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Premature Babies in Halacha
By Rav Ariel Ovadia
The challenge of premature and congenitally ill infants has riddled humanity from the beginning of time, and until as recently as the turn of the 20th century premature babies stood little to no chance to survive. The pages of the Talmud and Poskim are rife with discussions of babies born in the eighth month and prior, or babies who don’t survive past the first month G-d forbid, and their Halachic status regarding Shabbat, Avelut, Pidyon HaBen and more.
It was not until the mid-19th century, that the infant incubator was first developed, based on the incubators used for chicken eggs. Dr. Stephane Tarnier is generally considered to be the father of the incubator (or “isolette” as it is now known), having developed it to attempt to keep premature infants in a Paris maternity ward warm. Dr. Pierre Budin, Dr. Martin Couney and other pioneers followed in his footsteps.
Most early units had little equipment, providing only oxygen and warmth, and relied on careful nursing and observation. In later years, further research allowed technology to play a larger role in the decline of infant mortality. The development of pulmonary surfactant, which facilitates the oxygenation and ventilation of underdeveloped lungs, has been the most important development in neonatology to date.
The development of more and more sophisticated equipment and its successful implementation in NICU (neonatal intensive care units) across the worlds has brought hope to many parents and life to countless otherwise unviable newborns. All the while, modern-day Poskim have grappled with the Halachic implications of this technology.
Son of Eight
The Gemara in Masechet Shabbat[1] states that a baby born on the eighth month of gestation (Ben Shmona) is considered to be a Nefel – unviable fetus – and one may not desecrate Shabbat to perform a Brit Milah on such an infant. Rashi explains that this is because such an infant is considered to already be dead. This status also affects the desecration of Shabbat to save the life of such an infant, sitting Shiva at his passing and Pidyon HaBen. That is the ruling of the Shulhan Aruch.[2]
However, with the introduction of the very first incubator in Paris, by Dr. Stephanie Tarnier in 1880, the Helkat Yo’av[3] argued that such babies should no longer considered to be unviable, and that one should be allowed to desecrate shabbat to save their life as well as perform a Brit Milah on the eighth day.[4] This is the consensus of all modern-day Poskim, including Hacham Ovadia Yosef[5], the Minhat Yitzhak, Yesodey Yeshurun[6] and others. The Shemirat Shabbat K’Hilchata[7] adds in the name of Rav Shlomo Zalman Auerbach that even if the baby is not placed in an incubator – with our medical knowledge and techniques – one can assume the baby has a chance of survival and therefore it is treated in Halacha as a viable infant.
Moment of Birth
The question still persists: when is the moment of real birth in Halacha with regards to infant that needs the incubator to survive? Do we look at the actual birth – coming out into the world from the mother’s womb – or, do we define the baby’s birth as the moment it graduated the incubator and is able to live independently? We can argue that because the incubator is necessary for the premature baby to continue developing, one cannot consider the actual birth as the real moment of birth but rather the preemie’s independence from the incubator. This has various Halachic ramifications: when to count the 8 days for a Brit Milah, when to count for Pidyon HaBen, Bar/Bat Mitzvah, Avelut and more. [Also, there are ramifications for monetary Halacha, as an unborn fetus cannot be given property by a party other than the father[8].]
Rav Yitzchak Ziberstein[9] finds proof in the Gemara in Hullin[10] where the Talmud discusses one who conjoins two animals, and the fetus is transported from one uterus to the other. The Gemara probes whether the second uterus constitutes a continuation of the pregnancy or is the exit from the first uterus considered to be the moment of real birth.
Here too, argues Rav Zilberstein, the Halacha should be dependent on the Gemara’s conclusion in that case, as the incubator can be considered as a “second womb”. However, he draws a distinction between the Gemara in which the fetus was always in a womb, whereas, in the case of an incubator, that baby already came out into the world and is only in need of more intensive care before being fully viable.[11]
Indeed, he continues to cite his father-in-law Rav Elyashiv ztz”l who maintained that the real moment of birth is defined as the time of the actual birth and not when the baby was deemed fit to leave the incubator. He takes this so far that he even considers an infant that never survived outside the incubator, to be considered in the meantime a viable baby – if thirty days have passed from the actual birth – therefore requiring the parents to sit Shiva and obligating the father in Pidyon HaBen.[12]
On the other hand, many other recent Poskim – such as Rav Moshe Feinstein[13], Hacham Ovadia Yosef[14] seem to maintain that the incubator serves as a “continuation” of the pregnancy, and that we must count the days for Pidyon HaBen, Brit Milah, Bar Mitzvah etc. based on the baby’s gaining independence from the NICU.
