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Welcome to -  the most comprehensive and up to date mohel blog on the internet . My name is Avi Billet, and I am so ...

Sunday, February 21, 2016

Photos of A Healing Bris

Don't worry.

It's not what you think.

At least not here.

I don't put pictures of brisses - before or after - for a variety of reasons, most of which you can probably imagine. But as it is helpful to know what you will be seeing, I am happy to share with you a link of a pdf, put together by Dr. David Bolnick, Mohel, which contains one picture of a pre-bris penis, and 4 pictures of the healing process over a few weeks' time.

Here is the link. The photos are on page 16.

The swelling, as you can see, can get pretty ugly. It is not always that extreme, and, in some cases, if much of the membrane is removed in the process, most of that swelling will not be present.

Every baby is different, and every bris has a different outcome. Hopefully it all works out the same in the end for everyone!

[So use a marker!!!!!]

Thursday, February 18, 2016

Is Metzitzah Right For You?

Before the year 2000, metzitzah was a practice only people in the observant community knew about. When stories came out about babies contracting herpes after a bris, including some babies who died from the virus, metzitzah became a household word, and knowledge of the practice (even among those who couldn't recall the word) became a matter of concern.

What is metzitzah?
Metzitzah is understood to be the act of drawing blood "from distant places" out of the circumcision wound immediately after the removal of the foreskin. The word itself has many possible translations. Of course, technically any drawing of blood can be done with a gauze pad or sponge, or through a tube (such as is done when blood is taken for a blood test or for a blood bank), or, as is the "traditional" way through vacuum-suction as created by the power of the mouth. In this latter formula, there are two ways this has been done: a. through the medium of a straw, sterilized pipette, or inverted syringe, or b. through direct oral contact of the mouth. See both methods in this video (link is to youtube)

Is Metzitzah Necessary
There is no question that while the Talmud lists metzitzah as one of three steps of a traditional circumcision, that the practice of drawing out blood reflects the medical knowledge of the time, and that any vestige of metzitzah is a nod to an ancient tradition. 

However, as we don't take medical advice from the Talmud some of the great rabbis of today and yesteryear suggested that metzitzah in any form is unnecessary מעיקר הדין, as an absolute obligation (Rabbi Joseph B. Soloveitchik, Rabbi Herschel Schachter). Certainly there is no justification for putting a mouth on an open wound, knowing what we know of today in terms of hygiene and bacteria. 

If Unnecessary, Why Do It?
Since the Talmud says to do it, many traditional mohels will still do metzitzah via the alternative method which does not put the baby (or the mohel!) in danger. It fulfills tradition without any harm as the only things touching the baby are sterilized in the same machine as the surgical instruments.

I always do metzizah with a sterile pipette. Of late, when families specifically request "no metzitzah" I have been ready to accomodate them in light of the teaching of Rabbis Soloveitchik and Schachter.

For more on Metzitzah, see the Metzitzah Page

Monday, February 15, 2016

"So, why should I choose to hire you as my son's mohel?"

Time to repost what makes the MohelBillet experience unique!

Here are links to two of the times I've answered this question (in different ways)

Safety Precautions - What you need to know...

...and what you need to insist your mohel does!

Circumcision is a relatively easy procedure, with minimal risk to a baby when done under the following conditions:
1. Baby is 100% healthy.
2. Operator is skilled at his work
3. Sterile conditions are maintained
4. The proper amount of foreskin is removed.
5. Bandaging is done well - minimizing loss of blood

Any mohel who is not careful about #1 is not fit to be a mohel.

Any mohel with a good reputation plus experience is surely good for #2.

Unfortunately, the last three are never a guarantee, unless the mohel takes certain precautions and has a good track record.

With regard to sterility
Mohel should wear gloves when operating. Period. End of story. I wear gloves, of course. But you will be surprised how often this is not a given, and something you cannot take for granted.

Maintaining Sterility brings honor to this mitzvah. Living in the Middle Ages does not.

The highest standards of sterilizing instruments is in a sterilizing oven or autoclave machine, and not through cold sterilization. And trying to mimic an operating room as best as possible.

Surgical Instruments should be laid out on a sterile drape - not on a laundered diaper cloth (amongst other suggestions)

Metzitzah - will be the subject of the next blog post. Though here is a link to the Metzitzah page

Proper amount of foreskin removed
There is no room for mohel-arrogance when it comes to your baby's penis

Mohel should use a surgical pen to mark where the edge of the foreskin is (and he should follow his estimation) [Here's a horrible story that was completely avoidable which a nurse told me about a bris she attended]

Taking off too much skin is harmful for the baby in the long-term

Leaving baby bleeding
There is never any excuse for this. I would rather take as much time as necessary to make sure baby is fine than have a parent call me saying "the diaper was all bloody!" I find myself sometimes saying to parents, after my immediate post-bris check-up, "Your baby is fine - everything is great! I apologize only for the amount of time it took for him to clot."

Thursday, February 11, 2016

Knowing What Circumcision Is

Hopefully, anyone who is hiring a mohel understands that the act of Bris Milah includes a circumcision, and a circumcision is a surgical procedure in which the foreskin is removed. 

I don't post pictures on my blog of the before and after. But you can get a decent idea of the difference between how things look from this illustration. (*Graphic* but in a medical textbook sort of way)

While that illustration is nice and perfect, there is a healing process that every baby goes through after the circumcision. Here is my description of how things look before and afterwards.

These are the Methods of Circumcision that are generally utilized by mohels

Understanding the difference between a Clamp v Shield (shield method is more traditional)

Friday, February 5, 2016

Streamlining the Blog

There are two purposes for this blog:
1. It serves as my website as a mohel.
2. To provide information for the community of Jews who are researching Bris Milah on the Internet.

According to Blogger's count of these things, here is the current pageview stats from around the world - beyond the United States (which dwarfs the others) - over the last six years.

United Kingdom

So, as #2 is purpose has a mind of its own (thank you Internet), I'm going to try to bring things together in a more orderly fashion over the next few blog posts - essentially making the equivalent of pages dedicated to specific areas. Instead of rewriting the blog (always an interesting option!), I'll be putting together posts that are Tables of Contents for the areas of interest that have been raised thus far. Some of the "pages" which are linked at the top already do this. But it will provide more of a sense of order than the way the blog is currently structured.

Should be fun! 

We'll start with the most popular blog posts of all time: