Midwives

Ancient Roman relief of a midwife, from Wellcome Images on Wikimedia Commons, CC by 4.0. 

In any culture, pregnancy and childbirth carry a certain significance, and pose a considerable risk. Any number of things can go wrong between conception and birth, and can put both mother and child in danger.

In antiquity, pregnancy and childbirth were overseen by midwives — women trained to assist other women before, during, and after the delivery of their children. Given that the average married woman in antiquity was likely to have many children during her lifetime – probably between four and six, on average – and that miscarriage, infant mortality, stillborn, and late fetal death rates were quite high, ancient midwives would have done invaluable work.

Who were ancient midwives?

It’s hard to put together a clear image of the ancient women who practiced midwifery, but a number of academics have certainly tried; some of those attempts will be outlined here.

Unfortunately, no first-hand writing from these women survives, so funeral epitaphs, grave markers, and the work of male physicians and writers must be used instead. The drawback here is that what we know of these women is very limited, and, particularly when we draw heavily on ancient male authors’ descriptions of midwives, subject to a degree of idealization or undue criticism.

“Suitable” midwives, as defined by Soranus of Ephesus

Soranus of Ephesus was an ancient Greek physician who lived and worked in Greece and Rome between the second half of the 1st century CE and the middle of the 2nd century CE. Very little is known of his life, but, along with approximately twenty other medical books, he wrote what is effectively an instruction manual for midwives called Gynaecology. In a section called “What Persons Are Fit to Become Midwives?” he described an idealized midwife:

“A suitable person will 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.” (Gynaecology, 1.3)

These qualifications are all justified in the next section, and seem quite reasonable when explained:

• literate, because midwives had to be able to understand theory;
• quick thinking in order to have understood what was happening around her;
• a strong memory to make following instructions and learning simple;
• patience and a love of work in order to have persevered through births;
• respectable, because midwives’ clients had to trust them enough to let them enter their houses and oversee the birth of their children;
• sound of limb and un-handicapped so her work would be reliable and unaffected;
• robust, because a midwife’s work would have been very difficult; and,
• long, slim fingers and short nails so as not to hurt the women she worked with.

In Gynaecology, Soranus alluded both to the character of midwives, and to the training they might have received. His emphasis on midwives’ literacy and memory implies that there were texts for them to study, and theory for them to learn. In fact, his description of the best midwives lists those with a strong knowledge of therapy and theory as the most effective midwives.

Midwives that were clearheaded, well-trained, reassuring, and sympathetic were those who Soranus considered the best at their job. It was not necessary that midwives be young or mothers themselves to do good work — though Soranus has mentioned that some people thought, mistakenly, that these things were important.

It’s likely that Soranus was describing midwives of reasonable socio-economic status, as literacy and access to more formal medical training and theory were probably not available to poorer women living in rural areas, who would have needed midwives nonetheless. Soranus has outlined for us a general, idealized image of a midwife, if not a universal set of requirements for success in midwifery.

Funerary Inscriptions of Midwives

The funeral epitaphs of these women can also give us an idea of who they were in life.

Sixteen of the funeral epitaphs recorded among the Roman Corpus Inscriptionum Latinarum are dedicated to women who were midwives. The majority of these women were freedwomen (former slaves who had been freed or bought their freedom), or their daughters. The image below shows the epitaph of Sallustia Imerita, a Roman midwife and freedwoman.

Marble epitaph plaque of midwife Sallustia Imerita and Quintus Sallustius Artimidorus, 1st century BCE – 3rd century CE. It reads: “(Here lies) Sallustia Imerita, freedwoman of Quintus, midwife. Quintus Sallustius Artimidorus, freedman of Quintus, placed (this monument).” Found here, from the British Museum online collection, CC by 4.0.

Interestingly, this suggests that, at least in Roman society, midwifery was not a profession that was especially valued, or that offered any special social status. However, its prevalence as a profession among freedwomen suggests that midwives did make enough money to buy their freedom if they were slaves.

Compared to Roman inscriptions, far fewer Greek funeral epitaphs belong to midwives who were slaves or freedwomen. We know that some Greek women were allowed to receive medical training from their physician fathers and become physicians themselves; midwifery was a separate profession, but this suggests that women who worked in medicine were at least somewhat more valued and accepted in ancient Greece than in Roman society.

