Because we live in an increasingly depressing world, there are things that I must do and that I cannot do in order to maintain that my interest in this field (bris milah) is solely for the mitzvah - helping parents fulfill their biblically mandated requirement to have their sons circumcised to bear the mark of the Covenant.
This is why, as much as I want to share before and after photos so parents can know what to expect, I am resigned to explain it in words, leaving photos out.
This is why my care for most children ends one or two days after the bris, when things are healing nicely and I know that as long as post bris care follows my instructions, everything will be fine.
I have a colleague who likes to offer the change the baby's diaper if he bumps into the parents weeks down the road - it's his way of checking his handiwork to assure that all is healing as it should.
I am not so bold, and I don't ask parents for such opportunities. However, every now and then a parent will have a question or wants me to assure that all is good (especially if we left things as "let's keep in touch to see how things heal") and I get a chance to see how things have healed. This happened twice this week, and I am happy to report wonderful healing processes.
It is always flattering to see such beautiful results from one's handiwork. I hope they all turn out this way.
God bless!
Showing posts with label after care. Show all posts
Showing posts with label after care. Show all posts
Monday, December 1, 2014
Wednesday, January 26, 2011
Knowing What To Expect Afterwards
[For much more detail on this subject, click here. The short version follows.]
When your child is circumcised, it is a good idea to get a good feel for how long the healing process takes.
In most cases, I need to see the baby only once after the bris, often enough to remove a bandage, but even when the bandage comes off on its own, just to see that everything is healing nicely. This has changed the time frame of my care for the baby - I used to see the baby, in some cases, two whole days after the bris. Now I see him within a few hours.
I FIND SEEING THE BABY A FEW HOURS AFTER THE BRIS TO BE MUCH BETTER: FOR THE BABY, FOR HIS PARENTS, AND YES, EVEN FOR THE MOHEL
There are mohels who like to see the baby a few days later, or even to see how things are looking a few weeks later. This is admirable.
At the same time, in the event that something is not OK at that two week period, there is really nothing that a mohel could/should do at that point. Any "correction" should be taken care of right away, which would perhaps necessitate an additional follow-up visit.
In simple terms:
* The glans (tip of penis) should be a dark red, and the extent of its outline - like a helmet on a head - should be visible all around
* There will or will not be remains of a membrane below the glans (also a dark red, though a slightly different hue). It is often swollen, though to what degree depends on how much membrane is present.
* The skin where the incision took place should be identifiable below the glans or membrance, and should be as close to even in its circumference around the shaft. Depending on the baby's anatomy, in some cases, the mohel might cut at more of an angle, to compensate for a differently angled glans.
If this is what things look like after the bandage comes off (with the caveat of the possibility of some swelling below the glans), all your baby needs is "time." Some colors may emerge (white, yellow, green) that are just the way the area scabs. But even all this goes away within a couple of days, and certainly very quickly once ointments (vaseline or similar product) are no longer applied to the area.
For instructions on how to care for baby, see here
When your child is circumcised, it is a good idea to get a good feel for how long the healing process takes.
In most cases, I need to see the baby only once after the bris, often enough to remove a bandage, but even when the bandage comes off on its own, just to see that everything is healing nicely. This has changed the time frame of my care for the baby - I used to see the baby, in some cases, two whole days after the bris. Now I see him within a few hours.
I FIND SEEING THE BABY A FEW HOURS AFTER THE BRIS TO BE MUCH BETTER: FOR THE BABY, FOR HIS PARENTS, AND YES, EVEN FOR THE MOHEL
There are mohels who like to see the baby a few days later, or even to see how things are looking a few weeks later. This is admirable.
At the same time, in the event that something is not OK at that two week period, there is really nothing that a mohel could/should do at that point. Any "correction" should be taken care of right away, which would perhaps necessitate an additional follow-up visit.
In simple terms:
* The glans (tip of penis) should be a dark red, and the extent of its outline - like a helmet on a head - should be visible all around
* There will or will not be remains of a membrane below the glans (also a dark red, though a slightly different hue). It is often swollen, though to what degree depends on how much membrane is present.
