Rav Hayim Leiter
The Safest Circumcision
Updated: Apr 5, 2020
Israel is basically in complete lockdown. We are only meant to leave our houses if we absolutely need to. Other than restocking our supplies, I’ve only left our home twice in the last week: once to officiate a wedding and once to perform a Brit Milah. Whenever I mention this to people the first question is, ‘should you even be performing a Brit Milah under these conditions?’ The answer is yes, but some necessary precautions need be taken. Here is a list of things that must be done to protect your newborn. Keep in mind, the medical community is learning more and more about this virus each and every day, so this list is subject to change.
The Environment- Families should bring their baby home as soon as possible. When it comes to circumcision, a doctor who is not trained as a mohel tends to take 7-10 minutes to do the procedure alone, whereas a resident can take 20-45 minutes and parents are generally not permitted to be present. Mohalim tend to take 1-2 minutes to perform the same procedure substantially reducing the child’s discomfort. Additionally, if the circumcision is done in the hospital, before the eighth day, an additional procedure is religiously required called Hatafat Dam Brit (drawing a drop of blood). The best scenario is to do the Bris at home, on time with the subsequent precautions in place.
Guests- There is no requirement for a minyan when it comes to a Bris. It is advisable to keep the numbers to the bare minimum and certainly not exceeding ten people total, including the mohel and baby. Ideally, the event should be done at the family’s home with only the parents, baby and mohel physically present. All other family and friends can be present virtually on Zoom, or other similar platforms.
Tool Sterilization- if one is using disposable tools, they must be thrown away between each usage. For reusable tools (which are the norm), they must be sterilized in an autoclave in between each usage. An autoclave removes 100% of all germs. This sterilization practice is required under normal conditions, so all the more so for our present state in battling the virus.
Handwashing- the mohel must wash his hands with medical-grade soap for 3 minutes before setting up his tools. And once the hand washing is complete he must refrain from touching anyone or anything with his bare hands.
Gloves- mohelim should always be using gloves. After I wash my hands I use latex gloves to set up my tools and then sterile surgical gloves when the Bris is about to start. I have already seen footage of mohalim performing Britot in full body scrubs, including a cap and goggles but without gloves. This makes no sense and must be changed immediately.
Mask- The ideal mask to wear is the N95 because it’s the most tight-fitting. For instructions on the best way to put on the mask from the World Health Organization click here. Most of the literature states that masks are not for the individual wearing it but for those around them. And when it comes to the safety of the child, that is paramount. There have been very few reported cases of infants contracting Coronavirus, but even just the possibility of a newborn contracting the virus makes it our responsibility to keep the environment as safe as possible. Anyone who is close to the baby should also be wearing a mask, wash their hands, and be wearing gloves; that means the mohel, father, Sandek, and anyone holding or carrying him.
Metzitzah- under normal circumstances I advocate that Metzitzah with a sterile tube (either disposable or a glass tube that’s been sterilized in an autoclave with gauze inside). It should NEVER be done with direct oral contact. Whenever a mohel is even a little under the weather, he should not even use a tube for Metzitzah. It is well documented that the mouth of a healthy person is always dirty and can never be fully cleaned. The moment there are additional germs present, Metzitzah should be done as the Hatam Sofer and Rav Ovadia Yosef ruled permissible, by hand with sterile gauze.
There are many who will fight me on this last issue, but it’s imperative that this practice cease and desist immediately until the virus is under control. There is a great deal of misinformation presently floating around the internet. This is a publication from an organization called Anash which was released just before Shabbat and it details their halachic advice in the wake of the Coronavirus. When it came to Brit Milah the advice stated:
“The holy practice of metzitzah b’peh (orally) should be continued. The mohel should rinse his mouth with Listerine, as this destroys the virus. The Herpes virus is more dangerous to infants than the Corona virus, and Boruch Hashem no child has ever been infected with Herpes due to metzizah b’peh. Therefore, there is no reason for a mohel to discontinue this practice at this time, provided of course that he is not ill and takes the necessary precautions. If the child’s parents (are not religious and) refuse to allow metzitzah b’peh, the mohel should perform metzitzah with a tube instead, and he should not make an issue about metzitzah b’peh at this time.”
There is a litany of problems with this paragraph, but most troubling is that they’re ignoring one major factor of the Coronavirus: one can be infected with the virus but show no symptoms and be contagious. That’s the main reason we’re in the place we are globally. But more reasonable posekim, such as Rav Shachter, have railed against Metzitzah B’Peh even before the age of Coronavirus, so now is a time which requires even greater precautions.
The majority of this list is intended to help mohalim tailor their practices to continue our sacred ritual in a time of heightened health risks. But it is the job of parents to demand these practices from their mohalim as well. Do not be passive and trust that your mohel will do everything needed to keep your child safe. Protecting your newborn is your job. As Rav Schacter pointed out when speaking about the practice of Metzitzah B’Peh, the Halacha is listening to modern medicine. And the medical establishment is clear, these are the steps which must be taken to keep our children safe.
This first appeared here