The Procedure

4.1       Preparing for the Brit Milah

4.1.1     The Mohel should ensure that the proposed venue is suitable for the procedure.

4.1.2     The Mohel should advise parents to ensure the baby is clean in preparation for the procedure.

4.1.3     The Mohel should give parents specific instructions on what the baby should wear that is appropriate for the procedure, and that provides easy access to the operative site, whilst being sympathetic to family traditions.

4.1.4     The Mohel should advise the parents to have infant paracetamol suspension available to give to the child if he is distressed, and advise on the correct dose according to the baby’s weight, in line with the dose schedule published by The Regulatory Board (Appendix 2).

4.2       Hygiene

4.2.1     The Brit milah team, which means the Mohel and any assistants, should remove any rings, hand jewellery including watches or bracelets before commencing the procedure.

4.2.2    The Mohel should ensure that his clothes, including any tallit (prayer shawl), are clean and kept well away from the Procedure.

4.2.3    Disinfectant containing alcohol must be applied.

4.3    The Procedure

4.3.1    The Mohel must perform the Brit Milah under conditions of good illumination and at a height at which he can work comfortably and safely. He must satisfy himself before he starts the Brit Milah that the location is adequate to meet these needs.

4.3.2    The Mohel should use appropriate measures to minimise any possible pain and discomfort both during and after the procedure.

4.3.3    The Mohel must use sterile instruments that are either disposable or that have been vacuum or steam autoclaved. When using vacuum autoclaved instruments, the Mohel must keep records demonstrating sterility.

4.3.4    The Mohel must prepare the skin at the surgical site immediately before incision using an antiseptic (aqueous or alcohol-based) preparation: povidone iodine or chlorhexidine are most suitable.

4.3.5    The Mohel should be careful not to remove either too much or too little foreskin. The aim is to completely uncover the glans, but not to remove excess skin from the shaft of the penis.

4.3.6    Any remaining inner mucous membrane should be divided and reflected below the glans penis.

4.3.7    Where the circumcision is being performed according to Jewish custom and tradition the Mohel should then aspirate blood (metzitzah).

4.3.8   The Mohel should cover surgical incisions with an appropriate dressing at the end of the procedure.

4.3.9   The Mohel must place a pressure dressing over the wound at the end of the procedure.

4.3.10 The Mohel must dispose of all instruments including sharps in an appropriate fashion to minimise risks of injury (sharps container).

4.4       After the procedure

4.4.1     The Mohel must check the baby for haemorrhage within thirty minutes of the Brit Milah.

4.4.2     The Mohel must not leave until he has personally checked the baby and is absolutely satisfied that bleeding has stopped.

4.4.3     The Mohel must give clear verbal and written instructions to the parents on how to care for the baby after the Brit Milah.

4.4.4     The Mohel must give clear verbal and ideally written instruction to the parents about what to do if they become concerned; and this should include clear written instructions on how to contact the Mohel if necessary.

4.4.5     The Mohel must not leave until he is satisfied that the parents have received adequate verbal and written instructions, that they have understood them and have no further concerns or questions.

4.4.6     The Mohel must contact the parents within 6 hours of the procedure to enquire whether there have been any changes noted in the baby’s behaviour, and specifically enquire whether there has been any bleeding and whether the baby has passed urine.

4.4.7     The pressure dressing must be removed within 24 hours. Any subsequent pressure dressings must also be removed within 24 hours by the Mohel or a nurse or paramedically qualified person.

4.4.8     The Mohel or suitably qualified nominated deputy must be available to deal with any complications which may arise and must be aware of how and when to escalate problems which he is not competent to deal with. In particular, in the first two days after the Brit Milah, the Mohel or his deputy, must be available to respond at short notice if an urgent or emergency situation arises. If, in an emergency, it is not possible to reach the child in an appropriate time frame, he must refer the baby immediately to the nearest hospital and should consider advising the parents to use the local emergency services to transport the baby there.