Table of Contents
Part 1: Introduction………...………3
Part 2: The Institution of Medicine..………...………9
A Brief Background on the Institution of Medicine……….9
Distribution of Health in Israel……….……….10
Immigration and Women’s Health……….11
Feminism and Medicine………...………..13
Childbirth and Pain………...14
Medicalization of Childbirth………..…15
Part 3: Introducing Alternative Medicine………...………21
Postmodern Midwifery………..………...………..21
Complementary and Alternative Medicine in Israeli Obstetrics……….………..24
New Religious Movements and Alternative Medicine……….………..27
Part 4: Orthodox Judaism and Childbirth………...………..29
Haredi Society………..……..29
Consequences of Orthodoxy……….……….30
Solicitation of Support from Authorities and Communities………..……….31
Beliefs Regarding Abortion………34
Culturally Competent Care………..………..36
Part 5: Seeking Help and Protection………...………...………..40
The Evil Eye………..….40
Names………...………..42
Lilith………...………43
Rachel’s Tomb………...………45
Part 1: Introduction
Childbirth and reproductive health inform the worldview of women since ages past. Although this is relevant for all of humanity, Judaism provides a unique framework for investigating the sociological, anthropological, and religious aspects of women’s health and rights, especially in regard to reproduction. Many adherents to the Jewish religion consider families and children exceedingly important and resultantly place large responsibility on women to be caretakers, leading to implied norms for Jewish women. This is especially true in the case of Orthodox Jewish society, aspects of which elucidate the roles Judaism may play in pregnancy and childbirth.
The work of scholars such as Mary Douglas and Victor Turner can be used as a backdrop against cultural norms and social occurrences that relate to Jewish women’s journeys to
motherhood (Douglas 1966; Turner 1961). Douglas’s discussion of purity and danger, as well as Turner’s exploration of liminality, explain theoretical behaviors that can be compared to
anecdotal and scholarly writings about topics such as the medicalization of the delivery room, postmodern midwifery in Israel and beyond, alternative medicine, and Orthodox Judaism.
Turner’s definition of liminality provides useful insight into the ritual of childbirth. In his work, The Ritual Process, he defines rites of passage through the lens of liminality. An
Arnold van Gennep, drawing from themes of liminality, describes women giving birth as “betwixt and between” (Turner’s famous phrase). By this, he means they are between being a non-mother and being a mother, while actually being neither one of those (Cox and Ackerman 2009). A woman must pass through a liminal state, and violate normative and standard social categories. Turner’s definition of liminality emphasizes a transitional period in which an individual defies her previous social status. In Turner’s case study of the Ndembu tribe, he explores a liminal ritual in which a high-status tribe member must be isolated and treated as the lowest common denominator before he can assume a certain leadership role (Turner 1961).
These liminal rituals are not restricted to tribal culture. We see examples of liminality in places like the United States and Israel, especially in regard to childbirth. Take the example of baby hotels in Israel. Orthodox Jewish women often opt to stay in non-hospital facilities
immediately following childbirth. Here, they are separated from society, and exempt from their normal duties as Jewish women who likely have toddlers or older children back at home. These women are in a liminal state between being pregnant and not being pregnant. A woman is cared for and visited by family, without having to assume any of her normal responsibilities. One naturally wonders if such benefits provide an incentive for women to procreate more than they would without this special treatment.
in Israel. Pregnancy is a time of intense monitoring, as evidenced by the baby hotels and extensive prenatal checkups, as we will see in Part 2. In other contexts, the level of care for women may be considerably less attentive. Susan Sered suggested in her work What Makes Women Sick? that Israeli women have higher life expectancy but poorer health outcomes than
their male counterparts. Israel is one of the leading nations as far as longevity of life, so why do women become sick much more than men?
Sered further implies women’s bodies are often mobilized for the purpose of
reproduction, with the state using their offspring as a political motive. Take women in the Israeli Defense Forces as an example. "Women soldiers," writes Sered,
neither mothers nor true warriors, are in a problematic liminal state. It seems to me that the intense concern with the neatness and sexuality of women soldiers is an expression of that liminality. The 'proper' sexuality of the neat and attractive 'CHEN' [the recently disbanded Women's Corps] soldier signifies that she is on the appropriate path to suitable motherhood (Sered 2000).
While female soldiers compose a large portion of the Israeli Defense Forces, there are still institutional discriminations against the validity of a “woman soldier.” A woman is a mother before anything else. Even before she has children, she is expected to produce offspring. This may explain why fertility rates in Israel are higher than other developed nations such as the United States.
assist families experiencing infertility. Dr. Ronit Haimov-Kochman researched the particulars of treating Orthodox Jewish patients who are interested in fertility treatments; he found that there are special considerations regarding religious needs, and their imperative for reproduction is significant to consider (Haimov-Kochman et al. 2010).
Israel has seen times of desperation in regard to seeking offspring. In recent years, Israelis have looked towards places such as Nepal for surrogate mothers. Surrogacy is especially attractive for homosexual couples, as only heterosexual couples are allowed to opt for surrogacy in Israel. In 2015, a devastating earthquake killed thousands in Nepal, eliciting concern for fetuses carried by surrogate mothers on behalf of the Israeli government. After the earthquake, the Israeli government sent a plane to Nepal, rescuing 15 Israeli babies and zero Nepalese surrogate mothers (Kamin 2015). Here we have an example of the intense desire for the government to promote family growth, even if that means leaving behind surrogates who themselves felt the burden of pregnancy and childbirth.
Jewish women who experience difficulties with fertility and cannot afford surrogacy may find themselves in need of religious counsel. Pilgrimages are not uncommon for women going through something like this, especially in Israel. One of the most famous pilgrimage sites in Israel is Rachel’s Tomb. While Rachel is venerated for giving birth to Joseph after years of infertility, she was not perfect. She stole from her father and was even cursed by her own
spreading danger. Yoram Bilu writes about Dybbuk (demon) possession in the context of Eastern European Hasidic Jewish women serving as rabbis (Bilu 2001). This had to do with women’s attempts at equality, full participation, and working towards rabbi positions. There is a theme of women being unwelcome as spiritual leaders, and thus being susceptible to the danger of demon possession.
