Motherhood II: Conception & Pregnancy

Pregnancy begins with conception, and the Torah quickly lets it be known that the ability to conceive is not a given. Three of our four imahot—Sara, Rivka, and Rachel—struggle to conceive until God intervenes,¹ indicating that the key to fertility lies with God:

As in other areas of life, our tradition recognizes that there is room for human actions to try to effect change. In Bereishit, Rachel acquires Reuven’s duda’im (likely mandrakes) from her sister, in what may have been an effort to enhance her chances to conceive.

If this was an attempt to aid conception, then Rachel’s act is a first mention of a woman taking actions other than prayer in this direction. Unfortunately, as Radak points out, human knowledge can err and our efforts do not always bear fruit. That does not rule out trying, however. For example, our sages cite the possibility that steps that a couple take during relations can affect characteristics of the fetus conceived:

This passage concludes with the insight that both physical efforts and an appeal to on high are needed to influence conception.

Ovulation Tracking

Human endeavors to increase the chances of conception include one of the most practical steps a couple may take to pursue pregnancy, tracking ovulation. Knowing when a woman ovulates lets a couple plan to have intercourse during her fertility window, which typically extends from three days before ovulation until a day afterward.

Ovulation predictor test kits identify the surge in luteinizing hormone (LH) that usually takes place one to three days prior to ovulation. Other signs, such as a woman’s discharge becoming clear and stretchy, and shifts in cervical position and basal body temperature (BBT), can also be used to identify the likely timing of ovulation.²

Mikveh night commonly falls out during a woman’s fertility window, providing couples with the opportunity to conceive.³ Sometimes, ovulation occurs before immersion, which can interfere with conception on a given cycle. Still, because a woman’s bleeding and ovulation patterns can vary somewhat from month to month, missing or narrowing the chance to conceive one month does not necessarily translate to every month.

In some cases, however, a woman’s ovulation consistently occurs more than a day before her scheduled immersion. Since Halacha prohibits sexual relations during niddah up until immersion, this timing can reduce or eliminate the chance to conceive. In this type of situation, sometimes called halachic infertility, it is critical for a couple to seek halachic and medical guidance, to ensure that mikveh night takes place as early as possible and to investigate (and potentially adjust) a woman’s cycle.

In a landmark article on this topic, Yoatzot Halacha Drs. Tova Ganzel and Deena Zimmerman, MD, lay out a possible sequence for addressing suspected cases of ovulation before immersion medically and halachically:⁴

Nishmat’s Yoatzot.org has an excellent, detailed and practical discussion of this issue and how to address it here, including information on complementary medicine.

Tracking and Testing on Shabbat

Tracking ovulation is typically a daily activity, most reliable when performed consistently. This raises questions about tracking ovulation on Shabbat and Yom Tov. (Mentions of “Shabbat” in this discussion apply equally to Yom Tov.)

Checking secretions and cervical position on Shabbat is no different than on any other day, and is halachically permissible. In contrast, taking temperature on Shabbat is usually considered a violation of the rabbinic prohibition of measuring. Rav Eliezer Waldenberg argues that taking temperature with a mercury thermometer is permissible when someone is ill and tracking temperature is potentially important for their care or for the sake of a mitzva:

In a later responsum, Rav Waldenberg relates specifically to a woman tracking ovulation as a permissible act of measuring for the sake of a mitzva.

This logic has been adopted by other authorities as well, including Rav Neuwirth, who does not limit it to childless couples.

Rav Neuwirth’s permission is for using a mercury thermometer. Although it, too, is not electric, tracking ovulation on Shabbat with a urine stick test (ovulation predictor kit, or OPK) is more halachically complex. Urine applied to the stick causes one or two colored lines to appear on the white surface, which raises questions of dyeing, tzovei’a. As Rav Shneur Zalman of Liadi points out, the prohibition of tzovei’a is in full force only when someone specifically desires the color change. (See a more detailed discussion of this ruling in our discussion of menstruation and Shabbat.)

