by Maharat Rachel Kohl Finegold
It’s that time of year again. Jewish pregnant women around the world are talking to their doctors and to their rabbis (or perhaps their Maharats) about whether or not they should fast on Yom Kippur. They are asking friends who have done it what it was like. And maybe they are becoming concerned about whether they will make it through the fast, whether they will get to shul, whether they might need an IV, and whether they might even go into labor early, as one study recently reported. Nursing women are having similar concerns, about whether their milk supply might be diminished, or whether they might become dehydrated. Many women say that fasting while nursing is even more difficult than fasting while pregnant, which makes sense – you’re providing nourishment for not just a small fetus, but a few-month-old baby!
For some women, this is a no brainer. They fast easily, pregnant or not, and they know other women who have fasted through two, or three, or more pregnancies with no trouble. However, for other women, the thought (or previous experience) of fasting while pregnant or nursing is anywhere from worrisome to absolutely frightening.
What follows here is not a formal Teshuvah. This is an attempt to lay out some of the halachic and medical considerations as well as the metzi’ut – the reality – that may come into play when considering whether pregnant or nursing women should fast on Yom Kippur. (Tisha B’av and minor fasts should be discussed separately.)
- Yom Kippur is the only fast that carries the weight of a d’orraita – a Biblical commandment. We generally do not override a Biblical prohibition unless there is a clear sakana, danger. Women who do not have high-risk pregnancies are in no immediate danger when they fast, and the same is true for nursing women.
- Halacha allows a cholah, a sick individual, to break her fast on Yom Kippur if fasting might lead to sakana, a life-threatening situation. Even if medical advice says that it is safe for her to fast, the halacha trusts the individual’s instincts about her own body’s needs and allows her to eat if she says she urgently needs to. For normal pregnancies, it is difficult to know if and when a pregnant woman might cross over into the cholah category. Although it is generally not a life-threatening scenario, this category might be explored.
- Even though the assumption is that pregnant women should fast on Yom Kippur, the halacha takes into consideration a woman’s psychological need – her yishuv da’at. This is specifically discussed with regards to her cravings, but we might expand the idea of yishuv da’at to include her concern for the wellbeing of the fetus. This is not an objective medical need, but her own feeling of being unsettled or troubled. No matter how many medical facts you throw at her, it might not make her internally feel secure about fasting.
- The halachic principle of B’makom tzaar lo gazru might also be applied here. This means that if an individual experiences significant pain (physical or psychological) then there is room to be lenient on Rabbinic prohibition. This is what might allow a pregnant woman to eat or drink shiurim (small amounts every 9 minutes) so that she is only violating the Rabbinic-level fast, but she is still fasting on a Biblical level. She has not eaten or drank enough to be considered halachically “eating”.*
- A pregnant or nursing woman is actively involved in the great mitzvah of Pru U’rvu, bearing children. We should do everything in our power to support her ability to continue to do so unhindered.
- Pregnancy is a unique case because it is a medical status which is global (affects the entire body), and varies greatly from person to person. It also occurs in such a high number of people in the population that it is felt to be common, even though it brings on significant changes and sometimes difficulties.
- The most common risk of fasting while pregnant is dehydration, which may induce contractions. These contractions may lead to preterm labor, which is of greatest risk to the fetus between 22-32 weeks. Even between 32-37 weeks, the fetus may experience significant health difficulties if delivered early (low birth weight, incomplete lung development, jaundice).
- For nursing mothers, fasting may temporarily reduce milk supply, but will not undermine long-term ability to breastfeed.
- People’s ability to tolerate fasting varies significantly. It often correlates with a woman’s physical stature, but not necessarily. A pregnant woman’s ability to fast will also vary with her pregnancy history of this particular pregnancy as well as previous pregnancies, or pregnancy loss.
- Women’s experiences of pregnancy and nursing vary significantly. Some women feel their bodies are robust and resilient during pregnancy, and are confident that their baby is in no danger if they fast. Others feel concerned and worried that fasting will compromise their own health or that of the baby. These are not only mental thoughts, but can be visceral feelings, especially when it comes to a mother questioning the safety of her baby. Whether a pregnant woman is experiencing confidence or concern, no one can convince her to FEEL differently.
- For a woman who is absolutely committed to breastfeeding, being told that she need not be concerned about the possibility of a temporarily diminished milk supply, because she can just supplement with formula, is extremely troubling and is a very real form of tzaar (psychological distress) for that woman.
- Some doctors are not concerned about fasting after 37 weeks because the fetus is full term at that point. Since the biggest risk of fasting is that she will go into labor, there is no real danger. However, for a woman who is absolutely committed to a natural birth, being told not to worry if she goes into early labor is extremely troubling. Going into labor when dehydrated will increase the likelihood that she will need IV, or other interventions, and will decrease her confidence in her ability to push through (pun intended) the intense experience she will face.
