Call the (Roman) midwife
Even today, childbirth can be arduous, even dangerous – so how did mothers deal with the challenges in antiquity? Laurence Totelin introduces the midwives of the Roman empire and explores their techniques
Marcus Ulpius Amerimnus and Scribonia Attica, a husband and wife who lived in the second century AD, rest together in their funeral monument at Ostia, near Rome. According to an inscription on the walls of the tomb, Scribonia herself commissioned it for the eternal rest of her family and freed-people. Marcus was a surgeon, as we learn from a bas-relief on the tomb, where he is represented in the act of treating a leg wound, next to his – rather oversized – surgical instruments.
Scribonia was a midwife, as illustrated by her own bas-relief, where she is shown delivering a child. A naked woman sits in a birthing chair (a special seat with handles for the mother to grip during contractions), her belly swollen. She is supported by a woman, perhaps a relative, while the midwife sits on a low stool in front of them, ready to catch the baby; she looks straight out at us rather than at her patient’s genitals, perhaps to spare her blushes.
Scribonia, as another of her names, Attica, indicates, had Greek origins, as did her mother Scribonia Callityche; their ancestors probably included slaves. But the midwife Scribonia had gone up in the world: she had made a good marriage with a skilled healer, and she had acquired wealth. Like her husband, she had tools, which she brought to women in labour: the birthing chair and the stool on which she sat were hers.
Childbirth in the Roman empire, as everywhere in the ancient world, was women’s business. Female midwives and family members brought children into the world and attended to the care of newborns. However, with the exception of inscriptions or art on funeral monuments such as that of Scribonia, almost no first-person accounts of pregnancy and childbirth in ancient Rome are available; our knowledge is mediated instead through the writings of male authors.
Admittedly, some of these men were very well informed, sympathetic to women, and prepared to recognise the skill of midwives. Soranus of Ephesus in Asia Minor (in what’s now Turkey), who was a physician active at the turn of the first and second centuries AD, was such an author. An adherent of the Methodic school of medicine, he favoured gentle treatments over harsh ones – and nowhere is this more apparent than in his Gynaecology, the only one of his treatises to be preserved in full.
The volume opens with a description of the ideal midwife: she should be “literate, with her wits about her, possessed of a good memory, loving work, respectable and generally not unduly handicapped as regards her senses, sound of limb, robust and, according to some people, endowed with long, slim fingers and short nails at her fingertips”.
All this advice, down to the shortness of the nails, is very sensible but smacks of wishful thinking. Certainly, not all midwives in the ancient world were literate. Literacy was not an essential accomplishment for a trade that was often passed from one female relative to another in an apprenticeship based on the oral word. Some tricks of the trade, such as contraceptive or abortive remedies and preparations to speed up a difficult birth, were best kept secret – and therefore not written down.
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As for respectability, that was a matter of perspective. The author Eunapius, writing in the fourth century AD, reports an anecdote in which a hostess in a Roman wine shop – described as a relatively upmarket one – was serving a client when she was called by a neighbour and kinswoman to attend to a difficult birth (she was also skilled in midwifery). After the safe delivery of the child, she washed her hands and promptly returned to her customers. In many cases, midwifery was an occupation on the side – something undertaken by women as a contribution to their community’s welfare. Those who, like Scribonia, specialised in the business of birth and took the title obstetrix (midwife) may have been the exception rather than the rule.
It is tempting to assume that birth in the ancient world was a much more dangerous affair than it is today: there was little pain relief available, and little knowledge of infection and basic hygiene. However, in cases of uncomplicated births, women in the Roman empire could manage well with the assistance of only a wise family member – without much intervention apart from massaging of the genitals with an emollient such as warm olive oil. Advice on breathing could also help: Soranus tells us that women should “press their breath” when the pains are most acute.
Women may also have found some comfort in wearing amulets to speed up the birth. Many amulets in the ancient world were made from perishable materials, but examples from Roman Egypt (30 BC–AD 641) made from durable haematite stone have been discovered. One example, now at the Kelsey Museum in Michigan, was inscribed with magical formulas and a representation of the uterus that could be opened and closed with a key – closed when the woman wanted to avoid pregnancy or wanted to ‘lock’ her uterus after conception, and opened when she wanted to become pregnant or to open up her uterus for labour.
