Editor's Note: The medical guidelines in this article are those of Israeli medical authorities and the guidelines pertaining to Jewish law were endorsed by a competent rabbi. These are, however, only intended as general guidelines and it is advisable that a woman consult with her own doctor and rabbi regarding her specific situation.

There is only one reason why any healthcare professional or rabbinic authority would endorse a pregnant woman to go without food or drink for any length of time throughout her pregnancy: because G‑d said so. It's as simple as that.

There are several days in the Jewish calendar when G‑d asks us to put the needs of our bodies on the side and commands the Jewish people as a whole to fast. Yes, even pregnant Jewish people. The "major" fast days are Yom Kippur and the Ninth of Av.

Barring any specific medical conditions, some good planning and some practical coping techniques will allow most women in a low-risk pregnancy to manage a twenty-five hour fast without any complications to the pregnancy or risk to their babies. As we approach Yom Kippur, here's a list of the top ten fasting tips and guidelines I've gleaned over my years as a childbirth professional and as a woman who has successfully survived my share of major fast days while pregnant. It should also be noted that the majority of pregnant women have fasted successfully throughout the years so while one should take precautions, a healthy, pregnant woman should not be worried about fasting.

1. Have a chat with your physical doctor and your spiritual doctor (your rabbi) before the fast.

Consult your doctor or midwife before the fast to make sure that you are healthy enough to fast. If there is a pre-existing threat of miscarriage or preterm labor, chances are that G‑d may want you to alter your service this time around. Find out from your healthcare provider if you fall into the category of a low or a high risk pregnancy. A high risk pregnancy places the woman and her developing baby into a different category in Jewish law. So, the first step is to know who you are. (See #9 for a list of common definitions of high risk pregnancies and danger signs.)

With the exception of healthcare professionals well versed in Torah-law, the likelihood of a flat out endorsement to fast from a OBGyn or midwife is unlikely, so in tandem with your doctor's approval you will need a Rabbinical authority to help give you guidelines for fasting and/or breaking the fast. It is not your job to find harmony between your doctor's orders and "The Doctor of all Doctor's orders." That's where the rabbi comes in. Present your rabbi with the information about your specific situation and let him hammer out the details for you.

2. Understand the purpose of the day.

Every Jewish holiday has a specific mitzvah it is associated with. Some holidays have several. The main mitzvah on Yom Kippur is fasting. Then there are the other aspects: Praying is wonderful, praying like you mean it even better, going to synagogue, hearing Kol Nidrei, and listening to the rabbi's hallowed speech are all amazing and important features to this auspicious day. But none of those are on par with the mitzvah of fasting. Even if you don't pick up a machzor (High Holiday prayer book) the entire day, and all you can muster in terms of prayer is "G‑d, help me get through this" but you do fast, then you have fulfilled your obligation on Yom Kippur.

It may not sound as spiritual as standing in synagogue and praying in rhythm with the community, but our role as mothers change us, our service shifts. A pregnant woman should do everything she can to make herself as comfortable as possible, minimizing the non-vital aspects of the day, in order to allow herself the opportunity to fast as safely as possible on Yom Kippur.

3. Ease off the caffeine train.

The truth is pregnant women shouldn't be consuming massive amounts of caffeine anyway. But, if you are a committed coffee-drinker, then consider weaning yourself from coffee and on to green tea a few days before the fast. You should find a significant decrease in headache and fatigue. Know that caffeine has astringent properties and can interfere with hydration, so in addition to staving off headaches, you'll be aiding your system by allowing for more water retention. Anyone who has suffered an intense caffeine withdrawal headache will attest to the wisdom of a slow caffeine detox a week before a fast. You may just do so well that you wind up off caffeine for the rest of your pregnancy.

4. Drink Up and Cool Down.

For a few days before the fast, and certainly on the eve of the fast, drink, drink, drink and then drink some more. Ideally, you should still be urinating a few hours before the fast ends; that is a good sign that your body is still well hydrated. Make sure you are in a well ventilated area – if you're not a big air-conditioning person, consider becoming one for this one day, especially if your pocket of the world is a hot pocket. If you don't have an A/C unit in your home, you may want to move in with someone who does for the day – or rent a portable unit. Keeping your body temperature normal is essential to keeping yourself hydrated and hence your baby safe on a fast day. Keep in mind that excessive A/C can also be dehydrating – so please, make sure that the room is cool and comfortable enough. And if nothing else, invest in some good fans.

5. Make positivity your default browser.

Do not underestimate the power of a positive attitude. We have a beautiful Jewish saying "tracht gut vet zein gut" "think good and it will be good." If you go into the fast with a negative attitude about how difficult and schleppy it's going to be, it probably will be pretty difficult and schleppy. Likewise, if you get yourself fired up mentally before the fast, you'll be in a totally different headspace when the fast rolls in. Simply learning about the purpose and meaning behind the fast day can really help get you to that positive headspace. (Click here for a comprehensive list of inspirational and practical insights to Yom Kippur). Also, have a little chat with your baby-to-be, let your baby know that it's a fast day and that Mommy is going to need some solid participation on his/her part. It is also important to remember that you are not only fasting for yourself but for your baby! Tell your baby to check in with you (fetal movement) and let you know throughout the day that he/she is handling the fast well.