* The skin where the incision took place should be identifiable below the glans or membrance, and should be as close to even in its circumference around the shaft. Depending on the baby's anatomy, in some cases, the mohel might cut at more of an angle, to compensate for a differently angled glans.
If this is what things look like after the bandage comes off (with the caveat of the possibility of some swelling below the glans), all your baby needs is "time." Some colors may emerge (white, yellow, green) that are just the way the area scabs. But even all this goes away within a couple of days, and certainly very quickly once ointments (vaseline or similar product) are no longer applied to the area.
For instructions on how to care for baby, see here
Wednesday, May 12, 2010
When Baby is Cranky - Is Tylenol a Solution?
The impetus for this posting comes from two incidents which took place in the last few weeks.
1. Tylenol, and other OTC baby pain medications had some kind of recall (the details did not concern me personally as my children don't use any of the items in question, and I never recommend any of them as a mohel)
2. Someone I know, who lives in New York, had his son circumcised by a local NY mohel, and called me that evening, after his baby had an unusually difficult day, to confirm that what his mohel had told him was "normal" in the post-op care of the baby. Details to follow.
I will not address the Tylenol recall directly, as it is not my area of expertise. But the issue which is raised often enough is whether there is room to give the baby tylenol if he seems cranky after the bris?
My answer is twofold. Firstly, let your pediatrician recommend tylenol or something to ease your baby's discomfort. Most mohels I know are not physicians, and while they can offer advice, they are not in charge of your baby's long-term care. Even if the mohel IS a physician, if he (or she - there are female Dr. physicians who are mohelets) is not your baby's physician, the questions about medications should be directed to the primary long-term caregiver.
Secondly, and this leads into the second impetus as mentioned above, your baby should not feel discomfort after the bris.
You may ask, how could a baby not feel discomfort after going through this surgery? I don't know the answer to this question, but I can report on what I've observed.
Post-bris, most babies who have a bandage placed on comfortably, who have their needs met (clean diaper and full belly), sleep nicely, eat nicely, wet their diapers consistently, etc. They cry under the same conditions they cried for before the bris: dirty diaper, hungry, tired... The main difference will be that baby might wince when he urinates - which would be directly impacted by the bris.
So what causes a baby to be cranky after the bris?
The number one item that causes a baby discomfort is an uncomfortable bandage. It could be the material does not agree with him. The bandage may also be on too tight, constricting what should otherwise be an easy urine-flow.
In my personal experience, when I fiddle (as necessary, after the bris) to get a new bandage on, the baby will usually cry as I am reapplying a gauze pad. Once I am finished and leave the baby alone, he is usually calm and comfortable, the crying stops, and he either eats or goes right to sleep.
Solutions
And so I asked the father of the baby three questions:
1. Is it bleeding? (usually indicative of either a case that requires attention or a bandage that fell off prematurely)
2. Has the baby urinated? (if not, there is too much constriction on account of the bandage, and it needs to either be loosened, removed, or replaced with a looser and softer bandage)
3. Will your mohel come and check it?
If the bandage is on too tightly - guess what - Tylenol or Motrin ain't gonna do a thing.
*************************
I mentioned in a different posting that it is normal to see swelling after the bris, particularly on the ventral side of the penis. In this case, that was not as much of a concern from my perspective (though the father did see swelling and was concerned about it).
In the end, the mohel did come and check, he removed the bandage (or loosened it) and baby was able to urinate more readily, easily and comfortably.
The point of this story is not to knock another mohel. It is to encourage you to avoid jumping to conclusions, to avoid worrying, and to realize there may be a very simple solution.
I have taken steps to avoid this problem. The bandage I leave on the baby is a softer one, which usually comes off on its own a few hours after the bris. I remind parents from the get-go that they need to report to me if the baby has not urinated a few hours after the bris. I consciously put the bandage on tight enough to constrict the bleeding, but not so tight to be uncomfortable for baby.
