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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, December 31, 2017

Thank you for the honor

I am most grateful to all of the parents who entrusted their sons to my care to help fulfill the mitzvah of bris milah during the year 2017.

Every call I receive is a testament to a feeling of trust exhibited by parents in making this important decision. Some research way in advance, and some make a cold call, having received a recommendation from a friend or relative who had a positive experience.

Due to the natural tension and unease that comes (for some people) with the bris, I am grateful to be able to play the role that I play, and to hopefully make the experience positive, memorable in a good way, and one you look forward to in the future with confidence and anticipation.

Mazal tov. Blessings for many babies to have the new year's number on their birth certificates and bris certificates!

Wednesday, December 27, 2017

Addressing Some of the Anti-Circumcision Claims

The Forward published an article today entitled Anti Circumcision Activists are Making More Noice. Will They Make a Difference?

So I guess it's as good a time as any to address some of their claims against Jewish Circumcision (complain about routine hospital circumcision all you want, but that is not what we are doing.". Of course, it is worthy to note that nothing they say - and I mean nothing - will change how we operate. We don't do this for medical reasons, so any claim about the benefits of the foreskin or the inherent risks of circumcision are irrelevant. (Of course, it should go without saying, I am a big advocate of only trained, responsible professionals operating under safe conditions.)

One of the most inflammatory and ridiculous claims that anti-circumcision advocates make, driven by their belief that circumcision = cruelty to the child, is that Jewish circumcision is anti-Semitic.

Seriously. I am not making that up.

On the simplest level, you can’t take the defining act of Judaism, predating the giving of the Torah itself, commanded twice in the Torah (Bereshit 17 and Vayikra12) and referenced countless times in the Torah and the rest of the Bible, and say it’s anti-Semitic.

You can’t ignore all the references the Bible makes to the non-Jews living in that era, calling them ערלים (foreskinned), sometimes just as identification, and sometimes as a point of denigration, and say that removing the foreskin is anti-Semitic.

Every time I get into an argument with an anti-circumcision activist, a simple summary of the conversation is this: They produce their talking points, and I ignore them because of how fundamental Bris Milah is to who we are. And this gets them even angrier. Sad!

Put another way, they might even be polite in asking questions which go something like this: “I don’t understand why you can’t wait until the boy is 18 and then let him decide” or “Isn’t it true that if a boy has brothers who preceded him who died from circumcision that he doesn’t need to be circumcised and can still be a full Jew?” (technically yes, but for this to happen there would have be a. an undetected family case of hemophilia, b. a really really really bad mohel.) Or they’ll say, “God creates a child perfect.” Or “No God is so cruel that he wants to harm a child!” Or “Why do you sickos need your blood sacrifice?”


Firstly, I find strange irony in atheists, who don’t believe in God, using God when it is convenient for them. Really? You decry any reference to God anywhere, but then you use God to make a claim against Judaism?

Secondly, many of these people who talk about cruelty to the child have no problem at all with taking a healthy baby, while still in utero, and cutting off its limbs and draining its brain. Male or female. I would be willing to bet that every baby, if we could only poll it, would say - A. life with possibility of circumcision, or B. being murdered because I'm inconvenient? "A" please, every time.

Responses to God claims.

1. The God you don’t believe in is not the God I do believe in (thank you Yoel Oz for the great quote!)

2. God commanded circumcision. So to suggest He is cruel is asinine.
[Yes, Genesis 17 also refers to the circumcision of servants/slaves (depending on how the word עבדים is translated). So it is important to remember the following.
     a. Jewish law never mandates “you must own slaves.”
     b. Jewish law (and the Torah) address how you deal with slaves, what their status is in your household, and how you are to treat them. This certainly pertains to a time when slavery or this kind of servanthood was mainstream, as it was in every culture around the world. To suggest that Jews today have slaves (and/or are looking to circumcise them) is dishonest.]

3. When God commanded Abraham to circumcise himself and the males of his household, He first told him, “Walk before Me and become complete/perfect.” (The Hebrew word תמים can be taken to mean either complete or perfect.) Translation: before being circumcised, Abraham was incomplete/physically imperfect. Ever wonder why he couldn’t father a child with Sarah? She needed to have a circumcised husband!!

As for the anti-Semitic argument, we clearly view circumcision very differently. While I understand that some Jews are part of the anti-circumcision movement, I would suggest that by and large they are more culturally Jewish than religiously observant. In other words, they are driven more by emotion and feelings than by any base understanding of Judaism, its history and practices. I would also suggest that they are driven more by a political agenda than by any inkling of trying to at least understand the Jewish perspective. Let alone considering a perspective that circumcision has long-term benefits (we are doing it anyway, so the benefits is for the pro-circumcison outside of religion camp argument).

1. Calling circumcision a sacrifice is silly. We don’t murder babies. We circumcise them.

2. Calling circumcision mutilation is silly. It is a practice shared all around the world, by people who are not interested in destroying the functionality of the penis.

3. Comparing male circumcision to a "similar" (?!?) procedure on females, calling us hypocrites for excluding our girls from this "rite" is similarly ridiculous. We don't circumcise our girls because a. God said "males," and b. girls don't have penises. And no Jewish woman ever said, "Hey! Why was I left out of this one?!" (For the record, our women are part of the Covenant, they just don't bear the mark of the Covenant in their flesh)

4. To suggest we don't love our children is an accusation not worthy of a response.

5. The greatest anti-Semites in the history of the world tried to outlaw circumcision because they knew it also served as an identification marker of a people who refused to completely assimilate, who insisted on observing and practicing religion quite differently than anyone else. Look at the Greeks and the Romans, and in more recent times the Communists. This is why I say that those who are against Jewish circumcision, no matter who they are and no matter how they couch their claims, are the real anti-Semites here.

6. One of the more meaningful passages I have found which describes how we view circumcision can be found in the Pesikta Rabati, a Midrashic work that is over 1200 years old. And here it is

 When you honor God through performing a commandment that He gave you, you don’t do it with what is yours, but with what is His. When you “Honor God from your substance” (Proverbs 3:9) you honor Him from that which He graced you. If He gave you a son, circumcise him. If He gave you a house, place a mezuzah [on the door] and a fence [around the roof]. If He gave you a yard, build a Sukkah [for the holiday of Sukkot] on it. If He gave you a sheep, do the commandments associated with sheep. If He gave you other animals, fulfill the commandments associated with those animals. If he gave you silver and gold, fulfill commandments with them (such as giving to the poor, or buying things that enhance your performance of other mitzvoth).” 
 פסיקתא רבתי (איש שלום) פיסקא כה - עשר תעשר 
הוי אם כבדתם את הקדוש ברוך הוא במצוה שנתן לך, אין אתה מכבדו משלך אלא משלו, כבד את ה' מהונך ממה שחננך, נתן לך בן מול אותו, נתן לך בית עשה מזוזה ומעקה, נתן לך חצר עשה סוכה, נתן לך צאן הפרש בכורות וראשית הגז, נתן לך בהמה לא תחטא בהם אלא עשה מצות שלא תחרוש בשור וחמור ולא תרביע כלאים, נתן לך כסף וזהב עשה בהם מצות, עשר תעשר את כל מהו את כל אפילו ממונך. 

