In order to sensitively care for a pregnant woman within a practicing
Jewish family, nurses must know a little about the religion and a lot
A labor and delivery nurse concludes her report of a newly-delivered
primigravida with the following comments:
"I have some real concerns about this couple. Although they attended
childbirth preparation classes, the father wasn't physically supportive of his
wife. Oh, he was verbally supportive, but he wouldn't touch her at all, not
hand-holding or back-rubbing! Any time we checked his wife or gave her physical
care, he left the room and didn't return until we called him back. He refused to
enter the delivery room, too! He stayed in the labor room reading! In the
recovery room, he kept his distance. None of the hugging and kissing we usually
see after the birth. They both say they're happy with the baby and yet they
won't call her by name."
From this report, the postpartum unit nurse could suspect marital discord, a
potential attachment problem, or, as was the case, cultural variation. As the
parents under discussion were Orthodox Jews, their behavior is understandable,
appropriate, and predictable. And, although the nursing profession has long
appreciated the importance of considering the client's cultural beliefs when
formulating a care plan, a nurse unfamiliar with her client's differences may
easily misinterpret these variations and perceive problems where none exist.
Learning about the childbearing couple's beliefs and incorporating them into the
care place, can both enhance the nurse-client relationship and promote positive
perceptions of the childbirth experience.
A Framework of Jewish Belief
Judaism is based on the observance of the Torah laws given to
Moses by G-d on Mount Sinai. The laws are believed to have been designed by G-d
to fit the human personality, the common denominator for all societies in all
ages. Jews should follow the Jewish law because their beliefs on which
traditional Judaism is based, can serve as a conceptual framework that will
enable nurses to meet the needs of Sabbath-observant parents, for whom
respecting the interpretation of the Torah is of the utmost importance.
Traditional Judaism views each man as an individual created in
G-d's image with a soul that will survive eternally and be returned to G-d after
his death. During his lifetime, man may freely choose his own lifestyle.
Observant Jews accept the Torah laws that teach them how to emulate G-dlike
behaviors in their day-to-day lives, enabling them to become better human
beings. Thus, Jewish law details every aspect of daily life, instructing the
practicing Jew to live up to G-d's high expectations and to contribute to a more
perfect society. Even when the reason behind a Jewish law is not fully
uinderstood, the law is followed as a manifestation of faith.
For example, many people are familiar with the kosher dietary
laws. They are meant to elevate the act of eating to a context of holiness,
contrary to the popular belief that kosher laws are based on reasons of health
or hygiene. Other laws, called tzniut (modesty) laws, set down dress
requirements and protect the modesty and dignity of the human body, as it is
created in G-d's image. Likewise, Jewish niddah (separation) law
defines intimate relationships, elevating them, too, from a purely physical
Physical intimacy is not regarded in Jewish practice as a
necessary evil or a concession to man's weakness. Rather it is acknowledged as a
right of both men and women within the bonds of marriage. The niddah
laws mandate a physical separation between husband and wife, beginning with the
onset of the wife's menstrual bleeding or any other non-traumatic cause of
uterine bleeding. While actively bleeding, and for a time afterward, the woman
occupies a different ritual status as far as Jewish law is concerned. It is
important to note that men, too, are categorized by ritual status in Jewish law
and that this is not a concept peculiar only to menstruating women. Ritual
status has nothing to do with physical purity or cleanliness, another
The niddah laws are known to ensure a special
relationship between husband and wife. They specify that the marriage must be on
a foundation more solid than physical attraction, and provide for a newness and
vitality within the intimate relationship. While the wife is menstruating, the
couple maintains a physical separation. Consequently, they must establish
effective means of non-physical communication, and will anticipate the renewal
of the physical relationship, after the wife's immersion in the waters of a
mikvah (ritual bath), all the more.
Just as marriage is viewed as the only appropriate environment for
sexual expression, the family is viewed as the best environment for the practice
of Judaism. Children are a necessary extension of the marriage relationship,
having children is incumbent upon married couples as a means for providing
continuity to the Jewish people. Birth control, abortion, and sterilization are
not permitted unless the mother's physical or psychological health is at risk
and rabbinic counsel has been sought by the concerned couple.
It is important for nurses to recognize that Sabbath-observant
women are, traditionally, scrupulous in their respect for Jewish law, as one of
the woman's unique roles is to establish and maintain the level of spirituality
that will pervade the home. Whether she devoted herself only to the home and
family or works outside as well (an increasingly common practice within the
Jewish community), she is the cornerstone of the family's spirituality. She may,
therefore, feel strongly about respecting the laws of Judaism during pregnancy,
labor and delivery.
Adapting Care To Beliefs
The chart, Caring for Practicing Jewish Parents
(seen below), describes some of the more commonly-observed laws, their
interpretations, manifestations and appropriate actions nurses can take.
