Monday, May 30, 2011

Early Sources For Metzitzah

It's a little odd that this question takes up so much time and discussion in circles related to proper practices related to bris milah. I have mentioned elsewhere that metzitzah, the drawing of blood from the circumcision incision, is traditionally done with the power of the mouth. The debate as to how to do this best boils down to two practical possibilities:

a. Putting the mouth of the mohel, father, or erstwhile motzetz directly on the fresh wound
b. Putting a sterile tube (glass or disposable plastic) on the fresh wound

Both are followed by a quick "suction" action. In the former case, the mohel immediately spits out whatever blood enters his mouth.

If you have read any postings of my feelings regarding sterility, you know my feelings that the better method of achieving "metzitzah b'feh" is "method b," which certainly uses the mouth, but does not present any possibility of harm to the baby or the mohel.

Before the sterile glass possibility was introduced, there were those who advocated metzitzah be done with a sponge (what we would now call gauze) without the use of the mouth, due to the obvious problems that could come about from putting a "foreign" mouth directly on an open wound of a newborn.

There are still people who think there is no harm in a mohel putting his mouth on a fresh wound. And if you get lucky every time, I guess you can say there is no harm. But if something goes wrong once on account of this attitude, will you still say there is no harm?

Advocates for the mouth on baby method claim this is the way it's been done forever. Could be. It could also be they're wrong. It could also be that if it was done this way it was because people did not know any better. But we certainly know better now. I recently met an old acquaintance I hadn't seen in over ten years and he mentioned that his family's "practice" is to have metzitzah done with "method a." This young man is a cardiologist now. I asked him, "And how does this jive with your knowledge of medicine?" His answer was not very promising. "It doesn't," he said. "But it's our family's custom to do it this way."

Unbelievable.

So, in response to those who say the source is ancient, or that "God watches the simple - שומר פתאים ה ," or that "Those who are messengers to do a mitzvah are not harmed" or that "One who fulfills mitzvahs will not know of any bad results - שומר מצוה לא ידע דבר רע," there are two sources I'd like to share with you regarding lists of mitzvahs which are done with the mouth.

1. In Rabbi Yitzchak of Corbeil’s introduction to “Sefer Mitzvot Katan” he categorizes the commandments of the Torah based on the different parts of the body which will fulfill them. Commands 102-151 are to be fulfilled with the mouth. Metzitzah is not listed.  (Due to the length of the list, I am not reproducing the text here)

2. In Yalkut Shimoni Tehillim 723 King David reportedly praises all the parts of his body and the mitzvot he fulfills through them. The mouth and lips are mentioned only with reference to saying prayers and singing praise of God. Any reference to the practices of Bris Milah in this section aways group milah and priah together – with no mention of metzitzah as being part of the mitzvah, let alone metzitzah b’peh!


The male organ is for milah and priah, the knees are for holding a baby as a sandak, so milah and priah can be done.

ילקוט שמעוני תהלים רמז תשכג

כל עצמותי תאמרנה ה' מי כמוך, אמר דוד אע"פ שקלסתיך בכל אלו, עד עכשו איני יודע לקלס פי יספר צדקותיך כי לא ידעתי ספורות. כל עצמותי תאמרנה, אמר דוד אני משבחך בכל אברי ומקיים בהן המצות בראשי אני רופפו וקורא בתפלתי. בשערות ראשי, אני מקיים לא תקיפו פאת ראשכם, ותפלין אני מניח בראשי. בצוארי, עטיפת ציצית. בעיני וראיתם אותו. בפי, תהלת ה' ידבר פי. בשפתי תבענה שפתי תהלה. בזקני ולא תשחית את פאת זקנך. בלשוני, ולשוני תהגה צדקך. בלבי בלבי צפנתי אמרתך. בחזה, הציצית אני משים כנגד הלב כל זמן כל זמן שאני קורא קריאת שמע, שנאמר והיו הדברים האלה על לבבך. מאחרי ומלפני השלכתי שני כנפים של טלית כשאני עומד בתפלה. יד ימנית אני כותב בה ומראה בה טעמי תורה. יד שמאלית, בה אני קושר תפלין של יד, ובה אני אוחז ציצית בזמן קריאת שמע. צפרנים, לעשות בהם פריעה או מליקת העוף או שניהם יחד. ובוהן, להסתכל אור להבדלה. כליותי אף לילות יסרוני כליותי. מעי, ותורתך בתוך מעי. קרבי וכל קרבי את שם קדשו. רגל ימין לחליצה. רגל שמאל קודם לשלש פסיעות אחר התפלה. כרעים, כריעת ברכים בתפלה. הגיד, מצות מילה ופריעה. ברכים, בהן אני עושה סנדיקוס לילדים בשעת מילה ופריעה. לכך נאמר כל עצמותי תאמרנה ה' מי כמוך
I hope these two sources will at least give some form of indication for those who claim that a. metzitzah is a mitzvah (which it clearly is not), and that b. it must be done with the mouth, that the actual mitzvos which utilize the mouth do not include metzitzah as one on their rank.