In other words, nothing to see here. We view our children as a gift from God, the same God Who said to circumcise the males among us.

Those who are against Jewish circumcision don’t understand God (the way we do).
Those who are against Jewish circumcision don’t understand Judaism.
Those who are against Jewish circumcision don’t understand the Torah.
Those who are against Jewish circumcision don’t understand why we do what we do.
Those who are against Jewish circumcision don’t understand why this isn’t cruelty.
Those who are against Jewish circumcision don’t understand why we don’t obsess over our lack of foreskin.
Those who are against Jewish circumcision don’t understand what a commitment to a life different from their own could mean.
Those who are against Jewish circumcision don’t understand what has defined the Jewish people for thousands of years.
Those who are against Jewish circumcision don’t understand that just because they have ignorant-of-Judaism Jews in their camp, they will not change who we are, what we do, and why we do it.

And if you can't at least understand us, there's really nothing we can do to help you.
It really is that simple.

Monday, December 25, 2017

Bris and the Challenge of Consent

Every now and then my Facebook page is attacked by "intactivists" - these are militant online (to whatever degree you can be militant online) advocates for leaving babies alone and not circumcising them.

Aside from their unhealthy obsession with the foreskin, they are most often rude, obnoxious, foul-mouthed, relentless, disgustingly and shamelessly defamatory, one-sided, not-interested-in-facts-or-opinions-which-differ-from-theirs, and, frankly, quite boring.

They have six talking points that don't relate specifically to their misunderstanding of Judaism (they call Jewish circumcision anti-Semitic, they say God does not want this, and they note the very rarely applied halakha that if a child had 2 brothers who both died from their brisses, he is allowed to remain uncircumcised - the closest thing pre-modern halakha ever got to a recognition of a condition called hemophilia - which was concerned about the safety of this baby. In other words, the recognition was that blood loss was causing this, not specifically circumcision.)

1. Mohels are pedophiles and rapists
2. Circumcision is genital mutilation (they often compare it the clitoridectomy, which makes zero sense)
3. Those who circumcise have a fetish for foreskins and penises
4. Foreskin is natural (they have many pro-foreskin arguments), a child is perfect, God does not create imperfection - so leave it all alone!
5. Babies die from circumcision or are traumatized for life
6. There is no consent

Arguments 1, 2, 3 aren't even worthy of a response. They make gross (= disgusting) assumptions and are grossly so far from any sense of reality, normalcy and decency. Just regarding #5, more babies die or are truly maimed for life from bad vaccines (though see here how one family turned this experience into a miracle for thousands of children and families) or from traumatic birth experiences, or from (cough cough) abortions than any kind of real statistic about circumcisions, but the removal of foreskins is their issue. And the idea that anyone who was circumcised as a newborn is traumatized or remembers it is such fantastic gobblygook that only an idea-terrorist can come up with it.

(For the record, if there are practitioners who cause babies to die from circumcision, they should not be practicing. And if their actions are criminal negligence, they should be prosecuted. By and large, these stories are extremely rare. The only acceptable number of deaths from circumcision is ZERO. That is the track record of every mohel I know.)

I will leave #4 for a different time (though I've referenced it here). (and here)

So I will briefly address the question of #6, consent.

But first, a disclaimer. I don't care for routine (hospital) circumcision. Meaning, it doesn't matter to me what the medical community thinks, nor do I care what parents decide to do for their sons. I can agree or disagree with non-religion-based circumcision. But I respect that parents can make a choice either way.

So - how can we do this to a child who does not consent? Why, as the intactivists argue, can't we leave the child alone, and let him decide when he is 18, what he wants to do?

While their arguments don't hold water when submitted to the basest level of scrutiny (though they shout so loud, they don't listen to another side), there is a fundamental flaw in the question.
A child's entire life until 18 is directed upon them without consent.

They are conceived without their consent. They are born without their consent. They are put into a family without their consent. They have their umbilical cord cut without their consent. They may have surgeries, for real conditions, or for cosmetic reasons, without their consent. Anything that is "natural" (they were born that way!) is fair game, and is often enough taken care of while in infancy because the healing process is much quicker and the child will have no memory of it. They have blood tests, needle pricks, shots, vaccines, all without consent. Some of these are painful. Some may be unnecessary. And some can be life-altering. We educate our children the way we want, we send them to the schools we think are best for them, we make them play sports, play instrument, learn skills, all without their consent.

And those which are aborted are killed without their consent. Ask any baby - Do you prefer to live and possibly be circumcised, or killed before you are born because you are inconvenient? I bet if they could understand the question and answer, they would choose the former. 100 out of 100 times. [But, hypocritically, many intactivists are pro-abortion]

The Jewish people have a commandment, fundamental to our lives as Jews, that we circumcise our sons on the 8th day of life. Those who raise their children with the understanding of why this is essential to who we are give NO thought at any time in the year to how life might be different if we had a foreskin. We actually view the foreskin as disgusting - מאוסה הערלה. Many of the enemies of the Jewish people in the Bible are described as ערלים, uncircumcised. (It should be noted today that the biggest enemies of the Jewish people today are mostly circumcised, and that people who are not circumcised can very well demonstrate through their actions that they are friends (or at least not enemies) of the Jewish people)

Our consent is ingrained into us from birth. And reaffirmed when we circumcise our own sons. And those who don't understand Judaism will never understand this.

Could there be Jews who claim "I did not consent"? Of course there could be. (though I wonder what else is really driving their anger? I am sure there is often much deeper trauma or inadequacy from something else in life, and they are blaming life's problems on their lack of foreskin.)  And I would invite Jewish parents who are less observant to learn and teach their children why this is important to us as Jews, and to not simply do it for cultural reasons.

Along with the Torah itself, the mark of the Covenant is the most enduring and endearing item that has sustained the Jewish people through the millenia.

Friday, December 15, 2017

Tricks of the Trade

Stepping out of mohel shoes for a moment, I'm going to share with you some of the "daddy-tricks" (which are equally good for mommies!) that I've picked up over the years of having the chance to hold (and change the diapers of) many hundreds of babies.

