Calling a midwife, ambulance, or driving to the hospital:

A. From what stage of labor:[1]

One may call the midwife on Shabbos to care for a woman during labor even if she has not yet reached the stages of labor described above, once she believes that she is entering labor for giving birth. This applies, even if she is a mere doubt as to her labor and as to whether birth is imminent. [Accordingly, from the time one suspects his wife needs to give birth, even if she has not yet reached the Halachic state of a Yoledes, one may call an ambulance or drive her to the hospital.[2] Certainly, if her water has broken, then they may travel to the hospital and are not to wait until the leave of Shabbos.[3] Likewise, upon having even pre-labor contractions of every 15 minutes, she may travel to the hospital even though it is prior to her reaching the status of a Yoledes through entering active labor.[4] Likewise, if there is any reason to suspect for a medical emergency, one should immediately travel to the hospital.[5]]

 

B. Q&A regarding calling an ambulance:

May one call an ambulance to give birth in the hospital even in the event that there is a midwife available for a homebirth to be performed without desecrating Shabbos?[6]

Yes, even in such a case one may [and at times should] call an ambulance to give birth in the hospital.[7]

What’s Halachically better, to drive to the hospital oneself or to call an ambulance?[8]

Emergency: In all cases of emergency that medical assistance is immediately required even prior to reaching the hospital then obviously an ambulance is to be taken.

Non-Emergency: If the matter is not this urgent then it is better for a religious Jew to drive the patient to the hospital rather than call an ambulance.[9] [However, if one knows that the driver is a gentile, then it is better to call an ambulance then to drive oneself.[10] Likewise, if one will not be able to beware from all the unnecessary matters of Shabbos desecration involved in the driving, then it is better to take a taxi or ambulance.[11] Thus, for example, if one will be forced into parking his car and turning off the engine upon arrival at the hospital, which contains no allowance of Pikuach Nefesh, then it is better to take an ambulance.] If no religious Jew is available to drive then it is better to call an ambulance then have a non-religious Jew [i.e. taxi driver] do the driving.[12]

Should one ask a neighbor to drive the patient to the hospital rather than call an ambulance?[13]

One is not obligated to ask his neighbor to drive the patient to the hospital if his neighbor is currently sleeping or if by doing so his neighbor will end up being stuck away from his family for Shabbos.

Must one drive his neighbor to the hospital in order to prevent an ambulance from being called?[14]

One is not obligated to drive the patient to the hospital if by doing so he will end up being stuck away from his family for Shabbos. Nevertheless, as a meticulous act of kindness and sanctification of G-d’s name it is best for one to help diminish as much desecration as possible.

C. Q&A regarding calling a taxi:[15]

One who calls a taxi to take his wife to the hospital for her to give birth, should ideally prepare the money to pay the taxi driver from before Shabbos. If one did not do so, then he should ask the driver if he is willing to accept payment after Shabbos. If there is time, one should ask the Gentile driver to open the doors of the taxi on one’s behalf.

D. Q&A regarding accompanying the Yoledes to the hospital:

May a relative or friend accompany the Yoledes to the hospital?[16]

Any relative or friend who will help the Yoledes keep calm may travel with her. This applies even if there are other people in the car, such as a medic or EMT, and even if the Yoledes says that he/she does not need the escort of the relative or friend.[17] [However care must be taken to avoid Chilul Shabbos in the process, such as not to carry items with him/her if there is no Eiruv.] However, there are Poskim[18] who are less lenient and only allow an escort in a case that the Yoledes is asking for one. Others[19] allow it in the following cases: a) A first birth even if she says she does not need an escort. b) A 2nd birth and onwards so long as she does not say that she does not need it. c) Even if she says she does not need it by a 2nd birth and on, but she will be left in the ambulance in the care of gentiles. Thus, only if it is her 2nd or subsequent birth, and there is a Jewish driver or Medic with her, and she says that she does not need an escort should a friend or relative refrain from escorting her. 

May more than one person accompany the Yoledes to the hospital, such as her mother and husband?[20]

Seemingly this would depend on how badly the Yoledes wants their company, and for what reason, and if any Shabbos desecration will take place by the person accompanying the Yoledes [i.e. gentile driver within Techum Shabbos etc]. If no Shabbos desecration will take place, then it is permitted to be done.[21]

Having a doula accompany the Yoeldes to the hospital:[22]

It is permitted to have a doula accompany the Yoeldes to the hospital if the matter is very pressing for the Yoeldes, as she will feel anxious giving birth without her help and support. One may even desecrate Shabbos for this purpose and may thus call the Doula on Shabbos in order to inform her to come. If, however, the Yoledes does not see the service of the doula as necessary for her calmness and serenity, then she should not desecrate Shabbos in a biblical way in order to come to the hospital. However, if going to the hospital only involves rabbinical prohibitions then she may go.

