זירוז לידה

00:00 Speaker 1 Okay, Igros Kodesh. We are on page forty-six. We went back in time because we have a little bit of spare time now between, between now and when we start the Nissan letters. So we're going back a little bit to fill in the gaps of the stuff we didn't get to cover. So we're back on page forty-six. The letter is Yud 𐎗 Tev Reis Nun נ, Tav Reis Daled ד, Tav Reis Daled ד. Yud Tav Reis Daled ד. And it's from Zion Kislav Tav Shen Lamed Gimel ל"ג תרכ"א, fifty years ago. The Rebbe writes, "Shalom Ubraham, Thanks for telling me about or I'm responding for you telling me about your spouse. She should have a complete days of her pregnancy. It all should go well. And it should be easy. She should give birth to healthy and lasting children. In the proper time. In a goodly time. And it should be an easy delivery." This is a-- By the way, I looked up this line. This is a very standard line in the Rebbe's letters to women who are about to give birth. He reuses this exact phrasing over and over and over again, uh, because it seems a little bit repetitive, but there's clearly a reason for it, because otherwise he wouldn't keep on using it. So that's the Rebbe's go-to sentence for a woman about to give birth. This is not in all of those letters. He tells the husband, husband to be very careful to keep khitas, not to miss any days of

01:19 Speaker 1 khitas while his wife is pregnant. And and he says that the pan that they sent over the Rebbe's going to read at the Tzion soon. Okay, I don't know if that's soon. Whenever it works for the Rebbe. At a, at a, at a desirable time, the Rebbe's gonna read the pan. The Rebbe also gives him a bracha for his birthday. Again, a traditional response. That's the Rebbe's go-to phrasing for birthdays as well. In response to his question, . This is a little bit less conventional. So he says in answer to the person's question, we don't have a footnote here to tell us what the question was, but I think it's at least, uh, mostly self-explanatory. The Rebbe says, "In response to your question, it is self-understood." It's move on. It's good and proper. That she should complete her days of pregnancy. And they should not do anything to make her give birth prematurely. So they shouldn't do anything to speed up the delivery. And then the Rebbe adds, "I'm certain that you'll continue taking part in mitzvah tefillin and doing more of it." So the Rebbe has a couple pieces of guidance for this husband who's about to, uh, whose wife is about to give birth, and that was being very careful with khitas and taking part in mitzvah tefillin. And in this middle is the part we're gonna focus on today, is the Rebbe tells him, "Don't induce. Don't do anything to speed up the pregnancy. No inductions of labor." Uh, the Rebbe says

02:46 Speaker 1 this in a lot of places. This is definitely the Rebbe's shita, that generally speaking, of course, unless it's medically indicated, we don't induce labor. You probably have heard this before. Most of us are, uh, most of us are, are in the-- are in that parsha that we're, uh, we're, we're asking these sorts of shailas regarding induction. So a lot of us probably have had some kind of experiences around pregnancy and around indu-induction of labor or recently remember doing so. Um, just wanna do a little bit of background on the science before we get into the halakhic aspect of this, what the Rebbe is talking about when he says that it's better not to speed things up. So first of all, sometimes an induction is medically indicated. When an induction is medically indicated, all poskim, and of course, the Rebbe as well, agree that it should be done when it's necessary in order to protect the life of the mother and the baby. When does that happen? Uh, after forty-two weeks, it's almost always medically indicated that, uh, that we should do an induction because the placenta doesn't really work as well as it did in the earlier parts of pregnancy, starting at forty-two weeks. So about two weeks, um, late, a, a, uh, a induction is almost always medically indicated and therefore halakhically permissible. And not just permissible, but required at that point. There's also something called a placental abruption, which is when the placenta starts separating from the uterus, or there can be an

03:54 Speaker 1 infection in the uterus. These are go-to indications for a, for a, for a, uh, for a medical induction, for a labor induction. There's, uh, certain health problems that the mother could have, like diabetes, high blood pressure, pre-eclampsia, issues with their heart, lungs, or kidneys that require an induction. Sometimes they also will check and find that the baby doesn't have enough amniotic fluid. That's another case where doctors will say that in order to protect the life of the baby, we need an induction. And again, poskim are completely okay with these sorts of inductions. There's also something known as Rh disease. It can cause problems with the baby's blood if there's not an induction and things aren't done in a certain way. And under all of these circumstances, it's not even necessarily a question for poskim. If it's definitely a danger to the life of the mother, the life of the child, it's not even a question. Induction from here until tomorrow. But the truth is that inductions are often done for purposes of convenience, as you may know. There's actually a, there's a safer called There's also increased cases of bleeding after delivery by-- wh-when there's-- when labor is induced. Um, so bleeding after delivery is not a small thing. It can also cause life threats. So these are all serious things that come up of a medical indication in induction of labor. Now, as far as the Halakha goes, the idea of not making-- of not pushing delivery so it should come earlier comes-- goes

