Motherhood III: Childbirth

Our rabbis taught [in a baraita]: There are three partners in [producing] a human, God, his father, and his mother.

The birth-pains of the mashiach. The explanation of this matter is that when the messianic king arrives, because something new will come into the world that has never existed, and for that [to happen] there will be birth-pains, because any change entails birth-pains like the pains of a woman in childbirth, for the child who comes into the world is a change that never existed—therefore, there are pains.

To the woman He said, “I will greatly increase your pain and your pregnancy, in pain will you birth children.”

And the man called his wife’s name Chava, for she was the mother of all [human] life.

… She [the woman] affords deliverance from death and gives life; and, through her, man becomes immortal. Notice that Adam does not call her Chaya, but Chava. Chava always denotes giving spiritual life. ָ Yechaveh da’at [lit., declares knowledge] (Tehillim 19:3), achavecha [I will declare to you] (Iyov 15:17). In all respects, woman is em [mother] — a sine qua non (eem), not only for physical life, but for spiritual and emotional life as well. She gives life to the next generation, so that it may continue to fulfill the destiny of man.

A time to give birth and a time to die. When a woman sits on the birthing stool they [her attendants] scream to her “live,” and why do they scream “live”? Because she can die or live.

The woman when she crouches to give birth is in danger to her life…

During childbirth a woman necessarily leaves a lot to emunah peshutah (blind faith) just as she has done throughout the nine months of her pregnancy. However, she can minimize the fear by obtaining as much information as possible and deepening her understanding of herself and the process of birth.

Notwithstanding that some women find it more pleasant to give birth at home, one should avoid and even prohibit home births due to concern—even a small concern—for complications that are liable to be dangerous and even deadly. Halacha permits violating Shabbat in order to allow a woman in labor to get to the hospital, based on the concept that the increased safety of giving birth in a hospital is not a luxury…note 188: Rav Shammai Kehat Ha-kohen Gross…Rav Yitzchak Yosef…Rav Avraham Yitzchak Ha-levi Kilav…Rav Meir Nissim Mazuz…Rav Yosef Shalom Elyashiv…In a response…from 9 Cheshvan 5777, [Rav Dov Lior]: “Certainly one should prefer birth in a recognized hospital that has all the means to take care of problems or complications that are liable to arise on account of the birth…However it is difficult to completely ignore the mothers who desire, for whatever reason, to give birth specifically at home, but they have the obligation to ensure in advance that there should at least be an expert midwife present there, and also that there should be appropriate conditions in the case of complications so that they will be able to rush the childbearing woman to a nearby hospital…”

My approach is to advise not to move up the birth, and act against nature as established by God, if you want to say because of moving up the danger of childbirth, or if you want to say because moving up the birth may itself cause danger to life as I have heard from expert physicians… and if you want to say because of moving up the bringing of the child himself into the world before it was established by Divine providence. Unless, according to the judgment of an expert physician, there is more danger in waiting for a natural childbirth, much as we permit c-sections and the like.

One should not begin on Shabbat, nor even on Friday close to the beginning of Shabbat, to induce labor (even where it [an induction] is needed according to a physician’s opinion), unless there is danger, or concern for danger, to the fetus or the woman. And so is the law regarding c-sections, in a place where it is possible to delay its performance to after Shabbat, and this is on condition that there is no danger in the delay, neither to the mother nor to the fetus.

Rav Yitzchak son of Avdimi said: Chava received ten curses…”In sorrow will you birth children”—as it sounds.

“And the woman [Yocheved] conceived and bore a son [Moshe]”…Rav Yehuda son of Zevina said: It compares her childbirth to her pregnancy. Just as her conception was without pain, so was her childbirth without pain. From here we learn that the righteous women [slaves in Egypt] were not subject to the decree of Chava.

Is it permissible for a woman to request an epidural when giving birth on Shabbat? Rav Ariel’s response: A woman [in labor] is presumed to be in danger to her life, and if so it is permissible for her to undertake actions to ease the birth.

