There have been a number of times when I have been called to a home where the baby of the house is six months, ten months, even a year old or more. The little guy was circumcised when he was eight days old, but now he does not look circumcised.
And most of the time I was not the mohel - the family heard about me and did not want to bring their mohel back to look at it. (There have been cases where I have been called back when I was the mohel - I trust and hope it is because people feel comfortable contacting me, knowing the care I put into each baby's bris.)
Usually the issue only became apparent in the last few months. "At first it was fine. But lately, we've been having this issue."
Mind you, this happens with circumcisions done by doctors and mohels alike, and is usually due to the parent being unaware that this may happen, more than any oversight in the circumcision or a less than adequate job.
99.8% of the time the bris is fine and no touch-up surgery is required. However, there is something that does need to be done that will bother your baby in the minute it takes to do it, but does not have a healing process and will not cause any bleeding.
Again, this can usully be avoided with proper education.
Because a baby spends so much time on his back, and because his diaper smushes his penis together, and because many babies develop baby fat which is primarily deposited in the groin area, a percentage of babies develop one of a few symptoms that either A. make the shaft and glans of the penis disappear into the scrotum, or B. make it that you can't see the outer rim of the glans, which should appear distinct from the shaft.
If the bris is done correctly, what you should see is described in the second half of this post.
How to Keep it That Way
After the baby heals - say, about a week after the cessation of any ointment application, it is imperative that you make sure the outer edge of the glans remains distinct from the shaft.
All this requires is a gentle pushing of the skin below the glans at every diaper change - and particularly when the baby is in the bath.
Do not do this for at least a week after the actual bris, because any pressure on the penis during the first week of healing could reopen a wound and cause bleeding.
Sometimes not an issue at all
With some babies and with some circumcisions this is never an issue.
With others, no matter how the circumcision is performed, this can be an issue which, if unmonitored, can continue to cause concern for two years of the baby's life. In all this time, the baby is fine! But you, the parent, want to know why things look the way they do, and really want to understand what you are seeing.
Be on top of it, take charge, know what you are looking at and what you need to see. When you are in the know, you will know how to handle the situation such that the asthetic looks of the circumcision will never be a cause for alarm.
Disappearing penis
While less common than the "almost uncircumcised" look, the disappearing penis is essentially when the shaft and glans disappears into the scrotum when the baby is lying on his back. A gentle push on the 3 o'clock and 9 o'clock sides of the scrotum surrounding the shaft - or on the belly just above the "dark hole" will usually cause the shaft to pop out of its hiding place.
What can you do about it?
Firstly - follow above instructions to avoid it happening.
Secondly - if it's too late and the shaft disappears, there are two options.
A. Continue as above every time the diaper is open. Either it will clear up on its own through this counter-attack, or it will clear up on its own when the baby is walking - and particularly when he is out of diapers. Remember, the more time he spends on his back and the more baby fat he accumulates in his legs will both contribute to the disappearing penis look.
B. If it does not go away, corrective surgery is extremely effective. In most cases, however, you will not have to go this route. Consult with an honest pediatric surgeon who does not jump to do unnecessary surgeries, and you will get an honest opinion. Usually it is "wait it out. It will be fine."
Any questions - feel free to call me or email me.
[I am not looking to cause alarm - merely to educate about what is out there. I firmly believe that with proper monitoring, a properly done circumcision will look and turn out absolutely fine. Before you look at the following links, remember these cases are relatively uncommon. Nonetheless they are not so rare as for you to be unaware...
See more on this subject here and here...]
Tuesday, February 23, 2010
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
The Ceremony and the Honors
The baby starts off with his mother in a private room. The room changes depending on the venue - it could be a bedroom in an apartment or house, an office or bridal room in a synagogue or catering facility - any place which gives the baby breathing room and an intimate environment where baby’s mother can nurse or otherwise feed him after the bris.
The mohel may or may not prepare the baby prior to the bris. If the baby is “prep”ed by the mohel, the baby can be brought out when he is ready. Otherwise he should be brought out when the mohel calls for him.
For information on how to choose people for the following honors, see the end of this section.
The baby is brought into the room where the bris will take place by a “kvatter” couple. The couple consists of a male and female who are either married to one another or are mother/son or father/daughter or brother/sister. Their role is to be the medium passing the baby from his mother to his father.
After he is passed to kvatter, the mother can go to her “spot” for the bris. Some mothers prefer to stay in the back or in a different room. Some like to be right up front. If you have a rabbi, speak with him about what is best for you based on your tradition. There also tend to be different protocols for home circumcisions versus synagogue circumcisions.
In many traditions, the baby is next placed on the chair of Elijah, the “kisei shel Eliyahu.” Some verses are recited, paying tribute to a staunch defender of the covenant of Bris Milah, Elijah the prophet. Note how he makes an appearance here, similar to the one he makes at the Passover Seder.
The baby is handed to the father who first appoints the mohel to be his messenger to do the bris. This helps the father fulfill his obligation to be the actual person performing the circumcision.
(In Jewish law, a person can appoint a messenger, a “shaliach,” to perform certain commandments on one’s behalf. Other examples include sending someone to donate your charity money, or giving and accepting Jewish legal documents.)
Depending on the family custom, the father’s blessing might be recited now (Sephardic or Middle Eastern tradition).
The father places the baby on the sandak’s lap, where he will be held during the actual circumcision. The sandak honor is considered the highest one can bestow upon a person at the bris.
The mohel may or may not prepare the baby prior to the bris. If the baby is “prep”ed by the mohel, the baby can be brought out when he is ready. Otherwise he should be brought out when the mohel calls for him.
For information on how to choose people for the following honors, see the end of this section.
The baby is brought into the room where the bris will take place by a “kvatter” couple. The couple consists of a male and female who are either married to one another or are mother/son or father/daughter or brother/sister. Their role is to be the medium passing the baby from his mother to his father.
After he is passed to kvatter, the mother can go to her “spot” for the bris. Some mothers prefer to stay in the back or in a different room. Some like to be right up front. If you have a rabbi, speak with him about what is best for you based on your tradition. There also tend to be different protocols for home circumcisions versus synagogue circumcisions.
