Wednesday, November 17, 2010

Monitoring the News

There are some crusades which are just a little too reminiscent of bad stages in Jewish history. (It is ironic that this story came out in the weeks prior to Hanukkah - see the third sentence here as well)

There is a man in San Francisco who is reportedly gathering signatures for a petition to make it illegal to circumcise minors - which of course translates to anyone under the age of 18. The petition will merely allow the issue to be put to a general vote in the near future, which can always lose at the ballot box. But in San Francisco, who knows what can happen?

I am not going to go into the legalities beyond suggesting that such a ban is unconstitutional simply because it would step on the toes of religious freedom (for those religions such as Judaism that require circumcision), and also puts the law into people's private lives in a way that seems to be illegal according to US law.

Tuesday, November 16, 2010

What I Learned in the Operating Room

I have had the privilege of observing pediatric surgeons, pediatric urologists, and adult urologists operate in the operating room. Sometimes it was at their invitation, sometimes at my request, and sometimes at the insistence of the parents.

With the adult urologists (I use the term to differentiate from pediatric urologists - all urologists are adults), I learned much about the anatomy of the penis, the foreskin, the mucosal membrane underneath the foreskin, the glans, and the delicacy and intrigue of the male organ from a medical standpoint.

With the pediatric urologists and surgeons, I was present when the circumcision to be done was extremely complicated,

The Wrong Attitude Is Not to Ask

Someone recently called our home from New York. She gave birth to a boy a few weeks ago, and the bris took place on time – the services of a local NY mohel were obtained.

In her conversation with my wife, she indicated she had a few concerns and questions about her son's bris, so I was given the phone to offer a mohel's perspective and to put her mind at ease.

After describing the way the mohel had instructed her to oversee her baby's healing process, and giving the best explanation she could of what things looked like, she kept asking, "Is this normal?"

From the information that was shared, and obviously without having seen the baby, I felt that while the prognosis was not standard, with time all would heal properly and look fine.

I had a few questions of my own: Did the mohel explain everything that you'd see? (No). Did he give you instructions how to care for the bris? (Yes) Did he walk you through the process in advance? (No) Was he nice to you? (Yes – everyone uses him) Just because everyone hires him does not mean everyone has a nice experience – overall, do you think you would call him again? (No). Why not? (Uhhhh)

Then came what, to my mind, was the most disturbing comment in the conversation. "Now that I've had this experience, if I ever have a son again I'll know what to ask in advance, and I'll do it right."

[INSERT BUZZER SOUND]

Wrong thing to say!

Don't Make Your Son Into Your Experiment

Let us remember that each child is precious. That we want the best for every child. And, as best as possible, we should do what is right the first time around.

This means that if you are a parent, you must ask all the questions BEFORE your son's bris, even and ESPECIALLY if it is your first son.

[I will grant that if you've had a positive experience with a mohel in the past and trust the man completely, then you need not go through everything again – that is your choice, and I feel it is justified. But the conversation should be had with any mohel you are employing for the first time for your family – even if you've had (a) son(s) before!]

Some Links about IMPORTANT QUESTIONS

A list of 21 questions,
Triple C - Ceremony, Care, Complications
An old post about this subject of doing research beforehand
The 4 Most Important Questions ("how much will it cost?" is not one of them!)

Sunday, October 3, 2010

News Out of Israel

In an article today in Israeli newspaper "Yediot Aharonot" (the Hebrew article is available online here, and the English version is available here), a mohel in the northern part of Israel has been put under a cloud on account of "not doing brisses" according to Jewish law. The article does not call into question the individual's piety or intentions, but that as a practitioner who is required to produce a particular end result according to Jewish law, his practices have produced circumcisions that required regular touch-ups.

The cause for the touch-ups: Not removing enough foreskin.

I've blogged about this before: See here and here and here

It is also important to note that as much as cosmetic touch-ups are annoying and no one should ever need to go through them - not baby and not his parents - the good news is that the surgical touch up usually produces excellent cosmetic results. And if I were to have a choice, I would likely prefer the surgeon have something to work with (the extra skin that was not removed) than to have the baby at the mercy of having had too much skin removed.

Sunday, September 19, 2010

Bris For Conversion

There are a few occasions that would warrant what is called in rabbinic terminology "Milah L'Shem Geirut" - מילה לשם גירות - circumcision for the sake of conversion.

1. When a Jewish couple adopts a non-Jewish baby and are committed to raising him according to their lifestyle.

2. When a couple converts to Judaism, and their children convert along with them. Any males who have not been circumcised - from father to adult children to babies - require such a circumcision.

Testimonials

The number of testimonials below reflects only those who have found the time to share their experiences. Others have had glowing thanks, emails and "reviews" but if they don't make it public, I respect their privacy. [typically if one doesn't post here right after the bris, it usually slips the mind]. 

If you have any feedback that will help others utilize the same service you received (patience, caring, information, sterility, cleanliness, sensitivity), feel free to leave them in the comments.

If you are comfortable leaving a name or email address, that would be appreciated as well. (if you write it out like "avbillet at gmail dot com" that will help avoid potential spammers - though you may get inquiries from real parents looking to hear from someone other than me about their bris experience.)

Thank you for your trust in me, your patience, and for including me in this special time in your lives, the birth and bris of your son. And if you leave contact information, thank you for availing yourself to others seeking a similar experience to your own.

Avi Billet

Friday, August 27, 2010

The Color White

Nothing represents cleanliness and purity more than the color white. Any image you have in your head of heaven likely includes puffy white clouds and white angels dressed in white garments (to use an anthropomorphic image). A bride wears white on her wedding day, and in Jewish tradition, the groom wears a kittel as well when he and his bride complete the marriage ceremony under the Huppah. White garments (Tachrichim/n) are also placed on the deceased before they are placed in a coffin or are buried directly in the ground, as per the custom in Israel. It is also a widespread custom to wear white on Rosh Hashana and Yom Kippur. There are various reasons given for this, but the attempt to live a symbolic life of purity on these days is unmistakable.

Monday, August 23, 2010

Is the Mohel a Doctor?

This has been coming up a lot lately.

I wear a lab coat at the brisses I do (as you can see under my tallis in the photo on the right), for a few reasons:

1. It looks official
2. It looks clean - can't argue with the whiteness of white (who said I can't be profound?)
3. The lab coat has deep pockets for me to put the things I need accessible at different times through my bris workings.

For people who don't know me, though, it makes them think I am a physician. Which I am not.

Sunday, August 22, 2010

Correspondence

This post is not about bris milah per se, but more about how this blog has been received by others.

I have been getting a significantly higher number of emails and phone calls from people asking about circumcision - some from local towns, some from across the country. It is nice to discuss this subject matter with people, and to give them a fresh perspective on this ritual. Many people are truly learning about what they will be going through, and the ability to talk things through is something people have expressed appreciation for having.

I have also been getting attempts at Anonymous postings from people who are anti-circumcision. I don't know why people who post anonymously ever think their opinion will hold any credence.

So, let me clarify. This is not a "pro circumcision website." It is a pro-bris website that is informative for people who are going through this experience. I am not looking to convince people one way or the other - the assumption is being made that you are a parent expecting a child (or holding your newborn), who is just trying to find out information.

On that note, if there is any way I can help in your preparations for the bris, feel free to email or call me.

Thanks for looking and searching through the site. Best of luck with your baby.

A.B.

Saturday, August 14, 2010

When Baby is "Born" Through C-Section

The Torah says that when a woman gives birth to a male baby, he is to be circumcised on the eighth day of his life. (Leviticus 12:2-3)

What happens when the birth is not really a "birth"?

