Monday, August 11, 2008

Fasting on the 17th of Tammuz, pt viii

The previous version of this post got messed up in editing in Blogger, such that certain paragraphs dropped. I'll take this opportunity to revise it as well, with a certain anonymous commenter's comments in mind.

We now turn to discuss the position of Rabbenu Tam, as brought down in Magahot Maimoniot. Click on the image to the right to see it larger.

To translate:
"Rabbenu Tam permitted a yoledet to eat on Tzom Gedaliah, when it was eight days after she had given birth. And even though we say in perek Mefanin {in Shabbos, perek 18} that after seven days {from childbirth}, if she says 'I do not need,' we do not desecrate Shabbos on her behalf, and the fast of Gedaliah has the status of words of the Prophets {Divrei Kabbalah}, and the words of the prophets are like the words of Torah.."
To be continued in a moment. First, though, here is that gemara, Shabbos 129a:
אמרי נהרדעי חיה ג' ז' ול' ג' בין אמרה צריכה אני ובין אמרה לא צריכה אני מחללין עליה את השבת ז' אמרה צריכה אני מחללין עליה את השבת אמרה לא צריכה אני אין מחללין עליה את השבת ל' אפי' אמרה צריכה אני אין מחללין עליה את השבת אבל עושין ע"י ארמאי
The scholars of Nehardea said: A lying-in woman [has three periods: from] three [days after confinement], seven [days], and thirty [days]. From three [days], whether she says, 'I need it' or she says, 'I do not need it,' we desecrate the Sabbath for her. [From] seven [days], if she says 'I need it,' we desecrate the Sabbath for her; if she says, 'I do not need it,' we do not desecrate the Sabbath for her. [From] thirty days, even if she says, 'I need it,' we may not desecrate the Sabbath for her, yet we may do so by means of a gentile. Like Rav Ulla the son of Rabbi Illai, who said: All the requirements of a sick person may be done by means of a gentile on Shabbat, and as Rav Hamnuna, who said: In a matter entailing no danger [to life] {for a sick person}, one bids a gentile and he does it.
And now continuing the preceding. Even though it was Divrei Kabbalah, so how could we desecrate the fast for a woman eight days after birth?
even so, it is permitted, for we say in the first perek of Rosh haShanah that "he called it a fast day and he called it a joy, etc.," until "if they want, they fast and if they want, they do not fast." And therefore it is a reshut, and it is permitted for her to eat. Until here I {=Hagahot Maimoniot} found {in the teshuva from Rabbenu Tam}.

And it seems correct that even pregnant women and nursing women in general, who are in a great deal of pain, that they should be able to eat in all these fasts, with the exception of Tisha BeAv, from the fact that we said that "on Tisha BeAv, pregnant and nursing women fast and finish the fast on it, in the same way that they fast and finish the fast on Yom Kippur." Thus it is clear that the rest of the fasts, which are not so strict, they do not {need to} finish them."

I would note that Hagahot Maimoniyot extends to these two classes of women, and then restricts for Tisha BeAv. But he never explicitly restricted in terms of the yoledet 8 days after, in terms of Tisha BeAv. And indeed, looking at that gemara, she still has the status of a cholah, and if she says she needs it, we would ask a gentile to do a melacha. On the other hand, if he is equating these two to the first

Furthermore, this diyuk which Hagahot Maimoniyot makes from the words of Rava on Pesachim 54b, that Tisha BeAv is like Yom Kippur in terms of fasting and finishing, is his own diyuk. It may indeed make plenty of sense, but we don't know for certain that Rabbenu Tam would agree.

How could we say otherwise? I would simply point out a few points.

1) We see that one can say in the gemara in Rosh HaShanah that even Tisha BeAv is a reshut, but that they still sent messengers since everyone universally fasted, because of the doubling of the tzarot. That does not mean it is not a reshut, just that people did not take advantage of it. See Rambam on peirush haMishnayot, for example.