Terracotta funeral relief of a Roman mid-wife, 2nd century CE. Tomb 100/Tomb of Scribonia Attica at Ostia. “Funeral monument of a Roman mid-wife”, from Wellcome Images on Wikimedia Commons, CC by 4.0.

This 2nd century CE terracotta relief comes from the tomb of a midwife named Scribonia Attica, in the necropolis at Isola Sacra at Ostia. The tombs of this necropolis contain images that depict the work their occupants did while living.

In the image, a midwife – Scribonia Attica – squats in front of another woman who is seated on a stool, while a third woman supports her waist from behind. The seated woman doesn’t look particularly pregnant, which could point to the artistic idealization of the female body, or could just be due to how simple the relief is overall. Scribonia is reaching between the legs of the seated woman with her right hand, but she’s facing the viewer, not looking directly between the seated woman’s thighs.

This relief is particularly interesting for a few reasons:

• One, it’s a depiction of a real woman who lived and worked as a midwife, and was proud enough of this fact to want it displayed on her tomb.
• Two, midwifery was not such a scandalous or low profession that an image of a midwife at work could not be commissioned by an artist or displayed on the wall of a tomb.
• And three, this birthing scene with three figures lines up very closely to other written and visual depictions of childbirth and midwifery that we have from antiquity, giving a good idea of how ancient midwives probably worked.

While midwives don’t seem to have held particularly high status, and were often descended from slaves, they probably made enough money to buy their freedom, become freedwomen, and raise families. Many midwives’ funeral inscriptions mention their husbands, and several midwives, while not freedwomen themselves, were the daughters of freedwomen. Midwives were also proud enough of their line of work to have it displayed on their epitaphs and tombs, in both writing and reliefs.

What was their work like?

Ancient midwives had many responsibilities. Most of these have been relatively consistent through time: they tended to the mother during pregnancy, working to preserve her health and prevent miscarriage, directed women through the labour, and helped in the delivery of the child. Soranus suggests that midwives also assessed the wellbeing of newborn infants, and seem to have had some say over whether a child was healthy enough to be worth raising, or whether it should be exposed instead.

It’s likely that there were differences in the way Greek and Roman midwives worked, and the type of medical services they were able to offer. There were also probably considerable differences between the midwifery practiced by rural women of lower social status, and more wealthy women who lived in larger towns and cities.

Training

Ancient midwives almost certainly received some kind of training before being trusted enough to deliver people’s children. Unfortunately, we don’t know exactly what this training entailed, or how rigorous it was. It was also probably quite different, depending on the social status of the woman undergoing training and the older women or midwives directing her.

Soranus of Ephesus’ Gynaecology suggests that midwives studied theory and were somewhat familiar with Hippocratic medicine. Gynaecology, which Soranus probably intended for midwives to read, also contains a long section on female anatomy. His understanding of the female body was deeply flawed, but suggests that midwives might have been trained in anatomy in a theoretical way as well as a practical one. In Greece, midwives of slightly higher social status might have learned medical theory from their physician fathers or other close male relatives, the same way Greek woman physicians were trained. This is really just speculation though — physicians and midwives were distinct occupations, and there is nothing to suggest that female doctors and midwives received or required the same education.

Due to the number of ancient midwives we know were slaves or freedwomen, some academics have suggested that in Rome, slave women were somehow chosen to train as midwives, apprenticed, or taught midwifery by their mothers at a young age.

Roman and Greek midwives were trained in some way, which sometimes (but not always) involved familiarization with written medical theory, alongside practical instruction. Beyond this, it’s hard to know how midwives were trained – in schools? by mothers? in apprenticeship to other midwives? with physicians? – or by whom.

The work of midwives in Pliny the Elder’s Natural History

Pliny the Elder, or Gaius Plinius Secundus was a Roman writer who lived between the years 25-79 CE. In contrast to the Hippocratic medical theory that Soranus of Ephesus wrote about, Pliny’s encyclopedia Natural History described mostly folk medicine.