With the exception of babies who are extremely hungry after the bris, most babies I care for are calm when I finally leave them alone, and may even sleep comfortably for a few multi-hour stretches, waking up for feedings and diaper changes.
And I tell the baby's mother, "You see how he is now? That is how he should be throughout the rest of the day, except when he is telling you he is hungry or needs to be changed (which is when he normally cries anyway)."
Instead of Tylenol being the solution, let us return to appropriate TLC which will undoubtedly help ease the pain and make the ordeal so much easier for parents and baby.
1. Tylenol, and other OTC baby pain medications had some kind of recall (the details did not concern me personally as my children don't use any of the items in question, and I never recommend any of them as a mohel)
2. Someone I know, who lives in New York, had his son circumcised by a local NY mohel, and called me that evening, after his baby had an unusually difficult day, to confirm that what his mohel had told him was "normal" in the post-op care of the baby. Details to follow.
I will not address the Tylenol recall directly, as it is not my area of expertise. But the issue which is raised often enough is whether there is room to give the baby tylenol if he seems cranky after the bris?
My answer is twofold. Firstly, let your pediatrician recommend tylenol or something to ease your baby's discomfort. Most mohels I know are not physicians, and while they can offer advice, they are not in charge of your baby's long-term care. Even if the mohel IS a physician, if he (or she - there are female Dr. physicians who are mohelets) is not your baby's physician, the questions about medications should be directed to the primary long-term caregiver.
Secondly, and this leads into the second impetus as mentioned above, your baby should not feel discomfort after the bris.
You may ask, how could a baby not feel discomfort after going through this surgery? I don't know the answer to this question, but I can report on what I've observed.
Post-bris, most babies who have a bandage placed on comfortably, who have their needs met (clean diaper and full belly), sleep nicely, eat nicely, wet their diapers consistently, etc. They cry under the same conditions they cried for before the bris: dirty diaper, hungry, tired... The main difference will be that baby might wince when he urinates - which would be directly impacted by the bris.
So what causes a baby to be cranky after the bris?
The number one item that causes a baby discomfort is an uncomfortable bandage. It could be the material does not agree with him. The bandage may also be on too tight, constricting what should otherwise be an easy urine-flow.
In my personal experience, when I fiddle (as necessary, after the bris) to get a new bandage on, the baby will usually cry as I am reapplying a gauze pad. Once I am finished and leave the baby alone, he is usually calm and comfortable, the crying stops, and he either eats or goes right to sleep.
Solutions
And so I asked the father of the baby three questions:
1. Is it bleeding? (usually indicative of either a case that requires attention or a bandage that fell off prematurely)
2. Has the baby urinated? (if not, there is too much constriction on account of the bandage, and it needs to either be loosened, removed, or replaced with a looser and softer bandage)
3. Will your mohel come and check it?
If the bandage is on too tightly - guess what - Tylenol or Motrin ain't gonna do a thing.
*************************
I mentioned in a different posting that it is normal to see swelling after the bris, particularly on the ventral side of the penis. In this case, that was not as much of a concern from my perspective (though the father did see swelling and was concerned about it).
In the end, the mohel did come and check, he removed the bandage (or loosened it) and baby was able to urinate more readily, easily and comfortably.
The point of this story is not to knock another mohel. It is to encourage you to avoid jumping to conclusions, to avoid worrying, and to realize there may be a very simple solution.
I have taken steps to avoid this problem. The bandage I leave on the baby is a softer one, which usually comes off on its own a few hours after the bris. I remind parents from the get-go that they need to report to me if the baby has not urinated a few hours after the bris. I consciously put the bandage on tight enough to constrict the bleeding, but not so tight to be uncomfortable for baby.
With the exception of babies who are extremely hungry after the bris, most babies I care for are calm when I finally leave them alone, and may even sleep comfortably for a few multi-hour stretches, waking up for feedings and diaper changes.
And I tell the baby's mother, "You see how he is now? That is how he should be throughout the rest of the day, except when he is telling you he is hungry or needs to be changed (which is when he normally cries anyway)."
