Non-religious circumcisions are typically done in the hospital around 24 to 48 hours after the baby’s birth, though some parents may choose to circumcise their sons in a doctor’s office after the baby has been taken home. (The exact timing may depend on each pediatrician, but the procedure generally takes place within the first four weeks of a baby’s life.) Techniques used vary from doctor to doctor, but three methods are common in the U.S.: the Gomco clamp, the Mogen clamp, and the Plastibell, a ring attached to the penis underneath the foreskin. The procedure can take anywhere from 30 to 60 seconds with the Mogen clamp to 10 minutes with the Plastibell; most mohels use one of the clamps.

In a hospital setting, the parents may not necessarily be present while the procedure is performed. (After confirming with the family that they wanted their son circumcised, Finch says, members of the hospital staff “just came in and told us that it had been done and how to care for it.”) At a traditional Jewish circumcision, a baby is circumcised in the presence of his family, usually as he lays on a pillow that’s been placed on the lap of a family member. Mohels have varied methods for comforting the baby, including a sugar solution, a drop of wine, or topical or injectable anesthesia. Physicians in the hospital may use topical or injectable anesthesia to make the baby more comfortable.

Philip Sherman, a mohel and a cantor at Congregation Shearith Israel, a synagogue in New York, estimates that he’s done more than 21,000 circumcisions over his 40-year career, and that he now does one or two per month on non-Jews. While Sherman doesn’t perform Jewish blessings at the circumcision of a non-Jewish child, he says that his circumcisions always have a spiritual element, and that many of the parents he’s worked with tell him they pick him over physicians for religious reasons. “Families who are seeking traditional mohels like myself want someone who is not only a super-specialist, but someone who is religiously observant,” he says. “They are seeking the spiritual component and are often seeking to do this in the context of their own religion or spirituality.” In fact, Sherman has an entire website dedicated to “holistic circumcisions,” which he performs instead of a traditional Jewish ceremony for non-Jewish families. These circumcisions involve the same technique as a traditional Jewish ceremony without the blessings. Sherman will often open the ceremony with a humanistic prayer but encourages families to add their own readings, songs, and prayers.

Sherman draws a clear distinction between his work and the medical realm: “I do not perform medical procedures,” he explains. “All brisses and circumcisions that I perform are religious in nature. If it is a bris,” he said, using the Yiddish shorthand for Brit Milah, “it is a religious ceremony. If it is for a non-Jewish family, there may be scriptural readings, psalms, blessings, and prayers that are recited.”