A woman tracking ovulation is seeking to gain knowledge of her LH surge, not to create a colored line. This may leave room for more leniency with testing on Shabbat. Rav Shlomo Zalman Auerbach is reported to have considered this argument in ruling about using urine stick tests for blood sugar on Shabbat:

Rav Auerbach seems to permit the stick test, though he voices a preference that it be done in such a way that the urine makes its own way onto the stick, rather than the stick being urinated on or dipped into it, since indirect action is treated more leniently in Halacha.⁵

In practice, taking the test right before and right after Shabbat should not sacrifice accuracy, and a couple with no special fertility concerns can usually test only on weekdays and simply err on the side of having relations over Shabbat, just in case. In more pressing cases, however, there may be grounds to rely on more lenient positions.

Pregnancy tests raise a similar halachic issue on Shabbat to OPKs. However, since there is generally no need to perform them specifically on a Shabbat, they should be delayed until afterwards, outside of the context of emergency medical care.

The Talmud recognizes the possibility that some health issues might run in families. In Talmudic times, once a familial health issue was halachically established, the only solution was to avoid marrying into certain families altogether. This can be hard to imagine nowadays, when medicine has advanced to the point that even difficult health conditions can often be managed.

Thankfully, today there are more and better options for addressing genetic health concerns than this drastic measure. A range of test panels is now available to screen couples to see if they are carriers of genetic mutations that might lead to disease, some of which are especially prevalent in specific genetic groups, such as Jews with ancestry from a particular region.

Genetic testing first came to the fore in the late twentieth century, when it became possible to screen for Tay Sachs, a painful genetic disease in which children do not survive toddlerhood. Like many genetic diseases, Tay Sachs can be passed on only if both parents are carriers, in which case each child has a 25% chance of being born with the condition. Therefore, it can be prevented by avoiding marriage between carriers.

In 1972, Rav Moshe Feinstein permitted testing for Tay Sachs compatibility prior to marriage, provided the information is kept private.

In the decades since Rav Moshe issued this response, genetic screening has come to carry much less stigma. A first step was the development of confidential, non-stigmatizing screening programs (like Dor Yeshorim), which addressed Rav Moshe Feinstein’s concerns about privacy. Over time, genetic screening and disclosure have become more routine across populations, and test for a broader range of mutations. Rav Avigdor Nebenzahl has suggested a practical rule of thumb regarding disclosure:

Genetic screening is now widely recommended by halachic authorities, and relied upon even when there is a family history that creates a halachic presumption (chazaka) of a given disorder.

Screening and Preimplantation Genetic Testing

Most recently, the development of Preimplantation Genetic Testing (PGT) has reduced resistance to screening. PGT can enable carriers or carrier couples to marry and conceive with the help of In Vitro Fertilization (IVF) followed by testing or screening of their embryos. In this way, only those embryos that do not seem affected are transferred to the mother’s uterus.

In an early halachic ruling regarding PGT, Rav Asher Weiss was asked whether a couple who had one child with a genetic defect were obligated to pursue PGT to fulfill the mitzva of procreation, pirya ve-rivya. He ruled that pursuing PGT is not obligatory in such a case, but is strongly encouraged, especially since children born through IVF fulfill the mitzva of pirya ve-rivya:

This ruling establishes that PGT is encouraged once a married couple find themselves in the situation of a known genetic risk to their offspring. It does not address the question of a couple’s initial decision to enter such a situation.

On the question of how those who discover through screening that they are carriers should proceed, Rav Shlomo Daichovsky rules that they may go ahead and marry, on condition that they have children exclusively through IVF with PGT:

Once PGT is viewed among halachic authorities as a potential solution for carrier couples that can enable them to fulfill the mitzva to procreate, there is no longer the same level of concern about screening limiting carriers’ ability to marry.

In practice, couples who discover that they are carriers of a genetic disorder should consult personally with both a genetic counselor and a halachic authority with experience in this area when making decisions about marriage and conception.

Getting a positive result on a pregnancy test is a significant milestone. Nowadays, this can happen within two to three weeks of conception. In earlier times, while a missed period would have been a first indication, pregnancy would not have been confirmed for a while. The Torah mentions that it took three months for Tamar’s pregnancy from Yehuda to become apparent, at least to others:

Leaving aside the many complex elements of this story, from Yehuda’s strong reaction to this news of Tamar it becomes clear that visual recognition of pregnancy at about the three-month stage was considered decisive.

