Craig Singer, M.D.

-Certified Mohel-

(248)224-3577

Frequently Asked Questions

Yes. Dr. Singer is still performing brit milah in the home during the pandemic under the following conditions:
1. Only the parents are permitted to attend the ceremony. No grandparents or siblings of the parents are permitted. Older siblings of the baby may attend but they will need to stand far from Dr. Singer.
2. All family members must wear a mask during the entire time that Dr. Singer is in your home.
3. Dr. Singer needs 100% confidence that neither parent has any upper respiratory symptoms, including cough, sore throat, shortness of breath, or fever.
4. Dr. Singer needs 100% confidence that neither parent has had exposure to a COVID-19 patient.
Dr. Singer will take full precautions to protect himself as well as you and your baby. He will wear an N-95 mask, surgical hat  and a surgical gown. He will thoroughly disinfect his hands prior to putting on his PPE. If he touches his mask, he will change his gloves and reclean his hands. He will bring an alcohol spray bottle for easy use to disinfect.
The local anesthetic will be administered while Dr. Singer is wearing an N-95 mask. He will switch over to a fog less surgical mask just prior to the procedure. And then he will immediately switch back to an an N- 95 mask. He will change his gloves frequently, especially if he touches anything that could cause contamination. All family members will stand 6 feet away from Dr. Singer, except the father who will sit next to him during the actual circumcision.

A bris is performed on the eighth day of life. The day of birth counts as the first day, as long as the birth occurs before sundown. Thus, if a child is born during daylight on a Monday, his bris would be the following Monday. If he was born after sundown on Monday, the bris is the following Tuesday. A bris must take place before sunset, and it may be postponed only for medical reasons.

Yes. The Talmud derives that the positive commandment to circumcise on the eighth day of life supercedes the prohibition to perform work on Shabbat or Yom Tov. There are some exceptions to this rule, however. If the bris is postponed for medical reasons, it may no longer be performed on Shabbat or a festival. Also, a baby born through cesarean section may not have his bris on these holy days. It is always best to consult with the mohel or Rabbinic authority before confirming the day of the bris.

An outfit that is easily raised over the baby’s waist as the circumcision is being performed , and easily pulled over the baby’s body afterwards. A gown works well.  Otherwise, a 2 piece outfit (i.e. separate pants and shirt) is also easy for me to work around.  However, an outfit that snaps from above the waist all the way down to the feet is cumbersome. 

A minyan (group of 10) is preferable but not mandatory.

Yes. – With the assumption that the bris is being performed as the first step towards a Jewish life. If an interfaith family is planning to also  baptize the child, then having a bris may not be in the best interest of the child. The bris is the quintessential declaration of being a Jew  and establishes a covenant with G-d. Having a bris means living exclusively Jewish.

Traditional Jewish law holds that the religious status of the baby is  the same as his mother. So for example if the mother of the baby is Jewish, the baby is considered Jewish. But if the mother of the baby is Gentile, then the baby would be considered Gentile under Orthodox law.

The Reform movement issued the patrilineal descent in 1984 which in essence states that the baby is under “the presumption of Jewish descent” as long as either the mother or father is Jewish and as long as the parents demonstrate “timely and public acts of Jewish identification ” (e.g. bris, Hebrew school, bar mitzvah etc.). In other words, the reform movement does not require formal conversion of the baby if the mother is Gentile and father is Jewish as long as the parents raise the child as a Jew.

However you may want to discuss this issue with your Rabbi as to whether or not the Rabbi would recommend having the bris performed for purposes of conversion. The issue could arise again in the future if your son were to marry somebody in the Conservative or Orthodox movement, or if your son decided he wanted immediate citizenship in Israel one day.

 

I use the Mogen Clamp due to its speed and accuracy. The circumcision is performed in approximately 60 to 70 seconds with minimal distress to the baby. Care is taken to ensure complete separation of all glandular adhesions prior to the removal of the foreskin.

I use a number of techniques to minimize discomfort which includes soothing music, parental presence, a comfortable atmosphere, concentrated sugar solution, a nerve block, and a padded board. With all of these factors, most babies do not feel pain during the procedure. In the event that the baby does feel some discomfort, parents can rest assured that the procedure time is about 70 seconds. Approximately 45 minutes after the procedure, the local anesthetic will wear off and he will feel some discomfort, but at that point the parents can hold and swaddle the baby to comfort him.

