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Instructions for the Birthing team

As many of you already know, there’s more than dress alone that makes Hassidic and ultra-Orthodox couples very different from other couples we very different from other couples we see on the labor and delivery floor. Increasingly, Orthodox and Hassidic couples are taking childbirth classes, and the men are accompanying their wives though labor and delivery. Also, this population has so many babies —couples average five to seven children — that we tend these days to see lots and lots of very religious Jews in labor and delivery. So it’s important that we understand who this population is, and how we can best serve their special needs.

One of the most obvious differences between some Orthodox or Hassidic couples and other couples who are having babies is that the husbands do not touch their wives during labor. A Hassidic man, for example, will not touch his wife to relieve back pressure, nor will he wash her face, give her ice chips or even crank up her bed.

The reasons for this are laws called niddah. In practice, niddah means that when a woman has any type of uterine bleeding, her husband may not have physical contact with her. For the woman in labor, niddah begins — according to different rabbis’ interpretations — either when membranes rupture or when the bloody show appears or when the woman can no longer walk during a contraction. Though the husband cannot provide physical help to his wife, he can provide a great deal of emotional support. He can, for example, do the breathing exercises with her. But for many labor and delivery nurses, it is very difficult to understand a husband who is present in the labor room, perhaps breathing along with his wife, but yet unable to give her a teaspoon of ice chips. It often sets up an antagonistic situation between the couple and the nurse.

In my many interviews with Hassidic and ultra-Orthodox couples, one thing they all mention is the medical staff’s obvious intolerance for their lifestyle and religious beliefs. It is not uncommon for a nurse to say sarcastically to a woman in labor, “I’ll bet your husband was around when you became pregnant!” or, “He had no trouble touching you during lovemaking, but now that you’re in pain, where is he?” Also common, when the woman requested something from the nurse, was, “What’s wrong with your husband?”

I must stress to you as fellow nurses the need to have more respect and empathy towards couples with different lifestyles. Under the sheets is a woman in a great deal of pain who needs good nursing care —and that includes emotional as well as physical help. We mustn’t express disapproval of a couple’s different lifestyle either verbally or through facial expressions or nuances. We’ve all seen those raised eyebrows on a co-worker when dealing with a difficult patient. Remember that signs of rejection or hostility can make a woman’s labor more difficult. It’s not our job to make cultural and religious judgments; it’s our job to provide the best care possible.

If the woman’s husband is unable to provide physical support, then remember to stay with the couple throughout the labor. This might be hard for us to remember, because generally, if we see a husband in the room with his laboring wife, we assume he’ll be providing the basic care. That’s the whole idea of prepared childbirth! That’s why he’s there. But it’s different with an ultra-Orthodox couple. The husband may be completely unable to help his wife in any physical way. So be sure that you stay with the couple throughout. They need you.

Modesty —a word often forgotten in obstetrics—is of extreme importance to an ultra-Orthodox woman. Her head and body are to be covered at all times. This is often a problem in the busy labor department where a woman is examined by many different staff doctors who forget to put sheets back over a patient. In fact, this is one of the most common complaints of non-religious women —so just try to imagine what it is like for a young woman whose elbows and knees have never been exposed to find herself suddenly in lithotomy position, with the sheets around her toes, the hospital gown around her neck, being examined by two to four different doctors during labor— with the door to the labor room wide open. It’s outright humiliation.

Ultra-Orthodox women must be completely draped throughout examinations, during delivery and following it. This is especially important if the husband is there; a woman is never to be exposed in front of her husband. Many husbands, you might notice, will face away while their wives are being examined. Please tell husbands when exams are about to be done. That way they can choose to step outside the room. Also, if you don’t want a woman to wear her own head covering, remember to provide an alternative.

Childbirth classes are different too. For example, men who belong to the Satmar Hassidic sect will not take childbirth classes because it’s considered immodest to watch a strange woman do breathing exercises or to look at slides of undressed women, but they will learn the breathing techniques from their wives. The majority of Satmar men do not go into the labor room and almost none go into the delivery room. But please do try to remember that if you see a Satmar husband in the labor room, he is probably not fully prepared since he did not attend classes. The wife will need you to stay with her.

