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.
Showing posts with label doctor. Show all posts
Showing posts with label doctor. Show all posts
Thursday, May 25, 2017
Tuesday, May 12, 2015
Doctor vs Mohel
No, it's not the fight of the century.
But it is a question which comes up a lot. So here is the simple answer, from a mohel, of course.
[Though see here for a Reform Rabbi's answer http://www.jweekly.com/article/full/15332/which-one-is-better-doctor-or-mohel/]
Every person must do research and find the best operator for your needs, and for your situation.
In an ideal world, the person you are hiring is an observant Jew, who understands the significance of Bris Milah, the covenant, and all the laws associated with the performance of a bris milah. Whatever character traits you'd like in the person might also be significant to consider, when thinking about what kind of representative you (especially the father, who is really hiring the person to perform this mitzvah in your place) want to fill your place in this very important mitzvah.
ANYONE WHO FILLS THESE ROLES TO YOUR DESIRES IS A GOOD HIRE. [Even better, if he uses a marker when operating...]
Other things to consider:
1. Specialist
Who does more procedures? Many doctors I know (they are usually observant Jews) highly recommend a mohel over a doctor. They have the attitude that the mohel is a specialist. This is his field. He is the expert. Being highly trained in a specific discipline, and specializing in this unique field, makes the mohel most qualified to do this. [Obviously if a doctor happens to also be a mohel, this will work to his advantage in some people's eyes. But honestly, the service a doctor/mohel and a mohel provide is the same thing with respect to the circumcision and the result, except perhaps in two areas as I'll note below]
2. Method
Most doctors are more comfortable using a clamp - such as the Gomco or the Mogen clamp. Do research on these items, to decide if they are right for you. Some mohels (usually on the very modern side, or in the Conservative and Reform movements) use the Mogen clamp or a modified Mogen clamp. Most traditional mohels use what is called in Hebrew a Magen (מגן), a traditional "shield" (which protects the glans and the scrotum) which does not have a clamping arm. THIS IS THE PROCEDURE I USE While no procedure is completely bloodless (a real bris is not supposed to be bloodless), the clamps are supposed to cause less bleeding. The traditional method may have a little more bleeding, but in the hands of a good mohel, it is absolutely nothing to worry about.
And, as Rabbi Cartun points out in the article I linked to above (here it is again), the speed in which a mohel operates is usually much faster than any physician.
3. Numbing
See here for a discussion about this. Most doctors will give the baby several injections to create a nerve blockage. While the baby might not feel the bris, the baby will feel the injections (and may feel them hours later as well). Some mohels recommend or provide a topical anesthetic. Depending on its strength, it may remove the pain of the actual circumcision.
4. How is baby held?
Numbing does not help the baby's discomfort at having his legs held down. Most mohels have the sandak holding the baby's legs, and letting go as soon as the procedure is over. Many doctors might utilize a circumstraint to hold the baby, leaving the baby in an uncomfortable position significantly before and sometimes after the procedure as well.
5. Track record and Touch-ups
Probably the most important question is "what is the track record?" While I don't have statistical evidence, I have spoken to pediatric urologists and pediatric surgeons who have told me anecdotally that they do many more touchups on circumcisions done by doctors than by mohels. [Don't trust me. Ask similar doctors that you may know.]
Doctors tend to take off a little less foreskin, which leaves the penis looking uncircumcised in many cases of touch-up necessity.
[Many "problems" disappear when the child gets out of diapers, and certainly by puberty. But for babies who need their circ to be revisited - it is worth asking people and doctors who has a better track record.]
A surgical marker could resolve this issue, but most mohels and doctors don't use one (though I do! :))
I guess it is clear that I prefer a good and experienced mohel over a doctor. Surprised?
But it is a question which comes up a lot. So here is the simple answer, from a mohel, of course.
[Though see here for a Reform Rabbi's answer http://www.jweekly.com/article/full/15332/which-one-is-better-doctor-or-mohel/]
Every person must do research and find the best operator for your needs, and for your situation.
In an ideal world, the person you are hiring is an observant Jew, who understands the significance of Bris Milah, the covenant, and all the laws associated with the performance of a bris milah. Whatever character traits you'd like in the person might also be significant to consider, when thinking about what kind of representative you (especially the father, who is really hiring the person to perform this mitzvah in your place) want to fill your place in this very important mitzvah.
ANYONE WHO FILLS THESE ROLES TO YOUR DESIRES IS A GOOD HIRE. [Even better, if he uses a marker when operating...]
