Breastfeeding and Judaism, part II: fasting and menstruation

Welcome to part II in the Breastfeeding and Judaism series. Click here for part I, introduction and religious roots.

Fasting

As in some other religions, there are a number of fast days for Jewish people. There are several major fast days, such as Yom Kippur (the Day of Atonement, which is part of the Jewish New Year, in the autumn) and Tisha B’Av (a day of mourning), and also a bunch of minor fast days. Fasting means abstaining from both food and drink, unlike in some other religions, where drinking is allowed. It is a general expectation (a halachic, or religious, obligation) that everyone will fast, unless there is a medical reason. However, the people I spoke to noted that in actual fact, there is some flexibility around this. 

Some recommended that a pregnant or breastfeeding woman speak to her rabbi, doctor or lactation consultant about her individual situation; medical opinion is mixed about what could happen to the foetus if you fast during pregnancy and of course milk supply might decrease. In an academic piece by Maharat Ruth Balinsky Friedman (Maharat is her title, as she is ordained), she writes that pregnant or breastfeeding women who feel a “craving” do not have to fast, although it is very unclear what counts as a craving in this context. Friedman suggests asking pregnant or lactating women what they themselves want to do about fasting and then finding a solution or plan that works for them, while not endangering their health or their baby’s health.

Modern Orthodox, feminist Rabbanit Leah Sarna (Rabbanit is her title because she is ordained) said that, “Yom Kippur is one of the most important parts of our religious practice” and requires 25 hours of fasting from food and drink. If a woman fasts for 25 hours, her supply may dip and she might need to give her baby pumped milk or formula. Leah told me, “A huge number of women do a modified fast.” Such a modified fast would include “one cheekful (half a mouthful) of liquid every nine minutes (or one fl oz of solids),” to ensure they kept up their supply and could take care of their baby.

A number of people referenced the concept of “pikuach nefesh”, where saving a human life takes precedence over anything else, even if one has to break religious or other laws. It is considered that if a woman feels she needs to eat or drink in order to best care for herself and/or her baby, then that is what is most important. The Talmud, which is the book that describes Jewish law, includes the concept, “Whoever saves a single life is considered by scripture to have saved the whole world.” Each life truly matters. So if a woman needs to eat so her breastmilk supply doesn’t decrease or so she doesn’t feel unwell, then this matters more than fasting on a particular day. Hannah Katsman, the IBCLC in Israel quoted earlier, told me, “rulings that obligate a mother to fast for as long as she can, and only to break her fast once the baby has shown distress, have caused a lot of grief and ended many nursing relationships. The Chazon Ish has a ruling stating that babies shouldn’t get formula if it might upset their stomach, and that avoiding this situation is considered pikuach nefesh. That is a ruling that shows sensitivity to babies. Fortunately more and more rabbis are ruling more leniently regarding fasting.”

Shoshana Pritzker, a registered dietitian nutritionist and a Jewish, breastfeeding mother in the US, wrote the following to me: “Breastfeeding is highly demanding on the body when it comes to calorie needs and hydration of the mother. Moms need an additional 700 calories per day when breastfeeding. That’s 700 calories OVER their daily required calorie intake. So if your body needs 1800 calories per day, you now need to eat 2500 calories per day to provide sufficient calories to produce milk and provide ample nutrients for yourself. If you are breastfeeding twins or more than one child at a time, you need an additional 1000 calories per day. When fasting your body ends up in a deficit and utilizes stored body fat and muscle to keep you alive. If you’re breastfeeding, your body is going to use a lot more of your stored energy sources (fat and muscle) to continue production. Studies have shown that during a short fast, milk supply will not decrease; however, nutritional status of the mother will suffer and essential minerals found in breastmilk are reduced. Plus, mom is at risk for vitamin and mineral deficiencies and dehydration. During a fast, your body will make sure baby is getting what they need (whether pregnant or breastfeeding); however, it’s at the expense of the mother.” She suggests that Jewish women who are pregnant or breastfeeding and who want to fast first talk to their doctors or lactation consultants and also ensure that they drink at least one glass of water an hour. Some people do experience a drop in supply, but Shoshana felt it didn’t happen to everyone and said mothers shouldn’t worry about it. “Less stress is best!” she said.

Some women do like to fast on the Jewish holidays. Meira E. Schneider-Atik, a mother of three, told me, “I breastfed all three of my children and I loved it. It was good for me and for them. I fasted on Yom Kippur and Tisha B’Av with no issues even while pregnant and nursing. My doctor and my rabbi worked together with me and we came up with a plan that allowed me to fast. I prepared and hydrated beforehand and I stayed home from shul and rested. My husband was a huge help (he always is).”

Not everyone feels able to do this. Shoshana concluded, “If you experience mom guilt over not fasting during Jewish holidays, remember that Jewish law exempts anyone whose health may even be slightly harmed by it, and that includes pregnant and nursing mothers.” Clearly, fasting, as with much else in Judaism, will vary depending on a woman’s level of religiosity and the support she receives from her rabbi, physician, spouse and community.

Menstruation

For many people, one of the benefits of breastfeeding is lactational amenorrhea, where you do not get your period. This is generally useful as a way of preventing another pregnancy too soon, if you are in a opposite-sex relationship (you can, however, still ovulate, so it isn’t fail-safe). For religious Jewish women, the time spent without menstruating has additional positive outcomes. The key point here is that lactational amenorrhea allows for a couple to have more physical contact, because menstruation forces a separation between spouses. 

Rachel Neve Midbar, a Jewish mother of six children and a PhD student who specialises in menstrual poetry, talked to me about Jewish family purity laws and the connection to breastfeeding. For religious Jews, there is a ritual bath, which is called a mikvah (it is either a natural body of water or a human-made body of water that has to contain a certain percentage of natural water in it). One of the purposes of the mikvah is to separate life from death; if someone touches blood or death, they must clean themselves ritually. This could be if they killed a fly or if they visited a graveyard, for instance; they must then go to the mikvah to divest themselves of the link to death.

When a woman menstruates, Rachel explained, it is considered that she is touching death, because the egg, which once had the possibility of life, is now dead. So Jewish law states that when a woman is done menstruating, she must wait until absolutely no more blood comes (she can test this by inserting a white cloth inside herself and she can show it to her rabbi, if she feels she needs an outside opinion), then seven days later she goes to the mikvah to separate herself from her menstruant status. She enters the mikvah, recites prayers, and then is ritually cleaned. 

When a religious woman is “niddah”, or experiencing a discharge of blood, she is not supposed to touch her husband, sleep in the same bed as him, or even pass him anything. This means that for around two weeks per month, a married couple have to keep their distance from one another. For some couples, this might be a challenge. So exclusive breastfeeding and the concomitant lactational amenorrhea extends the time without blood and without the enforced separation, and allows the closeness that some people might prefer to have. (We can note that some people might like having less physical contact and instead prefer to rely on emotional and verbal connections.) 

Rachel emphasised to me that these rules are “not about cleanliness but about ritual purity,” and about separating life from death. So a menstruating woman (or a woman who has lochia after birth) is not dirty or impure but rather considered to be touching death. However, I must point out that not everyone agrees with Rachel’s interpretation (remember what I said about Jews loving to discuss and argue?). Other people I spoke to felt that a woman was in fact “impure” while menstruating, and that being close to death had nothing to do with all this. One reminded me that the mikvah is used in other circumstances, to purify the person, such as before marriage, or at conversion, or before prayer, and so on. 

While there is much more to be said about this, the most important part to understand is that breastfeeding not only can extend time between children, which could be beneficial in a community that often has quite a few children, but also allows for more connection between spouses.