48 Heb “and they [fem. ] feared”; the referent (the midwives) has been specified in the translation for clarity.
49 The verb is the Piel preterite of חָיָה (khaya, “to live”). The Piel often indicates a factitive nuance with stative verbs, showing the cause of the action. Here it means “let live, cause to live.” The verb is the exact opposite of Pharaoh’s command for them to kill the boys.

In other versions

But the midwives feared God and did not do as the king of Egypt commanded them, but let the male children live.

The midwives, however, feared God and did not do what the king of Egypt had told them to do; they let the boys live.

The midwives, however, feared God and did not do as the king of Egypt had told them; they let the boys live.

But because the midwives feared God, they refused to obey the king’s orders. They allowed the boys to live, too.

But the midwives feared God, and they did not do as the king of Egypt had said to them. They let the boys live.

But the midwives feared God, and did not as the king of Egypt commanded them, but saved the men children alive.

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