Dr. April RubinApril Rubin, M.D., F.A.C.O.G.
Mohel (Mohelet)
Board Certified Obstetrician/Gynecologist
Performing brit milah (bris) in DC, Virginia and Maryland
202-841-3329
aprilrubin@dcmohel.com

For OB/GYN practice and non-Jewish medical circumcisions:  202-547-4604

"May your mother and father rejoice; and may the one who bore you thrill with joy." (Proverbs 23:25).

Mazel Tov on the birth of your son.  And welcome to my web page.  This is an exciting time for parents, grandparents and the entire family.  The brit milah (bris), or ritual circumcision, is a heartfelt and joyous experience.  Arranging for it, however, can be stressful and confusing. Hopefully, the information I provide on this site will help make preparations smoother. 

As a board-certified obstetrician/gynecologist who has been performing circumcisions for over thirty years, and a mohelet (female mohel) performing brit milah since 2003, I will do my best to make this day the significant event that it is in your son’s life.  My approach to the brit milah ceremony is one of personal attention to your individual needs.  I work directly with the family to create a participatory service that is shaped by the specific needs and desires of the parents, intended to involve and include as many members of the family as possible, within the bounds of halachic requirements. I believe that everyone present at the ceremony, whether Jewish or of any other background, should be able to understand what is happening.

On the following pages, I present a brief overview of the brit milah ceremony and the circumcision.  Reading and following this guide will help you make things go more smoothly so that you, your family and your invited guests will be in a better position to enjoy this event.  Please do not hesitate to contact me at any time, even if you only have a question.  I look forward to being a part of this milestone in your son’s life when he is welcomed into the fold of the Jewish people.

The Tradition

Ceremony1Ceremony2
Brit milah literally means covenant of circumcision. This covenant is between G-d and the Jewish people. The Torah tells the story of G-d saying to Abraham: "I will establish My covenant between Me and you and your children after you, throughout all generations, as an everlasting covenant, to be your G-d and your children's after you ... This is My covenant which you shall keep ... every male among you shall be circumcised. And you shall be circumcised in the flesh of your foreskin; and it shall be a sign of a covenant between Me and you." (Genesis XVII, 7-11).

In modern times the expression "every male among you" is taken to mean every Jewish male among you. Circumcision does not make a male child Jewish; he is Jewish if his mother is Jewish or she had converted by the time of his birth. If a baby is not Jewish, he may have a brit as the first step of conversion.

Every Jewish father is obligated to circumcise his own son, just as Abraham circumcised his own son, Isaac. However, because most fathers are not versed in the Jewish laws concerning brit milah, nor are they trained to circumcise, a mohel is normally asked to serve as the father's stand-in. A mohel (or mohelet) is a righteous Jew who has received intensive instruction in the halakah (laws), minhagim (customs), brit (entry of a child into the covenant), and milah (surgical technique of circumcision). Any observant Jew who has mastered these skills may become a mohel; one need not be a physician, nor a rabbi. Historically, a mohel is considered so vital to a Jewish community that a scholar is forbidden to live in a community that does not have a mohel.

Eight days old is the age at which G-d commanded the Jewish people to circumcise their male children - "he that is eight days old shall be circumcised among you, every male throughout your generation ..." (Genesis XVII, 12). This mitzvah is so extraordinary that it can supersede the 'Laws of Shabbat' that normally prohibit such an operation on Shabbat and holidays. A brit may only take place during daylight hours; the earlier the better since we are eager to fulfill a mitzvah (commandment). The day of birth is counted as the first day, assuming the child is born before sundown. If he is born after sundown the following day is the first day of life.

Gainsbrit2Only certain circumstances justify the delay of a brit. Above all, a child that is not well may not be circumcised. Another exception is that, if the eighth day falls on Shabbat, but your son was born by cesarean section, the brit is delayed until the next day (Sunday). You should not delay a brit for convenience nor may it take place before the eighth day. If a brit is delayed for any reason, it may not take place on Shabbat or a holiday.

Traditionally, a brit was held in the synagogue to add beauty and sanctity to the mitzvah. Most parents prefer that a brit take place at home. The home is generally a warm, familiar environment. However, the brit may take place anywhere, as long as it is in a well-lit room large enough to accommodate all who are present.

If the eighth day falls on Shabbat or holiday, it is appropriate that the brit take place in a synagogue. In this way, it is appropriate for those attending the brit to travel, as they are doing so to daven (pray). Ceremony2However, all supplies and food must be brought to the synagogue before the start of Shabbat so as not to carry on Shabbat. The brit may either take place immediately following the Torah service, but before the Torah is replaced, or it may take place after the completion of morning services.

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The Ceremony

Ceremony3Brit milah is possibly the oldest ritual in our nearly 4,000 year history: thus, it is rich with many beautiful customs. I will describe the customs I routinely follow, although I am always willing to incorporate other customs, especially family traditions.