Danger is an important theme to consider while looking at childbirth in Judaism,
especially in Orthodoxy. Douglas, who prescribes to a structural functionalist perspective, writes about the origins of perceived danger in certain situations. She asks questions such as, what does cleanliness mean for the Jewish religion, what influence has Western ideology had on the
concept of pollution, and what is “dirt”? Douglas argues that it is important to think about dirt before the 18th-century concept of pathogenicity, and ends up defining dirt as anything that is out of place. In Douglas’s Purity and Danger, she discusses the natural boundaries both individuals and societies create towards pollution (in other words, something out of place). This leads to taboo and even fear, which tends to be the case in many realms of Judaism.
Douglas closely analyzed the purity laws found in the Torah, particularly in Leviticus. One of the most poignant Levitical laws is the prohibition of eating certain foods before entering the Temple to worship. This may demonstrate an institutional reluctance towards food
These laws carry over to contemporary Orthodox Jewish practices of separation of husband and wife during delivery and other situations involving prolonged vaginal discharge. Purity laws, such as niddah, require the separation of husband and wife until the woman ceases to bleed during her menstrual cycle. Jewish blog writer Hilarie Pozesky attends mikvah, which is a ritually purifying bath that Jewish women may attend after menstruation, and writes about how many Jews may find this problematic considering patriarchal enforcement of separation of “unclean” women (women on their period). Pozesky, however, finds the ritual spiritually beneficial and purifying (Pozesky 2016). Perle Feldman makes a similar point in describing the personal renewal and luxury a woman experiences during mikvah (recounted in an interview) (Semenic, Callister, and Feldman 2004). Though niddah may seem like a crude ritual to attend in certain contexts, the most important aspect of Pozesky’s attendance is her own perspective and benefit.
Part 2: The Institution of Medicine
Pregnancy and childbirth situate themselves within the context of medicine. In order to understand how pregnancy and childbirth fit into this framework, it’s important to consider some background on the institution of medicine.
A Brief Background on the Institution of Medicine
The concept of medicine as a professional field emerged in relatively recent years. Medicine in the United States has been defined from various sociological viewpoints, ranging from the functionalism of Durkheim to the anti-capitalist sentiments of Marxism to Weber’s “iron-cage” critique of bureaucracy. Although it is difficult to analyze a single medical entity due to stratification of medical professionals, there are overarching themes that inform the
medicalization of childbirth in Israel, as well as skepticism towards this medicalization in various societies, including the United States and Israel. The most alarming transition of medical care was the shift from strictly domestic services, to a booming market of a de-personalized industry.
explain how medicine in the United States has successfully prevented universal health-care insurance in the past (Calnan 2015). Further, Freidson did not argue that doctors are inherently flawed, but rather that this behavior was a function of the structure in which physicians trained and practiced. Individuals were merely socialized into the role of doctor, and this role was perpetuated throughout the world (Coburn and Willis 2000).
Distribution of Health in Israel
Israel is often considered a hub for modern medical technology. Although Israel ranks high across the world for life expectancy of both men and women, women suffer from more chronic illnesses than their male counterparts (Contemporary Women’s Issues Database 2004; World Health Organization 2016). As Israelis age, the health disparity grows between men and women. Women above the age of seventy suffer more from cardiovascular disease, mental disorders, respiratory issues, and fatigue than men the same age (Shedulat ha-nashim be-Yiśraʾel (Organization) and Merkaz ha-leʾumi le-vaḳarat maḥalot (Israel) 1999).
A longitudinal study from 1986 – 1990, by comparing the health and mortality of Jews living in Israel to Jews living in Montreal, Canada, found that these disease trends could not be attributed to the genetics of Jewish people. The cumulative mortality rates were much higher for Jewish women in Israel than in Montreal, suggesting environmental and cultural factors mediate health outcomes (Shatenstein and Kark 1995).
influence of immigration, either first or second generation. We cannot forget asylum seekers and refugees.
In her book What Makes Women Sick? Sered advocates that Israeli women are quite literally sick because of their enormous responsibilities but lack of authority in the realm of reproduction (Sered 2000). This imposed “sickness” distinguishes women and mothers from other groups (men). Women have a large pool of obligations, and the burden of it all weighs heavily considering that society implies women themselves do not have the authority to make rational decisions regarding their own well being.
Sered may view Israel as a place full of Israelis, while Israelis themselves consider Israel as a melting pot. Immigrants make up a large portion of Israeli society, so it’s relevant to
consider the impact this has on the health of women. When Israel became a state in 1948, it depended upon people migrating to become Israeli citizens. Immigration continues to be a
guiding principle, and contributes to a strong diversity religiously, culturally, and economically (Rosenfeld 2005). All of these factors have been known to mediate health outcomes. With all of this, we should consider the impact immigration has on health.
Immigration and Women’s Health
aspects (Benyamini et al. 2014). Results from this study, among others (Blumstein et al. 2012; Blumstein et al. 2016), indicated that long-term Jewish residents reported higher self-related health, along with higher physical and emotional health compared to the immigrant and Arab women. Self-rated health historically indicates future health outcomes and sheds light on current cultural and psychosocial factors. The fact that immigrant and Arab women report lower self-rated health than long-term Jewish residents should paint a picture of how religious or cultural differences, and the stress of immigration, can lead to health disparities, especially for women who are expected to be caregivers and nurtures amidst it all, despite the egalitarian healthcare model of Israel.
Yet claiming immigration negatively influences women’s health as a blanket statement merits caution (Foner 1998). Let’s take the influence of wage work on women migrating to the United States. The gains and benefits of wage work for immigrants coming to the United States oscillates with preference, culture, and socioeconomic status.
