The explanations for these roles and who gets them can primarily be found here, and in the latter half of this post.
Some of them have further explanations elsewhere in the blog: kvatter, Elijah's chair , etc.
THE LIST
* items marked with an asterisk are most commonly done,
- items marked with a dash and in parentheses are possibilities, but not necessary
* Kvatter - male and female who bring baby in to the room (transfer baby from Mom to Dad)
* Kisei Eliyahu/Elijah's Chair - places the baby on a specially designated chair
(- Min Hakisei (from the chair) - gives baby to his father)
* Sandak - holds the baby during the bris
(- Min Hasandak (very uncommon to have this) - takes baby off lap of sandak to give to...)
* Amidah L'brachos (Sometimes called the standing sandak) - holds the baby after the circumcision, for blessings (and naming - next honor)
(- Amidah for Krias Hashem - an additional honoree who takes the baby after two blessings and holds him while he is given his name)
* Brachos - the person who recites the blessings (in a mildly-traditional crowd, the rabbi or mohel will usually do this), and either does or does not name the baby (next honor)
(- krias hashem - the one who first announces the baby's up-until-now secret Hebrew name. Sometimes the person who says the blessings will also name the baby)
(- birkat hamazon - the one who leads the grace after the meals, particularly and ideally in the presence of a minyan of men.)
If you are not sure how to include everyone you need to include, let me know. We can always squeeze another one in. avbillet@gmail.com
Monday, May 24, 2010
Wednesday, May 12, 2010
When Baby is Cranky - Is Tylenol a Solution?
The impetus for this posting comes from two incidents which took place in the last few weeks.
1. Tylenol, and other OTC baby pain medications had some kind of recall (the details did not concern me personally as my children don't use any of the items in question, and I never recommend any of them as a mohel)
2. Someone I know, who lives in New York, had his son circumcised by a local NY mohel, and called me that evening, after his baby had an unusually difficult day, to confirm that what his mohel had told him was "normal" in the post-op care of the baby. Details to follow.
I will not address the Tylenol recall directly, as it is not my area of expertise. But the issue which is raised often enough is whether there is room to give the baby tylenol if he seems cranky after the bris?
My answer is twofold. Firstly, let your pediatrician recommend tylenol or something to ease your baby's discomfort. Most mohels I know are not physicians, and while they can offer advice, they are not in charge of your baby's long-term care. Even if the mohel IS a physician, if he (or she - there are female Dr. physicians who are mohelets) is not your baby's physician, the questions about medications should be directed to the primary long-term caregiver.
Secondly, and this leads into the second impetus as mentioned above, your baby should not feel discomfort after the bris.
You may ask, how could a baby not feel discomfort after going through this surgery? I don't know the answer to this question, but I can report on what I've observed.
Post-bris, most babies who have a bandage placed on comfortably, who have their needs met (clean diaper and full belly), sleep nicely, eat nicely, wet their diapers consistently, etc. They cry under the same conditions they cried for before the bris: dirty diaper, hungry, tired... The main difference will be that baby might wince when he urinates - which would be directly impacted by the bris.
So what causes a baby to be cranky after the bris?
The number one item that causes a baby discomfort is an uncomfortable bandage. It could be the material does not agree with him. The bandage may also be on too tight, constricting what should otherwise be an easy urine-flow.
In my personal experience, when I fiddle (as necessary, after the bris) to get a new bandage on, the baby will usually cry as I am reapplying a gauze pad. Once I am finished and leave the baby alone, he is usually calm and comfortable, the crying stops, and he either eats or goes right to sleep.
Solutions
And so I asked the father of the baby three questions:
1. Is it bleeding? (usually indicative of either a case that requires attention or a bandage that fell off prematurely)
2. Has the baby urinated? (if not, there is too much constriction on account of the bandage, and it needs to either be loosened, removed, or replaced with a looser and softer bandage)
3. Will your mohel come and check it?
If the bandage is on too tightly - guess what - Tylenol or Motrin ain't gonna do a thing.
