Medieval Midwives

Maternity Leave, Then and Now

In the Middle Ages, a mother might be confined to the home after giving birth for thirty to sixty days. The general idea was that childbirth made a woman spiritually and/or physically unclean for a time, and she was kept separate from much of society until she underwent a purification ceremony at a church or synagogue. The tradition began in the Jewish religion and was adopted by Christians as well.

England wasn’t always strict about this confinement period and churching business. Ideally, a devout Christian mother would attend the ceremony (commonly called “churching”) after giving birth, but she didn’t have to. She still might be confined to the home for a month or so, though.

Some scholars think the confinement was restricting and misogynistic, and it certainly had its roots in some misogynistic ideas (spiritually unclean, excuse you?) But others see it as a sort of medieval maternity leave. The mother was not expected to perform hard labor, have sex, or run errands outside of the home during this time, all of which she was probably expected to do otherwise (especially rural women, who helped work the fields.) It might have given her time to recover and bond with the new baby – childbirth is a difficult event, and medieval mothers faced great danger from birth complications and infection.

Nowadays women are not required to stay at home after birth. Indeed, for many women, that option never presents itself. Maternity in the U.S. is, frankly, abysmal compared to other developed countries – officially, the Family and Medical Leave Act requires that companies with 50+ employees give new mothers 12 weeks of leave. This sounds okay – better than the month typically expected of medieval mothers – except:

1) The leave is unpaid – in lower income or single parent households, mothers cannot afford to take 12 weeks of unpaid leave.

2) If both parents work for the same employer, the employer can divide those 12 weeks between the two parents – the parents don’t get separate leave policies.

3) The baby will only be 3 months old when it is left in the care of relatives, friends, or daycare workers. This is still very young!

4) Daycare costs in the U.S. are high. It is not unusual for a parent to need to choose between working a low-income job and spending a large chunk of it on childcare or risking a dip in household income to stay home with the baby. And of course, that’s only if someone else in the household is working.

5) You may not get leave if you work for a small company.

Compared to Scandinavian and other developed countries, which offer anywhere from 18 to 35 weeks of paid leave for mothers and some for fathers, the U.S. is kinda terrible at taking care of its young families.

This was arguably an issue in the medieval period as well, but there were differences. Rural had to work the fields, go to market, tend the garden, and so on, to keep their households fed and supplied. Very young children might be left in cradles or in the care of elderly friends or relatives. (This wasn’t always a good thing – a relative might just be a barely-older sibling.) Older children, perhaps around five or six years old, often attended their parents on the job. This was far from a perfect system, as rural work around livestock or in the fields could lead to serious accidents.

Fun for the whole family!
(Credit: https://www.medievalists.net/2014/06/year-medieval-farm/)

What about urban parents? London parents would have had neighbors to keep an eye on their children, or perhaps a nurse to help with childcare. In many cases the mother was most responsible for the child’s wellbeing and might have stayed home if the family could afford it. Older boys could have apprenticed in shops under their fathers, and older boys and girls might attend school (not everyone did.)

It might have been a great thing for medieval parents if they had a safe place to leave young children during the workday, like a daycare. We have them now, but at least in the U.S., the cost and wait lists are prohibitive for many parents. In the May 2019 Survey of Income and Program Participation, 30% of working families with children under 5 were considered low-income. Of those families, 4 out of 10 could pay for child care, but those payments took up an entire third of their household income. “Child care” in this case meant paying for licensed supervision of their children – a daycare, or preschool, or in some cases, a nanny.

Middle-class families spent 14% of their income on paid child care, according to this survey. The U.S. Department of Health and Human services considers child care “affordable” if it takes up only 7% of household income. That means that even middle-class families with employed parents are paying twice the recommended amount for daycare or nannies!

So what’s the solution? Well, for one thing, we could try to imitate some of those Scandinavian countries with subsidized daycares, paid parental leave, and policies stating that daycare should cost no more than a certain percentage of household income…but that would mean raising taxes. And we can’t have that.

Further Reading:

Barbara Hanawalt, The Ties That Bound: Peasant Families in Medieval England (1986) and Growing up in Medieval London: The Experience of Childhood in History (1993).

Sue Niebrzydowski, “Asperges me, Domine, hyssopo: male voices, female interpretation and the medieval English purification of women after childbirth ceremony” (2011).

Center for American Progress on the cost of child care: https://www.americanprogress.org/issues/early-childhood/reports/2019/06/20/471141/working-families-spending-big-money-child-care/

Educating Midwives

Education and training for midwives was a rollercoaster ride from antiquity to the Middle Ages. Rome and Greece educated and trained their midwives just as they educated and trained their other physicians. Medieval Europe…not so much.

That didn’t mean medieval Europe didn’t want or need midwives. Far from it! They just…didn’t support them as well as certain ancient societies.

Let’s take England, for example. What could you expect as an English mother if you wanted a midwife and lived in, say, the early twelfth century?