1. Getting everything ready FIRST
Whenever a baby needs to be cleaned, whether a full bath or a simple diaper change, it is always easiest if all necessary items are laid out in advance. Those who have a large changing table will have the easiest time with this, while smaller (regular) changing tables have everything within arm reach. The less you need to search, however, the quicker your changing job will go.  Of course, with a bath, when the water-use raises the stakes significantly, the quicker baby is out of the water and in a towel, pre-set on the counter, changing table or bed, the quicker we can all breathe easily.

2. Wipes
Don't use them. Seriously.
I know I have them listed in my list of supplies, but that's mostly because I never know the lay of the land where the bris will be taking place. And for me, in the event that I need to clean the baby, the wipes are a convenience.
HOWEVER, in my experience as a dad I've found that the number one cause for diaper rashes is... (brace yourself...) WIPES! They leave a moisture residue on the tush that gets trapped in by the diaper. Moisture of this nature is breeding ground for a rash.  My wife and I have been taking paper towels, wetting them with water and squeezing out the excess, to create the perfect wipe. No it doesn't smell like a summer breeze. But none of our babies (and we've had a bunch) over the last ten years - since we made this discovery - have gotten diaper rashes. And this moisture (water) can be patted away easily.
So use wipes as a last-ditch effort, but not as your first-attempt at cleaning. You'll save money on diaper-rash products, and you'll save your baby from the pain of the rash.

3. Method of changing 
Always put the new diaper, opened and prepared, down first, THEN put the baby on it while he's still wearing the old diaper. Open up the soiled diaper, clean baby, remove soiled diaper, CLOSE PREPARED DIAPER, then deal with folding up and throwing out soiled diaper. This method will save a lot of laundry from needing to be cleaned. You will get the occasional wasted diaper from the baby's previous mess or from his prematurely eliminating new wastes before diaper is closed. But it's a price worth paying.

4. Mohel swaddle
I really need to demonstrate it for you. Suffice it to say that you won't learn a better swaddle, not even in the hospital. (The only exception I've seen are women who have Russian ancestry (whether Jewish or not Jewish) in their blood have a good swaddle-method. )

5. Holding baby
Everybody must use common sense for how to best hold a baby. The baby might also dictate what he likes best. Some babies like being rocked in a rocking chair, while some babies hate when the person holding them is sitting down! When a baby is crying, however, other than changing his diaper, feeding him (nursing or bottle), his calmness may be dependent on how he is he held/rocked. When an adult puts one hand under baby's chest (thumb and pinky under baby's armpits) a simple and gentle up and down motion could be soothing. Also putting baby on one's shoulder, and creating a rocking sensation from the adult's knees, takes baby's soft skull concern (meaning, the worry about the damage shaking the baby could cause) out of the equation, alleviating the problem.

Hopefully we'll have clean and calm babies and households!

Monday, December 4, 2017

So... You Found Your Mohel on the INTERNET?!?

One thing I've learned over the years is that advertising mohel services in the traditional form of advertising is a useless endeavor.  Most people hire a mohel based on one of the following:

1. Word of mouth, ideally from a friend or relative.
2. Recommendation from a doctor or rabbi or synagogue office
3. Reputation or name recognition
4. Internet search

The Internet search is obviously a more recent approach, really unique to the current generation of parents, but even with the Internet search, all reservations still remain without having any of the first 3 "supporting" pieces of confirmation that the person you're hiring is right for you.

This is one of the reasons why I opted to go a very different route than others in how I built this website. It is a blog, and I have written hundreds of blog posts over the years to tweak out any information I can give over to you about what you need to know as a parent, about my own experiences as a mohel (including great stories and stories from which I learned valuable lessons), and about Bris Milah - its significance to the Jewish people and why we continue to do this.

I found that most mohel websites were the same - very little information, a bunch of smiling pictures of mohel holding baby, claims of being the best mohel. Just about every website I visited did not address the healthy tension that comes with having a bris, the feelings of uneasiness, the realities of what could happen at a bris (even though uncommon), and helpful information about the longer term healing that every circumcision undergoes. And of course the oft-repeated lie that the baby doesn't feel anything at the bris and that everything is smooth sailing from beginning to end. 

This is not a knock on their websites, per se (some are quite professional). But it is a hope that mohels can be more up front with people so that the experience they share together with the new parents can always be one looked back at fondly.

To be clear - that IS the experience many have. BUT I have met many people who found me for their second or third son who told me "I wish I knew all the things you're telling me for our first son's bris. I wish the mohel was as comprehensive and thorough and explained everything to us as clearly as you are explaining." (Many also call me for son #1, but they have nothing to compare to!!)

In sum, I am grateful to all those who called me based on the first 3 criteria. Those jobs are much easier to come by. But I am even more grateful to those who called me based on finding me on the Internet, reading through my site, liking what they read, and determining that I was the right match for them. And our experience together proved their intuition right. 

It means that the impression I was trying to leave reached where it was supposed to, and that a feeling of trust was created before you even picked up the phone. And for that I am most grateful.


Tuesday, November 7, 2017

Always a Good Idea to Think Before Speaking?

It was as innocent a mistake as they come.

I don't think I did anything wrong here.

Your thoughts? In the comments, please.

With very rare exception (such as if the Bris goes so perfectly and I can leave the baby without a bandage) I always visit the baby a few hours after the Bris to remove whatever bandage I left on him at the Bris. Some times the bandage falls off on its own before my visit - a circumstance I actually LIKE because the bandage's job has finished, and it means I don't need to bother the baby again.

Today was one such case, and when I opened the diaper I said (referring to the bandage) "O wow! It completely fell off!" And I had a big smile on my face. No need to bother baby! = Happy mohel!

Then I turned to baby's mom, whose face fell completely, and who had begun to cry! Yikes! What did I do?!

Quickly rewinding the moment's events, I VERY quickly clarified for her that everything was fine and that my words referred to the bandage!

Oy - the ways we can be misunderstood!!

Wednesday, October 4, 2017

Delaying Bris, and When the 8th day is Shabbos or Yom Tov

A bris takes place on the 8th day of life, because that is the Torah's rule. This means that we don't usually pick the day of the week for the bris as it is dependent on when the baby is born.

However, there are other rules which might prevent this from happening per schedule.

1. Since we only do a bris on a healthy baby, if baby unfortunately has a medical condition that needs attention, the bris will be delayed until he is clear. If the issue was systemic, the bris will be delayed to a full week after he is medically cleared.

2. If the baby was delivered via C-section, his bris MAY NOT TAKE PLACE ON SHABBOS or a Torah-mandated holiday (Rosh Hashana, Yom Kippur, Pesach (1st and last days), Shavuos, Sukkos (1st days), Shemini Atzeres/Simchas Torah), and will instead take place the following day, either Sunday or the day after

What happens when the bris is supposed to take place on Shabbos or Yom Tov, but it is inconvenient for the mohel, who does not drive on those days, to have the bris take place at the right time?

