "soaking" the baby gives those who change his diaper, and positions for holding a baby that can be calming, and can remove discomfort.

Reason #5

I am personally very detail oriented and a bit of a perfectionist, qualities which serve me well in my capacity as a mohel.

These character traits help me: run a respectful and organized ceremony, maintain cleanliness throughout the procedure, leave my workplace as neat or neater than how I found it, give you full instructions for how to care for the baby after the bris, make sure the cosmetic result is as best as I can make it.

Conclusion

Yes, there are other reasons as well, but these will suffice for now.

Most of all, it is an honor and privilege to be a part of your family's joyous occasion, which I appreciate very much and do not take lightly. I am grateful that you have opted to explore utilizing my services, and I look forwarding to serving your family with graciousness and sensitivity.

Mazal Tov! Best of luck to you, your baby and your family.


[**I have learned the laws, but not practical application, of how to slaughter animals. The squeamishness is different, and I don't know if I ever will learn the practical skill. It seems the Talmud is saying that a person should also know limits: If you have not learned the skill, do not undertake to do the action... It is very important for every person to be careful not to undertake tasks they are not trained to do. This may seem obvious, but in our world we hear stories all the time of people who thought something was "easy to do" or "didn't require training, skill or guided practice" and ended up with disastrous results.
As for writing, tying tefillin and tzitzit, and knowing the blessing of the groom, I am proud to put a check mark next to all of those.]

Monday, October 12, 2009

The Danger of Arrogance

Before you read this, please note: I share this conversation with you not to scare you, but to help you become aware of the possibilities out there, and to know there are ways to avoid many of the problems discussed here. My suggestions appear at the end of this entry, so please make sure to read through to the end.

Over the weekend I had an interesting conversation with a pediatrician friend of mine. Our discussion drifted towards the topic of this blog (circumcision) and he shared with me some horrific stories of circumcisions that came to his attention after the fact, when there was a problem.

Mild Problems

In cases where the baby is a bleeder, or the mohel needs help in containing the bleeding, the baby either needs to be sutured (a couple of stitches), cauterized, or, in some cases, better pressure needs to be applied to seal the wound. In some cases, different products that are often used to help coagulation can also be applied to stop the bleeding, without the need for the stitches or cauterization.

Thank God, I have never needed to send a baby to the hospital: I ask about hemophilia in advance, and I was trained very well in the skill of bandaging.

Different Problems

There is a small margin of difference between removing too little skin and removing too much skin.

Too little

Pros: easily correctable, no long term damage, might not need a correction
Cons: Baby may look uncircumcised for a long time, may need to be corrected, Baby has to go through two procedures (One person told me a story of how his son had a second Bris because the first was considered meaningless.)

Too much

Pros: Baby will definitely look circumcised. There won't be a need for any cosmetic adjustments
Cons: circumcision scar will be enormous. Sex (as an adult) will be a less pleasurable (perhaps more painful) experience.

All in all, these are a matter of debate regarding the pros and cons. Obviously a perfect circumcision every time would be preferred. But as all mohels (like all doctors) are human and are by definition not perfect, the guarantee of perfection would be dishonest. Instead, we do the best we can.

Below, I will explain steps that can be taken to help avoid these problems.

[See this posting about the different methods for how to do a bris]

Bigger Problems

My pediatrician friend described to me examples of children he examined who had been damaged by the mohel. "Damage" does not refer to brisses which are not 100% cosmetically beautiful - those are common enough and are no cause for concern. The penis generally heals nicely and functions normally.

But when the glans is nicked in the process (through the removal of the foreskin, a bris exposes the glans to the edge of the corona), or cut or [shudder] amputated, this is real damage. If an artery that can not be controlled through simple mohel techniques is somehow cut, we have a real problem.

The DANGER of ARROGANCE

Most mohels are trained by expert mohels in Israel or the US. If they follow the instructions of their teachers and do not look for shortcuts to make the process quicker, they can do no damage to the babies on whom they operate.

But if they think they know better, and worse, declare that they are the only ones who know how to circumcise and that others do not do "kosher brisses" because of the methods they employ to protect the baby - this is not only arrogant. It is stupid.

Methods ALL Mohels Should Employ

To reduce the negative possibile outcomes of a bris significantly, there are two steps I highly recommend. Most mohels already do the first in one form or another. Very few do the second. They are:

1. Use a Shield - a device that protects the glans during the incision. Whether one uses a traditional shield, or a clamping device such as the Bronstein/Mogen clamp, if the glans is pushed out of the way when the shield or clamp is applied, it will not be damaged in any way by the circumcision. (There are FDA problems and halakhic (Jewish law) problems with some clamps)

2. Outline the edge of the foreskin with a marker before beginning the procedure - This will reduce the "margin of error" significantly, and will assure a significantly better chance of having a clean and even incision all around.

