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The Expecting Woman in Ramadan

 

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O my sister in Allah, congratulations for the coming of Ramadan, and congratulations for your pregnancy. Ask Allah that He makes your baby safe, sound and healthy. Ask Him that he makes your pregnancy an easy one and that He facilitates your delivery. Here are some pieces of advice:...

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In the Name of Allah, the Most Gracious, the Most Merciful

 
O my sister in Allah, congratulations for the coming of Ramadan, and congratulations for your pregnancy. Ask Allah that He makes your baby safe, sound and healthy. Ask Him that he makes your pregnancy an easy one and that He facilitates your delivery. Here are some pieces of advice:
 
1 – If you are in the first trimester of your pregnancy, it is when the fetus is being created; you can easily fast if there are no complications affecting your pregnancy. Upon breaking the fast, you should choose the food which is rich in all the diverse food elements; proteins, carbohydrates, vitamins and fats. It has been proven that these elements help, by the grace of Allah, in the formation of a healthy fetus.
 
If you suffer from a lot of vomiting and craving, these symptoms have a significant psychological factor, and the situation depends on your condition. A lot of vomiting leads to the increase of the proportion of acetone in the urine. It also leads to a defect in the proportion of salt and metabolism. These cases require hospitalization and accordingly it is not recommended to fast. As for the simple cases of vomiting (once or twice) per day, put your trust in Allah and ask Him to help you in fasting after taking enough milk in the time of the sahur (the last light meal before dawn).
 
2 – In the second trimester of pregnancy (fourth, fifth and sixth month), the uterus gets heavy and blood circulation to it increases; to increase its size for the fetus and placenta. One of the substantial physiological phenomena is the low blood pressure which causes dizziness and sometimes fainting after standing for a long time. In such cases it is advised to take large quantities of fluids, especially in summer and to avoid stress. It is also advised to hasten in breaking the fast with some warm liquid after taking the dates. You should delay taking the sahur as commanded by our Prophet, prayers and peace of Allah be upon him, has said, “The people will remain on the right path as long as they hasten the breaking of the fast.” [Agreed upon]
 
«لا يزال النَّاس بخيرٍ ما عجلوا الفطر» متفق عليه
 
3 – In the last trimester of pregnancy (the seventh, eighth and ninth month) it is advised to take small quantities of balanced diets. Filling the stomach will cause indigestion. Fasting is the best medical prescription that will make you active and light. You can also perform prayers such as the traweeh prayers and the night prayers. You must eat a lot of dates upon breaking the fast; because it provides you with enough energy for the whole day. The dates have countless benefits; it is easy to digest and appetizing.
 
My pregnant sister: Do not eat a lot of fat or sugary food. After the light breakfast, take a second meal after two hours; it should also be light. Then, you should delay the sahur, for verily there is blessing in the sahur. All of these tips and licenses are for those who do not suffer any diseases accompanying their pregnancy. Do not forget that after breaking the fast you may feel dizzy; this is because of the process of digestion. This is normal so you should take a rest directly after breaking the fast.
 
 
Bleeding during pregnancy and fasting:
 
Scientific studies show that bleeding during pregnancy is due to the following:
 
1 – A bleeding that threatens for abortion especially in the early months of pregnancy.
 
2 – Ectopic pregnancy, it is usually accompanied by lower abdominal pain.
 
3 – Hydatidiform (Vesicular) Mole (grapelike).
 
4 – Issues in the reproductive system, such as adenixia, vaginitis, cervical varices and the presence of mal-positioned placenta, which cause bleeding; occasionally without pain and it may be periodical.
 