There are a few options.
1. The mohel or baby's family can make arrangements for mohel to stay nearby
2. Even if it's several miles, the mohel can offer to walk to the bris
3. The family might come to the mohel*
4. The mohel can say, "Look. It's your job to hire someone for the 8th day. I can't do it at that time. However, if you can't find anyone, I'm available the day afterwards." (This is what I often tell people)
5. The mohel might say, "Forget it. We'll do it after Shabbos or Yom Tov." (I find this to be disingenuous. If the parents want the bris on the 8th day, that should be presented as an option for them to pursue with someone else.)

* If the family plans to drive with the baby on Shabbos or Yom Tov (though 2nd day of yom tov raises an interesting question), that is certainly not within the spirit of the day. However, if it is the 8th day, and the baby is brought to the mohel (parents' choice), he (the mohel) does have an obligation to facilitate the fulfillment of the mitzvah of bris on the child.

Tuesday, October 3, 2017

An Insider View: When Two Mohels are Involved

I recently had a problem with an appliance in my house. Being a good American citizen, appreciative of how the free market works, I brought in a few repairmen to assess the situation and provide me with a quote. One will get the job. The others will not. That's called "the cost of doing business."

In the mohel world, things operate a little differently. While parents are encouraged to do their research before the baby is born (to call and interview the "repairmen"), once the baby is born the crunch time sets in. Because the mohel needs to be booked ASAP. And the bris needs to be prepared for the 8th day.

How many times does it happen that people call me, asking for my availability at a certain time - but, alas, there's another bris, elsewhere, at the same time? It happens a lot. (There are some mohels who book both without telling anyone - which causes delay and inconvenience to a lot of people. I saw that a lot in Israel!) So I have to decline - first come, first served is how things work.

But what happens when different family members take upon themselves to hire the mohel? Sometimes parents do the hiring, while a grandparent is looking for the mohel s/he likes! Unlike the analyzing repairmen, who come at different times and await a booking, a booked mohel pencils a bris into his calendar, and he expects to do the job!! Once that happens, he might turn down other opportunities as well, which is why some mohels have a cancellation fee.

I had this recently - had a set of twins bris booked in Miami for the Sunday after Rosh Hashana weekend (Rosh Hashana was Thursday and Friday, leading into Shabbos). I turned down another bris at the same time. And then got a text-message (!) Saturday night informing me that the baby's grandfather had booked a different mohel. Disappointing? Of course. But what can I do?

This is why only one person should book the mohel.

On the other hand, I have also been that second mohel in a number of circumstances. And while when I find out there's another mohel in the picture I typically bow out (out of courtesy for the other mohel), here are reasons for why I will take the job.

1. The parents had a bad experience before, and just discovered they could use a different mohel
2. The parents heard about a bad experience their booked mohel gave to a friend of theirs, and they are worried. They've cancelled him and are reaching out (usually late in the game) to find someone
3. The mohel is delaying the bris for his own convenience, while the bris need not be delayed (THIS ONE IS THE MOST COMMON)

So here are the easy guidelines for how to book a mohel
1. Make sure ONE PERSON in the family is booking
2. While you can interview as many people as you want before baby is born, once baby is born make sure YOU KNOW WHICH MOHEL you are hiring. Communicate this to family and avoid double-booking!
3. Please be respectful of mohel's time and schedule. If you book a mohel, assume he is giving up another bris for you. A cancellation on your part at the very least deserves a PHONE CALL (don't do it by text or email). (I'm torn about the cancellation fee - it's hard to expect people to pay for nothing... on the other hand, if a different bris was lost on account of the booking, that is significant to anyone who counts on the bris at least supplementing one's parnassah)
4. However if you're talking to a mohel who is using delay tactics, when your bris should be on time, and another mohel you speak with accepts the job at the right time, the delaying mohel is owed nothing. As far as I can see, if the bris was supposed to take place Friday, and he is trying to push it to Sunday, he was never booked.

Sunday, August 6, 2017

Halakhah v. Hashkafah

Bris Milah is one of the more unique mitzvahs, in that while in the world of people who fulfill it the desired results are the same, the permutations in terms of how to get to those results are as varying as languages. Aside from the simple order of the ceremony, which varies from Ashkenazic, to Sefardic, to Yemenite and other Middle Eastern cultures, and is even different inside or outside the Land of Israel, every step of the bris has its own adherents, some of whom are militant in their hashkafah (worldview), even though the halakhah (Jewish law) is flexible and fluid - often focused much more on the result than on the method of getting there. Hashkafah is guided significantly more by method than by result.

When the Talmud discusses how a bris milah is performed, it mentions three stages - milah (excision of foreskin), priah (removal of mucosal membrane from the glans), and metzitzah (drawing of blood from circumcision spot, following the acts of milah and priah).

In order to do each of these properly, different surgical instruments and methods have been created or introduced over time to make the experience easier for the mohel, and, in consequence, for the baby.

All of these have been addressed before, but here are the links for the items utilized, presented in their order of use - each has its own "debate" attached to it, summarized as briefly as I can

NUMBING - to numb or not to numb, that is the question. There are those who argue it is forbidden. Those who argue it is obligatory. And those who say it is optional. (And those who argue that injections cause more pain to the baby than the circumcision, and that a topical cream does more for the parents than for the baby (who will cry anyway), as cream makes things more slippery (not a good ingredient for something precise as circumcision)

GLOVES - to wear or not to wear, that is the question. There are those who argue it is forbidden (never done before, chatzitzah). There are those who argue it is obligatory (sterility). And there are those who argue it is inconvenient (slippery, or can't do priah properly). See this article by Rabbi Aryeh Leibowitz, in which he weighs all the pros and cons. 

MARKER - to mark or not to... (OK. I won't use the joke anymore). I can't even present the side against this, because it is beyond stupid. Anyone who argues that marking the edge of the foreskin with a surgical pen is anti-tradition is a full-scale idiot. I've seen too many babies have either not enough, too much, or an uneven (right v left sides) amount of skin removed, a problem alleviated by just using a little common sense plus a marker.

PROBE - The probe is used to separate the membrane from the glans so the circumcision can more likely remove the membrane at the same time as the foreskin. Those who don't use a probe argue that it is painful. And then they stick their fingernails underneath the foreskin to accomplish the same job. 😑.

