Misconception: (1) When a brit milah is delayed for medical reasons, it may be done as soon as the infant recovers, and (2) once it is delayed, there is no rush and it may be pushed off until a convenient time, such as Sunday in the US or Friday in Israel.1
Fact: If an infant had a localized medical issue that precluded a brit on day eight, he should be circumcised as soon as medically acceptable. If he had a systemic ailment, following his recovery (even before day eight)—even if there are no medical contraindications—there is a mandatory complete seven-day waiting period until the circumcision may be performed, at which point it should be done without delay.
Background: The Torah twice states (Bereishit 17:12; Vayikra 12:3) that a brit milah, circumcision, should take place on the eighth day2 after birth. This rule is so inviolable that when the eighth day is Shabbat, a yom tov or even Yom Kippur, the brit nonetheless takes place on that day (Shabbat 132a).3 However, because of the concern for the life of the newborn, the Mishnah in Shabbat (19:5 [137a]) gives a major exception to eighth-day circumcision and states: “An infant who is sick is not circumcised until he recovers.” This is the source for delaying the brit milah of a sick infant.4
A powerful, emotional rationale for this principle is offered by Rambam (Hilchot Milah 1:18; cited in Tur and Shulchan Aruch, YD 263:1): “We only circumcise a child who has absolutely no illness, because the danger to life takes precedence over everything. And circumcision can be performed at a later date, while it is impossible to ever restore a single Jewish life.”5
The Amora Shmuel, commenting on the mishnah (ibid.), says that if a baby had a high fever, then once the fever has subsided, the circumcision is delayed seven days6 to allow for his body to further strengthen. These seven days are seven twenty-four-hour periods (Yevamot 71a–b), and thus, a child declared healthy from his fever at noon on Tuesday is not supposed to be circumcised before noon the following Tuesday,7 and it is then done as soon as possible.
Shmuel’s statement mentioned only fever. Rambam views fever as an example and adds (Hilchot Milah 1:16): “recovers from fever or from a similar illness.” Rav Papa discussed (Yevamot 71b) an ailment for which the brit can take place as soon as the infant is healthy. This has led to a distinction (Shulchan Aruch, YD 262:2) between two categories of ailments: choli shebechol haguf (“systemic disease”) or only be’echad me’eivarav (“local illness”). In the former, there is a mandatory seven-day wait, while in the latter the brit should be performed as soon as the infant recovers—in other words, if he is deemed “healthy” at 4:00 pm, the brit should be done that afternoon.
Then there is the Thursday/Friday conundrum: Once it is halachically and medically permitted to perform the brit, it is forbidden to delay the brit for even one day (Rema, YD 261:1; Magen Avraham 249:5; Chochmat Adam 149:2), for example, to a day more convenient for the guests (Gilyon Maharsha 262:2).8 Nonetheless, in order that the second or third post-op day—the most difficult days for the child (Maggid Mishnah, Shabbat 2:14)—not fall on Shabbat (which might necessitate violating Shabbat for necessary medical treatment), some authorities prohibit doing a delayed brit on Thursday9 or Friday (Taz 262:3). This position received support among Sephardic poskim (Knesset HaGedolah and Birkei Yosef cited in Kaf HaChaim 331:31; Yabia Omer 5, YD 23). On the other hand, Ashkenazic poskim in general ruled that once the baby is ready for the brit, it should be done even on Thursday or Friday and not delayed further (Shach 266:18 and Nekudot HaKesef 262:3; Gilyon Maharsha 262:2; Mishnah Berurah 331:33).10
Determining whether a particular medical condition warrants postponing a milah, and if so into which category it fits—local or systemic—is not always obvious. The Aruch HaShulchan says that one should consult a doctor and the doctor can be relied upon (YD 262:18).11
Modern authorities have expressed opinions on some examples.12 Regarding the Talmudic example, Rabbi Shlomo Zalman Auerbach ruled that if the fever was above 38 degrees Celsius (100.4 degrees Fahrenheit), then after it returned to normal there should be a seven-day wait (Nishmat Avraham, YD 262:6:4). In 1964, Rabbi Moshe Feinstein ruled that a full-term infant who needed to be placed in an incubator gets the seven-day wait after being taken out of the incubator (Iggerot Moshe, YD 2:121; cf. Tzitz Eliezer 13:82:4). Rabbi Auerbach opined that the circumcision of an infant on antibiotics is delayed seven days from the time he is asymptomatic, not from the end of the course of antibiotics, which often continues longer (quoted in Nishmat Avraham, YD 262:6:5). On the other hand, Nishmat Avraham quotes opinions that a forceps delivery, a broken leg due to birth trauma, a cleft lip or a cleft palate likely should not delay the brit at all, but if they do, the delay is only until the infant is deemed healthy and there is no seven-day wait (Nishmat Avraham, YD 262:8, 10).
