Fasting – Also for Pregnant and Nursing Women

There is no reason to spend more time on Yom Kippur with detailed confessions than what is customary, since the main thing is the connection to the root and the inner will * The most important aspect of the day is atonement by fasting, and therefore whoever finds it difficult to fast – it is preferable to lie in bed all day and not come to synagogue to pray, so long as one does not eat * Today our body is not weaker than in the past, on the contrary, it is healthier and stronger, therefore pregnant and nursing women should not be lenient * The sick, pregnant, and nursing mothers who ask a doctor whether to fast, should ask a God-fearing physician who is not in a hurry to be lenient, and will respond in a practical manner whether or not they are in danger

Yom Kippur – Holy of Holies

The basis of teshuva is rooted in the most exalted reality, and consequently, the main service of Yom Kippur is performed in the Kodesh HaKodeshim (Holy of Holies). The Holy Temple is the place where all Divine values ​​are revealed, and from it, they flow to the entire world. In the ‘heichal‘(sanctuary) termed ‘Kodesh‘, rests the ‘menorah‘ symbolizing all categories of wisdom; the ‘shulchan‘(the Golden Table) signifies parnasah (livelihood); and the Mizbayach Haketoret (incense altar) denoting prayer and the longing for closeness to God. On a higher level in the Kodesh HaKodeshim, the foundations of Israel’s beliefs and teachings were revealed. Therefore, in the Kodesh HaKodeshim rested the Ark containing the Tablets and the Torah, and above it, two Cherubim which symbolized the bond of ‘brit‘(covenant) and love between God and Israel. Out from the Kodesh HaKodeshim flowed life to the entire world, hence its’ supreme importance, to the point where anyone who entered it is deserving of death by Heaven, and only the Kohen Gadol (High Priest) entered it on Yom Kippur on behalf of all Israel, so as to connect the entire world to its source, and draw atonement, forgiveness, and life to the whole world.

The Mitzvah to Fast – the Main Aspect of the Day

The most important aspect of atonement on Yom Kippur is contingent on fasting. By fasting, a person withdraws from all bodily actions, draws within his inner-self, his soul, and reveals his true, inner aspirations – to follow Torah and mitzvot, and thus participate in ‘tikkun olam’ (repairing the world). By doing so, his sins become external, and ‘zedonot’ (willful transgressions) are transformed into ‘shegagot‘(inadvertent errors). And if on account of Yom Kippur a person merits repenting deeply and completely, to the point where he amends all of his sins, he will also merit having his ‘zedonot’ transformed into ‘zechuyot‘(spiritual credits).

Consequently, the mitzvah of fasting is the only commandment intended for each and every Jew on Yom Kippur, as it is written: ” “[Each year] on the 10th day of the 7th month you must fast…this is because on this day you shall have all your sins atoned, so that you will be cleansed. Before God you will be cleansed of all your sins” (Leviticus 16:29-30).

Confession, Prayer, and Fasting

Some mistakenly believe that the main concern on Yom Kippur is to list all the possible sins and confess them, and to this end, print long versions of confessions. But the essence of Yom Kippur is deeper, and therefore the text of the confession that must be said on Yom Kippur is short and general: “Aval anachnu chatanu, avinu, pashanu” (Yoma 87b; Rambam, M.B. 607:12). It is customary to add a detailed version according to the order of the letters (Rav Amram Gaon): “Ashamnu, bagadnu, gazalnu…” We continue to elaborate by saying “al chait sh’chatanu lefanecha” etc. All the confession versions therefore are general, because the essence of the day is for every Jew to gather into the root of his soul, to shake off all the sins subject to the body by way of the fast, and connect to the Holy of Holies, i.e., the covenant between God and Israel revealed by the Torah.

Therefore, despite the fact that as a result of the fast and the rest of the afflictions it is difficult for us to concentrate on our prayers as on other days, one deep knowledge becomes clear – that our true desire is to adhere to the God of Israel, and correct the world in light of the Torah and its guidance.