HEMOSTAT - The hemostat allows for two of the stages of Bris Milah to be accomplished in one action - what is known in Hebrew as מילה ופריעה בבת אחת.  Very skilled mohels often do this when they grab the foreskin with their fingers. Otherwise the hemostat grabs them together. Those who are against it are adamant that the two stages be done separately, AND that priah be done using fingernails - tearing the membrane and folding it beyond the corona, AND they argue that the hemostat is painful to the baby. Those who use it argue that there is an ancient tradition of doing Milah and Priah at the same time, AND that tearing the foreskin with fingernails (method of those who don't use a hemostat) is also quite painful, AND that NOT removing all of the priah membrane could cause problems for the child down the line, either as a child or an adult requiring corrective skin removal surgery. In other words, the pain argument is a question of quantity and degree against both sides (short term v long term e.g. corrections)

SHIELD - The use of the traditional Shield is a hallmark of most Orthodox mohels. Its purpose is to isolate the foreskin (what we are removing) from everything else that we don't want to touch (shaft, glans, scrotum, etc) Some who do not use it opt for a clamp, which accomplishes the same thing in terms of protection (when used properly) but it has its own halakhic, hashkafic and safety issues. Others who do not use the shield do the entire procedure freehand, putting everything near and dear to the baby's safety at risk. As to the clamp - I don't use it nor do I recommend it. I've written plenty of things against clamps in this website. As to the shield, those who argue to use it are concerned for the baby's safety and are doing their due diligence to protect the baby from an unfortunate mishap. Those who argue against it claim that it hurts the baby (see previous paragraph for cost/benefit ratio question), and that it's an innovation from 400 years ago (or so) that has no place in this ancient tradition.

KNIFE - The idea behind using a double edged knife is based on a "drasha" from the verse וחרב פיפיות בידם. In general, the sharpest knife should be used, so the incision is as quick as possible. Using a double-edged knife is entirely a hashkafic issue, as the rules of bris say anything can be used to excise the foreskin (except a reed which could give the baby a splinter), "but the custom is to use a knife."

TUBE - Metzitzah, the third Talmudic stage of the bris, can be accomplished in a number of ways. The most common methods utilize the power of the mouth, while the less common method uses a sponge or gauze. The most common methods either have the operator putting his mouth directly on the open wound, or have a sterile tube serving as a barrier between baby and mohel. Both of these methods are halakhically "metzitzah b'peh (or b'feh)," while hashkafically, the tubeless method is deemed by purists to be the "only acceptable method." To those who are sterility conscious, the tubeless method is wholly unacceptable - potentially putting baby, and sometimes mohel, at risk of spreading an infectious disease. In this view, metzitzah should be done with a sterile tube.

This post is in response to a recent phone conversation I had with a new father in Florida who personally was interested in the circumcision taking place, but did not particularly care about methods - only results. His parents, however, who hail from a very right-wing Orthodox community in the Northeast, carry every hashkafic notion of bris in a manner that clearly views other methods as unacceptable. As a colleague of mine told me, "If people ask, you let them know that 'hiring me means you get this kind of service, and if you don't want that, hire someone else.'"

Not that I believe for one second that anyone wants any harm to come to a baby. However, a hashkafa that proclaims that achieving circumcision results using methods that don't conform to safety and sterility are IDEAL - when I have heard plenty of stories from people who had very negative consequences (hospital visits, infection, baby on antibiotics post bris) - troubles me personally and deeply.

My method, thank GOD, has a perfect track record in terms of no-infection post-bris. Because everything that needs to be protected is protected, and nothing is exposed to bacteria that could have negative consequences.

I certainly wish everyone well, and hope that everyone hires the right mohel for their purposes, with the best interests of their baby in mind. 

Wednesday, July 26, 2017

A Different Type of Busy

I don't know what triggers them specifically, beyond my existence, but every now and then my Facebook page is attacked by anti-circumcision activists, some of whom are respectful, some of whom are curious as to why we do what we do, some of who can not fathom how we don't view Brit Milah as a human-rights violation, and some of whom are vile human beings who spew filth and the most hate-filled language and invective towards me (as a representative of Brit Milah) and our backwards ways.

These latter people, some of whom go so far as calling me a pedophile, get blocked, banned, and their comments deleted. They don't call urologists and gynecologists sexual predators, so their comment in my direction is just disgusting. If no one ever hired me again for a bris, I would never see another foreskin (except on my own newborn son, I suppose) as long as I live. And I certainly have no interest in seeing my work once the healing process has completed and parents aren't asking me questions about it. (Though as long as they ask questions, it's in a professional capacity, and the physician parable remains...)

As for the rest of the people, if they have respectful comments and questions, I am happy to have the dialogue. Perhaps there is merit to trying to explain - in a respectful manner. Even though it takes time, and the conversation almost never convinces anyone of even the merits of our view.

Because the bottom line is this. People who have not bought into a. Judaism, and b. the Covenant (both of which are why we do this), as well as those who do not agree with the idea that parents who bring children into the world are allowed to raise them how they want, they don't accept that Brit Milah (which includes the act of circumcision, but is symbolically much more than a circumcision) isn't a human rights violation. 

They can argue that a child born of a Jewish mother is Jewish even without circumcision. This is certainly true. But try explaining to them the concept of 'karet' and you're viewed as a lunatic (so I don't - not worth it). They certainly don't understand why doing it this way is highly preferred over letting the child decide when he is 18. While I've met some people on FB who are disgruntled, in my personal dealings, everyone is happy their parents took care of it for them when they were babies (as per Torah law - Genesis 17 and Leviticus 12:3), so it's done and taken care of.

To these activitists, pro-circumcision views are irrelevant (not that we need them, because we're doing it anyway), and any perspective other than their own is unacceptable. One woman even said that circumcision is a form of Anti-Semitism (I can't make this stuff up!) 

They don't understand us. Period. One person told me there was a reason why Greeks and Romans outlawed circumcision. And I congratulated him on joining the ranks of the most evil people to ever inhabit this earth, who hated Judaism and (murdered) Jews on account of their being different, and for the acts they did which made them Jewish.

Most Jewish men I encounter give no second thought to their circumcision, and certainly don't obsess over how their lives would be different if they had their foreskin. Many are even proud of their circumcision, and even prouder that they had the opportunity to bring their sons into the mark of the Covenant as well. 

It's been an interesting week. But I look forward to focusing on the important work of bringing our Jewish boys into the mark of the Covenant. 

Sunday, July 16, 2017

The Pulitzer Prize-worthy photo that went viral

The first time I posted a picture that went viral on Facebook was, post-bris, after a mom put a creative Harry-Potter themed onesie on her baby.

This time - overwhelming those numbers - the photo I posted on Friday (2 days ago), has already been seen by over 100,000 people, has been shared over 500 times and has received over 1100 reactions, according to the stats I see through FB.