It depended on where you lived, but it could vary wildly. There were not many restrictions in place when it came to practicing medicine. These days, physicians are expected to go to school, get a degree or two, and get a license, so that we as patients know they earned a degree or two and can safely practice medicine. That wasn’t the case in Europe until the 1400s. There were universities that taught medicine, but you weren’t required to attend one to practice. If you lived in a rural area, your midwife could just be the woman in the neighborhood with the most experience having/delivering babies.

This woman’s lucky – these midwives are probably trained.

There were medical texts for women and childbirth since at least 100 – 200 AD, courtesy of the Greeks and Romans. But not everyone had access to education in medieval England, and if you were a woman, you were even less likely to be educated, unless you were in the upper classes. So not every midwife could read. And even if you could read English, you might not be able to read Greek or Latin, and a lot of those medical texts were written in Greek or Latin.

Luckily, some of those books had illustrations, and some midwives were literate. Those midwives could take on other women who wanted to learn, and in places like London they eventually formed networks to train and support each other.

If you’re saying, well that sucks for the women, but I’d just find a man to help me give birth, good luck. Male midwives were not really a thing until the 1300s, and even then you were more likely to find a physician or surgeon who dabbled in obstetrics, not a specialized midwife. Pregnancy and childbirth were regarded as an area for women. Later, male medical professionals would almost push women (including midwives) out of the European medical field entirely, but not in the beginning.

You invent forceps and suddenly you know everything.
(Credit: https://www.collectmedicalantiques.com/gallery/delivery-and-obstetric-forceps)

But wait, I hear you say. If childbirth was supposed to be an area for women, why didn’t they properly educate and train women to be midwives?

Good question.

Around the 1400s, medical professionals in France, Italy, and parts of England looked around and went, wait a minute. There are a lot of uneducated, illiterate women wandering around, managing clients and delivering babies. We can’t have ignorant people practicing medicine! That’s dangerous!

Well, yes, it certainly could be. But rather than invite women into the field and offer them more opportunities for education and training, those medical professionals spread the word that women midwives were untrained, untrustworthy, and illiterate – people were better off turning to trained male practitioners instead. And for at least a couple centuries, women were steadily pushed out of medicine.

Things began to turn around in western Europe around the 1600s. But in the U.S., midwifery is a small field, almost entirely overshadowed by hospitals and private ob/gyn practices. Which is problematic, because midwives could do quite a bit to help the overburdened healthcare system in the U.S.

According to a recent report, 49% of 3,143 U.S. counties lack a single ob-gyn, mostly because those counties don’t have hospitals that offer ob-gyn services. That’s more than 10 million women who may not have access to reproductive healthcare, including maternity care. The report also states, “Medical needs of the U.S. adult female population during the next decade cannot be met by ob-gyns, family physicians, and general internists alone…the addition of qualified nonphysician health care professionals, working in concert with physicians, should help meet those needs while potentially reducing the cost of care and the need for additional health care professionals.”

In other words, midwives could become a larger part of healthcare teams and healthcare services, especially in smaller/rural areas, and it would help ease the strain on other medical staff and provide affordable alternatives for pregnant women. And unlike medieval England, we now have programs to train and certify midwives and nurse-midwives. The U.S. model of healthcare may see a stronger movement toward midwifery in the coming decades.

Further Reading:

Monica Green, Making Women’s Medicine Masculine: The Rise of Male Authority in Pre-Modern Gynaecology (2008).

Doreen Evenden, The Midwives of Seventeenth-Century London (2000).

Costanza Dopfel, Alessandra Foscati, and Charles Burnett, Pregnancy and Childbirth in the Premodern World (2019).

Complications in Childbirth

How did medieval midwives and physicians deal with complications during childbirth?

We can’t speak for every midwife, or even every medieval country, but we’re beginning to get a larger picture of medieval medicine. Thanks to translations of books like the Trotula – a manual written in Italy, around the 1100s – we know that medieval midwives and physicians had an idea of how to deal with certain problems.

The Trotula was not the first manual with instructions and advice about childbirth. The earliest text for midwives that we know of is Soranus’s Gynaikeia, written between 100 – 200 AD. This ancient Greek text was four volumes long and contained illustrations and information about uterine anatomy, conception, miscarriage and abortion, pregnancy, labor and delivery, and care of the newborn. Some of the Trotula’s sections were inspired by the Gynaikeia and other Greek or Latin texts.

Presentations of the fetus in the womb from Soranus’s *Gynaikeia*

We deal with things differently now, thanks to improved medicines, technology, and sanitation, but in some cases medieval midwives were not far off the mark. According to the Trotula, if a woman had trouble passing the afterbirth (the placenta), the midwife or attending physician should induce vomiting by making her drink a concoction of specific herbs. The idea was that vomiting made the stomach muscles contract, which helped push out the afterbirth.

The logic was sound. The problem was that certain herbs used in the drink, like comfrey, are known to be poisonous. Of course the mother would throw up – her body was trying to get the poison out of her system. As if labor and birth didn’t make you sick enough! And if she vomited too much, she might run the risk of dehydration. If you had trouble passing the placenta in a hospital now, they might give you an injection to induce more contractions. Same idea, safer method (if still unpleasant.)