Consider this: In "Macbeth," Macduff was able to kill Macbeth, who was unable to be harmed by anyone of woman born, because Macduff was "from his mother's womb untimely ripp'd" — born via a Caesarean section.

A similar thought process occurs in some cases when a child is brought into this world through this abdominal surgical procedure.

Sunday, August 8, 2010

An "Inspired" Teaching

At a recent bris, the baby's grandfather told me a joke:

What blessing does a girl say at a bris? Shelo Asani BOY!

[Translation - "For not having made me a boy." The joke is because there are three blessings that are said in the morning, that begin with the phrase "shelo asani" - for not having made me "x" - and one of them is "Shelo Asani GOY"]

Anyway, while not specifically related to the actual bris and process the baby goes through, I was inspired to find a new explanation for these three blessings, with Bris Milah being an ingredient to my novel interpretation.

It is spelled out in much detail in this post in my other blog.

Enjoy!

Tuesday, August 3, 2010

Some Thoughts on Metzitzah


[Note from 4/30/11 - see here for more on this subject]
Metzitzah is the ancient practice of drawing blood from the wound after the excision of the foreskin. There is much debate amongst rabbinic authorities as to how this is to be done. Sadly, much of it has become a politicized debate to the point that the different sides of the aisle often cannot see or recognize the validity of a differing opinion.


In the Talmud, the main reason for removing a mohel from his position, ie not allowing him to continue to practice as a mohel, was if he did not perform metzitzah. (Babylonian Talmud Shabbat 133b, Maimonides Laws of Milah 2:2, Shulchan Arukh Y”D 264:3) Bear in mind, the lack of metzitzah does not a non-kosher bris make. (Avnei Nezer Y”D 338, especially letter “י”, mishneh Halakhot (Menashe klein))

Only the mohel who does not do metzitzah has questioned legitimacy. The baby and his bris are deemed kosher, with no further procedure necessary to rectify the flaws of the practices of the mohel.


The Talmud is not clear how metzitzah is to be done. As long as a mohel does metzitzah (many call it "Metzitzah B'Peh" or "Metzitzah B'feh" - drawing blood with the mouth, or the power of the mouth), be it orally or with a tube, he is Talmudically fit to be a mohel (assuming of course, his character is otherwise exemplary).


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


Much ink has been spilled over metzitzah. The only Jews who require metzitzah are the Orthodox and some Conservative communities.



How metzitzah is done is the subject of debate, though just about everyone who does it has the mouth involved, in some way performing suction of blood from the wound.
  • Some have the mouth directly touching the open wound.
  • Others have a sterile tube directly touching the open wound, while the mouth provides the suction to draw the blood.

Both methods have rabbinic authorities backing them, and either one is acceptable to most Jews. While I did not poll either community, I imagine that if someone from either camp discovered a bris had been done using the method of metzitzah to which they do not subscribe, they would be unlikely to declare the bris invalid or the mohel who did it invalid.
They certainly would not require the baby to have a wound reopened so metzitzah could be done the other way. Also, metzitzah is never done on an adult circumcision or for hatafat dam brit.



While I do advocate metzitzah be done, with a tube, it is worth noting that if for some reason the metzitzah is not done at all, whether by choice or by oversight, no one questions the validity of the bris itself.


The reason I recommend the tube is because I value the cause of sterility and good hygienic practice in the bris procedure. While Jews circumcise their sons because of the inherent spiritual value, I feel there is no excuse for subjecting the baby to the possibility of any infection - which can so obviously come to a baby through the direct contact of a stranger's saliva with the baby's open wound and the baby's blood which is truly "his life" (see Deuteronomy 12:23)


Final, and perhaps most important note: What sometimes is lost in translation is that the advocates for using a tube are not arguing or declaring a ban on metzitzah or even metzitzah b’peh! They are actually suggesting metzitzah b’peh be accomplished using a tube which can achieve the same result as the mouth, using the strength of the mouth.

I added to this topic in a different posting (as linked at the top of this page)

Pinch Hitting

It wasn't the first time, but it was special.

I received a phone call late last night, "Might you be available to do a bris tomorrow morning?" As things work out, thank God I was available.

"This is a late call. What could have happened?" I wondered.

"The mohel we called apparently had business in Guatemala and is stuck there."

Good thing he called to tell them before this morning.

"Sure. No problem. I'll be there."

It is a wonderful feeling to be called for a bris. It is an honor to be able to fill in on such short notice. In most cases, people appreciate the mohel and the role he plays just because the service is unique and is recognized as being so helpful in performing a special mitzvah. In cases like this, circumstances being what they are, the feeling is different, in a wonderful way, because I know the family's need was more urgent, more pressing, due to time constraints.

And thank God, the bris went well, the baby is doing wonderfully, and everyone seems happy.

Welcome, Miami Beach. I look forward to returning to you soon!

Sunday, July 25, 2010

Timing the Bris

The Bris takes place in daylight hours of the eighth day of the baby’s life. The day of birth is considered the first day of life, unless the baby is born after sunset, in which case the following day is considered the first day.

While a bris is never performed earlier than the eighth day of a baby's life, a bris may be delayed under very specific circumstances:

a. If the baby was born by ceasarian section and the eighth day is the Sabbath or a Festival

b. A baby who contracts an illness must be completely healed before he has his bris.

c. A premature or otherwise very small baby will wait until he achieves a suitable weight for him to withstand the stress of the bris.

While there is no exact definition of a healthy size, many mohels arbitrarily follow a five pound range (give or take a couple of ounces) as a minimal weight upon which to circumcize. Doctors will often clear the baby at lower weights, but when a mohel is uncomfortable due to size reasons it is better to be safe than sorry. Once the baby reaches five pounds, however, if the mohel continues to push it off, it is worth seeking another mohel so as not to continue delaying this important, timely mitzvah.

ps. When a baby is being circumcised for the sake of conversion (most typically on account of adoption - though some mohels will do such when the baby's mother is not Jewish), it need not take place on the eighth day of his life because there is no "mitzvah" to circumcise him. In this case, the circumcision should take place sooner than later, but the timing will be determined based on when the baby arrives at his adoptive family, and when they are ready to have his circumcision.

Why We Name the Baby at the Bris

[Subsequent to writing this, I wrote an article on this subject which appears in my other blog]

There is no Biblical injunction to name a baby boy at his bris. It is clear that when the forefathers were born they were named immediately - Yitzchak was given his name first (Genesis 21:3), THEN he was circumcised in the following verse (21:4).

When Yitzchak's sons were born, they were named immediately (25:25-26). Each of Yaakov's sons was named as soon as he was born (Chapters 29-30).

[Full disclosure: God changed Abraham's name from "Avram" to "Avraham" after he circumcised himself.]

So why do we name the baby at the bris?

This leads into a larger question of why we do all the things we do at the bris? Why does the ceremony look the way it does now? How much of it is rooted in Kabbalistic practices? Medieval practices? European practices? Middle Eastern practices?

After all, the Torah only commands that the baby be circumcised on the eighth day, and perhaps a celebration should accompany the circumcision. But there is no mention of a sandak, Elijah (who of course had not been born yet), or the formalized ceremony we see today, including the naming taking place after the circumcision.

What if the bris is postponed for health reasons, or not performed at all because of a history of hemophilia in the family? Is the baby not named? Of course the baby is given a name! Which would indicate that naming at the bris is not all that significant.

So why do we name the baby at the bris?

