It’s quite an accomplishment for a woman to be an obstetrician/gynecologist and
a specialist in fertility – a highly demanding medical sub-specialty – while at
the same time raising a family. But Dr. Chana Katan is also Orthodox, married to
a rabbi, the mother of a “large number” of children, aged 31 to 11, including a
set of twin girls, and with seven married children, is also a grandmother many
After 20 years in her field, Katan also found time to write a
239-page, Hebrew-language book, Hayei Isha: Mabat Ishi Urefu’i (A Woman’s Life:
A Personal and Medical View), that focuses on observant Jewish women but would
be informative for their secular counterparts as well. Already in its second
edition, the book could be translated into English due to the current
Born in Manhattan, Katan was brought by her parents to Israel as
a 15-year-old, studied at the Zionist Orthodox Zeitlin high school for girls in
Tel Aviv, studied medicine at the Hebrew University-Hadassah Medical School and
did her residency in pediatrics and ob/gyn at Sha’are Zedek Medical Center. She
worked for years at SZMC’s in-vitro fertilization unit and ran the hospital’s
sexology clinic. Katan remains a member of the hospital’s halachic committee on
fertility treatments. She also writes a fortnightly column on women’s health and
other issues in a modern-Orthodox weekend newspaper.
She established the
IVF unit at Laniado Hospital in Netanya and ran the Meuhedet Health Fund’s
women’s health center in the haredi town of Kiryat Sefer. Katan continues to
receive patients and works “10 hours a day,” but no longer has to go to
hospitals at all hours to delivery babies.
As fertility treatment
involves many halachic issues, her husband, Rabbi Yoel Katan – who works in a
rabbinical position at Moshav Sha’alavim near Latrun and edits religious books,
advises her regularly about individual cases.
Katan writes in her
introduction that she found writing “real therapy” and that it was “empowering”
to recall cases from the past.
The volume is divided into eight sections,
each with up to five chapters. The subjects run from marriage, pregnancy,
fertility and delivery to childbearing, family, menopause and grandmotherhood.
Throughout the book, she presents her personal views favoring marriage and life
as a two-parent family, while opposing postponement of pregnancy, abortions of
healthy fetuses and having superfluous tests during pregnancy. She also prefaces
each section with poems ranging from the Bible to Haim Nahman Bialik to the late
songwriter Ehud Manor.
In the “Wedding” section, she begins with being
Katan bemoans the fact that many young women in the modern
Orthodox sector especially – and certainly among secular women – postpone
motherhood. The fertility specialist has encountered many, man single women who
– because they have given priority to career, have been too “picky” or have not
received a marriage proposal – get pregnant “too late.” She states repeatedly
that fertility decreases sharply after the age of 35 and is almost impossible
(with one’s own ova) after 44. Women may think IVF, ova donations and frozen ova
will solve any problem, but Katan reminds readers that one can’t depend on them
for simple solutions.
“Many women fail to internalize – and even try to
forget – the simple facts of life... the significant and continuing drop in the
number of fertile eggs in the woman’s body as she gets older.”
constantly tell her: “If only I knew, I would have looked differently on the
years that have past. I think I also would have made [other] decisions.
would have chosen. But I didn’t know. Nobody told me that as time passes, my
chances of giving birth [seriously] decline.”
Such women, writes Katan,
think that having a menstrual period until around the age of 50 means they are
fertile until menopause and will have no problem getting pregnant. The author
notes that by repeating this at public forums, she usually comes under
As a result of this and the Jewish tradition of desiring offspring
at almost all costs, Israel has more IVF units per capita – one in nearly every
general hospital plus private ones – than any other country in the
Usually the first time that Katan meets her observant patients is
when they have gotten engaged and want to make sure they have had their period
and are able to go to the mikvah, or ritual bath, before the wedding. She
supplies them with contraceptives to regulate their menstrual periods. The
doctor uses the opportunity to explain the female reproductive system (many have
very little information about this), send them for genetic and other medical
tests including cytomegalovirus antibodies, prescribe folic acid to minimize the
risks of neural tube defects in the fetus and other information.
religious women go to paid “bridal counsellors” who give private lessons on
marriage, intimacy, family purity and the like. Sometimes, young women – often
accompanied by their mothers – reveal information that poses a significant moral
dilemma for the doctor. One mother, for example, said that her daughter finally
got engaged after a long search for a husband, but suffers from Turner’s
syndrome, which prevents her from menstruating and makes her infertile. Neither
the engaged woman, nor her parents, have told the future bridegroom about
Their failure to disclose the fact that she would need IVF to
conceive is a clear violation of Jewish law. In fact, the mother asks for
hormones that would give the bride artificial menstrual periods for a few months
so the young man would not discover his wife’s medical problem right
Other physicians, not obliged by their beliefs and practice to
follow halacha, could agree, but Katan wouldn’t dream of carrying out the
mother’s request. She finally gets permission to tell the young man about the
medical problem and explain what can be done about it.