…The Torah said, violate one Shabbat for him, perhaps he will keep many Shabbatot. Therefore, even for saving a fetus of less than forty days, which has no vitality at all/is not viable at all, we violate [Shabbat] for him…

Mishna: We deliver a woman on Shabbat, and call a chachama [midwife] for her from one place to another, and violate Shabbat for her…Gemara: Since it teaches “We deliver a woman on Shabbat,” what does “We call a chachama for her from one place to another” add? [It is] to include what our sages taught [in a baraita]: ‘If she was in need of a lamp, her attendant lights a lamp for her, and if she was in need of oil, her attendant brings oil to her in her hand, and if [the amount] by hand does not suffice, she brings it in her hair, and if [the amount] in her hair does not suffice, she brings it to her in a vessel.’ Master said: ‘If she was in need of a lamp, her attendant lights a lamp for her.’ That is obvious. No, it is needed in the case of a blind woman. What might you have said? Since she does not see, it is prohibited. This teaches us that it settles her mind [yishuv da’atah]. She thinks, if there is something [needed], my friend will see it and do it for me…Rav Ashi said…She brings it to her in a vessel—via her hair. For as much as it is possible to act with a shinui [modification], we do.

A yoledet [woman who gives birth] is like a chola she-yesh bah sakana [a person with a life-threatening medical condition] and we violate Shabbat for her for anything she needs; we call a chachama from one place to another for her, and we assist her to give birth, and we light a lamp for her, even if she is blind. And in any case, wherever we can act with a shinui [modification], we do, such as if we need to bring her a vessel, her attendant brings it hanging from her hair, and so anything similar to this.

The halacha is like Mar Zutra, in the case of possible threat to life we are lenient…Rav Yehuda said Shmuel said: A woman giving birth, as long as the womb is open, whether she says ‘I need it’ or whether she said ‘I don’t need it,’ we violate Shabbat on her behalf… From when is opening of the womb? Abbaye said: From the time when she sits on the birthing stool. Rav Huna son of Rav Yehoshua said: From the time when blood flows down. And some say: From the time when her attendants carry her by her arms.

A woman giving birth, from when the blood begins to flow down until she gives birth…we violate Shabbat on her behalf and take care of all her needs, whether she says she needs it or whether she says she does not need it.

We rule that in the case of possible danger to life we are lenient…therefore it follows that the measures [of the womb being open] do not depend on each other, and there are women who never sit on the birthing stool at all, for the baby emerges quickly, but from the time when she sits on the birthing stool, or the blood flows down, or her attendants carry her by her arms because she can no longer walk—she is presumed to be in danger and we perform [melacha] for her. And Rambam wrote [only] from when the blood flows down…Rambam thought to say that this is the earliest sign, and ruled that in cases of possible threat to life we are lenient.

The woman giving birth when she crouches to give birth is in threat to her life and we violate Shabbat on her behalf, we call her a chachama from one place to another, and cut the cord and tie it, and if she needs a lamp when she is crying out in her labor pains, we light a lamp for her.

For Rambam in Shabbat 2:11 makes clear that lighting a lamp deals with before the blood has begun to flow, for he wrote ‘at the time when she cries in her labor pains’ which is even a long time before…

One of these – and specifically regarding the matters that one can do without postponement or delay, for this one should wait until one of these three signs is seen, but regarding calling a chachama from a distant location and the like, where if we wait until these criteria have been met the midwife will be delayed in coming, perforce from the time when she feels a little, even in doubt, it is permissible to call her [the midwife] and even if she is three parasangs away [about ten miles, well beyond intercity travel limits for Shabbat].

It is permissible to telephone a physician in order…to ask for guidance for care…

A pregnant woman who has already reached her ninth month of pregnancy on a Friday as it is getting dark should insulate hot water so that if she gives birth on Friday night or on Shabbat day, hot water will be available, and they will not need to violate Shabbat.

A woman who has reached her ninth month of pregnancy needs to prepare from Friday a “birth bag,” and to place into it her identifying documents, her required medical permissions, and any other document that is liable to be required at the hospital. So too, one should place in the bag enough money for taxi fare if that is needed [in the case that a woman needs to pay a driver on Shabbat—she should not hand the money to the driver herself, but tell him to take it out of the bag]…In the bag, the woman should place something important that is permitted for use on Shabbat so that the bag will be a container for something permissible as well as something prohibited for Shabbat use, and thus will not be muktzeh, and in this way it is permissible for her to carry it…One calls for transport for a woman in labor [cab or ambulance] immediately when she begins to feel signs of birth, even if she is doubtful they call for transport. One who calls on the phone to order transport for the woman in childbirth should call with a shinui [modification] on condition that the matter not cause delay [as is explained above], such as pushing the buttons with another object, but there is no need to keep speech to a minimum during the conversation…One who is transporting a woman in labor to the hospital in a private car on Shabbat—it is permissible for him to drive his car as usual on a weekday and there is no need to drive with a shinui…He should shut down the engine with a shinui or with the help of a non-Jew, and not follow the opinions that say to leave the engine running. It is prohibited for the husband who drove his wife on Shabbat to return home by car on Shabbat.