Various folk treatments and remedies that Pliny listed include:

• A woman who wears a bag of gazelle skin containing hyena’s flesh, hair, and a stag’s genitals around her neck will never miscarry.
• Drinking a mixture of goose semen and water, or a weasel’s bodily fluids will ease delivery.
• The right foot of a hyena laid on a woman in labour will help delivery, but the left foot will kill her.
• Stones found in the bodies of deer and cows should be used as amulets for protection and health during pregnancy.
• A woman should eat wolf’s flesh close to her due date. During childbirth, the presence of another person who has done so can be either protective or extremely dangerous.

Most of the treatments written in Natural History are quite superstitious, and make repeated reference to spells and charms. Many also require the use of animals’ blood, body parts, and feces. Sometimes the book recommends that these materials be fumigated, and often it says they should be ingested. Beyond any questions about their actual effectiveness (which is extremely dubious by current medical standards), these treatments bring up concerns about sanitation and health. It’s entirely possible that some women became sick or died as a result of ingesting things like powdered sow’s dung while pregnant.

Pliny did not mention midwives explicitly in Natural History, but most women in ancient Greece and Rome probably received treatment that looked something like the folk medicine he described. These women would have been of lower socio-economic status, and probably lived in rural areas with lower populations. Their midwives likely would not have studied Hippocratic medicine or resembled Soranus’ literate, educated ideal.

Still, this doesn’t mean that the majority of women in antiquity would have had terrible treatment. They would have given birth at home, surrounded by their female relatives, and in the presence of a midwife they might have known closely. Folk remedies with no measurable scientific benefit may have still had a placebo effect that would have reassured women giving birth. Pliny’s Natural History sketches out an idea of what most midwifery may have looked like, performed by and for women of lower social status.

Soranus of Ephesus’ Gynaecology: a midwife’s instruction manual

Aside from its description of the ideal midwife, Soranus’ Gynaecology also outlines the practice of midwifery and obstetrics, and gives midwives instructions for dealing with the various problems that can occur during pregnancy and childbirth. It describes techniques and practices in detail, and is a hugely valuable source for our understanding of how ancient Greek and Roman midwives with some medical training might have worked.

The book is divided into four volumes:

1. Midwives and practicing midwifery during all stages of pregnancy
2. Caring for newborns
3. Diseases specific to women
4. Dealing with difficult births

Soranus strongly emphasized the importance of sanitation and sympathy for the pregnant woman. He notes the importance of using oil that had not previously been used to cook when lubricating one’s hands, and repeatedly tells midwives how to minimize the mother’s fear and make her feel as comfortable as possible. It’s also clear that Soranus understood the delicacy of newborn babies — he instructs midwives to hold infants with hands covered in cloth or thin papyrus, so it would not have slipped out of her grasp or been squeezed too hard. By extension, midwives who were able to study theory and read Soranus would have also had a grasp of sanitation, rather unlike the more common folk medicine-practicing midwives discussed earlier.

Soranus divided midwives’ care of pregnant women into three stages. In the first stage, it was the midwife’s job to prevent a miscarriage; in the second, she needed to treat the symptoms of the woman’s morning sickness and cravings; and in the third, it was to make sure the child was healthy and to prepare the mother for childbirth.

Pregnancy:

The first stage involved treatments like rest, gentle exercise, and anointment with fresh olive oil. The midwife would have advised the mother to avoid excess of food, drink, activity, and emotion, because Soranus (and by extension, other physicians and midwives) believed that any of these things could literally shake the seed loose from inside the uterus. For this same reason Soranus also advised midwives tell women not to drink alcohol, eat pungent food, or have sex.

The second stage of pregnancy, termed pica, was thought to set in around the 40th day after conception, and to last until about four months. Soranus wrote that a pregnant woman’s upset stomach and cravings could be treated with fasting, light consumption of bland foods like eggs and porridge, massages, and exercise.

In the third stage, treatments focused on helping women prepare to give birth, and on easing the burden of the later part of her pregnancy. Midwives would have told women to stay away from any sort of vigorous activity, and wrapped their stomachs with linen bandages to hold up its weight. Eventually, in the interest of bringing on a quicker delivery, Soranus wrote that midwives should loosen this bandage and let the stomach hold its own weight, give the woman warm, relaxing baths, and frequently dilate the vagina with her finger.

