Minimizing the Pain There are a number of things parents can do to minimize the pain of circumcision. Choosing a qualified mohel is a good start. Mohelim tend to be concerned about the infant’s pain, perform the circumcision quickly and smoothly, and often use other methods for pain control. If anesthetic is not used If the child is not adequately anesthetized, the ceremony (the part requiring the presence of the baby) should be kept to the minimum compatible with an adequate ceremony. If he is lucky enough to fall asleep, do as little as possible to awaken him. Most babies will not be awakened by the sounds of the ceremony, but some will. Most babies will awaken when they are passed from person to person. Once the baby is awake, it may be impossible to adequately console him and get him back to sleep soon. If anesthetic is used If the baby is adequately anesthetized, you will have a grace period with respect to pain. This period is relatively short – about 10 or 15 minutes for the usual anesthetic, about 25 minutes if a longer-acting form of antibiotic is added, beginning about 10 minutes after the anesthetic is given. The traditional Hebrew ceremony is relatively brief – our rabbis had no desire to prolong the infant’s agony. (But, you will need some of those minutes after the circumcision to give the baby an analgesic, possibly to change his diaper, to feed him and to get him to sleep. Therefore, limiting the part of the ceremony requiring the infant’s presence to about 15 minutes is highly desirable.) All other additions to the proceedings are optional. Optional additions can make a ceremony truly memorable, but they should not be overdone so as to cause the infant discomfort. Limiting the time the infant will have to be present at the ceremony can help insure a more pleasant outcome for baby, parents and guests. The 10 minutes from the injection to the circumcision are “free.” Up to 10 minutes can be used without compromising the infant’s comfort. These are usually used, at least in part, to explain the reason for Brit Milah and the nature of the proceedings and/or to formally welcome family and guests. Sometimes a part of this time is used for recitations by grandparents, etc. If the pre-circumcision agenda is substantial, time it with a dress rehearsal and reduce it to 10 minutes maximum. Another possibility is to adjust the time of the giving of the anesthetic. Any proceedings prior to that are also “free,” so you can take as much time as you like for the part of the ceremony that occurs prior to the anesthetic injection, as long as you plan things so that the injection is given 10 minutes prior to the circumcision. After the circumcision, it is not uncommon to take just a few minutes to read an English translation of the Hebrew ceremony for those who do not understand Hebrew. A brief explanation of the origin of the infant’s name (especially the Hebrew name) is a nice touch. Other common time-consuming additions and suggestions about them are listed below. But remember, keeping the infant around for these additions – especially for a long time – is merely theatrical and serves no useful purpose (not, at least, for the traditional ceremony or for the baby). If the above are accomplished expeditiously, then there is usually time to take care of the baby after the ceremony. Analgesics Oral medications (the most commonly recommended is acetaminophen, which is the ingredient found in Tylenol®) can be useful for treating soreness, but do not adequately protect the infant from the excruciating pain of circumcision. Their best use is for the recovery period after the circumcision. There are very strong analgesics, but they are not appropriate for infants. The wine that the baby gets during the circumcision is a few drops – not enough to offer any pain relief. Excessive wine consumption in a baby can result in respiratory depression. A pacifier, sugar water, and milk are excellent for distracting the infant from reacting to minor forms of pain, but offer no protection for the infant against moderate or severe pain. Other considerations 1. Distribution of numerous parts for family members or friends to recite: These parts can chew up a lot of time. Do a dress rehearsal to see how long they take. Take into account that parents and family members who read these parts often become emotional and “choke up” – making the actual time it takes to read the selections from 2 to 4 times as long as the times it took at a rehearsal. 2. Talking about the names chosen for the infant: Long eulogies about the individual (or, worse, individuals) for whom the infant is named are not really appropriate for a Brit Milah. A brief and upbeat mention of the name of the honoree, who he was and what characteristics he had that endeared him to the family and others is most appropriate. A whole page of 12 point type takes a very long time to read – that is, in comparison to the amount of time you have before the anesthetic wears off. And, if these are read by parents, they can be extremely time-consuming. Again do a dress rehearsal and double or quadruple the time (to account for emotional interruptions during the recital). 3. Conducting the proceedings in two rooms (one for a “private” circumcision, and one for Kiddush, etc., for everyone): Whenever the infant is transported through a crowd, well-wishers will want to stop you so they can say a few words and have a chance to view the baby and offer remarks about him – unaware that they are wasting very valuable time as the anesthetic effect is rapidly disappearing. 4. Speeches, particularly lengthy sermons by lay family or guests, are usually quite time consuming – not to speak of sometimes being boring to the audience. Discourses by the rabbi are quite appropriate, but are better given after the child is removed. That eliminates the time pressure concerning the child’s pain. 5. Passing out wine for everyone is nice – but very time consuming. Kiddush is made adequately with the one Kiddush cup. Kiddush is not a form of toast. Wine is drunk more appropriately by guests during the meal after the ceremony. 6. Passing the infant from person to person to create “honors” for family or special guests: This is a nice gesture and is usually not too much of a problem unless the number of transfers gets to be excessive. One would be surprised at how long it can take to get a baby to the circumcision table if passed through several people, each of whom has to hold the infant for a short period (so as not to appear to be too anxious to let him go). Conclusion Most of all, just keep the infant in mind. He has only a limited time to be relatively pain-free. And while things you do may take just an extra few seconds or minutes, there just aren’t very many minutes to spare. The ceremony is important, and it is important that adequate time be used to perform it. However, whatever can be done to not unduly prolong the ceremony should be done. It is my personal philosophy that torturing the baby for the sake of entertaining the adult guests is not the right thing to do.