In the matter of the woman when she needs to travel by taxi to the hospital on Shabbat to give birth, and she wants her husband or her mother to travel with her because that gives her yishuv da’at, if it can be permitted….In practice, since we have found with women in labor that they are liable to be in danger due to fear, who can rely on making distinctions when there is concern for saving a life? Therefore, if she says she is afraid even after they explain to her that there is nothing to be afraid of in traveling on her own, there is concern for saving a life and the husband or mother must travel with her. And even if she travels to the hospital when she is not yet crying out in her pains, if she lives far away, he should still travel with her, for even though now she is not in danger, it is possible that en route the labor pains will grow until she reaches the point of crying out from her pains, in which case one should be concerned for her fear endangering her. And in any case, with traveling by car there is no concern lest the melacha performed on Shabbat be increased on his behalf, for it is equivalent for one or many riders and in this itself there is no violation of Shabbat for the one who travels with her, since the trip is permissible for her, and I do not know even of any rabbinic prohibition if the hospital is within the city or within techum Shabbat, except perhaps for how it will look [mar’it ha-ayin]; therefore, one should permit it if it will distress her [not having accompaniment] even if it will not lead to danger.

The travel of an escort: The woman in labor needs someone to escort her, to help her and to take care that even in a very busy situation, the medical staff will care for her as needed. But since there is no need for more than one escort, it is prohibited for two escorts to travel with her. Even a doula is not needed on the level of saving a life and therefore if there is already one escort, such as the husband or the woman’s mother, it is prohibited for the doula to travel on Shabbat. And only in unusual situations, when the woman giving birth is hysterical and demands that both her husband and mother travel with her, can both of them travel. Note 6: …There are those who permit responding to the request of the woman, and to also include her mother or sister in the trip even when the woman is not hysterical…It seems that even according to the view of those who are lenient, it is permissible to be lenient only for someone who always relates to the travel of the additional escort as a matter of saving a life, for example, that even in the middle of their child’s wedding, they would leave everything to be an additional escort for the woman.

…Even if the husband of the woman giving birth is traveling with her to the hospital, if the woman giving birth asks at the stage of contractions that her mother or a doula come to escort her and prepare her for active labor, it is permissible to telephone them on Shabbat and call them to come, and it is permissible for them to travel to the hospital. Even so, one should try to minimize performing ordinarily prohibited acts.

There are those who permit – He reasons that in a case of performing a mitzva our sages did not decree against receiving payment for work on Shabbat…And a midwife is certainly permitted to take payment for work on Shabbat.

His students asked Rabbi Shimon bar Yochai: Why did the Torah say a woman who has given birth brings a sacrifice? He said to them: At the time when she crouches to give birth, she impulsively makes an oath that she will not sleep with her husband again, therefore the Torah tells her to bring a sacrifice.

He [a husband] should not look…at her [usually] covered places, but it is permissible to look at her [usually] exposed places even if he takes pleasure at seeing her.

Regarding whether the husband can be there to oversee that things are done properly and also to strengthen and encourage her, if there is a need I do not see a prohibition, and even without a need I do not see a prohibition. But it is prohibited for him to watch the actual emergence of the baby, for it is prohibited for him to look at her covered places when she is in nidda, and prohibited to look at her genitalia ….but when he takes care not to look, there is no prohibition, and it is also prohibited for the husband to look by means of a mirror.

We have learned how great the matter of yishuv hada’at is for a woman giving birth, and it is straightforward that if she is afraid to be without her husband that he is obligated to be with her and to keep himself from looking, and if it turns out that he cannot keep himself [from looking] it is still not a reason that stands up against saving a life…and also this type of looking, which is not for desire, is not a Torah prohibition according to the main opinions…And further it seems that the husband is preferred in the matter of yishuv ha-da’at to the nurses and the doctor, since the woman trusts someone she knows…But since the language of the baraita is “If she was in need of a lamp” etc., the implication is that she says these things; therefore, in my humble opinion, one should not permit something that could easily lead to prohibition without her request to put her mind at ease [for her yishuv da’at]. And the husband can be in the labor room without this [request] since in general his wife is covered up there and there is no prohibition at all, but to be in the delivery room his wife needs to request this for her yishuv da’at as I wrote at the beginning.

A man is obligated to separate from his wife in her days of ritual impurity until she counts and immerses….He should not touch her, not even her little finger, and not hand anything from his hand to hers, lest he touch her flesh.

