The Parent's Comprehensive Guide to Bris Milah
Rabbi Shlomo Golish
Choosing a Mohel
An important decision new parents have to make is which Mohel they will use. Many parents will use the Mohel their family or friends have used, and some just want the Mohel with the biggest name. Whatever the case, here are a few points to take into account:
Does the Mohel provide a Pre-Bris checkup? While there are many excellent Mohelim out there, some of them will not check the baby before the Bris. While in general a Mohel can establish in a quick phone conversation whether there are any issues with a baby, there can always be surprises. Also, some parents just want to be reassured that everything is OK, and some just want to get to know the Mohel a bit first.
Does the Mohel provide Post-Bris aftercare? Every Mohel bandages differently, and some tell the parents to remove the bandage themselves the day after the Bris. While some parents are fine with this, others don't want to touch the area at all and are afraid to get involved in this aspect. Others just want the Mohel to tell them that it looks great and is healing nicely.
Does the Mohel speak English? This may seem obvious, but frequently a new father will call a Mohel who doesn't speak English, and aside from other communication issues, frequently the mother is uncomfortable speaking to the Mohel at all, and she is left alone throughout the process.
Is the Mohel approachable? Many new mothers would like to speak to the Mohel and be reassured about any questions they have. It is important for a family to take a Mohel who they are comfortable communicating with and asking questions to.
Is the Mohel using natural ingredients or not? Unfortunately, over the past few years, many Mohelim have switched over to some controversial chemicals and techniques. They are the following:
Adrenalyn - This hormone causes the blood vessels to constrict, stopping the bleeding. It does a great job of that, but doctors are taught in Medical School that this should not be used on the body's extremities, i.e. fingers, face, toes, penis, ears, etc. The reason for this is simple. Using it on those areas can completely cut off blood to the area and cause gangrene, which is when an area of the body dies from lack of blood supply. The Mohelim who use this on the bandages will always make sure to remove it after the Bris, but even this is warned against by doctors. The effect of having a low blood supply to the area, even for small periods of time, frequently cause complications in the healing process.
Often, in the days after the Bris, the wound will look burnt, the glans will shrink and become white, a symptom of insufficient blood supply. The natural color of the glans is supposed to be red, not white. This hormone causes the wound to heal much slower than if natural methods were applied. In addition, there is no Mohel who can guarantee you that there are no long term consequences to using it, because no proper studies have been done. The reason no studies have been done is because in the world of medicine this is not used on newborn babies, or on penises. It is possible that the baby could loose some feeling there for the rest of his life. Some believe that the prevelant use of Adrenalyn has caused the spike in children with Meatal Stenosis, a condition where the child's hole which he urinates from is too small and needs an operation to open it up more. When used on certain babies with specific anatomies, it can cause the cut to heal itself to the glans, sometimes creating problems with erections. Be especially careful about this one, because not all Mohelim are honest about whether they use this or not.
Lidocaine 10% - Although most Mohelim use Lidocaine, a liquid anesthetic, on their bandages, many have started to use very highly concentrated amounts, up to 10%. The Health Ministry in Israel permits up to 5%. The truth is that even lower amounts like 2% are more than enough to numb the entire area. The reason high amounts are unsafe is that the anesthetic is being placed directly on the open wound, which is connected to the circulatory system. If there is too much anesthetic entering the circulatory system, it could go to the heart or the brain. In addition, the high volume of anesthetic slows down the healing process.
Cauterization - This is a method of manually burning blood vessels shut with a cautery pen. Many Mohelim who use this are trying to save themselves time, but it is the baby who has to pay for it. In essence, they are taking a boiling hot pen and burning the blood vessels shut.
This presumably causes a lot of pain, and frequently they use it all around the vessel, not just on the exact spot. This damages the healing process, and can potentially create complications down the line as well.
What I have written here are not theories, rather they are facts. I have the unique vantage point that I worked daily in the Beit HaChlamah of Telzstone, where I would care for all of the baby boys there, pre and post Bris (No matter the who was the Mohel). Approximately 10,000 new mothers and babies pass through there annually. I have carefully studied the negative effects of the aforementioned techniques and chemicals, and I have seen things there that would make one's hair stand on end.
As a rule of thumb, one should be looking for a Mohel who has the baby's best interests in mind, not one who makes decisions based on what makes things easier for themself or one who tries to finish the job and leave as fast as possible.