In the course of a long discussion on delaying a brit on account of eye ailments (which are often taken very seriously—see YD 262:2 and Nimukei Yosef to Yevamot 71a; Rabbi Avraham Yitzchak HaKohen Kook, Da’at Kohen 137), Rabbi Chaim Pinchas Scheinberg (Am HaTorah, Mahadurah 2, vol. 4 [5742]: 22–28) says that regarding an infant covered with pus-free pimples over his whole body that are considered normal,13 if the doctors say he is not suffering and will not be harmed from the milah, the brit may be on time.
An interesting topic that has merited much discussion is that of a “yellow baby.”14 The Gemara (Shabbat 134a) and Shulchan Aruch (YD 263:1) say that the brit of a baby that is yarok15 is postponed. Is that referring to neonatal jaundice, a relatively common condition in which there is a yellow tone to the infant’s skin and possibly to the sclerae and mucous membranes?
There are two broad categories of jaundice in newborns. The less common is “pathologic jaundice,” which indicates an underlying medical issue in the infant and would be treated as choli shebechol haguf.
In contrast, the overwhelming majority of cases involve “physiologic jaundice.” Although it results in elevated levels of bilirubin, a yellowish byproduct resulting from the breakdown of red blood cells that causes the yellow appearance, the infant is usually otherwise healthy. In a healthy newborn, this may be due in part to the newborn’s natural high hemoglobin level and an immature liver that has not yet fully developed the capacity to effectively metabolize and clear bilirubin from the bloodstream.
Most doctors would assert that physiologic jaundice is usually not an impediment to circumcision. Yet, if the “yellow baby” in the Talmud refers to jaundice, halachah mandates delaying the brit milah until after the skin color returns to normal, possibly with a seven-day delay. Contemporary authorities have weighed the conflicting issues: There is a strong prohibition to unnecessarily delay a brit; the Talmud says to delay a brit of a baby who is “yarok”; and modern medicine does not view physiologic jaundice as a reason to delay circumcision. Should the brit of an otherwise healthy jaundiced baby be delayed, and if yes, is there a need for a seven-day wait? And does treatment of an infant with bili lights [special blue lights used to treat newborn jaundice at higher levels] affect the halachah regarding when to perform the brit?
Some authorities (e.g., Chochmat Adam 149:4; Aruch HaShulchan 263:2) say the milah should be done as soon as the yellow subsides, while others (e.g., Tuv Ta’am Vada’at, YD 1:220; Shu”t Beit Yitzchak, YD 2:91) treat it as systemic and require a seven-day wait.
Rabbi Dr. Moshe Dovid Tendler (in the Yeshiva University journal Beit Yitzchak, vol. 27 [1995]: 112) felt that with non-dangerous physiologic jaundice (he writes—with a bilirubin level of less than 20 milligrams per deciliter on day eight), the brit can be done on the eighth day. On the other hand, Minchat Yitzchak (3:145, 6:92, 8:88) and Moadim u’Zemanim (3:205) ruled to follow the halachah literally and postpone the brit for even mild jaundice, even if the doctors said that the brit could be done earlier. Rabbi Eliezer Waldenberg (Tzitz Eliezer 13:81, 83) was uncomfortable ignoring the Gemara and thus ruled to delay the brit, but in deference to modern medicine felt that we could rely on the opinions that do not require a seven-day wait.