06:29 Speaker 1 back to a Gemara in Ta'anis two A. Almost everybody learns a little bit of Ta'anis, and almost everybody learns the beginning, so you might remember this one. The very beginning of Ta'anis, the Gemara there says that there are three keys that Hashem takes care of directly and doesn't use a Malach for them. They're God's personal keys, and that's the key to birth, rain, and trea semesen. So the tese is there that says that this means that there is no Malach appointed over the timing of birth, and since God himself is the one who oversees it, we have to leave it in his hands. There's this idea that goes all the way back to the Gemara that childbirth needs to be in Hashem's hands personally and that we can't really intervene in it. So the idea of induction is already something that Halakha seems to have the, uh-- to bristle at the idea of, since God's supposed to be in charge of it. Uh, obviously, like we said, when medically indicated, all the poskim say throw that out the window and save the mother's life, save the child's life, and, and induce. But, uh, there are some areas... Now we'll do the-- we'll do the Kulas first. There are some more leniencies than you would expect. There's a Chazanish that says as soon as she's two weeks overdue, it's medically indicated to induce labor. I mentioned that earlier with the forty-two weeks, so you should know it's in Poskim too. However, Zibrushtin, in that Sefer I

07:32 Speaker 1 mentioned earlier, the Terzia Ledus, he says that you can even induce early in order to get a qualified doctor if the labor is going to be a high-risk labor. So it's gonna be a high-risk delivery, and we need a very good doctor, and that doctor is only available today and is going away later. We can induce early, according to him, in order to, uh, in order to get a better doctor. And he says you can even induce in order to get a doctor that makes the woman more comfortable, assuming the induction's not on Shabbos. So he has a couple leniencies available. However, major poskim do not have these leniencies. They're much more in the Rebbe's spirit of V'leila Maher, Aleida Lichneza, et al. Rabbi Sternbach has a pretty famous Tshuva where he mentions a, a, uh, an Arizal. It's always fun when an Arizal shows up in Shaylas and Tshuvas. You just don't expect to find him there. The Arizal writes-- says that you shouldn't write a Kamea, an amulet. You shouldn't write an amulet for a woman to have an earlier labor because doing so can change the baby's mazel. The baby was meant to be born under a certain star, under a certain sign, and that mazel could have been very good for the baby. It would lead a life of riches and, uh, long life. And here this person writes a Kamea. They write an amulet to help the woman deliver early. That amulet could cause the baby to fall under a

08:32 Speaker 1 different mazel, and Chas a Shalom lead a life of poverty and early death. He lists all the terrible things that can happen if a mazel changes. And Sternbach brings that in the Tshuva as one reason. Sounds like the Arizal was already thinking about the potential spiritual dangers of an induction. He also mentions a certain Segula for inducing that he says is Mutar 'cause it's not real induction. It's a Segula for induction. And it's a, it's the stim-- It's stimulation of the, um, Lush Hankeo. A stimulation of the feeling that, of a baby, of a baby nursing. Stimulation of the feeling of a baby nursing. Um, that actually, uh, is-- He says it's a Segula that comes from the Steipler. The Steipler asked several women to do it, and it worked on almost all of them. It turns out this actually is in the scientific literature, and nipple stimulation apparently releases oxytocin. There are many studies that suggest it probably is a form of induction. But anyway, it shows up in the Tshuva, and I couldn't not mention it 'cause it's awesome. The most popular Tshuva on, uh, on the subject is from Rabbe Meisha. You'll find in Yera Dea two seventy-four. You'll also find in Arakhayim four one O five through six. In Arakhayim, he clarifies a lot of what he says in Yera Dea, so if you're gonna look these up, make sure to read both, not just one. And his main point here is that he says the birthing process itself cannot be