*************************
I mentioned in a different posting that it is normal to see swelling after the bris, particularly on the ventral side of the penis. In this case, that was not as much of a concern from my perspective (though the father did see swelling and was concerned about it).
In the end, the mohel did come and check, he removed the bandage (or loosened it) and baby was able to urinate more readily, easily and comfortably.
The point of this story is not to knock another mohel. It is to encourage you to avoid jumping to conclusions, to avoid worrying, and to realize there may be a very simple solution.
I have taken steps to avoid this problem. The bandage I leave on the baby is a softer one, which usually comes off on its own a few hours after the bris. I remind parents from the get-go that they need to report to me if the baby has not urinated a few hours after the bris. I consciously put the bandage on tight enough to constrict the bleeding, but not so tight to be uncomfortable for baby.
With the exception of babies who are extremely hungry after the bris, most babies I care for are calm when I finally leave them alone, and may even sleep comfortably for a few multi-hour stretches, waking up for feedings and diaper changes.
And I tell the baby's mother, "You see how he is now? That is how he should be throughout the rest of the day, except when he is telling you he is hungry or needs to be changed (which is when he normally cries anyway)."
Instead of Tylenol being the solution, let us return to appropriate TLC which will undoubtedly help ease the pain and make the ordeal so much easier for parents and baby.
1. Tylenol, and other OTC baby pain medications had some kind of recall (the details did not concern me personally as my children don't use any of the items in question, and I never recommend any of them as a mohel)
2. Someone I know, who lives in New York, had his son circumcised by a local NY mohel, and called me that evening, after his baby had an unusually difficult day, to confirm that what his mohel had told him was "normal" in the post-op care of the baby. Details to follow.
I will not address the Tylenol recall directly, as it is not my area of expertise. But the issue which is raised often enough is whether there is room to give the baby tylenol if he seems cranky after the bris?
My answer is twofold. Firstly, let your pediatrician recommend tylenol or something to ease your baby's discomfort. Most mohels I know are not physicians, and while they can offer advice, they are not in charge of your baby's long-term care. Even if the mohel IS a physician, if he (or she - there are female Dr. physicians who are mohelets) is not your baby's physician, the questions about medications should be directed to the primary long-term caregiver.
Secondly, and this leads into the second impetus as mentioned above, your baby should not feel discomfort after the bris.
You may ask, how could a baby not feel discomfort after going through this surgery? I don't know the answer to this question, but I can report on what I've observed.
Post-bris, most babies who have a bandage placed on comfortably, who have their needs met (clean diaper and full belly), sleep nicely, eat nicely, wet their diapers consistently, etc. They cry under the same conditions they cried for before the bris: dirty diaper, hungry, tired... The main difference will be that baby might wince when he urinates - which would be directly impacted by the bris.
So what causes a baby to be cranky after the bris?
The number one item that causes a baby discomfort is an uncomfortable bandage. It could be the material does not agree with him. The bandage may also be on too tight, constricting what should otherwise be an easy urine-flow.
In my personal experience, when I fiddle (as necessary, after the bris) to get a new bandage on, the baby will usually cry as I am reapplying a gauze pad. Once I am finished and leave the baby alone, he is usually calm and comfortable, the crying stops, and he either eats or goes right to sleep.
Solutions
And so I asked the father of the baby three questions:
1. Is it bleeding? (usually indicative of either a case that requires attention or a bandage that fell off prematurely)
2. Has the baby urinated? (if not, there is too much constriction on account of the bandage, and it needs to either be loosened, removed, or replaced with a looser and softer bandage)
3. Will your mohel come and check it?
If the bandage is on too tightly - guess what - Tylenol or Motrin ain't gonna do a thing.
*************************
I mentioned in a different posting that it is normal to see swelling after the bris, particularly on the ventral side of the penis. In this case, that was not as much of a concern from my perspective (though the father did see swelling and was concerned about it).
In the end, the mohel did come and check, he removed the bandage (or loosened it) and baby was able to urinate more readily, easily and comfortably.