Halachically, the point at which a pregnancy becomes known is called hukar ubarah (when her fetus is recognized).

Defining the point at which pregnancy begins is halachically significant for a range of issues, though the classic halachic discussion is regarding the laws of vesatot, times when a woman might expect to become nidda based on her prior cycles. A veset is typically observed by checking for bleeding (bedikot) and refraining from relations. As we will see, though the classic halachic discussion highlights vesatot, halachic recognition of pregnancy can also be relevant for determining when various accommodations for a woman who is pregnant can take effect.

Once a woman has reached the stage of hukar ubarah, she is officially considered to be mesuleket damim, not expected to menstruate. She is thus released from standard observance of vesatot.⁷

The Talmud describes a pregnant woman’s physical changes as a heaviness, and suggests that this heaviness is associated with the change of bleeding patterns.

According to one interpretation, it takes three months for a woman’s pregnancy to be recognized, as it did for the biblical Tamar.

Rabbi Yossi suggests that this only takes place once three of a woman’s usual cycle lengths have passed by:

On all of the perspectives that we have seen thus far, a woman’s pregnancy is halachically recognized with respect to vesatot roughly at the end of her first trimester. As we noted earlier, pregnancy tests nowadays can be conducted much earlier than three months into the pregnancy. Rav Moshe Feinstein rules that a positive pregnancy test suffices to establish a pregnancy halachically, even if performed very early in pregnancy:

In this responsum, Rav Moshe does not relate only to test results, but is also attentive to how a woman herself feels. He also refers to the fact that, for most women today, the first indication of pregnancy is a missed period, typically about two weeks after conception (which may not have been true in earlier times).

In practice, the debate about when Halacha recognizes pregnancy is often more significant in areas other than vesatot, for which this debate often turns out to be merely theoretical. New vesatot are typically based on a prior month’s bleeding, and many women do not experience blood flows during early pregnancy that would necessitate observing any additional vesatot.⁸

With respect to fasting, positions akin to Rav Moshe’s are prevalent. Many halachic authorities consider a woman pregnant for the purposes of being lenient with minor fast days from very early in her pregnancy.

Mishna Berura, for example, says that a woman can apply leniencies regarding fasting from forty days (calculated from conception) or at any sign of distress, as necessary.

Mishna Berura thus rules that halachic leniencies based on pregnancy can be adjusted depending on how a woman actually feels. In practice, on minor fast days many halachic authorities are lenient with pregnant women from the beginning of pregnancy. (For a practical discussion of pregnancy and fasting, see here and here.)

This logic of recognizing a pregnancy before three months when a woman experiences physical distress can be applied to other health-related situations as well, some of which we raise below in our discussion of prenatal care.

Pregnancy Disclosure and Purchases

Halacha does not dictate precisely when a couple may disclose a pregnancy to others. Some communities have the custom not to disclose a pregnancy until after hukar ubarah, (roughly the first trimester). This is presumably for two related reasons: because first trimester miscarriages are common, and out of concern for the evil eye in early pregnancy.

Even so, couples should not hesitate to share this information when it will be meaningful for them or helpful to the pregnant woman’s physical or mental well-being. Hesitating to share news lest there be a need to inform more people about a miscarriage is also a double-edged sword. The more people know about a pregnancy or pregnancy loss, the more they can offer various types of support.

Similarly, there is no halacha regarding when to buy things for a baby. In many religiously observant communities, however, baby showers are less common and purchases aside from necessities are often left to after childbirth.

In some Sefardi communities, though, there was a customary ceremony held during a first pregnancy somewhat reminiscent of a shower, “the cutting of the cloth”:⁹

In practice, making purchases before birth is left to family custom and a couple’s discretion, taking into account their practical needs.