Prior to the ceremony, I will examine your son, apply a topical anesthetic to his penis or a penile block, and review the ceremony with you. I normally arrive 30 minutes prior to the ceremony to do this. The ceremony itself has three parts. The first part comprises the ceremonial aspect of the brit as well as the actual circumcision. This part lasts twenty to thirty minutes. The circumcision itself is very quick, usually no more than a minute. The second part of the ceremony is the baby naming. This is usually an emotional event as parents are encouraged to talk about the person(s) the baby is being named after, and the characteristics they hope their baby will have in common with the honored individual(s) who previously bore this name. The third part of the ceremony is the customary festive meal (se-udat mitzvah) for all of your guests.

The ceremony itself starts with a friend or family member lighting the candles. The origin of lit candles is not clear. The Talmud refers to the practice during a time when circumcision was prohibited: a lit candle in a window signaled the community where and when a brit was to take place. A more spiritual origin may be that a lit candle represents a spark of life, a new soul entering the Jewish community. 

Following the lighting of the candles, I exclaim 'kvatter' and one or two appointed guests bring the baby into the room. As the baby enters the room, everyone stands and greets him with the words, Baruch Habah! (Blessed is he who entGainsbrit2ers!) The Kvatter then places the baby on a chair, which has been set aside for the prophet Elijah. The chair for Elijah is in recognition of his honor to be at each brit. Elijah the prophet is called the guardian angel of children because G-d allowed him to miraculously revive the lifeless son of a widow in the town of Zarepeth. Also, Elijah lived in the time of Ahab, king of the northern kingdom of Israel. Under the influence of Jezebel, Ahab's wife, people disobeyed G-d's commandments to the extent that they worshiped idols and did not perform brit milah. Elijah railed against the people for their false ways, and they eventually returned to worship G-d and perform brit milah. Finally, according to tradition, Elijah will return to Earth to announce the coming of the messianic era. Elijah's chair thus represents our silent prayer for the baby's safety, a sign of our faithfulness to G-d's law, and an expression of our hope that G-d will bring the Messiah soon, perhaps during the life of the child or even in our own lifetime. For these reasons, it is customary to decorate this chair. Ceremony with Grandma

The father then takes the baby from Elijah's chair and hands him to the Sandek, who will hold the baby during the circumcision. The Sandek will place the baby on the pillow placed on the table on which the circumcision will be performed. The table on which the brit will be performed is considered an altar. It can be beautified by covering it with a blue and/or white cloth, placing flowers and/or pictures of relatives (especially the person(s) your son will be named after) on it and the presence of your Kiddush (wine) cup. 

The Sandek holds the baby on the pillow while I recite the blessing of ritual circumcision and perfosteinbrit1rm the circumcision. The parent(s) then recites the blessing of the covenant. I then recite the Kiddush and several prayers of thanksgiving, and the baby is swaddled and handed to his mother. I (or a rabbi if present) then perform the naming ceremony. Usually at this time either the mother or father (or both) will speak about the person(s) for whom the baby is named. Any other suitable short readings (poetry or prose) may be selected for reading or recitation by parents, relatives or honored guests either at this time or just prior to the circumcision. Following this, we normally sing and then celebrate with the festive meal. I customarily stay for 15-30 minutes following the ceremony to allow sufficient time to ensure that your baby is not experiencing any complications and has weathered his entry in the Covenant with G-d in fine shape.  During this time, I will change the baby's diaper with you and go over care of the circumcision.

Some have asked what is done with the foreskin, which is removed. By custom, it is placed in earth or sand. Some will do this in their yard and plant a tree in the same spot. They may then cut a branch of this tree to be used in the huppah when that son marries. If you would like to bury the foreskin after your son's brit, please let me know and I will give it to you. Otherwise, I will dispose of it in an appropriate manner.

On the following pages I list the honored roles you may wish your guests to fulfill at the brit. Also following is a form I need filled out in advance since it provides information necessary for the ceremony.

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Honored Roles

Sandak. This is the most honored role. The Sandak holds the baby while the brit is performed. The Sandak should be a Jew who can testify that the brit was performed in accordance with Jewish law. While traditionally, the Sandak is a male, there is no reason a woman cannot be a Sandak. The high esteem in which the Sandak is held is manifested by a position of honor standing next to the chair of Elijah. Traditionally, this role is given to a grandfather. In some communities it is customary to give the rabbi this honor. And some suggest that the father of the child should himself be the Sandak, for since the mitzvah to circumcise the child is incumbent upon him, he should assist in the ceremony in every way possible. This is the custom in many Sephardic communities.

Kvatter (male) and Kvatterin (female). This couple (not necessarily husband and wife) brings the baby into the room where the brit will take place. They are colloquially known as the godparents. It is not necessary to fill both roles.

