What Should Jewish Ritual Practice be
Following a Stillbirth?
Background
The Need for a Specific Response
to Stillbirth
Stillbirth Requires a Ritual
Response Related to Formal Mourning
Ritual Responses to
Stillbirth
Burial/Funeral
Service
Mourning Practices Following
the Burial
Yahrzeit
Conclusion
Bio
Background
The body of halakhah associated with death and mourning is
one of the richest and most admired areas of all Jewish law.
Until recently, however, those who have faced a stillbirth,
the death of a newborn or the loss of a pregnancy have not
had a Jewish way of actively responding to the tragedy.
During the past two decades, there has been an increasing
interest in developing Jewish rituals for dealing with
pregnancy loss and infant death. Traditional rituals are
being applied to these losses and new rituals are being
created.
The Committee on Jewish Law and Standards has undertaken
a process of developing the halakhah in this area. In 1987,
the CJLS approved a teshuvah by Isidoro Aizenberg on
miscarriage; in 1991, it accepted a teshuvah by Debra Reed
Blank on a ritual response to miscarriage; and in 1992, it
adopted my teshuvah on Jewish practices following the death
of an infant who has lived less than thirty-one days. None
of those papers provides a satisfactory response to
stillbirth.
This paper should be read in the context of the teshuvot
referred to above, which contain full discussions of the
halakhic material related to pregnancy loss and neonatal
death. For the purposes of this teshuvah, "stillbirth" will
be defined as the death of the fetus in utero after
the point of viability or during delivery before the
emergence of the head or the majority of the body.
The Need for a Specific Response
to Stillbirth
Why does this loss require a response that is different from
either miscarriage or neonatal death? From the vantage of
traditional halakhah, a fetus is a nafel, not a
legal human being, until its head or the majority of its
body emerges from its mother's body. Prior to that moment,
halakhic mourning practices make no distinction between a
fetus that dies after the onset of labor and an embryo.
Rabbi Blank limits the applicability of her teshuvah on
miscarriage to about twenty weeks. Much of the
medical/therapeutic literature dealing with pregnancy loss
does not make a significant distinction between a stillbirth
and the death of a newborn. In that literature, both losses
are treated as the death of a baby. By the third trimester,
the physical condition of the mother and the emotional state
of the parents are similar in both cases. The mother whose
infant is stillborn must still go through the exertion of
labor and delivery. Afterwards, her body does not discern
that the baby she delivered was not alive. She experiences
the same hormonal changes and physical discomforts as her
body returns to its non-pregnant state.
Psychologically, once a pregnancy reaches the third
trimester, the parents assume that they will have a live
baby. Today, medical technology enables the father and the
mother to "see" their baby through ultrasound imagery (many
carry around a picture of the fetus in utero).
Although the father's connection to the fetus is obviously
quite different from the mother's, he too, quite frequently
"knows" and "interacts" with his baby.
By the third trimester, the community is also involved in
the pregnancy and awaits the arrival of a new baby. If the
fetus dies, no new baby enters this community. This is not a
private or secret happening. This is a public loss.
Stillbirth Requires a Ritual
Response Related to Formal Mourning
Underlying both the teshuvah approved by the CJLS requiring
full mourning for a baby that dies within a month following
birth and this teshuvah on stillbirth is a change in the
halakhic presumption of infant viability. The traditional
makil (lenient) position, which doesn't require
engaging in the obligations of avelut (formal
mourning) for an infant, is based on the presumption that a
significant number of even full-term infants will not
survive the first month. Avelut is considered
d'rabbanan (of rabbinic authority). In case of
safek (doubt) in matters that are
d'rabbanan, we are makil. Given the high
incidence of infant mortality in the past, the viability of
a baby was doubtful until it survived for one month.
Therefore, it became the custom not to require the rituals
of mourning. The rabbis were being compassionate. In times
of high infant mortality, parents might otherwise be
excessively burdened by repeatedly becoming
avelim.
In contrast, burial is considered d'oraita (of
biblical authority). In cases that are d'oraita,
when we deal with a situation which is safek, we
take the mahmir (strict) position. The body of a
fetus has a human form and was a potential life. Therefore,
burial is required. Today, due to improvements in medical
technology, our presumption is that the vast majority of
full-term infants and a significant majority of premature
infants born alive are viable and will survive past the
first month. Therefore, the viability of an infant born
alive is not a safek and we cannot be
makil in avelut when a baby dies. Given
the rarity and shock of stillbirth or infant death today, it
is cruel rather than compassionate not to permit parents to
behave as avelim.
The presumption of viability is critical to the
discussion of stillbirth and neonatal death. So is the
emotional connection of the parents to their child. The
halakhic statement underlying my teshuvah on neonatal death
is that of Mishnah Niddah 5:3: (A one-day-old infant, if it
dies, is considered to its father and mother like a full
bridegroom). Talmud Yerushalmi in Kiddushin 4:11 extends
this to the infant who dies after its head and the majority
of its body emerges and includes the relatives other than
the parents among those who grieve. These statements
recognize the emotional connection of the family with even
the newest of newborns and the appropriateness of applying
the strictures of avelut to the family of a newborn
who dies.