 

 

The scholars differed in considering this bleeding menstruation or istihadah (womb bleeding between periods). This difference in opinion is about the pregnant woman before labor. After labor, they have the consensus that the bleeding is considered puerperium. (Al-Majmû’ (The Collection) by An-Nawawi, Al-Mughni (the Sufficient), Bidâyit Al-Mujtahid (the Start of the Diligent) and Al-Qawânîn Al-Fiqhiyyah (the Jurisprudential Laws)
 
 

 

Bleeding during pregnancy is considered istihadah which is completely different from menstruation. Istihadah and menstruation do not concur as they are two opposites. If there is menstruation, there is no pregnancy. If there is pregnancy, there is no menstruation. (Menstruation, Pregnancy and Puerperium, by Dr. Umar Al-Ashqar)
 
A woman during istihadah is permitted to pray, fast and recite the Quran. However, she has to perform ablution for every prayer as shown in the words of the Prophet, prayers and peace of Allah be upon him, to Fatimah Bint Abu Hubaish, “Perform ablution for every prayer till that time comes (the time of the next menstruation).” [Reported by Al-Bukhari 228]
 
«ثمَّ توضئي لكلَّ صلاةٍ، حتَّى يجيء ذلك الوقت» رواه البخاري
 
We recommend fasting in cases of the light bleeding, which does not cause a decline in hemoglobin or anemia. As for severe bleeding and fainting, it requires hospitalization and taking large amounts of intravenous fluids and blood transfusion, then fasting is difficult, especially if the doctor has to plan for a close operation and that Allah burdens not a person beyond his scope.
 
 
Diabetes, pregnancy and fasting
 
In Kuwait, a lot of the cases of diabetes associated with pregnancy are detected. I mean High blood sugar during pregnancy.
 
- If the level of blood sugar is low and needs a diet to regulate it, then fasting is the best treatment for this category. But it should be taken into account to take snacks between the breakfast meal and the sahûr, and not to eat a full and rich meal. Following-up with your doctor is a must to maintain the rate of blood sugar.
 
- If the sugar level is high and needs insulin injection to reduce it, it is better not to fast especially if the injection is more than one dose per day; insulin reduces the rate of blood sugar after a very short time of taking it; so the meal should be immediately ready to be taken. The effect of the insulin injection often extends for many hours before the time of the next dose. During this period the pregnant woman needs another light meal lest she suffers a drop in blood sugar, which adversely affects her and her fetus.
 
As for the originally diabetic woman who takes insulin injections and got pregnant in Ramadan, it is better for her to continue in taking the insulin and not to fast in Ramadan; because sugar regulation at this stage is very important to avoid congenital malformations in the fetus.
 
 
High blood pressure and fasting
 
High blood pressure (the number of the cases is continuously increasing) has two types:
 
The first type: High blood pressure that the woman suffers from before conception and takes some kinds of drugs for treating it. Certain types of it need small amounts of drugs and do not affect the fasting; so she can take the medicine when it is time for breakfast and sahûr.
 
The second type: it is detected during pregnancy. It might be mild and treated by rest and taking drugs. Fasting is good for it as less eating lowers and adjusts high blood pressure.
 
The dangerous type: it is the severe high blood pressure with the appearance of albumin in the urine, swelling in the feet and the increase in the weight above the average; this is the so-called pre-eclampsia. It needs special care and taking drugs for more than three times a day, rest in bed and frequent taking of blood samples to check the healthiness of the kidney and the liver and the health of the fetus. In this case we advise rest and not to fast in this critical period until the situation stabilizes. The doctor may decide to perform premature delivery if there is risk for the mother and her fetus.
 
 
Breastfeeding and fasting:
 
{The mothers shall give suck to their children for two whole years, (that is) for those (parents) who desire to complete the term of suckling,} [Surat Al-Baqarah 2:233]
 
{وَالْوَالِدَاتُ يُرْضِعْنَ أَوْلَادَهُنَّ حَوْلَيْنِ كَامِلَيْنِ ۖ لِمَنْ أَرَادَ أَن يُتِمَّ الرَّضَاعَةَ} البقرة: 233
 
Transliteration: Waalwalidatu yurdiAAna awladahunna hawlayni kamilayni liman arada an yutimma alrradaAAata
 
So far, no match to the breast milk has been made. Some of its benefits are that it is warm, sterile, available, rich in protein, calcium and fat, easy to digest, rich in antibodies for some diseases. There are other benefits of breastfeeding for the mother such as the return of the uterus to its normal condition and the prevention of breast cancer, Allah willing. If you are breastfeeding and Ramadan has entered upon you, have your trust in Allah and increase supplicating Him to facilitate breastfeeding your baby. However, you should take all precautions, take a lot of fluids between breakfast and sahûr as well as a lot of vegetables, diversify the elements of food, and take a late sahûr before dawn; to give you and your child a reservoir of energy and to help in the generation of breast milk.
 
