Printed from JewishMelbourne.com.au

FAQ: Pain? Anaesthetic? Cost?

FAQ: Pain? Anaesthetic? Cost?

 Email

FAQs

Does the Baby Feel Pain During the Circumcision?

The traditional Jewish brit milah, the clamp and the baby

 
 

Hi Rabbi,

It’s the night before my son’s circumcision and I cannot sleep. I know my child is not the first to be circumcised, but I am worried about the lack of anesthesia. Will he feel much pain? Will he be traumatized?

Answer:

I can relate to your worries. It is normal for a mother to worry! In fact, I would be quite disconcerted if you were not worried about your newborn’s health and wellbeing.

Perhaps you can take comfort in the knowledge that circumcision, known as brit milah, has been performed in this manner for over 3700 years, and that it is incumbent upon the mohel, the expert Jewish circumciser, to perform the procedure in a way that will minimize your son’s pain and discomfort.

The Traditional Circumcision

When the mohel performs the circumcision he makes a swift motion with an izmel – a traditional scalpel used for brit milah – which is intended to minimize the pain and discomfort.

Those who stand close to the mohel will notice that the infant usually starts to cry as soon as the diaper is opened, and stops crying as soon as it’s closed. In fact, during the newborn stage, many infants cry anytime they are changed or bathed. The cry is not necessarily pain-related. Typically the infant is calm as the blessings are made over a cup of wine and his Jewish name is announced.

It’s interesting to note that the traditional circumcision is performed on the eighth day of the child’s life when his clotting factor has fully developed, which is optimal for healing. At the same time, the nerve endings are not completely developed which lessens the infant’s discomfort.

The traditional brit milah does not involve anesthesia, as we do not want to cause the possibility of additional complications. Ansthesia can also have negative side effects in such young children.

All said, the brit milah is performed at the healthiest time, using the best method, and it has been documented that complications from a traditional circumcision are extremely rare.1

The Painful Way

Hospital and non-traditional circumcisions often involve use of a clamp. This method is extremely painful and traumatic to the child as the clamp actually crushes the skin tissue prior to severing it. This painful method is prohibited by Jewish law and does not fulfill the Biblical requirement of circumcision.

 The FDA has also issued a warning in regards to using a clamp for circumcision as it can lead to laceration, hemorrhage, penile amputation, or urethral damage.

The Eternal Covenant

Think about the importance of the brit milah which has been observed faithfully for thousands of years, ever since our forefather Abraham circumcised himself at the age of 99.

I am sure when the circumcision is over, and you hold your dear son, you will realize the discomfort is short lived but the results are forever: your child will have entered an eternal covenant with G‑d.

Mazal Tov! May we share only joyous occasions!

See The Ritual Circumciser - The “Mohel” from The Handbook to Circumcision - Brit Milah.

 
 
 
 
FOOTNOTES
1.

See studies from Lander J, Brady-Fryer B, Metcalfe JB, Nazarali S, S. M.; and Shechet J, Fried SM, Tanenbaum B. J Am Med Assoc 1998; 279: 1170.

 

Anaesthetic

 The 2 most commonly suggested methods of anaesthesia during neonatal circumcision, the Emla cream and injecting an anaesthetic into the penis prior to the bris are either counter-indicated for traditional bris or, at best, unnecessary and even potentially damaging.

According to the manufacturers, use of Emla is not routinely recommended for a child 0-12 months of age. Additionally, from conversations with a number of local and international mohalim (ritual circumcisers), it has been commonly observed that the use of EMLA leads to a far greater incidence of post-operative bleeding. Accordingly, the vast majority of Mohalim recommend against the topical application of EMLA prior to a routine 8-day old bris.

Administering a local anaesthetic to a 8 day old child prior to bris, is both Halachicly problematic and seemingly medically unnecessary. From extensive research, it can confidently be stated that no credible Rabbinic Authority has ever recommended routine local anaesthetic prior to traditional circumcision; considering it perversion of the tried and tested tradition. Additionally, according to a number of medical professionals, the pain felt by the child in being injected with a local anaesthetic would be roughly equivalent to the pain of a bris performed by a competent mohel. In the words of one highly experienced mohel "the only reason to give a baby an injection before his bris is so that all those watching can congratulate the mohel on how little the baby cried. What right do you have to privately cause a baby pain before the bris, just so you can get a cheap compliment in public?"