In many traditions, the baby is next placed on the chair of Elijah, the “kisei shel Eliyahu.” Some verses are recited, paying tribute to a staunch defender of the covenant of Bris Milah, Elijah the prophet. Note how he makes an appearance here, similar to the one he makes at the Passover Seder.
The baby is handed to the father who first appoints the mohel to be his messenger to do the bris. This helps the father fulfill his obligation to be the actual person performing the circumcision.
(In Jewish law, a person can appoint a messenger, a “shaliach,” to perform certain commandments on one’s behalf. Other examples include sending someone to donate your charity money, or giving and accepting Jewish legal documents.)
Depending on the family custom, the father’s blessing might be recited now (Sephardic or Middle Eastern tradition).
The father places the baby on the sandak’s lap, where he will be held during the actual circumcision. The sandak honor is considered the highest one can bestow upon a person at the bris.
At the moment of circumcision the mohel recites a blessing and then the father recites a blessing (Ashkenazic tradition), and the congregation responds accordingly.
After the circumcision is over and the baby is bandaged and wrapped up, he is held by another honoree, who is sometimes called the “standing sandak.”
While the baby is held, two blessings are recited by the rabbi, mohel or an honoree, who is holding a cup of wine. After that another paragraph is recited in which the baby is officially given his Hebrew name.
Mazal Tov!
PICKING THE HONOREES
The rules: All participants in the bris ceremony should be Jewish.
Every other absolute rule is in bold. Anything else is a suggestion or might change based on the venue - ie home versus synagogue. Usually the honorees are all male, save in the kvatter component.
The kvatter: The kvatter is a married couple unless they are a male/female team as described above. Some people have the custom to give this honor to a couple who as yet do not have children, with the hope that in the merit of participating in this event they will be blessed to have a child. If all your married friends and relatives have children, then the honor can be given to any married couple. Some people give it to a great aunt and uncle.
What about having more than one “kvatter”?
No problem. Some people have unmarried siblings (aunts and uncles to baby) or other friends they’d like to get involved. My rule is simple: “Women first, then men. Let the last woman hand the baby to her husband (the first man).”
Elijah’s Chair: This honor can be given to anyone. Some give it to a rabbi, some to an uncle, some to a dear friend. If this is not your first son, many people try to give honors to individuals who were not honored at the previous bris.
Sandak: The sandak must be male. He is usually the baby’s grandfather or great-grandfather. There is a custom, once past the first bris, to use a different sandak for every subsequent bris of your children. A person may be sandak many times – but for only one of your sons. Some Sephardic traditions re-use sandaks.
Blessings and Naming: Should be read by someone who reads Hebrew fluently. In a traditional ceremony, the one who recites the blessings is an observant Jew. In many cases, the rabbi or the mohel will recite the blessings as the default honoree.
Holding the baby/Standing Sandak: This honor can be given to anyone. It is often split - one person for the blessings, and one for the naming. When there are two grandfathers, this is usually when one or both get involved. If one was the regular sandak, the other will typically fill this role. If a great-grandfather was the regular sandak, the grandfathers might split the baby-holding.
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.
Monday, January 11, 2010
Bris v. Circumcision
No - it's not one of those landmark Supreme Court cases.
But it is a question that comes up a lot: What's the difference between a circumcision and a bris? Isn't a bris just a souped up circumcision?
It is true that a bris contains a circumcision as part of its process, but a circumcision alone does not a bris make.
Circumcision
Male circumcision is the removal of some or all of the foreskin (prepuce) from the penis. (I got the concise definition from wikipedia, though the page has graphic images I don't recommend for the sensitive...)
Bris
A Bris includes the circumcision (though it would more accurately remove all of the foreskin), but also has ritualistic components as well as religious significance that is extremely important for the history and continuity of the Jewish people.
This is not the forum to respond to anti-circumcision people - so don't expect that here.
Do a google search of "anti-circumcision" or "against circumcision" and you will find hundreds of websites and millions of hits. This is not our issue. I assume you are looking to circumcise your son, just don't know if it would be better to do it with a doctor in the hospital or with a mohel in a bris ceremony.
A Medical Circumcision...
...consists of either an operating room procedure or an office procedure. Depending on who does it and how much pride the person takes in the outcome, and in his/her relationship with the baby and his family, you can get all kinds of different outcomes.
Doctors will use all different kinds of methods - some which produce excellent cosmetic results, some which produce shoddy results.
In cases where parents sign a waiver allowing hospitals to take care of the circumcision, unless they request otherwise, there is a good chance that a medical student will be operating, for the first time, on their baby.
Local anesthetic may or may not be used, and depending on the method of choice, the baby might be in a degree of discomfort for between 7 to 30 minutes.
Cosmetic results will differ based on the skills of the operator. A doctor who does many of these procedures will usually have it down to a science and should produce wonderful cosmetic results. Otherwise, you are at your own risk.
I have been inside operating rooms in which the surgeon took pride in his work, took the time, marked the foreskin, and made a clean and even incision, gently and carefully, all around the circumference of the glans.
I have also been in the operating room when the child in question was put "out" for a hernia operation, and the choice was made to do the circumcision at the same time, while the baby was under general anesthesia. In my own observation, while the doctor may have taken all the time in the world to do the hernia properly, the circumcision was an afterthought, and was treated as such. No mark, quick snip (forgive me), and a suture job afterwards that was not to my satisfaction. Argument: "It's only a 'circ.' What's your problem?" My problem is that it isn't "only" a circ.
A Bris...
... takes much less time. Depending on the operator, he may use a bronstein (Mogen) clamp or a Traditional Jewish shield, but will usually finish the procedural (circumcision) component in under a minute.
A bris requires the entire foreskin to be removed, as well as the mucosal membrane beneath the foreskin to be completely removed from the circumference of the glans. In addition to being the fulfillment of the requirement, this will inevitably produce a more asthetically pleasing result.
Not that we're doing this for asthetics.
The circumcision carries with it the promise made by God to Abraham in Genesis 17 that He will be the exclusive God for Abraham's descendants (defined in Genesis 15 as those who descended to Egypt, and ultimately experienced the Exodus and Revelation at Sinai - the Children of Israel) if they bear the mark of the covenant in their male offsprings' flesh.