There are some circumstances that may prevent you from breastfeeding, such as the coming of Ramadan in a hot summer and the length of the day which makes you need more fluids; or that you work outside the home more than the usual hours, in these cases you have the option of breaking your fast. Allah, Glorified and exalted, permits you not to fast if you fear the decrease of milk. However, you should take all precaution and after the continuous supplication. I also recommend you to try this if you intend not to fast: try not to fast for only two days a week, for example, or that you fast every other day. After that you have to make up for those days. Allah Almighty has said, {but if any of you is ill or on a journey, the same number (should be made up) from other days.} [Surat Al-Baqarah 2:184]
 
{فَمَن كَانَ مِنكُم مَّرِيضًا أَوْ عَلَىٰ سَفَرٍ فَعِدَّةٌ مِّنْ أَيَّامٍ أُخَرَ} البقرة: 184
 
Transliteration: faman kana minkum mareedan aw AAala safarin faAAiddatun min ayyamin okhara
 
 
Puerperium and fasting:
 
The scholars agreed that the maximum period for postpartum bleeding is forty days. They have as their evidence the Hadith of the Messenger of Allah, prayers and peace of Allah be upon him, “the woman in childbed used to stay for forty days during the era of the Messenger of Allah, prayers and peace of Allah be upon him, so we used to paint our faces with wars (a plant that produces a yellow dye) because of the freckles.” [Reported by At-Tirmidhi 139, Ibn Majah 532 and Al-Albani said, “It is good and authentic”]
 
«كانت النفساء تجلس على عهد رسول الله صلى الله عليه وسلم أربعين يوما، فكنا نطلي وجوهنا بالورس من الكلف » رواه الترمذي وابن ماجه وقال الألباني: حسن صحيح
 
The period of postpartum bleeding differs from a woman to another. Some women stop bleeding after twenty days, others may take a longer period than the forty days. It is not different if a woman delivered normally or by a caesarean section. After purification, a woman should pray and fast as long as there is no medical condition that prevents her from fasting. If the woman is administered to certain drugs that need to be taken at specified frequent hours such as antibiotics, insulin injections or the pills for epilepsy, etc… in such cases the woman must not fast but she should make up for these days when the medical treatment ends.
 
 
Menstruation, Istihadah and Fasting
 
Menstruation is the blood that comes out of the vagina from the bottom of the uterus. It consists of red blood cells, white blood cells and the endometrium (the mucous membrane lining of the uterus). It does not clot and has a distinct odor. It has a time that women know and are accustomed to; it happens periodically. Its duration differs from one woman to the other; the minimum is two days and the maximum varies from ten to fifteen days. The duration between one menses and the following one varies from a minimum of ten days to a maximum of forty five days.
 
As for the blood of istihadah, it consists of only red and white blood cells. The blood comes out from the uterus or from the private parts. It is ruby red in color and odorless. It might be continuous or it might come in-between the times of the menstrual cycle. It is irregular.
 
As you know, the menstruating woman does not pray or fast. However, the women having Istihadah can pray, fast and perform all the other acts of worship. She should perform ablution for each prayer. The frequently asked question by women in Ramadan is how to stop the blood of the menstrual cycle or the blood of istihadah and delaying it until the end of the month of Ramadan, especially in the last ten days of Ramadan; to seize them in performing the optional night prayers and remembrances and reading the Quran.
 
There are many ways to take drugs. In short, if you are taking contraceptive pills before Ramadan, you can continue taking them without interruption until you finish fasting, and expect bleeding after a period of up to one week. You can also start taking them with your last menstrual period and you keep taking them non-stop until the end of the fasting. The other way is to take the mono hormone pills (progesterone) before the date of the next menstrual cycle, for example ten days in advance; to ensure that there will be no bleeding at the date of the menstrual cycle. However, if you take the pills a few days before the cycle, the menstruation blood will not completely disappear. The quantity of the pills taken differs from one woman to another. Some women need more than one tablet up to four or six tablets a day to stop the blood, especially if they intend to perform Umrah in Ramadan.
 