Here are a few ideas I have found in researching this question

A. When Elijah the Prophet is present

In Genesis 2:19, the Torah says וכל אשר יקרא לו האדם נפש חיה הוא שמו. That after meeting all the animals, Adam gave each one a name.
I read somewhere that the acronym of the first five words of this phrase are the letters of the name אליהו - Eliyahu/Elijah. The first letters of the next three words, נ, and ח, and ה have a numerical value of 63, which is the same as the word נביא - prophet.

The last word is
שמו, which means "his name," and we have found our significance. When Elijah the Prophet is present, that is when "his name" is proclaimed.

B. Completing a Jewish Identity

Some will argue that the bris is the final step in making a baby a Jew, and so his name comes at this highly significant moment. I have already debunked this myth.

More palatable, the name is a completion of the individual's identity. If the bris completes his physical body (as Abraham is told in Genesis 17 to "walk before Me and become complete" through the act of circumcision), it is only after the bris that his name can be given to him. (Rabbi Menachem Azariah deFano (1548-1620), "Mamaarei Rama MiPano")

C. Tumah/Tahara
Until the bris he was uncircumcised – which is not the ideal state of a male Jew. Any name he may have had until his bris was unbecoming to his identity as a Jew – so he receives a Hebrew name at his bris, in celebration of his new physical status.

***********

There are differences of opinion as to when girls are named in relation to their birth, but everyone agrees that a girl is given her name on a day when the Torah is read, when her father is called for an aliyah or some other Torah reading participatory role.

For more on this subject - regarding boys and girls, see this article

Wednesday, July 21, 2010

Don't Use the Mogen Clamp!

An article in the Atlanta Journal-Constitution has reported on a lawsuit against the makers of the Mogen clamp. (text of article produced below)

I have never been a fan of this clamp (see method 1 here), and even the FDA has issued warnings against clamps because of their potential of irreversible damage

Simply put, no step in the circumcision procedure should be irreversible until the actual removal of the foreskin. Once the shield is in place, it is important to double check that the proper area of skin is ready to be excised. In the event the shield was initially applied incorrectly, it can simply be removed and repositioned - no harm done.

Once a clamp is put in place, anything in its clamping mechanism is essentially dead skin, and the excision/amputation which follows is irreversible.

PLEASE TELL ALL YOUR FRIENDS AND FAMILY - DO NOT ALLOW A MOHEL TO USE THIS DEVICE ON YOUR BABY, UNLESS HIS TRACK RECORD IS PERFECT WITH IT!

*****************************************************************************
Atlanta lawyer wins $11 million lawsuit for family in botched circumcision
By Ty Tagami


The Atlanta Journal-Constitution
Monday, July 19, 2010

The maker of an instrument used in circumcisions claimed that injury was impossible with its use, but after an infant lost a portion of his penis during an operation with the Mogen clamp, a judge awarded $10.8 million in damages against the company.

The judgment handed down Friday in New York involves an Atlanta lawyer who has been crusading against circumcision as a dangerous and unnecessary practice.

Attorney David Llewellyn won a similar case in Atlanta last year and the injury behind that prior lawsuit in Fulton County Superior Court put the New York clamp manufacturer on notice about the danger of the device, his current lawsuit said.

The baby in the current case, identified in court documents only as L.G., lost the entire glans, or head, of his penis after it was pulled into the jaws of the clamp, according to a federal magistrate's order. On Friday, U.S. District Judge Jack B. Weinstein ordered Mogen Circumcision Instruments of New York to pay $10.8 million in compensatory and punitive damages to the Florida boy, now 3, and his parents.

The parents "are extraordinarily distraught and angered that this company tells people it can't happen," Llewellyn said.

It's unclear whether they will ever collect the money. Mogen is already in default on a $7.5 million judgment in 2007 from a Massachusetts lawsuit, Llewellyn said.

The company is going out of business, according to a woman who answered the phone at its Brooklyn headquarters Monday. The woman, who said she was a secretary and would identify herself only as D. Rotter, the person whom Llewellyn said was served papers in the lawsuit. She said increased competition has undermined their business.

"It's just kind of dwindling down to nothing," she said, adding that the phones at the Mogen office were scheduled to be disconnected Tuesday. Mogen didn't defend itself in court, and Rotter said it was because the company couldn't afford it.

She said the Mogen clamp is "painless and safe" when used properly. The case involving the Florida boy was "unfortunate," she said, adding that "any medical mishap is unfortunate."

In this case, a New York mohel, or Jewish ritual circumcisor, performed the operation in the baby's home, Llewellyn said. The mohel negotiated a separate settlement, the terms of which Llewellyn would not disclose.

Llewellyn won another circumcision case in 2009 over an operation at South Fulton Medical Center. In that case, which involved a baby identified only as D.P. Jr., the mother contended that the doctor who circumcised him removed too much tissue and that his pediatrician failed to respond when a nurse complained of excessive bleeding.

The tip of the penis was placed in a biohazard bag and might have been reattached if he'd gotten attention in time, Llewellyn said in 2009. His lawsuit in New York says D.P. Jr. lost a third of his glans.

The jury found that both the pediatrician and the physician who performed the circumcision were negligent, and awarded $2.3 million to the plaintiffs. South Fulton Medical Center was absolved of liability.

In Friday's decision, the court determined that Mogen had to pay for medical expenses and for the years of psychotherapy that will be needed. The boy suffers pain when he urinates, the court order says. He will eventually be able to have sex, but he is likely to be embarrassed and will likely have trouble forming "meaningful" relationships with girls, it adds. "At 3 years old, L.G. is aware that he looks different from other boys based on both his own observations and comments from other children which make him feel inferior ."

Tuesday, June 22, 2010

The Sandak

The sandak is the person who holds the baby during the surgery component of the bris ceremony. It is considered the highest honor that can be given, as the sandak shares the unique distinction, along with the baby's father and the mohel, of the bris day being like a holiday for him.

This means that just like the father and mohel, if the sandak attends prayer services prior to the bris, he will cause the entire congregation to automatically join in the celebration of his holiday, to the point they will not recite the "Tachanun" (supplication) prayer, which beseeches God to help us in our hour of suffering. Who can possibly be suffering on a holiday?

It is sometimes asked if the baby's father can serve as the sandak. He may!

Contary to the Ashkenazic custom mentioned below about not repeating sandak in a family, a father is the only person who CAN serve in this role multiple times for his own sons. I remember attending a bris in Israel where the baby was the 10th boy in the family (talk about having it down to a system!), and the father was being sandak for the third or fourth time.  The reason? They had honored everyone else already once (who might play ths role otherwise) and as it's the father's mitzvah to be as involved as possible in the bris, the father chose to play the role of Sandak to fulfill his responsibility in the best way he could.

Where does the word SANDAK come from?

Some people think it comes from Greek:
Although circumcision is probably the most ancient of all the Jewish rites that are practiced today, neither of these two words is anywhere near as venerable. The older of the two, sandak, is a Hebrew loan word from Greek, as easily can be seen from its earliest appearance in Jewish sources in the 13th-century midrashic anthology Yalkut Shimoni, where it occurs as sandakos - סנדיקוס, with the Greek first-declension, nominative-case singular ending. This is curious, since nearly all Greek borrowings in old Hebrew date to the pre-Islamic period, when Greek was the spoken language of the eastern Mediterranean world.
Presumably, then, sandakos was in use among Jews for hundreds of years before this but simply left no record. Its etymology is from syndikos, i.e., an advocate in a trial, and also, a backer or supporter. Syndikos was a word commonly used in Greek to translate the Latin patronus, which also could mean either a legal counsel or a
social patron — and just as the Roman patronus had a moral if not legal obligation to assist whomever the person to whom his patronage is extended, so the Jewish sandak was originally thought of, it would seem, as responsible for the circumcised child throughout his life. For this reason, the sandak was traditionally chosen from among the close friends or relatives of the parents of the child, with whom he was expected to maintain a lifelong bond.

