In reply to your letter of the 2nd of Shvat in which you write that your doctor has suggested to your wife tichye
that she have surgery to:
- bind together the stitches of the first surgery that have become separated;
- to raise the womb and place it in its proper position:
In my opinion, it is worth doing so, but with the condition that another specialist in this field also agrees to these procedures.
With regard to the third suggestion — [that] the doctor suggests that while doing the above he also perform a tubal ligation:
I am not in support of this. Consult with a pious Rav with regard to the permissibility of this matter according to Jewish law. Even if it should be permissible according to law, it would seem from your brief words that the procedure would be such that your wife sheyichye would be prevented from ever being able to conceive again. Why should you do this?
Although you write that the doctors maintain that your wife's weakness results from the frequency of her pregnancies and births until now, nevertheless, it is possible that they are mistaken; with proper diet and with an untaxing daily life, her strength will return.
Even if, G-d forbid, it is dangerous for her to presently conceive due to her health, in such situations the Tzemach Tzedek permits the use of a moch (see his Responsa, Even HaEzer, ch. 89). Consult with a pious Rav as to the specific methods [of contraception].
(Igros Kodesh, Vol. V, p. 210)
In reply to your letter ... in which you ask about a woman who already has twice given birth by Cesarean section and the doctor says that if she will have to have another C-section, it might well be dangerous for her to conceive again, for which reason he wishes to perform a tubal ligation after she gives birth:
In general, my function is not one of ruling on halachic matters. However, the above suggestion is truly perplexing: The opinion of doctors (specifically in the last few years) is that even after a C-section a woman can have a normal birth.
Moreover, there is no limitation on the number of births she can have by C-section due to her past C-sections. Rather it depends on the woman's general health status at the time she gives birth.
In other words, a decision cannot be made based on a concern for her future pregnancy and birth; it depends entirely on her present health situation, and with regard to this there are many remedies that help strengthen the woman in general, strengthen her womb, and the like.
Additionally, there is the well-known ruling of the Tzemach Tzedek who permits the use of a moch during relations when it is a possible danger for the woman to become pregnant. According to the reasons [for this permission,] it would seem that this method is preferable to that of the woman having an operation that totally negates her ability to ever conceive again.
I would like to add the following point (and surely this will be conveyed to the doctor as well): In most cases, the operation performed to prevent pregnancy is done in a manner where they tie (and block) the woman's [fallopian] tubes. It happens quite frequently that these knots become untied, so with regard to preventing pregnancy, one may well ask what is the superior form of contraception: when done in the manner of the Tzemach Tzedek's ruling or when done by tying the tubes?
To add an additional point — and this too is of primary importance:
In light of the rapid advances in medical research during the past few years, every new day carries the possibility of bringing with it new medical knowledge and revelations.
A person should therefore seek to refrain from employing measures that cannot be undone, especially since new medical techniques and knowledge will have discovered that those measures should not have been taken. ...
(Igros Kodesh, Vol. XIX, p. 134)
women have had Cesarean sections more than three times and nevertheless did not
tie their tubes, as is well known.
(From a letter of the Rebbe, dated 6 Shvat, 5741)