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 about flexibility.
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 experience.
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 misconception.
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 family relationship.
Caring For Practicing Jewish Parents
Category Of 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 knees. 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
fully draped. |
| Niddah: laws that define the time of physical separateness between husband and wife. | 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 membrane rupture. |
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 mother. In place of the father, allow the presence of female labor companion, if the
mother desires. |
|
Laws pertaining to food and drink: Kashrut, or kosher laws, govern types of food and methods of food preparation. 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 Sabbath. 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
after childbirth. |
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 necessary. 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 necessary information. Do not ask the mother to fill out forms or sign policies on the Sabbath or a holiday 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 Sabbath.
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| 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 their daughter 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 |