My pain control protocol begins with the administration of an oral sucrose solution. Medical studies have proven that sugar raises the baby’s natural endorphins (i.e. natural painkillers). Once the baby is sucking on the sugar solution, the local anesthetic can be injected with minimal discomfort.

I administer a ring block (modified dorsal penile nerve block) with little to no discomfort to the baby. This method involves two injections at the base of the penis that temporarily numb the nerves that provide sensation to the penis. A third injection on the ventral aspect of the penis is also administered  to maximize the effectiveness of the block. Nerve blocks are extremely safe, and complications from nerve block are extraordinarily rare. Furthermore, nerve blocks are endorsed by the American Academy of Pediatrics as the standard of care for newborn circumcision.

Also, I use a much lower concentration of lidocaine (0.5% vs 1.0%) than that typically used in the hospital. The 0.5% preparation is equally effective as the higher strength, but is much safer. I also buffer the lidocaine solution with bicarbonate. This raises the pH of the solution and reduces the burning sensation of the anesthetic. And finally, I have developed a proprietary blend of local anesthetic for use at a bris that is unique, safe, and long lasting.

Soothing music and gentle touch further relax the baby. I estimate that 90% of babies do not cry during the circumcision.

The use of local anesthesia requires proper medical training and licensing. This means that only a doctor is permitted to give an injection of lidocaine at a bris.  Under no circumstance is a non-physician mohel (i.e. a Cantor or Rabbi) permitted to use any form of local anesthesia (i.e.  Nerve block).

There are two topical anesthetics available, but both are inferior to a DPNB: In addition, topical anesthetics can cause swelling of the penis and distort the anatomy making the circumcision more difficult.

EMLA ( Eutectic Mixture of Local Anesthetics) can produce some pain relief, but it has several significant drawbacks: (1) It is not FDA approved for use in circumcisions in babies less than one month of age. (2) One gram of cream has to be applied under occlusion to the baby’s penis prior to the bris. Parents often have difficulty accomplishing this.(3) The cream can cause swelling of the foreskin which distorts the anatomy of the penis.

Absolutely not. A hospital circumcision is surgery performed for medical benefit or social purposes. The procedure is carried out in a “circumcision room” away from the parents, devoid of religious meaning. In contrast, a bris is a mitzvah, a sacred obligation. The circumcision is performed with proper religious intent (Kavanah), as the baby is held by loving arms. It is never done before the eighth day, and it always includes meaningful blessings. The bris is a supreme act of identification with the Jewish people.

 

My ceremony is both traditional and enlightening with a nice blend of appropriate humor. It begins with an interesting explanation of the relevant halachah (Jewish law) and minhagim (customs). The principal participants are introduced, and blessings are recited both in Hebrew and in English. The circumcision, which takes approximately 60 seconds, is performed towards the end. The baby receives his Hebrew name and we rejoice in song and feast. The entire ceremony lasts approximately 15 to 20 minutes. My goal is for you and your family to gain a deeper appreciation of this awesome mitzvah.

Yes it may.
Some parents would prefer to have the surgery performed privately and separate from the rest of the ceremony. This is acceptable to do, but recognize that most of the prayers and designated honors will take place before most of your friends and family arrive. Also, I recommend that if you take this approach, you provide a 45 minute recovery period to allow the baby to feed and settle down before we proceed with the naming ceremony.

The only way I can bill your insurance is if the actual circumcision/bris is performed in my office. I am happy to accommodate  families with this request. However, if the circumcision is performed outside of my office, then I cannot bill insurance or provide you with a receipt. If you need a claim for an HSA account, I am happy to oblige.

My fee is based upon my time committment and distance traveled. I have a standard fee for travel within 25 minutes. I charge extra to travel beyond (e.g. Ann Arbor). My fee includes a 20 minute phone conversation with the family several days prior to the bris. In addition, I will arrive at the home or synagogue 30 minutes prior to the start of the bris and I will also observe the baby with the family and teach you aftercare for 45 minutes afterwards. I will also provide you with a special kippah for the baby as well as a  bris certificate from the Women’s League of Conservative Judaism.- All of this is included in my fee. I’m happy to discuss this further with you by phone.