09:37 Speaker 1 dangerous. It can't be that it's dangerous to give birth because Pru Urvu is a Berakha, it's not a Tsakanah. And also, a woman's not commanded to do Pru Urvu. A woman's not commanded, according to most authorities. A woman's not-- A woman does not have to have children. She's not halakhically obligated. It's not one of her mitzvahs. It's a man's mitzvah, and we just, you know, we've tried doing it alone, but it doesn't work. It needs a, a woman needs to be involved. Now, it's-- A wo-- A person's not allowed to put themselves at risk in order to help another person do a mitzvah. So it is self-understood that a woman's not put at risk by helping her husband do the mitzvah of having children since it's not her mitzvah. So how is she allowed-- So what, what, why does it appear risky? The Rabbe Meisha says that this is because naturally there is a Tsakanah, and God gives a special Berakha that people won't get hurt because he's in charge of this. And, uh, in answer to the question about the several Gemaras that mention women dying during childbirth for particular sins, he says that's for particular sins. But generally speaking, God protects women when they're about to go into labor, and he protects women during the childbirth process because otherwise the system wouldn't work. Says Rabbe Meisha, that only applies, that special protection only applies if you let God handle the process. If you take the process out of God's hands and put it

10:42 Speaker 1 in the hands of a medicine like Pitocin that speeds things up, now it's up to you. Now it's your, now, now it's your delivery, not God's delivery. And when it's your delivery, it carries all the normal risks of labor and delivery, which are substantial. It's a dangerous thing. So it's not a dangerous thing when it's in God's hands, says Rabbe Meisha, but it's a very dangerous thing when it's in the hands of medicine. But based on this, Rabbe Meisha Paskins that unless it's absolutely medically indicated, people should not be getting inductions. Um, on a personal note, uh, my children are always late. They're like me by Shachas, or honestly, by the Igresh here. They, they, they get it from their father. Um, uh, besides for my first, all of my children have been significantly overdue to the point that the doctors were pressuring for inductions. In each of those cases, I, uh, I called a Rav and said, "Uh, you know, the doctor's really bothering me. We're a week..." I never went more than two weeks, so we came close. I think we had one that was, like, twelve days overdue. Um, and I remember calling a Rav at each time. I think it was Rav Bruin all of the times, possibly. And every time I called Rav Bruin and asked him, you know, "The doctors are saying we're real close. At what point do I pull the trigger and induce?" He always said back to me, "I get a million of these calls a

11:42 Speaker 1 day in the Crown Heights area and, and, and abroad. And, uh, by the time they hang up the phone, usually their wives are in labor. So I'm, I'm not answering this question. I refuse to answer the question." I remember pushing him and saying, "Come on, give me a theoretical." He says, "There's no reason to give the theoretical because your wife will give birth." And in every case, he was right. They-- She, she had always happened before the fourteen days were up, so never actually got to see him Paskin the Shayla on the fly. I just got to see him tell me, "Don't worry, the baby's coming." Um, but in any event, there is, uh, there is significant Halakhic literature on the topic suggesting that we should not be inducing, certainly for convenience, um, and that we shouldn't be inducing unless it's strongly medically indicated. There are Hatarim available, which we've discussed, but obviously the thrust of Halakha is very much exactly what the Rebbe is saying here. Vemaamin L'shei Los And Mu Van Shetei Venach And Sheeg Mu R'meha Araya And V'leila Mahara Lei DeV'neiza, that people shouldn't speed things up. And in fact, that is what the medical literature says, too. ACOG has put out statements. That's the American College of Obstetrics and Gynecology. It's understood in the medical field now as well that non-medically indicated inductions are, uh, are an unnecessary risk and not terribly ethical. So, uh, we have now a small survey of the Rebbe's take on this particular aspect of

12:45 Speaker 1 pregnancy ... culled from a letter from exactly fifty years ago. Questions, comments, complaints?

12:53 Speaker 2 Yes, question.

12:54 Speaker 1 Yeah.

12:54 Speaker 2 Uh, what about, what about a scheduled C-section? Does that fall under this category?