Things became more complicated when labour was lengthy and a baby awkwardly positioned. Midwives and doctors relied on their most trustworthy instruments – their hands, with which they could gently encourage the opening of the uterus or attempt to reposition a baby whose presentation was poor.
Ancient texts do not mention episiotomies (cutting of the perineum to facilitate the birth of a child), nor are there references to forceps, and no such instruments have been found in the archaeological record. Though the ‘caesarean section’ allegedly derives its name from that of Caesar, Roman midwives and doctors did not undertake the procedure. Stories of ancient C-sections are all mythical – for example, the story of how baby Aesculapius, the god of medicine, was snatched from the womb of his dying mother, Coronis, by his father Apollo.
Treatments and traumas
Midwives and doctors might administer herbs that caused the uterus to contract when the labour slowed down. Accounts tell of women being tied to ladders and shaken in order to speed up labour, although Soranus vehemently decried the practice. In the worst situations the mother’s life took precedence, and an embryotomy was carried out: the embryo was cut into pieces and extracted from the womb using hooks. Another risk for women in labour was retention of the placenta, which could lead to haemorrhage. Latin medical texts preserve various recipes for remedies that allegedly facilitated the expulsion of the afterbirth.
Ancient authors were aware that childbirth could be an ordeal for women, and could leave them exhausted or even kill them. Pregnancy, too, could cause discomfort, strange cravings – for coals and earth, for example – and nausea, against which the first-century-AD natural philosopher Pliny the Elder recommended the pips of citron (a citrus fruit).
One source recounting a case of ancient morning sickness – or, rather, its most severe form, hyperemesis gravidarum – is found in the Miracles of St Stephen, a fourth-century Christian text falsely attributed to St Augustine. It tells the story of a woman named Megetia who was afflicted with such bad vomiting in pregnancy that she dislocated her jaw, which made her unable to properly take food. After physicians proved unable to treat her, she travelled to the sanctuary of St Stephen near Carthage where, upon being visited by a snake in a dream, she was healed by the power of her faith in the Christian god.
Early Christian texts in general offer interesting insights into pregnancy and childbirth, because they are more focussed on the experience of women than any preserved medical text. According to the Protoevangelium of St James, an apocryphal gospel dating to the second century AD, Joseph called upon midwives after Jesus was born in a cave (not a stable, as tradition usually has it). One of these midwives, Salome, refused to believe that a virgin had given birth, and asked to inspect Mary’s genitals to check for the normal vaginal distention and blood loss that accompany birth. She found none of those signs – but her hand caught fire, healing only after she repented of her doubts. Though the story is, of course, a miraculous one, it does demonstrate that ancient midwives were used to dealing with the normal blood, sweat and tears of childbirth.
Whose breast is best?
The question of whether mothers should breastfeed their own babies was a thorny one in ancient Rome. In antiquity, the only safe way to feed a newborn baby was breastfeeding. Finding animal milk (usually goat’s milk) in a big city such as Rome was not always easy, and the milk could prove indigestible or even dangerous. The vast majority of babies in antiquity were breastfed, often for what we would consider to be long periods of time – over 18 months. Ancient baby bottles have been discovered, but they were probably designed for feeding toddlers rather than very small babies.
Debates over baby feeding raged among the Roman upper classes. In one camp were advocates of maternal feeding; in the other, advocates of wet-nursing, at least in some circumstances. The physician Soranus, though not opposed to maternal feeding, acknowledged that the process could be exhausting for the mother, and that the milk of an overtired and feverish mother could prove harmful for the baby. A good wet-nurse – Greek, well-tempered and below the age of 40 – would be ideal. However, that perfect nurse may not always have been available, and other authors also worried about the bad influence that a wet-nurse could exert on her charge, because the Romans believed that character was passed through breast milk.
More generally, the Romans considered breast milk to be a powerful substance that could treat ailments ranging from phthisis (a respiratory illness) to cases of poisoning and eye complaints. Ancient recipes for eye remedies often recommended that ingredients be diluted in human milk – an ingredient that was readily available, and certainly cheap.
Laurence Totelin is senior lecturer in ancient history at Cardiff University.
This article first appeared in BBC History Magazine's 'The Story of Medicine' bookazine