"The Natural Approach"
Uniquely from all other mitzvos, over thousands of years, the Jewish Nation has clung onto the mitzva of Bris Milah. However, over the many years, the techniques and ingredients used have changed greatly. In general, Mohelim are greater experts in Bris Milah than doctors, however this progression has taken place outside the field of medical oversight and research. The issue with this is that over the past ten years, some Mohelim have started using ingredients and techniques which are potentially damaging. They claim that they haven't seen any problems as a result. The problem is that the Mohel only removes the bandage the day after the Bris. After that, in general, they will not see the baby again.
I spent a number of years working in the "Beit Hachlama" of Telzstone.
Working in the "Beit Hachlama" in Telzstone, as a Mohel whose responsiblily it was to care for approximately 5000+ post-Bris baby boys yearly, I had the unique vantage point of being able to observe the effects of the different chemicals and techniques that most modern Mohelim use.
There were frequent complications that arose due to these things (I will get to them shortly), but the most common problem which I observed was that the babies who had been treated with non-natural chemicals and techniques took much longer to heal.
I also noticed that while most Mohelim focus on doing a nice job, almost none of them focused on the healing process.
The three main catalysts which delayed the healing process were:
2) Excessive Lidocaine application, and
I will soon explain how these things adversely affect the healing process.
Another issue was that there were other complications which would occasionally arise:
1) Discolorization of the glans,
2) Burnt-looking wound,
3) Abnormal skin adhesion,
I will now explain how the aforementioned catalysts could cause these problems:
Adrenalyn is a vessel-constricting chemical which causes hemostasis, the stopping and clotting of blood. It is good for most large wounds, but it is not to be used on the extremities of the body, i.e. fingers, toes, penis, etc.
The reason is that using Adrenalyn could completely cut off circulation to the extremity. In the worst case scenario, this could cause gangrene, which is when that part of the body dies. Generally this is not the case, but frequently the wound suffers from lack of blood supply, causing other problems.
Another problem it can cause is abnormal skin adhesion. When a wound heals, the healthy skin will seek out another healthy skin to attach to. If the area in between is unhealthy, the skin will skip over that area and attach itself to the next healthy surface. When this happens, the area of the baby's wound could attach itself to the glans. If this happens, it can create erection problems such as inability to achieve or painful erections.
Additionally, when the wound has suffered a lack of blood supply, the area is unhealthy, which can cause a burnt look. Furthermore, since the skin is unhealthy now, it can delay the healing process greatly.
Excessive Lidocaine application is another common mistake that Mohelim make. The Ministry of Health in Israel legally allows the use of up to 5% Lidocaine. Many Mohelim use up to 10%, with multiple applications! Aside from being completely unneccessary (My experience is that 2% is fine), highly concentrated Lidocaine could make its way to the heart, and that could be very dangerous.
And like Adrenalyn, excessive use of Lidocaine damages the wound and delays the healing process.
Cauterization is another technique which is misused, albiet less commonly. Cauterization is when you locate a blood vessel which is bleeding, and manually burn it shut. For starters, this is painful for a baby! It leaves scarring and also slows down the healing process.
What is most bothersome about all of the above is that it is completely unneccessary: With proper bandaging and pressure, there should be no problem achieving hemostasis. This can occasionally take a little longer, but the healing is so much quicker and nicer that it is a no-brainer!
I very much believe in going with a Natural approach, using natural powders (Bismuth, Kaolin, Talc, etc) and techniques to achieve hemostasis. I have seen how babies with this approach heal within a day or two of the Bris!
It is also important for the Mohel to teach the parents how to clean the wound. This is something neglected by most Mohelim (or not known - many Mohelim just tell parents to soak the wound in a bath), and the difference is stark: When the wound is cleaned properly and daily, the wound doesn't need to fight off bacteria, and instead can focus on healing. This as well causes the wound to heal faster.
Although there is much more to be discussed about this topic, I hope I did justice explaining the nature and problems involved in these techniques.
For more information about Bris Milah, including What is a Bris, What do I need to know etc, visit my website: www.thebrisguide.com