Ritual Responses to
Stillbirth
It is the loss of a potential human life and the significant
effect on the parents and their community that make
stillbirth a religious issue. How can Judaism respond in a
way that is sensitive and halakhically appropriate? We can
apply rituals from the treatment of the holeh (sick
person), the treatment of a dead body, the treatment of an
avel (person mourning one of seven immediate
relatives) and use liturgy creatively and sensitively.
Since stillbirth is related to miscarriage, many of the
recommendations from Rabbi Blank's paper apply. The mother
is a holah in body and soul and the father is
holeh in soul. A mi'sheberah (blessing)
for their recovery should be recited. At some point, when
the mother has recovered physically from the pregnancy,
delivery and possible surgery, she should recite Birkat
Hagomel (thanksgiving for deliverance from danger). The
community must respond by fulfilling its obligation for
bikkur holim (visiting the sick) as described in
Rabbi Blank's paper. In addition, at the proper time, a
visit to the mikvah is recommended. As Rabbi Blank comments,
"In a case where the couple is not accustomed to observing
hilhot taharat hamishpaha [laws of family
purity], the rabbi can take special care in describing
the symbolic merits of such a visit." Some beautiful
tehinot (traditional personal prayers for women)
have been written for the occasion.
Because a stillbirth is significantly different from the
much more common early miscarriage, there is a need to mark
and mourn this potential life that came so close to being
and to respond to the loss and grief of the expectant
parents and their community. Therefore, for a full response
to stillbirth, we turn to the rituals associated with burial
and mourning.
Burial/Funeral
Service
Traditional halakhah already notes the quasi-human status of
this potential life by requiring the burial of the body of a
formed fetus from the end of the fifth month on. The body
should be wrapped in a clean white sheet and placed in a
kosher coffin. Some authorities require circumcision while
others do not mention it. Circumcision need not be done, but
it may be done during the preparation of the body if it
would be of comfort to the parents. No berakhah is recited.
Tohorah (ritual washing) need not be done. Burial
should be in a Jewish cemetery. Often, cemeteries have a
special section for the graves of stillborns and infants.
The stillborn may also be buried in a family plot.
Traditional halakhah does not require any special liturgy
or service. It is, however, around the burial of the body
that we have the opportunity to provide an important ritual
response in the face of a tragedy and a way to begin the
healing. If at all possible, parents and other relatives and
friends should attend the burial. In conversations with
women of all ages who have had a stillbirth, I found that
there was a universal sense of distress that they had not
been participants in the burial of their children, and they
regretted not knowing the exact spot of the graves. It has
been the experience of rabbis who have done funerals for
stillborns that attendance at the burial is larger than
expected. This indicates that family and friends want to
respond to the loss in a Jewish way, and that attending a
funeral is a natural way of confronting tragedy and a first
step in comforting the parents.
The funeral should be held as soon as possible. However,
to enable the mother to attend, the burial may certainly be
delayed until she recovers enough physical strength to be
present at the cemetery. The service would consist of
prayers, psalms and other readings. A liturgy for the
funeral of a stillborn, or infant of any age, is in the
Rabbinical Assembly's new rabbi's manual. In addition, there
are moving liturgies in many of the new books which contain
sections on Jewish women's life cycle. The burial service
for a stillborn should not include tziduk hadin
(the burial prayer). There will be no eulogy, but the rabbi
should speak words of comfort to the family. Keriah
(tearing) may be done, as is the usual custom, either on a
piece of clothing or black ribbon.
Kaddish may or may not be recited, at the discretion of
the rabbi. Some rabbis prefer to limit Kaddish to those very
specific situations when it is an obligation. That does not
include this occasion, since there was no death of a living
person. Other rabbis permit the recitation of Kaddish in
many situations and feel that this loss is close enough to
death to make it an appropriate part of the funeral
liturgy.
The baby should be given a Hebrew name, and that name
should be included in the service. The name might be the one
which the parents had intended to use for their child.
Alternatively, they might choose a name like Menahem or
Nehama, indicating a desire for comfort. Jewish folk
tradition recommends giving the child a name so that the
parents will be able to find their child when they arrive in
Gan Eden. Contemporary therapeutic thought is that giving
the stillborn a name aids the parents in the healing process
and helps to distinguish that child from any other children
of that couple.
At the conclusion of the service, the parents should walk
between two lines of comforters, and the traditional
statement of comfort should be said to them. At some later
time the grave should be marked with a stone that includes
the name chosen by the parents for their child.