2) The perek in Pesachim this din appears is called Makom SheNahagu. Perhaps even if it is a reshut on the level of Divrei Kabbalah, since this was the standard practice in these places, to universally fast, this was also the accepted practice in which pregnant and nursing women should fast and finish, just as they did on Yom Kippur.

3) We can read it Rabbenu Tam, and Hagahot Maimoniyot, in two ways:

a) that Rabbenu Tam said that this woman who had given birth should not fast because it was a reshut. If so, it would theoretically apply to any person whatsoever.

b) But alternatively, he did not say that anyone could opt out. He perhaps is holding something like Ramban, or Rosh. That is, on the level of Divrei Kabbalah, as we have seen, it is reshut. However, people accepted it upon themselves (and we can read this into ratzu or into some post-Talmudic imposition). Thus, the average person has the chovah to fast. But vis a vis the Divrei Kabbalah, it is only a reshut. Therefore, one cannot ask from the gemara in Shabbos about being mechalel for a woman eight days after birth, because indeed, there is no such restriction. And in terms of minhag, which this is, Tzom Gedaliah can be overcome for someone who has this status of cholah.

This still would obviously not apply to a pregnant or nursing woman on Tisha BeAv. After all, the gemara itself (Pesachim 54b) states that Rava expounded that pregnant and nursing women fast and finish the fast on Tisha BeAv, just as they do on Yom Kippur. But it is quite possible that a woman 8 days after birth is of sufficient cholah status that it would overcome this, since in terms of the Divrei Kabbalah it only has the status of reshut.

The chiddush of this step would be to reduce the level of cholah required to be able to break the fast. Even without the chiddush, at a specific level of illness, a sick man or woman can break his or her fast. But if what I am suggesting is correct, we can move the threshold for Tisha BeAv to be more in accordance with that of Shiva Asar BeTammuz, even though of course a pregnant or nursing woman would still not be included, as we have that explicit gemara to the contrary.

Though the following are not the words of Rabbenu Tam, I believe this would be an appropriate place to discuss a pesak that was brought up on another blog, Divrei Chaim.
Apparently, Rabbi Nachum Rabinovitch of Yeshivat Ma'aleh Adumim as allowing pregnant (after 5th month) or nursing mother to eat on 9 Av because these women are categorically to be treated as cholos.
An anonymous commenter there questions this rav's right to be called Rabbi, which is an unfortunate trend. I can certainly understand why this pesak is questionable, as it goes against an explicit gemara.

I have not read his teshuva, so I do not know the particulars or his justification. However, I can well imagine what it might be, and while I do not issue pesak on this blog, on a theoretical level I think his position may very well be halachically sound.

Assume as we have assumed above, that even Tisha BeAv is a reshut, within the context of the Divrei Kabbalah. Then the threshold for cholah is lowered, but still does not include pregnant or nursing women. Or alternatively, do not assume as we have assumed above. Then, the threshold is still higher than for other fasts, but there is indeed some level at which we would say that one should not fast -- if it is harmful. Now, Rava was doresh -- that is, he expounded practically, how people should conduct themselves, by taking note of both the halachic principles and the physical metzius.

It could very well be that a pregnant or nursing woman in Rava's day was not considered to be a cholah. It is difficult for them to fast, sure, because they have a baby in their womb and need to eat for two, or have a suckling infant taking fluid out of their body. But in Judaism, just because something is difficult does not mean you do not have to do it. If for some reason, someone had to exert himself, such that fasting would be difficult, he would still presumably have to fast. (Or if they are considered cholot, not necessarily of a serious type.)

We perhaps see this treatment in the words of the Hagahot Maimoniot. He wrote (above):
And it seems correct that even pregnant women and nursing women in general, who are in a great deal of pain, that they should be able to eat in all these fasts, with the exception of Tisha BeAv...
The case before Rabbenu Tam was a woman 8 days after birth, who was a quasi-cholah. But these women, pregnant and nursing, are just going to suffer a lot in keeping the fast. And he would extend it to them, because it is a reshut, after all. But Tisha BeAv has that special exclusion in the gemara, in Rava's statement.