Childbirth:

When labour is just around the corner, Soranus writes that midwives should ready “olive oil, warm water, warm fomentations, soft sea sponges, pieces of wool, bandages, a pillow, things to smell, a midwife’s stool or chair, two beds, and a proper room” (Gynaecology, 2.2.67). The midwife’s stool is especially interesting. It gets its
own description in Gynaecology:

“‘A midwife’s stool,’ in order that the labouring woman may be placed in position upon it. In the middle of the stool and in the part where they give support one must have cut out a crescent-shaped cavity of medium size, neither too big so that the woman sinks down to the hips, nor, on the contrary, narrow so that the vagina is compressed … the sides should be completely close in with boards, whereas the front and the rear should be open for use in midwifery … on the sides there should be two parts shaped like the letter II … on which to press the hands in straining. And behind there should be a back, so that both the loins and the hips may meet with resistance to any gradual slipping.” (2.3.68)

A German birthing chair from the 17th century that is similar to Soranus’ description of ancient birthing stools. From Wellcome Images on Wikimedia Commons, CC by 4.0. 

Women would give birth, sitting upright on this stool. Three or so female assistants would also have been present to help the midwife. Two of these women would have held the woman giving birth, and the third would attend the needs of the midwife. The midwife would have sat in front of the pregnant woman – Soranus wrote that kneeling was undignified – and directed her. Soranus instructed midwives not to stare directly at a woman’s genitals, to avoid embarrassing her and making her contract out of shame.

 

This description of birth lines up very nicely with the images of childbirth we have from antiquity. The relief on the tomb of the midwife Scribonia Attica mentioned earlier is extremely similar to Soranus’ description, for example.

Soranus’ description also matches a similar scene from an ivory relief from first century CE Pompeii. Slightly more detailed than the terracotta relief from Scribonia Attica’s tomb, it shows a woman sitting on a stool, holding herself up on its back like she’s pushing, and supported by a midwife’s assistant from behind. A midwife is settled in front of her, with a sponge in her hand. Another veiled attendant (or a servant) stands behind the midwife with her arms outstretched.

Ivory relief childbirth scene from Pompeii, 1st century CE. From VROMA image archive, with permission.

According to Gynaecology, when the expectant mother began to go into labour the midwife would have gathered her assistants and had the mother sit on the birthing chair, free of any restrictive clothing and with her hair loosened or down. Here the idea of a birthing room and all female attendants makes sense: a semi-naked woman, in pain, with her hair down would not have been considered appropriate for male eyes in ancient Greek and Roman society.

The midwife would lubricate the mother’s vagina with warm olive oil, and dilate it gently with a short-nailed finger. The midwife would have also directed her to breathe from the stomach, without screaming, and to direct her breath downward while straining. Parts of this section are missing, but Soranus directed the midwife to, at some later point, insert her fingers and very carefully draw the child out while her assistants pressed down on the mother’s stomach. Midwives were to finally receive the child very carefully, with hands wrapped in cloth or papyrus, and to take care not to drop it or hold it too tightly.

Interestingly, particularly complicated, abnormal, or dangerous births seem to have been dealt with by a male physician, who would have been called in by the midwife. Soranus still included instructions for delivering unusually large, breach, and stillborn children in Gynaecology, which could point to a number of things:

• Midwives and male physicians that worked in obstetrics had some shared training, and Soranus wrote Gynaecology with both professions in mind.
• Midwives remained in the room even after a male physician was called, either lending him her advice and assistance, or following his instructions.

Or, compellingly,

• Midwives sometimes or often oversaw abnormal births themselves, without the presence of a male physician, and were familiar with the procedures for dealing with difficult labour.

Unfortunately, this is purely speculative. Midwives and pregnant women without access to a trained doctor certainly dealt with difficult births, though, and it isn’t unreasonable to assume that some of them did so successfully. These births could be so dangerous that they probably ended in death more often than not, regardless of social status and any amount of help from a physician.

Caring for the infant and mother after birth:

Roman terracotta figure of woman nursing her infant child, signed by Leontius. Found here, from the British Museum online collection, CC by 4.0.