But why should we assume this Jewish role was borrowed from the Greeks? Especially when they (or at least Antiochus Epiphanes - starting 4th paragraph) banned circumcision? (This tradition has been around a lot longer than this new theory)

WHAT IS THE JEWISH SOURCE FOR THE SANDAK?


One approach is that סנדק is actually an acronym for סנגור נעשה דינו קטיגור - which means that the "defender becomes the prosecutor." This idea stems from the Kabbalistic work - The Zohar (p. 255) - which explains "When the little boy is undergoing his surgery, the sitra achra is broken down and has no power - because the bris becomes a litigator against him on behalf of Israel."

In other words, in a kabbalistic sense, the sitra achra is always trying to find flaws in the activities of the Children of Israel, constantly making them the defendants before God. But the bris is so powerful, and the helpful role the Sandak plays in protecting the baby and allowing the mohel to do his job properly, changes the keepers of the faith from being defendants against this evil spirit to being prosecutors against him. "How dare you suggest we are not keeping the law and following God's commandments when you see we begin at the very beginning of life with the covenant of our faith, the covenant of circumcision?"

Not as exciting

Yashresh Yaakov suggests that the numerical value of the word Sandak = 218, if you add the values, סנדק =
60 + 50 + 4 + 100 + the 4 letters of the word = 218, which refers to a "ריח ניחוח" - a sweet fragrance from a spice offering (ריח = 218). This most likely relates to the idea that the Sandak is compared to one who brings such an offering when he is holding the baby on his lap during the bris.

No Matter the Source...

... The Sandak is a great honor. It is often given to the baby's grandfather or great-grandfather, if the baby is blessed to have one.

The role can not be shared during a bris.

Amongst Jews of Ashkenazic descent there is a custom for parents not to reuse a sandak for another son of theirs. Essentially, the idea is to "spread the wealth around" (to coin a phrase) and give others a chance to play this highly significant and symbolic role.

Amongst Jews of Sephardic descent (Spain, North Africa and Middle East), the same person might be sandak every time, if the individual is a highly respected dignitary, such as a "Hakham" or great rabbi, or even the patriarch of a family.

Tuesday, June 15, 2010

The Importance of Trust

Time and time again I get calls from people who have used the services of a different mohel, who ask me questions they don't want to ask their mohel, after the fact.

I am happy to help however I can.

But the obvious question becomes, "Why did you not ask these questions before?"

And the follow-up, "Why aren't you comfortable asking these questions to your mohel?"

The excuses are what they are, but they usually boil down to a few points:
"He isn't open enough."
"He says a lot but does not really leave us open to asking questions."
"He seems to not be aware of what we're going through."

These are very unfortunate cases. Would you ever go to a doctor who you felt you couldn't talk to after he operated on you? I hope not!

It is important to trust your mohel, and to be able to have a frank and open conversation about the process. What happens, what happened, and what needs to be done to give the baby the "thumbs-up" and "clear" and "good to go" symbols...

When you call me, this is the service you get. We talk a few days before the bris (when it is possible, I will come and meet you and your son a few days before the bris as well), we talk the day of the bris, before the bris, after the bris (while the baby is being cared for), and later on when I come visit him to remove the bandage and to make sure all is good.

I call a few days later to see how all is going. I am always available by phone, and am happy to come take a look to assure you all is good (post-bris) if I can help reassure you in any way.


[Though if I am a distance away, I have found that sending me a photo through the phone works just as well!]



You are always in the loop, always in the know, you are always aware of what is going on or has gone on with your baby.

Give a call - be in touch - I look forward to meeting you.

Monday, May 24, 2010

A Comprehensive List of the Honors at a bris

The explanations for these roles and who gets them can primarily be found here, and in the latter half of this post.

Some of them have further explanations elsewhere in the blog: kvatter, Elijah's chair , etc.

THE LIST
* items marked with an asterisk are most commonly done,
- items marked with a dash and in parentheses are possibilities, but not necessary
* Kvatter - male and female who bring baby in to the room (transfer baby from Mom to Dad)

* Kisei Eliyahu/Elijah's Chair - places the baby on a specially designated chair

(- Min Hakisei (from the chair) - gives baby to his father)

* Sandak - holds the baby during the bris

(- Min Hasandak (very uncommon to have this) - takes baby off lap of sandak to give to...)

* Amidah L'brachos (Sometimes called the standing sandak) - holds the baby after the circumcision, for blessings (and naming - next honor)

(- Amidah for Krias Hashem - an additional honoree who takes the baby after two blessings and holds him while he is given his name)

* Brachos - the person who recites the blessings (in a mildly-traditional crowd, the rabbi or mohel will usually do this), and either does or does not name the baby (next honor)

(- krias hashem - the one who first announces the baby's up-until-now secret Hebrew name. Sometimes the person who says the blessings will also name the baby)

(- birkat hamazon - the one who leads the grace after the meals, particularly and ideally in the presence of a minyan of men.)

If you are not sure how to include everyone you need to include, let me know. We can always squeeze another one in. avbillet@gmail.com

Wednesday, May 12, 2010

When Baby is Cranky - Is Tylenol a Solution?

The impetus for this posting comes from two incidents which took place in the last few weeks.


1. Tylenol, and other OTC baby pain medications had some kind of recall (the details did not concern me personally as my children don't use any of the items in question, and I never recommend any of them as a mohel)


2. Someone I know, who lives in New York, had his son circumcised by a local NY mohel, and called me that evening, after his baby had an unusually difficult day, to confirm that what his mohel had told him was "normal" in the post-op care of the baby. Details to follow.


I will not address the Tylenol recall directly, as it is not my area of expertise. But the issue which is raised often enough is whether there is room to give the baby tylenol if he seems cranky after the bris?


My answer is twofold. Firstly, let your pediatrician recommend tylenol or something to ease your baby's discomfort. Most mohels I know are not physicians, and while they can offer advice, they are not in charge of your baby's long-term care. Even if the mohel IS a physician, if he (or she - there are female Dr. physicians who are mohelets) is not your baby's physician, the questions about medications should be directed to the primary long-term caregiver.


Secondly, and this leads into the second impetus as mentioned above, your baby should not feel discomfort after the bris.


You may ask, how could a baby not feel discomfort after going through this surgery? I don't know the answer to this question, but I can report on what I've observed.


Post-bris, most babies who have a bandage placed on comfortably, who have their needs met (clean diaper and full belly), sleep nicely, eat nicely, wet their diapers consistently, etc. They cry under the same conditions they cried for before the bris: dirty diaper, hungry, tired... The main difference will be that baby might wince when he urinates - which would be directly impacted by the bris.


So what causes a baby to be cranky after the bris?

The number one item that causes a baby discomfort is an uncomfortable bandage. It could be the material does not agree with him. The bandage may also be on too tight, constricting what should otherwise be an easy urine-flow.


In my personal experience, when I fiddle (as necessary, after the bris) to get a new bandage on, the baby will usually cry as I am reapplying a gauze pad. Once I am finished and leave the baby alone, he is usually calm and comfortable, the crying stops, and he either eats or goes right to sleep.