The point of this story is not to knock another mohel. It is to encourage you to avoid jumping to conclusions, to avoid worrying, and to realize there may be a very simple solution.
I have taken steps to avoid this problem. The bandage I leave on the baby is a softer one, which usually comes off on its own a few hours after the bris. I remind parents from the get-go that they need to report to me if the baby has not urinated a few hours after the bris. I consciously put the bandage on tight enough to constrict the bleeding, but not so tight to be uncomfortable for baby.
With the exception of babies who are extremely hungry after the bris, most babies I care for are calm when I finally leave them alone, and may even sleep comfortably for a few multi-hour stretches, waking up for feedings and diaper changes.
And I tell the baby's mother, "You see how he is now? That is how he should be throughout the rest of the day, except when he is telling you he is hungry or needs to be changed (which is when he normally cries anyway)."
Instead of Tylenol being the solution, let us return to appropriate TLC which will undoubtedly help ease the pain and make the ordeal so much easier for parents and baby.
Wednesday, April 21, 2010
Getting Family and Friends Involved
In addition to the excitement and joy which comes with the birth of every child, friends and family gather to celebrate the continuation of our People, and our relationship with God that is symbolized by the bris.
For most people, especially those with a very close family, it is essential that family members participate in the ceremony. This is ideal.
Thankfully, the ceremony has many roles that need to be filled. But first, a word about protocol.
Men and Women
When it comes to public ceremonies, Jewish tradition has a thought about what is considered proper and improper, modest and immodest. These issues are subjects of a much larger discussion which I may write about elsewhere.
In a nutshell, to help keep modesty in check, Jewish law established separation of sexes in public ceremonies. As such, while a man may stand next to his wife (and vice versa), it is considered immodest for a man to stand with someone else's wife lest others perceive something, get the wrong idea and perhaps start gossiping.
Where the bris ceremony takes place, such as a home or a synagogue, would determine the proper protocol for the setting - is it, in essence, a private or a public ceremony? This would also determine the degree of participation of both sexes.
The Roles to be Played
In this segment, I will lay out the roles, briefly explain them, and make suggestions as to who should/can play the role and in what context it is inappropriate. Participants in the ceremony should all be Jewish. In the event the father is not Jewish, there are times when he can hold his son during the ceremony as well.
Kvatter - This couple (man and woman) bring the baby to the bris room, the wife taking the baby from his mother, handing him to her kvatter husband, who brings the baby to his father.
This is a male/female tag team. They are either a married couple, or a father/daughter or mother/son team (some might allow sister/brother)
Kisei Eliyahu (Elijah's Chair) - A person puts the baby on a chair designated for Elijah the Prophet.
In a synagogue it is usually a male, often the baby's uncle or great uncle, or some other relative or friend. At home, it can be the same, or baby's aunt, etc.
Sandak - Holds the baby on his lap during the bris.
Synagogue or home - the sandak must be male. First dibs go to baby's grandfather or great-grandfather. If grandfathers have been used at brisses of your older sons, some people include rabbis or dear friends, as the custom in Ashkenazic families is to not repeat sandaks among siblings.
Brachot/Blessings - Two blessings are recited to sanctify the moment and give special significance to the day.
The male reciting the blessings should read Hebrew fluently, understand their meaning, and should be a committed Jew. The default figures for these blessings are the mohel or the rabbi.
Naming the baby - This is a paragraph in Hebrew that officially invokes the baby's Hebrew name.
It is often recited by the same person who is honored to say the blessings (previous). It may be recited by anyone, but as it is a long paragraph in Hebrew, the person should be able to read Hebrew well.
EVERYONE in the room responds with declarations praising God and wishing well - blessings and all - upon the baby. When the crowd is unfamiliar with these Hebrew statements, I generally recite them word by word so all can repeat them together in unison.
Holding the baby for blessings and/or naming (previous two entries) - The person who plays this (these) role(s), should be significant to your family. Imagine this person having a relationship with you and your baby for a long time.