Rabbi Auerbach is quoted (Nishmat Avraham 263:1:1) as saying that for intermediate bilirubin levels (11 to 18) one should wait until the yellow has subsided, while for higher levels one should wait seven days after it returns to 12. Yet he is also cited (ibid.) as permitting a brit on day eight in a particular case of an infant whose bilirubin level had been 19 on day three but was 13 by day five.
When to do the brit of a jaundiced baby is still the source of much discussion and disagreement, and like everything regarding the proper timing of a brit, a mohel should be consulted in conjunction with competent rabbinic and medical authorities.
Brit milah is a sign of the eternal covenant between G-d and the Jewish people. As a surgical procedure, it is one of two mitzvot that inherently contain risk16, the other being milchemet mitzvah (an obligatory war).17 The Midrash (Bereishit Rabbah 46:9; see Bereishit 17:7–11) links the two by noting that G-d states that if the Jews keep the mitzvah of circumcision, they will merit entering the Land. Conquering the Land, is, of course, a milchement mitzvah. Nonetheless, in both of those mitzvot we are obligated to minimize the risk; accordingly, the milah of a sick infant is delayed but only to the extent medically and halachically required. During that period, it should not be done (and performing the brit is not a chumrah); once that period has passed, it should be done as soon as possible.
Notes
1. For specific cases, halachic and medical authorities should be consulted.
2. All britot, eighth day or delayed, must be in the daytime (ShulchanA ruch, YD 262:1).
3. The Talmud (Shabbat 132a) suggests three derivations for why circumcision, which involves drawing blood—an activity generally prohibited on Shabbat—is nonetheless performed on Shabbat or yom tov.
There are important exceptions to this.
For example, the milah for babies born via Caesarian section (Shulchan Aruch, YD 266:10) or during twilight Friday afternoon/before chag or Shabbat/chag twilight, is postponed until the next available weekday. Also, non-eighth-day britot are not done on Shabbat or a chag. Modern poskim discuss whether a child conceived via intrauterine insemination (IUI) or in vitro fertilization (IVF) may be circumcised on Shabbat.
4. Usually at the brit milah ceremony, in addition to the surgical circumcision, the infant is named. However, if the circumcision will be significantly delayed, there is a preference to name the child before the brit, both to aid in parental bonding and to have a name for prayers for his welfare (Rabbi Dr. Avraham Steinberg, ed., Sefer Assia, vol. 4 (5743): 234–44).
5. The Chochmat Adam (149:4) quotes Rambam and then reports that he witnessed a case in which the midwife greenlighted the milah of a sick infant who then died that day. He writes that he likes the custom in Prague that the mohel goes to check the health of the infant the day before the brit.
6. The Yerushalmi (Shabbat 19:5, Yevamot 8:1) says thirty days; all codifiers follow the Bavli’s version.
7. Rabbi Yaakov Ettlinger (Binyan Tzion 1:87; Aruch LaNer, Yevamot 71b) suggests that this seven-day waiting period is of Biblical origin, a suggestion that Rabbi Shlomo Zalman Auerbach finds surprising—he says it is a rabbinic caution to avoid a danger to the child (Nishmat Avraham, YD 262:4) and adds that it applies to an adult circumcision as well. Thus, for example, according to Rabbi Auerbach, an adult convert should not be circumcised within seven full days of a fever or other systemic condition.
Minchat Yitzchak (6:92:3) says that one should wait seven days even if the doctors are encouraging doing the milah earlier, but if it is done within the seven-day waiting period, it is kosher. Note that a brit of a healthy boy done before day eight is post facto valid according to the Rema (YD 262:1), but the Shach (262:2) disagrees and requires hatafat dam on day eight (or later if not done on day eight).