Solutions


And so I asked the father of the baby three questions:

1. Is it bleeding? (usually indicative of either a case that requires attention or a bandage that fell off prematurely)

2. Has the baby urinated? (if not, there is too much constriction on account of the bandage, and it needs to either be loosened, removed, or replaced with a looser and softer bandage)

3. Will your mohel come and check it?


If the bandage is on too tightly - guess what - Tylenol or Motrin ain't gonna do a thing.

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



I mentioned in a different posting that it is normal to see swelling after the bris, particularly on the ventral side of the penis. In this case, that was not as much of a concern from my perspective (though the father did see swelling and was concerned about it).


In the end, the mohel did come and check, he removed the bandage (or loosened it) and baby was able to urinate more readily, easily and comfortably.


The point of this story is not to knock another mohel. It is to encourage you to avoid jumping to conclusions, to avoid worrying, and to realize there may be a very simple solution.


I have taken steps to avoid this problem. The bandage I leave on the baby is a softer one, which usually comes off on its own a few hours after the bris. I remind parents from the get-go that they need to report to me if the baby has not urinated a few hours after the bris. I consciously put the bandage on tight enough to constrict the bleeding, but not so tight to be uncomfortable for baby.

With the exception of babies who are extremely hungry after the bris, most babies I care for are calm when I finally leave them alone, and may even sleep comfortably for a few multi-hour stretches, waking up for feedings and diaper changes.


And I tell the baby's mother, "You see how he is now? That is how he should be throughout the rest of the day, except when he is telling you he is hungry or needs to be changed (which is when he normally cries anyway)."


Instead of Tylenol being the solution, let us return to appropriate TLC which will undoubtedly help ease the pain and make the ordeal so much easier for parents and baby.

Wednesday, April 21, 2010

Getting Family and Friends Involved

In addition to the excitement and joy which comes with the birth of every child, friends and family gather to celebrate the continuation of our People, and our relationship with God that is symbolized by the bris.

For most people, especially those with a very close family, it is essential that family members participate in the ceremony. This is ideal.

Thankfully, the ceremony has many roles that need to be filled. But first, a word about protocol.

Men and Women

When it comes to public ceremonies, Jewish tradition has a thought about what is considered proper and improper, modest and immodest. These issues are subjects of a much larger discussion which I may write about elsewhere.

In a nutshell, to help keep modesty in check, Jewish law established separation of sexes in public ceremonies. As such, while a man may stand next to his wife (and vice versa), it is considered immodest for a man to stand with someone else's wife lest others perceive something, get the wrong idea and perhaps start gossiping.

Where the bris ceremony takes place, such as a home or a synagogue, would determine the proper protocol for the setting - is it, in essence, a private or a public ceremony? This would also determine the degree of participation of both sexes.

The Roles to be Played

In this segment, I will lay out the roles, briefly explain them, and make suggestions as to who should/can play the role and in what context it is inappropriate. Participants in the ceremony should all be Jewish. In the event the father is not Jewish, there are times when he can hold his son during the ceremony as well.

Kvatter - This couple (man and woman) bring the baby to the bris room, the wife taking the baby from his mother, handing him to her kvatter husband, who brings the baby to his father.
This is a male/female tag team. They are either a married couple, or a father/daughter or mother/son team (some might allow sister/brother)

Kisei Eliyahu (Elijah's Chair) - A person puts the baby on a chair designated for Elijah the Prophet.
In a synagogue it is usually a male, often the baby's uncle or great uncle, or some other relative or friend. At home, it can be the same, or baby's aunt, etc.

Sandak - Holds the baby on his lap during the bris.
Synagogue or home - the sandak must be male. First dibs go to baby's grandfather or great-grandfather. If grandfathers have been used at brisses of your older sons, some people include rabbis or dear friends, as the custom in Ashkenazic families is to not repeat sandaks among siblings.

Brachot/Blessings - Two blessings are recited to sanctify the moment and give special significance to the day.
The male reciting the blessings should read Hebrew fluently, understand their meaning, and should be a committed Jew. The default figures for these blessings are the mohel or the rabbi.

Naming the baby - This is a paragraph in Hebrew that officially invokes the baby's Hebrew name.
It is often recited by the same person who is honored to say the blessings (previous). It may be recited by anyone, but as it is a long paragraph in Hebrew, the person should be able to read Hebrew well.

EVERYONE in the room responds with declarations praising God and wishing well - blessings and all - upon the baby. When the crowd is unfamiliar with these Hebrew statements, I generally recite them word by word so all can repeat them together in unison.

Holding the baby for blessings and/or naming (previous two entries) - The person who plays this (these) role(s), should be significant to your family. Imagine this person having a relationship with you and your baby for a long time.
If one grandfather sat as sandak, consider having the baby's second grandfather hold him for the naming - this role is sometimes called the "Standing Sandak." Otherwise, in a synagogue a male will often play this role, while at home, it might be either of the baby's parents or grandparents. Sometimes two people will hold the baby together - both grandmothers, for example.

Tuesday, April 13, 2010

What Makes a Jew

When I was studying to be a mohel in Israel, one kind of experience was repeated at many brisses.

As my teacher, Rabbi Mordechai Sasson, is a Sephardic mohel, most of the brisses he'd perform would be for Sephardic Jews, who have a rich cultural heritage which brings the entire family and community into every bris. (or should I say "brit"?)

Typically, after the ceremony was over and Rabbi Sasson was doing his post-op examination, some old-school grandmother or great-aunt would smilingly look upon the now circumcised baby and say עכשיו נהיית יהודי (akhshav nih'yayta yehudi) - "Now you have become a Jew."

Huh?

This concept may be true in other religions (e.g. before baptism, a Christian child is not a Christian), but in Judaism, one's Jewishness stems from one's birth mother. If the mother is a Jew, the child that emerges is a Jew. Consider girls, who are thankfully not circumcised. How are they to "become" Jews if circumcision is what makes a Jew?

Circumcision does not make a person a Jew.


While this blog is not the forum for discussing the rules surrounding conversion and the Reform practice of accepting people as Jews based on patrilineal descent, I am here to discuss the role of circumcision in all of these procedures.

Judaism manifests itself in Jews in two ways - nationally and religiously - and both are meant to be informed and enlightened by the totality of what we call "Torah" (not just the Five Books of Moses). According to Jewish law, the national element is given to a person at birth and can never be revoked (except in very extreme cases of apostasy). The religious component has always been a question of individual practice - there have always been Jews who were more observant of the law and the Torah's guidelines and Jews who were less observant of the law and the Torah's guidelines.

Religion

In the last few hundred years, there have been different movements in Judaism who defined new ways to experience the "religious" element of their Judaism (in no particular order): Hassidim (and all its branches and extremes), Maskilim, Reform (and all its branches and extremes), Conservative (and all its branches and extremes), Orthodox (and all its branches and extremes), Reconstructionist, BILU, New-wave, Humanist, Traditional, Cultural, non-affiliated (the list is surely not exhaustive).

Most continue to circumcise their sons. Some do not.

National

On the national level, a Jew should ideally feel a sense of camaraderie with other Jews. (Yesterday was Yom HaShoah - I have long advocated that if Hitler did not distinguish between Jews, why should we treat other Jews in any manner other than respectfully?) Some people express this through their family name, through a "Jewish feeling," culturally, identifying with other Jews ('some of my best friends are Jews!'), identifying with the land of Israel, the State of Israel, the people of Israel, Yiddish theater, eating "Jewish food," etc.

Most continue to circumcise their sons. Some do not.

