Our Gemara on Amud Aleph records an interesting hypothetical vignette imagined about a typical family man during the 40 years that the Jews wandered in the wilderness:

So too, in the case of the Jewish people, someone who had four or five children would be worried and say: Perhaps the manna will not fall tomorrow and we will all die of starvation. Consequently, everyone directed their hearts to their Father in heaven every day. The manna that fell each day was sufficient only for that day, so that all of the Jewish people would pray to God for food for the next day.

I point out an observation on this Gemara that I suspect you will only hear on Psychology of the Daf.  I will assume the number 4 or 5 children given in this Gemara was not random. Although you can squeeze other peshatim and explain away this number, the basic reading of the text implies that this was the average family size.  It is important that we take a moment to discuss Jewish family size in a realistic non-sensationalistic manner:

Of course, we all know of large families who have a dozen children, all of them beautiful, healthy and well-adjusted. However, sometimes because of what could be misdirected misplaced piety, these parents continue to have more and more children, causing damage to the children and to themselves.    From time to time I encounter parents who are under a combination of psychological stressors such as mental health difficulties, sholom bayis challenges, financial stress, and personal temperament that makes it highly inadvisable for them to have more children.  

Though the halachos regarding birth control are complex and subject to disagreement among poskim, in the end, the couple does not need to be sophisticated in the halakha.  Rather, they need to be honest with themselves and with their rav about their psychological and emotional stressors, and the reasons they are seeking a heter.  The halakhic details are up to the rav; the couple just needs to give the rav the complete picture.  This is not always easy to do, and shame often holds people back from telling the rav exactly what is going on.  

On the other side of the issue, the rav should be sensitive and listen carefully.  Some rabbonim may be afraid to “lead the witness” and not want to push for a heter if the person is not asking for it too strongly.  However, my experience is that often people understate their distress.  So, I hope this discussion can also encourage rabbonim to listen for hidden mental health and other stressors that their congregants may be too ashamed to speak of openly.  Mental health, distress, anguish and lack of sholom bayis can, at times, even be a matter of life and death.  However, it takes a sensitive and wise rav to read between the lines and to know when his congregant is hiding bigger issues behind a routine question.

A significant reason to hold off on having more children is Post Partum Depression which is unfortunately not uncommon.  While some cases are quite mild and heal on their own, there are women who suffer from Post Partum Depression for years after childbirth.  Many mothers who suffer from Post Partum Depression feel intense shame and inadequacy. They have tormenting thoughts of not wanting the baby, or hating the baby.  Such mothers may have a hard time admitting it to their husbands, or their husbands may be in denial, not able to fully accept the reality of the situation.  

Another aspect of shame and guilt that holds people back from seeking heterim even when they really need it is that of not living up to community standards.  In some communities, there is pressure to produce many children in the marriage – early and often.  Of course, it is a great mitzvah to have children, nevertheless, it is important to balance this zeal with a realistic acknowledgement of human limits. Having children is perhaps the most important mitzvah, but still like all mitzvos, requires common sense to enact it. Just as we do not give away all our money to charity to fulfill the mitzvah of tzedakkah, nor do we even get married at age 12 or thirteen to fulfill the mitzvah of having children, so too, once married, common sense is needed to determine how many children to have and when to have them.  In our times, medical science has advanced to the extent that the purely physical ability to have children has far surpassed the psychological ability.  In the time of the Gemara, a woman would generally not menstruate for 24 months subsequent to childbirth, obviously rendering her infertile.  (This is based on the Gemara Niddah 9a.  Note: The Gemara there attributes this state not solely due to nursing, but rather due to the trauma of childbirth “evareha misparkin”.  And, as we saw, there is some basis from our Daf to consider that the average family size was 4-5 children. Interestingly, Rav Henkin (Bnai Bonim, Teshuva 30) actually cites this Gemara as part of a general heter for some amount of spacing between children, though Rav Moshe rejects this approach (Igros Moshe, E.H. I:64.)  In today’s times, due to ample nutrition and advanced medical care, many women can easily conceive every year – in terms of pure physical stamina.  But not every woman can handle this in a psychological sense.  Such women should not be embarrassed or ashamed to take time to recover before having another child, and in some way, her peers and loved ones should recognize that and help temper this invisible pressure.

A new phenomenon that did not occur in my generation is that many newly married couples, chassidish and litvish, are getting heterim to wait to have children for a year or two.  This is fascinating sociologically as when I was a newly wed, no self-respecting rav, litvish or chassidish would dispense such a heter.  However, the growing recognition that couples can have a traumatic shana rishona with sexual dysfunction, extremely difficult pregnancy, and the what seems to be rising rate of divorce has led rabbonim to evaluate the risk reward ratio differently. As a therapist on the front lines, I am watching the halakha in this regard respond in new ways daily, as rabbonim and dayyanim from even the strictest communities acknowledge the growing need to respond to mental health realities.

Translations Courtesy of Sefaria, except when, sometimes, I disagree with the translation

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