12:59 Speaker 1 It actually does. It falls under the category so directly that, uh, Rav Moshe, in his Chilvei Yaredea, I'm trying to... I'm, I'm pretty sure it's the Yaredea one, not the Yerechim. The Yaredea one, he isn't sure that, uh, induction exists. He writes in the beginning of the letter, somebody asked him about inducing labor, and he writes something like, "I'm sure you mean in-- I'm sure you mean like a, like a C-section ahead of time, because I can't imagine a pill that can do this. But if there was a pill that could do this, this would be what the psak is." So Rav Moshe actually is very much basing his thinking on the idea of a scheduled C-section. He writes this letter in the sixties. I'm not sure how common it was in the sixties to give Pitocin. But yeah, we, uh, presumably, from the fact that Rav Moshe seems to feel that it's the same sugya, I, I would say that it's the same opinion. Uh, and in general, when things are... The, the, the general rule of medical Halakha and increasingly the general rule of secular medical ethics, lehavdil, is that things that are not medically indicated we can't do because every procedure carries some sort of risk. And if there's no medical reason to-- no medically indicated reason to do any procedure or provide any intervention, then it's inherently unethical to do so because of whatever risk it might carry will automatically outweigh a potential benefit of zero. Understand what I'm saying? If

14:04 Speaker 1 there's no benefit on the table, it's really understood by everybody now that, uh, that there's no real, um, ethical reason to do the procedure. That's also how Halakha has always viewed it. It's just medical ethics in America only caught up to, only caught up to this, uh, five, ten years ago. But in Halakha, this is always the idea. Does that answer your question, Ruby?

14:20 Speaker 2 Except-

14:21 Speaker 1 Yes.

14:21 Speaker 2 Except for one field in medical ethics today.

14:24 Speaker 1 Hold on one second. What, what did we say?

14:26 Speaker 2 So, so, so if you, if, uh, certain people need to have C-sections, they can't give birth naturally. So you're saying-

14:32 Speaker 1 Right

14:32 Speaker 2 ... we're not gonna, we're not gonna schedule anything. We're just gonna see. When the time comes, okay, let's go operate.

14:38 Speaker 1 Yeah, it sounds like that. Unless... Well, a lot of times if they're in that sort of a serious situation-

14:41 Speaker 2 That's not how anything works nowadays, though. You can't just walk into a hospital say, "We're having a C-section now."

14:48 Speaker 1 No, what you can do is you can say that we're gonna try for a, uh, a, a vaginal birth, and, uh, if it doesn't work, you just do a C-section.

14:53 Speaker 2 But that's not... In this case, that's not possible. Some people have to give birth via C-section. They cannot give birth naturally.

14:58 Speaker 1 In those ca-- in those cases, I assume you schedule it. But I assume you wanna schedule at the end of, uh, at the end of forty weeks. Also, this doesn't apply to twin births, by the way. Twin births and multiples, there's a, there's medical indication for, uh, for, for, for advancing and sometimes even doing a C-section when the baby's particularly large. Obviously, on a case-by-case basis for the posek. But, uh, no, in a case like that, I think you'd have to schedule it. Because once it's medically indicated there needs to be a C-section, we can't just do a C-section on a random day. They schedule those. Um, but that's a, but that's a very specific question. Yeah.

15:27 Speaker 2 Inducement falls under a medical inducement or you have, uh, a wife will say, "I'm done. I'm, I, I can't handle this anymore." And they'll start running and running up and down stairs to, to, you know, go into labor.

15:40 Speaker 1 Are you asking whether those inductions are problems? Those inductions are not problems at all. They're only medical inductions. Uh, uh, Rav Shenbach and Rav Moshe in their chilvas both mention that, uh, that the sort of home remedy methods for inducing are all completely mutar. Um, we're talking specifically here about drug induction.

15:54 Speaker 2 If you're gonna use a home remedy for inducing, there's better ones also.

15:58 Speaker 1 Am even yovan. And uh, as a matter of fact, a l-- a lot of them have fairly good data behind them. Um, there's even certain herbs that, that have not bad data on them. Uh, in each of these cases, I've been told by doctors, "Hey, why don't you, why don't you try this laundry list of things?" Um, but yeah, no, this... None, none, none of these rules apply to, uh, to, to non-medical induction, as we call it, to, uh, home remedy induction. Hmm. And in it... And to just conclude and make clear about the first thing you asked with the C-section, the real answer is that I, is that I don't know the answer. And the double real answer is that in a specific case like that, a posek needs to look at, uh, the whole body of information. There's no general rule for that. But my assumption is that that's, that's outside the realm of what we're talking about, and that goes into the area of medical indication, where then you would schedule the C-section, is my guess.