Latin American and Caribbean families, for example, might see a shift from the
patriarchal tendencies of their homeland upon arriving in New York. Women begin to work, and this fosters a sense of responsibility and leadership that otherwise would have been unfamiliar. At the same time, being a caretaker responsible for maintaining the household generally remains a central part of their identities; what changes are that husbands are forced to become more involved in the domestic domain in order to make up for the time women spend working.
men find jobs, and they may qualify for government assistance, women can stay home and take care of children. However, this can lead to depression and other psychosomatic health problems (Foner 1998). Ultimately, analyzing how female immigrants were influenced by their arrival in the United States and wage work is full of grey areas, especially from a feminist outlook.
Immigration is a complicated and multifaceted topic, and has many implications particularly for the health of women. While change towards more independence may prove beneficial for women in certain immigration situations, the stress of being culturally or economically disadvantaged while simultaneously feeling intense pressure to maintain a household of many children and an absent husband may produce unique psychosomatic health concerns for women, especially regarding motherhood.
Feminism in Medicine
Feminist perspectives migrated into the sociological investigation of medicine throughout the end of the 20th century. Many case studies in this realm focused on midwives – male
However, the feminist theory of medicine more specifically studies the health of women, and how patriarchy has influenced women’s health and reproduction. Before the 20th century, midwives and neighbors helped perform deliveries in the homes of women (Gibson 2017). It was not until women began to let male physicians into their homes during childbirth that they began to opt for pain mediating practices. This started as practices such as bloodletting and leech sucking, which could instantaneously reduce anxiety (Kass 1993). Eventually, physicians became more interested in studying obstetrics, and anesthetic procedures to go along with this.
Childbirth and Pain
The ancient Greeks administered alkaloid hyoscine during delivery, which acted as a sedative, hallucinogen, and amnesic. By the 19th-century, physicians knew the level of harm these types of drugs inflicted. Instead, people preferred laudanum and other opiates for pain management, even though many midwives frowned upon such practices. Later, inhalants become the popular form of anesthesia. First, it was diethyl ether gas, thanks to the discoveries and research of dentist William Morton (Caton 1999). Ether gas was reserved for well-connected women at this time. Notably, Fanny Longfellow, who was married to Henry Wadsworth
Longfellow, praised her experience of childbirth under the influence of ether gas (Gibson 2017).
chloroform persisted. One of the most famous examples of a successful “chloroform birth” was Queen Victoria in 1853 (Gibson 2017). This propagated the popularity of chloroform during birth throughout Britain.
More and more complications began to be associated with the administration of inhalants during delivery. At the start of the 20th century, infant survival dropped to 1 in 10 during the first year of life (Gibson 2017; MMWR. Morbidity and Mortality Weekly Report 1999). Around this time, hospital births became much more acceptable. The doctors were dedicated to relieving pain, and taking control of the mother’s situation as much as allowed. Thinking of Sered, we can see how this era of anesthesia and hospitalization led to women losing much of their agency at this pivotal moment in their life.
Today, to imagine delivering a baby vaginally, unconscious and under the influence of dangerous inhalants, is mind-boggling. In many ways, we have departed from this gruesome use of medical technologies, but in other ways, we still rely on dangerous medical procedures to assist in the delivery of our babies. Women may find themselves losing control, and submitting to the authority of the nearest hospital staff during delivery.
Medicalization of Childbirth
aforementioned incentives, translates to birth grant. The government covers the expenses of giving birth in a hospital and offers a supplementary monetary gift (Sered 2000). However, these monetary gifts are generally very modest, ranging from NIS 1,757 (about 484 USD) for a first child in the family to NIS 13,175 (about 3,627 USD) for triplets (National Insurance Institute of Israel 2018). These are directly deposited in women’s bank accounts.
The state of Israel almost unfailingly provides free routine visits to the doctor for prenatal care. Further, these visits institute a constructed dependence upon medical practitioners for pregnant women. Many women report having no say in the procedures conducted during
pregnancy or delivery, such as IV lines and even cesarean sections (Sered 2000). In this medical model of delivery, women lose their agency in many ways. The hospitals subject women to the notion that because they are women, and because they are pregnant, they are sick. No one in this situation doubts the value of bringing a healthy baby into the world. What the hospital system does seem to doubt is that the women are able to go through this relying on their own judgment.
provides a monthly allowance, for families who qualify, to afford the care of their children up until the child turns 16 years old (Sweden Sverige 2018a).
While these benefits are resonant of a healthy medical care system, we still see aspects of women feeling at a loss for control over their bodies, especially in the hospital context. While the Swedish medical system protects against classifying pregnant women as “sick,” there is a
knowledge gap about motherhood and delivery that still makes childbirth in some ways a difficult process. Take a study published in 2005 in which women were interviewed about two years after giving birth in Sahlgrenska University Hospital in Göteborg, Sweden. The essential structure involved women reporting the process as “an unavoidable situation, which was demanding for both control and loss of control” (Lundgren 2005). Women generally do not know where they are giving birth until the actual time of delivery, which can produce anxiety. Midwives are responsible for the delivery of low-risk pregnancies, and the team is constantly shifting. In a sense, women are responsible for their own delivery, yet still must rely on the discretion of the hospital. Overall, giving birth in Sweden is a simplistic and cheap process; however, the inevitability and lack of knowledge of what the process will entail may contribute to a loss of agency for the women.
In a study based out of Bob Shapell School of Social Work in Tel Aviv, researchers assessed the attitude women in Israel had towards the medicalization of childbirth. Previous research has indicated that attitudes influence planned and actual modes of birth. Eight hundred thirty-six pregnant women were recruited from women’s health centers and natural birth
communities; they were all asked to fill out questionnaires regarding their fear of childbirth, planned birth choices, and opinions on the medicalization of delivery. They found that younger and less educated women, along with immigrants from the Soviet Union and women with complicated obstetric backgrounds, felt more positively towards medicalization. For first time mothers, positive attitudes decreased throughout the pregnancy. Overall, positive attitudes towards medicalization were associated with a greater fear of birth. Women who feared
childbirth more were more likely to have C-sections and instrumental births, whether those were planned or unplanned (Benyamini et al. 2017).