Instead of Tylenol being the solution, let us return to appropriate TLC which will undoubtedly help ease the pain and make the ordeal so much easier for parents and baby.
Sunday, January 31, 2010
What Will It Look Like Before and Afterwards?
I try to leave graphic images out of this blog, so I will do my best to explain here what the penis looks like before and after the bris.
BEFORE
Take a look at your baby! Now you know how it looks before the bris!
Just kidding.
The uncircumcised shaft of the penis looks like an inverted hourglass. It is thinner as it hits the scrotum, and thinner at the tip, but significantly fatter in the middle. The reason for this is because the glans, the part of the penis which is revealed after the circumcision, is hidden underneath the foreskin. Were you to slowly (and gently) pinch the tip of the penis, you'd see the "bump" in the middle of the shaft move it's way towards the scrotum. Let go of the tip of the penis, and the bump will slide back to its natural position. That bump is the outer edge of the glans - usually the 1/3 or midway point of a baby's penis.
THE FORESKIN
The foreskin (a.k.a. "prepuce") is an outer coating which covers the glans. It covers around half of the shaft. As only the foreskin is removed during circumcision, when the glans is revealed, one can easily see (contrary to popular culture's 'complaint') that the penis is not "smaller" - it just looks different.
[While I won't put the photo in the actual blog - I believe you can get the idea of what this all means when you look at this photo of a circumcised banana.]
AFTER
Before you read this section, understand that most circumcisions do not necessarily turn out exactly the same. All babies are different, and may have different "surprises" under their foreskins, which are not usually detected until after the circumcision itself.
For example, every baby has a differently shaped glans. Thus the first thing you see will look different from child to child.
Secondly, some babies have a minimal mucosal membrane underneath the foreskin, which might completely come off as well during the circumcision. Others have much more membrane with a significant amount left over after the bris, even if it is no longer coating the glans. Still others have significant tissue webbing, which would be undetected until the foreskin is removed. Depending on the extent of the webbing, it may need to be removed separately after the circumcision.
THREE SECTIONS
After the circumcision, one can usually identify three distinct sections on the circumcised penis.
SECTION #1: THE GLANS is the first things you see. It is the tip of the penis, and it almost looks like an army helmet - were the shaft to be standing upright.
A kosher bris consists of the farther rim of the glans being completely revealed, visible, and distinct, with no skin tags attached to it, and nothing hampering its distinct view.
It is usually a very deep, dark, raw RED COLOR (though it is sometimes PURPLE).
SECTION #2: THE MEMBRANE may or may not be completely removed in the bris process. If some of it remains, it may be slightly swollen, and may seem a little puffy below the glans.
Like the glans, it is typically a dark RED COLOR, though it does not usually have the same deep color of the glans. It will also look raw.
If the Membrane is completely removed, the area below the glans will look empty, but there will usually be a gap of a couple of millimeters between the glans and...
SECTION #3: The SPOT OF THE INCISION. This is the spot on the skin itself where the foreskin ended - or at least where the mohel estimated the foreskin ended. Ideally, the incision mark will be fairly close to the glans - but depending on the size of the baby's shaft, the mohel may have found the need to remove more or less skin in order to avoid future problems which may come from the glans falling back into the shaft and/or scrotum.
Dr. Neil Pollock - a very busy circumciser in Vancouver, has detailed information about this on his website. Feel free to read through the information he has - it can be found here [Start with the "Parents Guide to Circumcision" and move on from there!]
WHAT YOU WILL SEE
Aside from the dark red colors and the swelling, the scab tissue which sometimes develops in the area will typically be of a yellowish/ greenish hue. This is normal.
It is not advisable to pick at this, or to rub it as it will only cause the penis to bleed. A warm bath is good and promotes healing. Otherwise, like any scab, it is best to put bacitracin on it for a few days and then stop using ointments when the danger of infection is gone and it just needs to continue healing on its own.
BEFORE
Take a look at your baby! Now you know how it looks before the bris!
Just kidding.
