Tools of the Trade VII - The MARKER

We've been through all the standard items that just about every mohel uses or should use. Now we get into the realm of what makes one mohel demonstrate his being more responsible than another mohel.

The only place which I'll leave open for debate is the Magen shield v. the MOGEN clamp. While I don't recommend the clamp (I don't own one and have never used one) for both safety reasons and halakhic reasons, if the operator using it knows what he is doing, I believe the bris is kosher at least b'dieved (not in the ideal sense, but nonetheless kosher).

HOWEVER, using a surgical pen to mark the edge of the foreskin is what truly makes a mohel a cut above (no pun intended) everyone else.

The foreskin, as everyone likely knows, is very malleable. It is designed to accommodate a significant amount of stretching. As such, when the mohel pulls on it to set it up for circumcision, he can no longer tell where the proper edge of the foreskin is, UNLESS IT HAS BEEN MARKED. Surgeons mark any incision they are going to make. Does a baby deserve any less care in the effort to give him an aesthetically-pleasing circumcision?

So this tool should be in every mohel's arsenal. And every mohel should take the extra minute or two to mark the foreskin, and he should be blessed to follow the mark when circumcising, so the baby can have not just a circumcision, but a nice-looking circumcision. As even as possible all around, with the proper amount of foreskin - not more, not less - being removed, per our sacred Mitzvah.

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?

Denuding the Shaft

I have written about this before, in the context of a discussion about arrogant mohels, and in the context of a bad story I was told by a baby nurse I worked with, and I hinted to it when I recounted a conversation I had with a urologist-grandfather with whom I worked directly. And I mentioned here why I would personally do my research in this regard were I to look for a mohel myself. Alas, being a mohel, I knew who was going to circumcise my sons.

But now I am calling it what it is.

This Type of Thing Should NEVER Happen

At today's bris, as I was changing the bandage post-bris (in the Private Room), I was chatting with the baby nurse. She is relatively new in the field, and so all of her experiences are very clearly etched in her memory.

She told me that the last baby she cared for was brought to the hospital after the bris, because the mohel cut too much. I could not get a sense of the gravity of the details in question, though she indicated that the baby's glans had been seriously nicked. In either case, she said, "There was so much bleeding. It was a horror."

I asked her if she had accompanied the baby to the hospital. She did, with the baby's parents and their other child.

The Mistakes Many Parents Make Before Their Son's Bris

I have met parents who had less than an A-1 experience with a mohel, who returned to have a similar experience a second time with their second son. Their reason? (usually one of three)
a. We heard you're not supposed to change mohels;
b. We only know one mohel;
c. We didn't want to hurt his feelings.
[I've also met quite a few parents who have told me, "You were our third mohel, and the only one we would call again, if we have another son."]

Is this about you and your baby? Or about the mohel? [Hint: IT'S NOT ABOUT THE MOHEL]

I want to make clear: If you had a positive experience with a mohel, you should absolutely return to him when you are blessed with another son. But if you didn't have such an experience, why would you want to?

So here it is: The Top Ten List : Mistakes Parents Make When Hiring a Mohel

The Magic of a Marker

Mohels are funny. When we see another mohel as a guest at a bris we are doing (some people know more than one mohel as a friend, but can only have one of them do the job), we will invite him to watch and to critique us. I don't enjoy critiquing. But I do enjoy watching so I can learn from someone else's techniques. For the record, the main "critique" I ever give is that the man might consider putting a wastebasket next to his working area, to cut down on the mess he either leaves or has to otherwise clean up afterwards.

[A dentist friend of mine once observed me in the 'critique' position and said to me, "How can you stand it? I hate watching another dentist do an extraction!" Translation: Since he's invariably not doing it the way I would do it, it becomes painful to watch. I told him I am learning what "to do" and what "not to do."]

But my real NUMBER ONE CRITIQUE (other than sterility, which people won't listen to anyway) is my belief that Every Mohel should use a magic marker to guide the incision he will be making in his circumcising the baby.

The results of not doing so are aesthetically unpleasant, at best, and cosmetically hideous at worst.

No human being is perfect, and no one can guarantee a perfect job any time. But taking precautions such as this one will help us be a little closer to perfect and accurate, in a manner that will be appreciated by all parents who trust their babies to our care.

News Out of Israel

In an article today in Israeli newspaper "Yediot Aharonot" (the Hebrew article is available online here, and the English version is available here), a mohel in the northern part of Israel has been put under a cloud on account of "not doing brisses" according to Jewish law. The article does not call into question the individual's piety or intentions, but that as a practitioner who is required to produce a particular end result according to Jewish law, his practices have produced circumcisions that required regular touch-ups.

The cause for the touch-ups: Not removing enough foreskin.

I've blogged about this before: See here and here and here

It is also important to note that as much as cosmetic touch-ups are annoying and no one should ever need to go through them - not baby and not his parents - the good news is that the surgical touch up usually produces excellent cosmetic results. And if I were to have a choice, I would likely prefer the surgeon have something to work with (the extra skin that was not removed) than to have the baby at the mercy of having had too much skin removed.