Also, for the Satmar man, the concept of a team approach with his wife and nurse is incomprehensible. He may feel very uncomfortable speaking to a strange woman, namely the nurse, especially if she is wearing a short-sleeved, skimpy scrub dress. Finally, many Satmar women will choose not to have their husbands with them in labor because of their modesty and their sense of segregated male/ female spheres. It’s important to give the same encouragement to a woman whose husband is not present as we give to a couple working together. Very often, we assume that if a woman is alone, she won’t manage without additional medication. In childbirth prep classes, emotional dependency on the husband is encouraged and fostered; we’ve all heard the woman who says, “I could not have done it without my husband.” But the Satmar woman knows from the beginning that she will have to depend on herself to get through labor. The Satmar woman who has taken classes needs all the encouragement and nursing care possible to make up for the absent husband.

In contrast, the Lubavitch Hassidim will attend classes and will look at the birth atlas pictures, but will not look at slides or movies which explicitly show the delivery. Though they cannot touch their wives throughout labor, they can provide tremendous emotional support and encouragement. Several Lubavitch women to whom I talked requested to be allowed to have a woman coach even if their husbands are present. This is an excellent idea, and should be considered by hospitals that generally allow only one coach.

In the delivery room, the Lubavitch husband is not allowed to view the birth. He may stand by his wife’s head and see the baby being lifted up. The nurse can help the uncomfortable, hesitant husband by reassuring him that his wife will be properly draped, and she can turn the mirror so that the birth cannot be seen in it. The husband who does not want to be present for the delivery can be asked to come into the delivery room immediately after the birth, as long as his wife is completely covered.

Some ultra-Orthodox and Hassidic men will cut the umbilical cord and most will bathe the baby after the cord has been cut. Most ultra-Orthodox and Lubavitch women will have skin-skin bonding and breast-feeding with their babies on the delivery room table in their husbands’ presence. The majority of Satmar women, on the other hand, will not breast-feed or have skin-skin bonding in their husbands’ presence. Still, the nurse should discreetly offer the option and, if the woman would like to attempt it, a loose large sheet can be placed over the woman and infant.

A couple of final comments:

— Drinking sufficient milk may be a problem for the post-partum mother. Milk and meat may not be taken at the same meal, and milk may not be drunk for six hours following a meat or poultry meal. You can be sensitive to this dilemma by providing the mother in the hospital with at least two glasses of milk before the meat meal is served or serving fish as a substitute for meat or poultry if the mother wants to drink extra amounts of milk through the evening. Fish is considered neither dairy nor meat.

— If a woman goes into labor or delivers on a Friday night or Saturday (the Jewish Sabbath) or on a religious holiday, the couple cannot carry the Lamaze goody bag (since carrying is forbidden). Once in the hospital, the husband cannot buy food or drink, make a phone call, drive or take a cab home. He must stay in the hospital until the Sabbath or holiday is over. The staff must understand the restrictions placed on him and should make sure he is provided with meals and a chair or couch to sleep on if that becomes necessary. Pillows and a blanket would add to his comfort. The woman in the hospital cannot call for a nurse by using the electrical call light, and cannot operate the switch to lower or raise her bed on the Sabbath or on a religious holiday.

— Finally, one thing mentioned to me by almost all the religious women I talked with was the inevitable remark by the nurse to the husband following delivery: “Aren’t you going to kiss your wife?” This always makes the couple feel that somehow they are less joyful and appreciative of the experience they just shared. A simple mazal tov or congratulations may be just what the couple needs.

Sheila Stanger has worked for 13 years as a childbirth instructor in Brooklyn. This article is adapted from a speech she delivered at a conference for nurses and midwives.

An Ancient Prayer at Birth

Ancient birth prayers, pre-dating the Jewish liturgy, were incantations intended to help ensure a beneficial result. But beyond their magical purpose, they are recitations in which we find expressions for awe and dread, solace for pain and awareness of power.

This poem is an Akkadian birth incantation dating from about 1700 8.C.E. found on a clay tablet from Mesopotamia. It was translated from the Akkadian by Tikva Frymer-Kensky, and is taken from her book Motherprayer, which will be published next year by Beacon Press.

In the waters of intercourse,
homes were created.
With tissue of muscle,
the birthling was formed.

In the waters of the turbulent and fearful sea,
in the waters of the distant sea,
where the child’s limbs are tied,
into the midst of which
the eye of sun does not shine—
there Asarluhi saw him.

He opened the bonds
by which he was bound.
He prepared the road for him, opened the route.

The way is open, far you, the way k clear.
She will assist you 
she who assisted in the creation,
she who assisted in the creation of us all.

To the locks
she will say “be loosened”
The door sills are apart,
the door is raised.

As a desired child,
bring yourself forth.