‘A woman who is sick and she is in nidda, it is prohibited for her husband to touch her’: but to hand her an object to her hand or to take one from her hand, and similarly other acts that entail touch through an object, such as putting on shoes and the like, are permissible even according to the view of Shulchan Aruch…[On Rema’s ruling] bathing her is an act of great intimacy and was not permitted on account of her sickness unless she is in danger unless she is bathed in which case it is permissible…and regarding the matter of serving or mixing a drink it seems that there is no need to be stringent…

For if the woman who is about to give birth strongly insists that her husband hold her hand at the time of childbirth—an issue for the laws of nidda—and it is apparent that she needs it for the sake of her emotional calming down, then there is room to permit it to him and to her…when there is true anxiety and a concern for her well-being. A wise suggestion in this matter…is for the husband to wear a thin medical glove on his hand, in this way, the halachic issue is much less grave…for these words apply only when there exists a true problem that cannot be resolved in another way…There is no reason for us not to see calming the woman in childbirth as a medical need in every respect, and as they permitted to kindle a light for the blind woman in childbirth in order that her mind be put at ease [she-tityashev da’atah]…He [another rabbi] further commented that there is a concern that this permission would spread, and women will insist on this from the husbands even when there is no true medical need. I think that the proper way [to address this] is education and pre-marital education…In a case in which, in accordance with the doctor’s view, the woman in childbirth is in a state of hysteria, or there is a concern for her state of mind during the process of childbirth, and her husband is the only one who can help her, then it is his obligation not to be stringent with himself…

If it is a pressing situation such as when the assistance of the husband is needed to relieve her pain, one should permit him to touch her even if she has reached the point of sitting on the birthing stool and cannot walk by herself.

A woman who gives birth [vaginally], even if she did not see blood, is temei’a [ritually impure, i.e., prohibited from physical contact with her husband] like a nidda.

[A baby] born via the abdomen [i.e., a c-section], if blood only came out through the abdomen, his mother is tehora [ritually pure] from [the impurity of] birth…

[Vaginal] birth itself makes a woman temei’a, and from the time when the head of the baby emerges, or most of [its body], even if no blood came out with it, the woman is temei’a on a Torah level with tumat leida [impurity of giving birth], a week for the birth of a boy and two weeks for the birth of a girl. Often, before the baby comes out, blood starts to come out of the uterus, because of the pressure of contractions, and then the woman becomes temei’a. But if according to the opinion of the doctor or the midwife the blood was vaginal or cervical [and not uterine], then she remains tehora [pure, i.e., physical contact with her husband is permitted].

From when is the opening of the womb? Abbaye said: From the time when she sits on the birthing stool. Rav Huna son of Rav Yehoshua said, from the time when the blood flows down and some say, from the time when her attendants carry her by her arms.

I was asked a question regarding a woman who had reached her time to give birth…and she thought that her labor contractions had begun. She sent for the women as was customary and all agreed that the time of birth had come and they called the chachama [midwife], and they were occupied with her as is customary for women who crouch to give birth, and after some time the midwife did not see the child and the contractions did not begin, and [the woman] was still walking around with her pregnant stomach for about four weeks. Now, the women from Poland attest that the custom in all the lands of Poland is that as soon as they call a midwife and she checks the woman whether or not her time to give birth has come, they presume her to be temei’a and she needs to count seven clean days and then become tehora for her husband through immersion. But all other women of Ashkenaz, may God save them and keep them, said that they never heard such a thing, for even though the midwife was checking her, even so she was tehora for her husband. This is the crux of the question…I did not find this matter explicated in the Talmud or among halachic authorities, neither to permit nor to prohibit…I said to myself that the custom of Israel is Torah. How much more so when we are a place of Torah and all their acts are for the sake of Heaven. And I found a hint at the end of chapter Mefanin (Shabbat 129a), “From when is the opening of the womb?”…And if so, if when she sits on the birthing stool is considered opening the womb, and we maintain that there is no opening of the womb without blood…As a stringency regarding nidda, which is a matter of spiritual excision [karet]…it is simple that if the blood flows she is temei’a. And if so, the halacha is the same if she sat on the birthing stool prior to the blood flowing, she is likewise temei’a…And if so, here too one should compare our matter to opening the womb since the midwife checked her…And therefore in my opinion they [the women] said the [correct] halacha, that she is prohibited to her husband until she goes through the process of becoming tehora.

