From MIDWIFERY MATTERS, Issue No.109, Summer 2006
MY FIRST JOB after qualifying as a midwife was at St Mary's, a large teaching
hospital in Manchester. I was based on a mixed antenatal and postnatal ward
which served the clients of two consultants. One of our two consultants appeared
to be favoured by the Orthodox Jewish women and as such we cared for a lot of
these ladies on our ward. I knew absolutely nothing about the Orthodox Jewish
religion or practices and probably made a lot of mistakes, but learned through
trial and (lots of) error what was OK and not OK within midwifery care.
My current post is based in an area where about half my caseload is from the
Orthodox Jewish community. My clients have a choice of place of birth and many
of them stick with the consultant I used to work with at St Mary's and have
their babies there. The consultant they book with is very enlightened when it
comes to induction, caesarean section, breech birth and caring for grand multips
- very important issues to all women, but of particular significance when your
baby's birthday is believed to be pre-ordained and very significant, and when
you hope to have a large family. Others choose a hospital which is geographically
close (a shorter distance to travel on Shabbos - see below), while an increasing
number of women are choosing the Birth Centre at Hope Hospital, where I work
one day a week. Homebirth is very rare but I carry birth equipment with me all
the time as I live very close to the community and would probably be the first
to arrive at an unplanned home birth.
I'm still learning and still probably getting things wrong, but people in the community have been very patient with me and willing to teach. So I'd like to share some of what I have learned with you so that you can try to care for Orthodox Jewish families in a way that is acceptable to them.
Understanding Shabbos (Sabbath)
If I ask my Mum what Sunday was like when she was a little girl, she talks
about not being allowed to do anything enjoyable - no playing outside, no singing
(except hymns), no reading for fun and definitely no working. On a Sunday these
days we can do just about anything, although shops are open for shorter hours.
In a way that's a big shame because when Sunday was different, you had to stay
at home and do stuff with your family. It was traditional to have a meal together
and to play games and talk. So my Mum remembers all the things she was not allowed
to do, but there was a big pay off - a family centred, restful day.
The Jewish Shabbos reminds me of my Mum's old- fashioned Sunday. It lasts from
nightfall on Friday evening to after nightfall on Saturday evening. The timings
change with the lengthening and shortening of days. On Shabbos it is not permitted
to do any work or handle money. So people will not do their ordinary work, cook,
clean, travel by car or public transport or operate machinery. These things
are only permitted in an emergency.
I learned about Shabbos when I was a brand new midwife. The Orthodox Jewish
women didn't phone in to say they were coming if they laboured on a Friday night
or on Saturday - they just came. Their husbands didn't use the buzzer to get
into the ward - they just waited until somebody noticed them. The women would
sleep on the ward with the light on all night if nobody offered to turn it off
for them. They didn't have a bath unless somebody ran the water for them. They
cleaned their babies' bottoms with oil and didn't use nappy cream or nipple
cream until Shabbos was over. The women discharged on a Saturday didn't get
picked up until two hours after dark. It seemed like a big long list of nots
- and some of my colleagues voiced their disapproval of these customs and practices.
Now that I work in the community and have visited Jewish homes during Shabbos,
I have seen how this is a family centred, restful day full of traditions that
remind people of their heritage.
I think I would benefit from a day without my TV, phone, computer, car, cooker and so on - I would relish the time with my family and would appreciate my gadgets so much more when I started to use them again. There is obviously a deeply religious aspect to Shabbos which I can only glimpse, but I understand the special and different nature of this day and I can appreciate that the rules should not be watered down or modified because this could easily lead to the erosion of that special and different nature.
Understanding 'Niddah'
The first time I cared for an Orthodox Jewish woman in labour, I was surprised
that although her husband was present, he did nothing physical to help or support
her in labour. As my experience with members of the community increased, I noticed
that sometimes the men stayed for the birth, sometimes not, but their main job
seemed to be being there and reading, reciting or singing Psalms. Many of the
women brought a labour supporter with them to do the back rubbing, hand holding
and physical support. I now know that this lack of physical contact between
the couple is because a labouring woman is considered to be a niddah from the
onset of labour until she had taken a ritual bath seven days after her lochia
has stopped completely.
This niddah law applies to all uterine bleeding. My Jewish friend explained
that she and her husband would not have any physical contact for the duration
of her period until she had been to the ritual bath. That night would be a new
coming together which they would both be really looking forward to!
Practically, this law means that couples cannot pass items to one another in case accidental physical contact occurs. This kind of contact would also be forbidden between non-married people of the opposite sex. I have found that most of the Orthodox Jewish men are grateful that I appear to understand this law - for example, I put things down on the table for them to pick up. I have to be extra careful not to brush past Orthodox men as I have a rather large bottom and I'm quite clumsy!
Being Separate and Dressing Modestly
The area where my Orthodox Jewish clients live feels very separate from other
parts of the community. They have their own shops, schools, exercise classes,
playgroups, and so on because their customs are not well catered for in the
wider community. I feel very welcome though - the separateness does not feel
exclusive.
The dress code within my local community is very modest, with men wearing traditional
clothes (such as long shiny black jackets, prayer shawls with tassels and hats),
full beards and hair that is long near their ears. The women cover their arms,
have skirts that are below knee, and wear tights or stockings. The women also
cover their hair either with a scarf or a wig - taking this off only in their
husband's presence or when only women are present.
I wear a trouser suit uniform as I believe I have unsightly legs. This is considered immodest, as are my short sleeves which I endeavour to keep covered unless it's really hot, and my uncovered hair - but my clients are used to me and they seem to let me off. I think I'm looked on as a bit of an oddity but word has got about that I mean well and that I understand that I am not modestly dressed. I would dress modestly and appropriately when entering a synagogue or school.
Getting it Wrong
I can now laugh at my mistakes in the early days of working in the community
but I was mortified at the time when I realised what I had done. I reached out
to shake hands with the Orthodox Jewish GP I was going to be working with. I
went over to a man holding his baby and took the baby directly from him causing
all kinds of physical contact. I got little boys and girls mixed up because
the boys wear their hair long (I've learned to check the shoes - girls wear
girly shoes!). I talked to older siblings about the new baby in mummy's tummy
- they don't know there's a baby until he or she comes home from the hospital
so imagine the level of amazement at an unplanned home birth! I'm sure there
were many other mistakes which I have glossed over in my mind. But every time
I get it right I can see how much my knowledge and very minor efforts are appreciated.
It's a wonderful community to work in. The families are traditionally large
so I get to meet my clients over and over again - or their sisters and sisters-in-law.
Word of mouth is important so they know I'm OK and I'm going to try to do all
the right things even if I get it wrong sometimes - but they know I'm willing
to learn! And small acts on my part can be really really useful on Shabbos or
Yom-Tov (festivals) - I have turned off burglar alarms, spread Lansinoh on breastpads,
taken the bulb out of the fridge so it can be opened, collected prescriptions,
run baths, delivered notes to husbands at home that their wives and babies are
OK. It's great to feel useful and to feel welcomed.
I hope this piece helps to explain some of the customs you may observe in Jewish
families. Between communities there will be variation in dress code and how
strictly the laws are observed. As usual, the best approach is to ask what people
need and be willing to learn.
RECOMMENDED READING
The Orthodox Jewish Way of Life for Health Professionals 3rd edition. by Dr
Joseph Spitzer ISBN 0953234312
Updated LW October 3, 2006