The uncircumcised shaft of the penis looks like an inverted hourglass. It is thinner as it hits the scrotum, and thinner at the tip, but significantly fatter in the middle. The reason for this is because the glans, the part of the penis which is revealed after the circumcision, is hidden underneath the foreskin. Were you to slowly (and gently) pinch the tip of the penis, you'd see the "bump" in the middle of the shaft move it's way towards the scrotum. Let go of the tip of the penis, and the bump will slide back to its natural position. That bump is the outer edge of the glans - usually the 1/3 or midway point of a baby's penis.
THE FORESKIN
The foreskin (a.k.a. "prepuce") is an outer coating which covers the glans. It covers around half of the shaft. As only the foreskin is removed during circumcision, when the glans is revealed, one can easily see (contrary to popular culture's 'complaint') that the penis is not "smaller" - it just looks different.
[While I won't put the photo in the actual blog - I believe you can get the idea of what this all means when you look at this photo of a circumcised banana.]
AFTER
Before you read this section, understand that most circumcisions do not necessarily turn out exactly the same. All babies are different, and may have different "surprises" under their foreskins, which are not usually detected until after the circumcision itself.
For example, every baby has a differently shaped glans. Thus the first thing you see will look different from child to child.
Secondly, some babies have a minimal mucosal membrane underneath the foreskin, which might completely come off as well during the circumcision. Others have much more membrane with a significant amount left over after the bris, even if it is no longer coating the glans. Still others have significant tissue webbing, which would be undetected until the foreskin is removed. Depending on the extent of the webbing, it may need to be removed separately after the circumcision.
THREE SECTIONS
After the circumcision, one can usually identify three distinct sections on the circumcised penis.
SECTION #1: THE GLANS is the first things you see. It is the tip of the penis, and it almost looks like an army helmet - were the shaft to be standing upright.
A kosher bris consists of the farther rim of the glans being completely revealed, visible, and distinct, with no skin tags attached to it, and nothing hampering its distinct view.
It is usually a very deep, dark, raw RED COLOR (though it is sometimes PURPLE).
SECTION #2: THE MEMBRANE may or may not be completely removed in the bris process. If some of it remains, it may be slightly swollen, and may seem a little puffy below the glans.
Like the glans, it is typically a dark RED COLOR, though it does not usually have the same deep color of the glans. It will also look raw.
If the Membrane is completely removed, the area below the glans will look empty, but there will usually be a gap of a couple of millimeters between the glans and...
SECTION #3: The SPOT OF THE INCISION. This is the spot on the skin itself where the foreskin ended - or at least where the mohel estimated the foreskin ended. Ideally, the incision mark will be fairly close to the glans - but depending on the size of the baby's shaft, the mohel may have found the need to remove more or less skin in order to avoid future problems which may come from the glans falling back into the shaft and/or scrotum.
Dr. Neil Pollock - a very busy circumciser in Vancouver, has detailed information about this on his website. Feel free to read through the information he has - it can be found here [Start with the "Parents Guide to Circumcision" and move on from there!]
WHAT YOU WILL SEE
Aside from the dark red colors and the swelling, the scab tissue which sometimes develops in the area will typically be of a yellowish/ greenish hue. This is normal.
It is not advisable to pick at this, or to rub it as it will only cause the penis to bleed. A warm bath is good and promotes healing. Otherwise, like any scab, it is best to put bacitracin on it for a few days and then stop using ointments when the danger of infection is gone and it just needs to continue healing on its own.
Monday, January 18, 2010
Instructions for After-Care
While there is still a bandage
* Before every diaper change, wash your hands with soap and water
* Prepare a gauze pad with a generous heap of vaalon, aquaphor, or A&D ointment on it.
* Open the diaper, wipe as normal – do not touch the gauze or bandage.
* Before closing the new diaper, reach under the gauze to hold the wrapped bandage in place, then gently remove the gauze pad.
* If the gauze pad sticks, either leave till next diaper change or apply a small amount of baby oil to spot that sticks, then remove.