For the Jewish people, this prospect of being "the firstborn of God" (see 4:22) is highly significant.
The Bris Ceremony makes reference to Biblical defenders of the faith, who outwardly defended the covenant and the concept of circumcision - Abraham, Pinchas, and Elijah the Prophet. It includes prayers to God on behalf of the operator (mohel), the father of the baby, the sandak (who holds the baby during the bris), and, most importantly, the baby - that he should experience his circumcision with minimal pain and discomfort and that he should heal speedily.
There is symbolism in the blood that emerges from the incision (compare this to the blood on the doorposts (12:7-13) that was used to effect the "Passover" event)
There are blessings that are recited invoking God, the covenant, and national significance for all the Jewish people.
The baby is given his name in ceremonial fashion, with a cup of wine - just as we have for kiddush on Sabbath and holidays, and at other important ceremonies such as a wedding.
And, perhaps most significantly, friends and family gather together to celebrate the arrival of the baby, the continuing of a tradition, and the continuity of the Jewish people.
I conclude with the words I've already written in this posting
The doctor v mohel question is for a different discussion - it has been addressed in the second half of this posting.
But it is a question that comes up a lot: What's the difference between a circumcision and a bris? Isn't a bris just a souped up circumcision?
It is true that a bris contains a circumcision as part of its process, but a circumcision alone does not a bris make.
Circumcision
Male circumcision is the removal of some or all of the foreskin (prepuce) from the penis. (I got the concise definition from wikipedia, though the page has graphic images I don't recommend for the sensitive...)
Bris
A Bris includes the circumcision (though it would more accurately remove all of the foreskin), but also has ritualistic components as well as religious significance that is extremely important for the history and continuity of the Jewish people.
This is not the forum to respond to anti-circumcision people - so don't expect that here.
Do a google search of "anti-circumcision" or "against circumcision" and you will find hundreds of websites and millions of hits. This is not our issue. I assume you are looking to circumcise your son, just don't know if it would be better to do it with a doctor in the hospital or with a mohel in a bris ceremony.
A Medical Circumcision...
...consists of either an operating room procedure or an office procedure. Depending on who does it and how much pride the person takes in the outcome, and in his/her relationship with the baby and his family, you can get all kinds of different outcomes.
Doctors will use all different kinds of methods - some which produce excellent cosmetic results, some which produce shoddy results.
In cases where parents sign a waiver allowing hospitals to take care of the circumcision, unless they request otherwise, there is a good chance that a medical student will be operating, for the first time, on their baby.
Local anesthetic may or may not be used, and depending on the method of choice, the baby might be in a degree of discomfort for between 7 to 30 minutes.
Cosmetic results will differ based on the skills of the operator. A doctor who does many of these procedures will usually have it down to a science and should produce wonderful cosmetic results. Otherwise, you are at your own risk.
I have been inside operating rooms in which the surgeon took pride in his work, took the time, marked the foreskin, and made a clean and even incision, gently and carefully, all around the circumference of the glans.
I have also been in the operating room when the child in question was put "out" for a hernia operation, and the choice was made to do the circumcision at the same time, while the baby was under general anesthesia. In my own observation, while the doctor may have taken all the time in the world to do the hernia properly, the circumcision was an afterthought, and was treated as such. No mark, quick snip (forgive me), and a suture job afterwards that was not to my satisfaction. Argument: "It's only a 'circ.' What's your problem?" My problem is that it isn't "only" a circ.
A Bris...
... takes much less time. Depending on the operator, he may use a bronstein (Mogen) clamp or a Traditional Jewish shield, but will usually finish the procedural (circumcision) component in under a minute.
A bris requires the entire foreskin to be removed, as well as the mucosal membrane beneath the foreskin to be completely removed from the circumference of the glans. In addition to being the fulfillment of the requirement, this will inevitably produce a more asthetically pleasing result.
Not that we're doing this for asthetics.
The circumcision carries with it the promise made by God to Abraham in Genesis 17 that He will be the exclusive God for Abraham's descendants (defined in Genesis 15 as those who descended to Egypt, and ultimately experienced the Exodus and Revelation at Sinai - the Children of Israel) if they bear the mark of the covenant in their male offsprings' flesh.
For the Jewish people, this prospect of being "the firstborn of God" (see 4:22) is highly significant.
The Bris Ceremony makes reference to Biblical defenders of the faith, who outwardly defended the covenant and the concept of circumcision - Abraham, Pinchas, and Elijah the Prophet. It includes prayers to God on behalf of the operator (mohel), the father of the baby, the sandak (who holds the baby during the bris), and, most importantly, the baby - that he should experience his circumcision with minimal pain and discomfort and that he should heal speedily.
There is symbolism in the blood that emerges from the incision (compare this to the blood on the doorposts (12:7-13) that was used to effect the "Passover" event)
There are blessings that are recited invoking God, the covenant, and national significance for all the Jewish people.
The baby is given his name in ceremonial fashion, with a cup of wine - just as we have for kiddush on Sabbath and holidays, and at other important ceremonies such as a wedding.
And, perhaps most significantly, friends and family gather together to celebrate the arrival of the baby, the continuing of a tradition, and the continuity of the Jewish people.
I conclude with the words I've already written in this posting
The doctor v mohel question is for a different discussion - it has been addressed in the second half of this posting.
Tuesday, January 5, 2010
The Traveling Mohel
Welcome to my blog about bris/t milah, and about being a mohel!
I hope you find the content of the blog informative and helpful in the research you are doing to find the right mohel for your son.
This entry is more of an advertisement than a traditional "blog" (since when can a blog be categorized as "traditional" anyway? There were no blogs in "Fiddler"!)
Whether you live in a place that has many mohels, or a place that has zero mohels, I invite you to consider engaging my services as your son's mohel, for a number of reasons:
1. I will speak with you about every aspect of the bris: logistics, details, family sensitivities, etc., to make sure you are 100% comfortable and emotionally prepared for the roller coaster that is the day of the bris. I am available on the phone almost always, and if you leave a message, I will get back to you quickly.