Bottom Line

According to all Jewish approaches, if a child is born to a direct maternal-line of Jews, the child is Jewish, regardless of levels of observance. (The questions arise when a conversion took place in that maternal line, as to what were the circumstances of the conversion.)


The circumcision the boys undergo puts a mark on the flesh that is the symbol of the covenant God made with Abraham in Genesis 17.

When a male non-Jew decides to go through the process of conversion, he may undergo circumcision (if he was not circumcised as a child) or an equivalent procedure significance-wise (if he is already circumcised), but the circumcision is not what makes him a Jew.

Any person who converts undergoes a program of study, and is dutifully tested for sincerity and commitment to the Jewish faith, and subsequently immerses in a mikveh to complete the conversion.

Thursday, March 18, 2010

Hatafat Dam Brit

With the holiday of Pesach (Passover) approaching, it is appropriate to discuss the connections that bris shares with the holiday - and there are many.

One of them is the role of blood in the covenant.

The name of the holiday of Pesach comes from two sources: A. the Paschal lamb, the offering that was set aside for three days before being sacrificed and eaten by the Jewish people in Egypt, and B. the fact that God "passed over" the homes of the Hebrew slaves in Egypt on the night of the "Death of the First Born."

The Paschal Lamb is called the קרבן פסח - Korban Pesach, and the verb to "pass over" is פסח - Pasach - which is formulated slightly different in the name of the lamb and the holiday itself.

What caused God, or the destroying angel, or the death force to pass over the homes of the Hebrew slaves, the Israelites? If the edict against first borns was only against Egyptians, did the Israelites really need to do anything in order to be bypassed?

The answer to the first question is the blood of the lamb. The Israelites were instructed to put the blood of the lamb on the doorposts and mantle of their homes on the evening of the final plague to cause their houses to be skipped.

The second question is a trick question. Surely God knows the difference between the homes of those He is looking to punish and those He wishes to avoid. That is clear. But the Israelites needed to do something, to indicate they understood what was going on. They needed to show their faith in God, and in Egypt, on that night, their faith was demonstrated through following instructions.

Thus, in Egypt, the people were physically and symbolically saved through the merit of the blood of the Paschal lamb.

While the greater significance of blood is not the scope of this posting - there is much written about it in rabbinic teachings - the general significance of blood is that covenants are forged through it.

To our point - bloodless circumcisions, medical circumcisions and circumcisions pre-conversion

In the event that a baby is circumcised through a bloodless technique - which can be accomplished through the use of certain clamps - the bris is not considered to be "kosher." (This point is worthy of discussion, and I will return to it in a different posting) Of course, once the baby is circumcised, (hopefully) there is no more circumcision to be done.

Circumcisions done either not for the sake of a bris (ie by a doctor), before the eighth day of life, or by a non-Jewish officiant are all not considered to be "covenantal." In order to turn the "circ" into a "bris milah" a minor procedure involving the drawing of blood needs to take place under the proper auspices.

We draw a minimal amount of blood from the circumcision scar, typically using a medical lancet, the sterile pin used for blood tests. Once blood is drawn under the auspices of a bris ceremony, the circumcision is now considered to be a bris according to Jewish law.

(To bring an example from a different religion, and NOT TO COMPARE THE TWO RITUALS, you can pour as much water as you want onto a baby or a convert to Catholicism. But until the water comes in the form of baptism and is done by the right person in the right place, it is considered meaningless.)

The blood we are talking about is absolutely minimal. Most people who experience it as adults (converts, or those who discover they were circumcised in the hospital and want to make sure it is "corrected") feel the significance more than they feel the pin-prick that draws the blood.

Babies upon whom I have done this are usually smiling and cooing through the half second it takes.  Healing time is virtually nothing.

Tuesday, February 23, 2010

The Most Common Issues After the Bris

There have been a number of times when I have been called to a home where the baby of the house is six months, ten months, even a year old or more. The little guy was circumcised when he was eight days old, but now he does not look circumcised.

And most of the time I was not the mohel - the family heard about me and did not want to bring their mohel back to look at it. (There have been cases where I have been called back when I was the mohel - I trust and hope it is because people feel comfortable contacting me, knowing the care I put into each baby's bris.)

Usually the issue only became apparent in the last few months. "At first it was fine. But lately, we've been having this issue."

Mind you, this happens with circumcisions done by doctors and mohels alike, and is usually due to the parent being unaware that this may happen, more than any oversight in the circumcision or a less than adequate job.

99.8% of the time the bris is fine and no touch-up surgery is required. However, there is something that does need to be done that will bother your baby in the minute it takes to do it, but does not have a healing process and will not cause any bleeding.

Again, this can usully be avoided with proper education.

Because a baby spends so much time on his back, and because his diaper smushes his penis together, and because many babies develop baby fat which is primarily deposited in the groin area, a percentage of babies develop one of a few symptoms that either A. make the shaft and glans of the penis disappear into the scrotum, or B. make it that you can't see the outer rim of the glans, which should appear distinct from the shaft.

If the bris is done correctly, what you should see is described in the second half of this post.

How to Keep it That Way

After the baby heals - say, about a week after the cessation of any ointment application, it is imperative that you make sure the outer edge of the glans remains distinct from the shaft.

All this requires is a gentle pushing of the skin below the glans at every diaper change - and particularly when the baby is in the bath.

Do not do this for at least a week after the actual bris, because any pressure on the penis during the first week of healing could reopen a wound and cause bleeding.

Sometimes not an issue at all

With some babies and with some circumcisions this is never an issue.

With others, no matter how the circumcision is performed, this can be an issue which, if unmonitored, can continue to cause concern for two years of the baby's life. In all this time, the baby is fine! But you, the parent, want to know why things look the way they do, and really want to understand what you are seeing.

Be on top of it, take charge, know what you are looking at and what you need to see. When you are in the know, you will know how to handle the situation such that the asthetic looks of the circumcision will never be a cause for alarm.

Disappearing penis

While less common than the "almost uncircumcised" look, the disappearing penis is essentially when the shaft and glans disappears into the scrotum when the baby is lying on his back. A gentle push on the 3 o'clock and 9 o'clock sides of the scrotum surrounding the shaft - or on the belly just above the "dark hole" will usually cause the shaft to pop out of its hiding place.

What can you do about it?

Firstly - follow above instructions to avoid it happening.

Secondly - if it's too late and the shaft disappears, there are two options.

A. Continue as above every time the diaper is open. Either it will clear up on its own through this counter-attack, or it will clear up on its own when the baby is walking - and particularly when he is out of diapers. Remember, the more time he spends on his back and the more baby fat he accumulates in his legs will both contribute to the disappearing penis look.

B. If it does not go away, corrective surgery is extremely effective. In most cases, however, you will not have to go this route. Consult with an honest pediatric surgeon who does not jump to do unnecessary surgeries, and you will get an honest opinion. Usually it is "wait it out. It will be fine."

Any questions - feel free to call me or email me.

[I am not looking to cause alarm - merely to educate about what is out there. I firmly believe that with proper monitoring, a properly done circumcision will look and turn out absolutely fine. Before you look at the following links, remember these cases are relatively uncommon. Nonetheless they are not so rare as for you to be unaware...
See more on this subject here and here...]

Sunday, January 31, 2010

What Will It Look Like Before and Afterwards?

I try to leave graphic images out of this blog, so I will do my best to explain here what the penis looks like before and after the bris.

BEFORE

Take a look at your baby! Now you know how it looks before the bris!

Just kidding.

