Call the midwife

As labour pains kicked in, many medieval women leant on the expertise of experienced professionals

Childbirth in the Middle Ages was a community effort. Family members, parish priests and local experts all lent a hand – and when midwives were called in to assist, they often worked in teams.

A late 12th-century English account describes the presence of seven midwives at the labour of Eliza of Middleton. Such a large team could pool their knowl- edge and share the demanding tasks involved in assisting the delivery.

These women could find their services called upon in all kinds of circumstances. In 1259 in the French village of Saint-Saëns, two local midwives attended the nun Nicola of Rouen, who gave birth inside her nunnery. Nicola’s child was baptised, probably by a priest at the monastery, although midwives were themselves empowered to perform baptism in cases where the child’s soul was in peril.

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Midwives were expected to be moral arbiters, looking out for instances of illegitimacy – no doubt the case for Nicola’s baby – and infanticide. At the same time, their own conduct came under scrutiny. In 1481 the English midwife Agnes Marshall was accused of using quasi-magical incantations. Indeed, English midwives, poorly paid and sometimes suspected of witchcraft, had a less positive experience than their counterparts in France and Germany, who received professional training and were officially employed by town governments, even if they earned much less than male medical practitioners.

Physicians and surgeons only rarely assisted women in childbirth, although doctors were some- times called upon when aristocratic women gave birth. Blanche of Anjou, the second queen of James II of Aragon, received the attention of physicians during all 10 of her confinements. Nonetheless, she died in 1310 soon after the delivery of a daughter.

Treat hospital as a last resort

When it came to giving birth in the Middle Ages, there was no place like home

Most medieval women went through labour in a domestic, non-medicalised environment. And, if they were aristocratic and merchant-class, that often meant retiring to a birthing chamber (a darkened room provided with soft furnishings) a month before they expected to give birth.

While the birthing room was very much a women’s domain, attended by female friends and relatives and midwives, men were still heavily invested in childbirth, especially since the continuation of the family line was at stake. While pregnant in 1441, the Norfolk woman Margaret Paston asked her husband to wear a protective ring that she had sent him, thereby implicating him in her safe pregnancy and delivery.

In sharp contrast to today, hospitals were very much a last resort for women in labour. Medieval hospitals were charitable institutions for the sick poor, and fittingly it was women in unstable domestic situations who found themselves in hospital birth wards. Unmarried mothers were especially in need of hospital care. Their precarious social situation meant that their infants were often abandoned and needed to be fed by wet nurses at foundling hospitals.

One such institution, the Santa Maria della Scala in Florence, had a turning box in the wall where babies could be left anony- mously (the box was then turned and the baby taken into the hospital). It also had beds for wet nurses, and sent infants out to a network of wet nurses in the countryside.

Patients in birthing wards still had access to the knowledge of midwives. And by the end of their careers, these midwives must have had great experience not only of childbirth but also the social difficulties faced by the poorer women that they assisted.

Don’t place all your faith in medicine

Official medical advice was in short supply, so women often turned to magico-religious remedies

Childbirth was, initially at least, the Cinderella of medieval medicine. While there was official guidance available to women suffering with gynaecological problems, or those needing help with fertility, expert advice on giving birth was far harder to find. In the Middle Ages, having a baby was seen as a natural process rather than a medical problem, and hence did not require the in-depth application of medical theory. And, since physicians tended not to build up practical experience by attending deliveries, it was difficult for them to write about childbirth.

But medical writers didn’t entirely pass over the subject. The Trotula, the principal text on women’s health that circulated from the 12th century, addressed complications in childbirth, discussing for example how to stitch a tear between the vagina and the anus “in three or four places with a silk thread”.

Another learned text, compiled by the physician Aldobrandino of Siena in the 13th century, advised that two or three weeks before the birth the mother should bathe in water steeped with herbs and lubricate her legs, thighs and vagina with camomile oil and chicken fat, no doubt to ease the delivery. However, Aldobrandino could not offer a medical solution if the child presented in the wrong position, only suggesting that the midwife should manually turn the infant in the womb.

Aldobrandino probably had the high-stakes reproductive health of a specific group of women in mind, since he was personal physician to Beatrice of Savoy, Countess of Provence, who had four daughters, all of whom became queens through marriage and thus needed to produce healthy heirs. By the later Middle Ages, more written sources of advice were available, especially in medical recipes. One English manuscript from the 15th century mixes herbal and magico-religious remedies intended to bring about a safe delivery. The labouring woman is advised to drink hyssop (a herb of the mint family) in hot water, and wine or water that has washed a bowl on which a pater noster prayer is written.

Be prepared for the worst

No two deliveries were the same. Luckily, medieval midwives had a plan for all eventualities

It’s easy to imagine childbirth as a harrowing experience for a medieval woman, with little access to pain relief, or control over what was happening to her. However, the birthing chamber was well-equipped and midwives had the expertise to ensure a smooth delivery and to intervene when complications arose.