2. I am the world's biggest stickler for creating and maintaining a sterile field and sterile environment for the bris. There is no compromising in making sure the ultimate care is taken to assure nothing negative - such as an infection - will result from the bris.
3. You will not find a more easy-going and time-giving mohel. I make sure you know everything you need to know, and everything you want to know as far as what I am doing or need to do or as far as how to take care of your baby when I am not around.
4. You get full details about how to care for the baby, what you will see, how long things take to heal
5. I check the baby immediately after the bris and a few hours later. The efficiency with which this is done assures your son has the most aesthetically pleasing circumcision, and that he requires the most minimal care on your part by the time my role is finished. You do not have to deal with bandages that are on long term, and you do not have to take off any bandages or deal with any bleeding. This is a full service operation.
6. The cost to you can be within your budget. Because travel expenses vary, I am happy to talk with you to determine what can work. Everything is spelled out here. If you have other local mohel options, we'll have an open conversation about what works for you and me as I am somewhat flexible. If you must fly in a mohel in any case, your options become limited, so we'll have that open conversation as well.
I am quite serious about the offer to travel - even great distances. Check out my other site http://www.travelingmohel.com/
So. Whether you (or someone you know) live(s) in a remote area and need a mohel (recommendations are always appreciated!), or you want a mohel who suits your needs best and most identifies with the Judaism you practice, we should have a conversation. Even if it won't be me, I can help you make sure you find the right person, and give you information that will help you make sure you know "exactly" what is going on, and that you are taking charge of your son's entry into the mark of the covenant.
I hope you find the content of the blog informative and helpful in the research you are doing to find the right mohel for your son.
This entry is more of an advertisement than a traditional "blog" (since when can a blog be categorized as "traditional" anyway? There were no blogs in "Fiddler"!)
Whether you live in a place that has many mohels, or a place that has zero mohels, I invite you to consider engaging my services as your son's mohel, for a number of reasons:
1. I will speak with you about every aspect of the bris: logistics, details, family sensitivities, etc., to make sure you are 100% comfortable and emotionally prepared for the roller coaster that is the day of the bris. I am available on the phone almost always, and if you leave a message, I will get back to you quickly.
2. I am the world's biggest stickler for creating and maintaining a sterile field and sterile environment for the bris. There is no compromising in making sure the ultimate care is taken to assure nothing negative - such as an infection - will result from the bris.
3. You will not find a more easy-going and time-giving mohel. I make sure you know everything you need to know, and everything you want to know as far as what I am doing or need to do or as far as how to take care of your baby when I am not around.
4. You get full details about how to care for the baby, what you will see, how long things take to heal
5. I check the baby immediately after the bris and a few hours later. The efficiency with which this is done assures your son has the most aesthetically pleasing circumcision, and that he requires the most minimal care on your part by the time my role is finished. You do not have to deal with bandages that are on long term, and you do not have to take off any bandages or deal with any bleeding. This is a full service operation.
6. The cost to you can be within your budget. Because travel expenses vary, I am happy to talk with you to determine what can work. Everything is spelled out here. If you have other local mohel options, we'll have an open conversation about what works for you and me as I am somewhat flexible. If you must fly in a mohel in any case, your options become limited, so we'll have that open conversation as well.
I am quite serious about the offer to travel - even great distances. Check out my other site http://www.travelingmohel.com/
So. Whether you (or someone you know) live(s) in a remote area and need a mohel (recommendations are always appreciated!), or you want a mohel who suits your needs best and most identifies with the Judaism you practice, we should have a conversation. Even if it won't be me, I can help you make sure you find the right person, and give you information that will help you make sure you know "exactly" what is going on, and that you are taking charge of your son's entry into the mark of the covenant.
Wednesday, December 23, 2009
Why Can't the Baby Eat Before the Bris?
I generally recommend that the last pre-bris feeding take place 90 minutes before the bris.
For babies who drink formula, this usually does not present a problem, as they are usually on a schedule.
But for babies who nurse (I am happy to report that the number of nursing moms is on the rise), this presents a bit of a problem. My wife likes to call herself "Mommy's 24-hour open bar," so I understand very well how nursing moms like to provide when baby asks. And this is a wonderful thing. One might argue that the only downside of nursing is that babies love it! and don't want to give mommy a break.
Before a bris, however, the problem is twofold.
A: Nursing during the bris is impossible - for obvious reasons.
B: The baby's system needs to be cleaned out in anticipation of the bris.
I assume I don't have to explain the first reason, so here is the explanation for reason "B."
The baby will be crying in a way he might not be consolable while the bris or bandage change is taking place, and if he happens to have recent food in his system, there is a good chance he'll spit it up. "Spitting up baby + crying and can't be moved due to position he is in when caring for his circumcision wound" is not an equation we want to deal with.
For babies who drink formula, this usually does not present a problem, as they are usually on a schedule.
But for babies who nurse (I am happy to report that the number of nursing moms is on the rise), this presents a bit of a problem. My wife likes to call herself "Mommy's 24-hour open bar," so I understand very well how nursing moms like to provide when baby asks. And this is a wonderful thing. One might argue that the only downside of nursing is that babies love it! and don't want to give mommy a break.
Before a bris, however, the problem is twofold.
A: Nursing during the bris is impossible - for obvious reasons.
B: The baby's system needs to be cleaned out in anticipation of the bris.
I assume I don't have to explain the first reason, so here is the explanation for reason "B."
The baby will be crying in a way he might not be consolable while the bris or bandage change is taking place, and if he happens to have recent food in his system, there is a good chance he'll spit it up. "Spitting up baby + crying and can't be moved due to position he is in when caring for his circumcision wound" is not an equation we want to deal with.
The best I can recommend if the 90 minute window does not work for you is to try to estimate how much time he can handle, so he'll be ready for a good feeding (nice and hungry) 15 minutes after the bris is scheduled to begin.
After the bris he can eat all he wants.
But it is not worth risking a spit up during the bris or when I am checking his bandage right after the bris. Choking baby is much worse than crying baby.
I hope you will agree.
After the bris he can eat all he wants.
But it is not worth risking a spit up during the bris or when I am checking his bandage right after the bris. Choking baby is much worse than crying baby.
I hope you will agree.
