I would like to wrap up the "Husband in the delivery room" topic and tie up a few loose ends.
First, I have one more item from the list on the Yoatzot website that I need to deal with, which was item #5. This was in reference to the rabbis who prohibit versus those who permit a husband from being present in the labor room. Obviously, the reason for those who prohibit is based on their concern for the potential transgressions that we have been discussing in this series. The reasoning for those who permit is because they accept that one can take the precautions mentioned to avoid these transgressions.
I noted that it seems from the language used by the website, that none of these rabbis actually encouraged the presence of the husband. However, the logical result of the arguments I have presented in this series should now be obvious to readers of this blog. If the husband's presence in the room will provide comfort to his wife and she will feel less anxiety, than it is a mitzvah for him to be there.
A few more comments are now called for. An anonymous commentor has been paying very close attention to my series and has made many helpful comments and criticisms. In many cases, I was forced to amend and correct some statements that I had made. It is my goal to pursue Truth. I capitalized the word "Truth" for a reason, as we know that "Chotamo shel HKB'H Emet" - "The seal of God is Truth". I sincerely appreciate comments that are made with the goal of the pursuit of truth. I am very happy that this anonymous commenter has engaged me in real conversation. Even if we disagree on some major points.
This blog differs from some other blogs in one fundamental way. As I am anonymous myself, I completely respect the fact that many people do not want to share their identity. I actually find that in some cases, anonymity allows people to speak their minds honestly and say things they may not have been willing to say had their identities been known. Obviously, if one uses anonymity in order to speak dishonestly or in vulgar or demeaning ways, such comments will not be allowed to appear on my blog. But respectful comments in search of truth will always be welcome, no matter how much they agree or disagree with me.
Two issues must be discussed before I wrap up this subject.
Where does early labor bleeding come from?
Back in my post here, I argued that the bleeding of the early stages of labor is generally from cervical dilation and not uterine blood. Uterine blood however usually begins in a significant way after the delivery of the baby, and especially with the separation of the placenta. I therefore argued that even if there is some "bloody show" in labor prior to delivery, we can assume that it is "dam makkah" (non-uterine blood that comes from another known source such as from cervical dilation) and therefore she would not be a Niddah until the delivery of the baby. At that point, even if there was no bleeding (which is essentially impossible anyway, as there always will be some bleeding) the bleeding would be from a uterine source, as the "opening of the womb" ("petichat haKever") has occurred with the delivery, and she would now have the status of a Niddah (or a "Yoledet", but for our purposes now that is essentially the same thing).
Some obstetricians, (mostly offline or in emails), challenged me by stating that there still could be some bleeding from within the uterus during labor. They agreed with my basic premise that until delivery most of the bleeding would be attributable to the cervical dilation. They also agreed that unless there was a problem such as a placental abruption, that bleeding from the uterus would likely be a small amount, but it still "could be" that there is some uterine blood.
I responded to this objection by stating that as long as we have a clear "makkah" or "wound" to attribute the bleeding to, and she has a "chezkat tahara" - which means that she is in a known state of purity, we can always assume that the blood is from a cervical source. She would not be a Niddah until she had definite uterine bleeding, which occurs with delivery. This is a basic halachic concept, and I stand by this assertion. The fact that Poskim have assumed that cervical bleeding is not "impure" is well known from the many poskim who assume that bleeding from "stripping the membranes" or a doctors exam of the cervix is not considered blood of a Niddah.
"Dam Koshi" or "Bleeding Due to Labor" is always considered impure in modern times.
This was a serious objection to my idea that bloody show in early labor does not cause a woman to have the status of a Niddah. It can get quite complex, so please allow me to summarize as follows.
The Talmud in Niddah 36b discusses the concept of bleeding that occurs as a result of the pain of labor. It is clear from the discussion of the Talmud that the bleeding under discussion is from a uterine source, and that as a result of labor pain there can be uterine bleeding. The Talmud therefore has a lengthy discussion regarding the need to determine if this bleeding occurred during her "days of Zivvah" or her "days of Niddah". In the terminology of the Talmud, uterine blood can be of two major types, "Zivvah" blood, or "Niddah" blood. How this is determined is dependent generally on timing. There are certain days within which the bleeding is considered "Zivvah" and certain days when it is considered "Niddah". There is no modern scientific equivalent that can explain what these concepts refer to, so I cannot translate those terms into English.
