Childbirth and obstetrics in antiquity

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.

Midwifery

Midwifery flourished in the 2nd century AD, in the beginning of the Hippocratic Corpus. Soranus 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^[1].

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 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^[2]. If the birth was successful, the mother would make a thank-offering of some of her clothes to the goddess as well^[3].

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^[4]. 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^[5].

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^[6].

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^[7].

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^[8].

Caesarian sections

The word “caesarian” possibly derives from the ancient Roman ruler Julius Caesar, because it was believed that Caesar was delivered through this procedure ^[9]. 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”^[10].

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)^[11].

Evidence suggests that Jews in ancient Rome practiced C-sections on living mothers who were not in danger of dying^[12]. Evidence of these procedures is found in several collections of ancient Roman Rabbis (the most famous of which is called the Mishnah^[13]).

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^[14].

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^[15]. 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^[16].

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^[17]. 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.)^[18].

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^[19].

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^[20].

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^[21].

References

1. ^ Mary R. Lefkowitz and Maureen B. Fant, Women's Life in Greece and Rome, (Baltimore, Maryland, 2005), 265
2. ^ Ginette Paris, Pagan Meditations, (Dallas: Spring Publications, Inc., 1986) 109.
3. ^ Robert Garland, “Mother and Child in the Greek World,” History Today, March 1986, 43
4. ^ Donald Todman, “Childbirth in ancient Rome: from tradition folklore to obstetrics,” Australian & New Zealand Journal of Obstetrics and Gynecology, 2007, 83
5. ^ Donald Todman, “Childbirth in ancient Rome: from tradition folklore to obstetrics,” Australian & New Zealand Journal of Obstetrics and Gynecology, 2007, 83
6. ^ Donald Todman, “Childbirth in ancient Rome: from tradition folklore to obstetrics,” Australian & New Zealand Journal of Obstetrics and Gynecology, 2007, 83
7. ^ Donald Todman, “Childbirth in ancient Rome: from tradition folklore to obstetrics,” Australian & New Zealand Journal of Obstetrics and Gynecology, 2007, 83
8. ^ Donald Todman, “Childbirth in ancient Rome: from tradition folklore to obstetrics,” Australian & New Zealand Journal of Obstetrics and Gynecology, 2007, 83
9. ^ Anon. “Caesarian Section.” U.S. National Library of Medicine. Maryland: Bethesda. Jan., 1993, updated May 2008
10. ^ Anon. “Caesarian Section.” U.S. National Library of Medicine. Maryland: Bethesda. Jan., 1993, updated May 2008
11. ^ Depierri, Kate P. “One Way of Unearthing the Past.” American Journal of Nursing, vol. 68, 1968: 521 524
12. ^ Boss, Jeffrey. “Caesarian Section with Maternal Survival Among Jews in the Roman Period.” Man, Royal Anthropological Institute of Great Britain and Ireland,1961, 18-19
13. ^ Boss, Jeffrey. “Caesarian Section with Maternal Survival Among Jews in the Roman Period.” Man, Royal Anthropological Institute of Great Britain and Ireland,1961, 18-19
14. ^ Anon. “Caesarian Section.” U.S. National Library of Medicine. Maryland: Bethesda. Jan., 1993, updated May 2008
15. ^ Boss, Jeffrey. “Caesarian Section with Maternal Survival Among Jews in the Roman Period.” Man, Royal Anthropological Institute of Great Britain and Ireland,1961, 18-19
16. ^ Depierri, Kate P. “One Way of Unearthing the Past.” American Journal of Nursing, vol. 68, 1968: 521 524
17. ^ Depierri, Kate P. “One Way of Unearthing the Past.” American Journal of Nursing, vol. 68, 1968: 521 524
18. ^ Depierri, Kate P. “One Way of Unearthing the Past.” American Journal of Nursing, vol. 68, 1968: 521 524
19. ^ Brisbane, Todd. "Childbirth in ancient Rome: from traditional folklore to obstetrics," Australian and New Zealand Journal of Obstetrics and Gynaecology 2007; 47: 82-85
20. ^ Riddle, John M. "Contraception and Abortion: From the Ancient World to the Renaissance," (Cambridge: Harvard University Press, 1992) 7-15 passim
21. ^ Brisbane, Todd. "Childbirth in ancient Rome: from traditional folklore to obstetrics," Australian and New Zealand Journal of Obstetrics and Gynaecology 2007; 47: 82-85