Tuesday, December 22, 2009
Prioritizing our questions
I've received a number of calls in the last couple of weeks, from people who are doing their research before baby arrives. I mean this with all sincerity - kudos to you! It it so important to do proper research before the baby arrives.
The question I hear most often is about the "cost." Let me assure you this is not an issue - I graciously accept whatever you offer. [Note from 1/2/11 - here is a new posting on the subject] [And yet another posting on why Costs should not be a determining factor - August 2011]
While it is most understandable that this is a top question, at the same time, I feel that other questions which should be at the top are not asked at all.
Are there ever complications?
What is the healing process like?
What are your methods for maintaining sterility? (See the second half of the link)
How will you treat our baby and how will you treat us?
More examples of Important questions can be found here and here (this second one is the same as the link above, but the questions in it focus more on things you ought to be asking yourself - to help you decide what you want out of the bris experience).
Let's talk!
The question I hear most often is about the "cost." Let me assure you this is not an issue - I graciously accept whatever you offer. [Note from 1/2/11 - here is a new posting on the subject] [And yet another posting on why Costs should not be a determining factor - August 2011]
While it is most understandable that this is a top question, at the same time, I feel that other questions which should be at the top are not asked at all.
Are there ever complications?
What is the healing process like?
What are your methods for maintaining sterility? (See the second half of the link)
How will you treat our baby and how will you treat us?
More examples of Important questions can be found here and here (this second one is the same as the link above, but the questions in it focus more on things you ought to be asking yourself - to help you decide what you want out of the bris experience).
Let's talk!
Thursday, December 17, 2009
What is a "Kvatter"?
The role of the "kvatter" is to bring the baby from the mom to the dad at the start of the bris ceremony.
The term is Yiddish, and probably comes from the term "K'fater" which means "like the father." Those of Germanic descent might pronounce the word "g'fotter" with an "umlaut" over the "e" (the "e" should be pronounced like the "e" in "yes," as opposed to rolled over as it is in "fodder").
[Update 11/2014 - In the book "Minhagei Worms" (customs of the city of Worms), the author notes a custom that the woman who would take the baby from the mother (who is called the "Sandeket") would give the mother a gift called the "גיפאטר שאפט" (Gifater Shoft) in order to distract the mother from the pain her child is about to go through as she enjoys her new gift. I don't know what the literal translation of the term is (though "שאפט/shoft" seems to mean "community"), but clearly "G'fater" relates to our word in question.]
The word may also come from a diminutive or derivative of "Godfather."
There are different customs related to who is honored to play this role, particularly as pertains to what is called a "segulah" - a special merit to achieve a certain result.
This is not the place to discuss the general benefits of "segulah"s - but there is a nice list of segulahs at the "In the Pink" blog - you can read it here. [I don't recommend the last one for "getting pregnant" - and I happen to think it is a mistake. There is no way that anyone "really" ever did that. At least I hope I am correct]
The major "segulah" of this role is for people who are not yet parents to merit to become parents. Just as they are participating in the bris, just as the woman and man are "like" the mother and father of the baby in the way they are bringing him to his bris, they should merit to have a child, and if he's a boy, to bring him to his bris.
Brief History
Before the age of the mega-mom and the DIY ladies of today, whom we admire very much, by the way, women would not attend a bris in the way they do now. The mother might be in a different room or building, possibly being forced to rest by all her relatives or attendants after having given birth, and the baby would be brought to his bris.
Who would bring the baby? A woman who is trustworthy to the mother.
Who would she give the baby to? The baby's father, surely, except that it was considered immodest for a woman to hand something to a man, who is not her husband, in a public ceremony. So she would give the baby to her husband, who would bring the baby to his (baby's) father.
Present Day
I have not yet met a mother who chose to hide in a room somewhere while the bris takes place elsewhere. So why do we still have the kvatter? Let the mother bring her son to his bris!
There are a few reasons why the kvatter is still used, and other thoughts to consider when choosing a kvatter.
1. Married couples who observe the laws of "niddah" are not supposed to pass things to each other, on account of rules which limit certain practices between husband and wife during the niddah period. While "niddah" status is usually a private affair, a woman who has given birth is known to be in the status of "niddah" on account of her having given birth, so in a public Jewish ceremony, we help them follow the rules by having the "kvatter" couple as their go-between.
2. Some situations and circumstances do not make the mother's entrance possible, such as in certain synagogues or smaller rooms which have limited space. As such, the male half of the kvatter is in the room anyway and he'll take the baby from his wife to bring him to the ceremony.
3. The segulah to have a child is something that some people put a lot of stock in. Why not give them the opportunity, if it would be meaningful to them?
4. In a ceremony with limited participation - most of the honors consist of holding the baby briefly - it provides an opportunity to have more people hold the baby. Many people like to get additional "kvatter people" involved to give additional grandmothers, great aunts, friends and the like the opportunity to participate. It also provides more opportunities for photographs.
My rule in this respect (#4) is simple. Let the women pass the baby first, and the last woman gives the baby to her husband before other men pick up the hand-offs.
What if I don't have any childless married friends? Do I need to find such a couple? (Or - Who else could serve as kvatter?)
No. The couple should ideally be married to one another. Some people give it to the baby's aunt and uncle, or a great-aunt and great-uncle, or even the baby's grandparents. In the case that a married couple is not available, or they are being utilized for something else, the honor can also be given to a male-female team whose contact with one another would not be considered "immodest" in a public Jewish ceremony: for example, a mother/son or a father/daughter team. I guess a brother/sister team could also work.
Update - I made an interesting discovery in 2017 that touches upon this topic
What if the couple I want to include as kvatter are expecting - in other words, the wife is currently pregnant?
It really depends. Technically they don't have a baby yet, so the "segulah" could still apply. Some who are superstitious might view their being kvatter as a curse on their unborn baby (I believe this to be nonsense). Some feel that an expectant couple don't "need" to play this role.
May they be kvatters? Yes. Is it commonly done? No.
What if there is a couple with no kids that have been kvatter many times?
If they do believe in the segulah and want to play the role again, it is appropriate to give it to them as many times as possible.
BUT... be sensitive!