8. Pitchei Teshuvah (YD 262:2) quotes an extreme case in which a brit was delayed for health reasons and the father decided to delay it until erev Pesach so the firstborns could eat at the meal. The Noda B’Yehudah thought this abhorrent and ruled that if erev Pesach arrived and the brit had not yet been done, they should not do the brit so as not to set a precedent.
9. See Shach 266:18, Nekudat HaKesef, and Rabbi Akiva Eiger 262 that maybe Thursday is a problem but Friday is okay.
10. Similarly, and based on the halachot (Shulchan Aruch, OC 248) regarding when one may set sail, contemporary authorities discuss the permissibility of elective surgery on Thursday and Friday (Shemirat Shabbat Kehilchatah, 32:33; Tzitz Eliezer 12:43; Emet LeYa’akov, OC 331:3—who specifically mentions not electively inducing labor on Thursday or Friday).
11. A doctor is relied upon for categorizing the medical condition but not for authorizing a brit against an explicit halachah. For example, Rabbi Moshe Feinstein says (Iggerot Moshe, YD 2:121) that a “blue baby” who had a blood transfusion is certainly considered choleh bechol haguf and thus must wait seven days after he is better even if the doctors opine that he can be circumcised sooner. Rabbi Chaim Pinchas Scheinberg (Am HaTorah, Mahadurah 2, vol. 4 [5742]: 26) and Minchat Yitzchak (3:145, 6:92, 8:88) expressed similar views.
12. Two important references with lists of medical conditions are Rabbi Dr. Avraham Steinberg, “Brit Milah—Medical and Halachic Aspects,”Techumin2 (1981): 306–24 and Avraham-Sofer Abraham, Nishmat Avraham (5774), YD 262–63. Note that some of these halachic decisions were proffered decades ago and medical opinions, which affect the halachah, may have changed. Also note that many mohalim will want an infant to reach a certain weight, often about 2.5 kg (5.5 pounds), before circumcising him.
13. Rabbi Scheinberg might be referring to either erythematoxicum or transient neonatal pustular melanosis.
14. An issue that seems to have not merited sufficient discussion is that of an otherwise healthy premature baby who spends time in the NICU (neonatal intensive care unit). Certainly, a seven-day wait is warranted, but when should the count start? From the last desaturation or bradycardia or temperature instability, etc., or from the discharge itself?
15. “Yarok” in modern Hebrew means green. In the Talmud, there are fewer words for colors and “yarok” was used to refer to green, yellow-green, indigo (blue-green)and pale green, depending on context. The Mishnah (Niddah2:6 [19a]) refers to “yarok” blood, which Meiri understood as green blood, while Tosafot (Niddah 19b) said it is yellowish like a ripe etrog. See Tosafot, Sukkah 31b, s.v. hayarok kekarti, where they struggle to identify the color yarok. When used to describe an animal’s lung, yarok can be the color, for example, of an egg yolk and not kosher (YD 38:1) or green and permissible (38:4). Yarok is also used to describe non-kosher milk (Avodah Zarah 35b) and the face of a man after death (Avodah Zarah 20b; Ketubot 103b), where it most likely means a pale green (see Julius Preuss, Biblical and Talmudic Medicine, trans. Fred Rosner [New York 1978], 164–67). On “yarok,” see Nadav Shinrav, Techumin 23 (5763): 509–11, 514. In the context of milah, it is unlikely that they were referring to a green baby, while a yellow baby (jaundice) is a relatively common occurrence.
16. Chatam Sofer (Shu”t YD 245), based on Rashi to Gittin 57b, suggests that milah on the eighth day is actually much more dangerous than it seems, and that the fatality rate is as low as it is only because the merit of the mitzvah is protective.
17. See Rabbi Dr. Ari Z. Zivotofsky, “What’s the Truth about . . . Milchemet Mitzvah?” Jewish Action 85:1 (fall 2024): 90–92, https://jewishaction.com/religion/jewish-law/whats-the-truth-about-milchemet-mitzvah/.
Rabbi Dr. Ari Z. Zivotofsky is a professor of neuroscience at Bar-Ilan University in Israel.