Other things to consider:
1. Specialist
Who does more procedures? Many doctors I know (they are usually observant Jews) highly recommend a mohel over a doctor. They have the attitude that the mohel is a specialist. This is his field. He is the expert. Being highly trained in a specific discipline, and specializing in this unique field, makes the mohel most qualified to do this. [Obviously if a doctor happens to also be a mohel, this will work to his advantage in some people's eyes. But honestly, the service a doctor/mohel and a mohel provide is the same thing with respect to the circumcision and the result, except perhaps in two areas as I'll note below]
2. Method
Most doctors are more comfortable using a clamp - such as the Gomco or the Mogen clamp. Do research on these items, to decide if they are right for you. Some mohels (usually on the very modern side, or in the Conservative and Reform movements) use the Mogen clamp or a modified Mogen clamp. Most traditional mohels use what is called in Hebrew a Magen (מגן), a traditional "shield" (which protects the glans and the scrotum) which does not have a clamping arm. THIS IS THE PROCEDURE I USE While no procedure is completely bloodless (a real bris is not supposed to be bloodless), the clamps are supposed to cause less bleeding. The traditional method may have a little more bleeding, but in the hands of a good mohel, it is absolutely nothing to worry about.
And, as Rabbi Cartun points out in the article I linked to above (here it is again), the speed in which a mohel operates is usually much faster than any physician.
3. Numbing
See here for a discussion about this. Most doctors will give the baby several injections to create a nerve blockage. While the baby might not feel the bris, the baby will feel the injections (and may feel them hours later as well). Some mohels recommend or provide a topical anesthetic. Depending on its strength, it may remove the pain of the actual circumcision.
4. How is baby held?
Numbing does not help the baby's discomfort at having his legs held down. Most mohels have the sandak holding the baby's legs, and letting go as soon as the procedure is over. Many doctors might utilize a circumstraint to hold the baby, leaving the baby in an uncomfortable position significantly before and sometimes after the procedure as well.
5. Track record and Touch-ups
Probably the most important question is "what is the track record?" While I don't have statistical evidence, I have spoken to pediatric urologists and pediatric surgeons who have told me anecdotally that they do many more touchups on circumcisions done by doctors than by mohels. [Don't trust me. Ask similar doctors that you may know.]
Doctors tend to take off a little less foreskin, which leaves the penis looking uncircumcised in many cases of touch-up necessity.
[Many "problems" disappear when the child gets out of diapers, and certainly by puberty. But for babies who need their circ to be revisited - it is worth asking people and doctors who has a better track record.]
A surgical marker could resolve this issue, but most mohels and doctors don't use one (though I do! :))
I guess it is clear that I prefer a good and experienced mohel over a doctor. Surprised?
Tuesday, August 2, 2011
Don't Let Finances Deter You!
Every now and then I either hear a story about someone or hear from someone directly that they either chose not to circumcise or to have a doctor do it instead of a mohel (which usually means when the baby is 1 or 2 days old, instead of on the eighth day - the correct day for the bris), on account of financial reasons.
Often, they never even spoke with a mohel: they chose to go that route without even consulting with anyone.
This is very unfortunate, for a few reasons.
1. Any real mohel would prefer your child have a bris than a hospital-circumcision
2. Any real mohel will "work something out" if that is your circumstance
3. A circumcision before day 8, as well as almost any hospital circumcisions are not considered brisses
4. A routine hospital circumcision has a different definition than a bris circumcision. Significantly (and statistically) more often than with a mohel, the hospital cosmetic result will have a child who has not had enough skin tissue removed, who requires another procedure.
5. Anecdotal evidence (from physicians and pediatric surgeons I know) suggests that more "touch-ups" come from work done by doctors than by mohels. This is not to say mohels are perfect, or that doctors never do a good job. Just that mohels (generally speaking) have a better track record than doctors when it comes to the cosmetic results of their circumcisions. [Of course, the doctors who do the cosmetic touch-up work usually do a great job!]
Your research is a great first step. Now pick up the phone, and let's work something out!
Often, they never even spoke with a mohel: they chose to go that route without even consulting with anyone.
This is very unfortunate, for a few reasons.
1. Any real mohel would prefer your child have a bris than a hospital-circumcision
2. Any real mohel will "work something out" if that is your circumstance
3. A circumcision before day 8, as well as almost any hospital circumcisions are not considered brisses
4. A routine hospital circumcision has a different definition than a bris circumcision. Significantly (and statistically) more often than with a mohel, the hospital cosmetic result will have a child who has not had enough skin tissue removed, who requires another procedure.