If they seem to be remorseful, or if it seems to be embarrassing to them because "everyone" knows they are "always" the kvatter couple, and "everyone" sees every time that they "still don't have kids" - which, of course, is nobody's business, then give the honor to somebody else.
Bottom Line
Follow the rules of a couple or appropriate tag-team, and give the honor to someone you care about and/or love.
p.s. Afterthought question
For those who follow the laws of niddah, what happens if the kvatter couple themselves are in a state of niddah?
There are two approaches:
1. This is nobody's business, and as it is a public ceremony, it does not matter. You should not be asking them, and they certainly should not be offering such information.
2. In some circles and some communities, the wife bring the baby in on two pillows, and the husband takes the baby and only the top pillow. In this way, the possibility of the wife handing the husband the baby is taken away. And as "everyone" does it this way, it removes any uncomfortable situations or needs for explaining.
The term is Yiddish, and probably comes from the term "K'fater" which means "like the father." Those of Germanic descent might pronounce the word "g'fotter" with an "umlaut" over the "e" (the "e" should be pronounced like the "e" in "yes," as opposed to rolled over as it is in "fodder").
[Update 11/2014 - In the book "Minhagei Worms" (customs of the city of Worms), the author notes a custom that the woman who would take the baby from the mother (who is called the "Sandeket") would give the mother a gift called the "גיפאטר שאפט" (Gifater Shoft) in order to distract the mother from the pain her child is about to go through as she enjoys her new gift. I don't know what the literal translation of the term is (though "שאפט/shoft" seems to mean "community"), but clearly "G'fater" relates to our word in question.]
The word may also come from a diminutive or derivative of "Godfather."
There are different customs related to who is honored to play this role, particularly as pertains to what is called a "segulah" - a special merit to achieve a certain result.
This is not the place to discuss the general benefits of "segulah"s - but there is a nice list of segulahs at the "In the Pink" blog - you can read it here. [I don't recommend the last one for "getting pregnant" - and I happen to think it is a mistake. There is no way that anyone "really" ever did that. At least I hope I am correct]
The major "segulah" of this role is for people who are not yet parents to merit to become parents. Just as they are participating in the bris, just as the woman and man are "like" the mother and father of the baby in the way they are bringing him to his bris, they should merit to have a child, and if he's a boy, to bring him to his bris.
Brief History
Before the age of the mega-mom and the DIY ladies of today, whom we admire very much, by the way, women would not attend a bris in the way they do now. The mother might be in a different room or building, possibly being forced to rest by all her relatives or attendants after having given birth, and the baby would be brought to his bris.
Who would bring the baby? A woman who is trustworthy to the mother.
Who would she give the baby to? The baby's father, surely, except that it was considered immodest for a woman to hand something to a man, who is not her husband, in a public ceremony. So she would give the baby to her husband, who would bring the baby to his (baby's) father.
Present Day
I have not yet met a mother who chose to hide in a room somewhere while the bris takes place elsewhere. So why do we still have the kvatter? Let the mother bring her son to his bris!
There are a few reasons why the kvatter is still used, and other thoughts to consider when choosing a kvatter.
1. Married couples who observe the laws of "niddah" are not supposed to pass things to each other, on account of rules which limit certain practices between husband and wife during the niddah period. While "niddah" status is usually a private affair, a woman who has given birth is known to be in the status of "niddah" on account of her having given birth, so in a public Jewish ceremony, we help them follow the rules by having the "kvatter" couple as their go-between.
2. Some situations and circumstances do not make the mother's entrance possible, such as in certain synagogues or smaller rooms which have limited space. As such, the male half of the kvatter is in the room anyway and he'll take the baby from his wife to bring him to the ceremony.
3. The segulah to have a child is something that some people put a lot of stock in. Why not give them the opportunity, if it would be meaningful to them?
4. In a ceremony with limited participation - most of the honors consist of holding the baby briefly - it provides an opportunity to have more people hold the baby. Many people like to get additional "kvatter people" involved to give additional grandmothers, great aunts, friends and the like the opportunity to participate. It also provides more opportunities for photographs.
My rule in this respect (#4) is simple. Let the women pass the baby first, and the last woman gives the baby to her husband before other men pick up the hand-offs.
What if I don't have any childless married friends? Do I need to find such a couple? (Or - Who else could serve as kvatter?)
No. The couple should ideally be married to one another. Some people give it to the baby's aunt and uncle, or a great-aunt and great-uncle, or even the baby's grandparents. In the case that a married couple is not available, or they are being utilized for something else, the honor can also be given to a male-female team whose contact with one another would not be considered "immodest" in a public Jewish ceremony: for example, a mother/son or a father/daughter team. I guess a brother/sister team could also work.
Update - I made an interesting discovery in 2017 that touches upon this topic
What if the couple I want to include as kvatter are expecting - in other words, the wife is currently pregnant?
It really depends. Technically they don't have a baby yet, so the "segulah" could still apply. Some who are superstitious might view their being kvatter as a curse on their unborn baby (I believe this to be nonsense). Some feel that an expectant couple don't "need" to play this role.
May they be kvatters? Yes. Is it commonly done? No.
What if there is a couple with no kids that have been kvatter many times?
If they do believe in the segulah and want to play the role again, it is appropriate to give it to them as many times as possible.
BUT... be sensitive!
If they seem to be remorseful, or if it seems to be embarrassing to them because "everyone" knows they are "always" the kvatter couple, and "everyone" sees every time that they "still don't have kids" - which, of course, is nobody's business, then give the honor to somebody else.
Bottom Line
Follow the rules of a couple or appropriate tag-team, and give the honor to someone you care about and/or love.
p.s. Afterthought question
For those who follow the laws of niddah, what happens if the kvatter couple themselves are in a state of niddah?
There are two approaches:
1. This is nobody's business, and as it is a public ceremony, it does not matter. You should not be asking them, and they certainly should not be offering such information.
2. In some circles and some communities, the wife bring the baby in on two pillows, and the husband takes the baby and only the top pillow. In this way, the possibility of the wife handing the husband the baby is taken away. And as "everyone" does it this way, it removes any uncomfortable situations or needs for explaining.
Tuesday, December 15, 2009
Methods of Circumcision
Most parents looking to have their son circumcised just want it to be done as efficiently as possible, as speedily as possible, with minimal pain to the baby.