If one grandfather sat as sandak, consider having the baby's second grandfather hold him for the naming - this role is sometimes called the "Standing Sandak." Otherwise, in a synagogue a male will often play this role, while at home, it might be either of the baby's parents or grandparents. Sometimes two people will hold the baby together - both grandmothers, for example.
For most people, especially those with a very close family, it is essential that family members participate in the ceremony. This is ideal.
Thankfully, the ceremony has many roles that need to be filled. But first, a word about protocol.
Men and Women
When it comes to public ceremonies, Jewish tradition has a thought about what is considered proper and improper, modest and immodest. These issues are subjects of a much larger discussion which I may write about elsewhere.
In a nutshell, to help keep modesty in check, Jewish law established separation of sexes in public ceremonies. As such, while a man may stand next to his wife (and vice versa), it is considered immodest for a man to stand with someone else's wife lest others perceive something, get the wrong idea and perhaps start gossiping.
Where the bris ceremony takes place, such as a home or a synagogue, would determine the proper protocol for the setting - is it, in essence, a private or a public ceremony? This would also determine the degree of participation of both sexes.
The Roles to be Played
In this segment, I will lay out the roles, briefly explain them, and make suggestions as to who should/can play the role and in what context it is inappropriate. Participants in the ceremony should all be Jewish. In the event the father is not Jewish, there are times when he can hold his son during the ceremony as well.
Kvatter - This couple (man and woman) bring the baby to the bris room, the wife taking the baby from his mother, handing him to her kvatter husband, who brings the baby to his father.
This is a male/female tag team. They are either a married couple, or a father/daughter or mother/son team (some might allow sister/brother)
Kisei Eliyahu (Elijah's Chair) - A person puts the baby on a chair designated for Elijah the Prophet.
In a synagogue it is usually a male, often the baby's uncle or great uncle, or some other relative or friend. At home, it can be the same, or baby's aunt, etc.
Sandak - Holds the baby on his lap during the bris.
Synagogue or home - the sandak must be male. First dibs go to baby's grandfather or great-grandfather. If grandfathers have been used at brisses of your older sons, some people include rabbis or dear friends, as the custom in Ashkenazic families is to not repeat sandaks among siblings.
Brachot/Blessings - Two blessings are recited to sanctify the moment and give special significance to the day.
The male reciting the blessings should read Hebrew fluently, understand their meaning, and should be a committed Jew. The default figures for these blessings are the mohel or the rabbi.
Naming the baby - This is a paragraph in Hebrew that officially invokes the baby's Hebrew name.
It is often recited by the same person who is honored to say the blessings (previous). It may be recited by anyone, but as it is a long paragraph in Hebrew, the person should be able to read Hebrew well.
EVERYONE in the room responds with declarations praising God and wishing well - blessings and all - upon the baby. When the crowd is unfamiliar with these Hebrew statements, I generally recite them word by word so all can repeat them together in unison.
Holding the baby for blessings and/or naming (previous two entries) - The person who plays this (these) role(s), should be significant to your family. Imagine this person having a relationship with you and your baby for a long time.
If one grandfather sat as sandak, consider having the baby's second grandfather hold him for the naming - this role is sometimes called the "Standing Sandak." Otherwise, in a synagogue a male will often play this role, while at home, it might be either of the baby's parents or grandparents. Sometimes two people will hold the baby together - both grandmothers, for example.
Tuesday, April 13, 2010
What Makes a Jew
When I was studying to be a mohel in Israel, one kind of experience was repeated at many brisses.
As my teacher, Rabbi Mordechai Sasson, is a Sephardic mohel, most of the brisses he'd perform would be for Sephardic Jews, who have a rich cultural heritage which brings the entire family and community into every bris. (or should I say "brit"?)
Typically, after the ceremony was over and Rabbi Sasson was doing his post-op examination, some old-school grandmother or great-aunt would smilingly look upon the now circumcised baby and say עכשיו נהיית יהודי (akhshav nih'yayta yehudi) - "Now you have become a Jew."
