Traveling Method WORKS - May Even Be Safer

Sometimes, Jewish newspapers have a bad habit of being critical of Jewish practices. Sometimes the criticism is out of line and unsubstantive, and is particularly meant to make religion and observance look bad. Sometimes the critique is in order, and certain practices need to be changed or modified for the criticism to be removed.

In the case of the article presented here from the Jerusalem Post, they are not saying circumcision is bad, or that circumcision done by a mohel is unsafe. They are saying that when the bandage is on the baby for a long period of time (over 24 hours), chances of a urinary tract infection increases manifold.

Lucky you! When you are serviced by the Traveling Mohel, the baby's bandage often comes off on its own (which is a good thing!), or it is taken off within a few hours after the bris.

Here is the link to the article. In case, over time, the link becomes inactive, the article is reproduced below in its entirety.

The gist is this: Calcium alginate is an effective form of achieving hemostasis (stopping bleeding). Once hemostasis is achieved, the bandage can be removed and the baby will naturally heal on his own.

I have been bandaging this way for years, and (with God's help this will continue) have never had a baby develop any post-operative infections from my brisses.

June 14, 2010 Monday 2 Tammuz 5770



'Traditional Israeli brit mila technique ups infection risk'
By JUDY SIEGEL-ITZKOVICH

J'lem doctors say employing different method to stanch bleeding could reduce complications.

The long-time practice by Israeli ritual circumcisers (mohelim) of using gauze for as long as 26 hours to stop penile bleeding is responsible for the significantly higher rate of urinary tract infections (UTIs) within a few weeks of the Jewish ritual.

According to pediatricians and infectious diseases experts at Shaare Zedek, by adopting a different, yet simple medical technique for stanching the bleeding, many UTIs can be prevented. Drs. Ori Toker, Shepard Schwartz, Gershom Segal, Nadia Godovitch, Yechiel Schlesinger and David Raveh published their findings in the May issue of the Israel Medical Association Journal (IMAJ), along with an editorial by Dr. Jacob Amir, a pediatrician at Schneider Children’s Medical Center in Petah Tikva.

According to standard medical practice, a newborn infant who develops a fever must be hospitalized for observation in case the baby has developed meningitis (an inflammation of the meninges covering the brain) or other serious infection. This requires a painful spinal tap with a needle to remove a sample of cerebrospinal fluid through the baby’s back, and a few days of hospitalization until the fever subsides. This type of hospitalization is costly for the health system, and frightening and exhausting for parents.

Studies conducted abroad have showed that UTIs were infrequent when a physician performed the circumcision, even outside a hospital or clinic, compared to the rate among Israeli males circumcised by a mohel. The difference, the authors suggested, was in the method used to stop the bleeding. While mohalim wrap the penile shaft in gauze, thus raising the risk of urine retention that can lead to infection, physicians stop the bleeding by briefly applying pressure with a gloved hand, using calcium-sodium alginate fiber and adding a “wound cavity dressing” that disintegrates in two to three hours.

In his editorial, Amir urged that Israeli ritual circumcisers – supervised by a joint committee of the Health and Religious Services Ministry – be persuaded to change the way they stop the bleeding (called hemostasis in medical jargon), an aspect of brit mila that is not dictated by Jewish law. If they “adopt the hemostasis technique used by physicians – or at least shorten the duration of the shaft wrapping” – the number of UTIs and resultant hospitalizations could be minimized, he wrote. “The unique phenomenon of the high rate of UTI in male infants in Israel seems to be related to the traditional technique of hemostasis. It is time to improve the practice of traditional circumcision.”

After being asked to comment, the Health Ministry told The Jerusalem Post it would seriously consider the recommendations in the journal articles and decide whether to ask the Religious Services Ministry to direct mohalim to change their hemostasis techniques.

The Shaare Zedek team studied the medical records of 449 newborns up to the age of four weeks who were brought with fever to the hospital’s pediatric emergency room between 1997 and 2006. All underwent urine cultures for UTIs, and the 290 with a positive culture had cultures taken of their cerebrospinal fluid. Their parents were asked if the infants had recently undergone circumcision and, if so, whether it had been performed by a non-physician mohel.

After eight days of life, 24.7% of circumcised boys who had fever were found to have UTIs, compared to 8.4% of girls of the same age. Meningitis was found to be very rare.

Mohalim have already changed some of their methods out of health considerations. For example, they abandoned direct sucking by mouth of the bleeding organ to avoid giving or getting hepatitis B or C, or HIV infections, and instead suck through an hourglass-shaped glass tube in which cotton wool is inserted to prevent transmission of pathogens in either direction.