Childbirth and Obstetrics in Antiquity
Encyclopedia
Traditionally obstetrics
is defined as the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium, although in Antiquity surgical intervention did not exist. Without the presence of surgical technology an alternative was necessary. In 2nd century AD, physician Soranus
wrote a text on gynecology introducing the occupation of the midwife.
Midwifery and obstetrics are distinctly different but overlap in medical practice that focuses on pregnancy
and labor. Midwifery emphasizes the normality of pregnancy along with the reproductive process.
states that for a woman to be an eligible midwife she must be “A suitable person…must be literate to be able to comprehend the art through theory too. She must have her wits about her so that she may easily follow what is said and what is happening. She must have a good memory to retain the imparted instructions (for knowledge arises from memory of what has been grasped). She must love work, to preserve through all vicissitudes (for a woman who wishes to acquire such vast knowledge needs manly patience).
The most qualified midwife would be trained in all branches of therapy. She should be able to prescribe hygienic regulations for her patients, observe the general and individual features of the case, give advice by recalling from previous knowledge what medical decisions would work in every case and to be reassuring to her patients. It is not necessary for her to have had a child to deliver another woman’s child, but it is good if she has been in labor to enhance sympathy with the mother.
To obtain good midwifery habits, she will be well disciplined and always sober, have a quiet disposition sharing many life secrets, must not be greedy for money, be free of superstition to not overlook salutary measures, keeping her hands soft by staying away from wool-working as this may harden her hands and use ointments to acquire softness. She too needs to be respectable, the people of the household will have to trust her within their household, may not be handicapped in the performance of her work. Long and slim fingers with short nails are necessary to touch deep-lying inflammation without causing too much pain. Midwives that acquire of all these will be the best midwives.
Superstitions and religion played a major role in antiquity including childbirth. Women in labor called upon the goddess Artemis
who had the ability to bring new life into the world and take it away. Though she remained a virgin herself, it was said that she witnessed the pain of her mother during the birth of her brother, Apollo
, and immediately assumed the position of midwife. If a woman died while during childbirth, her clothes were taken to the temple of Artemis due to the fact her death was attributed to her. If the birth was successful, the mother would make a thank-offering of some of her clothes to the goddess as well.
Herbs and plants were used heavily in the delivery process also with strong ties to superstition. For example, a drink sprinkled with powdered sow’s dung was given to relieve labor pain and fumigation with the fat from a hyena was thought to produce immediate delivery. Most of these practices had little to no medical efficacy, but they did probably provide some placebo effect. These superstitious practices were very common and required little or no medical training.
Significant advances were made in child bearing with the introduction of the Hippocratic Corpus
in the 3rd century BCE, though this document still proved to implement many ideas concerning superstitions. Physician, Galen
, also provided much advancement in medicine for women in the late 1st century CE, though he focused mostly on specific diseases with only some aspects of labor mentioned. Physician Soranus, who wrote several texts on gynecology in the 2nd century CE, has proven to be the most eminent authority on childbirth and obstetrics in antiquity.
Soranus described three main stages of pregnancy: conception which regarded keeping the male seed within the womb, pica which occurred 40 days into pregnancy and included symptoms of nausea
and cravings for extraordinary foods. During this phase women were also instructed to exercise and sleep more to build up strength as preparation for the labor process. Lastly the last stage of pregnancy was described being the labor and the process of delivery. In preparation for labor, the woman was advised to bath in wine and sweet-water baths to calm her mind before delivery. Her belly was then rubbed with oils to decrease the appearance of stretch marks and her genitals were anointed with herbs and injected with softeners such as goose fat.
The role of the midwife was very important during the process of childbirth and Soranus described her role in great detail. For example, the midwife was to have certain tools to ensure a safe delivery including: clean olive oil, sea sponges, pieces of wool bandages to cradle the infant, a pillow, strong smelling herbs in case of fainting, and a birthing stool.
The midwife would ready her supplies as labor began. During the labor process, the mother would lay on her back on a hard, low
bed with support under her hips. Her thighs were parted with her feet drawn up. Gentle massage was implemented to ease labor pains as cloths soaked in warm olive oil were laid over her stomach and genital area. Against the woman's sides were placed hot compresses in the form of warm oil-filled bladders.
During the actual birth, the mother would be moved to the birthing stool where she was seated with a midwife in front of her and female aids standing at her sides. In a normal headfirst delivery, the cervical opening was stretched slightly, and the rest of the body was pulled out. Soranus instructed the midwife to wrap her hands in pieces of cloth or thin papyrus so that the slippery newborn did not slide out of her grasp.
, because it was believed that Caesar was delivered through this procedure . However, this is probably based more on tradition and myth than historical accuracies. Another possibility for the etymology of the word “caesarian” is the Latin word caedere, meaning “to cut”.
