A few years ago, after a mohel in the New York area allegedly gave two neonates herpes as a result of his use of metzitzah b'peh during the ceremony, there were calls for banning the direct sucking of blood from the penis by the mohel. Interestingly halacha provides support for both the indispensibility and dispensibility of direct metzitzah b'peh so the call to protect the health of neonates was certainly not an attack on Judaism or halachic observance. Of course, the Chareidi community predictably announced that it was and got its leadership to declare that metzizah b'peh is the only way. (Kinda catchy when you rhyme peh with way)
As passions over the issue have cooled, it's nice to see an experienced mohel weigh in with what sounds like a practical solution. As opposed to those who would dismiss the concerns of one side or another, he acknowledges the concerns of both and comes up with an interesting compromise solution:
Relative to other surgeries, bris milah is a simple procedure, with a surprisingly low risk rate. At the same time, an incision, an open wound and the removal of skin tissue necessitate precautions which will minimize danger to the child. The parents and the mohel must be on the same page on this latter point.
In an operating room, a surgeon takes many precautions to minimize the chance of bacterial infection reaching the patient. Mohels should be held to these same standards when operating on infant boys. It is understood, of course, that the public nature of the ceremony makes complete sterility an impossibility. Nonetheless, we are a far cry from where standards should be...
A mohel who washes his hands and is careful not to shake others’ hands should be commended. But when he adjusts his pants, head-covering, lab coat or tallis, not to mention his instrument bag or a bottle of wine while laying out instruments, he has negated any previous hand washing.
Some mohels will operate with bare hands “sterilized” by alcohol or Purell. Nice as this is, touching the pillow, baby, sandak, and baby’s diaper make previous efforts meaningless. Additionally, it is virtually impossible to completely clean under the fingernails, unless (with a big ‘perhaps’) the mohel soaks in a chlorinated pool for 20 minutes immediately before the bris. This is an uncommon practice.
Mohels should be required to wear sterile gloves, donned immediately before touching sterile instruments and the sterile field of the bris. If it is time consuming, he can wear two pairs, removing the outer pair immediately prior to beginning. Non-sterile gloves are a step up from “no gloves,” but they are still less than ideal.
“Metzitzah” is defined as drawing “deeper” blood from the circumcision spot, which some view as a medical necessity while others view it, based on modern medical knowledge, as a ritualistic remnant of what may have once been deemed a medical requirement (Shabbat 133a-b).
Over time the idea of doing metzitzah with the power of the mouth was introduced, which is defined in two ways: either put a mouth directly on the wound, or use the power of the mouth through a sterile pipette. The latter avoids direct contact and the sharing of body fluids between mohel and baby.
Both are halachically sanctioned, while only one meets the approval of any unbiased modern medical sensibility. Arguments such as “saliva heals” and “one’s first instinct is to suck a cut on your finger” are irrelevant to the case of a mohel’s mouth touching a fresh wound in a newborn.
Any parent who insists that metzitzah be done with direct oral contact should do the metzitzah himself.
Maimonides writes, “It is impossible to restore the lost life of a Jewish child” (Milah 1:18). While he says this to allow delaying a bris on a child who is not physically ready, certainly the same dictum should be followed when circumcising a child: no step in the bris procedure should allow the slightest possibility that its inclusion can open the door to giving the baby an infection.
It is our responsibility and right to demand the best for our children. For the sake of the health of our children, let us begin with insistence that the bris maintains the highest standards of sterility.
I don't doub there will be those who attack his position as kefirah. I think it's a wonderful compromise that can accomodate anyone's halachic sensibilities.