I have a somewhat historical question I guess that I was wondering if you knew anything about. A common trope I see in any media taking place in any time period before early to mid 20th century is the mother dying in childbirth thing? And I was just wondering (even just in regards to the time period of your expertise) what we're the mortality rates for women in childbirth?
Heh. Well. (This is probably going to be way more than you wanted to know, but I believe in being thorough.)
First, childbirth has always been risky (women still die from it in modern countries in modern hospitals with all of 21st century medicine behind them, and it’s still a major health concern for countries in the developing world – Sierra Leone in Africa has the worst maternal mortality rate in the world, with up to 1,360 deaths per 100,000 births, or a 1 in 17 chance). So childbirth in the pre-modern era, without possibility of surgical intervention (unless to save the baby and kill the mother), painkillers, modern hygiene, X-ray/ultrasound equipment, and sterilized hospital settings, was dangerous. Ignaz Semmelweis and Alexander Gordon, two 18th/19th-century obstetricians who investigated the causes of puerperal fever or childbed fever, and concluded that it could often be prevented by the doctor just vigorously washing his hands between deliveries (and not, you know, performing an autopsy on a dead body and going straight to deliver a baby) were treated with complete ridicule by the scientific establishment and branded as charlatans. (This, as you may notice, will become a theme.) Modern germ theory and sterile instruments weren’t established until the late 19th century. So yes, the risk was very real, and noble and common women alike died in childbirth. We obviously don’t have anything resembling detailed demographic information, but we can conclude the rate would be similar to a developing country today.
However, this is very far from saying that no kind of maternal or prenatal care or practice existed. This is once again where we discover how terrible the late medieval/Renaissance era was for women’s rights/education/professional liberty/basically everything (seriously, Renaissance, your art is nice, but otherwise you can fuck off). In the eleventh and twelfth centuries, the famed medical university at Salerno, in Italy, fairly freely accepted female students and professors, and their most famous professor and scholar on women’s health was Trota of Salerno, who gave her name and a good deal of her own experience to the three texts known as the “Trotula.” These were each written by a different author under Trota’s supervision and authority, and the first two books, “Book on the Conditions of Women” and “On Treatment of Women” represent a detailed gynecological handbook with advice on all kinds of pregnancy/childbirth-related ailments – uterine prolapse, perineum tears, medicines, and other solutions from a practitioner who, unlike her male counterparts, could actually touch and study her patients’ bodies. Trota is referred to as a “magistra” (the female form of Latin magistro or master) and her work was widely circulated and read in England and Normandy as well as Sicily (which was under Norman rule itself from about the mid-eleventh century). So she was a famous doctor and scholar in her own day (until, of course, she was obscured/changed to male/ignored/nearly forgotten until the twentieth century). Another “magistra”, Hersend of France, accompanied Louis IX on crusade in the thirteenth century and treated both the king himself and the female members of the crusade contingent.
Of course, ordinary women would not have had access to these highly trained female physicians, and most midwives had no special or formal training aside from their own practical experience. As well, almost everyone writing medical texts was (shockingly!) a man, making it nearly impossible to know much about these actual practitioners. Since pregnancy was, of course, a result of sex, the church had plenty of opinions on it as well. The suffering of childbirth was supposed to be the proper punishment for original sin, so anything that dulled the pain was frowned on, and when actual training of midwives was instituted in the later medieval era, the concern was mostly on whether they knew how to perform an emergency baptism for the child’s sake, rather than any care of the mother. (Wow…. this sounds… awfully familiar, doesn’t it?) Nonetheless, there are literally dozens of texts from antiquity to the Renaissance, representing folk/informal recipes and methods for contraception and abortion. We don’t know how well any of these worked, if at all, and they were usually (again) written by men trying to tell women what to avoid (but having the effect of also giving them the information if they wanted it). But there was a vast and probably at least somewhat effective corpus of traditions/medicines/rudimentary contraceptive methods available and transmitted through female practitioners.
None of this was ever taught to men, naturally, and the universities, as they became more established, did their damndest to stamp out “unlicensed” practitioners, which really meant women. The 1322 trial of Jacoba Felicie, a female doctor in Paris, is basically representative of the later medieval pushback against women practitioners. Jacoba’s patients, both male and female, testified that she was a highly skilled doctor and they had gotten better after visiting her – but the court’s judgment was that since she was a woman, she couldn’t possibly be as good a doctor as a man, and she was barred from practice. (If this post was Misogyny, Take a Shot, I think we would all be hammered by now.) That decision also led to legislation to keep women out of universities/medical school in France (in 1421, Henry V also banned them in England). So once again: You Suck, Renaissance!
This also involves questions of medieval sexuality, religion, and general hygiene/attitudes toward cleanliness and medical care. First, aside from the texts mentioned above that discuss folk remedies for contraception, a medieval woman had various strategies to space her children that didn’t just rely on hoping her husband didn’t rape her too much (as I have ranted about before). Also, it’s worth pointing out that children were a natural and expected part of medieval marriage, and most couples would be more interested in ensuring they had children, rather than preventing them – limiting family size to the average 2.5 children is a modern conceit once more linked to capitalism and the de-coupling of marriage/family/household from its function as a unit of economic production, as I wrote about here. Children were valuable as heirs to noble families or working members of a lower-class family, and with likewise high infant/child mortality, you could sometimes have a number of children and hope that one or two of them made it to adulthood.