I did not do this bris - it took place in Israel - but the story is so heartwarming. The great-grandfather held his own brother during WWII, as his brother died. The baby was named for that brother - what a different position to be in! To have held and lost over 70 years ago, and now to hold for life!!!

Here is the post. Am Yisrael Chai!!!

Thursday, July 6, 2017

Tefillin at the Bris

Image result for bris photo
I don't know what's going on in this photo, but the person on the right is still wearing his hand tefillin
When davening leads directly into the bris, the baby's father (as well as the Sandak) will often ask me, "Do I leave my tefillin on?"

According to the Sha"kh (Y"D 265:10) "the custom was to not remove tefillin until after the Bris, because tefillin are a sign (אות) and Milah is a sign (אות)."

Yosef Weissberg, in his Otzar HaBris Vol 2, page 250, addresses many of the rules associated with Tefillin in conjunction with a bris. 

* The Sefardic custom in Jerusalem is that the father and the Sandak put on tefillin (or leave them on) for the Bris. If it's after davening, the Mohel leaves them on too. (This assumes the mohel davens with the family, which is not always the case. Also, from experience with my first son, I'll note that I took off my hand tefillin, but left my head tefillin on, as the hand tefillin get in the way of doing a good job  - AB)

* In the book אות חיים ושלום (from Munkatch) concurs with my parenthetical comment about the mohel, but felt that the Sandak should keep the tefillin on. 

* There is another viewpoint (recorded by Ateret Tzvi, and reported as practice of Chozeh of Lublin and others) not to keep the tefillin on for the Bris. This is also true for the Yemenite Jews - tefillin are removed prior to the bris. 

* A reason for removing the tefillin follows a similar reasoning for why we don't wear tefillin on Shabbos. Since Shabbos is an אות, we don't need tefillin that day. Since מילה is an אות, we don't need to have another אות around at the same time as we are introducing a new אות. 

* In the book כורת הברית, he doesn't recommend taking them off. But if one is not wearing tefillin, he should not put them on, as he looks like he's seeking an אות when he is already partaking in the marking of a very special אות. 

* Rabbi Moshe Feinstein argued with the logic of most recent bullet point, because the new אות is not on the person wearing the tefillin - it's on the baby! So if the tefillin are on - whether kept on, or put on in honor of the bris - this is not a contradiction. 


Wednesday, July 5, 2017

Bris During the Three Weeks

For babies born yesterday and for the coming three weeks, any bris will be during the period which is called "Bein Ha'Mtzarim" in Halakha, or the "three weeks" in English. This period starts on the 17th of Tammuz and ends with Tisha B'Av.

As this is a time of mourning on the Jewish calendar, some rules of the bris experience are a little different than usual.

All of the following is recorded in Yosef Weissberg's bris Otzar HaBris volume 1, pages 289-291, where he has all the footnotes supporting the viewpoints presented.

The Baalei Bris (Father, Sandak, Mohel) may get a haircut in honor of the bris. Some are of the opinion that if the bris is during the week when 9 Av will be taking place, that haircut should be skipped. [In a footnote, he essentially argues that the same rule applies to cutting fingernails]

The Baalei Bris (see above) may wear "Shabbos clothes" to the bris. The woman who brings the baby into the bris - the female half of the Kvatterin - may also wear Shabbos clothes, though the male Kvatter may not.

The wine should be given to children to drink, or to the mother of the baby. But the one who makes the bracha during the bris ceremony should not have, and neither should the Baalei Bris (see above) taste the wine. [Though he doesn't specify, I assume this rule is actually during the 9 days, when the custom is to refrain from wine, except on Shabbos, and not from 17 Tammuz until Rosh Chodesh]

Everyone who is present for the mitzvah and therefore the meal are permitted to eat meat and drink wine as part of the "seudas mitzvah" celebratory meal. The wine used for bentching may also be consumed.

However, during the week in which 9 Av falls, one should limit the size of the guest list to relatives and enough to make a minyan. The exception to this rule is if the bris is on Shabbos - even on Shabbos which is 9 Av (for which the fast will be observed on Sunday) - then everyone can participate.

Monday, June 26, 2017

Another adorable shirt choice

Easily the best shirt I've seen on a baby post bris is the one that went viral on Facebook. 
(Last link is to my blog about it. This one is to the Facebook post)

Last week, a couple with a wonderful way about them (very chilled out), with a shared sense of humor bought the "perfect" shirt for their baby to wear to his bris. And here it is.

I've written about the tasteless kind of humor that some people think belongs at the bris. But I am not against the kind of humor that eases the natural tension in the room, and the kind that is totally appropriate.  This qualifies.
Image may contain: one or more people, stripes, closeup and indoor


And the bris was perfect.

Sunday, June 18, 2017

Recent travels

Thank God, some of my recent brisses have taken place out of state. Ever grateful for the traffic from and a reputation that is, thank God, growing, these brisses always turn out to be wonderful experiences.  They often include meeting Jews in further-away communities, who are, of course, grateful for the gift of their new baby. But who are also making a go of a Jewish life away from family, and sometimes, away from a mainstream Jewish community.

It's always a marvel how people manage in their own way, their own observance, their own approach to a relationship with God. And how, for all of these people, the question is never "should we do a bris?"

It is always, "Where, and when will the bris take place? And how can we make sure we have a mohel for the proper time?"

Kudos - God bless - and may you raise your children with joy.

Thursday, June 8, 2017

Comics about Bris

I was cleaning out some old files and I came across these - from my New York days when we would get the Jewish Week.

In general I don't like jokes about Bris as they are usually inappropriate and irreverent (as demonstrated in the second one). A colleague of mine likes to say to the person who tells a bris joke, "I have a lot of respect for that joke because it's older than you and me combined."

That said, enjoy?

Sunday, May 28, 2017

Baby Feeling Pain - Myths and Facts

I just came across this article on, and thought I'd give a slightly different perspective on the question of whether the baby feels pain at the bris. The main reason for sharing the following perspective is because I prefer to be a realist and share truth, rather than paint a rosy picture, blaming realities on straw-men, and ignoring the facts-of-life.

I do agree with the article in that we've been doing this for a very long time, and when done right, most babies are fine shortly after the procedure is over. And certainly have no memory of it.

I've written about this subject before - you can search "pain" in my website (this link will do it for you if you're not on a computer or laptop) and you'll get my thoughts on this more spelled out.

But here is the brief version.

Anything out of the baby's comfort zone causes a baby to cry. This may include: wearing a diaper, not wearing a diaper, being hungry, being handled for a diaper change, having legs pushed out of fetal position, any kind of pain.

Babies nerve endings aren't developed so they don't feel pain.