The Arrogance

If a mohel decides he can do a better job freehand (using just his fingers to hold the foreskin, and a knife to excise, without using a shield to guide his incision and protect the glans - see method 3 here), I maintain that he is a fool and should not be allowed to operate.

To suggest that "God wants it to be done this way" is arrogance of the highest order.

I am not suggesting that I know what God wants any better than someone else. As a Jew who believes in the Torah, I believe God wants us to circumcise our sons, and that there are a few other requirements as to what is supposed to take place during a bris.

But I also believe that we are to take every precaution to assure that the chances of danger to the child beyond the inherent danger of removing skin tissue (the definition of the bris circumcision) be reduced to an absolute minimum.

I repeat (and add):

EVERY mohel should use a device that guards the glans
EVERY mohel should mark the edge of the foreskin before beginning
EVERY mohel should wear sterile gloves
EVERY mohel should maintain a sterile field during the bris
EVERY mohel should not allow any part of his body to come in direct contact with the open wound during or after the bris.

With proper monitoring and education, we can minimize the negative bris stories as we take charge in taking good care of our sons.

Wednesday, October 7, 2009

The Inspiration of Bris

The commandment of "bris milah," to bear the mark of the covenant between God and the Jewish people, first appears in Genesis chapter 17.

In essence, Abraham seals a covenant with God, an agreement that has survived until this day. Abraham and his descendants agree that God will maintain and sustain the Jews as His "chosen people" (an oft misunderstood term) if the Jews bear the mark of the covenant, circumcising their sons on the eighth day as per God’s commandment.

The “bris,” as it is known, has its own ups and downs. Everyone is joyful over welcoming a new baby. But the milah (circumcision) causes pain during which a baby cries. Some people say to the baby, “This should be the only pain you ever know.” Others say, “It’s not easy being a Jew.”

The truth is, however, that while the baby’s health is certainly our number one concern, the bris itself is more about an affirmation for everyone in the room, than it is for the baby. By all rights, every person should stand up and protest, “How can you do this to a newborn?”

Of course we don’t do this. Because we know in our hearts that the circumcision is but a small sacrifice to make to get God to live up to His end of the deal. That a nation which has experienced downs, such as the Jewish people have experienced, can continue to experience ups – this is the hand of God as revealed as it can ever be. It is what our lives are all about, it is what our experience on this earth is all about.

We use Avraham’s model of a struggle-filled life (see Genesis chapters 12 through 16 to understand his struggles) to arrive at the unstriking conclusion that the covenant with God is what keeps us going.

In the words of Rabbi Joseph B. Soloveitchik, in his “Tribute to the Rebbetzin of Talne,” we live “to feel the presence of the Almighty and the gentle pressure of His hand resting upon my frail shoulders.” It is a struggle worth living when the Comforter is so great.

Monday, October 5, 2009

Typical Bris Set Up

The setup at a bris varies from mohel to mohel, and from tradition to tradition.

Standard Ashkenazic

In most Ashkenazic brisses (where the husbands family is of Eastern European or Russian descent), the setup will consist of two chairs and a table. Good lighting is always appreciated.

Depending on the mohel's preference, the table will be on either the left or the right of the chairs.

One chair is used by the sandak, who holds the baby during the actual circumcision.



The second chair will be demarcated as the chair of Elijah the Prophet. There is a widely observed custom to set aside a chair for Elijah the Prophet to bear witness to the ceremony, much as we set aside a cup for him at the Passover Seder.

[See other examples of this chair here]
Standard Sefardic
Those who descend from Spanish Jewry, North African and Middle Eastern lands will usually have the table and the Elijah Chair, and will use the Elijah chair twice - first to put the baby on Elijah the Prophet's "lap," and then for the sandak to hold the baby during the bris.
Additional Items
Some have the custom to light candles.
Some set up a dish with dirt in it, so the excised foreskin may be placed in it - a prelude to its being buried shortly after the ceremony.
Modern Ideas
In different circles (mostly non-Orthodox), where many mohels happen to be physicians and are more used to babies being "out of commission," a circumstraint might be used to contain the baby's movements.

I don't recommend this device.
Others opt to have the baby held on a table for the procedure.
Finally, it is recommended to put a tablecloth on the table and a wastebasket under the table in case there is a need to dispose of any waste-filled diapers, sterile packagings, or used bandages.

The "Afterthought" Question

Please note I have another post on this subject here

New parents have many things on their minds. (Thank you "Baby Blues" for putting it so nicely)

Before preparing for a bris, the first thing everyone is concerned with is the adjustment - getting life back to a semblance of "normal" routine. First-time parents need to get used to the reality of a new person in their lives, whose care they are responsible for, and whom they possibly (probably) love more than they even love each other.

Parents with other children need to deal with the adjustment of a new baby in the house, possible jealousy of siblings craving attention, as well as the needs of the new baby himself, even though they are "seasoned" parents.

A bris puts what could potentially be a very stressful burden onto parents of a newborn, with a very fast deadline: No more than seven days to prepare.

Those who work out as many details in advance of the birth, whether they know the baby's gender or not, are a step ahead. They know where the bris will take place, they know who will cater, they've made arrangements with a mohel.

And somehow in the middle of it all, "the" question gets lost in translation.

"What's the fee?" "How much will it cost?" Most mohels do not raise such a question on their websites.






The truth is, how can you put a price on a mitzvah of such intimate, personal, and national significance?

My answer to the question is simple: I can't, so I don't. It's up to you.

According to Jewish law, the actual commandment in the Torah, is for the father to do the circumcision himself. People ask me all the time, "Did you circumcise your own son?" You see, bris and mohel-ing is not like a medical procedure for which it is ill-advised to have a family member preside over the surgery - even if the family member is the top in his or her field.

For a bris, the father is supposed to do the surgery.

Yes. I circumcised my son. Thank God, I am in a unique position of being a father who is trained and knows how to circumcise.

Most fathers are not trained, however, and would prefer to put their sons' well-being in the hands of skilled practitioners. And even if they think they can do it, the baby's mommy will never allow it, so it's usually a moot issue.




"Come on, Rabbi. Give me a range."

I can do that, but I don't want you to feel pressure to "match up" to others who may be in a different financial position. Ask yourself what it is worth to you to have this taken care of by someone else, and that is an appropriate honorarium.

It is my practice to say "Thank you" - no questions asked.

Final two notes:

A. If you live in a relatively close proximity to my home or regular travels, I look forward to meeting you before the bris. I will always make at least one follow-up visit, and may come back two or three times, depending on your child's needs. All travel expenses are included in whatever remuneration is offered - and is, of course, most appreciated.

B. For those looking for a range, people generally offer anywhere between $0 and $1000. Most people settle somewhere in the middle range ($250 to $750).

Here is the link to this question in the FAQ section of my website.

It may or not be helpful, but it is the best I can give you. Parents of a new baby could be at very different stages in their lives - from barely newlyweds who have no money to wealthy CEOs having their last hurrah at age 40. Let each do according to their means.

I am truly honored to participate - the role of mohel is a reward in and of itself. The opportunity to help, and everything else, is a gift of God.

See part II of this discussion

Wednesday, September 30, 2009

Good Questions to Ask ANY Mohel

You know you're having a boy. Or you're doing research just in case. What do you ask, to be sure you're getting the information you need to ascertain if the mohel you're speaking with is right for you.

For some of these questions, different answers are a matter of preference for you.

I feel the questions which relate to cleanliness and sterility should only have one acceptable answer... but that's only my opinion.

Please note - my answers to these questions can be found here - searchable by categories

1. Do you wear sterile gloves while doing the bris?
2. How do you do metzitzah – by mouth or with a tube?
3. Do you use a hemostat to accomplish milah and priah at once? Or do you use your fingernail to do priah?
4. Do you use a clamp? If so, what kind? Why?
5. Do you mark the spot where you plan to make the incision?
6. What kind of knife do you use for the bris?
7. How do you sterilize your instruments?
8. What is your opinion about the pain the baby feels during the bris? Can anything be done to ease it?
9. Do you plan to see the baby before the day of the bris?
10. When is the last time the baby should eat before the bris?
11. How soon after the bris can my son eat?
12. Do you plan to make any follow-up visits in the days following the bris?
13. Do you ever need to do anything to my son, other than change his bandage, after the bris?
14. How long does the healing process take?
15. Do you have printed instructions for how to care for the bris?
16. Would you do a bris if one of the parents is not Jewish?
17. Do you offer a certificate?
18. Do you have a list of items that need to be prepared for the bris?
19. What is the wine for? Who drinks it?
20. What is your fee?
21. Do you double book brisses – will you be on time?

Again, my answers to these questions can be found here

What Kind of Party?

The birth of a child is a joyous occasion. Boy or girl, people delight in a new baby, and the newness and freshness of life. The beauty and innocence of a baby is appreciated by all, and the new child brings an endless source of blessings from relatives, friends, and neighbors alike.

The First Celebration

Jews celebrate in all kinds of ways. For any birth, some people make a "kiddush" in shul on a Sabbath after the baby is born (sometimes weeks or months after the birth).

After the birth of a boy, some will have a celebration in the home on Friday night.