Nevertheless, a lot of women suffer from some troubles by taking these pills. Instead of not fasting for five or seven days, they do not fast more than ten days because of the pills. Not fasting in Ramadan is a permit from Allah, Glorified and Exalted, and Allah likes it when His permits are seized. Know, my sister in Allah that not fasting during your menstruation does not prevent you from supplicating Allah, Glorified and Exalted, from the glorification of Allah or saying Allah is greater. It does not prevent you from increasing performing righteous deeds, giving charity, etc... Sheikh Ibn ‘Uthaymeen, may Allah have mercy on him, mentioned in the Book of Fatwas of Fasting (the Standing Committee for Issuing Fatwas), “What I see in this issue of taking pills during Ramadan to prevent the menstrual cycle (menstruation) is that women should not do it. They should remain on what Allah Almighty has destined and prescribed on the daughters of Adam. There is no doubt that these pills cause a harmful reaction on a woman’s body and the Prophet, prayers and peace of Allah be upon him, has said, “no harm, no harm.” [Narrated by Ibn Majah 1910 and Al-Albani said, “It is authentic by the virtue of another Hadith.”]
 
«لا ضرر ولا ضرار» رواه ابن ماجه وقال الألباني: صحيح لغيره
 
As you know, my sister in Allah, that these drugs are all hormones; they stop the bleeding and may have harmful effects if not taken for treatment under the supervision of a physician.
 
 
Women’s issues that do not break the fast
 
1 – Vomiting during the carving period. It usually happens in the first three months of pregnancy and takes the same ruling of unintentional vomiting. The Prophet, prayers and peace of Allah be upon him, has said, “Whosoever cannot help vomiting does not have to make up for the fast. But whosoever deliberately makes himself vomit, he must make up for the fasting day.” [Narrated by At-Tirmidhi 720 and authenticated by Al-Albani]
 
«من ذرعه القيء فليس عليه قضاء، ومن استقاء عمدًا فليقض» رواه الترمذي وصححه الألباني
 
2 – Taking blood samples to perform some required lab analysis that cannot be postponed for a pregnant woman; such as the cases of diabetes, anemia and pre-eclampsia. Sheikh Ibn Baz, may Allah have mercy on him, mentioned in the book ‘Fatwas of Fasting’, “Such analysis does not invalidate the fast; rather it is pardoned; because it is needed and it is not among the breakers of the fast known in Islam.”
 
3 – Vaginal examination: it is preferable to postpone it if it is not necessary, a matter determined by the physician; as it requires the uncovering of the private parts. It is preferred that the women sees a woman doctor, the male Muslim doctor comes in the second place; taking into account the expertise of the doctors; all this if it is necessary as it requires the uncovering of the private parts which are sternly warned against uncovering. As for the vaginal examination in itself, it does not break the fast as there is no food entering the stomach nor is it sexual intercourse. Vaginal ultrasound takes the same verdict.
 
4 – Urinary incontinence: it is the inability to control urine, especially with sneezing or coughing, it might happen during praying. Its ruling, Allah willing, is the same ruling of Istihadah; it does not invalidate the fast. However, ablution is a must before every prayer. If anything of the urine comes out during praying, it does not invalidate it, Allah willing. It is preferable to use sanitary pads.
 
 
A last word
 
Some women take their pregnancy and breastfeeding as an excuse not to fast. All the praise and gratitude be to Allah, the means of comfort are available nowadays and our circumstances are far better than others in the Muslim countries.
 
My sister in Allah, remember that you are fasting in a cool air conditioned place. The means of comfort are available in almost every house. So, shall we not thank Allah for these blessings by completing fasting in this holy month of Ramadan? Remember also that pregnancy is not a disease but a physiological process that you must cope with so that Allah facilitates your pregnancy till you give birth.
 
 
Acknowledgements:
The scientific material is presented by Dr. Samira Al-Awadi
Consultant Physician of Obstetrics and Gynecology
Maternity Hospital
May Allah bestow upon her the best reward
 
 

 

Patients Assistance Fund


 

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