Babies feel pain. However, they don't have a very long-term memory. When pain sensation ends, and especially if amicably distracted (otherwise comfortable, eating, etc), crying can stop.

Babies are at their prime for clotting on day 8, so the 8th day is the best day to have a bris.

The 8th day is the best day for a bris because God said so. Clotting factor is irrelevant to pain.

A bris is really pain-free because it is a mitzvah.

A bris is often less painful than a hospital circumcision because the hospital variety utilizes clamps that crush the skin and destroy tissue (from the clamping). Some mohels use a clamp too, so let the customer beware (fwiw, I don't use a clamp). The baby cries when being handled, so the longer he is exposed, subject to metal surgical instruments, and with his legs restrained from being in the fetal position, the more he will cry. Saying he doesn't feel the circumcision in a bris ceremony is a lie.

While I'll leave the debate of numbing for a different discussion (search for numbing is here), I think the main points to consider are DEGREE of pain-inducing contact, and the amount of TIME during which baby is subject to the same.

A mohel should not use a clamp, and should work neatly, efficiently, and should be done - start (separating membrane) to finish (bandaging) in 30 seconds. Less contact → less discomfort → less crying baby → happier everyone.

Thursday, May 25, 2017

Maybe My Kvatter "Rules" Are Wrong!

I find this depiction of a bris, in particular the description of who served as Kvatter, to be fascinating. And who was the baby? At the time he was the son of a prominent rabbi in Piotrkow. Now that baby is a former Chief Rabbi of Israel. Rabbi Israel Meir Lau.

הרב לאו.JPG
Rabbi Lau
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Naftali Lavie and Rabbi Lau shortly after liberation
The bris story was recorded by Naftali Lau-Lavie in his book, "Balaam's Prophesy"Image result for naphtali lavie

A Bris Milah Roundup

As most of what I've ever wanted to say about Bris Milah has already been recorded in this blog, the challenge is ever present to say something new, to couch something a new way, or to come up with new material that has not yet been addressed. As it happens, there are many sefarim (Hebrew books) written on the subject, so if I would either like to get esoteric, or start discussing out of the ordinary circumstances (such as what happens if the bris is on a pushed off fast day and the baby's father dies before the circumcision), those options are always available.

At the minimum I'm trying to blog once a month, so before May is lost, here goes.

I've gotten two more inquiries from physicians - I mentioned a previous one from two months ago here. And once again a physician (or two, or more?) wants to become a mohel and is having a hard time finding a mohel to train him.

One needs to be consistently busy to train others, and as I'm finding out, babies tend to come in spurts and seasons. I have about 12 babies lined up for brisses at the end of June through early August - and that's just the people who call well in advance! (And some of them may turn out to be girls, which will obviously lower the numbers)

In the news: Europe is going crazy again, couching their anti-Semitism in the guise of liberalism. Save the babies! Save the animals! From those nasty Jews!  (the title is mine, but that is the truth behind this latest assault)

I spoke to a father this week who had two very preemie twin boys. They will need a lot of time before they are ready for a bris. And as I write this I am waiting in an airport for my delayed flight to take me to a bris for another set of twins - though only the brother half will be having his bris.

Life goes on. Babies are born every day, and this blog continues to service people around the globe. Not sure why, but for the first time I know of, the hits from Israel outshine from even the USA - 3929 website visits from Israel in this week alone, compared to a meager 411 in the USA.

Germany, Brazil, UK and Netherlands are the next top visitors. I hope they're mostly Jews looking for information, rather than anti-Semites looking for fodder to fuel their anti-Semitism (see mention of Europe above).

That about does it! Looking forward to the summer and the many anticipated (and unknown to me) births which are coming. May the babies all be healthy, and may the boys have their brisses at the right time.

Friday, April 21, 2017

The Consultant, plus a word on safety precautions

I've had a few conversations this week with new parents who just had their baby circumcised. They are in New York area - I was not the mohel.

They had questions about what had happened in their son's bris. Mind you - this is pretty atypical. Most people have a wonderful, surprise-free experience, and all goes well. But life is sometimes accompanied by surprises and unexpected turns.

While the photos that were sent to me can't be shared on this blog, I will tell you that there's a reason that I pride myself on the circumcision looking as nice as possible hours after bris. There is often swelling, and not much we can do about that. But aside from the natural swelling, to have the circumcision look palatable to any observer is really an important goal. I've had many parents squeamishly look only to discover, "Hey. That actually looks good!"

The natural redness that is exposed through the act of circumcision is not a frightening vision - you just need to know what to expect.

But when things don't go exactly as they should, you need to understand EVERYTHING that has happened in the circumcision and in what direction a proper healing process should go.

Anyway, these parents had questions. In general, when I get these kinds of calls, while in some cases they are in fact talking to their mohel, in other cases, they don't want to talk to him because they either do not want to hurt his feelings or feel they do not have a sympathetic ear for their concerns. This is why I do believe that parents who do not know the mohel they are hiring should at the very least have a phone conversation in advance of the birth, to be sure they are comfortable with their choice of mohel. 

Some previous blog posts addressing these issues are linked here:

And just FYI - I take many precautions to avoid the issues that I have been consulted to share information. I always tell parents that without actually having examined the baby, my opinion is only worth so much (a picture is good, but it isn't the same).

It's hard enough for some people to circumcise. Should the experience be anything other than as smooth as possible? I don't think so. Here are a few precautions every mohel should be taking. If they are not doing these, I honestly think every parent should look elsewhere.

Monday, March 13, 2017

Perceptions, Perceptions

I should probably learn how to do circumcisions on adults (Rephrase: I know how to do circumcisions on adults. I should learn how to administer local anesthetics and how to suture). What is it about adult men who want to get circumcised, and rather than going the medical route, they seek out a mohel? I've gotten 3 requests this month alone.

Which brings me to the irony of other conversations I've had in the last few weeks. I blogged about one here. And I received another email (from someone out of state who had been in touch with me - no local mohel options available in that town): "we are going to go with a local pediatrician to perform the brit."

And then there was the doctor from a northeastern state who called me today asking if I could advise him on where to train to hone his circumcision skills. Seems he recently watched a bris performed by a certain mohel (he did not identify the mohel) and felt, as a meticulous physician, he could do a better job. And yet, he is turning to mohels to seek that training.

Then there is this article from the Atlantic (goes back to 2015) entitled "Why Non-Jews Are Choosing Jewish Circumcision Ceremonies."

Bottom line: Who is better - a mohel or a physician? A silly question gets a silly answer.