Rona Mor, a journalist for the Israeli newspaper, Haaretz, described her experience with the birthing industry in Israel. She argues that her childbirth was more painful than it had to be and that this has to do with the extensive medical intervention. Unlike in Sweden, where women schedule as few prenatal care visits as possible, Israeli women are pressured into constant visits to the doctor. This translates to tension, anxiety, and intrusive thoughts reminding them of what could go wrong in the delivery room. Doctors are legally responsible for their patients, and often medically intervene in manners that may be unnecessary. When a mother goes into labor, she waits in a sort of service line, hoping that the medical staff will attend to her in a timely manner.
For Mor’s particular case, she was administered a large amount of epidural anesthesia at the advice of her cold-mannered midwife too early in the process, which led to complications indicating the necessity of a C-section. The doctors were called in just as the baby was entering the pelvis. Decidedly, the doctors inverted the baby’s position, tearing Mor’s uterus and causing immense pain. This sort of trend seems to be the norm for what were initially low-risk
pregnancies. Well off women aware of this process often pay great sums of money to hire personal midwives or doulas, and in turn, avoid needing a doctor to give birth when they arrive at the hospital after starting labor (Mor 2012).
So why do women so often go to the hospital if this experience is reportedly extensively stressful? Kol Zchut, a website that helps Israelis navigate their rights and entitlements, has a section dedicated to pregnancy and birth, which is considered a right in Israel. Until recently (2017), women could not qualify for a maternity grant if they chose to give birth at home.
baby to be checked out by a physician. The number of home births in 2002 was 290 out of about 150,000 (Shuval and Gross 2008). Now, to qualify for a birth grant, a doctor or midwife must be present during the delivery, and the Ministry of Health’s home birth regulations must be met (Kol Zchut 2018). So prior to 2017, there was a blatant monetary incentive for women to give birth in hospitals.
Part 3: Introducing Alternative Medicine
Postmodern Midwifery
Each society has unique methods of childbirth. These methods, which often become ritualized, provide narratives of these societies in many ways. Delivery can be considered in many different contexts, including nationally, religiously, or locally. A historically important example of a society that produced unique birthing methods is “The Farm.”
In 1971, a group of young, like-minded, and strong-willed people in southern California decided to depart from what they knew. This was not in an effort to escape, but an attempt to correct what they perceived as a world fallen to corruption and chaos. Stephen and Ina May Gaskin acted as the leaders of this group, forming The Farm. Over 1,400 individuals joined this society, all agreeing to take a Vow of Poverty and leave behind the comforts of the material world that is the United States. Along with this Vow, members of the Farm had to give up all of the chemicals and medicines they relied on before, including birth control. Inevitably, this led to countless pregnancies. Farm members started adopting practices such as multiple marriages, where up to four parents were all equally responsible for a set of children (Croshere and Mundo 2013).
groundbreaking finding. Pregnant women, especially in places like the United States and Israel, often convince themselves that they must deliver in a hospital to ensure the safety of their babies and even of themselves. According to Gaskin’s research and experience, this is not entirely true.
Rates of cesarean births have risen across the world, and doctors have confessed these deliveries are associated with lower survival rates than natural deliveries (Gaskin 2011). In the United States, 1 in 3 women has a cesarean delivery. Gaskin found that many modern physicians never acquired what she assumed were common skills regarding childbirth, including estimating fetal weight manually, breech skills, and Leopold’s maneuvers. These skills, among others, are common knowledge for midwives who prescribe to the natural childbirth method.
The fear that surrounds childbirth in the United States and Israel has become implicit and in essence unavoidable. Gaskin’s work and research in many ways aim to reduce the fear of delivery. Prior to giving birth, she encourages women to feel confident in the fact that they are able to have a safe delivery. In a TED talk she presented in Sacramento, she mentioned that humans are the only mammals capable of doubting our own capacity to give birth (Gaskin 2013). When a woman goes into labor, this is potentially a time of stress, frantic panicking, and pain. So how should women deal with this?
culture and tradition has not been infiltrated with fear surrounding childbirth. They know how to make the process pass quicker.
Other recommendations are sitting in low-light areas to reduce sympathetic, or “fight-or-flight,” nervous system responses. Another effective practice is being intimate with a romantic partner to increase hormones such as oxytocin. Oxytocin not only helps women feel better but also is vital for the birthing process. Physiologically, a woman’s body naturally produces endogenous analgesic opiates, especially when she feels happy. Gaskin and other midwives commonly incorporate humor into the delivery room to promote this natural analgesia.
Complementary and Alternative Medicine in Israeli Obstetrics
As an alternative to the dominating medical model, the American concept of natural childbirth has migrated into Israel. This model emphasizes educating the pregnant woman about childbirth in order to prepare them as much as possible. Its mission is to give women control over their situation by understanding exactly what childbirth entails, and being prepared to properly apply this knowledge during delivery. Accordingly, someone who is a proponent of natural childbirth may claim that birth is an achievement. They might also say that being able to endure the pain without medical intervention should be valued as the catharsis of the journey of pregnancy.
In Israel, where the natural model exudes a foreign aura, the majority of women lean towards the medical model of childbirth. Many expectant mothers come in contact with
knowledge and information born out of the natural childbirth model but still, remain in the realm of medical childbirth. Sered noted from her interviews that many women had chosen Misgav Ladach Hospital because it promised to be an environment suited for natural childbirth, only to find that medical interventions such as induced labor and fetal monitors were necessary in their case (Sered 2000).
While I have discussed this loss of agency in the hospitals of Israel, it’s important to note that numerous midwives have adopted complementary and alternative medicine practices in attempts to bring feminism into the delivery room. As in the United States, embracing alternative medicine during the dominance of medicalization was a product of social tension. Exposure to Eastern spirituality and postmodern values may have brought to the forefront the fact that medical professions were understood to be unfaltering voices of expertise and authority, even though this may have been socially constructed more so than earned (Shuval and Gross 2008).
discrepancy is provided in Sered’s discussion. Israeli obstetricians are only heavily involved when it comes to high-risk pregnancies, and high-risk pregnancies are often divorced from alternative medicine, as far as possible.