Personal Check, Cash, and Venmo are accepted.

The medical benefits of circumcision are numerous and include reduction in urinary tract infection, reduction of certain sexually-transmitted diseases, reduction of penile cancer , and elimination of problems that may develop as a result of a foreskin.

The risks include bleeding, infection, errors in skin removal and injury to the penis. Dr. Singer has never encountered a situation in which he could not control the bleeding.  He has never seen firsthand an infection that developed as a result of the circumcision. Finally, Dr. Singer he has never had a complication that consisted of significant/permanent injury to the penis.

For a more thorough discussion, please visit the following website www.MichiganCircumcision.com

A bris is performed on the eighth day of life. The day of birth counts as the first day, as long as the birth occurs before sundown. Thus, if a child is born during daylight on a Monday, his bris would be the following Monday. If he was born after sundown on Monday, the bris is the following Tuesday. A bris must take place before sunset, and it may be postponed only for medical reasons.

Yes. The Talmud derives that the positive commandment to circumcise on the eighth day of life supercedes the prohibition to perform work on Shabbat or Yom Tov. There are some exceptions to this rule, however. If the bris is postponed for medical reasons, it may no longer be performed on Shabbat or a festival. Also, a baby born through cesarean section may not have his bris on these holy days. It is always best to consult with the mohel or Rabbinic authority before confirming the day of the bris.

An outfit that is easily raised over the baby’s waist as the circumcision is being performed , and easily pulled over the baby’s body afterwards. A gown works well.  Otherwise, a 2 piece outfit (i.e. separate pants and shirt) is also easy for me to work around.  However, an outfit that snaps from above the waist all the way down to the feet is cumbersome. 

A minyan (group of 10) is preferable but not mandatory.

Yes. – With the assumption that the bris is being performed as the first step towards a Jewish life. If an interfaith family is planning to also  baptize the child, then having a bris may not be in the best interest of the child. The bris is the quintessential declaration of being a Jew  and establishes a covenant with G-d. Having a bris means living exclusively Jewish.

Traditional Jewish law holds that the religious status of the baby is  the same as his mother. So for example if the mother of the baby is Jewish, the baby is considered Jewish. But if the mother of the baby is Gentile, then the baby would be considered Gentile under Orthodox law.

The Reform movement issued the patrilineal descent in 1984 which in essence states that the baby is under “the presumption of Jewish descent” as long as either the mother or father is Jewish and as long as the parents demonstrate “timely and public acts of Jewish identification ” (e.g. bris, Hebrew school, bar mitzvah etc.). In other words, the reform movement does not require formal conversion of the baby if the mother is Gentile and father is Jewish as long as the parents raise the child as a Jew.

However you may want to discuss this issue with your Rabbi as to whether or not the Rabbi would recommend having the bris performed for purposes of conversion. The issue could arise again in the future if your son were to marry somebody in the Conservative or Orthodox movement, or if your son decided he wanted immediate citizenship in Israel one day.

 I  have extensive experience using two surgical instruments – the Gomco clamp  and the Mogen clamp. My preference is the Mogen clamp due to it’s speed and accuracy.  The total procedure time is 60-70 seconds.

The short answer is yes. However, much can be done to minimize the baby’s discomfort.

No parent wants to see his/her baby in pain. Neither do I.  Through years of experience, I have developed a protocol that minimizes the pain of the procedure.


STEP 1– Giving the baby an oral sucrose solution. Medical studies have proven that sugar raises the baby’s natural endorphins ( his natural pain killers). Once the baby is sucking on the sugar solution, the local anesthetic can be injected with minimal discomfort.

STEP 2- Administer a Dorsal Penile Nerve Block (DPNB) while the baby is sucking on sugar. Dr. Singer has developed a proprietary blend of local anesthetic for use at a bris that is unique, safe, and long lasting.

STEP 3– Perform the circumcision in one minute using the Mogen clamp.