6. Call in the re-enforcements for your other kids.

Husbands, babysitters, older kids, neighbors, and friends should all be invited to help you get through Yom Kippur with as much style and grace as possible. There is strength in asking for help. Consider a rotating babysitting swap with a small group of local friends or neighbors. Each family can take the kids in two-hour shifts, giving you at the very least, two-hours kid free. Make sure you make a plan before the holiday, so that you know how many children to expect and your kids have a chance to get comfortable with the idea of being farmed out.

Depending on what part of the world you're in, outdoors may not be a great option for the kid-watchers, so plan on some fun, Yom Kippur-kid-friendly indoor activities. Often, some of my girlfriends and I will swap toys and books before a fast day to give our kids the feeling of having something "new" to play with. Playing blocks and dress up clothes are both usually a big hit in our house.

7. Prepare easy food for kids before the fast begins.

In order to minimize your contact with food, it's a good idea to have your food plan for the kids mapped out ahead of time. You may want to prepare food you don't have to smell. Some simple ideas for snacks and meals are: Crackers and cheese, pre-made sandwiches (take orders the day before), hard boiled eggs, granola and yogurt with fruit (they can make an activity out of making their own parfaits), cold cereal, cold pizza, cold chicken cutlets, pasta, pre-cut fruit and veggies.

Anything they can grab by themselves that will limit your involvement in the prep and serving will be helpful. I also like to keep a decent supply of popsicles in the freezer, and some fun nosh in the "junk" drawer. This is a great day to feed a kid's boredom with yummy snacks – you can brush their teeth after the fast.

8. Slow Down on a Fast Day.

As my midwife is fond of saying to women after birth, "If you have a choice between sitting and standing: Sit. If you have a choice between sitting and lying down: Lay down." I would apply this same thought to a fast day. The less active you are, the less active your uterus will likely be.

9. Look out for Danger Signs:

Danger signs that may warrant breaking the fast include:

Bleeding (even light)

Contractions (4 or more in 1 hour)

A clear decrease in fetal movement

Blurred vision and/or intense headache

Extreme fatigue

Extreme weakness


*A pregnant woman experiencing any of the above symptoms must seek immediate medical counsel from her healthcare provider.

Some examples of pregnant woman who fall in a high risk category include:

Anemic women

Women with or with a history of premature contractions (before 36th week)

Women on bed-rest

Abnormal blood pressure

An IVF pregnancy in its early stages

Fever, Angina, or other infection (it should be noted that fever alone is not a sufficient reason to break the fast but is reason to consult a doctor to see if the fever is a danger to the woman or the baby).

Gestational Diabetes

Bleeding (especially after the 12th week)

Threat of early miscarriage

Later stages of a twin pregnancy

Dehydration due to vomiting and/or diarrhea

Extreme weakness and fatigue

If you do fall into any of these categories, and have been instructed by your doctor not to fast, then the protocol for eating on Yom Kippur is as follows: (again please consult with your local rabbinic authority and your doctor about your personal situation).

A person who needs to eat on Yom Kippur for health reasons is permitted to eat or drink 35-40 ml. (a bit more than one fluid ounce – or one cheek-full) every 4-9 minutes. For a drink, it is best that it is a high energy drink, preferably with electrolytes (found in many sports drinks) to help with re-hydration. Concerning food, again, a high energy, low sodium choice is preferable. If you know in advanced or suspect that you may need to eat and/or drink on Yom Kippur, then it is advisable to prepare the accurately measured quantities of food in advance. (These measurements do not apply to the 9th of Av).

Women should note that any time there is danger to the life of the mother or the fetus, the fast absolutely must be broken and it is considered a mitzvah to eat. In any of the above circumstances, you should call your doctor to find out if your situation is indeed a danger to either yourself or your baby. Women should also find out before Yom Kippur how to reach their rabbi for questions as many rabbis make themselves available to help pregnant women who are not sure if they must continue to fast.

10. Make a slow break

It may be tempting to wolf down a whole bowl of whatever you've been craving the moment the fast ends, but be careful. Due to the growing baby inside, your stomach is already smaller then it normally is. Plus, you haven't eaten all day, so your stomach is even smaller than it was! The only way to feel decent after breaking the fast is to introduce food and drink SLOWLY.

I encourage women to break their fast on a warm beverage (I like a glass of herbal tea with milk). Sip it slowly. Wait a few minutes after you've finished it and if you would like, have another one. Once that has settled, and G‑d willing you're feeling fine, try ONE piece of cake or some other carbohydrate. Let that settle for at least 5-10 minutes before you consider eating more.

May we, along with our children, young and old, all merit to be inscribed and sealed for a good, healthy, and joyous year.

*This article is not intended to serve in place of medical or Rabbinic advice. Please contact your doctor and your rabbi for a ruling about your specific situation.