Notwithstanding the proliferation of halachah hotlines, it is getting harder and harder to get hold of a rav or posek during a critical time. One very common question that comes up for couples involves the induction of labor (as opposed to waiting for labor to occur naturally) through a drug called Pitocin administered in the labor and delivery room. Pitocin is a synthetic version of Oxytocin, believed to be the body’s own labor-stimulating hormone.
Inducing labor with Pitocin involves delivery of the drug through an IV in the patient’s arm. The nurse gradually raises the level of Pitocin until there are regular contractions.
But what are the halachic parameters as to when one may induce labor?
Rav Moshe Feinstein, zt’l, writes in Igros Moshe (Y.D. Vol. II #94) that one should not induce labor unless it is medically indicated. One reason is that a person should wait for Hashem to bring the baby at its proper time. If there exists a concern for the welfare of either the baby or the mother, both Dayan Vozner, zt’l, (Shevet HaLevi Y.D. Vol. VI #128) and Rav Ovadia Yosef (Taharas HaBayis Vol. II p. 54) rule that one may induce.
The Three Keys
The idea of not precipitating the birth earlier is based upon a Gemara in tractate Ta’anis 2a. The Gemara states that there are three keys that Hashem handles directly and not through an angel. Those are birth, rain, and techiyas ha’meisim. Tosfos in Niddah 16b states that there is no malach that is appointed over the timing of the birth. Since it is Hashem Himself Who oversees it, there is greater reason to avoid hastening an earlier birth. This reasoning, however, should never be employed when there can be any danger to the mother or child. The Torah tells us “v’chai ba’hem — and you shall live by them and not die by them.”
Even in the secular world there is the idea of “if it ain’t broke, don’t fix it.” Unless an induction is medically necessary, many people (and clinicians, both doctors and midwives) prefer to let nature take its course.
So what might be the medical necessities that warrant early induction? One should never rely on print or internet articles for one’s halachic rulings. But it is a good idea to become familiar with these issues and to speak to one’s rav or posek for guidance as to these parameters.
From a medical point of view (but check with your provider), any risk of polyhydramnios, preeclampsia, fetal growth restriction, diabetes, and other birth complications would warrant induction.
Rochel Lieberman of South Shore Midwives, one of the leading practitioners of midwifery in Five Towns and Long Island, tells the Five Towns Jewish Times, “ACOG now recommends that pregnancies of women age 40 and above should not go past 40 weeks, which is how the initial due date is calculated, and therefore that might also warrant an induction of labor. If the water breaks but labor has not yet started, if the woman is more than two weeks overdue, or if the labor has stalled or stopped midway, then it is likely that the doctor or midwife may introduce the drug.”
It should be noted that natural means of inducing earlier labor are permitted. This includes walking during pre-labor, use of homeopathic remedies, or other natural types of stimulation. The Steipler Gaon would advise people of this.
Rochel Lieberman advises that this should not be done for the general convenience of the doctor or midwife, nor to get a tax benefit of a December 31st birth. It should also not be done to be able to watch the Super Bowl or in order to have the baby featured as the first child born in that secular year.
But what if the more experienced provider is about to leave the hospital and someone else is scheduled to take over? Some poskim only permit the induction when it is considered a higher-risk pregnancy. If it is not high risk then they do not permit it (See Rav Yitzchok Zilberstein in Toras HaYoledes 1:1–2) unless the mother is connected to and/or set upon the first doctor. Others are more lenient (see Sefer Pu’ah p. 64 citing Rav Shlomo Fisher, brother of Dayan Fisher, zt’l).
What if the current provider is kind of droopy-eyed and seems to be getting tired? Rav Zilberstein permits being induced only when there is no other clinician who can take over.
If the woman is nervous because of the particularly youthful appearance of the second doctor or midwife, it seems to this author that it would be permitted as well. This is based on the idea that one is permitted to violate Shabbos in the case of active labor in order to appease the woman in active labor.
It should be noted that one does not have to wait until there is a clear and present danger. Even if there is a significant chance of danger then one may clearly introduce the Pitocin. It should be noted that Pitocin is usually not the first-line drug given. There are other medications that first help prepare the body for delivery. They are introduced through a different route, and their mechanism of action is also different. These medications are usually used to prepare the woman’s body so that Pitocin can then be administered, making for a more successful overall induction of labor.
There are a number of benefits to the use of Pitocin when used judiciously, advises Rochel Lieberman. It seems to reduce the risk of a C-section delivery, because it increases the chances of having a normal birth, according to a study published in the Canadian Medical Association Journal.
There are also some risks involved with a Pitocin induction. There is greater risk of infection, as well as overstimulation and/or rupture of the uterus. There is also the risk of fetal distress and/or a drop in the fetal heart rate. That is why the mother and baby must be strictly monitored during the duration of the induction.
There is also the rule that the woman being induced is not allowed to eat. This is because of the risk of aspiration under anesthesia in an emergency cesarean delivery. Pitocin contractions are also stronger, last longer, and are often more challenging to endure, and could interfere with rest.
As mentioned earlier, one should consult with one’s posek and rav prior to the actual labor so that the guidelines are clear. May all those who are expecting deliver b’sha’ah tovah u’mutzlachas.
Rabbi Hoffman can be reached at Yairhoffman2@gmail.com.