One thing is certain though, and that is that both categories of blood are from a uterine source. The laws of each category are very different, and thus determining whether a woman is in her "Zivah" days or "Niddah" days is halachically important. In modern times we cannot be certain whether bleeding is "Zivvah" or "Niddah", therefore custom has become to be stringent in all cases and assume the worst.
There is a third possible cause of uterine bleeding, and that is "dam Koshi" or bleeding due to labor. This refers to uterine blood that flows as a result of contractions. My assumption has been, and remains, that when the Gemara refers to "dam Koshi" the gemara is discussing blood with a uterine source. This is why the Gemara states that if the labor stops, we then would have to determine if she is a "Niddah" or a "Zavvah". This only makes sense if we are talking about uterine bleeding. Obviously, if the bleeding was determined to be "Dam Makkah" (blood from a wound), there would be nothing to talk about. She would be still considered in a state of purity.
The conclusion of the Halacha is that "dam koshi" (which as I just explained is blood of uterine origin) that results from labor, is considered pure if she is in the days of "Zivvah", and impure if she is in the days of "Niddah". Since in modern times we have no way of differentiating between when a woman is in either state, we assume that she is in the days of "Niddah" and thus uterine bleeding as a result of labor would be considered impure no matter what.
However, if we know that the likely source of the blood is a makkah, such as from cervical dilation, there would be no reason to assume that the woman is a Niddah at all until the actual birth, from which time she has the impurity of a Yoledet (a woman who gave birth).
I therefore still stand by my assertion that a woman in labor, even if she has bloody show, is not a Niddah. I do admit that in cases where blood is "flowing", in which cases many doctors would have a suspicion that it may be coming from inside the uterus, that would be considered "Dam Koshi" and we would have to assume that she is a Niddah. This is because we no longer differentiate between "Niddah" and "Zavvah" nowadays. I can tell you as an experienced physician myself, that when such cases of "flowing" blood in early labor do occur, we are usually very concerned about the potential for a serious problem called an abruption or other types of obstetric complications.
It seems clear to me that the Talmud is referring to what the rabbis of the Talmud assumed to be uterine bleeding, not "dam makkah". We now know, through our extensive knowledge of the physiologic process of parturition, that there can be both cervical and uterine sources of bleeding during labor. We also know that in most normal cases, the early bloody show if of cervical, not uterine, origin. It is exceedingly reasonable to therefore state that Chazal were discussing uterine bleeding, not cervical. The terms that the Talmud uses, such as "shefa", denote a flow of blood, which is very different than what most women experience. One can say this regardless of your opinion regarding the much-debated issue of Chazal's understanding of modern science. Whether you believe in the infallibility of Chazal regarding scientific issues, or whether you believe that Chazal's expertise in science was limited to the science of their contemporaries, this explanation remains the most coherent and understandable reading of the Talmudic discussions.
Allow me to summarize my conclusions in this series, so that I can move on to the next topic.
- A husband should be encouraged to be there for the support of his wife in the delivery room, if his wife feels comforted by his presence.
- A woman is not a Niddah until the birth of the baby, unless she has a significant flow of bleeding (more than just what is often called "bloody show")
- Any supportive touch that gives comfort to the woman in labor, can and should be given by a husband to his wife, even if she already has the status of a Niddah
- What the husband does or does not see should not be a matter of concern when in the delivery room. Obviously, and it shouldn't be necessary to say this but I will anyway, he should always act in an appropriate, respectful, and modest manner.
- How a woman dresses and whether or not she wants to use a mirror to help her push, is a decision that should be made by the woman in labor base on whatever she is comfortable with. What the husband may or may not see should not even enter into the discussion.
I would love suggestions for new topics, you can feel free to send me messages by email or in the comments.