If on Shabbos one traveled to a hospital outside of Techum Shabbos as an escort for a Yoledes, may he/she walk out of the hospital?[23]

Yes.[24] One may walk within 2000 cubits from his destination. If he arrived in a city, he has the same Techum as do the city inhabitants.

E. Q&A regarding traveling to the hospital:

May one travel to a hospital of their choice or must it be the closest available hospital?[25]

One may travel to whichever hospital he/she feels that they will receive the best medical treatment or care, irrelevant of the distance. However, one may not travel to a more distanced hospital simply to save money.

 

When traveling to the hospital on Shabbos what items may one bring with him?[26]

All items which the Yoledes will need for the actual birth, even if it is merely to help her feel relaxed and calm, may be brought in all cases.[27] All other items may only be brought if:

1. The item is not Muktzah and,
2. One is traveling within the city [i.e. within Techum Shabbos] and,
3. There is an Eiruv in the city and,
4. The item is needed on Shabbos.

If one prepared their bag before Shabbos with items that may not be brought, must they remove these items on Shabbos prior to leaving?[28]

If there is no time to do so, such as that the Yoledes must immediately go to the hospital, then there is no need to clear the bag. If, however, time does remain then the Muktzah and other unnecessary item are to be shaken out.

 

If one is traveling outside of Techum Shabbos must the escorts diminish in the amount of clothing they wear? Such as may the husband take his hat, gartel, kapata?

No.[29]

Advice to be able to carry items out of Techum:[30] Those traveling on Shabbos and Yom Tov to a hospital that is outside of the Techum may only bring with them items that are of absolute necessity for the birth, as explained above. If, however, one makes the item Hefker before Shabbos/Yom Tov, then it is permitted to bring the item outside of the Techum. Hence, it is advised that the wife and escort make Hefker all items that they desire to bring with them to the hospital [and are not needed for the actual birth]. Initially, the items are to be made Hefker in front of three people. If this is not possible, it is to be made Hefker even amongst oneself.

F. Desecrating Shabbos to arrange for a babysitter:[31]

If the couple have only small children at home, then they should make arrangements prior to Shabbos for an adult to take care of them in the event that they must travel to the hospital on Shabbos. If one did not do so, then one may even desecrate Shabbos for the sake of arranging for a babysitter on Shabbos, if the children are too young or scared to stay alone at home.

________________________________________________________________

[1] Admur 330:3 “However, to call a midwife from place to place which is a matter which takes time and delay is permitted to be done prior to this [i.e. to her reaching the above mentioned state of a Yoledes] from the time that she feels a little [need to give birth], even if she is in doubt.”; Michaber 330:1; Taz 330:2; Nitei Gavriel 58; See Kinyan Torah 5:27;  Toras Hayoledes Chapter 30; Piskeiy Teshuvos 330:3 footnotes 32-36

[2] See Toras Hayoledes Chapter 3; Piskeiy Teshuvos ibid

[3] Nitei Gavriel 58:1; Toras Hayoledes 3 p. 51; Piskeiy Teshuvos ibid

[4] See Toras Hayoledes 3 p. 50-51

[5]  See Toras Hayoledes 3 p. 51-54 in length for various cases of Sakana

[6] See Toras Hayoledes Chapter 7

[7] The reason: Being that in today’s times hospitals are more equipped for births and the various possible complications associated with birth, than is a home birth with the assistance of a midwife. Likewise, many more Shabbos desecrations may need to take place by a homebirth verses in a hospital [Toras Hayoeldes ibid] However, in previous times where there was no advantage of giving birth in a hospital versus at home with a midwife, then some Poskim ruled that one may not desecrate Shabbos for the sake of giving birth in the hospital. [Ketzos Hashulchan 140]

[8] Piskeiy Teshuvos 328:12; See Toras Hayoledes Chapter 10:1; 20-21, 24

[9] The reason: As by doing so one diminishes in the transgression of making the phone call, as well as the ambulance drivers usually are not careful in matters of desecration of Shabbos which are not needed, such as driving back to the station, while a religious driver will be. [Now, although the Ketzos Hashulchan 140: footnote 3 rules the opposite that it is better to take an ambulance then to have one drive, this was only because back then the cars would drive back home, which was forbidden, while the ambulances would drive back to their station which was permitted due to that they need to be on call. However today even the Ketzos Hashulchan would agree that it is better for a religious Jew to drive as the religious driver will not drive back home. Thus, there is desecration of Shabbos being saved.]