Candle lighter. Generally a relative or close friend.

Readers. Parts of the ceremony need not be read by the mohel. If there are individuals whom you would like to read the naming ceremony (in either Hebrew or English), please let me know.

If either the Kiddush cup or candlesticks have special significance, please let me know so that I can make reference to them at the brit.

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Information for Brit Milah



























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About Circumcision 

steinbrit2Circumcision is a common, minor surgical procedure which is performed about 1.2 million times per year in the United States. The same procedure (including sterilized equipment) that occurs at the hospital and the doctor's office will occur at your home. As an obstetrician/gynecologist I have performed thousands of circumcisions on babies I have delivered without any complications.

In addition to the religious significance of circumcision, there are some medical benefits. These include a reduction in urinary tract infections (on the order of three to ten times less frequent than in those who are not circumcised) and an almost complete elimination of penile cancer. Sexually transmitted diseases are less likely to be transmitted if you are circumcised (including AIDS). There is no evidence that circumcision affects sexual function or the ability to feel pleasure. In fact, a survey of adult males suggested less sexual dysfunction in circumcised adult men.

As with any medical procedure, it is important to know about the risks. These include bleeding, infection and a poor cosmetic result. Fortunately, these occur at a rate of approximately 0.2%, and most of these are minor bleeding. More serious complications are extremely rare and are usually related to faulty technique, untrained individuals performing the procedure, or unsafe circumstances for the procedure.

shane jerryThe pain of circumcision can be significantly reduced. I use a combination of three separate methods for pain relief. First, I have the parents give Tylenol to the baby before the brit. Second, I apply a topical anesthetic or an injectable anesthetic to the penis before the procedure.  Lastly I give the baby either a pacifier or gauze saturated with sweet wine during the procedure. Parents rarely report any increased fussiness in the baby after the circumcision.

Please feel free to ask me any further questions regarding the benefits and risks of circumcision. More detailed discussion of the benefits and risks of circumcision may be found in Pediatrics, Volume 103, No. 3, March, 1999, p. 686-693 (American Academy of Pediatrics: Circumcision Policy Statement).

After you have had a chance to have all your questions answered, I will have you fill out a routine medical consent form prior to the brit. I have enclosed this as the last page of this document for your information. 

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Guidelines for Caring for Your Newborn's Circumcision

Here are a few guidelines to help you care for the circumcision in the first few days after the brit milah ceremony.

  1. Care of the circumcision is quite simple.  Circumcisions generally heal by themselves.  The object of care is to keep the area of the surgery as clean and comfortable as possible until the tissue heals.
  2. There is a gauze square with petroleum jelly on the baby's penis. The first time you change him, leave the gauze. The second time you change his diaper throw away the gauze. If the gauze should fall off before this time do not attempt to replace it. When you change the diaper, clean the diaper area, leaving the penis alone. If you wish to wash the area of the circumcision, or if stool gets on it, use a cotton ball and warm water to gently clean the skin. Do not use alcohol and do not rub the tissue with any force as this may cause bleeding.
  3. It is not necessary to use gauze again, but every time you change him for the next five to six days place some petroleum jelly (about one teaspoon) around the entire circumference of the cut. Continue this until the area looks healed.
  4. The local anesthetic will last about one hour. While many babies do not seem to be in any distress after the circumcision, some may be uncomfortable for the first two or three days, especially when their diapers are being changed or when their urine initially comes into contact with the raw tissue. Feeding or nursing should not be affected. You may give your baby some liquid infant Tylenol for the first twenty-four hours if he is irritable. The dose is 1.25cc every six hours. There is a mark on the dropper.
  5. Healing is usually rapid. You should remember that this is like any other cut and there are many factors that influence healing, but most importantly every child heals differently. First, the cut edge seals and bleeding ceases within minutes. Within twenty-four hours the area behind the glans will become swollen; this inflammation will subside within a week or two. In a day or two there may be an off-white or yellowish, patchy appearance of the glans. These patches are a type of scab and are associated with normal healing. You will also notice that the glans is red and glossy. This is because the skin covering the glans of an uncircumcised penis is mucous membrane (like the skin inside your cheek). Once exposed, the mucous membrane will toughen (or keratinize) and in time take on a normal appearance (like the skin outside your cheek). The penis should take on a 'normal, healed appearance' in about a month. As the circumcision is healing, gently push the skin of the shaft of the penis toward the abdominal wall to expose the entire glans (head of the penis). This will prevent adhesions from reforming between the glans and the skin of the shaft.