5. Anecdotal evidence (from physicians and pediatric surgeons I know) suggests that more "touch-ups" come from work done by doctors than by mohels. This is not to say mohels are perfect, or that doctors never do a good job. Just that mohels (generally speaking) have a better track record than doctors when it comes to the cosmetic results of their circumcisions. [Of course, the doctors who do the cosmetic touch-up work usually do a great job!]
Your research is a great first step. Now pick up the phone, and let's work something out!
Monday, August 23, 2010
Is the Mohel a Doctor?
This has been coming up a lot lately.
I wear a lab coat at the brisses I do (as you can see under my tallis in the photo on the right), for a few reasons:
1. It looks official
2. It looks clean - can't argue with the whiteness of white (who said I can't be profound?)
3. The lab coat has deep pockets for me to put the things I need accessible at different times through my bris workings.
For people who don't know me, though, it makes them think I am a physician. Which I am not.
I wear a lab coat at the brisses I do (as you can see under my tallis in the photo on the right), for a few reasons:
1. It looks official
2. It looks clean - can't argue with the whiteness of white (who said I can't be profound?)
3. The lab coat has deep pockets for me to put the things I need accessible at different times through my bris workings.
For people who don't know me, though, it makes them think I am a physician. Which I am not.
Sunday, November 15, 2009
Putting Parents At Ease - More Considerations
Over the weekend, I attended a presentation/discussion in which one person mentioned her impression that bris turns some people off from Judaism. Almost as an aside she said "They think it is barbaric."
It wasn't my forum, so I kept quiet. I have a lot to say on the subject, but it's for a different place. My blog, for example.
Firstly, I don't believe the bris turns people off from Judaism. It's a big world out there. People who are unhappy with Judaism will find any excuse they want.
As far as circumcision being barbaric, that statement is a hard sell in the United States when over 60% of the newborn male population is circumcised - either routinely with a clamp (with or without a local anesthetic), in the O.R. under general anesthesia, or as part of a religious or holistic ceremony - and until relatively recently, over 90% of the newborn male population of this country was circumcised.
The American Choice
In American culture, people have all kinds of reasons for circumcising their sons. I learned about this recently when our son was born, when my wife and I were handed a pamphlet about circumcision which boiled the choices down to two: "to circumcise or not to circumcise; that is the question."
They have a number of reasons why people may opt to circumcise.
* Medical suggestions that urinary tract infections, penile cancer, and other penile illnesses (including STDs) are less common and the penis is less susceptible when circumcised.
* It is easier to clean.
* Family - father and brothers are circumcised
* Cultural - everyone else does it
* Aesthetics - You like the circumcised "look" better than not.
* And, of course, religious reasons.
Reasons not to circumcise include:
* It is healthy tissue which guards a very sensitive area of the body
* No medical benefits if the child is taught how to clean under the foreskin
* Why subject a child to such surgery, which may be unnecessary?
The "barbaric" nature of circumcision is not raised, even if people may personally feel it to be such.
Why Jews Circumcise Their Sons
While the religious reason is most obvious, the best verbal explanation I have heard of late was in the documentary "Partly Private" - a film made by a secular Israeli woman living in NY, who was researching whether or not to circumcise her as-yet-unborn son (they had circumcised his older brother, but were displeased with the experience).
When a number of her Israeli friends gathered to be a sounding board for her deliberations, one of her friends who had become observant said, "If you are deliberating circumcision because you think it is 'barbaric' - you are right. Don't circumcise. But if you have faith in God and understand that this is what God asked of the Jewish people, as this is a mark of the covenant He forged with Abraham, then this is not barbaric. This is an act of love: for your child, for your people, for your God."
He is so right. The reason we circumcise is FAITH.
But it's still BARBARIC, Right?
It really depends on your perspective.
Most medical authorities who deal strictly from a medical perspective (in other words, who do not have an agenda), will argue the benefits versus the risks, the pros versus the cons. Very few will call it a barbaric procedure.
Most people who call it barbaric have an agenda, have an obsession, and find it hard to not think about how life (read "sex") would be different if the parents had not chosen to "make the cut" on them.
And they'll usually show a picture of a red, screaming baby to show the kind of pain a baby feels when undergoing a circumcision.
Before we continue, it is important to understand that there are different kinds of circumcision procedures, and all kinds of situations that can make a baby cry and scream bloody murder.
Setting the record straight
Babies cry. They scream. They can be in all kinds of discomfort. And sometimes there is not much we can do to ease their pain.
Babies who have blood tests, shots, raw diaper rashes, or sometimes just have colic may very well be inconsolable. Would you not have your baby have the necessary blood test or innoculation just so your baby won't ever cry?
Sometimes benefits outweigh the downsides. And sometimes not.