If in the time of the gemara they did not consider pregnant women to be an "invalid" of some sort, such that fasting could have a negative effect on them, that is not generally the case nowadays.

Here I will take pains to be clearer than I was in the previous version of this post. I am arguing here that this approach is halachically sound, rather than halachically correct. (It might be both.) By sound, I mean that one can take a set of axioms and set of ways to derive new facts, and derive the conclusion. But that does not mean that the axioms are correct -- one might argue with the scientific basis, or whether the interpretation of certain sources are the most compelling.

Nowadays, we understand that a woman who is pregnant is not just burdened by having to carry the baby, but there is a developing infant inside. And that that developing infant can be affected by hormonal changes in the mother, stress levels in the mother, nutrition of the mother, and so on. And if Chazal understood this (e.g. see how the manna could not taste like certain foods), we understand it at a better level.

In terms of pregnant women for certain, fasting can have an impact, by causing labor. Indeed, there is a spike in Jewish births immediately after Yom Kippur every year for precisely this reason. And I know of women who went into labor after fasting on Yom Kippur. And Rabbi Nachum Rabinovitch was speaking of pregnant women after the 5th month of pregnancy.

Now perhaps this is true only of women who have reached full term, as the anonymous commenter notes that the study concluded. I am not sure this is the only study on the subject. There are indeed many studies on the impact of fasting on developing infants. Here are a few:

http://64.233.169.104/search?q=cache:UBuubi3SqJAJ:diglib.tums.ac.ir/pub/magmng/pdf/386.pdf+pregnant+woman+fast+study&hl=en&ct=clnk&cd=4&gl=us&client=firefox-a

http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=863768

http://jn.nutrition.org/cgi/content/abstract/133/5/1709S

http://www.ncbi.nlm.nih.gov/pubmed/6643131

http://pt.wkhealth.com/pt/re/ajog/abstract.00000447-200108000-00024.htm;jsessionid=Lp7SLwGZm1VGXQLTG2s3wjN040cjJK3ZtZVFpbTZ2k6dLwqy6XJH!1805002056!181195629!8091!-1

According to the abstract for the third one, from nutrition.org,
"Epidemiological evidence suggests that maternal psychosocial stress, strenuous physical activity and fasting are independent risk factors for preterm birth and low birth weight."
Thus, fasting and stress can cause preterm birth and low birth weight. Other studies might contradict that. Fine. But then we have conflicting studies. Plus, there is the impact on the developing infant.

Ask most physicians nowadays if it is advisable for a pregnant or nursing woman to fast -- without subjecting them to pressure about the religious importance and significance of the fast -- and they will tell you "no". Perhaps this would raise pregnant or nursing women them to the level of cholah, particularly if we agree with the lowered threshold as defined above.

Or perhaps it is due to threat of dehydration, or other such factors that we know more about nowadays.

This may then be a case in which we can claim that the reality has changed (nishtaneh hateva). On a straightforward rendition, we can say that Rava was relying on ancient science, which was incorrect in assessing pregnant and nursing woman. Given a different knowledge of metzius, even Rava would have been doreish otherwise. We can "frum up" this claim as that the women nowadays are weaker than they were in the past, or that babies are different. We see this idea in legitimate halachic sources. Thus, we have some Rishonim (IIRC, Rosh) who discuss that a prohibition on drinking zugos do not apply, because that was only in those times in those geographical locations. And others say similar things as to the prohibition of eating fish with meat due to sakana -- that because of changing circumstance, it does not necessarily apply.

That does not mean that back then, they were acting incorrectly. They were not aware of the potential medical effects of fasting on nursing and pregnant women. And then we could apply "shomer petaim Hashem." But nowadays, it is inappropriate for a pregnant (or nursing) woman to fast on Tisha BeAv, as she is properly classified into the category of cholah.

