In Jewish law, health always trumps ritual observance. As has often been stated, Jewish law provides a code to live by, not to die by. For any observance, whether it is postponing a brit milah ceremony or even eating on Yom Kippur, such deviations from standard practice are allowable, in fact, mandated in Jewish law if life or health are endangered.
As noted previously, if a brit milah ceremony is postponed for health reasons, it can be rescheduled any time at least 7 days after the baby’s doctor says the baby is healthy–except that it cannot then be performed on the Sabbath or on a Jewish holiday.
There are several health reasons that could force the postponement of the brit milah ceremony from the eighth day:
Prematurity
This is the most common reason for postponement of a bris. If a baby is considered too small or too physiologically immature to undergo the minor surgery of circumcision, according to Jewish law the procedure is postponed until at least seven days after the baby’s doctor says the baby is healthy enough to have it performed.
Jaundice
A newborn’s liver is often not yet capable of breaking down the chemical products of dissolving red blood cells and other metabolites. This can lead to a rise in the level of bilirubin, causing a yellowing of the skin known as jaundice. If the bilirubin level gets too high, it can cause injury to the newborn brain. Pediatricians have means of decreasing excessive amounts of bilirubin–but since the mild trauma of performing a circumcision might raise a baby’s bilirubin level, circumcision in such cases is put off until bilirubin levels are back down to normal.
Infection or other illness
Any elective procedure that might stress or weaken a baby already dealing with a health problem is not performed. Thus, a brit milah procedure would be put off until at least seven days after the pediatrician says the baby is absolutely healthy and capable of safely having his circumcision.
Underweight or not eating well
If there is concern about a baby’s weight or eating status, the brit milah ceremony would be postponed until such time as the baby is feeding well and gaining weight. Five pounds is usually considered the minimum weight at which a baby can safely be circumcised, but this of course depends upon all other aspects of the baby’s health status. Again, Jewish law dictates a seven-day waiting period after a baby is judged healthy enough to be circumcised before the brit milah ceremony should take place.
Congenital anomaly
Some babies are born with abnormal penile anatomy. The most common defect is hypospadias, a condition in which the meatus—the opening from which urine emerges—is located on the undersurface of the shaft of the penis instead of at its tip. In such cases the surgery necessary to correct this defect may require use of the foreskin in the repair. Thus circumcision is postponed when hypospadias is present at least until the reparative surgery has been completed. If a circumcision is performed as part of the hypospadias repair and arrangements have not been made to have the brit milah prayers recited just before or just after the surgery, then a hatafat dam brit ceremony (see subsequent chapter on hatafat dam brit) is subsequently performed.
Blood clotting abnormality
If tests or family history determine that a baby’s blood clotting ability is not normal, circumcision will either not be done or will be postponed until the baby’s physician can make arrangements to have the procedure conducted safely despite the clotting disorder.
Again, the basic rule is that health supersedes Jewish ritual. Once health issues are resolved, a brit milah ceremony is scheduled any time seven days after the “all clear” is given–excluding Shabbat and major Jewish holidays.