There are some who will argue that babies nerve endings are underdeveloped and so they don't feel the circumcision.
This is a lie.
Babies absolutely feel pain. But they only feel the pain to which they are subjected - and that, only if nothing is done to numb them from the pain. Which brings us to two points worthy of consideration when considering the difference between what is known as "routine circumcision" and a bris (A circ in an O.R. is a completely different story, because once the baby is under general anasthesia, all bets of pain and discomfort are off.)
SPEED OF PROCEDURE and NUMBING
Click this line to read the article in which it appears: "A mohel does not usually use anesthetic, because his anesthetic is the speed with which he does the circumcision. "
Most routine circumcisions are done elaborately, painstakingly, with a clamp that crushes the skin in order to achieve hemostasis. Since the skin is essentially dead when it is excised, there is usually no bleeding by the time the last skin is removed. Kudos.
Meanwhile, the baby has been in excruciating pain throughout the procedure (which usually takes between 5 and 20 minutes), unless the circumciser has used a penile block (3 injections around the circumference of the penis, along the lower base of the abdomen), to numb the area during the procedure.
3 injections = 3 shots. If your kid screams during one shot, imagine THREE, even if their outcome is a numbing. The shots themselves are painful!
A good mohel is usually done with the procedure, start to finish, in between 5 and 10 seconds. That's less time than it takes to administer the injections. Yes, there is usually a little more blood at a bris (only a little), but the drawing of blood is (like it or not) a necessity for the procedure according to Jewish law. The covenant was forged over blood. (If you like movies, you can see how a covenant is forged over blood in Kevin Costner's "Robin Hood" when he swears to avenge his father's murder in the first quarter of the film - I used to have a link to youtube here, but the video was taken down.)
NUMBING [See this posting - in which I revised what I wrote below - AB, 2012]
I happen to be a fan of numbing the foreskin, but not with injections. I prefer a topical analgesic with a dose of 30% lidocaine + 70% acid mantel cream base, to be applied to the penis at least a half hour before the bris. It doesn't hurt the baby at all in its application, and it does the same thing for the small amount of time it is helpful. Most of the discomfort at the bris comes from being handled, not from the pain of the bris (proof is that the baby usually stops crying once he is no longer being touched).
And even without it, the bris speed is, as mentioned above, its own form of anesthesia.
In Conclusion
If I were not Jewish, would I circumcise my son? Knowing what I know about circumcision, I probably would. My wife would probably not, just because she would not want to subject the baby to a painful experience - even a fleeting one.
As we are Jewish, we agree that we do it because the Torah commands it of us.
I don't think it is a barbaric custom, and I think those who do it properly have a tremendous sense of satisfaction that the baby is well and that the chapter of bris is behind them.
Consider the method and you have your answer. (Clamps, injections, drawn out, hospital v home, physician, resident, mohel, surgery v bris)
And hopefully, if you call me, you'll find what you're looking for in a mohel and you'll uncover the answers to more questions through our conversations.
It wasn't my forum, so I kept quiet. I have a lot to say on the subject, but it's for a different place. My blog, for example.
Firstly, I don't believe the bris turns people off from Judaism. It's a big world out there. People who are unhappy with Judaism will find any excuse they want.
As far as circumcision being barbaric, that statement is a hard sell in the United States when over 60% of the newborn male population is circumcised - either routinely with a clamp (with or without a local anesthetic), in the O.R. under general anesthesia, or as part of a religious or holistic ceremony - and until relatively recently, over 90% of the newborn male population of this country was circumcised.
The American Choice
In American culture, people have all kinds of reasons for circumcising their sons. I learned about this recently when our son was born, when my wife and I were handed a pamphlet about circumcision which boiled the choices down to two: "to circumcise or not to circumcise; that is the question."
They have a number of reasons why people may opt to circumcise.
* Medical suggestions that urinary tract infections, penile cancer, and other penile illnesses (including STDs) are less common and the penis is less susceptible when circumcised.
* It is easier to clean.
* Family - father and brothers are circumcised
* Cultural - everyone else does it
* Aesthetics - You like the circumcised "look" better than not.
* And, of course, religious reasons.
Reasons not to circumcise include:
* It is healthy tissue which guards a very sensitive area of the body
* No medical benefits if the child is taught how to clean under the foreskin
* Why subject a child to such surgery, which may be unnecessary?
The "barbaric" nature of circumcision is not raised, even if people may personally feel it to be such.