This practice is probably much older than Caesar, but C-sections as performed by the Romans were to rescue the baby from a dying or already dead mother (performed post-mortem).
Evidence suggests that Jews
in ancient Rome
practiced C-sections on living mothers who were not in danger of dying. Evidence of these procedures is found in several collections of ancient Roman Rabbis (the most famous of which is called the Mishnah
).
Greeks
and Egyptians
did not perform C-sections post-mortem or on living mothers. However, Greeks would have had at least some knowledge of the caesarian operation/ procedure. The Greek god Aesclepius was fabled to have been extracted from his mother’s womb through this process.
Other than the evidence of Jews practicing C-sections in antiquity (very little in ancient Rome, even less in ancient Greece), not much more evidence exists regarding caesarian-operation birth. One reason could have been that C-sections were not performed very often because of medical complications or superstitions surrounding C-sections.
In early Christian Rome, C-sections were almost non-existent. Loss of skill is a possibility for the lack of C-sections. Infant mortality rates were high in antiquity, so C-sections certainly could have been useful. However, early Christian doctors could have disregarded C-sections as a socially acceptable surgery because of religious beliefs.
The lack of education for women (who would have been the most knowledgeable about childbirth procedures) and the social norm that women remained in the private sphere of life (as opposed to public) could also have contributed to a shortage of C-sections. Midwives were the primary persons involved in the childbirth process. Midwives were women, and were not actually physicians. They did not record their medical practices in writing like Soranus or Galen. Thus, C-sections could have potentially occurred on a fairly regular basis, accounts were just not recorded.
Disease, need for secrecy, and social discouragement could also have been factors that lead to the decline in C-sections among early Christians in Rome (for almost no evidence exists for C-sections in the Christian world until the 10th c.).
Maternal
Maternal mortality figures are available only through comparison. While well-attested in the sense that sources are not lacking, all evidence is anecdotal and difficult to extrapolate valid statistics from. Therefore, maternal mortality is thought to be comparable with figures for similar, but much later, societies with more surviving records, such as eighteenth-century rural England, where maternal mortality averaged 25 per 1000 births.
Infant
The question of infant mortality in antiquity is complicated by infanticide and exposure, neither of which reflect on medical ability during the period, though both remove children from family records. The former does this through intentional death of the child, and the latter through abandonment, and possible death. These reflect instead on social conditions and norms. While valuable, this is not the information sought, and scholars having painstakingly attempted to eliminate the noise from their inquiries.
While it is difficult to construct actual figures of the infant mortality rate in antiquity, comparisons have been made between ancient societies and modern non-industrialized societies. The figures suggested for these are then compared with those of modern industrialized societies to put them in perspective. While infant mortality is less than 10 per 1000 in modern industrialized societies, non-industrialized societies display rates from 50 to 200+ per 1000. Scholarship using model life tables and assuming life expectancy at birth of 25 years produces the figure of 300 per 1000 for Roman society.
Obstetrics
Obstetrics is the medical specialty dealing with the care of all women's reproductive tracts and their children during pregnancy , childbirth and the postnatal period...
is defined as the surgical specialty dealing with the care of a woman and her offspring during pregnancy, childbirth and the puerperium, although in Antiquity surgical intervention did not exist. Without the presence of surgical technology an alternative was necessary. In 2nd century AD, physician Soranus
Soranus
Soranus was a Sabine god adopted into ancient Roman religion. He was worshipped on Mt. Soracte in Etruria. The area was sacred to underworld gods, like Diespiter....
wrote a text on gynecology introducing the occupation of the midwife.
Midwifery and obstetrics are distinctly different but overlap in medical practice that focuses on pregnancy
Pregnancy
Pregnancy refers to the fertilization and development of one or more offspring, known as a fetus or embryo, in a woman's uterus. In a pregnancy, there can be multiple gestations, as in the case of twins or triplets...
and labor. Midwifery emphasizes the normality of pregnancy along with the reproductive process.
Midwifery
Midwifery flourished in the 2nd century AD, in the beginning of the Hippocratic Corpus. SoranusSoranus
Soranus was a Sabine god adopted into ancient Roman religion. He was worshipped on Mt. Soracte in Etruria. The area was sacred to underworld gods, like Diespiter....
states that for a woman to be an eligible midwife she must be “A suitable person…must be literate to be able to comprehend the art through theory too. She must have her wits about her so that she may easily follow what is said and what is happening. She must have a good memory to retain the imparted instructions (for knowledge arises from memory of what has been grasped). She must love work, to preserve through all vicissitudes (for a woman who wishes to acquire such vast knowledge needs manly patience).
The most qualified midwife would be trained in all branches of therapy. She should be able to prescribe hygienic regulations for her patients, observe the general and individual features of the case, give advice by recalling from previous knowledge what medical decisions would work in every case and to be reassuring to her patients. It is not necessary for her to have had a child to deliver another woman’s child, but it is good if she has been in labor to enhance sympathy with the mother.