The uncircumcised shaft of the penis looks like an inverted hourglass. It is thinner as it hits the scrotum, and thinner at the tip, but significantly fatter in the middle. The reason for this is because the glans, the part of the penis which is revealed after the circumcision, is hidden underneath the foreskin. Were you to slowly (and gently) pinch the tip of the penis, you'd see the "bump" in the middle of the shaft move it's way towards the scrotum. Let go of the tip of the penis, and the bump will slide back to its natural position. That bump is the outer edge of the glans - usually the 1/3 or midway point of a baby's penis.

THE FORESKIN

The foreskin (a.k.a. "prepuce") is an outer coating which covers the glans. It covers around half of the shaft. As only the foreskin is removed during circumcision, when the glans is revealed, one can easily see (contrary to popular culture's 'complaint') that the penis is not "smaller" - it just looks different.

[While I won't put the photo in the actual blog - I believe you can get the idea of what this all means when you look at this photo of a circumcised banana.]

AFTER

Before you read this section, understand that most circumcisions do not necessarily turn out exactly the same. All babies are different, and may have different "surprises" under their foreskins, which are not usually detected until after the circumcision itself.

For example, every baby has a differently shaped glans. Thus the first thing you see will look different from child to child.

Secondly, some babies have a minimal mucosal membrane underneath the foreskin, which might completely come off as well during the circumcision. Others have much more membrane with a significant amount left over after the bris, even if it is no longer coating the glans. Still others have significant tissue webbing, which would be undetected until the foreskin is removed. Depending on the extent of the webbing, it may need to be removed separately after the circumcision.

THREE SECTIONS

After the circumcision, one can usually identify three distinct sections on the circumcised penis.

SECTION #1: THE GLANS is the first things you see. It is the tip of the penis, and it almost looks like an army helmet - were the shaft to be standing upright.

A kosher bris consists of the farther rim of the glans being completely revealed, visible, and distinct, with no skin tags attached to it, and nothing hampering its distinct view.

It is usually a very deep, dark, raw RED COLOR (though it is sometimes PURPLE).

SECTION #2: THE MEMBRANE may or may not be completely removed in the bris process. If some of it remains, it may be slightly swollen, and may seem a little puffy below the glans.

Like the glans, it is typically a dark RED COLOR, though it does not usually have the same deep color of the glans. It will also look raw.

If the Membrane is completely removed, the area below the glans will look empty, but there will usually be a gap of a couple of millimeters between the glans and...

SECTION #3: The SPOT OF THE INCISION. This is the spot on the skin itself where the foreskin ended - or at least where the mohel estimated the foreskin ended. Ideally, the incision mark will be fairly close to the glans - but depending on the size of the baby's shaft, the mohel may have found the need to remove more or less skin in order to avoid future problems which may come from the glans falling back into the shaft and/or scrotum.

Dr. Neil Pollock - a very busy circumciser in Vancouver, has detailed information about this on his website. Feel free to read through the information he has - it can be found here [Start with the "Parents Guide to Circumcision" and move on from there!]

WHAT YOU WILL SEE

Aside from the dark red colors and the swelling, the scab tissue which sometimes develops in the area will typically be of a yellowish/ greenish hue. This is normal.

It is not advisable to pick at this, or to rub it as it will only cause the penis to bleed. A warm bath is good and promotes healing. Otherwise, like any scab, it is best to put bacitracin on it for a few days and then stop using ointments when the danger of infection is gone and it just needs to continue healing on its own.

Monday, January 18, 2010

The Ceremony and the Honors

The baby starts off with his mother in a private room. The room changes depending on the venue - it could be a bedroom in an apartment or house, an office or bridal room in a synagogue or catering facility - any place which gives the baby breathing room and an intimate environment where baby’s mother can nurse or otherwise feed him after the bris.

The mohel may or may not prepare the baby prior to the bris. If the baby is “prep”ed by the mohel, the baby can be brought out when he is ready. Otherwise he should be brought out when the mohel calls for him.

For information on how to choose people for the following honors, see the end of this section.

The baby is brought into the room where the bris will take place by a “kvatter” couple. The couple consists of a male and female who are either married to one another or are mother/son or father/daughter or brother/sister. Their role is to be the medium passing the baby from his mother to his father.

After he is passed to kvatter, the mother can go to her “spot” for the bris. Some mothers prefer to stay in the back or in a different room. Some like to be right up front. If you have a rabbi, speak with him about what is best for you based on your tradition. There also tend to be different protocols for home circumcisions versus synagogue circumcisions.

In many traditions, the baby is next placed on the chair of Elijah, the “kisei shel Eliyahu.” Some verses are recited, paying tribute to a staunch defender of the covenant of Bris Milah, Elijah the prophet. Note how he makes an appearance here, similar to the one he makes at the Passover Seder.

The baby is handed to the father who first appoints the mohel to be his messenger to do the bris. This helps the father fulfill his obligation to be the actual person performing the circumcision.

(In Jewish law, a person can appoint a messenger, a “shaliach,” to perform certain commandments on one’s behalf. Other examples include sending someone to donate your charity money, or giving and accepting Jewish legal documents.)

Depending on the family custom, the father’s blessing might be recited now (Sephardic or Middle Eastern tradition).

The father places the baby on the sandak’s lap, where he will be held during the actual circumcision. The sandak honor is considered the highest one can bestow upon a person at the bris.

At the moment of circumcision the mohel recites a blessing and then the father recites a blessing (Ashkenazic tradition), and the congregation responds accordingly.

After the circumcision is over and the baby is bandaged and wrapped up, he is held by another honoree, who is sometimes called the “standing sandak.”

While the baby is held, two blessings are recited by the rabbi, mohel or an honoree, who is holding a cup of wine. After that another paragraph is recited in which the baby is officially given his Hebrew name.

Mazal Tov!

PICKING THE HONOREES

The rules: All participants in the bris ceremony should be Jewish.

Every other absolute rule is in bold. Anything else is a suggestion or might change based on the venue - ie home versus synagogue. Usually the honorees are all male, save in the kvatter component.

The kvatter: The kvatter is a married couple unless they are a male/female team as described above. Some people have the custom to give this honor to a couple who as yet do not have children, with the hope that in the merit of participating in this event they will be blessed to have a child. If all your married friends and relatives have children, then the honor can be given to any married couple. Some people give it to a great aunt and uncle.

What about having more than one “kvatter”?

No problem. Some people have unmarried siblings (aunts and uncles to baby) or other friends they’d like to get involved. My rule is simple: “Women first, then men. Let the last woman hand the baby to her husband (the first man).”

Elijah’s Chair: This honor can be given to anyone. Some give it to a rabbi, some to an uncle, some to a dear friend. If this is not your first son, many people try to give honors to individuals who were not honored at the previous bris.

Sandak: The sandak must be male. He is usually the baby’s grandfather or great-grandfather. There is a custom, once past the first bris, to use a different sandak for every subsequent bris of your children. A person may be sandak many times – but for only one of your sons. Some Sephardic traditions re-use sandaks.

Blessings and Naming: Should be read by someone who reads Hebrew fluently. In a traditional ceremony, the one who recites the blessings is an observant Jew. In many cases, the rabbi or the mohel will recite the blessings as the default honoree.

Holding the baby/Standing Sandak: This honor can be given to anyone. It is often split - one person for the blessings, and one for the naming. When there are two grandfathers, this is usually when one or both get involved. If one was the regular sandak, the other will typically fill this role. If a great-grandfather was the regular sandak, the grandfathers might split the baby-holding.