FINAL THOUGHT:
Somebody once tried to claim that this midrash clearly states that there were three stages of a bris, Milah, Priah and Metzitzah.
במדבר רבה פרשה יא

מי מלן רבי ברכיה תני לה בשם רשב"י משה מוהל ואהרן פורע ויהושע משקה וי"א יהושע מוהל ואהרן פורע ומשה משקה
However, it does not take much to see that Yehoshua (or Moshe in the second version given) would give a drink to those who were circumcised. (It says משקה - to give to drink, and not מוצץ - to draw their blood through suction). Using this as a source for metzitzah is clearly an incorrect reading.

On that note, of course, there is no custom (that I'm aware of) to do metzitzah for an adult circumcision. [I shudder at the thought of such a practice.]

Wednesday, May 25, 2011

The Private Room

In a bris that takes place outside of one's home, it is important for a room to be set aside for the mother and baby, for before and after the bris. In advance of the bris, many mothers find it advantageous to have their own space, a little peace and quiet, and a chance to mentally prepare for the bris.

In addition, the mohel appreciates the opportunity to speak with the mother without interruption (and the father, when he is there too), and to prepare the baby for the bris in whatever manner he feels is necessary. I do a non-invasive preparation that consists of cleaning the baby with alcohol, marking the edge of his foreskin with a surgical marker and swadding his legs in a receiving blanket.

After the  bris, the room comes in handy in keeping the baby away from the admiration of friends and family who don't "get it." It is also very helpful in any post-bris checkings or monitorings that need to take place. I, for example, always like to see how the circumcision looks, and I change the bandage immediately after the ceremony is over.

As this last procedure might take a few minutes, and mostly because the baby cries during this time, it is best that it all take place in the private room. Additionally, a nursing mother will want to feed her baby after the bris, to soothe and comfort him and to give him the feeding he is ready for as he hasn't eaten for close to two hours. Having a private room is advantageous to giving you the space you need to bond with baby, without the interruptions others may bring - even if they are "only trying to help."

What is the Private Room?
It is either the rabbi's office or the synagogue office (both in a synagogue), the caterer's or manager's office (perhaps a synagogue or a restaurant). It might be the bridal room in a place that sometimes hosts weddings as well.
It will typically have a table or desk and a chair or two, which is ample enough for mother's needs and mohel's needs.

Tuesday, May 17, 2011

Interesting Portrayal of Adult Circumcision

In reading something else, I came across this positive description of an adult circumcision - done for conversion purposes - in 1844. The writer is a physician, William Clay Wallace, a non-Jew, and his narrative flows from the perspective of the neutral reporting anthropologist to the admiring physician who could not replicate what he saw when he tried to perform a similar operation.

See it here: http://onthemainline.blogspot.com/2010/05/account-of-adult-circumcision-of-male.html

It's amazing to me how the person in question seems to have been circumcised the same way mohels circumcize babies, and how the focus seemed to be on getting the bleeding to stop through cold water and lint (?). He leaves no indication of longer term bandaging, and makes no mention of suturing. I don't know if the aftereffects would pass the cosmetics test and muster of today, but I still found the account fascinating.

Let me know what you think in the comments here!

Saturday, May 14, 2011

On Creating Standards for Sterility

First an anecdote, then the reason for this posting:

I am big stickler for the use of a "sterile technique" at a bris.

One parent recently commented to me - unprovoked - how much he appreciates my systematic cleanliness and regard for sterility when dealing with the baby. I honestly don't see how things can be done any other way. Unrelated, a friend recently told me that a relative of his called a mohel, who came to visit them after they had brought their baby home. The mohel came in, and picked up the baby to examine him - and much to the dismay of the new mother, he did not wash his hands, ask them if they cared, or even use a hand sanitizer. (The mohel should say "I would like to examine your baby. Where can I wash my hands?")

You can say "they're being ridiculous." But they're not being ridiculous. This is their baby, and they have a right to assume and insist that their baby be handled in a manner with which they are comfortable. They subsequently decided to go with a different mohel. As is their right.

The Inspiration for this posting

A pulpit rabbi told me that he is uncomfortable when mohels come to perform a circumcision in his synagogue, and insist on doing metzitzah with direct oral contact to the baby. The first problem is that many of this rabbi's congregants are not even aware to ask, and were they to know what the mohel is doing, they would surely prefer he use a glass tube.

