“What do you do about the sucking”, the mother said to me in broken English, and it took all of my strength not to hug her with all my might. She was the first parent to ever ask me if I perform Metzitzah B’Peh (oral suction), even if she did ask in a slightly cryptic fashion. And as excited as I was, I still felt heartbroken because this question should be as commonplace as asking how much I charge. But so few parents out there know what Metzitzah is and the dangers involved.
So let’s begin at the beginning. Metzizah is the process of drawing blood out of the circumcision wound and it’s one of the steps in the process of a Brit Milah. So, of course, now you should be asking yourself, why in the heck would this be done? To answer that, we have to go to the time of Hazal (the rabbis of the Talmud).
In the time period of the Talmud, Hazal were greatly influenced by Greek medicine. The Greeks believed that coagulated blood, if left to collect, was extremely dangerous and could cause (what we call) an infection and could result in the child’s death. Rav Papa in Mesechet Shabbat of the Talmud clearly states that Metzizah need be done because if it’s not done, the child is in life-threatening danger. Performing Metzitzah is so important, in fact, that we even do it on Shabbat, even though it could easily be construed as a Shabbat violation. And if a Mohel intentionally doesn’t perform Metzitzah he is not allowed to be a Mohel.
So where does the controversy come in, you may be asking? The Gemara never states how to perform Metzitzah but the tradition developed to draw the blood out of the wound by direct contact between the Mohel’s mouth and the incision. The problem is that adults can be carriers of Herpes, as well as a whole host of other germs. And while these may have little to no effect on the adult, when they are transferred to an eight-day-old baby, they can result in infections, brain damage, or even death. So, in effect, Metzitzah B’Peh has done a complete 180. It has gone from being a life-saving measure to life-threatening process if done orally. And I think we would all agree that Rav Papa would not stand for this.
But for some time now we’ve had a way of doing Metzitzah that’s safe for both the child and the Mohel. Using a pipet to do the suction avoids direct contact between Mohel and child, thus protecting both parties. The tube is universally endorsed as 100 percent safe for both the child and Mohel. We’ve already spoken about the dangers for the child, but Metzitzah B’Peh is also extremely dangerous for the Mohel. There are stories of Mohelim performing Metzitzah B’Peh in the ‘80s, contracting AIDS and dying.
Even though this may seem like a cut and dry issue (no pun intended), over the last few centuries it has been a great source of debate. There have been many Teshuvot (Jewish legal responsa) on both sides of the issue, featuring such names as the Hatam Sofer and Rav Samson Raphael Hirsch, who were both against direct contact. This divide has led us to our present situation.
Unfortunately, there are many Mohelim in many communities around the world who still perform Metzitzah B’Peh because they believe this is the tradition. Interestingly, Rav Hershel Schachter (the Rosh Yeshivah of Yeshivah University) definitively points out here that the tradition is to listen to modern medicine. And the medical community is very clear that Metzitzah B’Peh is life threatening to children. Rav Shachter also pointed out that even if there were a doubt (which there is not) as to whether or not oral suction was causing these problems, it wouldn’t matter. Even with an element of doubt, we are lenient on life-threatening cases and we shouldn’t perform Metzitzah B’Peh. But maybe an even bigger problem than those that adhere to the practice for no reason is that there are so many parents who haven’t a clue that this is even happening during their son’s Brit. So, how do we protect these children?
The first way to protect them is for the Mohelim to use a pipet and do the suction without direct contact between the child and the Mohel. There is a great deal of literature out there — some of which can be found here — with a plethora of doctors and rabbis who have all come out in support of using a tube for Metzitzah. These rabbis and doctors weigh in on both the health benefits and the Halachic permissibility of using a tube.
The second way to protect the children, is that all clergy and other communal leaders must take a stand against Metzitzah B’Peh. You have to know which Mohelim are practicing oral suction in your community and you must to pressure them to stop. If that doesn’t work, then every time a congregant informs of an upcoming Brit Milah with a Mohel who performs Metzitzah B’Peh, you have to refuse to attend, unless the family is willing to use another Mohel. There needs to be a unified front on this issue within the communal leadership and it must transcend the denominations.
The third, and potentially most important, way to keep your children safe is for parents to ask their Mohel not to do Metzitzah B’Peh. This can have two effects. Firstly, there are many Mohelim who prefer to do Metzitzah orally but travel with sterilized tubes and if requested, they would happily use them. The second reason to ask is because if your Mohel refuses to do it in any other way than oral, then your solution is simple: find another Mohel. As Rav Papa said, this is life and death we’re talking about. So I guess my question to all of you is: what do you do about the sucking?