A Sick Person Whose Life is Not in Danger is Obligated to Fast

Even one suffering pain from his illness, as long as his life is not in danger, it is forbidden for him to eat or drink anything. If necessary, he should lie in bed all day, rather than eat or drink something.

This is the difference between Yom Kippur and other fasts – namely, on the fast of Yom Kippur, ill people must also fast because it is a Torah prohibition; on the fast of Tisha B’Av, ill people are exempt from fasting; and on the minor fasts, pregnant and nursing mothers are also exempt.

Swallowing Medication

Nevertheless, a sick person who experiences discomfort from his ailment, or those who take medication daily, are permitted to swallow medicine on Yom Kippur, provided these pills do not taste good, and as such, are not considered food. One should take care to swallow them without water. Those who cannot swallow them without a liquid can mix a drop of soap in water, thus exceedingly impairing its taste, and swallow the pill with such water.

Individuals suffering from intense headaches due to not drinking coffee are permitted to take pills containing caffeine, or pills to relieve headaches.

The Gravely Ill

Someone who is gravely ill and the fast is liable to result in his death, is commanded to drink and eat as necessary, because ‘pikuach nefesh’ (saving a life) overrides the mitzvah of fasting, as is the case for all other mitzvoth from the Torah (Yoma 85b). A person in a state of ‘safek sakana’ (questionable risk of death) and is ‘machmir‘ (stringent) with himself not to drink or eat, sins, for He who commanded us to fast, also commanded us to eat and drink on Yom Kippur when the fast is likely to endanger life.

How to Evaluate ‘Sakanat Nefashot’

A doctor who is in doubt should contemplate what he himself would do if, on Yom Kippur, he became aware of a sick patient who was fasting. If he would get in his car and drive ten minutes in order to instruct the patient to drink and eat, thereby saving the patient from ‘safek sakana’, it is a sign that indeed it is a case of ‘safek sakanat nefashot’, and he should instruct an ill person coming to him to eat and drink on Yom Kippur. But if in spite of his responsibility for human life, he would not be willing to drive on Yom Kippur for ten minutes, it’s a sign there is no ‘safek sakana’, and he should instruct the patient to fast. This advice is beneficial for an ordinary doctor who, on the one hand, is not lazy, but on the other hand, does not particularly enjoy scurrying around between patients.

Ask an Observant Doctor

This halakha is entrusted to doctors, namely, that in accordance with the medical information at their disposal and their personal experience, they must determine when there is – or is not – a fear of danger. Still, a problem arises:  there are doctors who, due to excessive indecision or disregard of mitzvoth, inevitably instruct every sick person to drink and eat on Yom Kippur.

Therefore, in regards to this issue, people who are ill must take advice from a religiously observant doctor. And religious observance does not depend on the kippa one wears; rather, the most important thing is that the doctor be honest and ethical, and exhibit great responsibility towards both the sanctity of the fast and that of human life in his decision.

An ill person who mistakenly asked a doctor who is not observant and indeed was instructed to eat and drink, should hasten to ask an observant doctor before Yom Kippur. If one erred and did not ask an observant doctor, and has no opportunity to do so, he should drink and eat on Yom Kippur because although there is doubt whether the doctor replied correctly, the realm of doubt still remains, and in any situation of ‘safek nefashot’, one must be ‘machmir‘ (stringent) and eat and drink.

The Greatest Mistake in Eating in Measurements

A common and widespread misconception among doctors and the ill is the belief that the advice to drink in ‘shiurim‘ (measured quantities) is sort of a middle-path, suitable for sick individuals for whom the fast is not life-threatening. In truth, however, the status of ill people not in a life-threatening situation is similar to all others, and the severe Torah prohibition applies to them as well, i.e., it is forbidden for them to drink or eat anything.

