- Gillian Clark
- Gender Studies
- Science, Technology, and Medicine
Childbirth was generally the concern of women, either family and neighbours or experienced midwives who were sometimes ranked as doctors, but male doctors expected to be called in for difficult cases. Several treatises in the Hippocratic corpus (see hippocrates (2)) include some discussion of childbirth. On the Nature of the Child ascribes the onset of labour to the movement of the foetus, which breaks the membranes. Diseases of Women says that prolonged and unsuccessful labour usually means a difficult presentation, stillbirth, or multiple birth. Suggestions include vigorous shaking to stimulate delivery, and drugs to speed labour (ōkytokia); if all else fails, the doctor may resort to embryotomy, the extraction by instruments of a foetus which is stillborn or impossible to deliver alive. The uterus is envisaged as a container rather than as a powerful muscle, and labour is described as pains not contractions. Aristotle (HA 586b) notes that pains can occur in the thighs and the lower back as well as the lower abdomen, and that women can help delivery by effort and correct breathing. Dissection by Herophilus, in the 3rd cent. bce, revealed that the uterus is muscular, and Galen (Nat. Fac. 3. 3) argues that it has the power to retain or expel the foetus.
The most detailed account of labour and delivery is in the 1st-cent. ce handbook written by Soranus for midwives, the Gynaecology. Soranus envisages delivery on a birthing-chair, or on a hard bed if the mother is weak. He does not discuss contractions or distinguish stages of labour, but does describe dilation of the cervix and the breathing-technique to be used in delivery. Pain relief is provided by warm cloths on the abdomen and sharp-scented things to smell, and Soranus emphasizes that the midwife and helpers must reassure the mother and be careful not to embarrass her. At the birth, the midwife signals whether the baby is male or female, then lays the baby on the ground and assesses whether it is ‘worth rearing’. She judges when to cut and tie the umbilical cord, cleans and swaddles the baby, and puts it to bed.
Soranus invokes psychological and physical factors in the mother, as well as big babies, multiple births, and abnormal presentations, to explain difficult labour. He offers techniques for relieving a narrow or obstructed cervix (these do not include episiotomy) and for turning a foetus, but makes no mention of obstetric forceps or of Caesarean section as an alternative to embryotomy: a mother could not have survived the trauma of a Caesarean. He has no confidence in drugs, induced sneezing, and shaking to stimulate delivery of the baby or the placenta, and disapproves of cold baths, tight swaddling, and hard beds for newborns. He notes the belief that delivery is impeded if the woman's hair or belt is tied, and the reluctance of some midwives to cut the cord with iron.
Maternal mortality, like neonatal and infant mortality, is often assumed to have been high, but estimates of the maternal death rate range from 5 in 20,000 to 25 in 1,000. Women may have died from exhaustion and haemorrhage in a difficult delivery (especially if they had poor health or were very young) or from eclampsia, a kind of epilepsy which can now be detected early; puerperal fever occurred, but infection is relatively unlikely in home delivery.
In Greek tradition, childbirth ritually polluted those present because blood was shed, and delivery on sacred ground was therefore forbidden (see pollution). Olympian goddesses are not represented as giving birth. The deities most often invoked in labour were ArtemisEileithyia (sometimes regarded as separate deities) or Hera in Greece, Juno Lucina in Rome. Roman childbirth rituals are briefly described by Augustine (De civ. D. 6. 9), but his source is the antiquarian Varro rather than common practice. There are also allusions to rituals in which the father lifts the child from the earth (tollere liberum) or carries the child round the hearth (amphidromia), but these would not always be practicable—for instance, in a house with no central hearth or when the baby was born on the upper floor of a tenement—and it was the name-day celebration, approximately ten days after the birth, which publicly acknowledged the child as a family member. See embryology; motherhood; pollution.
- V. French, in M. B. Skinner (ed.), Rescuing Creusa (1987).
- A. Hanson in S. B. Pomeroy (ed.), Women's History and Ancient History (1991).
- R. Jackson, Doctors and Diseases in the Roman Empire (1988).