To obtain good midwifery habits, she will be well disciplined and always sober, have a quiet disposition sharing many life secrets, must not be greedy for money, be free of superstition to not overlook salutary measures, keeping her hands soft by staying away from wool-working as this may harden her hands and use ointments to acquire softness. She too needs to be respectable, the people of the household will have to trust her within their household, may not be handicapped in the performance of her work. Long and slim fingers with short nails are necessary to touch deep-lying inflammation without causing too much pain. Midwives that acquire of all these will be the best midwives.
Labor and delivery
Midwifery and the process of labor and delivery in antiquity go hand in hand. Hospitals did not exist so delivery took place in the home of the expectant mother with a midwife and the presence of other females to aid the midwife.Superstitions and religion played a major role in antiquity including childbirth. Women in labor called upon the goddess Artemis
Artemis
Artemis was one of the most widely venerated of the Ancient Greek deities. Her Roman equivalent is Diana. Some scholars believe that the name and indeed the goddess herself was originally pre-Greek. Homer refers to her as Artemis Agrotera, Potnia Theron: "Artemis of the wildland, Mistress of Animals"...
who had the ability to bring new life into the world and take it away. Though she remained a virgin herself, it was said that she witnessed the pain of her mother during the birth of her brother, Apollo
Apollo
Apollo is one of the most important and complex of the Olympian deities in Greek and Roman mythology...
, and immediately assumed the position of midwife. If a woman died while during childbirth, her clothes were taken to the temple of Artemis due to the fact her death was attributed to her. If the birth was successful, the mother would make a thank-offering of some of her clothes to the goddess as well.
Herbs and plants were used heavily in the delivery process also with strong ties to superstition. For example, a drink sprinkled with powdered sow’s dung was given to relieve labor pain and fumigation with the fat from a hyena was thought to produce immediate delivery. Most of these practices had little to no medical efficacy, but they did probably provide some placebo effect. These superstitious practices were very common and required little or no medical training.
Significant advances were made in child bearing with the introduction of the Hippocratic Corpus
Hippocratic Corpus
The Hippocratic Corpus , or Hippocratic Collection, is a collection of around 60 early Ancient Greek medical works strongly associated with the physician Hippocrates and his teachings...
in the 3rd century BCE, though this document still proved to implement many ideas concerning superstitions. Physician, Galen
Galen
Aelius Galenus or Claudius Galenus , better known as Galen of Pergamon , was a prominent Roman physician, surgeon and philosopher...
, also provided much advancement in medicine for women in the late 1st century CE, though he focused mostly on specific diseases with only some aspects of labor mentioned. Physician Soranus, who wrote several texts on gynecology in the 2nd century CE, has proven to be the most eminent authority on childbirth and obstetrics in antiquity.
Soranus described three main stages of pregnancy: conception which regarded keeping the male seed within the womb, pica which occurred 40 days into pregnancy and included symptoms of nausea
Nausea
Nausea , is a sensation of unease and discomfort in the upper stomach with an involuntary urge to vomit. It often, but not always, precedes vomiting...
and cravings for extraordinary foods. During this phase women were also instructed to exercise and sleep more to build up strength as preparation for the labor process. Lastly the last stage of pregnancy was described being the labor and the process of delivery. In preparation for labor, the woman was advised to bath in wine and sweet-water baths to calm her mind before delivery. Her belly was then rubbed with oils to decrease the appearance of stretch marks and her genitals were anointed with herbs and injected with softeners such as goose fat.
The role of the midwife was very important during the process of childbirth and Soranus described her role in great detail. For example, the midwife was to have certain tools to ensure a safe delivery including: clean olive oil, sea sponges, pieces of wool bandages to cradle the infant, a pillow, strong smelling herbs in case of fainting, and a birthing stool.
The midwife would ready her supplies as labor began. During the labor process, the mother would lay on her back on a hard, low
bed with support under her hips. Her thighs were parted with her feet drawn up. Gentle massage was implemented to ease labor pains as cloths soaked in warm olive oil were laid over her stomach and genital area. Against the woman's sides were placed hot compresses in the form of warm oil-filled bladders.
During the actual birth, the mother would be moved to the birthing stool where she was seated with a midwife in front of her and female aids standing at her sides. In a normal headfirst delivery, the cervical opening was stretched slightly, and the rest of the body was pulled out. Soranus instructed the midwife to wrap her hands in pieces of cloth or thin papyrus so that the slippery newborn did not slide out of her grasp.
Caesarian sections
The word “caesarian” possibly derives from the ancient Roman ruler Julius CaesarJulius Caesar
Gaius Julius Caesar was a Roman general and statesman and a distinguished writer of Latin prose. He played a critical role in the gradual transformation of the Roman Republic into the Roman Empire....
