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Denise Punger MD FAAFP IBCLC

Bris: My Journey and Struggle as a Physician, Mother and Lactation Consultant

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Circumcision is a personal choice a family makes. There are a lot of sites on the Internet denouncing circumcisions. So many, that besides me who would admit that all three of my boys are circumcised and then have the nerve to write an article about it? If you are one of the parents who choose to circumcise your son after being well informed, you also have the right to that decision without being condemned. Whatever reason you could give to justify circumcision, there is a web site with rebuttal. I was surprised to find responses on the Web against a Brit Milah (bris), a Jewish ritual circumcision and covenant with G-d, claiming it is unnecessary. On a Torah-based Internet discussion group about circumcision, a mother stated that she felt the original source of the anticirc movement has roots in anti-Semitism. She makes an excellent point.

My first time witnessing a circumcision was in a rural newborn nursery where I worked as a nursery assistant. Three boys were lined up in infant restraint trays. The doctor walked in the room and did the procedure quickly and efficiently. The babies cried. There was no immediate consolation. The doctor was done and left. The nurses then diapered and dressed the boys and they went to their mothers who were waiting in their rooms on the postpartum floor. This is how the circumcisions were done in this hospital, usually within the first day or two of life.

Later, in my residency I did over two hundred newborn circumcisions. We got signed consent. The nurses lined the boys up so as residents we could be in and out, just like the doctor in the small hospital. Virtually all boys were circed in my training. The consent forms didn't list nearly all the risks these anticirc sites do. It took me about 20 before I was very comfortable and quick with the procedure. I had direct supervision for the first few only. I was more assertive then most of my colleagues to inform the mothers that it wasn't a requirement. However, we are encouraged to do procedures in residency. A circ is something we could log in as having accomplished and mastered: a strange sort of satisfaction to compile such a long log, a preamble to going to the operating room to do more complicated surgery, and a simple procedure that reimbursed well.

Then I was expecting my first son, William. My husband, John, insisted the circumcision be to be done. I was hoping that my Latin husband would forget. I didn't understand him. Latin families don't circ their sons. How could he easily ignore all the bias against circumcision? Jewish families do want circs and I was the one that didn't want to. Usually we worry about situations that don't come to be. Such was the case. After birth when I looked at his penis, I thought his foreskin looked short. On the second day of life, the pediatrician recommended an urologist to examine and circ  him because his penis looked different. My son was prepped in the nursery and restrained just as in my previous experiences. The urologist made the first dorsal slit. He confirmed my suspicion. He was concerned that William had a curvature at the end of the penis. In order to officially confirm a diagnosis he requested another surgical tool not usually found on a newborn circ tray. The tool took along time to arrive. My son was restrained and crying. I was getting very angry with the staff for taking so long. It finally arrived. Chordee was diagnosed. This meant he would need an adult type circumcision to release the skin, which in turn would correct the curve. If not corrected, he would not have a straight erection as an adult. The slit was made, but no skin was removed. The little skin he had was needed for the eventually correction. Because an incision was made now, my son suffered with swelling.

We were referred to a pediatric urologist. He suggested doing the circ with an epidural and light general anesthesia between 6 and 18 months. He said boys heal and forget it very quickly. He was right. My husband and I lost more sleep then William. On the day scheduled, I was told not to nurse for four hours prior. Quietly however, I decided to nurse two hours prior because babies don't understand NPO (nothing by mouth). There was no aspiration or other consequence. I got to carry him myself to the OR. While still in my hands an anesthesia mask was placed on him. He was quickly asleep and I left the OR. The procedure was also quick. I had William back in my arms in no time at all. He nursed on demand. We were released. Honestly it didn't seem to bother him a bit.

The pediatrician in the hospital per newborn protocol uneventfully circumcised my next son, Scott. My husband wanted the boys to look alike.

Prior to my third son, I learned that gentile woman were seeking mohelim, who are specially trained to follow Jewish Law to perform circumcisions, for a more compassionate way to get the job done. I knew one mother who scheduled a non-ritual bris. I had asked her if went better. She had never seen them done the other way so she didn't know. Her son was circed at he husbands insistence. How interesting that again it is the dad demanding the circumcision. Grown men don't seem to regret being circumcised.

This is what I was expecting and told about a bris: First of all, it is a covenant, not just surgery, and a baby naming ceremony. Spiritually, the bris and the baby naming are important and not complete without both components. Second, there is health reason for waiting until the eight day of life: blood clotting factors have matured, the possibility of newborn jaundice is behind, and bonding has occurred, After a week, moms are often feeling better and can perhaps dote on baby more confidently. Also, and very important, unlike hospital circumcisions that are done before breastfeeding is established (a lactation consultants nightmare!) and then often interferes with successful nursing, a bris is done after breastfeeding is established. (Perhaps, in the case of circumcision, the early writers of the Torah had important insight that modern medicine ignores.) Subsequently, since feeding is established nursing can immediately be used to console the baby. A relative can hold the baby during the procedure. The circumcision is usually done in a synagogue or at home. The babies also get to suck on gauze soaked with kosher wine for anesthesia and comfort.