Our tradition recognizes that pregnancy is not always comfortable or simple for the mother, even beyond the feeling of heaviness mentioned above. To start with, the Talmud presents the travails of pregnancy as part of Chava’s punishment:

After she has endured years of infertility, Rivka’s prayers would seem answered with a pregnancy, but she finds herself struggling with carrying her twins to the point that she is not sure why she persists in living:

In an essay for Lehrhaus, Rabbanit Leah Sarna discusses the significance of deeply considering Rivka’s story and what it means for pregnant women today:¹⁰

As the sources we’ve seen acknowledge, participating in a miracle does not necessarily feel miraculous. In his commentary on the passage about Chava’s curse, Rashi makes a statement of halachic significance. He stipulates that pregnant women in general are considered cholot, ill, a halachic state subject to a range of accommodations.

This does not indicate that pregnancy is a disease. Rather, the halachic status of chola (or choleh) encompasses anyone who needs special care and consideration for health reasons, including pregnant women.

Halacha teaches us to be careful about health. In a published interview, Rabbanit Chana Henkin highlights how health and spirituality intersect during pregnancy:

The halachic charge to care for our health includes availing ourselves of medical assistance as necessary.¹¹ A woman should try to choose her healthcare providers wisely, as different medical professionals have varying approaches to prenatal care and childbirth. A physician’s attitude toward Judaism and sensitivity to the patient’s religious commitments can also prove significant at different stages of care.

Rambam teaches that taking steps to maintain health, including preventative medicine, is also a key value in Halacha:

Halacha thus also approaches conception and pregnancy with an emphasis on preserving and promoting health. This begins by following widely accepted medical advice on preparing for pregnancy, such as taking folic acid, going for a preconception check-up, and getting any needed dental work done in advance of conception.

The importance of preserving a pregnant woman’s life in its own right is underlined by her status as a chola. Her role as carrier of the fetus gives concerns for her health and well-being extra weight.

There is a general halachic principle that Shabbat and Yom Tov restrictions are pushed aside when needed to preserve the life of any person. Obviously, this includes a pregnant woman. Less obviously, it also includes the fetus.

Ramban extends this ruling to a fetus:

Therefore, a pregnant woman should not hesitate to seek medical help or to call for a medical opinion on Shabbat or Yom Tov in any case of doubt.

Early authorities add that extending similar protections to the health of mother and fetus is simply logical, because the health of a pregnant woman and her fetus are interrelated.¹²,¹³

Yishuv Da’at

The imperative to take care of a pregnant woman’s health, even if doing so is at odds with what is ordinarily considered normative Halacha, comes to the fore in a Talmudic discussion of ways to attempt to accommodate a pregnant woman’s cravings, even for non-kosher food.

The process moves step by step, checking in with the pregnant woman at each stage to see when she has attained yishuv ha-da’at, a settled mind, putting her at ease, as opposed to tiruf ha-da’at, a mind that is frenzied, losing its cool and its ability to reason.

Giving a pregnant woman food on Yom Kippur is likewise described as a way to settle her mind, as if her craving for food has driven her into a sort of frenzy, even if only indicated by her face. Shulchan Aruch rules as follows:

Again, the instructions are to move step by step, checking in with the pregnant woman and seeing what calms her with making minimum adjustments to a woman’s standard halachic practice. Rav Shlomo Daichovsky points out that this ruling is unique to a pregnant woman:

Depression during pregnancy (perinatal depression) is unfortunately very common, and in general, men or women struggling with mental illness are often subject to halachic leniencies parallel to those struggling with physical illness.¹⁴

Rav Daichovsky sees an additional factor here, however. Even absent specific mental health considerations, a pregnant woman is especially emotionally vulnerable. Settling her mind, preserving her ability to function and reason, is a halachic value that can sometimes override other halachot.

Food-Related Accommodations

Our tradition’s first record of a careful prenatal care regimen comes from the angel’s instructions to the mother of Shimshon:

The instruction here to refrain from drinking wine is based not on health considerations, but rather on Shimshon assuming nazirite status in utero.

Physicians are not angels and following their advice is no guarantee of offspring destined for greatness. Nevertheless, this passage may still resonate for modern women, because of the underlying idea that a pregnant woman restricting some types of consumption can be important for her fetus.

Nowadays, drinking wine is a matter of concern in the prenatal diet for medical reasons. Alcohol is not generally considered safe for consumption during pregnancy. Some physicians view a small amount of wine taken for kiddush as harmless, while others recommend against taking even a sip.