Huh?
This concept may be true in other religions (e.g. before baptism, a Christian child is not a Christian), but in Judaism, one's Jewishness stems from one's birth mother. If the mother is a Jew, the child that emerges is a Jew. Consider girls, who are thankfully not circumcised. How are they to "become" Jews if circumcision is what makes a Jew?
Circumcision does not make a person a Jew.
While this blog is not the forum for discussing the rules surrounding conversion and the Reform practice of accepting people as Jews based on patrilineal descent, I am here to discuss the role of circumcision in all of these procedures.
Judaism manifests itself in Jews in two ways - nationally and religiously - and both are meant to be informed and enlightened by the totality of what we call "Torah" (not just the Five Books of Moses). According to Jewish law, the national element is given to a person at birth and can never be revoked (except in very extreme cases of apostasy). The religious component has always been a question of individual practice - there have always been Jews who were more observant of the law and the Torah's guidelines and Jews who were less observant of the law and the Torah's guidelines.
Religion
In the last few hundred years, there have been different movements in Judaism who defined new ways to experience the "religious" element of their Judaism (in no particular order): Hassidim (and all its branches and extremes), Maskilim, Reform (and all its branches and extremes), Conservative (and all its branches and extremes), Orthodox (and all its branches and extremes), Reconstructionist, BILU, New-wave, Humanist, Traditional, Cultural, non-affiliated (the list is surely not exhaustive).
Most continue to circumcise their sons. Some do not.
National
On the national level, a Jew should ideally feel a sense of camaraderie with other Jews. (Yesterday was Yom HaShoah - I have long advocated that if Hitler did not distinguish between Jews, why should we treat other Jews in any manner other than respectfully?) Some people express this through their family name, through a "Jewish feeling," culturally, identifying with other Jews ('some of my best friends are Jews!'), identifying with the land of Israel, the State of Israel, the people of Israel, Yiddish theater, eating "Jewish food," etc.
Most continue to circumcise their sons. Some do not.
Bottom Line
According to all Jewish approaches, if a child is born to a direct maternal-line of Jews, the child is Jewish, regardless of levels of observance. (The questions arise when a conversion took place in that maternal line, as to what were the circumstances of the conversion.)
The circumcision the boys undergo puts a mark on the flesh that is the symbol of the covenant God made with Abraham in Genesis 17.
When a male non-Jew decides to go through the process of conversion, he may undergo circumcision (if he was not circumcised as a child) or an equivalent procedure significance-wise (if he is already circumcised), but the circumcision is not what makes him a Jew, though it is part of the process and his conversion would be incomplete without it.
Any person who converts undergoes a program of study, and is dutifully tested for sincerity and commitment to the Jewish faith, and subsequently immerses in a mikveh, under the auspices of a Bet Din to complete the conversion.
As my teacher, Rabbi Mordechai Sasson, is a Sephardic mohel, most of the brisses he'd perform would be for Sephardic Jews, who have a rich cultural heritage which brings the entire family and community into every bris. (or should I say "brit"?)
Typically, after the ceremony was over and Rabbi Sasson was doing his post-op examination, some old-school grandmother or great-aunt would smilingly look upon the now circumcised baby and say עכשיו נהיית יהודי (akhshav nih'yayta yehudi) - "Now you have become a Jew."
Huh?
This concept may be true in other religions (e.g. before baptism, a Christian child is not a Christian), but in Judaism, one's Jewishness stems from one's birth mother. If the mother is a Jew, the child that emerges is a Jew. Consider girls, who are thankfully not circumcised. How are they to "become" Jews if circumcision is what makes a Jew?
Circumcision does not make a person a Jew.
While this blog is not the forum for discussing the rules surrounding conversion and the Reform practice of accepting people as Jews based on patrilineal descent, I am here to discuss the role of circumcision in all of these procedures.
