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Dr. Karen Jaffe places a wine-soaked gauze square on the lips of 8-day-old Charles Carlin during his Briss Milah ceremony last week.
Photo Credit: Lynn Ischay/The Plain Dealer

Her full-time gig is as an OB-GYN who practices at University Hospitals Suburban Health Center in South Euclid. But when duty calls, Dr. Karen Jaffe becomes a Moheles, or a female Mohel, a central figure in one of the most revered traditions in the Jewish religion.

The Briss Millah -- or Briss, as it is more commonly known -- is the ritual circumcision of a newborn Jewish boy, usually performed on the eighth day of life. The procedure, the surgical removal of the foreskin of the penis, is an outward sign of the covenant between God and Jewish people.

Jaffe is the only female Mohel (rhymes with "oil") in Ohio and one of only a few dozen Moheless in the United States. Traditionally, Mohalim were Orthodox men who received special training to perform circumcisions. Often that training was handed down from father to son.

Dr. Karen Jaffe prepares her surgical instruments before performing the Briss Milah. Jaffe uses a local anesthetic for the procedure.

The need for more Mohalim became apparent as the number of American Jews belonging to the religion's Reform and Conservative movements grew. Two problems existed:

One was a religious issue. If the father is Jewish but the mother is not, for example — or if the mother is a convert but is not recognized as such by Orthodox Jews — many Orthodox rabbis or cantors choose not to perform the bris.
The other was the scarcity of people qualified to do a bris.

"There was a dearth of trained Mohalim in America," said Rabbi Gary Atkins, a Shaker Heights native who now lives in Hartford, Conn., and has been a Conservative rabbi for more than 35 years.

Dr. Karen Jaffe prepares her surgical instruments before performing the Briss Millah. Jaffe uses a local anesthetic for the procedure.
Photo Credit: Lynn Ischay/The Plain Dealer

To address these issues, the new crop of Mohalim is primarily made up of physicians.

"They're the only ones able to do this because of malpractice and other issues," said Atkins, himself a certified Mohel who was trained by another rabbi.

In 2003, Atkins and Dr. Neil Pollock, a certified Mohel and physician in Vancouver, British Columbia, launched their own program, which provides instruction to doctors in both surgical technique and religious training. Two other programs in the United States account for nearly 400 new Mohalim in the past 15 years. Female Moheless make up roughly 10 percent of that number.

Jaffe, an OB-GYN in the Cleveland area for more than 20 years, said she longed to fill a need here, where the only other Mohel is Orthodox.

"At some point it became clear to me that I had another service that I had to offer," she said. "I feel that's really my role. It is a lovely ceremony, and people feel very strongly about it."

Circumcision wasn't new to Jaffe, who like many OB-GYNs (as well as urologists and some pediatricians and family practice physicians) performs them regularly in the hospital -- on babies of all faiths -- often right before mother and baby are discharged.

According to data from the National Hospital Discharge Survey, 77.9 percent of newborn boys born in the North Central region (which includes Ohio) were circumcised in 2006, down from 80.1 percent in 1994. An estimated 90 percent of babies born at UH are circumcised at the hospital. For her religious training, Jaffe turned to the Briss Millah Program, which trains Jewish physicians and certified nurse midwives with the appropriate surgical backgrounds who also are in good standing with a synagogue. Jaffe completed a four-day intensive course in May 2007 in Chicago and performed her first bris a few months later.

"I found over and over people who really wanted their son circumcised and would like to have a Jewish ceremony that didn't fall under the auspices of the Orthodox Mohel," she said.

When she first became a Moheles, Jaffe met with Reform and Conservative rabbis in the community to let them know about her services. In her first full year, Jaffe performed 20 Briss Millahs. Jaffe has performed twice that amount already this year, the most recent one on September 8.

The first part of the ceremony focuses on Jewish prayers, followed by the Briss.

Melissa and Jacob Carlin hold their 8-day-old son, who was named Charles Wallace and given the Hebrew name Enoch during his Briss Millah ceremony last week. Dr. Karen Jaffe, right, performed the ceremony.
Photo Credit: Lynn Ischay/The Plain Dealer

How much of the procedure parents and others actually watch is up to them. Most people don't see their babies being circumcised in the hospital, so it's not uncommon for people to skip that moment of the ceremony.

Following the procedure (which only takes a few minutes), the ceremony focuses on giving the baby his Jewish name and stories about the person he is named for. Jaffe stays for about 30 minutes after the ceremony to make sure there isn't any unexpected bleeding from the procedure.

In recent weeks, the national discussion about circumcision has heightened. Opponents call it an unethical practice when done without the consent of the patient, such as an infant. Proponents point to studies that have shown that uncircumcised men were more likely than circumcised men to be infected with HIV and the human papilloma virus, or HPV.

The official stance of the American Academy of Pediatrics is that circumcision has no proven medical benefit.

Even though parents approach a Briss as part of their religious observance and not as a health precaution, that doesn't mean that they don't have questions, Jaffe said.

"They still have a modern approach," she said, adding that the fact that she is a physician reassures parents who are nervous about circumcision.

"They want to know the risk," she said. "They want to know how it's going to be done [and] what can be done to make the baby more comfortable."

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