I had mixed feelings about the wine. It wasn't about giving "alcohol" to a baby. I liked the idea of comfort, but being the assertive IBCLC (International Board Certified Lactation Consultant) that I have become; I wanted my baby to be exclusively breastfed for six months without introduction of anything else to alter gut flora. I asked the mohel if we could soak the gauze with breastmilk "No," he said. I got the impression this was nonnegotiable. I turned to an international breastfeeding forum to ask experienced Orthodox Jewish IBCLCs who may deal with this often how they felt about this little bit of wine. Even though I posed the question as if it were to get information for a client not myself, it didnt slow down the anticirc type e-mail. I got reminders that circ was off-topic instead of an answer. I dared posted again. This was not a circ or not to circ question. The circ was decided on. This was a newborn gut flora question and very much on-topic for this group. The few responses I did get from IBCLCs did not think the few drops would be enough to alter flora. The replies came with the disclaimers, "I am not Jewish, but I have been to a bris," and "Even though I am responding to your question, I dont believe in genital mutilation." I put the gut flora issue behind me. My soul was feeling a bit wounded.

This is what actually happened. The mohel came to my house on day nine. David's eighth day of life was the Sabbath, the day of rest. He said Jewish Law says to perform the bris on day nine if the eighth is the Sabbath in cases in which Sabbath observance couldnt be upheld by people coming to the bris. I am glad he came to us. On day nine postpartum I was in no shape to drive 65 miles to the nearest synagogue. John didn't understand why I made an issue about having a mohel. I just kept it simple: we had a homebirth and it went better than expected, now let's have a circ done at home. It will probably go better, too. The mohel happened to be a physician also. That gave my husband, also a physician, greater confidence in him. He was also thinking he could put the bill through to the insurance and medical spending account. Men!

I had never been to a bris and neither had anyone else present. I warned the mohel about this. The boys were much better prepared for their brothers birth they watched, but they did know that David would have skin cut off and he would cry. William was outspoken, "Not my David." William would vigilantly protect his little brother from harm. I hoped I wasn't going to have a problem with his protection.

The mohel started the bris by saying, "Babies don't like this, but hopefully they will appreciate it when they are older." I applaud him for acknowledging this. The mohel did use a restraint board. (I didn't insist otherwise: It didn't seem important.) He gave David three wine saturated gauze pads to suck on-- a little more than the two drops I was told. David actually seemed more content sucking on my finger. During the procedure the mohel gave me a Hebrew transliteration to read. The timing of this reading served to distract me from what was going on and it did. I didn't grasp the full meaning of the Hebrew blessing then, but I felt like I was reading something powerful. By the time I was done concentrating on the words, the procedure was over. When he gave David back to me and I went to put him on my breast, the mohel said he still had something to finish reading before the baby could nurse (so there was a very short delay to the breast). This final blessing gave him a Hebrew name, David Tzvi. But like I said, David was happy sucking on my finger and fell asleep into a deep slumber. He had slept most of the rest of the day in sling or being held by William. The mohel, following tradition, gave the other boys Jewish names: Zev Yonatan to William, which means, "wolf," and "G-d gave" and Simcha Alexander to Scott, Simcha means "happiness" and from the Greek origin Alexander means "helper of men." The older boys like their names. David means "beloved."

John thought it was the quickest circ he'd ever seen. The mohels speed compared to mine when I was a resident. The boy's response was "where was the knife?" I wasn't sure what they meant, but if neither of them noticed any "cutting" when they were attentively watching, I can concluded this must not be too barbaric.

I thought, "Glad it's over." How odd of me to willingly have this ceremony in my home when I have always questioned faith. But I suppose I should be thankful for my three healthy sons and finally have a baby welcoming and naming ceremony for all of them.

When I was searching for boys names, I found out Judah (Judaism) means "thankful." Israel means "he who struggles with G-d." I'm in better company than I would've thought in the Jewish community.  Perhaps the struggle we have as mothers with the decision to have a bris despite adversity is a test of our faith.

My friend, Dawn, who was present, summed up her point of view most humorously by saying, " The adults attending are the ones who need to drink the wine before hand to relax."

My only regret is that I did not have my camera handy to photograph the mohel holding David up to present him with a blessing. So much more was going on then just the routine circumcisions of my previous experiences. Even Dawn was sorry that she did not take a picture for our family.

Three boys, three circumcisions, three different reasons, initially, by different specialist each time; after 4,000 years circumcision is not going away for Jews or gentiles. The first mohel I telephone interviewed expressed opinion that only Jewish men need to be circumcised. However since Davids bris I have picked up on the notion from men, not just Jewish men, that just as a woman endures labor and childbirth, circumcision is the ultimate bodily sacrifice he makes in exchange for physical earthly pleasure and G-dly love. I also sense many men feel it is done for potential future health benefits. The anticirc sites often taught that there are no benefits. I question that if the Torah was right about the Vitamin K maturity, establishment of breastfeeding and bonding first, then the commandement to be circumcised must have health benefits, too. Whatever informed parents decide doesn't make "circ-day" any easier for mothers and we, mothers of circumcised boys, should be allowed to share sorrow amongst ourselves without accurse.

 

Furthur reading:

http://www.rabbizions.com/mohel.htm

Historical Fiction:

The Cross by Day, the Mezuzzah by Night by Deborah Spector Siegel  (If you have any doubt about the spiritual significance of a bris, read this novel!)

Short Fiction: I fellow attachment parenting mom, sucessful VBAC, writes about her husband's conversion to Judiasm.

http://www.goldamagazine.com/article.asp?article_id=46

 

 

 

 

DenisePunger MD

http://denisepunger.tripod.com

12/01/03

...And more reading... Other articles that I refer to bris, naming and spirituality...

How My Boys Were Named

A Tribute To My Grandmother

 
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Denise Punger MD FAAFP IBCLC
4640 S. 25th Street
Ft. Pierce, Florida, 34981
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