Matters to beware upon driving to the hospital: See Toras Hayoledes Chapter 20 for laws relating to the turning on of lights in car upon opening the door; Chapter 21 for details relating to 1) carrying the keys; 2) taking a  phone; 3) opening and closing the doors; 4) placing on seat belt; 5) Turning on lights 6) Turning on air in car; 7) How to drive with a Shinuiy; 8) How to drive, pace and breaks; 9) Turning of the engine upon arrival.

[10] Piskeiy Teshuvos 328:13 and Toras Hayoledes ibid

Opinion of Admur: Tzaruch Iyun if according to Admur who rules that a Jew is to do the desecration over a gentile, if this applies even in this case [that a Jew should do the driving rather than call a gentile ambulance] being that here people will simply think that the gentile ambulance was contacted not because that a Jew cannot do the driving but rather because it is an emergency, and there is thus no longer a worry that people may come to think that the Jew cannot drive. Furthermore, it is evident to all that the Jew had to call the gentile ambulance and it is thus evident to all that a Jew may desecrate Shabbos to save a life. Thus, it seems clear that in a case that a gentile ambulance driver is available he should be contacted rather than have a religious Jew drive to the hospital, being that although one adds in the phone call he nevertheless diminishes the entire transgression of driving. To note that so rules Piskeiy Teshuvos 328:13 and Toras Hayoledes ibid

[11] See previous footnotes!

[12] As he will do extra Shabbos transgressions unnecessarily; See Toras Hayoledes 13:8-9

[13] Piskeiy Teshuvos 328:13; SSH”K 40:72; Toras Hayoledes 10:2

[14] Piskeiy Teshuvos 328:13; SSH”K 40:72

[15] See Nitei Gavriel 58:4, 5-7, 14, 15; Toras Hayoledes Chapter 24

[16] See Ketzos Hashulchan 140:3; Igros Moshe 1:132; 141; Piskeiy Teshuvos 330:1 footnote 3; Nitei Gavriel 58:8-10; Toras Hayoledes chapter 14

[17] Koveitz Igros Chazon Ish 141; Az Nidbaru 1:29; Beir Moshe 6 Kuntrus Elektry 51; Nachalas Meir 16; Toras Hayoledes p. 80

[18] So is implied from Igros Moshe 1:132

[19] Teshuvos Vehanhagos 2:177

[20] See Nitei Gavriel 58:9; Piskeiy Teshuvos 330:1

[21] Kinyan Torah 4:38; Igros Moshe ibid

[22] See Toras Hayoledes 35:26; Piskeiy Teshuvos 330:1 footnote 5

[23] Based on 407:1; See Toras Hayoledes Chapter 29

[24] As this is similar to a midwife which has traveled to help a woman give birth. Likewise, the escorts are also considered to have traveled due to Pikuach Nefesh. Now although in 405:5 Admur rules that “when one left the Techum due to Ones then if there is a Kosher Eiruv in the city one may walk anywhere in the city. If there isn’t a Kosher Eiruv in the city, then one may not leave the hospital building for any purpose.” Nevertheless, in a case that one left to help save a life the Sages did not limit them to their 4 cubits even if there is no Eiruv in the city.

[25] SSH”K 32 footnote 17-109; Piskeiy Teshuvos 330:1; Nitei Gavriel 58:18-19; Toras Hayoledes 7:1-7 [see there for various scenarios]; See Kaf Hachaim 330:3

[26] See Nitei Gavriel 58:11; Toras Hayoledes 2:29-31; 14:5; 17; Piskeiy Teshuvos 330:1 footnote 2

[27] Minchas Yitzchak 8:30; Shraga Hameir 4:30; Shevet Halevi 3:92

[28] See Nitei Gavriel 58:12-13; Toras Hayoledes 18

[29] Tzchebiner Rav answer to Rav Gerelick of Kfar Chabad [brought in Yagdil Torah Tzemach Tzedek]; Toras Hayoledes p. 32

[30] See Toras Hayoledes 2:30; See Admur 246:9; Kuntrus Achron 445:1

[31] See Nitei Gavriel 58:16-17; Toras Hayoledes 2:46; 12; Piskeiy Teshuvos 328:30; 330:1 footnote 13