Some Poskim, such as Rav Moshe Sternbuch[15] and the Rav Shmuel Wosner[16] distinguish between whether the baby at his actual birth was viable but just needed some support from the incubator – in which case the live birth would be the moment of real birth – as opposed to a baby that at the live birth was unviable and the incubator allowed it to reach its full maturity as a fetus, in which case we would wait until the baby graduates the incubator for it to be considered to be “born”.[17]
Conclusion
While according to all Poskim, premature babies in our days are considered viable if the technology is there to support their eventual independent life, there is still a debate whether a preemie’s birth is at the real birth or when the baby leaves the incubator. Rav Elyashiv maintains the real birth is always the Halachic birth, while Hacham Ovadia Yosef and others consider the incubator to be a continuation of the pregnancy. Rav Sternbuch and Rav Wosner say that it depends on the function of the incubator in each particular case. L’Halacha, one should consult with a Posek and a doctor in each specific scenario, and when in doubt be stringent in Torah matters.
[1] קל”ה ע”א
[2] או”ח סי’ של סע’ ז’-ח’, יו”ד סי’ רסו סע’ יא
[3] ח”ב סי’ סב
[4] ובאמת, אף דקי”ל להלכה דמחללים שבת להציל חייב עובר, מ”מ הא מיהת דאינו מכלל וחי בהם כמבו’ בנדה מ”ד ע”ב בן יום אחד הרי הוא כחתן שלם, אולם אם יש לו רק דין עובר, לא מיבעיא לדעת הראשונים דאין מחללים שבת, ומ”מ אף לדידן דקי”ל דמחללים עליו שבת אי”ז מדין וחי בהם אלא מדין חלל עליו שבת אחת כדי שישמור שבתות הרבה.
[5] לוית חן עמ’ קסב, הובא בילקו”י הל’ שבת סי’ שכט וסי’ של
[6] הובאו דבריהם בשמירת שבת כהלכתה ח”א עמ’ תצה הערה כד
[7] שם
[8] כמבואר חושן משפט סי’ ר”י ס”א המזכה לעובר של אחר לא קנה.
[9] תורת היולדת, מוספים וביאורים סי’ עט
[10] ע.
[11] וציין שם גם לדברי התוס’ כתובות ד’ ע”ב ד”ה עד שכתבו דאיבעיא דהגמ’ הדביק שני רחמים היינו אפי’ לא יבא לעולם, וכתב בתורת היולדת דתהיה בזה נפ”מ לדידן, ע”ש. וע”ע שו”ת דעת סופר (חיו”ד סי’ קיד) מש”כ להוכיח מחולין נז: ומה שהשיב עליו בשו”ת לבושי מרדכי (וינקלר או”ח מה’ תליתאה סי’ לה), וע”ע ס’ התלמוד ומדעי התבל (ש”ג עמ’ מז) שהביא ראיה מסוגיא דבכורות נז. במקומנו מפשיטין את המתה ומלבישין את החי.
[12] וע”ע שו”ת באר שרים ח”א סי’ ע”ה, וחלקת יעקב יו”ד סי’ קע”ט
[13] אגרות משה יו”ד ח”ב סי’ קכ”א
[14] יביע אומר ח”ט יו”ד סי’ ל”ז
[15] תשובות והנהגות ח”ג סי’ ש”ל, וע”ש מה שהעלה לחלק בין פדיון למילה, וע”ש עוד ח”ד סי’ רמ”ג
[16] שבט הלוי ח”ט סי’ רכ”ח, הובאו דבריהם בס’ תורת העובר שרגא פרק כב עמ’ תרו, וכן נקט שם המחבר. ובדעת הגרש”ז אוירבאך יעו’ שם אות ח’, ובכמה מקומות שהביא שם משמו.
[17] ועיין עוד בשבט הלוי ח”ג סי’ קמ”ג בעניין אבילות על עובר כזה רח”ל