“Note to self: figure out how to synthesize oxytocin.”

Other, less drastic measures from the Trotula include stitching any tearing, getting the mother up and moving around if her labor was stalled, and in case of a breech birth, turning the baby in the womb (ow). All of those are still done today, except now we have the benefit of numbing medications, and breech births can be addressed with safer surgeries if the baby can’t be rotated.

One thing that can be said for childbirth in current, developed countries is the survival rate for mother and infant. Even though medieval mothers, midwives, and surgeons did their best with what they had available, death in childbirth was common, and many children did not survive their early years. Today the maternal mortality rate in England is down to 7 out of 100,000, and infant mortality is 4 out of 1,000.

The U.S. shows slightly higher numbers: in 2016, maternal mortality was 16 out of 100,000, more than double than the U.K. For infants, it was almost 6 out of 1,000. In fact, the U.S. maternal mortality rate has increased over the past decade, due to a host of reasons: outdated ideas about post-birth complications, lack of emergency training for medical staff, more women giving birth later in life, etc. The good news? News outlets published reports on the issue, and now that the word is out, the pressure is on for the medical field to address those problems.

Further Reading:

Monica Green, Trotula (2011)

Francesca Marchetti, “Educating the Midwife: The Role of Illustrations in Late Antique andOne Medieval Obstetrical Texts” in Pregnancy and Childbirth in the Premodern World (2019)

American Pregnancy Association, “Labor and Birth”: https://americanpregnancy.org/labor-and-birth/

NPR’s series “Lost Mothers:” https://www.npr.org/series/543928389/lost-mothers

Home Births in Medieval England

Most women would not give birth in hospitals until the twentieth century. And for good reason! In the medieval period, hospitals were not as sanitary as they are in developed countries today, and were more like sick houses or temporary living for the impoverished.

Not a good place for mother and baby to go! Instead, women in the medieval period usually gave birth at home, attended by female friends, relatives, and hopefully a midwife. A male priest or surgeon might arrive if things became dangerous for the mother, but men were otherwise kept out of the birth room. If you were part of the aristocracy or nobility, the birth chamber might be a private, heated room, and comfortable.

Wealthier women might have different beds in their birth chamber. They could move from bed to bed as they pleased (with assistance if they needed it.) A pallet bed on the floor was most helpful to the midwife during the act of giving birth, and a higher bed with a down mattress and pillows allowed the mother to rest and recover after the event.

Domenico Ghirlandaio’s “The Birth of John the Baptist,” painted late 15th century

The birth chamber needed to be a calm, quiet, darkened space, so as not to disturb mother or the new arrival. Henry VIII’s mother drew up some official recommendations for the royal nursery and birth chamber, but even before that it was believed that the room should be decorated in a pleasant, soothing fashion. Tapestries could not feature scenes that might excite or frighten the mother or baby. Gold and silver plates and cups decorated a cabinet or mantlepiece. The windows were shuttered and the curtains drawn, except for perhaps one window or two, to provide some natural light. Someone might burn incense. It was quite a different environment from the brightly lit hospital rooms of today. (Whether a dark, incense-filled room is better or worse than a sterile hospital room depends on the mom!)

Such comforts were reserved for those who could afford them. What about poorer folk, like rural villagers? We know something about their living conditions thanks to descriptions left in wills and written reports.

Cozy!
(https://www.archaeology.co.uk/articles/peasant-houses-in-midland-england.htm)

Their homes ranged from one-room cottages to three-room houses, depending on their income. Poorer peasants might house their animals under their own roof, with the livestock room separated from the humans’ space by a short passageway. Other peasants, better off, would erect separate buildings for their animals, but most homes were single-storey and births would have happened in a ground-floor room. The mother may or may not have had much privacy – they could be separated from the rest of the household by a wall, door, or just a curtain.

As for beds, most peasants in the Middle Ages could afford straw pallet beds – that is, a straw mattress on a wood pallet, which rested on the clay or dirt floor. A wealthier peasant might have a feather mattress, but they certainly could not afford to have three or four beds available for a woman to give birth. The main source of heat would have been a fire in the hearth, which could be as much of a danger as a help.

In the U.S., most births now take place in hospitals. In the twentieth century, medical professionals urged women to deliver in hospitals instead of at home, citing benefits for health and safety.

“When the Stork Arrives,” Good Housekeeping vol. 59, 1914.

The campaign was successful: according to the National Center for Health Statistics, almost all births in 1900 happened in homes or birthing centers, but in 1940 more than half of all births took place in hospitals. In 2017, 98.39% of all births took place in hospitals, a dramatic change in less than 120 years!

Further Reading:

Peasant Houses in Midland England: https://www.archaeology.co.uk/articles/peasant-houses-in-midland-england.htm

Barbara Hanawalt, The Ties That Bound: Peasant Families in Medieval England (1986)

Sue Niebrzydowski, “From Bedroom to Courtroom: Home and the Memory of Childbirth in a Fourteenth-Century Marriage Dispute” (2015): https://doi.org/10.2752/175174209X416553