* Replace with new gauze pad, placing center of the gauze over the glans, pinching the sides of the gauze so it forms a tent over the penis. (Take care not to pinch or squeeze the glans)
* Close diaper.
Once bandage is off (typically after the last time I see the baby)
* First twenty fours hours (up to 2 days), place vaseline (etc) on gauze as above
* After two days of no bandage, apply vaseline directly (no gauze) for two to three full days, at every diaper changing (you can dispense it directly and rub it in with your finger, or dispense onto a Q-tip and apply with the Q-tip)
* After the three or four day period, ointments should no longer be applied as the bris needs to finish healing on its own.
* Baby can bathe the following evening (24+ hours) after the bandage comes off.
* Before every diaper change, wash your hands with soap and water
* Prepare a gauze pad with a generous heap of vaalon, aquaphor, or A&D ointment on it.
* Open the diaper, wipe as normal – do not touch the gauze or bandage.
* Before closing the new diaper, reach under the gauze to hold the wrapped bandage in place, then gently remove the gauze pad.
* If the gauze pad sticks, either leave till next diaper change or apply a small amount of baby oil to spot that sticks, then remove.
* Replace with new gauze pad, placing center of the gauze over the glans, pinching the sides of the gauze so it forms a tent over the penis. (Take care not to pinch or squeeze the glans)
* Close diaper.
Once bandage is off (typically after the last time I see the baby)
* First twenty fours hours (up to 2 days), place vaseline (etc) on gauze as above
* After two days of no bandage, apply vaseline directly (no gauze) for two to three full days, at every diaper changing (you can dispense it directly and rub it in with your finger, or dispense onto a Q-tip and apply with the Q-tip)
* After the three or four day period, ointments should no longer be applied as the bris needs to finish healing on its own.
* Baby can bathe the following evening (24+ hours) after the bandage comes off.
Wednesday, October 21, 2009
What to Prepare for a Bris
Every mohel has a similar list of items you'll need for the bris and for caring for the baby after the bris.
Here is my list:
The setup of the room can be found at this link (or http://www.mohelinsouthflorida.com/2009/10/typical-bris-set-up.html)
Here is my list:
- 2 pillows (to hold the baby before, during and after the bris)
- 1 small wastebasket (for packagings, bandages, and the occasional dirty diaper)
- 5 disposable diapers with wipes (in case baby soils more than his share...)
- 5 hospital-style receiving blankets (not expensive blankets) (see previous)
- 1 large tube/tub of Vaseline (to lubricate the bandage, and the circumcision after bandage removed)
- 1 box of 25 individually wrapped 3"x3" gauze pads (to put on top of the dressing)
- 1 bottle of sweet kosher red wine (for the blessings which accompany the bris)
- 1 kiddush cup (to hold the wine :) )
The setup of the room can be found at this link (or http://www.mohelinsouthflorida.com/2009/10/typical-bris-set-up.html)
Wednesday, September 30, 2009
Good Questions to Ask ANY Mohel
You know you're having a boy. Or you're doing research just in case. What do you ask, to be sure you're getting the information you need to ascertain if the mohel you're speaking with is right for you.
For some of these questions, different answers are a matter of preference for you.
I feel the questions which relate to cleanliness and sterility should only have one acceptable answer... but that's only my opinion.
1. Do you wear sterile gloves while doing the bris?
2. How do you do metzitzah – by mouth or with a tube?
3. Do you use a hemostat to accomplish milah and priah at once? Or do you use your fingernail to do priah?
4. Do you use a clamp? If so, what kind? Why?
5. Do you mark the spot where you plan to make the incision?
6. What kind of knife do you use for the bris?
7. How do you sterilize your instruments?
8. What is your opinion about the pain the baby feels during the bris? Can anything be done to ease it?
9. Do you plan to see the baby before the day of the bris?
10. When is the last time the baby should eat before the bris?
11. How soon after the bris can my son eat?
12. Do you plan to make any follow-up visits in the days following the bris?
13. Do you ever need to do anything to my son, other than change his bandage, after the bris?
14. How long does the healing process take?
15. Do you have printed instructions for how to care for the bris?
16. Would you do a bris if one of the parents is not Jewish?
17. Do you offer a certificate?
18. Do you have a list of items that need to be prepared for the bris?
19. What is the wine for? Who drinks it?
20. What is your fee?
21. Do you double book brisses – will you be on time?
For some of these questions, different answers are a matter of preference for you.
