Halachic and Hashkafic Q’s & A’s on Infant and Pregnancy Loss
By Rabbi Dr Akiva Tatz
Overview: Outlined in this article are some questions pertaining to infant and pregnancy loss from a Torah perspective. Rabbi Tatz offers halachic and hashkafic answers to these difficult questions and through these answers allows one to find nechama in the face of these tragic times of loss.

With regard to your questions, regarding the loss of a pregnancy.

The first general question is: what is the Torah’s view about a Neifel (stillborn child) “hashkafically”?

A child that has reached the stage of being recognized, in other words, when the pregnancy developed enough that the child has a human form, which is technically speaking, from 40 days on, but in practice when it can actually be recognized as a child. That relationship is ongoing, which means that the child will be part of the family in Techiyas Hameisim and that’s why the child is buried. We also do a Bris Milah on a dead child like that. (In fact, I did one on my own child, we lost a pregnancy at 5 months when we moved to South Africa. A beautiful little baby boy and I did a Bris myself on that child before burying the child). So, there is no question that it’s preparation for Techiyas Hameisim.

What is the parents’ relationship to this child? And any difference between a child that is born and dies vs. miscarriage?

No, there is not really a difference as long as the child is formed enough to be recognizable as a human form, then there’s no real difference when the child does not survive, either before the term of pregnancy or after birth. Anything up to 30 days is basically in the same category.

The Minhag is not to have a marked grave and we do not do Aveilus, because the child is not established in this world, as you probably know. (Without getting into the problematic area of premature babies and exactly which time we count. Do we count 30 days after birth or 30 days after expected date of delivery. That is an interesting side point.)

You might be interested to know that the Mekubalim say that in our generation we have a lot of miscarriages and the reason is that the Gemara in Sanhedrin Perek Chelek says “Mashiach will not come until all the Neshamos have been put into bodies.” And since Mashiach’s time is approaching, many Neshamos that have not been brought down, or not been brought down for another necessary Gilgul, need to come down. And that is one reason that there are many miscarriages now. Even the duration of a pregnancy is enough that a child will have an ongoing existence in Techiyas Hameisim.

We also learn this from Miriam, who said to her father when Amram separated from Yocheved because the boys were being killed. Miriam pointed out to her father: First of all, she accused him of not letting girls come into the world. But the other point that she said to him, that even if they do kill the children – your Mitzva is to produce children. If they are killed, they have a Techiyas Hameisim. In other words, if you withhold children from being born in the world, or being conceived and formed in the world, whether they survive or not, you deprive them of Olam Habah.

And so the most important thing to understand Hashkafically, is that when a child is formed, a Neshama is put into a body. Whether the child is born at term or not born at term, there is an ongoing existence. Which means they will be part of Techiyas Hameisim. That is a very important thing to know.

This is a key to your next set of questions:

Why is there no formal Aveilus?

The reason is twofold: One, the child is not fully established in the physical world yet, so it is not a departure from the world in that sense.

But equally important is that Aveilus is a helping of the Neshama on its journey. The Mitzva of Aveilus is to act in empathy with a Neshama that’s left the world. That’s why it’s so particularly important for mourning of a parent. They helped you and carried you, now you carry them. By the way, that’s why the Dinim of Aveilus are to do the things the Neshama is doing. It cannot appear in the world; your clothes are torn. It is not moving, you sit down. It cannot walk through the world; you have no shoes. These are very deep things. The Nefesh Hachaim explains that a Na’al, which means a shoe, also means to ‘lock’ into the world. Nefesh Hachaim says that the body is the shoe of the Neshama. Just like the Neshama has no body when a person dies, you operate without shoes. It needs a lot more explanation, but that is the key. And therefore, the Mitzva of Aveilus is to carry a Neshama on a journey that it needs.

The Rambam paskens that if a person does not fulfill the Mitzva of Aveilus, they’re guilty of cruelty. You could have helped the Neshama and you didn’t. And therefore, the Mitzva of Aveilus, the key is, apart from all the side benefits like coming to terms psychologically and emotionally. The issue is that you have an obligation to carry the Neshama on a journey and to help it in its transition.

Now, a child that is not born into the world fully and does not live in the world, does not need a Tikkun. They do not need help on their journey. There is no attachment of the world that they need a Tikkun for.

And therefore, there is no Aveilus because it’s not necessary. That is very important to understand.

Why no Kaddish?

No Kaddish, because the essence of Kaddish is to put Kedushah into the world for a spark of Kedushah that has left. So, when a Jewish Neshama is in the world, it adds Kedushah to the world, and when it leaves the world, the world and Klal Yisrael are devoid of that element of Kedushah. You say Kaddish in a Minyan, in Klal Yisrael. Kaddish has nothing to do directly with the dead. Kaddish is a statement of Kedushah that awakens the community to respond, which means there is an active Kedushah in Klal Yisrael. And so when a person leaves the world, there’s a diminishing of Kedushah, we put it back, we replace it, through Kaddish. But this is a child that left the world at that stage, it was a child that was never in the world. It never entered the world fully as a part of Klal Yisrael within the world and therefore there is no Kaddish that needs to be said to replace Kedusha for them.

Yahrtzeit is the same theme – there is no Aliyah that the child goes through for a Tikkun situation after a year and therefore that’s not necessary either.

You do not need to do things L’ilui Nishmas the child, because there’s no Ilui that they need, in this sense of a normal person in the world. It’s customary to do things by all means to commemorate the child. But again, without a name, as according to the Minhag, many do not name the child in such a situation. If there’s no name, there is no Tikkun that’s needed.