Evidently, the Israeli people and even Israeli doctors value the concept of integrative and naturalistic healthcare. So why is alternative medicine recommended for all walks of health, but then becomes taboo in the delivery room? There is no doubt that rates of medical interventions in childbirth have greatly increased in recent years. In places like Israel and Sweden, where women generally see a doctor during delivery if something is “wrong,” the question lingers: how does naturalistic healthcare fit into the delivery room?
An elite hospital in Jerusalem offers an additional 108-hour training course for midwives, teaching complementary and alternative medicine techniques such as shiatsu, natural childbirth, Chinese pressure points, herbal medicine, reiki, and reflexology (Shuval and Gross 2008). In the United State and Canada, there is thought to be a subset of feminist midwives who advocate for alternative medicine and home birth, while the majority of midwives continue practicing within the general registered nurse mindset, not openly incorporating feminism into their practice. Further, the feminist midwives do not doubt the power of biomedicine but have values grounded in feministic thought that they believe can be brought into the delivery room.
opposed (Shuval and Gross 2008). Otherwise, midwives find themselves navigating debates with obstetricians who oppose such practices. Ultimately, all midwives are aware that life-threatening situations mandate biomedical intervention.
Findings from this study also elucidate that this group of midwives may draw from a broad context of feminist ideology. Many themes were extracted from analysis of the qualitative interviews, including: rejection of the medicalization of birth, a strong belief in the “naturalness” of childbirth, rejection of the overuse of technology, empowerment of women,
nostalgia/reverence for the past, centrality of intuition and emotion, and active advocacy (Shuval and Gross 2008). Midwives in Israel are granted autonomy in the delivery room and are
generally able to implement these ideologies, given a low-risk and uncomplicated birth. However, they may encounter difficulty when physicians must be involved in the delivery, ultimately indicating that medicalization model of childbirth has a monopoly over obstetrics.
New Religious Movements and Alternative Medicine
Alternative medicine practices may be viewed through the lens of new religious movements in Israel. Following the formation of the state of Israel, modernist religious
States, such as the one led by the Gaskins, made a second wave of impact in Israel about a decade later. The new Jewish religious movements spread and adapted over time but primarily stemmed from the activism formed in the United States (Ariel 2010).
As the new religious movements integrated into Israel, the Jewish tradition was not lost, but rather became intertwined with the movements as they developed. “In general, Israelis have taken greater interest in movements that emphasize self-improvement and spiritual well-being and have often shied away from traditions in which there is explicit worship of ‘alien deities’” (Ariel 2010). Self-betterment colored the new spirituality following the tapering support of Zionism, explaining why holistic lifestyle and complementary medicine gained popularity throughout Israel. While the Jewish tradition was not lost, American concepts of a healthy, simple, and free way of life produced tangentially by the “summer of love” movement struck a chord with Israelis facing their own religious identities.
The Jewish tradition emphasizes childrearing and family growth as inescapable responsibilities and religious pursuits. Thus we can understand why the medical institution possesses the realm of reproduction. Israel is a progressive place and seeks to utilize the
Part 4: Orthodox Judaism and Childbirth
While Orthodox religious groups may generally be associated with reverence for traditionalism of the past coupled with disdain for modern technology, Orthodox Judaism, or Haredi society, embraces the biomedical technology that promises safe and effective
pregnancies. For instance, many Haredi women (though not all, as we will see) choose to indulge in epidurals and other pain mediating interventions during childbirth because they see these medical resources as gifts from God (Shimrit Prins Engelsman, Ephrat Huss, and Julie Cwikel 2018).
Haredi Society
Consequences of Orthodoxy
Many demographic studies have suggested that increased religiosity corresponds to higher rates of childbirth, particularly among Muslims, Jews, and Christians (Okun 2017;
Schellekens and Atrash 2018; McQuillan 2004). For Haredi women, in particular, they may refer to birth as ‘avodat Hashem, or “service for God” (Raucher 2016). Pregnancy is not only
expected; it is a sacred mandate.
When religion has institutional power in political and social contexts, as it does in Israel, religion has greater authority to implement norms. As Sered mentions in her work, enhanced fertility among women is a national ideal. Just as women in the United States and Israel strive for a slim body shape that often requires strict diet and exercise regimes, fecundity is another
societal ideal that promotes certain behaviors and comparison habits (Sered 2000). Among Haredi women, the norm is to get married young and begin trying for pregnancy very early on in the marriage. There is a drop in birthrate among Haredi women after the age of 30, whereas secular Jews have seen a rise in the age of marriage along with a postponement of pregnancy following marriage (Hleihel 2011). In 2009, the birthrate among Haredi women stood at 6.9 children per woman of reproductive age, compared to 2.07 children per women of reproductive age among non-Haredi Jews (Shimrit Prins Engelsman, Ephrat Huss, and Julie Cwikel 2018).
how they coped with difficult experiences during both pregnancy and childbirth. Six themes emerged from the interviews, elucidating issues faced by Haredi women: social pressure to conceive, availability of social communal resources for women after childbirth, seeking
knowledge about reproductive healthcare, medical practices and choices, traumatic experiences of reproductive events, and spiritual issues (Shimrit Prins Engelsman, Ephrat Huss, and Julie Cwikel 2018).
Considering that Haredi women have about seven children on average, the lack of
medical knowledge about pregnancy and childbirth presents a unique framework. Young women who have minimal sexual education compared to their secular counterparts are expected to dive headfirst into a long journey of motherhood as soon as they are married. Many women in the interviews indicated a desire to receive further education about fetus development and pregnancy in general (Shimrit Prins Engelsman, Ephrat Huss, and Julie Cwikel 2018). Chana Luba Etral, a doula in Pittsburgh, noted that many Orthodox women have terrible experiences with their first birth, primarily due to their lack of knowledge about the process. Further, during subsequent births, there is clearly more motivation to seek out educational opportunities for the birthing process (Lobell 2014).