- For many women, the conversation with their rabbi and doctor goes something like this:
Woman asks rabbi: Am I obligated to fast on Yom Kippur?
Rabbi responds: Does your doctor say it is safe for you to fast?
Woman asks doctor: Is it safe for me to fast on Yom Kippur?
Doctor responds: Yes, there is no danger to you or to the fetus. But if you don’t feel well, you should break your fast.
Women tells rabbi: My doctor says there is no danger and that I should fast, unless I start to feel sick.
Rabbi responds: Then you are obligated to fast, since your doctor says it is safe. Fast as long as you are able to. If you absolutely need to break your fast, then drink shiurim.
Here are the difficulties in this typical scenario:
- Medical professionals vary in their opinions on this and many other issues. Some doctors have told me that they never advise a pregnant woman to fast, whereas others regularly advise it. When there is a range in medical opinion, often doctors will take their cues from the patient. This is generally good medical practice – good doctors listen carefully to hear what a patient is experiencing, and what they need. However, some doctors believe that their religious clientele want to be told that they can fast. One doctor who has many Hareidi patients told me that she is “lenient” and “allows” her patients to fast. Her belief is that she is allowing the patients their full religious practice. However, doctors may not realize that if they were more medically “strict” and cautious, the halacha would respect this. And some women might even be relieved to receive the medical advice that they should not fast.
- The woman in this scenario now has the onus of deciding when she is “sick enough” to need to break her fast. On Yom Kippur, if she is sick in bed, she will not be able to phone the doctor to ask if she needs to eat. She takes Yom kippur extremely seriously, and she now carries the burden of determining her own medical and halachic status. Even though the halacha trusts her own instincts, chances are she will wait as long as possible before finally taking it upon herself to break her fast. At that point, she might be very dehydrated, and she might have begun feeling contractions (I know some women who have driven themselves to this point), and drinking small amounts every 9 minutes might not be sufficient. She may need to even break her fast completely.
NOTE: It isn’t just the women of our own generation who delay breaking their own fast. The Aruch Hashulchan OH 617 points out, “In our time, it is known that the women themselves tend to say they do not need to eat…”
Imagine a conversation between a woman and her halachic advisor that was more of a give and take, where the woman could share her thoughts and hesitations. Imagine if she was told to speak to her doctor, not only to ask whether it was “safe” for her to fast, but to discuss her fears and her previous experiences with fasting. Imagine she also asked her doctor to specify what it might mean to “feel sick enough to eat”, what particular symptoms to look for, so that she would feel more empowered to make that decision on the day of.
Imagine, also, that a woman was encouraged to begin utilizing the possibility of drinking shiurim when her yishuv daat was disturbed, even before she felt very physically ill. If she thinks that she won’t make it through the day, how much better it would be for a woman to drink shiurim earlier, before she feels extremely ill. Then she will be more likely to be able to make it through the fast and still have technically kept the commandment of fasting.
Many generations of pregnant and nursing women have fasted on Yom Kippur. Our halachic authorities, including the revered Shulchan Aruch, would not have advised women to fast if they thought it posed a serious risk. Is this simply a case where we modern women are more anxious about our bodies, and less trusting in their resiliency? It is possible. We are more accustomed to treating any discomfort by popping a tylenol, rather than just riding it out and trusting our bodies will get through the difficulty. However, it is also possible that women were not an active part of the halachic conversations, and that their own subjective experiences were not fully considered. And even if women’s experiences have changed, and we are accustomed to feeling comfortable, (and even fall into the category of istinis – someone who is spoiled or particular), shouldn’t the subjective concepts of yishuv daat and tzaar still apply, even if some women’s experiences are different than those of generations earlier?
I hope to someday write a full halachic article addressing this issue thoroughly, and citing the extensive sources on the topic. For now, I suggest that we, as a community, consider these important questions: Why are we telling women to fast until they are sick? And why are women going into early labor on Yom Kippur? Even on the day when we are commanded to afflict ourselves “Ve’initem et nafshoteichem”, I still believe that the Torah is “deracheha darchei Noam” – its ways are pleasant and beautiful. Surely, the Torah’s path must protect and respect the most treasured and Divine process that a human being can involve herself with, the miracle of birth.
*It is not clear that eating in shiurim constitutes only a Rabbinic prohibition. There is a machloket recorded in the Gemara (Yoma 74a) about this, and normative halachic codification accepts the opinion that eating less than a shiur is still a Biblical prohibition although not punishable. However, the Gemara elsewhere (Kritut 13a) permits a pregnant woman to eat less than a shiur. A further discussion of the various opinions is required. Please do not consider this blog post as “psak” or as a substitute for consulting your own halachic authority as well as your doctor or midwife.