The second problem is that the mohel is not being completely upfront with the parents. To compare - I make it my business to tell the parents "In addition to my sterilized instruments and bandages, I use sterile drapes and gloves to the point that I am never in contact with your baby directly. Is there anything about the process of the bris you would like to know? Would you like me to show you what the foreskin is?"

Some parents appreciate the honesty and candor, and some are not interested in seeing what the foreskin is, preferring to say, "It's OK. I trust you." I appreciate the trust. And while I understand some people are squeamish, I don't understand why people would not want to know what will be happening to their baby. But that's just me.

Anyway, the rabbi said, "What should I do?"

So here are a few options:

1. The shul can have a few standards that must be followed in order for a bris to take place in the shul itself. For example, the shul can say, "The mohel must wear gloves, must bring all his instruments in autoclaved packages, and must do metzitzah with a glass tube." [The rules can be adjusted for a shul that thinks these standards are unimportant. But new parents should think long and hard about what kinds of rules they prefer to be adhered to in the circumcision of their child.] If parents prefer not to follow these standards, they are welcome to have their bris elsewhere. This is a strict shul policy.

2. The shul can do the research themselves and have a list of "acceptable mohels" they provide for their members - always happy to accept another mohel, of course, provided he abides by the standards the shul has demanded of those on the list.

3. Most importantly, the rabbi might need to have a frank discussion with prospective parents (better when they are expecting than after the baby is born) as to "WHY" these standards are important to us as Jews and as a community. Discuss why these rules benefit the cause of Bris Milah and all the individuals who will be doing brisses for their sons in the future.

IN CONCLUSION

I will not play the role of mohel basher. But I will say that some mohels have their own convictions take prority over the convictions of the people hiring them. It is dishonest and improper to support such behavior. The mohel is hired to give the child a kosher circumcision. He is not hired to bring in all of his own convictions in the realization of those ends. He must respect where the parents of the baby are coming from in their own Jewish experience.

Were you to go to a barber who reveals to you that he achieves the same result with a blowtorch that others achieve with a scissors and comb, you'd probably walk out the door before you allow this barber to touch a single hair on your head. You want the method you trust.

Should we not be as selective and careful when picking a mohel who will circumcise our sons? Just because the results typically look more or less the same does not mean the means to achieve those ends are the same.

What Is Done With the Foreskin?

There are so many misunderstandings about this one. For example, take a look at this link, where the author writes of all kinds of superstitions (segulahs in Hebrew), and includes an extremely odd idea related to a foreskin and its powers of helping a woman become pregnant.

I honestly think it is a mistake or a misunderstanding. No matter how you look at it - it is just plain wrong.

I suppose there are some mohels who discard the foreskin with the bandages and refuse created in the process of the bris (packagings, diapers).

But, in simple terms, most of us bury it at our first opportunity.

There is even a custom to get the ball rolling on the burial process by having a dirt-filled dish at the bris so the foreskin can be immediately deposited in the dirt once removed. Those who go so far to prepare the dirt bowl nowadays are usually either Hassidic or so-called "ultra-orthodox." It is by no means a law, it is only a custom.

If you think about it, burying the foreskin makes a lot of sense. Our regard for the human body once its function of housing the soul is complete is to treat it with respect and to return it to the earth "from whence it came." Once the foreskin's function - to serve as the vehicle to allow the completion of the Jewish male (see the midrash quoted in the 3rd and 4th paragraph here) - is completed, it too returns to the earth from whence it came.

Wednesday, May 11, 2011

Importance of Good Lighting

I did a bris in a country club a couple of months ago. While the decor was beautiful for the party, the lighting was a little inadequate for the circumcision.

Thankfully, when I asked for assistance, they were able to bring a standing lamp that provided the necessary light for the procedure.

When considering the venue - whether the bris will take place in a synagogue, a restaurant, a country club, or even your home - please remember that you want the mohel to be able to see what he is doing!

I would argue that as far as the choices you make for the circumstances of the bris, the lighting at the area where the bris itself will take place is perhaps the most important factor to consider.

People will either remember the party or they will not. But you don't want to run the risk of what could happen if the mohel could not see when operating on your son.

Tuesday, May 10, 2011

Gloves

I happened to look at a website of a mohel who posts photographs of himself "in action." I don't know the man, so I will not comment about the need to demonstrate the play by play.

But I notice he is not wearing gloves on his hands when he does the circumcision.

And this really really really bothers me.