I feel the questions which relate to cleanliness and sterility should only have one acceptable answer... but that's only my opinion.
1. Do you wear sterile gloves while doing the bris?
2. How do you do metzitzah – by mouth or with a tube?
3. Do you use a hemostat to accomplish milah and priah at once? Or do you use your fingernail to do priah?
4. Do you use a clamp? If so, what kind? Why?
5. Do you mark the spot where you plan to make the incision?
6. What kind of knife do you use for the bris?
7. How do you sterilize your instruments?
8. What is your opinion about the pain the baby feels during the bris? Can anything be done to ease it?
9. Do you plan to see the baby before the day of the bris?
10. When is the last time the baby should eat before the bris?
11. How soon after the bris can my son eat?
12. Do you plan to make any follow-up visits in the days following the bris?
13. Do you ever need to do anything to my son, other than change his bandage, after the bris?
14. How long does the healing process take?
15. Do you have printed instructions for how to care for the bris?
16. Would you do a bris if one of the parents is not Jewish?
17. Do you offer a certificate?
18. Do you have a list of items that need to be prepared for the bris?
19. What is the wine for? Who drinks it?
20. What is your fee?
21. Do you double book brisses – will you be on time?
Wednesday, September 23, 2009
Different Types of Mohels
There are many excellent mohels in this country. There are many fine mohels as well.
In Israel these differences are marked by the title "Mohel Mumcheh" (מוהל מומחה) (expert) and the standard "Mohel Musmach" (מוהל מוסמך) (certified or ordained to be a mohel). The differences between them vary and depend upon certain qualifications such as advanced study and examination, and years and volume of experience.
Just to bring an example, on this list of certified over 350 mohels in the Jerusalem area, very few of them are "experts." It's kind of like going to the top doctor who is less accessible when just about any other doctor will do the same job for you.
Trifecta: Ceremony, Care (Results), Complications (a.k.a 'The Triple C')
These three components will help you determine the kind of mohel you want. Unless a mohel is right out of mohel school, any experienced mohel has done hundreds, if not thousands of procedures. So you need not worry about your son being horribly damaged. As a pediatric surgeon I know has said, "We fix more circumcisions done by OBGYNs than anything else. With mohels, we'll usually hesitate to do anything to their work because they generally do a really good job. The worst case scenario, if anything, is a slight cosmetic touch up. Which is extremely rare and usually unnecessary."
Taking his lead, let's look to other criteria, because just about any mohel you will hear about is probably a fine, good, or excellent mohel whom you can trust your son's care to. A pediatrician I consulted with many times (particularly to determine if the bris needs to be delayed due to the baby's health) told me that many brisses he sees (in his neighborhood in NY there are many mohels so he saw the gamut of "results") look awful in the first few days, but they usually heal quite nicely and end up looking fine. [Before I moved to Florida, he called me to say how much he'd miss me and that I was the first mohel name he gave to clients who asked for a suggestion.]
Ceremony
Care (and Results)
Complications
In Israel these differences are marked by the title "Mohel Mumcheh" (מוהל מומחה) (expert) and the standard "Mohel Musmach" (מוהל מוסמך) (certified or ordained to be a mohel). The differences between them vary and depend upon certain qualifications such as advanced study and examination, and years and volume of experience.
Just to bring an example, on this list of certified over 350 mohels in the Jerusalem area, very few of them are "experts." It's kind of like going to the top doctor who is less accessible when just about any other doctor will do the same job for you.