Solicitation of Religious Support from Authorities and Communities
told the researchers: “A rabbi takes greater spiritual responsibility because he is fearful of God, which is higher than the fear of malpractice” (Shimrit Prins Engelsman, Ephrat Huss, and Julie Cwikel 2018).
Michal Raucher, an ethnographic researcher of Haredi Jewish women, takes a particular interest in reproductive ethics. In her work, she noted that the lines between rabbis and doctors are often blurred. Doctors who abide by Orthodox laws may enter partnerships with rabbis, whereby the rabbis refer women to doctors they feel confident will abide by halakhah. This is also economically advantageous for the doctors involved. Such a doctor may ask a woman if she has consulted with her rabbi before prescribing her birth control, for example. The integration of rabbinical advice into the everyday life of Orthodox Jews has been referred to as da’at Torah (“knowledge of the Torah”) (Raucher 2016). Reliance on advice from a male figure of religious authority may present another example in which women have less authority and autonomy when it comes to making decisions about their bodies, especially if women are not allowed direct access to communication with their rabbis.
The period immediately following childbirth is immensely important for Orthodox women for many reasons. Orthodox women prefer to really experience the childbirth process, particularly after delivery. This is especially true for mothers who have multiple young children back home. Instead of being told the process is over immediately after giving birth and being sent home as soon as possible, it’s preferable to lavish in time where the mother is taken care of by others, and she is not the only person responsible for the newborn. For this reason, among others, an Orthodox woman may opt to deliver in a religious hospital that adheres strictly to Jewish law. In these hospitals, women do not have to worry about whether their meals are kosher or not, for example. Another reason religious hospitals can be beneficial is that many of them have partial rooming-in. With this, the baby is cared for in the nursery to allow the mother time to relax before going back to her family, where all of the household and childcare responsibilities will fall back on her (Shimrit Prins Engelsman, Ephrat Huss, and Julie Cwikel 2018).
Besides the standard degree of emotional and mental support the doulas are able to provide, the spiritual support is a key factor for an Orthodox woman seeking an Orthodox doula. It also saves the woman from emotional work of having to explain certain traditions, such as aforementioned purity laws, because the Orthodox doula will already be familiar with these customs. Along with this, because niddah does prevent physical contact between wife and husband during delivery, doulas are able to offer massages for relaxation or adjust tichel for modesty reasons if necessary. Prayers and song are also integral to helping keep women calm during the process. When a doula understands how childbirth is a deeply religious experience for Orthodox Jewish women, the women are able to better focus on their own birth, as opposed to external factors that conflate the stress of the pregnancy.
Beliefs Regarding Abortion
When seeking out advice and support from the religious community, there are certain things that are advised against. Rabbis will attempt to guide women away from induced labor. According to the Torah, God decides when to bring life into the world, so it is not up to doctors and parents to control when the baby comes. However, the rabbi will make exceptions to this guideline for medical emergencies and life-threatening situations (Citron 2019).
Gurion University indicated that Haredi women prefer less involved prenatal procedures. Yehudit, a woman interviewed during this research, did not perform detailed ultrasounds at the advice of her rabbi. For her, any abnormalities or issues indicated from invasive prenatal procedures would have only caused distress, especially considering abortion would not be an option (Shimrit Prins Engelsman, Ephrat Huss, and Julie Cwikel 2018).
Shmuel Singer, a rabbi from New York who received his degree in Jewish history from Yeshiva University, discussed abortion from an Orthodox Jewish viewpoint in an interview with Bert Wade in 1989. One of the most common reasons for genetic screening of the fetus among the Jewish community is Tay-Sachs, a life-threatening disease most common among European Jews. However, abortion is unacceptable for an Orthodox Jewish woman carrying a Tay-Sachs fetus. Although birth control is generally not acceptable, Rabbi Singer advises women who carry the Tay-Sachs gene to practice birth control, particularly in the form of oral contraceptive, in order to prevent the conception of a Tay-Sachs fetus. Oral contraceptive is permissible because it does not violate the principle of not spilling the seed. In that same vein, the use of condoms is prohibited under all circumstances (Wade 1989).
The issue comes in determining which cases are potentially life-threatening. The borders become fuzzy in pregnancies where anxiety or depression could culminate into suicidal ideation, for instance. Ultimately, a single person cannot make these types of decisions. Women and their partners must consult their rabbi not only for difficult decisions but also even for the mundane. If a concern is presented that the specific rabbi does not feel equipped to address, the rabbi will refer to another individual who they feel has more experience with this particular issue. The guideline that “abortion is allowed when the mother’s life is at risk” may be as broad or as narrow as an individual rabbi interprets it. It is thus important for clinicians and health care providers to be aware of the unique relationship between spirituality and healthcare that exists within the Orthodox culture, especially when such difficult decisions must be made.
Culturally Competent Care
A study that investigated spiritual and cultural themes surrounding childbirth for
Orthodox Jewish women in Montreal, Canada concluded that culturally competent care benefits mothers in many ways. When her spirituality is both understood and respected, an Orthodox woman is more likely to experience self-actualization, along with strengthening of familial relationships (Semenic, Callister, and Feldman 2004). For this group of women, giving birth serves to enrich their Jewish faith; the conditions that surround this event must, therefore, supplement this enrichment.
public hospital would for such a special case, the general trend is for women to feel more
comfortable where their unique religious beliefs are accommodated. In an article published in the Jerusalem Post, Siegel-Itzkovich reported that Shaare Zedek, a large medical center that caters to many ultra-Orthodox patients, performs a very low and stable percentage of cesarean section deliveries. Despite rising rates of cesarean deliveries performed throughout the world, religious hospitals maintain low rates because women are planning on having more children; C-section deliveries are not recommended when women are expecting more pregnancies (Siegel-Itzkovich 2015).
