FAQ
WHEN DOES THE BRIS OCCUR?
The bris occurs on the EIGHTH DAY OF LIFE, which is generally the same day of the week as the birth (ie: a baby born before sunset on Tuesday would have a Tuesday bris). If a baby is born after sunset, it is considered Erev for the next day (a baby born after sunset on Tuesday would have a Wednesday bris). A bris may at times occur on Shabbat or other Holy Days, depending on specific circumstances. A bris performed after the eighth day is still kosher, however, it can never occur before the eighth day, and must always occur during daytime (before sunset).
WHAT DO YOU USE FOR PAIN RELIEF?
I have perfected an anesthetic approach which uses four different pain relief methods, each working through different pathways, to maximize the baby's comfort.
I will call in a prescription for EMLA, a topical Lidocaine formulation used in many hospitals and by many doctors and mohelim for circumcision.
I also recommend a single, preemptive dose of infant Tylenol. Having the pain medication on board BEFORE the pain occurs, makes it significantly more effective.
I arrive early and prepare a sugar solution to give to the baby. Sugar water is used routinely as pain relief for newborns about to undergo medical procedures in the NICU and newborn nursery,
I give the baby a small amount of Manischewitz sweet wine, the pain relief options used for millennium.
These steps are used in coordination with the timing of the baby's feeding schedule, to give him maximal comfort during the circumcision and throughout the ceremony. Ninety percent of my babies sleep through the circumcision.
I have been asked if giving an injection of lidocaine is more effective than the EMLA cream. I do not believe so, there is pain to the baby at the time of the injection, so although it blocks some experience of pain, it also adds additional pain. I have circumcised both with and without injectable lidocaine and I have observed that the baby is as comfortable, if not more comfortable, with my current four step method.
I am aware that there are a small number of mohelim who express opposition to the use of EMLA cream but have never heard any reasonable rationalization from them. Some erroneously believe that pain should be a part of the bris. This is not true, in fact even in the time of Maimonides, minimizing the experience of pain for the baby was supported. There are no major health risks associated with the proper use of EMLA, which is used on newborns routinely, and even required for circumcisions in some hospitals. Because the cream does require a prescription, non-medical mohelim may merely oppose what they cannot provide.
WHAT CLAMP DO YOU USE?
There are two clamps most commonly used in the US for britot and circumcision: the Mogen and the Gomco. The Mogen has a design which more closely resembles the tools used in antiquity but with some modifications. The Gomco was designed in 1935 to be an improved method of circumcision. Both tools are extremely safe, there are only a small number of serious complications that occur each year, but only the Mogen is associated with injury to the glans (penile head). I trained with both and feel comfortable to use either. However, I use the Gomco exclusively to decrease the surgical risk of this ritual. An additional benefit of using the Gomco is that it results in a nicer aesthetic look because it distorts the tissue less.
WHEN SHOULD I GET IN TOUCH?
I recommend reaching out to me about 4-6 weeks ahead of the due date. I like to learn about you and discuss any questions or particular concerns you might have. I will need you to fill out and email back an information sheet, most of which you can complete before the baby's arrival. Having that done in advance can make things smoother when we are actually in the time crunch after birth. Please call me so we can talk. I do prioritize families that I have been working with when determining my schedule.
WHAT IF I DON'T KNOW IF I AM HAVING A BOY OR A GIRL?
I do not mind talking to you even if you are unsure of the sex of the baby. It is still a useful opportunity to share some information and to have the chance to think about various options for welcoming your child, boy or girl.
WHAT DO I DO WHEN I DELIVER?
Email me AS SOON as you deliver. I may have more than one family who delivers on any given day, I need to as soon as possible so I can arrange the schedule.