Although the focus of the intervention column is on labor and delivery, the same
principals of care apply throughout the maternity hospitalization. Although some
couples seem to relax their observance of some of the tzniut and
niddah laws during labor and delivery (although this is incorrect),
nurses must judge whether the couple's change in behavior is based on a concern
that unless they relax their standards, the mother's physical needs might not be
adequately met. Nurses who understand the concerns of Sabbath-observant Jews can
appropriately supplement the father's coaching role, thereby enabling the couple
to successfully meet the demands of both labor and religion.
The guidelines suggested in the chart provide a framework from
which nurses can work as they plan care for practicing Jewish families. As she
deals with each individual family, the nurse can alter her care plan according
to their religious needs. With knowledge of Judaic law, the behaviors of the
couple that so concerned the labor nurse in the vignette at the beginning of
this article can be easily understood. The father's verbal and psychological
support of his wife, his decision to remain in the labor room at the time of
delivery to pray (for reasons of modesty, female labor coaches are preferred),
the lack of postpartum physical contact and the couple's reluctance to call
their daughter by name, in this situation, were actually indicative of a healthy
Caring For Practicing Jewish
Law Manifestation Interventions
|Tzniut: laws of modesty that maintain the dignity of the human body
Orthodox women generally choose clothing that covers their elbows and
Women should cover their hair with a wig, scarf or other head covering.
Jewish men, despite their intimate relationship with their wives, do not
directly observe their wives while they are immodestly exposed, maintaining
their wife's dignity.
Provide a long-sleeved gown that the mother can wear with the opening in
front, covering her back.
Permit the mother to wear her hair covering and/or provide a bouffant-style
operating room cap.
Give the father the opportunity to leave the room during care and exams in
which his wife's body will be exposed.
Husband should not be present during delivery. He may enter when wife is
|Niddah: laws that define the time of physical separateness between husband
||Rabbis interpret the law to mean that niddah is signalled by the onset of
regular uterine contractions, others at the appearance of "bloody show" or
Determine when the couple begins observance of niddah laws.
Encourage the father's non-physical coaching efforts such as eye-to-eye
contact, verbal support, or prayer. Once the husband stops providing physical
care, the nurse steps in, applying back counter-pressure, checking relaxation,
sponging the mother or applying compresses, and stroking or massaging the
In place of the father, allow the presence of female labor companion, if the
Laws pertaining to food and drink:
Kashrut, or kosher laws, govern types of food and methods of food
Hand washing and blessings at mealtime.
Jews who observe the kosher laws do not eat meat and dairy during the same
meal or use the same plates.
Before eating bread, the mother washes her hands. Before and after she eats
she recites blessings
Make sure that kosher meals have been ordered for the mother.
Permit the mother to eat food brought from home to supplement hospital meals,
if her diet allows.
Set aside a separate refrigerator in the lounge area or in her room so that
she can store her own food.
Provide basin, water pitcher and cup so that the mother confined to bed rest
can wash her hands before each meal.
consult with the mother, her family and the hospital dietician to assess and
plan for postpartum nutritional needs.
|Sabbath and Holiday laws: The Jewish Sabbath, which begins at sundown on
Friday and lasts until dark on Saturday, is a day of rest, signifying that G-d
rested after having created the world. Observant Jews will abstain from
labors that display man's mastery over nature. Holiday observances are similar,
except that they last for two days.
Observant Jews will not travel (except on foot), use the telephone or
electricity (including call bells and bed controls), or write on the
The observance of Yom Kippur, the Day of Atonement, and some other holidays,
include fasting. Women after childbirth should not fast until after the 3rd day
Encourage the mother to rest and promise her interaction with the baby on
the Sabbath when she may not receive visitors. A lack of visitors on the
Sabbath, does not indicate lack of family support.
Anticipate the mother's needs so that she will not be compelled to use the
call button. Make rounds more frequently. Adjust bed position and lights as
Avoid discharge on the Sabbath or on a holiday. Begin discharge planning and
patient teaching immediately after delivery so that if the mother is released
early to avoid discharge on the Sabbath or a holiday, she will have all the
Do not ask the mother to fill out forms or sign policies on the Sabbath or a
Check availability of a nearby facility such as an empty patient room or
on-call room that the family could use in order to stay nearby on the
|Bris Milah: the covenant of circumcision. The bris is performed no sooner
that the baby's eight day of life, by a mohel (pronounced moil) designated by
the family. At this time, the male baby is officially named and welcomed into
the family. (Females are named by the father at a Torah reading ceremony.) The
baby's condition may determine a postponed bris.
Parents may be reluctant to disclose the baby's name or call the baby by name
until after the naming ceremony
Parents will want to wait for a Torah reading at a synagogue service to name
NOTE: THIS CHART CAN BE PRINTED OUT AND CONVENIENTLY PLACED
INTO THE PATIENT'S MEDICAL FILE FOR REFERENCE.
Post-circumcision care is managed by the mohel. Review principals of care
with the mother before discharg