[Some have a similar celebration after the birth of a girl, but this is more likely due to an influence of the need for equality of the sexes in modern times. The truth is that any symbolic parties surrounding the birth of a baby boy relate to the fact the he will be circumcised on the eighth day of his life. The Torah thoughts shared, the spirituality brought to the celebrations are meant to serve as "protectors" for him, so his bris will be successful and without incident.

As a girl is thankfully not circumcised, these celebrations are not relevant and can happen at any time.]

The Bris Itself

As a bris is the fulfillment of a commandment, the meal associated with it is considered a "seudat mitzvah," a meal celebrating the commandment. Just as we prepare a festive meal for a wedding, for a bar or bat mitzvah, and for a siyum [read about the laws of a siyum from my friend Rabbi Dr. Aaron Ross], it is customary to prepare a festive meal for a bris.

How Elaborate?

It's a matter of taste, size of guest list, and - of course - budget.

[It should go without saying, but just to be sure: in accordance with Jewish tradition and practice, all food at a bris should be kosher.]

**** Taste ****

If you are the all-out type (or if the baby's grandparents want to sponsor and that is their personality), then the party could be as big as a bar mitzvah or wedding. I have presided over brisses where the entire meal followed a "theme." Often enough there are generic "baby boy" themes - such as stuffed animals, balloons and lots of blue. I have also seen themes that include: a jungle, a sports team (the father was a big fan), a sports theme (athletic family), and ninjas (???).

While brisses more often take place in the morning and consist of bagels, eggs and other breakfast foods, it is not out-of-place to have a meat meal to celebrate the occasion. In the US, a meat meal will not usually go over well for breakfast, however, so those who prefer a meat meal will more often do a lunchtime bris or a dinner time bris. [All of these are fine, as long as the circumcision itself takes place during daylight hours.]

More on the extent of this in the "Budget" section below.

On the other hand, if you are the simple-type, and want to be classy but not over the top, providing bagels and spreads (cream cheeses, tuna fish, lox, etc), salads, with cakes and pastries and drinks is respectable.

**** Size of Guest List ****

Who will be participating?

There is an old custom not to "invite" people to a bris due to the belief that the spirit of Elijah the prophet is in attendance. Were people to be invited and not come, this would seem as an affront to the prophet. But if they are merely informed that "the bris will take place at such and such time and place" they are not declining any invitation if they don't show up.

Regardless, people generally have a good idea of who will be there.

** A More Intimate Crowd **

If the bris will take place in a home, the rules of the home will usually trump all else. You do what is in your style. Your guests are usually family and really close friends, so whatever you choose to do will work just fine.

Some people order all the food on platters from a caterer. Others have family and friends pitch in. In either case, everyone participating knows you and loves you and are happy enough just to be there.

** In a synagogue - with drop-ins **

If a family has the bris right after the morning services (Shacharit) in a synagogue, there is always a chance that people who were not informed about the bris may come. A bris is considered a community celebration, and people are happy to stay to join in the festive occasion.

A bris in a synagogue is usually a bigger affair than at home anyway, but in some cases, the number of guests could end up being over 100 people. Knowing that you'll be feeding that many people (and in some cases, their children), it is important to think in advance of how much food is necessary to feed that many people, and then to consider how much of the food you are ordering is essential (the bagels), versus how much is excessive (the omelet stations and all of the hot food).

Of course, if you are writing a blank check to a caterer, none of this matters.

**** Budget ****

When doing a bris outside of one's home, a number of things need to be considered when budgeting for a bris:

* Rental cost of the space. This may even apply in a synagogue
* Caterer (in the case of some synagogues, you may not bring in any food: it all must come from the caterer)
* Additional people who may drop in
* dairy versus a meat meal
* Do you want to save costs by making some of the food, or having friends or relatives bring food? If so, you probably won't be having the bris in a synagogue.

Time of day may help change some factors. During the day, you'll have fewer drop-ins. But you might opt for a meat meal. Also, people who come might stay a while and may look for second helpings of food.

Some Final Suggestions

If money is no object, then make a party that is respectable, memorable for you, and which demonstrates your appreciation to God for having blessed you with a child.

If money is a concern, you may want to see if any relatives (ie. baby's grandparents) want to chip in something to the cause.

Consider different venues, not just because of cost but because of what works for you and your baby. If you don't want the baby leaving the house, have the bris at home.

If you have lots of "peripheral friends" who will celebrate because "everyone loves a bris," it is also possible to give them a respectable display of "food for the road" such as coffee and cakes, juices and fruit, while you have the celebratory meal with just closer friends and family in a different location, or after the 'uninvited' guests leave.

With a little foresight, everything will work out just fine. And with the help of those nearest and dearest to you, it will be as stress-free as possible.