Such could be, in my opinion, a potentially sound justification for this pesak. But I am not paskening, nor have I seen this pesak inside, so I do not know that it is the justification. And I still have many sources to go through, in order to see how this develops. E.g. how are pregnant or nursing women treated in other contexts, and how Rabbenu Tam's position is interpreted and developed.

11 comments:

Anonymous said...

"If in the time of the gemara they did not consider pregnant women to be an "invalid" of some sort, such that fasting could have a negative effect on them, that is not generally the case nowadays. In terms of pregnant women for certain, fasting can have a negative impact, by causing premature labor. Indeed, there is a spike in Jewish births immediately after Yom Kippur every year for precisely this reason. And I know of women who went into labor after fasting on Yom Kippur. And Rabbi Nachum Rabinovitch was speaking of pregnant women after the 5th month of pregnancy. And ask most physicians nowadays if it is advisable for a pregnant or nursing woman to fast, and they will tell you "no"."

The study DID NOT find a general rise of women going into labor. It only found a rise in women going into labor *if they were already at term.* IOW if they are going to give birth any day. In fact, they found a DECREASE in premature labor for women not a term.

Of course in case of any risk factors for mother or child, of premature labor etc consult with doctors and your rabbi. And take reasonable precautions not to get dehydrated, rest etc.

It would be good if you could correct what you write in the post about what the data show because misinformation about what the study found is not helpful

Anonymous said...

Just to reiterate, in the study you reference about premature labor after fasting, the authors conclude that pregnant women in general do NOT need to refrain from fasting b/c the spike in labor is from woemn who are at term. they do caution that women otherwise at risk for premature labor may have extra risk and of course they should consult with doctor/rav. (I'm assuming that we all presuppose that women with risk factors do such consultation. The question here is whether ALL pregnant women as a rule not fast.)

R Bleich has a piece on fasting and pregnant women in one of his contemporary books. He points out that in the Yerushalayim climate one can get deyhdrated without manifesting the usual symptoms, so extra precautions are necessary. I'm wondering if the reason for these psakim from Israel are due to the climate there, and women getting dehyrated. Esp since many do not have air conditioning. I'd guess that there are precautions one can take to avoid dehydration, but obviously that is something to discuss with rav and doctor

I've read two blogs in which the conclusion was "today we know fasting is risky" based presumably on R Rabinowitzs psak. But that's not what the study concluded.

joshwaxman said...

thanks.
I'll try to correct the post. The point is that *if*, for some reason, they are now in a different status of cholah, this would apply. This is in part why I said it is sound, rather than necessarily correct.

joshwaxman said...

The post is now corrected. I am not sure I agree with what you have said. See above for elaboration.

Kol Tuv,
Josh

Anonymous said...

one of the studies you cite is hypothesizing based on experience with animals

the others that I can access are on ramadan where fasting goes on for a full month (and even so one of them with info in the abstract finds no effect on nursing mothers). I assume that the length of ramadan affects the results esp since the study on jewish women fasting comes accompanied with discussions on how little literature these is on the topic

as opposed to this we have a study done on jewish women fasting.

Anonymous said...

...and i apologize for not taking a pseudonym i did not see your request on top of the comments box when i posted. Ill try to remember in future

joshwaxman said...

Thanks.

So we have *one* study specifically about Jewish women. And just one study means we are standing on shaky ground. Can you give me reference to the specific study, so that we know which we are talking about, and so that I can look it up? Does that study examine impact on fetal development?

Indeed, there are many other studies based on animals, or on women during Ramadan. I don't know the specifics of the studies I linked to above.

While not endorsing (or the opposite) the conclusion about the metzius I would guess this Rav (and apparently Rav Shteif -- see the comment thread at divrei chaim) drew is that it does pose a medical risk. And this could even be in terms of stress to the developing infant and the impact on fetal development. And if a lot of fasting has a major impact, it is possible that the stress of a little fasting can also have an impact.

Or perhaps that it is not the place of laymen to examine and argue the medical literature, but rather to follow what the common medical consensus is.