Rather, the point about drinking in ‘shiurim’ is that even when a dangerously ill person needs to eat and drink on Yom Kippur, some authorities say it is preferable to eat and drink in ‘shiurim’. The ‘shiur’ for drinking is ‘k’mlo peev’ (a cheek-full of liquid), each person according to the size of his mouth. The ‘shiur’ for eating is ‘k’kotevet hagasa‘(a type of large date). In other words, eating and drinking less than a ‘shiur’ means drinking less than ‘k’mlo peev’, and eating less than ‘k’kotevet’, which is approximately 30 ml (S.A. 612:1-5, 8-10). The interval between drinking and eating is approximately nine minutes. Some authorities say that if the sick person is dangerously ill, he should drink and eat normally. And if there is a danger, even remote, that drinking and eating in ‘shiurim’ will cause even the slightest negligence in the strengthening of the dangerously ill person, he should drink and eat normally.

Pregnant Women

Pregnant and nursing women are obligated to fast on Yom Kippur (Pesachim 54b; S.A.617:1). Even on Tisha B’Av, pregnant and nursing women are obligated to fast, kal v’chomer (all the more so) on Yom Kippur, whose requirement stems from the Torah.

There are some poskim (Jewish law authorities) who sought to permit pregnant women to drink in ‘shiurim’ because in their opinion, women have become weaker nowadays, and fasting may cause them to miscarry. However, from studies conducted in Israel and abroad, it was revealed that fasting does not increase the risk of miscarriage. Only in rare cases is fasting liable to induce labor in the ninth month of pregnancy and, in any event, this does not entail ‘sakanat nefashot’. Also, there is no evidence to the claim that nowadays women are weaker. On the contrary – today people are healthier than in the past, due to both the diversity and abundance of food, better hygiene, and medical advancements. This is also reflected in the rise of life expectancy by tens of years. Consequently, there is no room to be more lenient than in the past, and the halakha remains firm that pregnant and nursing women are obligated to fast (Nishmat Avraham 617:1).

Therefore, even a pregnant woman suffering from vomiting, high blood pressure, low hemoglobin (iron) or various ailments is obligated to fast on Yom Kippur, and it is forbidden for her to drink in ‘shiurim‘. Only in exceptional cases where the pregnancy is at risk, and in accordance with the advice of a religiously observant doctor, should a pregnant woman be instructed to drink, and in such a case, preferably in ‘shiurim’.

Nursing Women

A nursing woman is obligated to fast on Yom Kippur (Pesachim 54b; S.A. 617:1). Although nursing causes fasting to be difficult because it results in a further loss of fluids, there is no danger to the mother or the fetus. Some poskim sought to be lenient regarding nursing women because in their opinion weakness has descended upon the world, and today, without nursing, babies are at risk. However, their opinions are extremely puzzling, for although there are certainly positive benefits to nursing and mother’s milk, nevertheless, there are many women who do not nurse at all, and we have yet to hear of doctors conducting a crusade in support of women continuing to nurse in order to save their children from mortal danger. If in the past when numerous babies died in their first year of life and there were no good substitutes for mother’s milk, the unambiguous halakha was that a pregnant woman was obligated to fast – even on Tisha B’Av – how is it conceivable that nowadays when there are good substitutes, this issue has become one of pikuach nefesh?!

Good Advice for Nursing Women

Doctors we are familiar with advise nursing women to drink three days before Yom Kippur at least four liters per day, and on the eve of Yom Kippur – from morning until the fast begins – about five liters, in order to store fluids ahead of Yom Kippur, and thus, also increase milk. Experience has shown that if a woman does so not only will Yom Kippur not affect her nursing, but as a result, her milk supply will increase. Very possibly, she might even be able to extract surplus milk ahead of Yom Kippur. Another piece of advice from my wife for the fast to be easier for both mother and baby: to alternately skip two feedings – one at noon-time on Yom Kippur, and another towards the end of the fast, and instead, feed the baby a milk substitute.

This article appears in the ‘Besheva’ newspaper, and was translated from Hebrew.

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