What to watch for:

  1. There may be a small amount of blood on the gauze. This is normal. If there is a flow of blood, pressure for five minutes (watch the clock) will usually stop it. If the bleeding persists, call your pediatrician or me.
  2. There will be some redness and swelling at the area of the circumcision for a few days. This is normal. If the swelling extends down the shaft and onto the abdominal wall you should call. Infection is extremely rare after circumcision.
  3. Since part of the circumcision is on a mucous membrane, a yellowish-gray area may form at the site of the cut. This may be similar to what you see at the site of the umbilical cord insertion. This is NOT pus and does not represent infection, but is normal for the healing process.
  4. On occasion, a poor aesthetic result occurs when too little or too much skin is removed, or more likely when the cut edge of the skin attaches too high or too low along the length of the penis. In nearly all cases the penis will heal properly and in time take on a normal appearance.

The circumcision should be entirely healed within seven or eight days. If you have questions you may call me at (202) 841-3329.

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About April Rubingainsbrit3

Following completion of Internship and Residency training at the University of Chicago, April Rubin M.D. has practiced obstetrics and gynecology on Capitol Hill since 1982. She has performed well over 1,000 medical circumcisions on babies she has delivered. In 2003 Dr. Rubin was designated a mohel (feminine: mohelet) in the Conservative Movement of Judaism after completion of the Brit Kodesh course at the Jewish Theological Seminary in New York. She now performs 50-60 brit milah, brit le'shem gerut (brit for purposes of conversion), hatafat dam (conversion of a previously circumcised male) and brit bat (naming ceremony for a girl baby) each year.

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Items Needed for the Brit

It is necessary for you to provide the following items at the brit (I will bring everything else):

  1. A sturdy table (not a folding table) with a good light source. On the table you should place candles (with matches to light them) and a Kiddush cup. In addition, my instruments will be on the table. It is nice to have the table covered with a decorative white or blue cloth cover. There should be a trash can or garbage bag under the table.
  2. Two sturdy chairs, one for Elijah and one for the Sandak.
  3. Kosher Concord grape wine.  The Kiddush cup should be partially filled with wine.
  4. Challah, to start the festive meal.
  5.  Baby wipes, bulb syringe, diapers, pacifier, and petroleum jelly.
  6. Pillow, standard size. As it is common for babies to urinate just prior to, or after the circumcision, please do not use a pillow, which may be ruined by urine.
  7. Tallit for the father and Sandak; yarmulkes for the guests.
  8. The baby should wear a gown that can be raised above the diaper level.

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Other Instructions

  1. Feed the baby just prior to my arrival. In this way he will be less fussy during or just after the brit. Please give him 2.5cc of infant Tylenol or Tempra (concentration should be 160 mg/5cc) one hour before the scheduled time of the brit milah. This, along with the cream I will put on the penis when I arrive will ease the discomfort of the circumcision.
  2. Turn off phones before the ceremony. Place a sign on the door that reads "Please come in" so that guests will not knock on the door during the ceremony.
  3. A minyan (ten Jewish adults) is not necessary, but is preferred. Have your guests come fifteen minutes before the start of the ceremony so that it may begin on time.
  4. Photographs and video are fine (except on Shabbat), although I ask that you refrain from photographing the actual circumcision.
  5. Your son's penis should be examined by his physician before the day of the brit. This will reduce the chances of a last minute postponement for any sort of health reason. Prior to the ceremony, I will want to examine the baby.  In a separate room, there should be either a table or changing board on which I can examine him. In addition, there should also be a trash can or garbage bag. Should your son develop any medical problems prior to the brit milah please let me know.

Please feel free to call me at any time at 202-841-3329 to discuss anything in this handout or otherwise pertaining to the brit milah of your son.

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Except in the circumstance of a brit on Shabbat, there is no need to submit this form in advance.  However, at the time of the ceremony you will be asked to sign the following consent form prior to your son's brit milah.

I request that my son be circumcised by Dr. April Rubin as part of the brit milah ceremony.

I understand and agree that this circumcision is not intended to establish a patient/physician relationship and that it is part of a religious ceremony and not being performed as a medical treatment or procedure.

In signing this form for a circumcision I affirm that Dr. Rubin has explained the procedure, its risks and potential complications, including, but not limited to, bleeding, infection, removing too much or too little foreskin, trauma to the penis and the need for further surgery.  I understand that it is impossible for Dr. Rubin to inform me of all the potential complications that may occur.

I affirm that I understand the above-mentioned risks regarding the procedure and that Dr. Rubin has explained post-circumcision management to me.

I affirm that Dr. Rubin has answered all of my questions regarding the procedure to my satisfaction.

 

______________________________                     ____________________

Signature of Parent or Guardian                              Witness’s Signature

 

______________________________                      ____________________

Parent or Guardian’s Name (printed)                       Witness’s Name (printed)

 

______________

Date

 

______________________________

Address

 

______________________________

Phone Number

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Contact Dr. Rubin


Email Dr. Rubin at AprilRubin@DCMohel.com

For OB/GYN practice and non-Jewish medical circumcisions:  202-547-4604


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