Regardless, it is not so far-fetched for them to take this position as a legitimate halachic position. Even if you or I do not agree with the conclusion.

Kol Tuv,
Josh

joshwaxman said...

Also, from the third article listed:

"Fasting and the risk of preterm birth. In 1970 Felig and Lynch (106) were the first to study the difference in the metabolic effect of fasting between pregnant and nonpregnant women. A group of women undergoing termination of pregnancy at 16–20 wk fasted for 84 h and were compared with a group of nonpregnant women who also fasted. Pregnant subjects had significantly lower blood sugars as early as 12 h into the fast compared with nonpregnant subjects and mean levels fell to hypoglycemic levels (<2.8 mmol/L [50 mg/100 mL]) by 60 h. In concert with significant lower glucose levels at 12 h, insulin levels were significantly lower and acetoacetate and ß-hydroxybutryrate levels were significantly higher, suggesting early ketosis. This study suggested that pregnant women were vulnerable to heightened ketonemia after a brief period of fasting (12 h). Subsequently Metzger et al. (107) reassessed fasting by studying both lean and obese women who skipped breakfast (12-h fast) and on the next day skipped lunch (18-h fast). By 16 h the pregnant group had significantly lower glucose levels and significantly higher free fatty acids and ß-hydroxybutyrate levels. Both lean or obese women showed similar changes. As a result of these findings they coined the term accelerated starvation. Because of the concern about ketonemia on fetal well-being, these authors suggested the common practice of skipping breakfast whether by personal preference or for doctor-initiated laboratory testing should be avoided during pregnancy."

So we are not dealing with fasts as long as Ramadan, and in one case a fast which is less than tisha beAv, and it is not recommended because of fetal well-being.

Kol Tuv,
Josh

me said...

Regarding the study you clipped -
Do you really believe that if a woman skips breakfast once or twice in the course of her pregnancy, she's damaged the fetus? People are much more resilient than that! Yet you're treating the study you are citing as though if one skips even a single meal for eight hours, who knows what trouble will result?! The idea is not to skip meals REGULARLY not that if you skip a meal once that's it for the baby.

we are dealing with fasting for a single day. A study that recommends not fasting regularly doesnt demonstrate that fasting once will harm the baby

I think the real problem is the baseline assumption - mine is that without clear evidence, shomer psaim hashem kicks in. Every year, whole communities of women fast with no observed ill effect.

"So we have *one* study specifically about Jewish women. And just one study means we are standing on shaky ground. Can you give me reference to the specific study, so that we know which we are talking about, and so that I can look it up? Does that study examine impact on fetal development?"

That's the point. We have one study that doesn't show ill effects of fasting for most women and the authors dont even recommend that most women not fast. ISTR that they do say there should be more studies, but right now where's the evidence that for most women/babies fasting is dangerous to counteract our general experience that it's not and that frum women who fast are not at any observable risk of delivering unhealthy babies?

Doctors recommendations don't mean that much,because they are speculating without much data and are cautious. If we didn't observe that Jewish women routinely fast, we might not recommed it either. No one is recommending that women fast during pregnancy/nursing as a routine matter. But we actually do have experience that most women have been fasting with no ill effect - why should we discount it when the only study done on these women does not indicate cause for alarm for most women?

Anonymous said...

"Regardless, it is not so far-fetched for them to take this position as a legitimate halachic position. Even if you or I do not agree with the conclusion."

I haven't been relating to the teshuva because I havent read it and don't know his reasoning - you write you haven't seen it either. I know R Rabinovich has a reputation for being a big t"c. What I'm questioning is the assumption I see in the blogosphere that today we "know" that fasting is typically dangerous

joshwaxman said...

first off, let me stress again that I am not arguing that one position is correct to the exclusion of the other. If I wanted to, I could argue your side, though possibly a bit differently.