However, that didn’t mean that all medieval women just pumped out babies until they couldn’t have any more. The third-century Roman physician Galen’s theory of female orgasm being necessary to conceive was considerably well-known in the medieval era. While this backfired on rape victims, as it was figured they couldn’t have gotten pregnant if they didn’t enjoy it (paging Todd Akin… wow, this is depressing, isn’t it?), it also meant that your average medieval married couple would have believed that the woman, not just the man, experiencing pleasure was necessary to have children. Cue the church clutching its pearls in the background, but the official Catholic theology and teaching of sexuality was, again, mutable. The thirteenth-century sect of the Cathars viewed all sex, married or otherwise, as evil, so in response and opposition to them, the Catholic church began glorifying marital sex to some degree. There was a recognition that both spouses owed each other sexual availability and pleasure, and marriages could be dissolved if this wasn’t upheld on either end.
As well, since close to half the days of the year (Wednesdays, Fridays, Sundays, Lent, Advent, holy days, six weeks after childbirth, etc) were regarded as impermissible for sexual activity, that meant couples (if they were religiously observant, or if they just wanted to avoid the possibility) had the option of spacing out procreative sexual activity. There wasn’t any institutional or official acceptance of sex outside marriage (though oh boy, it happened – up to 30% of brides were pregnant at their wedding), but there was also a lot of argument about what constituted marriage. It could just be as simple as saying “I take you as my wife/husband” without any church framework or institution whatsoever, and then having intercourse. (See chapter three, “Sex and Marriage,” in Sexuality in Medieval Europe.) The church viewed these couples as fornicators if they hadn’t been married formally, but what we would consider cohabiting unmarried couples (similar to a couple living together before actual marriage today) were fairly common. Noblewomen in particular were expected to give their husbands heirs, but after that, if they didn’t like each other much, he would have mistresses and she could be excused from it. The noble couples we know of with a high number of children seem to have been the ones who genuinely liked each other/had happy marriages anyway, and thus continued having sex even after the succession was secured.
Plus, the ideal of chastity, both inside and outside of marriage, was very socially influential. The late medieval English mystic Margery Kempe managed (after having fourteen children with her husband) to get him to agree to a chaste marriage (we have him sadly asking her if she would prefer to kill him with a hatchet rather than letting them have sex again – which, after fourteen kids, she might). Women who chose to be virgins or abbesses or nuns were also excused from childbirth, although they sometimes faced pressure from their families to marry and continue the line. But chastity was admired in both men and women, and considered a prerequisite for holiness, so it was a way to avoid sexual activity (and thus more children) as well as getting in the church’s good books.
Lastly, there’s the general idea that people in the medieval era were filthy, dirty, foul-smelling, had rotten teeth, etc. Medieval people probably had structurally better teeth than we did (though obviously without modern dentistry/orthodontics) albeit worn down from grit/particles, because processed sugar wasn’t part of their diet. Next, while obviously they did not know about germs/the root causes of illnesses, they logically associated filth and bad smells with disease. Most cities had ordinances about where you could dump your waste and strict punishment for litterbugs. Full-body bathing was rare, because of how much time and effort it would take to fill a whole tub (especially if you were drawing water from a well or pump), but they washed hair, hands, faces, etc regularly. They prized sweet smells and perfumed/fragrant herbs, so while they would obviously have more body odor than we do with daily showers/soap/deodorant/etc, they wouldn’t be some strange shit-smeared, rotten-toothed rustic barely one step above a caveperson. In the 1400s, we find the Hotel-Dieu, the major hospital in Paris, believing that pregnant/postnatal women should have three baths a week and their linen washed regularly (that whole article is worth a read – said hospital was also entirely staffed by women/religious sisters).
Since this has gotten super long (as I said, more than you want to know), allow me to summarize. Midwifery/women’s health care has (surprise!) a very long history and was intentionally destroyed/excluded from male-dominated university curriculums, medieval women giving birth did die but not outlandishly/without any treatment at all, and the presence of women in medical school/practice was increasingly restricted up to and around the Renaissance. (It’s a subject of debate how many midwives were targeted in witch hunts, but some of them definitely were.) This also connected to medieval attitudes about sexuality, procreation, religion, and women, and the options that medieval women had for controlling the number of children they had or didn’t have, and their relationships with their husbands and what was expected of them as a result.
I will also note in closing that the “dying in childbirth” thing in historical fiction is a way to easily invoke the ever-present Dead Mother trope in a historically plausible, if rather lazy, way. Since everyone knows women did die (and do die) in childbirth, it becomes an easy way to kill off the protagonist’s mother or to make some point about The Dangers Of Women’s Lives Back Then (whether in-universe or intended for the modern audience). All of which is absolutely the case, but which ignores, as usual, the complexity of the ways in which premodern medicine for women, and women themselves, created a corpus of knowledge and treatment that remains unacknowledged, overlooked, dismissed, or otherwise intentionally destroyed by a patriarchal, misogynistic system.
/takes a bunch of shots