Judaism manifests itself in Jews in two ways - nationally and religiously - and both are meant to be informed and enlightened by the totality of what we call "Torah" (not just the Five Books of Moses). According to Jewish law, the national element is given to a person at birth and can never be revoked (except in very extreme cases of apostasy). The religious component has always been a question of individual practice - there have always been Jews who were more observant of the law and the Torah's guidelines and Jews who were less observant of the law and the Torah's guidelines.
Religion
In the last few hundred years, there have been different movements in Judaism who defined new ways to experience the "religious" element of their Judaism (in no particular order): Hassidim (and all its branches and extremes), Maskilim, Reform (and all its branches and extremes), Conservative (and all its branches and extremes), Orthodox (and all its branches and extremes), Reconstructionist, BILU, New-wave, Humanist, Traditional, Cultural, non-affiliated (the list is surely not exhaustive).
Most continue to circumcise their sons. Some do not.
National
On the national level, a Jew should ideally feel a sense of camaraderie with other Jews. (Yesterday was Yom HaShoah - I have long advocated that if Hitler did not distinguish between Jews, why should we treat other Jews in any manner other than respectfully?) Some people express this through their family name, through a "Jewish feeling," culturally, identifying with other Jews ('some of my best friends are Jews!'), identifying with the land of Israel, the State of Israel, the people of Israel, Yiddish theater, eating "Jewish food," etc.
Most continue to circumcise their sons. Some do not.
Bottom Line
According to all Jewish approaches, if a child is born to a direct maternal-line of Jews, the child is Jewish, regardless of levels of observance. (The questions arise when a conversion took place in that maternal line, as to what were the circumstances of the conversion.)
The circumcision the boys undergo puts a mark on the flesh that is the symbol of the covenant God made with Abraham in Genesis 17.
When a male non-Jew decides to go through the process of conversion, he may undergo circumcision (if he was not circumcised as a child) or an equivalent procedure significance-wise (if he is already circumcised), but the circumcision is not what makes him a Jew, though it is part of the process and his conversion would be incomplete without it.
Any person who converts undergoes a program of study, and is dutifully tested for sincerity and commitment to the Jewish faith, and subsequently immerses in a mikveh, under the auspices of a Bet Din to complete the conversion.
Thursday, March 18, 2010
Hatafat Dam Brit
With the holiday of Pesach (Passover) approaching, it is appropriate to discuss the connections that bris shares with the holiday - and there are many.
One of them is the role of blood in the covenant.
The name of the holiday of Pesach comes from two sources: A. the Paschal lamb, the offering that was set aside for three days before being sacrificed and eaten by the Jewish people in Egypt, and B. the fact that God "passed over" the homes of the Hebrew slaves in Egypt on the night of the "Death of the First Born."
The Paschal Lamb is called the קרבן פסח - Korban Pesach, and the verb to "pass over" is פסח - Pasach - which is formulated slightly different in the name of the lamb and the holiday itself.
What caused God, or the destroying angel, or the death force to pass over the homes of the Hebrew slaves, the Israelites? If the edict against first borns was only against Egyptians, did the Israelites really need to do anything in order to be bypassed?
The answer to the first question is the blood of the lamb. The Israelites were instructed to put the blood of the lamb on the doorposts and mantle of their homes on the evening of the final plague to cause their houses to be skipped.
The second question is a trick question. Surely God knows the difference between the homes of those He is looking to punish and those He wishes to avoid. That is clear. But the Israelites needed to do something, to indicate they understood what was going on. They needed to show their faith in God, and in Egypt, on that night, their faith was demonstrated through following instructions.
Thus, in Egypt, the people were physically and symbolically saved through the merit of the blood of the Paschal lamb.
While the greater significance of blood is not the scope of this posting - there is much written about it in rabbinic teachings - the general significance of blood is that covenants are forged through it.
To our point - bloodless circumcisions, medical circumcisions and circumcisions pre-conversion
In the event that a baby is circumcised through a bloodless technique - which can be accomplished through the use of certain clamps - the bris is not considered to be "kosher." (This point is worthy of discussion, and I will return to it in a different posting) Of course, once the baby is circumcised, (hopefully) there is no more circumcision to be done.