Other such ethical
dilemmas that Katan has experienced were families who hid the fact that their
daughters suffered from epilepsy and even – after the couple married – claimed
the woman developed diabetes during pregnancy when in fact she was born with
type 1 diabetes.
Katan walks on eggshells.
“I am aware of the
secret, but I am obliged to dismantle it. I tell the truth because it hurts. I
choose trust, faith and prayer that will be the basis for the [doctor/patient]
relationship, and not a lie.”
She strongly urges young singles, when they
begin to consider dating or are being offered “matches,” to get a blood test at
Dor Yesharim, a voluntary organization set up in New York and expanded to Israel
Recessive genetic diseases are identified, but the
would-be bride and bridegroom are registered only by number and told whether a
certain prospect would be genetically compatible with them. It was originally
set up by Rabbi Josef Eckstein who had four children who died as young children
from Tay-Sachs disease; he wanted to prevent such tragedies from
Katan explains various sexual matters very modestly, in terms
that even the ultra-Orthodox would not find objectionable.
pregnancy is achieved, Katan says she is in favor of ultrasound scans and other
tests, but that Israeli women undergo more than anywhere in the world not only
because doctors fear lawsuits but also because of the “perfect baby
In many cases, she continues, there is only a very small
statistical risk of a fetal defect, but doctors may recommend an abortion.
Katan, by the way, reveals in her book that she herself went through seven
miscarriages in addition to giving birth to “a large number” of healthy
She tells the tale of a woman who whose fetus was found in an
ultrasound to have a rather disfiguring cleft palate, which can usually be
repaired satisfactorily with plastic surgery. Her doctor advised her to have an
The mother replied that she herself had been born with a cleft
palate, which was repaired and showed no signs in her sessions with the
Advising pregnant women not to undergo every possible test,
some of which could endanger the fetus, has exposed Katan to possible lawsuits
if tragedies result, but the author notes she is willing to be in that situation
if she can save lives worth living.
She would recommend women undergo
pre-implantation diagnosis and then IVF with healthy fetuses if they were
carriers of defective genes that cause serious disease in children or young
peoiple, Katan notes, but she would not do so if the fetus develop Alzheimer’s
disease when they were old.
If a woman has a natural miscarriage, the
doctor greets her by saying: “Mazal tov! I am happy for you.” This often shocks
the woman, who mourns her unborn child.
But Katan quickly explains that
having a miscarriage “means that you are able to have a pregnancy, that all the
systems work. It’s unfortunate when a pregnancy does not succeed, but this is
good news. You will have, God willing, many children.”
There could have
been chromosome or other damage that would have meant a child with a very short
lifespan or one who had to undergo terrible suffering, which is why Katan says
She also discusses “silent deliveries,” in which a fetus is
stillborn. Katan notes that in the past, parents were advised to hold the
stillborn baby in their arms and part from it before burial, but that in recent
years, “there is no reason to press them to do so. This helps them internalize
that the baby was not meant to live,” she explains.
Saying “Baruch Dayan
Ha’emet” is encouraged, but Jewish law does not instruct parents to sit shiva
and mourn for the infant.
Explaining the subject of multiple pregnancies,
Katan relates how she and her husband coped with their fraternal twins when she
was a busy young doctor. She recalls that after giving birth to another child at
the beginning of her career, there were so few obstetricians on duty that she
got out of her hospital bed and changed into her doctor’s white coat – shocking
new mothers who a short time before had seen her lying in the obstetrics
The problem of infertility – the woman’s, the man’s or both – is
dealt with very sensitively. Katan writes about her objections to the law that
entitles women (or couples) to have free IVF treatment up to one’s mid-40s until
they have two healthy children, even though the chances for achieving this are
small, and at the same time limiting government subsidies to young infertile
couples to only two even though they want more.
The author is a strong
advocate of epidural anesthesia to minimize the pain of childbirth – she herself
was a pioneer in getting the injection for one of her deliveries. But she
discourages intentional home births, noting that it “isn’t worth it” to suffer
the risks to the baby and mother of a breech birth or a torn uterus for the
“joy” of delivering in a familiar setting.
She also devotes a chapter to
menopause, explaining the feeling of loss among many observant and other women
who mourn their fertility. The option of taking hormone-replacement therapy is
discussed, as are its potential problems, such as requiring middle-aged women to
go to the mikvah due to bleeding.
Becoming a grandparent, Katan
concludes, is “great fun,” and with it come new experiences and challenges,
especially to couplehood. She notes that life is full of “saying goodbye” – from
one’s pacifier, diapers, kindergarten, bachelorhood, breastfeeding, fertility
and live-in children – but there are compensations.
“Thank God that we
have safely reached one stage of life after another, and we look expectantly to
the next, to old age. With God’s help, I hope we have as soft a landing as