If someone else is making kiddush, a woman need not drink at all. If she wishes to partake, or is making kiddush herself, she can typically use grape juice or a small cup of diluted wine (at a wine-to-water ratio of two to one). Learn more about making kiddush and about eating before kiddush here.

For the four cups on Pesach, grape juice is generally the preferred option. (A woman with gestational diabetes should seek personalized halachic guidance.)

Our sages recognized that in pregnancy a woman may have different nutritional needs than usual. The Talmudic discussion that we saw of attending to cravings exemplifies that. A midrash recognizes this well. According to this midrash, when Moshe Rabbeinu first expresses doubts about his mission in Egypt, he raises practical concerns, and meeting the nutritional needs of pregnant women is one of them:

At the same time as we make accommodations, however, Rema suggests that a pregnant woman needs to take particular care not to eat anything unkosher, to protect her fetus spiritually:¹⁵

While urgent cravings for specifically non-kosher food are now rare, we do still make some kashrut accommodations for pregnant women. So, for example, in our day, Rav Yitzchak Yosef rules that a pregnant woman who feels unwell without dairy may wait less time between meat and milk if necessary:

A common application of this ruling is when a pregnant woman drinks milk to relieve heartburn.

So, too, he rules that a pregnant woman who needs it can eat meat during the nine days or the week of Tish’a be-Av:

In practice, these rulings can be case-specific. For example, women who are anemic or have hyperemesis gravidarum will need special consideration. A woman should not hesitate to consult personally with a halachic authority.

We discuss the laws of pregnant women on minor fasts here and on Tish’a Be-Av and Yom Kippur here.

Ritual Modifications

Beyond dietary and fasting adjustments, pregnancy may also necessitate modifications to a woman’s usual ritual practice. For example, a woman who is finding it difficult to stand might limit her standing during tefilla to Shemoneh Esrei and Yishtabach. Or a pregnant woman struggling with morning nausea might need to daven shacharit later, to cut short her prayers, or to rely on opinions that it suffices for her to recite brief words of praise, request, and thanks. (Learn more here about these views and here about prayer priorities.)

A wide range of prenatal testing is currently available, including blood tests, ultrasounds, and screening that combines the two. These common tests are not known to pose any risk to the fetus.

Halachic discussions of their permissibility have centered on two points. On the one hand, they allow parents and healthcare providers to make adjustments to prenatal care and childbirth plans, to prepare for medical challenges with the fetus, or even to treat certain conditions in utero. On the other hand, there is concern that these tests might lead to abortions, which are a sensitive question in Jewish law, though there is a range of cases in which they may be permitted.

On the whole, the potential advantages of this testing are seen as outweighing the risks:

A couple of prenatal tests, amniocentesis and chorionic villus sampling (CVS), do pose a slight risk to the fetus. These procedures are typically considered halachically permissible when deemed medically important, but are usually discussed with a halachic authority on a case-by-case basis.

The gender of the fetus is usually easily discernible on the ultrasound scans that are routine for all pregnant women. There is no halachic constraint on finding out the gender before birth, or in disclosing it to others.

During pregnancy, the dynamics of sexual intimacy often change for a couple. The Talmud suggests that this may vary by trimester:

While the patterns of intimacy still can change over the course of a pregnancy, intercourse is now considered safe for both mother and fetus throughout pregnancy, unless it is contraindicated for a specific medical reason.

In general, a husband’s obligation of ona, to have relations at appointed times and to be responsive to his wife’s desires, remains in place throughout pregnancy.

Likewise, a woman retains her ability to waive this obligation if relations aren’t right for her. (Learn more about the mitzva of ona here.)

The prohibition of zera levatala (wasting seed) also remains in place during pregnancy.

While intercourse remains permissible even when it will not result in a new conception, acts other than intercourse that “waste” semen are still prohibited. This means that a couple experimenting with different ways to enjoy intimacy as pregnancy progresses should still keep the constraints of zera levatala in mind.

In some specific cases, a couple may be advised not to engage in intercourse for health reasons during pregnancy. In these situations, a couple should request specific medical guidelines about what is and is not permissible and seek out individual halachic guidance in light of their specific situation.