Each mohel - whether medical doctor or simply mohel-specialist - must be judged as a practitioner on his own merit. Either he is good at what he does, or he is not as good as the other guy. Either he works well under pressure or he does not. Either he delivers a beautiful cosmetic result or he does not. Either he is the right person for your family or he is not. Your preference for one type over the other boils down to your perception, but should really boil down to your research.

Make no mistake. Mohels have been doing this for a very long time - much longer than it became "in vogue" for circumcision to be widespread and for doctors to get in to the "circ-service" industry.

Feel VERY comfortable trusting a specialist. Feel free to call me to have a conversation. The doctor I spoke with today was grateful, and I trust you'll find our conversation pleasant and informative as well.

Thursday, March 9, 2017

Metzitzah in the News - Again

Is it a witch hunt? More like "which" as in, "which mohel is responsible for being irresponsible?"

Seriously, this is beyond ridiculous. I have it on high authority that metzitzah is not even required today (Rabbi Herschel Schachter and his reporting on Rabbi Joseph B. Soloveitchik), let alone the permissibility of doing it without a barrier (Rabbi Moshe Dovid Tendler, who has told me it is forbidden to do metzitzah with direct oral contact - not that I was ever doing it that way anyway).

For those of us who are not abandoning the practice of Bris Milah, there is a very simple way to avoid these kinds of stories - completely sterile technique. No exceptions.

Thursday, March 2, 2017

Doing Research Properly

I got an email today from someone with whom I had been in contact for a little while about possibly doing her soon-to-be-born son's bris.

She apologized profusely, saying "my husband wants to try a doctor this time." This was followed by "Hope no hard feelings."

First of all - there are NEVER hard feelings when people are doing research and being open. You must do what you feel is best for your son and your family. And I support that.

However, you must also do RESEARCH and know what you are getting into, no matter who you hire for your son's bris.

This isn't a question of Dr. v. Mohel. A mohel, after all, is a specialist in this field. So being a Doctor doesn't make anyone better at circumcisions than a mohel.

What DOES matter, is how the circumcision is performed.

What METHOD is used

Whether the precaution of a marker is utilized

How much foreskin (see #5 there) and membrane is removed

And, of course, the follow up.

There are MANY fine mohels. There are MANY fine doctor-mohels. The questions every person must ask before hiring either one is, "Have I done my research? Do I know what I want for my son? Have I found the right mohel-specialist for the experience I want my son to have, and the experience I want to have?"

When the answer to all of these questions is YES, then proceed accordingly. Until that time, there is work to be done as a parent. Best of luck!!

Friday, February 10, 2017

Parental Vigilance

Dear Parents,
I can not emphasize this enough. (I've written about this before)

After the bris is over, and I am finished with MY job, YOUR job kicks in.

So let me explain to you what MY job is, so you understand what your job is and why your job is very important.

My job:
1. To get as even and aesthetically pleasing circumcision as possible. To achieve this I use a surgical marker to guide the incision
2. To make sure I take off the correct amount of foreskin, which actually has a small range of flexibility, and not to take off too much.
3. To make sure that beyond removal of foreskin there isn't an excessive amount of membrane left behind, which could give the baby the appearance of being uncircumcised.
4. To control the bleeding and make sure the baby is well on the road to healing and recovery post circumcision
5. To give you information about how things will look over the next few days and weeks
6. To give you instructions for after-care and what your job is over the next few days and weeks

Which leads us, most obviously to YOUR job
1. To follow the instructions for after-care (see 6 above)
2. To be in touch with ANY and ALL questions
3. To keep the diaper area as clean as you can during the healing process
4. Over the next few days, weeks, sometimes months, to avoid the Fusion Concern
5. To be aware of the Chubby Baby Syndrome

It boils down to this.
After circumcision, the body realigns the penis and restructures itself in the absence of the foreskin. Depending on how the circumcision goes, there may be a ring of leftover membrane between the incision spot and the glans, or there may be no membrane there at all. IN EITHER CASE, because the baby spends so much time on his back, and especially if he becomes chubby over time, the glans has a tendency to sink a little back into the membrane or the shaft and stay there, giving the baby a partially (as opposed to completely) circumcised look.

Which is where YOU come in.
Every time you change his diaper, every time you give him a bath, make sure that the glans is free and clear of anything that is below it. It really is a very simple massage every time his diaper is open, until time (could be weeks or even months) indicates that no intervention is required any more.

In simple terms - I met an adult recently whose parents did not take care of this when he was young. After a brief consultation I suggested he speak to a urologist, and he ended up having corrective surgery. This could have been avoided if his parents had been vigilant!

Tuesday, January 31, 2017

Being Prepared for Out of the Ordinary Circumstances

As much as possible, I try to meet the baby a couple of days before the bris. It gives me a chance to speak with his parents face to face, and it also helps prepare me in terms of what to expect with the technical side of the circumcision.

In other words, not all male anatomy develops in the same way.

In examining a baby recently, I noticed that the glans was extremely close to the body in its natural state, while when pushed on the two sides of the shaft to elongate the penis, the entire organ seemed to emerge. I have seen situations in which the entire penis was inside the body, requiring a reconstructive surgery to draw everything out - which I was later privileged to observe in the operating room, under the skilled hands of one of the finest surgeons I have ever seen in action. But this was not so extreme at all, as everything was external, it just seemed pulled by nature to be less prominent.

I explained to the parents what I needed to do - to be as precise as possible in marking the foreskin, to avoid this problem, and to see to it that everything looks right after the bris.

As luck would have it, the marking went perfectly, the incision was precise, and it looked like all was going to be smooth sailing. However, as sometimes happens, I noticed afterwards that there was extra membrane, necessitating this quick touch-up.

But it turned out to be so much more. What is often a tiny piece of membrane tissue turned out to be a significant amount of below the foreskin webbing. It kept emerging, causing me to realize what was pulling the glans almost into the belly itself. 

Thankfully, it seems this was it. When it was all removed, the baby looked like every other baby post-bris, and the internal issue he had that was pulling his penis, making everything so retracted, was resolved. 

As I told the father, if we hadn't taken care of this now, he may have developed phimosis or the inability to have a complete erection, with internal membranes pulling him away from being able to do what he'll need to do one day.

Baruch Hashem, a good ending and a happy story. It's a warning to mohels to be humble and to remember that not everything is "textbook" every time. It is also a reminder to parents that mohels must treat each case as if it is the most important thing he is doing now. I have seen cases similar to this one in which the circumciser erroneously removed ALL shaft skin because he thought that was what was required due to the unique anatomy.

Thankfully that wasn't the case here, wasn't the approach tried nor the results achieved (which were actually quite impressive)!

May we be blessed to deal positively with all new situations, and be guided to always fulfill the mitzvah of bris milah properly, including in non-textbook circumstancs.