Instructions for After-Care

While there is still a bandage

* Before every diaper change, wash your hands with soap and water
* Prepare a gauze pad with a generous heap of A&D ointment on it.
* Open the diaper, wipe as normal – do not touch the gauze or bandage.
* Before closing the new diaper, reach under the gauze to hold the wrapped bandage in place, then gently remove the gauze pad.
* If the gauze pad sticks, either leave till next diaper change or apply a small amount of baby oil to spot that sticks, then remove.
* Replace with new gauze pad, placing center of the gauze over the glans, pinching the sides of the gauze so it forms a tent over the penis. (Take care not to pinch or squeeze the glans)
* Close diaper.

Once bandage is off (typically after the last time I see the baby)

* First twenty fours hours, apply polysporin/bacitracin on gauze as above
* After twenty four hours of no bandage, apply polysporin/bacitracin directly (no gauze) for two to three full days, at every diaper changing (you can dispense it directly and rub it in with your finger, or dispense onto a Q-tip and apply with the Q-tip)
* After the three or four day period, ointments should no longer be applied as the bris needs to finish healing on its own.
* Baby can bathe the following evening (24+ hours) after the bandage comes off.

Monday, January 11, 2010

Bris v. Circumcision

No - it's not one of those landmark Supreme Court cases.
But it is a question that comes up a lot: What's the difference between a circumcision and a bris? Isn't a bris just a souped up circumcision?

It is true that a bris contains a circumcision as part of its process, but a circumcision alone does not a bris make.

Circumcision

Male circumcision is the removal of some or all of the foreskin (prepuce) from the penis. (I got the concise definition from wikipedia, though the page has graphic images I don't recommend for the sensitive...)

Bris

A Bris includes the circumcision (though it would more accurately remove all of the foreskin), but also has ritualistic components as well as religious significance that is extremely important for the history and continuity of the Jewish people.

This is not the forum to respond to anti-circumcision people - so don't expect that here.

Do a google search of "anti-circumcision" or "against circumcision" and you will find hundreds of websites and millions of hits. This is not our issue. I assume you are looking to circumcise your son, just don't know if it would be better to do it with a doctor in the hospital or with a mohel in a bris ceremony.

A Medical Circumcision...

...consists of either an operating room procedure or an office procedure. Depending on who does it and how much pride the person takes in the outcome, and in his/her relationship with the baby and his family, you can get all kinds of different outcomes.

Doctors will use all different kinds of methods - some which produce excellent cosmetic results, some which produce shoddy results.

In cases where parents sign a waiver allowing hospitals to take care of the circumcision, unless they request otherwise, there is a good chance that a medical student will be operating, for the first time, on their baby.

Local anesthetic may or may not be used, and depending on the method of choice, the baby might be in a degree of discomfort for between 7 to 30 minutes.

Cosmetic results will differ based on the skills of the operator. A doctor who does many of these procedures will usually have it down to a science and should produce wonderful cosmetic results. Otherwise, you are at your own risk.

I have been inside operating rooms in which the surgeon took pride in his work, took the time, marked the foreskin, and made a clean and even incision, gently and carefully, all around the circumference of the glans.

I have also been in the operating room when the child in question was put "out" for a hernia operation, and the choice was made to do the circumcision at the same time, while the baby was under general anesthesia. In my own observation, while the doctor may have taken all the time in the world to do the hernia properly, the circumcision was an afterthought, and was treated as such. No mark, quick snip (forgive me), and a suture job afterwards that was not to my satisfaction. Argument: "It's only a 'circ.' What's your problem?" My problem is that it isn't "only" a circ.

A Bris...

... takes much less time. Depending on the operator, he may use a bronstein (Mogen) clamp or a Traditional Jewish shield, but will usually finish the procedural (circumcision) component in under a minute.

A bris requires the entire foreskin to be removed, as well as the mucosal membrane beneath the foreskin to be completely removed from the circumference of the glans. In addition to being the fulfillment of the requirement, this will inevitably produce a more asthetically pleasing result.

Not that we're doing this for asthetics.

The circumcision carries with it the promise made by God to Abraham in Genesis 17 that He will be the exclusive God for Abraham's descendants (defined in Genesis 15 as those who descended to Egypt, and ultimately experienced the Exodus and Revelation at Sinai - the Children of Israel) if they bear the mark of the covenant in their male offsprings' flesh.

For the Jewish people, this prospect of being "the firstborn of God" (see 4:22) is highly significant.

The Bris Ceremony makes reference to Biblical defenders of the faith, who outwardly defended the covenant and the concept of circumcision - Abraham, Pinchas, and Elijah the Prophet. It includes prayers to God on behalf of the operator (mohel), the father of the baby, the sandak (who holds the baby during the bris), and, most importantly, the baby - that he should experience his circumcision with minimal pain and discomfort and that he should heal speedily.

There is symbolism in the blood that emerges from the incision (compare this to the blood on the doorposts (12:7-13) that was used to effect the "Passover" event)

There are blessings that are recited invoking God, the covenant, and national significance for all the Jewish people.

The baby is given his name in ceremonial fashion, with a cup of wine - just as we have for kiddush on Sabbath and holidays, and at other important ceremonies such as a wedding.

And, perhaps most significantly, friends and family gather together to celebrate the arrival of the baby, the continuing of a tradition, and the continuity of the Jewish people.

I conclude with the words I've already written in this posting

The doctor v mohel question is for a different discussion - it has been addressed in the second half of this posting.

Tuesday, January 5, 2010

The Traveling Mohel

Welcome to my blog about bris/t milah, and about being a mohel!

I hope you find the content of the blog informative and helpful in the research you are doing to find the right mohel for your son.

This entry is more of an advertisement than a traditional "blog" (since when can a blog be categorized as "traditional" anyway? There were no blogs in "Fiddler"!)

Whether you live in a place that has many mohels, or a place that has zero mohels, I invite you to consider engaging my services as your son's mohel, for a number of reasons:

1. I will speak with you about every aspect of the bris: logistics, details, family sensitivities, etc., to make sure you are 100% comfortable and emotionally prepared for the roller coaster that is the day of the bris. I am available on the phone almost always, and if you leave a message, I will get back to you quickly.



2. I am the world's biggest stickler for creating and maintaining a sterile field and sterile environment for the bris. There is no compromising in making sure the ultimate care is taken to assure nothing negative - such as an infection - will result from the bris.



3. You will not find a more easy-going and time-giving mohel. I make sure you know everything you need to know, and everything you want to know as far as what I am doing or need to do or as far as how to take care of your baby when I am not around.



4. You get full details about how to care for the baby, what you will see, how long things take to heal



5. I check the baby mmediately after the bris and a few hours later. The efficiency with which this is done assures your son has the most aesthetically pleasing circumcision, and that he requires the most minimal care on your part by the time my role is finished. You do not have to deal with bandages that are on long term, and you do not have to take off any bandages or deal with any bleeding. This is a full service operation.



6. The cost to you can be within your budget. Most mohels who put a price on the bris will charge between $400 to $1000. When I travel longer distances (more than 50 miles from my home - or by plane), I only ask you to cover the travel expenses. The rest, as always, is up to you.

I am quite serious about the offer to travel - even great distances. Check out my other site http://www.travelingmohel.com/


So. Whether you (or someone you know) live(s) in a remote area and need a mohel (recommendations are always appreciated!), or you want a mohel who suits your needs best and most identifies with the Judaism you practice, we should have a conversation. Even if it won't be me, I can help you make sure you find the right person, and give you information that will help you make sure you know "exactly" what is going on, and that you are taking charge of your son's entry into the mark of the covenant.