Regarding the matter he was asked about, where a woman had contractions and labor pains and thought that her time to give birth had come and sent for a midwife, etc…I ruled to permit her, what does it matter to us the words of a few collections of halacha that are seeking out new stringencies, and the author of Nachalat Shiva…was stringent with this, and we don’t heed his words, and in his dreams he compared this to if her womb was beginning to be open. But our sages when they said, “it is impossible for the womb to open without blood,” this is if the womb opens and something solid like a child comes out…But regarding the womb opening on its own when nothing solid came out, they did not say it is impossible without blood…This is itself in doubt regarding birth, from what point is considered opening the womb, and it is simple regarding rendering her temei’a to her husband that we try to be lenient for there is no Torah prohibition here…And the fundamental matter here is to ask the woman; if she says that she had a distinct sensation of the opening of the womb, certainly she is temei’a from the perspective of nidda as explained at the beginning of [Shulchan Aruch YD] 190. But if she says she did not feel, she is permitted to her husband.

With every woman giving birth, the concern for her womb opening is as explained in the Sidrei Tahara from the point that she can no longer walk. And even when she has contractions and the physicians say she is dilated two or three fingerbreadths, she is tehora as long as she can walk…With water breaking, there is doubt…In practice one should be stringent when it seems from the situation that she is immediately before birth….A mucus plug that comes out before birth, one should be concerned about opening the womb, and one should ask a rabbi.

Even granted also that opening the womb for the purpose of violating Shabbat is not opening the womb for the purpose of the prohibition of nidda…sitting on the birthing stool is very close to birth itself, see II Melachim 19:3, “children have come to the birthing stool [mashber], but there is no strength for the birth,” and Rashi explains that the mashber is a seat for the woman who crouches to give birth…And similarly, from the time when her friends carry her by her arms is close to birth, and in the view of Rambam is when the child has already begun to exit the cervix…In my humble opinion one should not rule that the woman is temei’a for the reason of ‘it is impossible for the womb to open without blood’ except for close to birth itself…and even if there was a doubt as to when would be called sitting on the birthing stool, or when would be from the time when her attendants carry her, one should not be stringent because there are a number of doubts as I have written…

We also need to remember what’s happening: A soul is making its way into this world. Just as a couple is careful to conceive that child in kedusha, it’s critically important to usher that life into the world in kedusha. There is a great deal a husband can do within the realm permissible by halacha and this should be his focus.

Regarding the midwives, it is impossible to say that there were only two, for how could two women suffice for a large and numerous people like benei Yisrael?…Rather, the matter is thus, that the custom in Egypt was that two midwives would come to stand with each woman giving birth, and one of them would be occupied with the delivery of the baby and with tending to it; therefore, she was called Shifra, because she would beautify [mashpira] the baby. And the second would be occupied with strengthening the birthing woman and helping her with words and sounds and prayers, and therefore she was called Puah, as in the language of “like a birthing woman I will cry out [eph’eh]” [Yeshayahu 42:14]

From the hundred cries a woman cries out when she sits on the birthing stool—99 are for death and one is for life.

And she said, I have gained a man with God.

Those sitting on the birthing stool, bring them out from darkness to light, and may the child emerge in a good time, and may no sorrow or damage befall the women in childbirth or their children.

Childbirth is a team effort on many levels. It is a relationship between the woman and the baby she is bringing into the world, between the woman and her support people, and between the woman and Hashem. What Hashem has in store for her cannot be known, but she must never underestimate the power of tefillah….Kavanah is the key to transforming childbirth from a frightening ordeal to an exciting and fulfilling challenge. The direction and sense of purpose of the woman’s mind during labor along with the preparation she makes beforehand alter the experience for her. If she believes that she is fulfilling the ratzon Hashem [the Will of God] with all her mind and heart, this can elevate the physicality of childbirth into a pure form of service to Hashem. In labor, a woman can also feel that she stands before Hashem in prayer, opening her soul to him as she opens her mind to her birth experience and opens her body for her baby.

I give thanks to God with a full heart because I have come to nine months and to this point He has saved me from bad mishaps that can harm a pregnant woman and her fetus. The Good because His mercies do not end. Therefore, I request mercy from Him that He should help me and support me when the child comes to the birthing stool. And He should give me strength to give birth to him. Please, God, help me and I will be saved and redeem me from sorrows in a way that the child shall come out of me to life and well-being and there should not be in him or in any of his limbs not damage nor lack nor injury nor accidental harm nor pain nor spasms nor blemish nor sickness…For You are God who protects us and saves us from now and forever…