Ramadan is the blessed month in the Muslim calendar. It is obligatory on Muslims to fast in this month. Fasting is not meant to create excessive hardships to the Muslims. The Quran specifically exempts the sick individual from fasting; especially if fasting can lead to harmful consequences. Fasting for extended periods for one month can cause health issues in patients with number of medical illnesses.
Pregnant and breastfeeding mothers are examples of such people whom Allah has exempted from fasting. The following is some general health advice that would help such mothers with the approach of the month of Ramadan. A pregnant women or lactating mother must consult doctor to decide whether she able to fast during pregnancy or while breastfeeding. If a pregnant or breastfeeding mother fears harm upon herself because of fasting, then it her religious right to break the fast. This is because in the first months of pregnancy, balanced meals required for the fetus in order to grow normally.
A pregnant woman who may face problems if she fasts must have a well-balanced meal at the time of breaking her fast. Her meal must include starches that supply the body with the required calories, like rice, bread or pasta. A pregnant woman usually needs around 2250 calories daily, and these calories must come from food sources that are rich in vitamins and minerals, such as iron and calcium. We also advise her to drink a large glass of fruit juice immediately after breaking her fast. She should stay away from meals that are difficult to digest, like deep fried foods, as this may cause indigestion. Moreover, she must avoid overeating because this may cause difficulty in breathing.
Any pregnant woman who suffers from complications during pregnancy, like high blood pressure, diabetes, kidney infections or heart problems must refrain from fasting because her health situation does not permit her to fast, as these complications risk the health of the fetus. If a pregnant woman fasts, then she must take a good rest during the daytime. If a pregnant woman fasts, then we advise her to eat a light meal between `Iftaar’ which is the meal at sunset and `Suhoor’ which is the predawn meal. Adequate water intake is essential. It helps the internal organs to function properly and helps in the digestive process and digest food properly. In addition to reducing dehydration, mothers are encouraged to reduce daily activities and not overly exposed to sunlight.
Correspondingly, a baby will not be harmed if a breastfeeding mother decided to fast because she will be able to keep making breast milk while fasting. Reducing how many calories intake for this period of time should make no difference to the amount of milk you produce. A breastfeeding mother’s body adapts by changing the way it uses the available calories. It appears to make up for the lack of food or fluid by becoming better at releasing energy and stepping up milk production. In fact, the breastfeeding mother could eat nothing for 24 hours without it affecting either the quantity or the nutritional value of your breast milk. You would feel the effects of fasting, and probably need to stop, before it affected how much milk you produced.
The “Yes & No” of Medical Procedures during Ramadan
By: Dr. Siti Nurhayati Adznan
The principle of fasting is that the person who is fasting is to fast in a moderate manner, neither putting himself in a severe disadvantage of health by doing anything that causes weakening of the body, nor is he allowed to ‘cheat’ via additional energy from external forces.
A simple guide to fasting is succinctly described in a verse from the Holy Qur’an and further completed by various hadiths by the Prophet (saw).
It has been made permissible for you the night preceding fasting to go to your wives [for sexual relations]. They are clothing for you and you are clothing for them. Allah knows that you used to deceive yourselves, so He accepted your repentance and forgave you. So now, have relations with them and seek that which Allah has decreed for you. And eat and drink until the white thread of dawn becomes distinct to you from the black thread [of night]. Then complete the fast until the sunset. And do not have relations with them as long as you are staying for worship in the mosques. These are the limits [set by] Allah , so do not approach them. Thus does Allah make clear His ordinances to the people that they may become righteous. (Al-Baqarah 2:187)
The verse above mentions briefly the 3 acts that nullifies fasting, which are:
- Sexual intercourse
- and Drinking
Several authentic hadiths from the Prophet further adds to the above the following:
- Anything regarded as eating or drinking eg. Smoking, blood transfusions, IV infusions, dialysis
- Letting blood by means of cupping and the like eg. Blood donation
- Deliberately vomiting
- Menstruation and nifaas (post partum bleeding)
Based on the above as well as further discussions between Fiqh scholars and physicians, several common medical procedures had been highlighted and the following was summarized by The Council of the Islamic Fiqh Academy regarding surgical and several gynecological methods of examination and diagnosis.
1. Anything introduced into the uterus, be it digital examination (examination using fingers), per speculum, suppositories, bath water, intrauterine devices (IUDs) for whatever reason, ureteroscope (a camera at the end of a tube to visualize the uterus) or intra vaginal auscultation does not nullify fasting.
2. Anything introduced through your anus that does not reach the stomach and/or the procedure does not involve the absorption of substance does not nullify the fast. Examples include: per rectal examination, enemas, and rectal scope.
3. Anything introduced into the urinary tract of a man or a woman: probe, ureteroscope or radio-opaque substances (can be visible on X-Ray), following the same principal as the gynecological examination in 1 also does not nullify the fast
4: Anything introduced through the mouth however, further down the digestive tract from the areas involving dental procedures DOES NULLIFY fasting. This is because, anything introduced to the throat might trigger the swallowing reflex and further down; for example gastroscope or similar will cause unintentional absorbtion of procedure related substances.
However, prior to each diagnostic study it is advised that the physician should counsel for postponement if there is no urgency indicated.
Dr. Siti Nurhayati Adznan is a private general practitioner in Melaka.
- The Council of The Islamic Fiqh Academy