1) regarding that study I cited, that was contained in the third study mentioned above. So I was citing this text to demonstrate that it was not just studies on women fasting for extended periods, such as Ramadan.

furthermore, the idea of not skipping breakfast -- a 12 hour fast -- was part of the recommendations of that study, because that was as early as it *could* set it. They "were vulnerable to heightened ketonemia after a brief period of fasting (12 h)." But a fast on Tisha BeAv is longer than that -- more than 24 hours!

Yes, humans are resilient -- but that does not mean that there cannot be things that impact in ways we do not necessarily realize.

2) "I think the real problem is the baseline assumption - mine is that without clear evidence, shomer psaim hashem kicks in. Every year, whole communities of women fast with no observed ill effect."

I would have to disagree, though you are of course entitled to your opinion. What do you mean "no observed ill effect?" How could you know this? The only way you could know this is if you spun off another universe in which the women did not fast, and compared on a case by case basis to see that no woman had premature labor in our universe, and that the birth weight and fetal development was are the same.

In fact, some portion of women do miscarry or have premature labor. And some infants have problems with development. Are these the result of fasting? I certainly do not know. But you certainly do not know either. However, studies performed on animals as well as on fasting pregnant women can assist in assessing that.

It is a similar issue with metzitza befeh. We have centuries of precedent in which nothing went wrong as a result of it. Or do we? If we did not realize the causality between herpes and this practice, we would not necessarily attribute it to the milah, in the few instances it occurred. And then we would claim precedent that nothing has gone wrong, for all this time.

3)
"That's the point. We have one study that doesn't show ill effects of fasting for most women and the authors dont even recommend that most women not fast. ISTR that they do say there should be more studies, but right now where's the evidence that for most women/babies fasting is dangerous to counteract our general experience that it's not and that frum women who fast are not at any observable risk of delivering unhealthy babies?"

Again, do you recall the name of the study, or the authors? My point about that one study is that it needs to be repeated. There are studies reported in the news all the time - X is bad for you -- then another study that X is good for you. Doctors often do not change practice based on one study. A consensus forms based on a *lot* of studies being performed, and validating previous research. All sorts of things could be attributed to sample size, research set up, confounding factors, etc. So having "one study" does not mean that we should ignore all the other research on this matter.

On the other hand, we have a bunch of other studies that find linkages between fasting and early birth or problems with fetal development. And we have a better picture of what goes on inside a woman during pregnancy than we had in centuries past.

"Doctors recommendations don't mean that much,because they are speculating without much data and are cautious."
Yet the halacha tells us to consult with doctors for assessing risks. And they are speculating based on a *lot* of data -- though much of it is animal studies or studies of people who underwent prolonged fasts. The question is whether to apply it to the case of a single fast.

Rava did not have access to all this data, to know that there was *any* possible risks to the fetus in terms of early birth or stunted development. It may well be that the *possibility* of risk would have been enough to dissuade Rava from ruling like this. And he would have categorized her as a cholah. Chamira sakanta meiIssurah.

And I am no doctor, to assess risks. But I do not believe you are either. And it is perhaps not the place of laymen to decide on such matters. Especially when a cherished religious practice is on the line, such that one can rationalize risks away.

That does not mean I am telling pregnant women not to fast. I am just not convinced that *if* this is the basis for the reasoning, that it is an illegitimate argument. Even though others may well have a legitimate argument in the other direction.

"shomer pesaim hashem" is an interesting topic, but would be a digression. to briefly digress, in general, that line is used in the gemara to explain why we do not *forbid* some activity because of sakana. From my own survey of it, only in one possible instance -- in yevamos about women using a moch -- does it possibly *compel* an activity despite the possible danger. And whether it is "compelling" (which would be strange) or "not forbidding" in that case is subject to a dispute between Rashi and Tosafot. Yet here this rule is being brought to bear to compel fasting, despite the possible risk. I am therefore not so sure it is applicable. But that discussion would be a very big digression.

____


4) As to your second comment -- yes, we really need to see the teshuva to see what he said. From the excerpt I heard -- that these had the status of cholah -- is *seems* that the issue is risk of *something*, but it is indeed conjecture.

Kol Tuv,
Josh

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