The joys and dilemmas of a woman physician

Obstetrician, gynecologist and fertility specialist Dr. Chana Katan, writes about her life and career.

By JUDY SIEGEL-ITZKOVICH
Dr. Chana Katan 370 (photo credit: Courtesy)
Dr. Chana Katan 370
(photo credit: Courtesy)
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 times over.
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 demand.
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 single.
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.”
Women 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.
I 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 fire.
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 world.
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.
Most 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 it.
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 away.
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 and elsewhere.
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 happening.
Katan explains various sexual matters very modestly, in terms that even the ultra-Orthodox would not find objectionable.
Once a 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 syndrome.”
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 babies.
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 abortion.
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 physician.
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 “Mazal tov.”
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 ward.
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 possible.”