And we do not go to the Kever, that’s an old Minhag. Not only do not you go the Kever, the very strong Minhag is that it’s not even noted or marked, and again, that’s not a Tikkun that’s needed.

You will meet the child again at Techiyas Hameisim. But you do not need to go to the Kever and communicate with the Neshamah, that seems to be the reason. There must be more to that, I am not aware of what it is. Possibly, people who know more could answer that question.

Also, the Minhag of adding an additional candle – I’m not aware that that is done.

Giving a name, again, I think that is subject to Minhag. You can ask that question as well.

Are you supposed to include this child in your children or forget about him?

You are not expected to forget about this child, on the contrary, every Neshamah will be real in Techiyas Hameisim. Once a body is united with a Neshamah, it’s an ongoing reality, as we have said. A Neshamah that never comes into the Guf is a potential person but not manifest as a separate identity. Once the Neshamah has been put into a body, that is part of the family, that is your child. There’s no specific awareness that needs to be carried forth. Again, the Neshamah needs no Tikkun, but you can look forward to meeting that child in Techiyas Hameisim.

When does a Neshamah come down? Conception, heartbeat, delivery?

That’s a debate between Rebbe and Antoninus in Perek Chelek and the Maskana there is that the Neshamah comes into the child at conception. It’s a debate there, you can look it up – it’s on Daf ד”צ-ג”צ, in Perek Chelek. The discussion there is: is it at conception or after 40 days. The Maskana in the Gemara is that it is at conception that the Neshamah comes in and at birth the Yetzer Hara comes in. So, heartbeat and delivery are not relevant.
There is an important thing about 40 days after conception when the child achieves a different status there and after that technically ending a pregnancy becomes more Chamur and various other issues as well.

To terminate a pregnancy when necessary for the mother’s health:

As you know, the Mishnah says in Ohalos that when the mother’s life is at risk then the pregnancy needs to be terminated. And that is entirely the correct thing to do.

Physical malformation in a baby – what does it mean Hashkafically?

We no longer have Nevuah to know which physical problems, illnesses, or malformations, what they reflect in the spiritual world. While there is a direct connection and a direct meaning, we do not know what it is in any particular case. Two things we don’t have access to: we don’t know what that connection is anymore, and we don’t know the Tikkun. The Sefer Harefuos has been hidden from us and so we don’t know what those things mean in particular, and we don’t know how to fix them. There is a direct, very specific connection with each part of the body and its pathology, but since Nevuah has left the world, we no longer have access to that connection.

What role does aiyn yisurim b’lo cheit (there is no suffering without sin) play?

Every type of suffering can be a Tikkun and when parents go through this, there is a Tikkun. It does not mean there was a Cheit that caused this, that’s a misunderstanding. Aiyn yisurim b’lo cheit means – all Yisurim in the world is due to the human condition which is deeply intertwined with Cheit. But there is a lot of suffering in the world for other reasons as the Ramchal explains very clearly, a Tzaddik can suffer for the generation, and there are many other reasons for suffering. We don’t know why a particular suffering happens to us, except in very rare circumstances where the connection is very clear. But ordinarily that is the work for a Navi and we don’t have that anymore.

Es asher yehav Hashem yochiach (Hashem gives rebuke / suffering to those He loves)

Again, we don’t know whether it’s a Tochacha (rebuke), or a punishment, or a Tikkun, or suffering for the Dor. Look in Ramchal, he gives 12 reasons why things happen in the world, or listen to my shiur online called “Why things happen.” We don’t know which of it applies in any particular situation.

These are some of the important things. Im Yirtze Hashem, we should know no more sorrow, this should be the last suffering anyone in your family ever goes through. We push on in the world. We build what we need to.

We will be reunited with all the Neshamos in the proper time.

Very best wishes.
Akiva Tatz

Rabbi Dr Akiva Tatz
Rabbi Dr. Akiva Tatz was born in Johannesburg, South Africa. He studied medicine at the University of Witwatersrand. He spent a year in St. Louis, Missouri, as an American Field Service Scholar and subsequently returned there for elective work in internal medicine at Washington University. Rabbi Tatz subsequently moved to Israel where he practised both in hospital and general medicine in Jerusalem, as well as engaging in Yeshiva study. After practising medicine and studying in Yeshiva concurrently for some time, Rabbi Tatz undertook a number of years of Talmudic study and later teaching in Jewish thought and medical ethics in Jerusalem. Rabbi Dr. Tatz founded the Jerusalem Medical Ethics Forum, of which he is Director, for the purpose of teaching and promoting knowledge of Jewish medical ethics internationally. He is the author of the textbook Dangerous Disease and Dangerous Therapy in Jewish Medical Ethics – Principles and Practice. He has written a number of books on the subject of Jewish thought and philosophy: Anatomy of a Search, which documents the process of transition from secular to observant lifestyles among modern Jews, Worldmask, The Thinking Jewish Teenager’s Guide to Life, Living Inspired, Will, Freedom and Destiny, and most recently, As Dawn Ends the Night. Rabbi Tatz is the co-author of Reb Simcha Speaks (with Yaacov Branfman) and Letters to a Buddhist Jew (with David Gottlieb). His work has been translated into Spanish, Russian, French, Portuguese, Italian and Hebrew. He currently lectures on Jewish Thought and Medical Ethics at the Jewish Learning Exchange in London where he has been based for more than 20 years. He is also a regular speaker for Olami.