Once the child had been delivered, its mother would rest. At this point, the midwife would assess the newborn and decide whether it was worth raising or not through a series of tests. Had it been born prematurely? Did it cry heartily when set down? Did it have any visible disabilities? Were its eyes, ears, nose and mouth clear of obstructions? The midwife would also have taken into account the health of its mother over the pregnancy; Soranus (and again, by extension his readers) seems to have had a pretty good understanding of the link between a woman’s health and lifestyle during her pregnancy, and the health of her child.

The mother and child’s comfort and health were prioritized. Midwives were instructed to cut the umbilical cord at the equivalent of about four centimetres from the mother’s body, using a sharp knife rather than blunt one, to avoid bruising. The child would have been washed, gently, with lukewarm water and salt, and then swaddled. The mother and child would have both been allowed to rest and recover before nursing.

Overall, Gynaecology is an incredibly useful source for understanding the more professional medical procedures that some midwives would have followed.

Conclusion

Ancient midwifery was vitally important. Infant mortality rates in antiquity were potentially as high as 5%, if not higher, and miscarriage and stillborn rates may have been as much as 20%. Women in antiquity generally had several children, putting them and their children at alarming risk for complications. Midwives worked not only to make mothers comfortable, but to keep them and their children alive in the face of these risks.

Further reading:

This article draws heavily from Valerie French’s “Midwives and Maternity Care in the Roman World,” (2000) which is an excellent source that summarizes a great deal of knowledge about ancient midwives. In fact, number of the other sources used here also cite it! An older version of the article is available here in its entirety.

Christian Laes’ article “Midwives in Greek Inscriptions in Hellenistic and Roman Antiquity,” (2011) provides a strong analysis of the funeral inscriptions of ancient Greek midwives.

Soranus’ Gynaecology is unfortunately not freely available online, but Pliny’s Natural History can be found here on the Perseus Digital Library and is worth a read for shock value, at least.

References:

D’Ambra, E. (1988). A Myth for a Smith: A Meleager Sarcophagus from a Tomb in Ostia. American Journal of Archaeology, 92(1), 85-99. Retrieved from http://www.jstor.org/stable/505872/

Demand, N. (1994) Birth, Death, and Motherhood in Classical Greece. Baltimore, MD: The Johns Hopkins University Press.

Flemming, R. (2007). Women, Writing, and Medicine in the Classical World. The Classical Quarterly, 57(1), 257-279. Retrieved from http://www.jstor.org/stable/4493489?seq=1#page_scan_tab_contents/

French, V. (2000). Midwives and Maternity Care in the Roman World. In E. Van Teijlingen, G. Lowis, P. McCaffery, & M. Porter (Eds.), Midwifery and the Medicalization of Childbirth: Comparative Perspectives (pp. 53-62). Huntington, NY: Nova Science Publishers.

Karamanou, M., Tsoucalas, G., Creatsas, G., & Androutsos, G. (2013). The Effect of Soranus of Ephesus on the Work of Midwives. Women and Birth, 26(4), 226-228. doi: 10.1016/j.wombi.2013.08.160

Laes, C. (2011). Midwives in Greek Inscriptions in Hellenistic and Roman Antiquity. Zeitshrift Für Papyrologie Und Epigraphik, 176, 154-162. Retrieved from http://www.jstor.org/stable/41291113/

Parker, H. (2015). Women and Medicine. In S. L. James & S. Dillon (Eds.), A Companion to Women in the Ancient World (pp. 107-124). Chichester, West Sussex: Wiley.

Pliny, the Elder. (1855) The Natural History. (H. T. Riley, Trans.). Retrieved from Perseus Digital Library http://www.perseus.tufts.edu/hopper/text?doc=urn:cts:latinLit:phi0978.phi001.perseus-eng1:1.dedication/

Soranus, of Ephesus. (1956). Soranus’ Gynecology. (O. Temkin, Trans.). Baltimore, MD: The Johns Hopkins Press. (Original work published 1st – 2nd century CE.)

Todman, D. (2007). Childbirth in Ancient Rome: From Traditional Folklore to Obstetrics. Australian and New Zealand Journal of Obstetrics and Gynaecology, 47(2), 82-85. doi: 10.111/j.1479-828X.2007.00691.x