Generally speaking, a kohen is prohibited from becoming tamei, ritually impure, through contact with a dead body:

This prohibition extends to entering an area within which a dead body can convey ritual impurity, such as a cemetery or hospital:

The Talmud teaches that this prohibition applies to male kohanim only:

However, the question arises whether a pregnant woman married to a kohen has limits on where she can go, based on the possibility that her fetus is male.

As we will see, since hospitals are often necessary for optimal healthcare of a woman and her fetus, in practice a pregnant woman’s entry for healthcare is not limited, regardless of this concern. Cemeteries are a more complicated matter, since there is no health-related need to go into them. About 800 years ago, Rokeach permits a pregnant woman married to a kohen to enter a cemetery, based on a dual doubt:

In the seventeenth century, Radbaz suggests that this argument is usually unnecessary, because the fetus is considered to be fully contained within the mother’s uterus, and thus not subject to ritual impurity:

Radbaz suggests that the double doubt is required only shortly before a woman’s due date, at which point there is a concern that at any moment the fetus will begin to emerge and thus will cease to be contained. Mishna Berura seems to rule this way as well.¹⁶

In practice, nowadays, the gender of the fetus is often identified via ultrasound. If the fetus is female, there is no halachic issue. If it is male, then there is only one doubt, not two. Modern halachic authorities disagree as to whether the view that the fetus is fully contained suffices.

Rav Moshe Sternbuch ultimately rules that the fundamental halacha is to permit the wife of a kohen to enter a cemetery or a hospital, because there is no prohibition of causing ritual impurity for a fetus until it is ready to come out and because he is not convinced that women are prohibited from causing ritual purity for a fetus at all.

Rav Sternbuch rules that it is fitting for the woman to be stringent specifically when she is liable to give birth, and that even then if there is a need, one should not be stringent. Therefore, for example, there would be no constraint whatsoever on her entering a hospital, since the health concerns are clear.

Interestingly, in many communities, even pregnant women who are not married to kohanim have the practice not to enter a cemetery. Minchat Yitzchak suggests that this custom might have its origins in a mistaken misapplication of the discussion of the wife of a kohen, or might reflect a hope of having children born in ritual purity who could merit to participate in a red heifer ceremony, upon the rebuilding of Beit Ha-mikdash:

In practice, this custom does not stand in the way of a pregnant woman going to the cemetery when it is especially important for her, as for a funeral or yahrzeit of a close friend or family member.¹⁷

Nails

The Talmud relates that it is dangerous for a pregnant woman to step on fingernail clippings,¹⁸ likely based on a tradition that nails were associated with witchcraft,¹⁹ or a midrashic tradition that connected them to the punishment of Chava.²⁰ This is not mentioned, however, in halachic codes, likely because this might have changed over time or because it would refer specifically to someone walking over cuttings barefoot, which would be unusual nowadays.²¹

For the expectant mother, pregnancy is an all-encompassing experience, affecting body and soul. Spiritually, the inherent uncertainty of the process makes it a heightened time for prayer—whether praying to conceive, like the Biblical Chana:

Or praying just to make it through a difficult pregnancy, like Rivka:

Or praying for the child’s well-being. The Talmud discusses prayers for a parent over the course of a pregnancy:

For the most part, these prayers focus on the fetus’s health, with requests attuned to each stage of development. The gender request is permissible through forty days from conception, which is roughly when sex differentiation takes place for an embryo. If a couple wish for a female, that is of course an acceptable prayer as well. The Talmud there gives the example of Leah praying for Dina to be a girl:

Many women create their own prayers for pregnancy. This one was composed in 18th century Italy, for relief of pregnancy distress:

Additionally, some women choose to immerse in the mikveh in their ninth month, without a beracha (when there is no specific health concern in doing so), which is considered in some quarters to be a segula. When this is done, the woman should take care not to slip and to make sure the water has been properly treated.

Though by no means obligatory, immersion in late pregnancy can be a meaningful opportunity for the woman carrying a baby in her womb to place herself in God’s embrace, in faith and in prayer.