Preparing for a Brit Milah

Assessing the health of your baby

The health of your baby and the safety of the procedure is of paramount importance.
The Mohel will wash his hands with an alcohol based bactericidal soap and dry his hands on a clean towel before touching your baby at any time.
The Mohel will assess the health of your baby to ensure that he is fit for Brit Milah. This includes taking a thorough history and performing a physical examination of your baby.
The Mohel will not perform a Brit Milah in instances of any concerns about your baby’s health until authorisation has been given to the baby’s parents/legal guardians by the doctor caring for the baby.

When will the Mohel not perform a Brit Milah?

Any baby weighing less than 2.5 kg.
Any baby over the age of 6 months, unless the Mohel is a medical practitioner, or unless previously authorised in writing by the Medical Officer of The Regulatory Board.
When your baby has jaundice unless it is minimal and resolving (see below).
Presence of blood dyscrasias or abnormalities (for example haemophilia, von Willebrand’s disease, other clotting factor deficiencies etc.), until deemed safe by an appropriate medical specialist.
A family history of bleeding disorders until it has been established by an appropriate medical specialist whether your baby has inherited the condition.
Congenital disorders of the penis including hypospadias, congenital chordee or deficient shaft skin, such as penoscrotal fusion or congenital buried penis, unless advised in writing that it is safe to do so by an appropriate medical specialist.
In the case of a home birth, until the Mohel has confirmed from the attending midwife that your baby has received vitamin K in accordance with standard practice in new born care.

What is Jaundice?

Jaundice refers to a yellow discolouration of the skin and eyes. Jaundice in newborn babies is fairly common (more than 50% of babies) and should not cause undue alarm. This type of jaundice is called “physiological jaundice” and is essentially due to an immature liver that is developing or due to breastfeeding. This jaundice is not harmful to your baby. It resolves on its own and should not be a reason to stop breastfeeding your baby.

Your Mohel is an expert in making decisions about this jaundice. He will be able to advise if this is no cause for concern (physiological jaundice) or whether there may be an underlying problem (pathological jaundice). Pathological jaundice is usually present at birth and is most often picked up in the birthing room by the medical or nursing staff. It will require a medical diagnosis by a doctor.

Your Mohel will also be able to advise you on the correct timing of the Brit Milah in relation to the jaundice. If you notice the presence of jaundice in your baby, contact your Mohel as soon as possible. Please be aware that the presence of jaundice may result in the Brit Milah being delayed.

The venue and what your baby should wear

The Mohel will ensure that your proposed venue is suitable for the procedure.

The Mohel will advise you to ensure your baby is clean in preparation for the procedure.
The Mohel will give you specific instructions on what your baby should wear that is appropriate for the procedure, and that provides easy access to the operative site, whilst being sympathetic to family traditions.

Pain Control

Pain may be controlled with simple measures. Breastfeeding your baby before the Brit Milah will help make him calm and works like a painkiller for the actual procedure. Another well recognised ‘strong’ pain killer for babies is sucrose (sugar water). Medical studies have proven that this is an effective pain killer for babies. Your Mohel may give your baby some drops of Kiddush wine to suck on. This wine contains the sucrose needed and will help as a pain killer for your baby. You should notice almost immediate calming of your baby when sucking the wine.

You can also give your baby infant Paracetamol (Panado, Calpol) as a painkiller. Unless your doctor or paediatrician has told you that there is a specific contra-indication to Paracetamol, it is usually quite safe to administer to newborn babies. The Mohel will advise on the correct dose according to your baby’s weight or please follow the dosage instructions on the actual bottle or the leaflet inside the box.

It is not routine to give an anaesthetic for a Brit Milah. Please discuss pain control with your Mohel if you require further information.