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מכון שלזינגר לחקר הרפואה על פי ההלכה

לידה מוקדמת תוך סיכון האשה במקרה של סיכוי להצלת ולד

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23 באוקטובר 2018

הרב המשיב: הרב ד"ר מרדכי הלפרין

שאלה:

Dear Dr. Halpern:

Due to the clarification of some vital statistics the Sha'alah was delayed. Batsheva has been hospitalized in order to monitor her for the possibility for induced labor. She is 28 weeks pregnant with a small fetus whose development has been somewhat retarded. If she goes to term, then the baby in all likelihood will not live for more than 14 days, because there will no further growth in the womb. If the baby is delivered within the next 12 hours, then a classical (Up-down) c-section must be performed. Even then, there is a 25%-50% chance the baby will not survive and a 20% chance that stage 3 or 4 hemorrhaging to the baby will occur. Such hemmorhaging is serious and in 50% of the cases, fatal.

The crux of the problem is: that if she undergoes this procedure to save the fetus, then this type of c-section will subject her to the potential of rupturing of the womb in subsequent pregnancies. There is a 10% chance that after a classic (up-down) c-section, there will occur a rupturing of the womb, which is unpredictable and if it happens outside of the hospital could be fatal to Batsheva. If tis clear to me that the priority is to save the existing fetus regardless of future consequences. Nevertheless, the opinion of Rabbi Elyashiv would be very meaningful to Batsheva.

P.S. If she goes to term she will not require a classic (Up-down) c-section.

תשובה:

In that case it is clear that Batsheva has no obligation to agree to go through a c-section, and it is recommended for her not to go through it.

According to R. Sh.Z. Auerbach zatsa"l a woman has never an obligation to go through any c-section, even not a regular (transverse) one. (Nishmat Avraham, vol 5 on Y”D, 130:a, p.37)

According to R. Elyashiv a woman has an obligation to go through a regular (transverse) c-section if the fetus is a healthy one. But she has no obligation to go through any c-section, if the fetus has high chance to be disabled or crippled or invalid. Nevertheless it is recommended for her to go through the c-section to save the fetus. (Nishmat Avraham, vol 5 on Y”D, 130:a, p.36)

All the above is when the question is about a regular (transverse) c-section.

But in the above case, when the question is if to perform a classical c-section, which can put the woman in the future in a status of a real pikuach-nefesh (and may put a real question mark on her future ability to have more children) – all agree that there is neither obligation nor recommendation to endanger herself by the c-section. (See Nishmat Avraham, vol 5 on Y”D, 130:a, p.36)

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