Although multiparous women are celebrated among Orthodox Jews for the religious and societal implications of having many children, there are still difficulties that cannot be ignored. Despite the physical toll of vaginally delivering more than two or three times, being the primary caretaker for about seven children is a heavy responsibility. Many of the Orthodox women interviewed after giving birth in a Montreal hospital described birth as a “bittersweet paradox.” They used language such as “obedience to the law,” an “achievement,” “painful but joyous,” and “sacrificial” to describe the journey to motherhood (Semenic, Callister, and Feldman 2004). Being fruitful, or bearing many children, is quite simply a commandment from God. Further, it is the norm among their religious communities and creates a sense of fulfillment on account of pressure from religious authorities, friends, and family.
Thinking back to the spiritual midwifery of Ina May Gaskin, one can see why many Orthodox women often choose natural childbirth. Orthodox women approach this process from a predominantly spiritual perspective. Because they wish to really experience the birth (the
lines up with many aspects of this rationale. The natural childbirth method is about immersing yourself into the full breadth of the birthing progression. The pain of delivery becomes a bonding tool for you and your baby, and is a temporary obstacle to overcome. A woman from the
Montreal interviews recounted that the process was so painful that for a few hours that she thought, “the world is going to end,” but when her baby arrived that pain seemed trivial and transient (Semenic, Callister, and Feldman 2004).
Because Orthodox women receive minimal prenatal intervention and avoid C-sections, induced labor and other invasive procedures after going into labor, natural childbirth often makes practical sense. Midwives and doulas, as aforementioned, are able to physically comfort women when husbands are not restricted from doing so. Further, natural childbirth embraces the
spirituality of giving birth. Although there are birthing centers that specifically cater to Orthodox Jewish women, the natural birth model is generally spiritual, even for non-Jewish women. The natural model embraces the liminality of the transition between pregnancy and being a mother to a newborn. There is a change in status associated with delivery – the woman goes from not being a mother to being a mother. This is particularly moving in the Orthodox Jewish religion, where spirituality is infused into every aspect of life. The creation of a human being is revered as one of life’s greatest miracles; this process is not to be taken lightly.
was pinning amulets or red ribbon to the child’s clothing or bassinet. This serves to prevent any sort of evil spirit interacting with the baby (Cassar 2006).
Part 5: Seeking Help and Protection
The Evil Eye
The evil eye has a complex history. Evil eye folklore has existed across many cultures, extending beyond Judaism. The folklore and blessings for good health among Sephardim are often connected to the evil eye. An example of one such blessing is “May you live and grow like fish in the fresh water.” Fish are protected from the evil eye for one because they live in water, through which the glance of the evil eye cannot pass, and because their eyes lack eyelids and are located on either side of their head, allowing them to see around them at all times (I J Lévy and Zumwalt 2013). This elucidates an important aspect of the evil eye – it must be visible to the person to inflict harm. Another quality of the evil eye is that its agency is independent of the character of the person it possesses. If someone happens to catch the evil eye, their glance becomes envious and destructive; it is a direct result of the evil eye, not a result of the person’s demeanor or character (Kern-Ulmer 1991).
It occurs predominantly between women who are likely to become pregnant, newlyweds and newly pregnant women, two pregnant women, or a new bride and a woman who recently experienced a miscarriage (Isaac Jack. Lévy and Zumwalt 2001). This ritual symbolizes a balance of fertility in the world, and hopefully staves of envy that may exist between the two parties. Again, envy is a permeating theme with evil eye folklore. If a beautiful child is given a compliment, the mother may spit on the child. This “dirties” the child, reducing desirability and hopefully alleviating the envy inflicted by the compliment that might be welcoming the glance of the evil eye.
One particular association made in Semitic and Indo-European cultures is the relationship between the color blue and protection against the evil eye. In 1876, the Syrian rabbi Abraham ben Isaiah Dayan described instances of the evil eye and recommendations for how to cope with them. While the Zohar mentions that parents should place a cloth over their baby’s head when they bring the child out in public to protect from the evil eye, Dayan further recommends that children also dress in blue clothing in these circumstances. He likened the Arab color term for blue, azraq, to the Hebrew term for blue, tekhelet. The color blue is intimately related to protection against the evil eye in Mediterranean cultures. According to medieval Kabbalistic myth, a dazzling blue garment, which represented the feminine aspect of the godhead, protected against contact with evil forces (Sagiv 2017).
Further, malkhut is feminine, which could relate to themes of defenselessness in Kabbalistic text. In his famous Kabbalistic treatise on colors, Gate of Colors, Moses Cordovero discusses tehelet extensively, seemingly concluding that this blue color was protective against evil forces on account of its threatening force (Sagiv 2017). Ultimately, femininity is intertwined with evil eye folklore not only in mothers and their babies being especially susceptible to its threats but in the symbolism of color associated with the evil eye.
Names
Another important aspect of warding off evil is the name of the child. The name holds value in that what the child is called becomes intertwined with the character of the child. The baby’s name cannot be announced before specific ceremonies, depending on the sex of the baby. For a male, the name will be announced at the child’s bris, which occurs eight days after birth. For a female, the name is announced at the first Torah reading after birth. It is not permissible to announce the name of the baby before these events.
According to the Encyclopedia of Jewish Folklore and Traditions, names also have protective or powerful qualities. For instance, the name that would be at the top of one such amulet that would be pinned to the baby’s bassinet would read El Shaddai, which is a Hebrew name for God. The names of angels would be written to the left and the right of God’s name, with Adam’s name written over Lilith’s name at the bottom right. According to Jewish
different names of Lilith are written out to prevent her from entering the baby’s bassinet deceitfully by using a name besides Lilith (I J Lévy and Zumwalt 2013).
Lilith
Lilith is a major figure in Jewish folklore. Her infamy derives from her portrayal as an evil seductress, and as a threat to feminine fertility. She has commonly been called a child-killer and has been likened to vampires and demons (Lagasse 2018). In various legends associated with Lilith, she is considered the predecessor to Eve in the Garden of Eden, or Adam’s first wife. Though Lilith was only mentioned once in the Bible in Isaiah 34:14 (although it remains a point of contention whether the lylyt haunting desert places was actually the demon who was once married to Adam), her popularity in Jewish folklore picked up beginning with a collection of commentaries on Genesis in the late Talmudic period, Genesis Rabbah (Humm 2014). Around the ninth century CE, she was also mentioned in a satirical work, Alphabet of Jesus Ben Sira.
infants, and decreed that she had dominion over newborn males for eight days, and newborn females for twenty days. She added that if the angles names were written on amulets given to young children, she would have no power over them (Humm 2019).