Of course they'd prefer the circumcision be aesthetically pleasing, and that the circumcision heals sooner than later with no complications.
When doing research about ANY mohel, the end results are important. (I've written elsewhere about the demeanor and the ceremony and the need for things to be done at your speed.) And most people leave the method to achieving those end results up to the mohel, and how he feels most comfortable getting there.
However, there is not "only" one way to circumcise. And if it is important to you, it is important to ask about methods, and to inquire if the mohel can accomodate your desires.
Please note that I use Method #2 presented below and as described at the end of this post.
There are some methods which are questionable according to some (in some cases, many) rabbinic opinions. There are others which are standard - even if the "innovation" in them is "only" hundreds of years old. And there is old-school, bare bones (literally), which is advocated by few.
Sadly, those who advocate the latter method often knock everyone else, even going so far as to declare other circumcisions "unkosher" and requiring hatafat dam brit - a ceremonial drawing of blood from the circumcision scar that would "kosherize" the bris. This is not only a form of lashon hara and rechilut (talebearing), but is a lie, a form of fear-mongering, and does nothing but increase hatred amongst Jews.
Hmmmmm. That last paragraph was a mouthful. Take a deep breath and let's move on to methods:
INTRODUCTION
Bris Milah has three steps:
1. Milah - the removal of the foreskin
2. Priah - the removal of the membrane that is found between the foreskin and the glans
3. Metzitzah - drawing of "distant" blood
The foreskin is drawn forward and removed. The membrane is often removed with the foreskin. If it is not completely removed, then it is torn and folded back beyond the glans. Finally, blood is drawn from the wound.
In the interest of space, the methods described will not include metzitzah, which will be the subject of different posts.
And I will leave the issue of whether the mohel is wearing gloves up to you, the parents, as well. I've addressed this in a number of posts already. [Search "sterility" in the keywords]
Method #1. Clamp
Of course they'd prefer the circumcision be aesthetically pleasing, and that the circumcision heals sooner than later with no complications.
When doing research about ANY mohel, the end results are important. (I've written elsewhere about the demeanor and the ceremony and the need for things to be done at your speed.) And most people leave the method to achieving those end results up to the mohel, and how he feels most comfortable getting there.
However, there is not "only" one way to circumcise. And if it is important to you, it is important to ask about methods, and to inquire if the mohel can accomodate your desires.
Please note that I use Method #2 presented below and as described at the end of this post.
There are some methods which are questionable according to some (in some cases, many) rabbinic opinions. There are others which are standard - even if the "innovation" in them is "only" hundreds of years old. And there is old-school, bare bones (literally), which is advocated by few.
Sadly, those who advocate the latter method often knock everyone else, even going so far as to declare other circumcisions "unkosher" and requiring hatafat dam brit - a ceremonial drawing of blood from the circumcision scar that would "kosherize" the bris. This is not only a form of lashon hara and rechilut (talebearing), but is a lie, a form of fear-mongering, and does nothing but increase hatred amongst Jews.
Hmmmmm. That last paragraph was a mouthful. Take a deep breath and let's move on to methods:
INTRODUCTION
Bris Milah has three steps:
1. Milah - the removal of the foreskin
2. Priah - the removal of the membrane that is found between the foreskin and the glans
3. Metzitzah - drawing of "distant" blood
The foreskin is drawn forward and removed. The membrane is often removed with the foreskin. If it is not completely removed, then it is torn and folded back beyond the glans. Finally, blood is drawn from the wound.
In the interest of space, the methods described will not include metzitzah, which will be the subject of different posts.
And I will leave the issue of whether the mohel is wearing gloves up to you, the parents, as well. I've addressed this in a number of posts already. [Search "sterility" in the keywords]
Method #1. Clamp
The foreskin and membrane are grasped with a hemostat and a clamp is applied to the foreskin. There are two kinds of clamps that have been utilized by mohels over the last sixty years. The first is the Gomco (on the right in the photo), which is often the method of choice for doctors in hospitals, but is not largely used by mohels. The second is the Mogen or Bronstein clamp (on the left), which is the method of choice for many mohels in the US (though most Orthodox mohels, including me, do NOT use it). The foreskin and membrane are then removed together in one incision, with a scalpel or bris knife.
Method #2. Shield
The foreskin and membrane are grasped either with a hemostat (as in method #1) or skillfully with the fingers. A metal plate with a thin slit is applied to the foreskin, leaving the foreskin resting above the plate, with the glans safely shielded below. A scalpel or bris knife is used to excise the foreskin.
If the membrane is removed along with the foreskin, metzitzah follows.
If the membrane is not completely removed along with the foreskin, it will either be cut with scissors, or the mohel will tear it with his sharpened thumbnails - in both cases to reveal the entire glans.
Method #3. Free hand
Without using any device other than a blade, the mohel will estimate the length of the foreskin, grasp it with the thumb and forefinger of one hand and excise the foreskin with the knife in his other hand.
Membrane removal will follow that of method #2. Metzitzah will follow.
PROS AND CONS OF THE METHODS
Obviously, the "con" of the baby having skin tissue removed and being subject to the pain of circumcision, and any bleeding are a given. If you are having your baby circumcised, it is assumed you understand that this is the down side (if you even view it as a downside) of the spiritual, national and Jewish significance attached to this procedure - which is the fulfillment of a commandment.
The pro: Baby bears the mark of the covenant established between God and Abraham, and all of the Jewish people, which established God as our only God, and we, the Jewish people, as His firstborn, the chosen people who have a mission on this earth to spread monotheism and ethics to as many people as we can.
Pros and Cons of #1 (Clamp)
Benefits include:
* Usually a bloodless circumcision.
* The mohel may not even need to use a bandage.
* If applied correctly, the glans is protected.
Cons:
* Usually a bloodless circumcision. (Blood is an essential element of the bris)
* Estimating the end of the foreskin along the shaft is inexact
* The FDA has issued severe warnings about the use of the clamp, as it could grasp and amputate the glans or the tip of the glans.
