Guidelines re Pregnant and Nursing Women on Yom Kippur
- Pregnant
- Is a pregnant woman in the category of safek pikuach nefesh regarding her baby?
- According to Shulkhan Arukh, pregnant and nursing women – in a normal case, no special conditions, high risk, etc. – fully fast on YK – OH 617:1 – עוברות ומיניקות מתענות ומשלימות ביום הכיפורים. This has been the practice for close to 1,500 years.
- However, in recent years, a number of poskim, doctors, and women have become aware and drawn our attention to the fact that fasting, and in particular, not drinking liquids, can increase the likelihood of miscarriage or premature birth or other similar serious complications. It is hard to get exact studies and statistics about this, and some people, including some doctors, dismiss this concern, but others – doctors and poskim – treat it as a very real concern. One article reports that in a study of over 700 deliveries in Israel over the last 20 years, there were twice as many premature births on Yom Kippur than on any other day. There are also studies which indicate that there is no increased risk.
- In the end, like any other debated medical issue, a person should follow their doctor. If the doctor says, “Yes, I believe that there is an increased risk of miscarriage or serious complications,” and the woman shares this concern and trusts her doctor, then that needs to be followed – but with shiurim (see below).
- To be clear: We do not give weight to doctors who just say “You shouldn’t fast.” Obviously, they don’t like fasting when a woman is pregnant, but they are not in a position to judge if it is warranted or not. The question is, do they think it will or might increase risk of miscarriage?
- Her own doctor aside, if the woman alone says – I am concerned for this possibility, then we should treat it as a safek pikuach nefesh, since there are doctors who treat this as a real concern.
- Psak
- Rav Nahum Rabbinovich z”l proactively told women, starting from 20 weeks (5 months) on to drink bi’shiurim on Yom Kippur. Before the 5th month, he would rule similarly if they told him that they were concerned about a miscarriage.
- Rav Yisrael Yakov Fisher (in his approbation to the sefer Penei Barukh on Bikkur Cholim) similarly writes: “Nowadays, when we are weaker than previous generations, and many scores of women miscarry as a result of the fast, all women who are pregnant, until the ninth month, have to eat on Yom Kippur bi’shiurim.
- My own approach is to not proactively tell women to drink, but if a woman asks and is concerned for miscarriage or premature birth or complications that create a risk factor for the baby (in contrast to saying “If I’m pregnant I shouldn’t have to fast”) or says that her doctor told her that this increases the risk of miscarriage (not just, “You shouldn’t fast”), and she wants to listen to her doctor, then I would tell her to drink bi’shiurim.
- Is a pregnant woman in the category of safek pikuach nefesh regarding her baby?
- Nursing
- An infant, as a rule, is considered to be a choleh (“sick,” i.e., in a delicate state of health) and mother’s milk is considered by many poskim to be something so necessary that withholding it puts the infant into a safek sakanah (possible-risk-of-life) category. Others do not give the same weight to mother’s milk, so we are again in the category of a matter of medical debate.
- Fasting can impact women’s milk supply in a way that it can take days to get back to what it was, and for some it runs the risk of drying up completely.
- A woman who is concerned that fasting will impact her milk supply, now or later, and who is concerned that this interruption of nursing / milk supply will not be good for her baby’s health, can drink bi’shiurim.
- Some poskim who allow drinking bi’shiurim for nursing mothers, only do so if the baby’s sole or primary nutrition is mother’s milk. Rav Nahum Rabinovich permitted even if the baby was eating food, sometimes had formula, etc., as long as the mother was still nursing and still believed that the ongoing nursing was important for the baby’s health (and would be impacted by fasting on YK).
- Shiurim
- Food: 2 tablespoons (=1 fluid ounce/ 30 cc) of food every 6 minutes – if it’s necessary to eat.
- Liquid: 2-3 tablespoons (=1-1.5 fluid ounces/ 30-45 cc) of liquid every 6 minutes.
- This can be orange juice or the like, if that will be helpful to the person’s health, it doesn’t have to just be water
- N.B.: The volume for liquids is actually subjective – how much liquid can fit in one of that person’s cheeks. Before YK, a person should fill both of her cheeks (puffed up, but not overly so) with liquid, spit out, measure, then divide by 2. The result should come to about 2-3 tablespoons.
- For women, this might come to 2 tablespoons/ 1 ounce / 30 cc of liquid. Which is why a person should measure ahead of time.
- If it is necessary to both eat and drink, a person can do them both within the same 6 minutes. They don’t combine.
- The time is measured from the end of the first eating/drinking to the beginning of the next.