Circumcisions done either not for the sake of a bris (ie by a doctor), before the eighth day of life, or by a non-Jewish officiant are all not considered to be "covenantal." In order to turn the "circ" into a "bris milah" a minor procedure involving the drawing of blood needs to take place under the proper auspices.
We draw a minimal amount of blood from the circumcision scar, typically using a medical lancet, the sterile pin used for blood tests. Once blood is drawn under the auspices of a bris ceremony, the circumcision is now considered to be a bris according to Jewish law.
(To bring an example from a different religion, and NOT TO COMPARE THE TWO RITUALS, you can pour as much water as you want onto a baby or a convert to Catholicism. But until the water comes in the form of baptism and is done by the right person in the right place, it is considered meaningless.)
The blood we are talking about is absolutely minimal. Most people who experience it as adults (converts, or those who discover they were circumcised in the hospital and want to make sure it is "corrected") feel the significance more than they feel the pin-prick that draws the blood.
Babies upon whom I have done this are usually smiling and cooing through the half second it takes. Healing time is virtually nothing.
One of them is the role of blood in the covenant.
The name of the holiday of Pesach comes from two sources: A. the Paschal lamb, the offering that was set aside for three days before being sacrificed and eaten by the Jewish people in Egypt, and B. the fact that God "passed over" the homes of the Hebrew slaves in Egypt on the night of the "Death of the First Born."
The Paschal Lamb is called the קרבן פסח - Korban Pesach, and the verb to "pass over" is פסח - Pasach - which is formulated slightly different in the name of the lamb and the holiday itself.
What caused God, or the destroying angel, or the death force to pass over the homes of the Hebrew slaves, the Israelites? If the edict against first borns was only against Egyptians, did the Israelites really need to do anything in order to be bypassed?
The answer to the first question is the blood of the lamb. The Israelites were instructed to put the blood of the lamb on the doorposts and mantle of their homes on the evening of the final plague to cause their houses to be skipped.
The second question is a trick question. Surely God knows the difference between the homes of those He is looking to punish and those He wishes to avoid. That is clear. But the Israelites needed to do something, to indicate they understood what was going on. They needed to show their faith in God, and in Egypt, on that night, their faith was demonstrated through following instructions.
Thus, in Egypt, the people were physically and symbolically saved through the merit of the blood of the Paschal lamb.
While the greater significance of blood is not the scope of this posting - there is much written about it in rabbinic teachings - the general significance of blood is that covenants are forged through it.
To our point - bloodless circumcisions, medical circumcisions and circumcisions pre-conversion
In the event that a baby is circumcised through a bloodless technique - which can be accomplished through the use of certain clamps - the bris is not considered to be "kosher." (This point is worthy of discussion, and I will return to it in a different posting) Of course, once the baby is circumcised, (hopefully) there is no more circumcision to be done.
Circumcisions done either not for the sake of a bris (ie by a doctor), before the eighth day of life, or by a non-Jewish officiant are all not considered to be "covenantal." In order to turn the "circ" into a "bris milah" a minor procedure involving the drawing of blood needs to take place under the proper auspices.
We draw a minimal amount of blood from the circumcision scar, typically using a medical lancet, the sterile pin used for blood tests. Once blood is drawn under the auspices of a bris ceremony, the circumcision is now considered to be a bris according to Jewish law.
(To bring an example from a different religion, and NOT TO COMPARE THE TWO RITUALS, you can pour as much water as you want onto a baby or a convert to Catholicism. But until the water comes in the form of baptism and is done by the right person in the right place, it is considered meaningless.)
The blood we are talking about is absolutely minimal. Most people who experience it as adults (converts, or those who discover they were circumcised in the hospital and want to make sure it is "corrected") feel the significance more than they feel the pin-prick that draws the blood.
Babies upon whom I have done this are usually smiling and cooing through the half second it takes. Healing time is virtually nothing.
Tuesday, February 23, 2010
The Most Common Issues After the Bris
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...]
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...]
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.
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