* The pain of the crushing of the foreskin is immense
* Once the clamping mechanism is applied, the estimation of the foreskin is irreversible. Even if one were to remove the clamp and then reapply it correctly before excising the skin, the skin tissue that remains would be dead, and would liekly either become the equivalent of a growth or fall off on its own.
* In order to achieve its desired effect, the clamp usually needs to be on for a significant amount of time - from 30 seconds to five or ten minutes. This is significantly longer than the next methods which take 3-4 seconds.
* Rabbinic approval is scant.
While Reform and Conservative mohels will often use this device, Orthodox mohels who use it usually do not have rabbinic dispensation to do so. Many will use it out of their own convenience (in other words, not because they have the baby's best interests in mind) so they need not come back and check the baby. This is not nice - every baby should be checked after the bris. No matter the method used.
Those who use it usually swear by it. I think they feel this way because of the lack of necessity to follow-up. But I may be wrong.
Pros and Cons of #2 (Shield)
Pros:
Quick procedure
* There is blood (necessary component of the bris)
* No chance of anything happening to the glans
* Until the actual incision is made, nothing is irreversible
Cons:
* Estimating the end of the foreskin along the shaft is inexact
* While the foreskin is not crushed, it is squeezed tightly for a few seconds.
The shield is an innovation which dates back at least four hundred years. It's purpose was (and remains) to protect the glans which is at great risk of being cut or amputated when a bris is done by anyone other than an extremely skilled operator. Like in the previous method, once the shield is in place, the actual removal of the foreskin - cutting along the shield, is the easiest part of the job.
Pros and Cons of #3 (Free-hand)
Pros:
* Quickest procedure
* Relatively painless
Cons:
* Estimating the end of the foreskin along the shaft is inexact
* There is no chance to second guess because the mohel never gives himself a chance to double check before excising the foreskin
* The possibility exists that the blade might cut the glans
* If done by anyone other than a skilled operator, the outcomes could be disastrous
The only people who still do brisses this way are some Chassidic Jews. While each person is entitled to have an opinion, those who do it this way are the most outspoken about - and against - any other form of circumcision.
THEREFORE
You may have noticed that the con that reads "Estimating the end of the foreskin along the shaft is inexact" was on every "con list." This is because many mohels were never taught to use a surgical pen to mark the edge of the foreskin before beginning the procedure. If the mohel's initial estimation is marked with a pen or marker, the "con" is removed from each list, as long as the mohel makes sure to cut along the mark.
I wrote about pain in the last few sections of this post. In simple terms, I think it is important to numb the area before the bris, but I think injections are not the way to go about doing it. There are topical methods out there that do just as good a job, and don't cause the baby pain from three "shots."
My Method
In addition to marking the end of the foreskin, I use Method #2 for a host of reasons. While I personally do not agree with methods #1 and #3, I believe that the bris is kosher if the operator is fit to be a mohel. I also think that parents should know what they are getting in to when hiring a mohel, and that the method which best suits your needs should be employed for your son.
When I circumcise, I aim to remove the foreskin and membrane at the same time, to minimize pain to the baby and the need to bother him too much. I always check the baby later, either a few hours after, the evening after, or the day after the bris. I wear gloves. I package all my instruments and bandages and sterilize everything in an autoclave machine - unless it is sterile in its packaging, e.g. gloves and drapes.
I hope this has been helpful to you. As always, feel free to contact me by email with any questions, or call me
* Rabbinic approval is scant.
While Reform and Conservative mohels will often use this device, Orthodox mohels who use it usually do not have rabbinic dispensation to do so. Many will use it out of their own convenience (in other words, not because they have the baby's best interests in mind) so they need not come back and check the baby. This is not nice - every baby should be checked after the bris. No matter the method used.
Those who use it usually swear by it. I think they feel this way because of the lack of necessity to follow-up. But I may be wrong.
Pros and Cons of #2 (Shield)
Pros:
Quick procedure
* There is blood (necessary component of the bris)
* No chance of anything happening to the glans
* Until the actual incision is made, nothing is irreversible
Cons:
* Estimating the end of the foreskin along the shaft is inexact
* While the foreskin is not crushed, it is squeezed tightly for a few seconds.
The shield is an innovation which dates back at least four hundred years. It's purpose was (and remains) to protect the glans which is at great risk of being cut or amputated when a bris is done by anyone other than an extremely skilled operator. Like in the previous method, once the shield is in place, the actual removal of the foreskin - cutting along the shield, is the easiest part of the job.
Pros and Cons of #3 (Free-hand)
Pros:
* Quickest procedure
* Relatively painless
Cons:
* Estimating the end of the foreskin along the shaft is inexact
* There is no chance to second guess because the mohel never gives himself a chance to double check before excising the foreskin
* The possibility exists that the blade might cut the glans
* If done by anyone other than a skilled operator, the outcomes could be disastrous
The only people who still do brisses this way are some Chassidic Jews. While each person is entitled to have an opinion, those who do it this way are the most outspoken about - and against - any other form of circumcision.
THEREFORE
You may have noticed that the con that reads "Estimating the end of the foreskin along the shaft is inexact" was on every "con list." This is because many mohels were never taught to use a surgical pen to mark the edge of the foreskin before beginning the procedure. If the mohel's initial estimation is marked with a pen or marker, the "con" is removed from each list, as long as the mohel makes sure to cut along the mark.
I wrote about pain in the last few sections of this post. In simple terms, I think it is important to numb the area before the bris, but I think injections are not the way to go about doing it. There are topical methods out there that do just as good a job, and don't cause the baby pain from three "shots."
My Method
In addition to marking the end of the foreskin, I use Method #2 for a host of reasons. While I personally do not agree with methods #1 and #3, I believe that the bris is kosher if the operator is fit to be a mohel. I also think that parents should know what they are getting in to when hiring a mohel, and that the method which best suits your needs should be employed for your son.
When I circumcise, I aim to remove the foreskin and membrane at the same time, to minimize pain to the baby and the need to bother him too much. I always check the baby later, either a few hours after, the evening after, or the day after the bris. I wear gloves. I package all my instruments and bandages and sterilize everything in an autoclave machine - unless it is sterile in its packaging, e.g. gloves and drapes.
I hope this has been helpful to you. As always, feel free to contact me by email with any questions, or call me
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