Dorsal penile nerve block is the standard form of local anesthesia used for newborn circumcision. This block is performed by injecting lidocaine at the base of the penis and it temporarily numbs the nerves that provide sensation to the penis. The American Academy of Pediatrics has endorsed local anesthesia as the standard of care for all newborn circumcisions.

The use of local anesthesia requires proper medical training and licensing. This means that only a doctor is permitted to give an injection of lidocaine at a bris.  Under no circumstance is a non-physician mohel (i.e. a Cantor or Rabbi) permitted to use any form of local anesthesia (i.e.  Nerve block).

There are two topical anesthetics available, but both are inferior to a DPNB: In addition, topical anesthetics can cause swelling of the penis and distort the anatomy making the circumcision more difficult.

EMLA ( Eutectic Mixture of Local Anesthetics) can produce some pain relief, but it has several significant drawbacks: (1) It is not FDA approved for use in circumcisions in babies less than one month of age. (2) One gram of cream has to be applied under occlusion to the baby’s penis prior to the bris. Parents often have difficulty accomplishing this.(3) The cream can cause swelling of the foreskin which distorts the anatomy of the penis.

Absolutely not. A hospital circumcision is surgery performed for medical benefit or social purposes. The procedure is carried out in a “circumcision room” away from the parents, devoid of religious meaning. In contrast, a bris is a mitzvah, a sacred obligation. The circumcision is performed with proper religious intent (Kavanah), as the baby is held by loving arms. It is never done before the eighth day, and it always includes meaningful blessings. The bris is a supreme act of identification with the Jewish people.

My ceremony is both traditional and enlightening with a nice blend of appropriate humor. It begins with an interesting explanation of the relevant halachah (Jewish law) and minhagim (customs). The principal participants are introduced and blessings are recited both in Hebrew and in English. The circumcision, which takes approximately 60 seconds, is performed towards the end. The baby receives his Hebrew name and we rejoice in song and feast. The entire ceremony lasts approximately 15 to 20 minutes. My goal is for you and your family to gain a deeper appreciation of this awesome mitzvah.

Yes it may.

 Some parents would prefer to have the surgery performed privately and separate from the rest of the ceremony.  This is acceptable to do, but recognize that most of the prayers and designated honors will take place before most of your friends and family arrive.  Also, I recommend that if you take this approach, you provide a 45 minute recovery period to allow the baby to feed and settle down before we proceed with the naming ceremony.

The only way I can bill your insurance is if the actual circumcision/bris is performed in my office. I am happy to accomodate                        families  with this request. However, if the circumcision is performed outside of my office, then I cannot bill insurance or provide you with a receipt. If you need a claim for an HSA account, I am happy to oblige.

My fee is based upon my time committment and distance traveled. I have a standard fee for travel within 25 minutes. I charge extra to travel beyond (e.g. Ann Arbor). My fee includes a 20 minute phone conversation with the family several days prior to the bris. In addition, I will arrive at the home or synagogue 30 minutes prior to the start of the bris and I will also observe the baby with the family and teach aftercare for 45 minutes afterwards. I will also provide you with a special kippah for the baby as well as a  bris  certificate from the Women’s League of Conservative Judaism.- All of this is included in my fee. I’m happy to discuss this further with you by phone.

Personal Check, Cash, and Venmo are accepted.

The medical benefits of circumcision are numerous and include reduction in urinary tract infection, reduction of certain sexually-transmitted diseases, reduction of penile cancer , and elimination of problems that may develop as a result of a foreskin.

The risks include bleeding, infection, errors in skin removal and injury to the penis. Dr. Singer has never encountered a situation in which he could not control the bleeding.  He has never seen firsthand an infection that developed as a result of the circumcision. Finally, Dr. Singer he has never had a complication that consisted of significant/permanent injury to the penis.

For a more thorough discussion, please visit the following website www.MichiganCircumcision.com

It's a boy!

If you have already delivered, please contact me immediately on my cell phone: (248)224-3577

Craig Singer, MD
Dermatologist and Certified Mohel

E mail: craig@brismd.com

Office:

31000 Telegraph Road, Suite 260

Bingham Farms, MI 48025

(248)792-3785