In late Roman and early medieval Judaism, Lilith appeared on magical bowls, which were typically buried under thresholds to keep unwanted spirits away, in a similar fashion to protective measures taken against the evil eye at boundaries. These were particularly protective against threats during the danger of childbirth and infancy, but could also be used to protect against sexual attacks. These sexual attacks play a large role in Jewish folklore. In Kabbalistic texts, Lilith is the wife of Satan. In other contexts, she’s referred to as the Devil’s Queen or a sexual temptress. She was said to play the role of a succubus, having sex with men in their sleep (Humm 2014).
The relationship between Lilith and temptation found in Kabbalistic text and beyond emphasizes the relationship between her femininity and sin. In a sense, Lilith represents
womanhood gone wrong; she was not the ideal wife and was replaced by Eve, a more submissive partner to Adam. By the end of the twentieth century, when feminism gained traction, Lilith became somewhat of a feminist hero (Humm 2014). Her refusal to submit to her male
counterpart, along with demands that she and Adam were made from the same material and did not deserve inequality, set her up nicely for this archetype.
However, feminist ideology suppressed the more demonic nature of Lilith’s character. Lilith threatens values particularly important to Jewish women. Her primary function is to kill infants and secondarily endangers the health of the mother during childbirth. Her role as a
The folklore and concerns associated with Lilith illuminate many of the concerns Jewish women have faced for centuries.
Rachel’s Tomb
In Israel, there is a particular holy site that women may seek out during difficulties associated with womanhood: Rachel’s Tomb. In the 1940s, there was an increase in visits to Rachel’s Tomb. Sered attributes this to both the biographical history of Rachel and the political climate of the time (Sered 1989). This relates to the mobilization of women’s bodies for
reproduction mentioned in some of Sered’s other work.
Rachel has been respected throughout the Jewish tradition, primarily for being the mother of Joseph, a prominent biblical leader. Jacob, Rachel’s cousin, fell in love with her and worked seven years so that he could marry her. On her wedding night, Laban, Rachel’s father,
substituted Rachel’s sister Leah in place of Rachel. Leah was the eldest daughter, so Laban justified this deception to Jacob by claiming the eldest should be married first. Later, Jacob was able to take Rachel’s hand in marriage as well.
birth to three more sons, Rachel finally became pregnant with Joseph. But as soon as Joseph was born, Rachel desired more children.
Rachel and Leah were also dissatisfied because Laban never gave them the bridewealth that accumulated from Jacob’s years of work to take Leah and Rachel’s hand in marriage. Rachel decided to take action on account of this frustration. She stole Laban’s household gods
(teraphim) as her family was leaving for Canaan. Because of her womanhood, she would not qualify to receive Laban’s teraphim, which was an important part of the inheritance of his estate. So Rachel used her womanhood to hide the teraphim from both Jacob and her father when Laban came looking for them – she sat on top of them and claimed she could not get up because she was menstruating. However, Jacob did not know that Rachel had stolen the teraphim, and promised Laban that whoever possesses the stolen teraphim will not live.
Later, when Rachel became pregnant with her second son, Benjamin, she died in
childbirth. The curse that Jacob placed came to fruition. More significantly, her fertility is what killed her. Rachel’s womanhood worked towards her benefit when hiding the teraphim and eventually giving birth to Joseph, but ultimately proved to be her demise when she died on the road to Canaan. Instead of burying Rachel in the ancestral tomb at Machpelah, Jacob created her own tomb and buried her on the road to Efrat, outside of Bethlehem (Frymer-Kensky and Jewish Women’s Archive 2009).
Part 6: Conclusion
One of the most important Jewish teachings is to be fruitful and multiply. For many Jewish families, especially Orthodox Jews, having a large family and thoroughly investing in the religious education of children is essentially a sacred mandate. Jewish women not only bear the responsibility of childrearing but also experience intense pressure to avoid all danger and risk associated with childbirth. This mindset has been enforced by the increasing medicalization of obstetrics, despite evidence that natural and homeopathic modes of delivery are just as safe and effective for low-risk pregnancies. This is further evidenced by the fact that natural childbirth is gaining popularity throughout the world, particularly among Jews in Israel. Even within the context of natural childbirth, the pressure to deliver without epidurals or pain mediation presents as problematic when a woman struggles to identify her own preferences and desires amidst standards and pressures to conform to a certain mode of delivery. Though the medical model still dominates, trailblazing midwives such as Ina May Gaskin have laid the groundwork for a
revolution against the fear inspired by harsh medical procedures that pregnant women often experience in hospital delivery rooms, such as emergency Cesarean sections or episiotomies for cases of shoulder dystocia.
in the hospital setting. Women are fed ideas that their bodies cannot handle childbirth, and that to be safe they must have a bio-medically trained obstetrician with access to the most contemporary medical tools.
We know that this is not true based on basic physiology and evolution – our bodies have handled childbirth, granted not without a measure of difficulty, since we have existed. For ultra-Orthodox women, they must rely on the ability of their bodies to handle childbirth, especially considering Haredi families have about seven children, on average. But there is still fear of the dangers of childbirth evident in folklore and popular belief among this population. The Jewish demon Lilith is a pertinent example, with her history of taking life from newborn babies and their mothers.
During delivery, Jewish women exist in a problematic liminal phase. The pain of
childbirth is compounded by cultural expectations to be a good mother, which includes having a safe and effective delivery. Though years of research and experience, especially on the part of midwives, have given humans insight into how pregnancy and childbirth may progress smoothly, there is still danger and fear. Jewish women have found various ways of coping with such fears, whether that is through reliance upon the medical system, through natural childbirth, or through rituals to protect against unseen forces.
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