Trifecta: Ceremony, Care (Results), Complications (a.k.a 'The Triple C')
These three components will help you determine the kind of mohel you want. Unless a mohel is right out of mohel school, any experienced mohel has done hundreds, if not thousands of procedures. So you need not worry about your son being horribly damaged. As a pediatric surgeon I know has said, "We fix more circumcisions done by OBGYNs than anything else. With mohels, we'll usually hesitate to do anything to their work because they generally do a really good job. The worst case scenario, if anything, is a slight cosmetic touch up. Which is extremely rare and usually unnecessary."
Taking his lead, let's look to other criteria, because just about any mohel you will hear about is probably a fine, good, or excellent mohel whom you can trust your son's care to. A pediatrician I consulted with many times (particularly to determine if the bris needs to be delayed due to the baby's health) told me that many brisses he sees (in his neighborhood in NY there are many mohels so he saw the gamut of "results") look awful in the first few days, but they usually heal quite nicely and end up looking fine. [Before I moved to Florida, he called me to say how much he'd miss me and that I was the first mohel name he gave to clients who asked for a suggestion.]
Ceremony
- Do you want a simple ceremony? A flashy ceremony?
- Do you want the mohel to be the star of the show? Or do you want the baby to be the center of attention?
- Do you want your family involved? Do you want the mohel to do everything?
- Do you want to do the bris your way? The mohel's way? Guided by Jewish tradition? (These do not have to conflict)
- Do you have customs based on your family's most ethnic point of origin (as in North Africa, Middle East, or Eastern Europe - not North America, Middle America, or the Eastern Seaboard)?
- Do you want explanations of the ceremony? Significance explained, lessons taught, stories told?
- Do you want bare bones, no talking except what is written in the prayer book?
Care (and Results)
- Does the mohel see the baby before the bris? Does he make a follow up visit after the bris?
- Is he sensitive to the baby? Is he sensitive to the mother?
- Does he wear gloves and have a sterile technique - see here and here ?
- Does he put you at ease (see here too)? Is he preoccupied thinking only about what he has to do?
- Does he inform you how to care for the baby after the bris?
- Does he tell you what to do in an emergency situation?
- What is his track record? Was his work ever revisited by surgeons? (for most mohels the answer may be yes. This is a simple matter of statistics. Out of 100 brisses, at least one may have an issue. Either he won't tell you, or, and this may very well be the case, he does not know because the parents did not tell him about it)?
- How long does it take to heal and what are the cosmetic results like (in general)?
Complications
- What kinds of complications can or do arise after a bris?
- How does a mohel deal with them?
- What if aesthetics or other matters come up or become apparent a few months down the road? How does the mohel deal with these circumstances and questions?
- I was trained by the government supervisor in Israel, Rabbi Mordechai Sasson. Before retiring he was one the five "expert" mohels on the list linked above.
- The number of brisses I have performed is in the 4 digits - which is an explanation I likely won't be updating for awhile (will need to get to 10,000 for that!) - in my over 25 years as a mohel (updated this info in 2024, as my training ended in 1998)
- Many parents have called me to do a bris for them a second time (on a different son of theirs, of course), a third time, and even four times! Some sets of grandparents have watched me circumcise anywhere from three to a dozen of their grandsons. This may include babies from three or more (sets) of their own children.
- I am not flashy, I am very respectful, and I guarantee the highest standards of sterility in the care of your son.
- I recognize that every baby is different, not all babies have the same circumstance of anatomy - and underneath the foreskin there can be all sorts of hidden surprises which may often determine a different result. Not all brisses end up looking the same.
- I have (thank God) never had a baby go to a doctor or hospital due to bleeding issues after a bris while under my care.
- I have (thank God) never had a baby develop an infection as a result of the bris.
- I view my role very seriously, and come to a bris with a sense of trepidation over the seriousness of the moment and the Jewish, traditional significance attached to the bris.
- On an equal scale, I value the trust you put in me as a practitioner, to give your son the care he deserves for undergoing this procedure, in fulfillment of the commandment first given to Abraham and concretized by Moses on Mt. Sinai. (If not for these last reasons, I would never serve in this capacity.)
I hope your research brings you back to this site and look forward to talking with you when your son is born.
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