, because it was believed that Caesar was delivered through this procedure . However, this is probably based more on tradition and myth than historical accuracies. Another possibility for the etymology of the word “caesarian” is the Latin word caedere, meaning “to cut”.
This practice is probably much older than Caesar, but C-sections as performed by the Romans were to rescue the baby from a dying or already dead mother (performed post-mortem).
Evidence suggests that Jews
Jews
The Jews , also known as the Jewish people, are a nation and ethnoreligious group originating in the Israelites or Hebrews of the Ancient Near East. The Jewish ethnicity, nationality, and religion are strongly interrelated, as Judaism is the traditional faith of the Jewish nation...
in ancient Rome
Rome
Rome is the capital of Italy and the country's largest and most populated city and comune, with over 2.7 million residents in . The city is located in the central-western portion of the Italian Peninsula, on the Tiber River within the Lazio region of Italy.Rome's history spans two and a half...
practiced C-sections on living mothers who were not in danger of dying. Evidence of these procedures is found in several collections of ancient Roman Rabbis (the most famous of which is called the Mishnah
Mishnah
The Mishnah or Mishna is the first major written redaction of the Jewish oral traditions called the "Oral Torah". It is also the first major work of Rabbinic Judaism. It was redacted c...
).
Greeks
Greeks
The Greeks, also known as the Hellenes , are a nation and ethnic group native to Greece, Cyprus and neighboring regions. They also form a significant diaspora, with Greek communities established around the world....
and Egyptians
Egyptians
Egyptians are nation an ethnic group made up of Mediterranean North Africans, the indigenous people of Egypt.Egyptian identity is closely tied to geography. The population of Egypt is concentrated in the lower Nile Valley, the small strip of cultivable land stretching from the First Cataract to...
did not perform C-sections post-mortem or on living mothers. However, Greeks would have had at least some knowledge of the caesarian operation/ procedure. The Greek god Aesclepius was fabled to have been extracted from his mother’s womb through this process.
Other than the evidence of Jews practicing C-sections in antiquity (very little in ancient Rome, even less in ancient Greece), not much more evidence exists regarding caesarian-operation birth. One reason could have been that C-sections were not performed very often because of medical complications or superstitions surrounding C-sections.
In early Christian Rome, C-sections were almost non-existent. Loss of skill is a possibility for the lack of C-sections. Infant mortality rates were high in antiquity, so C-sections certainly could have been useful. However, early Christian doctors could have disregarded C-sections as a socially acceptable surgery because of religious beliefs.
The lack of education for women (who would have been the most knowledgeable about childbirth procedures) and the social norm that women remained in the private sphere of life (as opposed to public) could also have contributed to a shortage of C-sections. Midwives were the primary persons involved in the childbirth process. Midwives were women, and were not actually physicians. They did not record their medical practices in writing like Soranus or Galen. Thus, C-sections could have potentially occurred on a fairly regular basis, accounts were just not recorded.
Disease, need for secrecy, and social discouragement could also have been factors that lead to the decline in C-sections among early Christians in Rome (for almost no evidence exists for C-sections in the Christian world until the 10th c.).
Death and childbirth
Mortality is considered to have been quite high in antiquity, due to a few factors: a lack of sanitation and hygienic awareness, no understanding of micro-organisms, and a dearth of effective drugs all contributed. In the context of childbirth, however, maternal and infant mortality were seriously raised by modern standards. This inflation resulted from the toll childbirth took on women, and the increased risk of infection following labor. Infants in the modern era are fragile compared to adults, and the lack of sanitation mentioned above contributed further to this fragility.Maternal
Maternal mortality figures are available only through comparison. While well-attested in the sense that sources are not lacking, all evidence is anecdotal and difficult to extrapolate valid statistics from. Therefore, maternal mortality is thought to be comparable with figures for similar, but much later, societies with more surviving records, such as eighteenth-century rural England, where maternal mortality averaged 25 per 1000 births.
Infant
The question of infant mortality in antiquity is complicated by infanticide and exposure, neither of which reflect on medical ability during the period, though both remove children from family records. The former does this through intentional death of the child, and the latter through abandonment, and possible death. These reflect instead on social conditions and norms. While valuable, this is not the information sought, and scholars having painstakingly attempted to eliminate the noise from their inquiries.
While it is difficult to construct actual figures of the infant mortality rate in antiquity, comparisons have been made between ancient societies and modern non-industrialized societies. The figures suggested for these are then compared with those of modern industrialized societies to put them in perspective. While infant mortality is less than 10 per 1000 in modern industrialized societies, non-industrialized societies display rates from 50 to 200+ per 1000. Scholarship using model life tables and assuming life expectancy at birth of 25 years produces the figure of 300 per 1000 for Roman society.