Mourning Practices Following
the Burial
A meal of concern should be provided by the community on the
return of the family from the cemetery. The family might
also light a twenty-four-hour yahrzeit candle, or even a
Shabbat candle. In contrast to the traditional seven-day
candle, this candle symbolizes that the potential life of
the baby did not come to fruition.
This paper does not recommend shiva. It is clear that in
the case of a stillbirth, in contrast to a neonatal death,
we do not have a halakhic mandate for shiva. In addition,
rabbis who have adapted the teshuvah on neonatal death to
deal with stillbirths have told me that parents of
stillbirths still prefer a one-day shiva.
In recognition of the fact that we are dealing with a
loss that is not identical with, but is close to, death, we
recommend a one-day yom nihum (day of comfort) to
be observed by both the parents and the community. The
parents should remain at home. The community should be
present and offer comfort. The yom nihum could
include a minyan at the parents' home the evening following
the funeral. The parents may recite Kaddish or some other
prayer or psalm. The rabbi should speak words acknowledging
the loss of the expected baby and instructing the community
in how to treat the parents.
The community's obligation would then revert to the
bikkur holim model. However, the unique nature of
the illness/loss would have been publicly acknowledged. The
parents should not be prohibited from observing some of the
private practices associated with shiva during the remainder
of the week following burial or from reciting Kaddish in a
minyan. Despite the fact that we are not obligating or even
calling the mourning time "shiva," there is a connection
between the seven days of shiva and the seven days following
birth, after which the brit milah or simhat bat would have
been held.
The usefulness of the model based on avelut as a
response to stillbirth is especially important for the
father. Husbands and wives have different experiences of
pregnancy and will experience the loss of the expected baby
in different ways. The father's loss is no less real than
the mother's although its manifestations may be less
physical or obvious. When the father is treated as an
avel, equal to the mother, he is relieved of the
burden of "being strong." He has a specific set of ritual
tasks to do and a specific role through which he can
confront his loss. In addition, family and friends have a
responsibility to be present and to care for him as well as
for the mother.
Pregnancy loss and infant death are associated with an
increased risk of divorce. This is often related to the
inability of the parents to share their grief with each
other or with others. Through these rituals, Judaism
provides a structure for the parents to be supported and
protected from the isolation associated with stillbirth.
Although the stillborn's grandparents will not have the
status of avelim, the public nature of these
rituals is also very important for them. They, too, need
permission to grieve, as well as specific rituals through
which they can help their bereaved children.
As with any death/loss, it is important to remember that
the family is not healed and does not recover after a day or
a week or a month. The family has been irrevocably changed.
The community needs to continue to express its concern and
offer support, as it should for all mourners.
Yahrzeit
The final recommendation is that parents may observe the
yahrzeit of their lost baby. Some have expressed discomfort
with marking the loss, which was not exactly a death, with
the rituals associated with death. Nevertheless, this
anniversary will be noted in any event (most often by a
minor depression or some other type of crisis). Reciting
Kaddish, giving tzedakah and/or lighting a yahrzeit candle
provides a ritual outlet for remembering a tragic event in
the family's past.
When would the yahrzeit of a stillbirth be observed? In
most cases, the exact time of the fetus's death is unknown,
and delivery will be at a later time. When the exact date of
death is unknown, one custom is to observe the date of the
burial as the yahrzeit. Another option when it is impossible
to determine the date of death is for the relative to choose
a day on which to observe the yahrzeit. This seems to be the
most reasonable solution. Some parents might choose to
observe the day when they learned that the fetus would be
stillborn; others might choose the day when the body was
delivered; still others might choose the day of burial.
Since there is no hiyyuv (obligation) associated
with this yahrzeit observance, the parents, and even
siblings who were alive and old enough at the time of the
stillbirth, may mark the anniversary for only the first
year, or for as many years as it is meaningful to them. It
is not morbidity, or an inability to close a sad chapter,
that suggests continuing to mark yahrzeit after the first
year, but rather a ritualized acknowledgment of a fact in
the history of that family.
Conclusion
In the event of a stillbirth, burial in a Jewish cemetery is
required. We strongly recommend a funeral service at the
time of burial attended by family and others. The stillborn
may be named and circumcision can, but need not, be done.
The grave should be marked later.
Following the burial, we recommend a one-day yom
nihum which may include a minyan at which the parents
may recite Kaddish or some other prayer. After the first
day, the parents may observe the practices associated with
shiva b'tzniut (private observances which do not
involve the community). After the yom nihum, the
community should treat the parents as if they were in the
category of holim (those who are ill), visiting
them if it is desired and providing for their physical
needs. The parents may observe yahrzeit.
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Stephanie
Dickstein, assistant dean and director of
admissions for the Rabbinical School, wrote this
responsum. Her practical application of this
teshuvah appears as an appendix in Nina Beth
Cardin's Tears of Sorrow, Seeds of Hope: A Jewish
Spiritual Companion for Infertility and Pregnancy
Loss (Woodstock, VT: Jewish Lights, 1999).
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