We live in the 21st century. We know all kinds of things about cleanliness, sterility, hygiene, blood, transferring disease, not touching an open wound with anything other than something which is objectively sterile.

Unless you blowtorch your hands (which I don't recommend), they will not be sterile. Clean? Perhaps, if you scrub long enough. Sanitized? With the right hand sanitizer, it's my word versus the company's word. Sterile? Not possible. We have fingernails! And cracks in our skin!

How any mohel can still operate without gloves on is beyond me. How he gets away with it is beyond my comprehension.

And the parent who does not even inquire, who does not ask "Will you please wear gloves?" Or "In what manner are you protecting my son from your hands?" does not really understand what is taking place here.

If you would allow a doctor to go without gloves when doing a procedure on you in which blood will be drawn, then I withdraw my comment. (Though I question your concern for yourself, and your doctor's concern for himself or herself). If you would allow a dentist to poke around in your mouth without wearing gloves, then I withdraw my comment. (Though I question how your dentist has not contracted some kind of dangerous disease.)

FOR THE SAKE OF JEWISH BABIES, PLEASE DISCOURAGE MOHELS FROM CIRCUMCIZING WITH THEIR BARE HANDS! INSIST THAT THEY WEAR GLOVES!

Monday, May 9, 2011

Why I don't have tons of pictures in my Mohel Blog

For a whole host of reasons, I chose to blog about bris milah. I enjoy writing, and I enjoy sharing ideas. And I feel there is not enough information out there that is easy to find, and that truly gives you, the parents of a baby soon to undergo a bris (or in the post-op stage wondering why things look the way they look).

So I blog, and when things come up, I try to address them. Especially when they come up a lot in conversation, or in the emails or phone calls I receive on a regular basis.

People have asked me how come I don't have pictures of myself doing a bris? Because I work alone and don't have the opportunity to snap photos of myself when I am caring for a baby.

People have asked me why I don't have pictures of me smiling holding a baby? Because that gives no indication of whether I am a good mohel. All it does is demonstrate how starched my mohel-jacket is, and whether I am photogenic.

I prefer not to put up dozens of pictures of the same bris to make it look like I am very busy when I am not. Or even to put up single pictures from many brisses to prove how busy I am.

You need information. Not smiling Jon. So, poke around, read what I've written. And if you believe I care enough about sterility, and your baby, and you, and not about me, my "show" and how "I will look," then call (516 850 9694) or email me (avbillet@gmail.com)

When I do your son's bris, you can take a picture of me. And if you send it to me, maybe I'll put it in a posting. But only at your request.

Miami Mohel - In Search of a Mohel in Miami

  I googled Miami Mohel and when this website did not appear, I figured I'd have to write Miami Mohel a bunch of times to get it to show up. Miamimohel dot com takes up the first five slots or so. So this mohel in south Florida is writing about being a Miami Mohel or a Mohel in Miami with one motive in mind. To appear a little higher on a Google listing. If you are looking for a mohel in Miami, this is a website that will be helpful to you. You will want to call me or email me as soon as you can. There are other mohels in Miami, but you have seen them all before. Try something new, branch out, bring another Mohel into Miami.

Miami Beach Mohel will work too. Miami, Miami Beach, whatever. The point is to show up in a Google search, or a Yahoo search, or any search that will bring a search for "Miami Mohel" to this webpage.

Thanks for reading. And thanks for directing all those seeking a Mohel in Miami or a Miami Mohel to this website.  Now check out the FAQ section, and the testimonials. See that this is a real deal. And give a call. I am honored by your exploration and your sincere attempts at researching, to find the person that BEST fits YOUR needs.

Find the best mohel for YOUR needs. You have the right to choose the mohel that fits the empty silhouette in the front of your ideal bris picture.

Happy hunting and happy finding your Mohel in Miami.

When the Baby is a Girl (on a lighter note)

Before a baby is born, there is a fifty-fifty chance that I could be considered as the mohel. My standard line, when people ask me if I'll travel to circumcise their child, is "Only if it's a boy. I don't touch the girls."

I have had many friends call to APOLOGIZE (I kid you not) when their daughter was born. "Sorry we can't give you the business," they say. "I tried to get my wife to have a boy... But what can we do? She didn't listen to me!"

While I think the apologies are unnecessary - I, for one, am very happy for them. I am glad they have a healthy baby. And, of course, God knows (as do we all) that we need girls too. So I won't have a bris. Believe me - when it's a girl, it doesn't bother me.

But I think this week I received the funniest "apology" of all time. A father of a newborn baby girl dropped off a challah roll that his family had on their table for shabbos, with a note saying "Dear Rabbi, THIS is the only bris I can give you. Cheers!"