Editor: The question below was submitted to www.yoatzot.org, Nishmat's Women's Health and Halacha (Jewish Law) website for the lay public.

"I delivered a baby by c-section six months ago. I was instructed immediately to go on birth control pills. I thought birth control pills were a halachic problem so I did not take any. The doctors say that they don't want me to get pregnant preferably for a year after delivery because of uterine scar tissue. Is it permissible to take birth control pills? I'm nursing and haven't had my regular cycle yet anyway."

This question demonstrates the need for proper communication between health care professionals and the observant couple. It appears that in this case the issue was not discussed fully and the patient simply chose to ignore the doctor's advice and set herself up for a pregnancy earlier than intended. While her nursing may have helped protect her initially (see article on LAM), it is not sufficient at this point.

When there is a medical need for contraception, it is important to assure that the patient understands the importance of avoiding pregancy. Ask if she has any concerns with this advice. If she mentions that she wishes to speak to her rabbi, consider writing a note to the rabbi indicating the medical indication for the recommendation. A statement such as "women who conceive within the first year after a cesarean are at increased risk of rupture of the uterus" carries much halachic weight.

It should be noted that many authorities also approve the use of birth control even after a normal birth to allow for recuperation of the mother. Therefore, it is wise to raise the issue during late pregnancy to allow a woman to discuss this with her halachic advisor.

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