Rabbi Moshe Mordechai Epstein (1866-1934) was widely considered to be one of the more impressive Talmud scholars of his generation.
In his "Levush Mordechai" (Ch. 30) he writes, "If anyone were to suggest doing metzitzah with the mouth, we would say the worst things about him because there is nothing more disgusting [than] placing a wounded [bleeding] organ into the mouth. Especially that organ." His conclusion, however, is that "since it is a mitzvah, there is justification."
He compares metzitzah to circumcision itself, arguing that we only do both – against, perhaps, what logic might dictate – because they are mitzvot.
That circumcision is a mitzvah is clear from Genesis 17 and Leviticus 12:3.
But Rabbi Epstein shares only one side of the view of metzitzah – it isn't in the Bible. It first appears in the Talmud (Shabbat 133a), but the method and mitzvah-status is absent from the Talmud and most sources until the Middle Ages. Even Maimonides and the Shulchan Aruch mention metzitzah but leave out any mention of putting the mouth directly on the wound.
The question is, does the Talmud view metzitzah as a requirement or as a medical suggestion?
According to the Talmud (Shabbat 137b) removing the foreskin but leaving the membrane ["milah" without "priah"] is an incomplete circumcision: it will need to be redone.
Not so if metzitzah were skipped. Rav Pappa says (Shabbat 133b) "One who skips metzitzah must be removed: he is putting the baby in danger." Note how "no metzitzah" does not produce an invalid bris. It reflects badly on the operator, not the operation.
Conclusion: metzitzah was more a medical suggestion than a mitzvah requirement.
Rabbi Moshe Feinstein, the leading 20th century American Orthodox decisor, certainly supported the act of Metzitzah. But he wrote that metzitzah is not part of the mitzvah, and a bris without it is kosher. There is, therefore, no conclusive obligation to do it in any specific way.
The polemics favoring direct-contact oral suction are relatively new (mid-1800s), typically attributed to a reaction to the Reform Movement's efforts to abolish Jewish practices that did not conform to modern sensibilities.
Early Reformers certainly saw metzitzah (and circumcision) as barbaric. The "Orthodox establishment" reacted quite strongly, upholding the practice of metzitzah specifically with the direct oral contact method (MBP), to take the strongest stand against the destruction of Judaism as they knew it.
I believe this mid-1800s attitude guides the defenders of MBP today. If they had the common sense of Rabbi Epstein, they would scream from every hilltop that MBP is a disgusting practice to be abolished. Combining this approach with Rabbi Feinstein's "obvious" understanding, would demonstrate that Metzitzah in any form is not even considered part of the mitzvah.
MBP made sense in a medicine world defined by the Hippocratic Method. But in our world, with knowledge of germs and bacteria, the practice is unacceptable.
Those arguing against the proposed law in New York State claim that if MBP is outlawed, Bris Milah will be next. I strongly disagree because I don't believe Bris Milah is in danger in the United States of America.
The American Academy of Pediatrics recently issued a report stating that there are clear medical benefits to circumcision that outweigh the risks of the procedure. They don't endorse the practice, but they don't discourage it either. Most US hospitals offer circumcision as an option, and parents make the choice for their son.
Furthermore, there is no need to defend Bris Milah from the Reform movement – there is a Reform Berit Milah Board!
I agree, however, that government should keep out of regulating this religious practice. Government does a fine job of warning smokers not to smoke, without mandating waivers. Along with doctors, medical professionals and rabbinic leaders, government can issue similar warnings regarding the dangers and risks of MBP. This should not come at the cost of a fine or legal action by the state.
I am a mohel, and I practice metzitzah in a halachically approved manner, using a sterile tube powered by the mouth (which makes it "B'peh"). It fulfills the needs of those who require metzitzah and has the added benefit of providing zero risk to the baby. It also elevates the mitzvah of Bris Milah and makes it appealing even to Jews who are not observant.
Three final thoughts:
First: A father who insists on MBP should do it himself. Bris is his mitzvah, he shares his baby's DNA, and he may run the risk if he and his wife agree to it. What makes any mohel's mouth, no matter how pure and holy the man is, a bastion of germ-free saliva?
Second: Government intervention will not stop people from doing what they think their religion tells them. A law against the practice will push people under cover where they will do it anyway. This too is unacceptable – the United States is not Czarist Russia.
Third: Change must come from within. Rabbis and Yeshiva leaders in these communities must ignore the insistence of their followers that this practice be maintained and must teach that metzitzah with a sterile tube is not only an acceptable option (Rabbi Elyashiv, the Israeli sage, said it isacceptable in 1989), but should really be the only option.
Without the rabbis preaching a different tune, nothing will change. And while the babies who die from metzitzah are rare, fortunately, the only acceptable number of metzitzah-related infections or deaths is zero. As long as direct-oral-contact metzitzah continues, any rabbi who does not ban the practice is partly responsible for negative metzitzah outcomes.
Avi Billet is a traveling mohel who blogs about Bris Milah at www.mohelinsouthflorida.com