One approach to labour was to seat the pregnant woman on a birthing stool; another scenario was for her to pull on a rope. Aldobrandino of Siena advised: “If she is fat, let her lie on her stomach and draw up her knees towards her head, and place a cushion under her belly.”

Certain fossils were understood to ease pain in childbirth, and a stone known as the eaglestone was attached to the labouring woman’s thigh, since Christian, Jewish and Muslim traditions understood that it would expedite the birth.

Of course, not all pregnancies ended happily: a fast delivery was considered especially important when the foetus was believed to have died, and many medical recipes existed for this difficult situation. An Anglo-Saxon text prescribed a herbal drink including pennyroyal, a plant that was also used in abortive remedies for its ability to cause the lining of the uterus to shed.

Midwives also needed to be prepared to take action if the mother died but the infant was still living. In these instances a Caesarean section could be performed, either by the midwife or by a surgeon called in to intervene. Following the delivery of a living infant, the umbilical cord was cut and tied with a soft woollen thread and the child was immediately swaddled. This practice was intended to maintain the warm environment of the womb and to support and protect the baby’s flexible limbs. A bed was provided for the infant, ranging from a cradle to a simple basket.

Seek help from the heavens

It was widely believed that the success, or otherwise, of a pregnancy was in the gift of the saints

While official medical guidance on pregnancy may have been hard to come by, divine assistance (or at least the promise of it) certainly wasn’t. Our medieval predeces- sors believed that several saints supported a safe pregnancy and birth. Perhaps unsurprisingly, the majority of these saints were female, and the most prominent of them all were the Virgin Mary and St Mar- garet. In late medieval England, however, a lesser known saint, Julitta, was also widely venerated, alongside her son Quiricus.

Julitta and Quiricus were jointly martyred, symbolising the holiness of the relationship between mother and child. This pair of saints, alongside the Virgin and other holy figures, featured on birth girdles, long parchment scrolls that were intended to come into contact with the mother’s body, whether wrapped around the abdomen or carried in a rolled up form.

Girdles were similar to relics – the idea being that a material object connected to a saint was imbued with beneficial powers. They also included magical features such as protective verbal remedies or charms. In the run-up to the birth of her seventh or eighth child, Elizabeth of York, the queen of King Henry VII of England, paid a monk for bring- ing a girdle of the Virgin to her. She also visited a monastery at Hampton Court, no doubt to gain further divine protection. Sadly, she died after the delivery in February 1503, as did her infant daughter.

Girdles and other devotional arte- facts, such as small statues of saints, were used by less affluent women as well as the elite, and even objects that did not have any religious associations were valued in connection with childbirth. In the 12th century, following a difficult delivery that she and her baby son survived, the Empress Matilda, daughter of the English king Henry I, gratefully donated the silk mattress on which she lay during her illness for the benefit of leprosy sufferers. As well as being a luxury item connected to a royal figure, this mattress was now associated with comfort, reassurance and healing.

Rejoice – but don’t relax

Following the birth, many mothers spent weeks in enforced confine- ment, rebuilding their strength

Statistics paint a bleak picture of childbirth and infancy in medieval Europe. In 1420s Florence, giving birth was responsible for about one in five of all deaths of married women, while archaeological evidence from medieval Wharram Percy in North Yorkshire indicates that 19 per cent of infants died before the age of two.

There’s no single reason for this terrible death toll but one of the chief culprits was infection. A major cause of infection for the mother was the retention of the placenta. A miracle story of St Thomas Becket recorded in the 1170s tells how Herbert of Felton’s wife was deeply afflicted because only part of the afterbirth had been released from her body. She needed the saint’s assistance to alleviate pains and breathing problems caused by the retained matter.

After the birth, the vulnerable infant was furnished with objects believed to have protective powers, such as coral and amber amulets. The mother remained within the birthing chamber for four to six weeks for a period of confinement which prevented her from rejoining her community but allowed her to rest and regain her strength. This was part of a cleansing process that reflected the belief that the mother’s body was made impure by childbirth, much as a woman was understood to be contaminated during menstruation.

After her long period of confinement, the mother was ritually accepted back into the parish church. She met the priest in the porch to be sprinkled with holy water, then made an offering and received mass. This rite was known as “churching”.

Although churching restricted the mother’s freedom of movement, it also provided opportunities for feasting and celebration, within both the birthing chamber and the wider parish community. In fact, so woven was this rite into the fabric of medieval life that women in northern Europe opposed efforts to bring it to an end during the Reformation. Churching may well have bolstered negative stereotypes about women but it also reinforced their identities as mothers – and that was something they clearly valued.

Dr Elma Brenner is Wellcome Collection’s medieval specialist. She is co-editor of Leprosy and Identity in the Middle Ages: From England to the Mediterranean (Manchester University Press, forthcoming 2021)


This article was first published in the February 2021 edition of BBC History Magazine