Why Jews Circumcise Their Sons
While the religious reason is most obvious, the best verbal explanation I have heard of late was in the documentary "Partly Private" - a film made by a secular Israeli woman living in NY, who was researching whether or not to circumcise her as-yet-unborn son (they had circumcised his older brother, but were displeased with the experience).
When a number of her Israeli friends gathered to be a sounding board for her deliberations, one of her friends who had become observant said, "If you are deliberating circumcision because you think it is 'barbaric' - you are right. Don't circumcise. But if you have faith in God and understand that this is what God asked of the Jewish people, as this is a mark of the covenant He forged with Abraham, then this is not barbaric. This is an act of love: for your child, for your people, for your God."
He is so right. The reason we circumcise is FAITH.
But it's still BARBARIC, Right?
It really depends on your perspective.
Most medical authorities who deal strictly from a medical perspective (in other words, who do not have an agenda), will argue the benefits versus the risks, the pros versus the cons. Very few will call it a barbaric procedure.
Most people who call it barbaric have an agenda, have an obsession, and find it hard to not think about how life (read "sex") would be different if the parents had not chosen to "make the cut" on them.
And they'll usually show a picture of a red, screaming baby to show the kind of pain a baby feels when undergoing a circumcision.
Before we continue, it is important to understand that there are different kinds of circumcision procedures, and all kinds of situations that can make a baby cry and scream bloody murder.
Setting the record straight
Babies cry. They scream. They can be in all kinds of discomfort. And sometimes there is not much we can do to ease their pain.
Babies who have blood tests, shots, raw diaper rashes, or sometimes just have colic may very well be inconsolable. Would you not have your baby have the necessary blood test or innoculation just so your baby won't ever cry?
Sometimes benefits outweigh the downsides. And sometimes not.
There are some who will argue that babies nerve endings are underdeveloped and so they don't feel the circumcision.
This is a lie.
Babies absolutely feel pain. But they only feel the pain to which they are subjected - and that, only if nothing is done to numb them from the pain. Which brings us to two points worthy of consideration when considering the difference between what is known as "routine circumcision" and a bris (A circ in an O.R. is a completely different story, because once the baby is under general anasthesia, all bets of pain and discomfort are off.)
SPEED OF PROCEDURE and NUMBING
Click this line to read the article in which it appears: "A mohel does not usually use anesthetic, because his anesthetic is the speed with which he does the circumcision. "
Most routine circumcisions are done elaborately, painstakingly, with a clamp that crushes the skin in order to achieve hemostasis. Since the skin is essentially dead when it is excised, there is usually no bleeding by the time the last skin is removed. Kudos.
Meanwhile, the baby has been in excruciating pain throughout the procedure (which usually takes between 5 and 20 minutes), unless the circumciser has used a penile block (3 injections around the circumference of the penis, along the lower base of the abdomen), to numb the area during the procedure.
3 injections = 3 shots. If your kid screams during one shot, imagine THREE, even if their outcome is a numbing. The shots themselves are painful!
A good mohel is usually done with the procedure, start to finish, in between 5 and 10 seconds. That's less time than it takes to administer the injections. Yes, there is usually a little more blood at a bris (only a little), but the drawing of blood is (like it or not) a necessity for the procedure according to Jewish law. The covenant was forged over blood. (If you like movies, you can see how a covenant is forged over blood in Kevin Costner's "Robin Hood" when he swears to avenge his father's murder in the first quarter of the film - I used to have a link to youtube here, but the video was taken down.)
NUMBING [See this posting - in which I revised what I wrote below - AB, 2012]
I happen to be a fan of numbing the foreskin, but not with injections. I prefer a topical analgesic with a dose of 30% lidocaine + 70% acid mantel cream base, to be applied to the penis at least a half hour before the bris. It doesn't hurt the baby at all in its application, and it does the same thing for the small amount of time it is helpful. Most of the discomfort at the bris comes from being handled, not from the pain of the bris (proof is that the baby usually stops crying once he is no longer being touched).
And even without it, the bris speed is, as mentioned above, its own form of anesthesia.
In Conclusion
If I were not Jewish, would I circumcise my son? Knowing what I know about circumcision, I probably would. My wife would probably not, just because she would not want to subject the baby to a painful experience - even a fleeting one.
As we are Jewish, we agree that we do it because the Torah commands it of us.
I don't think it is a barbaric custom, and I think those who do it properly have a tremendous sense of satisfaction that the baby is well and that the chapter of bris is behind them.
Consider the method and you have your answer. (Clamps, injections, drawn out, hospital v home, physician, resident, mohel, surgery v bris)
And hopefully, if you call me, you'll find what you're looking for in a mohel and you'll uncover the answers to more questions through our conversations.
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