According to a prominent Melbourne paediatrician*, who has observed a number of Rabbi Greenbaum's Brisses as well as brises performed under anesthetic by another Mohel, he could observe no appreciable difference in either the amount the babies cried during the bris, nor was there any justification, as far as he could understand to justify the (admittedly small) risks of anaesthetising a healthy neonate for the (at best) minute differential in short-term pain experienced during the circumcision.

* for professional reasons, the doctor did not wish his name publicised online, but kindly offered to privately answer any questions from concerned parents currently contemplating a bris. Please contact Rabbi Greenbaum on 0403 490 434 for his details.

 

How Much Does a Mohel Cost?

Dear Rabbi,

My rabbi gave me the number of a mohel, an experienced ritual circumciser. We had a wonderful conversation, and he was very helpful; however, when I asked him what the charge was, he told me that I could pay however much I wanted.

I am amused and confused at the same time. I find it amusing that such a complicated procedure does not have a set charge, and on the other hand, I am confused as to how much I should actually pay.

Answer:

Mazel Tov on the birth of your new child! May you merit bringing him into the covenant of Abraham.

Jewish law states clearly that it is incumbent upon the father to circumcise his son by himself. However, most fathers cannot do the circumcision by themselves, and therefore appoint a surrogate, an expert mohel, to perform the circumcision, the brit milah, on their behalf.1

Recognizing the difficulty this extra expense could cause, Rabbi Moses Isserles writes in his gloss on the Code of Jewish Law that the mohel should not refuse to perform a circumcision if someone does not have the funds to pay for it. He adds that, in fact, mohels are generally enthusiastic to circumcise a child even if there is no payment.2

For this reason, it is the custom among many mohels not to ask for any specific amount, leaving it in the hands of the family to decide how much to pay. The mohel you called is actually following an ancient Jewish custom.

I once asked the well-known expert mohel Rabbi Levi Heber: does he keep a list of those who owe him money? He shrugged his shoulders and said, “I have no such list, and if a family that did not pay would come to me in several years, I would not remember if they paid or not.”

While there are some circumcisers who have income from other sources, the Rebbe, Rabbi Menachem Mendel Schneerson, of righteous memory, suggested that the mohel should not say that the service is free, and should let the family know that they can pay whatever they can afford.3

A reason why the circumcision should not be done free of charge might be explained by the requirement, mentioned above, that the father actually do the brit milah himself. When the father pays for the services of the mohel, it is considered as if he actually did the mitzvah himself, even more than if he were to just delegate the mohel as a surrogate.4

I could not get a straight answer from my mohel on how much to pay for the brit, but from asking around, it seems that most parents give somewhere between $400 and $800 (Though one parent explained to me that such a great procedure should not be done for so little, and he gave $1,500).

When calculating how much to pay, keep in mind that today many mohels do this for a living. In your calculation, you should add any travel costs that he may have had.

Rabbi Heber said that in his experience as a mohel he has even lost money doing circumcisions, with sometimes even his travel expenses not being covered. “For me, the most important thing is that the young child should be circumcised; payment is secondary.”

See also The Ritual Circumciser—The Mohel, from our minisite Brit Milah: The Covenant of Circumcision.

Let me know how it works out.

 
 
 
FOOTNOTES
1.

The Code of Jewish Law (Shulchan Aruch), Yoreh De’ah 260:1 and 261:1.

2.

Ibid. 261:1.

3.

Heard from Rabbi Aron Leizer Ceitlin, whose father asked the Rebbe if he should stop accepting payments.

4.

See Rabbi Y.D. Weissberg, Otzar Habrit 3:6.

 

 

 

 Email
JAE

Your Child will be EXCITED to Attend!

 
Bagel Babies

For Mums, Bubbas, Bubs & Tots

 
Sparks Holiday Blast

#1 Jewish Website