Learn Blogs Roman women and children Part 2 - Pregnancy and childbirth By Sheila Cadge - Volunteer Guide Much of the information I’ll be referring to in the following sections comes from a four-volume treatise, Gynaecology, written by Soranus of Ephesus who lived at the end of the first century AD. His writings were to a large extent based on observation and common sense, and many of his observations would be instantly recognisable to a medical practitioner today. As usual we have little from women themselves, but epitaphs do provide some information. Contraception and abortion It was the woman’s responsibility to take care of contraception, rather than the man’s. Contraception was not illegal and several methods were available, some of which would have been more effective than others. Most Roman mothers would have continued breastfeeding for much longer than the current norm, for between two and three years, and this would have had a natural contraceptive effect. Bottom of the list in effectiveness for me is Pliny the Elder’s suggestion, namely that you should cut open a type of hairy spider, which has a very large head with two small worms inside. If the worms are tied on to women with a strip of deer hide, allegedly they will not conceive for a year. Washing after sex with a vinegar douche was recommended along with magical preventatives or a post-coital routine of squatting and sneezing and drinking something cold. Washing facilities were always supplied in brothels where it was important that women did not get pregnant as this would lead to a loss of income for the brothel keeper. Soranus enumerated several different options and methods for preventing pregnancy. He recommended avoiding the most fertile time of the month, but unfortunately, he thought the middle of the menstrual cycle was not a likely time to become pregnant, so this would have been a counter-productive suggestion. Barrier methods included smearing on spermicides such as elephant dung, rancid olive oil mixed with honey, myrtle oil, white lead and blocking the entrance of the uterus with a clump of fine-spun wool. He also suggested women insert suppositories on the days before sex. One recipe includes pomegranate peel and oak apple shaped into the form of an acorn. John M Riddle, a medical historian, carried out laboratory tests in the 1990s on some of the substances prescribed by Soranus. For example, in some of these experiments, if female rats were fed pomegranate (skin), this resulted in only 72% as many pregnancies as would normally have been expected. Forty days later the rats’ fertility returned to normal. Riddle posits that the legend where Persephone ate six pomegranate seeds and so was doomed to stay in the underworld for six months, resulting in the barren winter months on earth, was more than coincidence and linked to ancient knowledge about this fruit’s properties. Of the ten plants mentioned by Soranus, Riddle judged eight as having contraceptive or abortifacient properties to varying extents. An ancient plant called silphium (a type of giant fennel), which has never been exactly identified and which is now probably extinct was recommended, although scholars differ about how effective it would have been. Whereas contraception was legal, abortion wasn’t, as this was viewed as depriving the father of his property i.e., the unborn child. In his Satires, Juvenal alludes to the fact that many women in illicit relationships resort to abortions and abortifacients, if contraception has failed, telling the husband that this is a good thing: ‘Be grateful, you wretch, and offer your wife yourself whatever she has To take, since if she had chosen to let vigorous boys vex and stretch Her belly, you might have been father to an Ethiopian!’ (Juvenal Satires VI) Juvenal was very disparaging of women in general, and while conceding that a lower-class woman who went through with pregnancy had to endure the dangers of childbirth and all the effort of nurturing offspring, he complains: ‘Hardly any woman who sleeps in a gilded bed will lie there in labour, Such is the power of the arts and drugs, of that woman who procures Abortions, and contracts to murder human embryos in the womb.’ (Juvenal Satires VI) To induce an abortion, Soranus recommends taking strenuous walks and being shaken up by draught animals. The woman should make violent leaps in the air and lift objects which are too heavy for her. If this doesn’t work, she should be placed in a sitz bath in a decoction of linseed, fenugreek, mallow, marshmallow and wormwood then bled. Alternatively, suppositories made from myrtle, snowdrop seeds and bitter lupine seeds can be used. Rue was used both as a contraceptive and abortifacient. Ovid in his Amores II exhibits a really harsh attitude to women who, in his opinion, underwent abortions just so that their stomach would remain wrinkle free. His argument is that the human race would have become extinct if every woman did this. He said that women attempting abortion often die themselves and commented that when a woman dies and is carried to the funeral pyre, everyone who sees her pyre shouts, ‘She deserved it’. Conception Soranus advised that no intercourse should take place before physical and anatomical maturity and the onset of menstruation. However, in the event of very early marriages, ‘whether or not these marriages were consummated is an awkward and unanswerable question’, as Mary Beard rather grimly points out in SPQR. As soon as a young girl began her periods the world around her would have quickly closed in, with a chaperone appointed to guard her virginity and her visitors carefully monitored. Her diet was altered to remove meat and reduce animal fats, as this was considered a healthy preparation for pregnancy. The Romans believed that a male child was produced with sperm from the right testicle, as this was higher than the left, befitting the male status in life compared to the female, who, it was believed, was conceived with sperm from the lower left testicle. To avoid having a female child a man was advised to tie a cord round his left testicle during intercourse. The best time of the month to conceive, according to Soranus, was ‘when menstruation is ending and abating, when the urge and desire for intercourse are present (…) and when a pleasant state of body and mind exists.’ Successful conception to the ancient mind was, in its simplest form, the male seed being retained in the womb. Symptoms of conception included: a shivering sensation after intercourse, swollen breasts, cessation of the menses, and heaviness of the limbs. Pregnancy When pregnancy seemed likely, the first stage of prenatal care began. This stage focused exclusively on retaining the seed within the womb, which was regarded as a tricky business, since many activities were believed to remove it, such as ‘coughing, sneezing, blows and falls...lifting heavy weights, leaping, sitting on hard sedan chairs, (and)..drunkenness’, along with strong emotions. Soranus writes that the care of a woman through this seed-preservation phase involved anointing her with freshly extracted oil from unripe olives, confinement to bed for two days, and a light diet of grains. Relaxing activities such as drinking wine or enjoying baths, were to be avoided for a week. Gradually, activity and bland food could increase, although sexual intercourse was barred, allowing the uterus to rest. Pliny the Younger tells us about a miscarriage suffered by his third wife, whom he probably married when she was no older than 14. In a letter to her grandfather, he lamented ‘She’s a young girl and didn’t even realise she was pregnant, consequently she failed to take certain precautions necessary for pregnant women and she did things she should not have. She has paid for her ignorance and her lesson has been costly.’ The second stage of maternity care was known as the pica or magpie stage (so called because magpies allegedly eat almost anything) beginning about 40 days after conception, and exhibiting symptoms such as nausea, upset stomach, fever, dizziness, and bizarre food cravings for items such as, ‘earth, charcoal, tendrils of the vine, and unripe and acid fruit’. For nausea, a one day fast was prescribed to ease the stomach and prevent sickness, and an oil rubdown was given. Pliny the Elder recommended the pips of citron (a citrus fruit) for this symptom. Small portions of easily digestible food were offered, such as porridge or soft-boiled eggs, along with cold water. Astringents such as rose oil, myrtle, or unripe olive oil were sometimes applied to relax an extremely upset stomach, along with having a tightly wrapped woollen girdle. Most importantly, the pregnant woman should not be allowed to eat unhealthy foods, despite cravings. In the third stage of pregnancy, increased exercise, food, and sleep were prescribed in order to build up the pregnant woman's strength in preparation for labour and childbirth. After the seventh month, less physical activity was recommended, and linen support bandages were used to help bear the added weight. As well as this, wine and sweet-water baths were used to calm the woman's mind. Her belly was rubbed with oil to avoid stretch marks, and her vagina anointed with softening agents such as goose fat. Childbirth The production of children was a dangerous obligation, and thousands of deaths are recorded on tombstones throughout the empire. There was a high risk to mother and child because of factors such as infection, haemorrhage, and often the very young age of the mothers, with underdeveloped pelvic bones. As already mentioned, about one in every fifty pregnancies ended with maternal death as a result of childbirth. As a single example of some of these dangers, one of the skeletons found at Pompeii is thought to be of a slave girl about 16 years old, who was heavily pregnant and in a very poor physical state from the life she had been forced to lead. She was undernourished and underdeveloped, and four of her vertebrae were fused together as a result of heavy labour while her body was still growing. She would undoubtedly have died in childbirth, and the eruption spared her from an agonising and prolonged death. As everywhere in the ancient world, childbirth was women’s business. Female midwives and family members or friends would be responsible and men would not normally be present unless as a physician or surgeon in the case of a complicated birth. Pregnancy and childbirth were, however, subjects of interest to male physicians and scholars such as Pliny the Elder who lived a century before Soranus. In his Gynaecology, Soranus gives clear and precise instructions for the whole process of giving birth, including preparations and how to conduct labour. With the exception of inscriptions or art on funeral monuments such as that of Scribonia Attice, a midwife buried in Ostia, whose tomb contains reliefs of the process of childbirth, almost no first-person accounts of pregnancy and childbirth in ancient Rome are available. In cases of straightforward births, women in the Roman empire, from lower social classes especially, would have to manage as best they could with the assistance of an older female member of their family. The services of a midwife would have been too expensive. Plants and herbs such as dittany (a type of oregano) leaves, catmint in hydromel (fermented honey and water) and verbena root were used for relief during labour. Also, various remedies were employed such as consuming a drink powdered with sow’s dung to relieve labour pains or inhaling fumes from hyena loin fat. Expectant mothers may have worn amulets to speed up the birth. Examples from Roman Egypt have been found covered with magical formulas and a representation of the uterus that could be opened and closed with a key. The amulet would be opened to promote a speedy labour. Women would also let down their hair to encourage the entrance to the womb to relax. The development of midwives greatly improved the birthing process. Midwives assisted births in the home and prepared the mothers with oil for lubrication, warm water, sponges, and provided bandages for the newborn. Soranus writes that the best midwife should not be superstitious. She needed to be knowledgeable about theory in addition to handling actual cases, she should be sympathetic, discreet, unruffled in crises and always sober because she’s never sure when her services will be required. It is unknown however, how many people would have had access to this type of midwife. On Scribonia’s bas-relief she is shown delivering a child. A highly pregnant woman sits naked in a birthing chair. 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. The birthing stool was a vital piece of equipment for a midwife and Soranus gives very detailed instructions on how it should be manufactured and used. It was crescent-shaped with a high back and strong arms for the mother to grip during contractions. However, not all midwives, would have been able to afford one of these, and Soranus says that if this is not available the woman giving birth could sit in another woman’s lap. This woman needed to be strong enough to bear the mother’s weight and keep her still. Both midwives and doctors were convinced that delivery was easier if the mother sat in an upright position. Things became more complicated when labour was lengthy and a baby awkwardly positioned. There are accounts of women being tied to ladders and shaken in order to speed up labour, but the main way to remedy this for midwives and doctors was by using their hands, with which they could gently encourage the opening of the uterus or attempt to reposition a baby. Once the baby was born the midwife would cut the umbilical cord and remove the placenta. In the worst cases the mother’s life took precedence and the embryo would be cut into pieces and removed from the womb using hooks. There was no doubt a high maternal death rate from this procedure as well. Roman midwives and doctors did not practise Caesarean sections, and it is a myth that Julius Caesar gave his name to this practice. The only time such an operation would take place is if the mother had already died. This blog has been written as part of our Roman Holiday Project. Reference material Juvenal -Satire 6 Soranus of Ephesus -Gynaecology Shelton J-A - As the Romans Did (source book) Oxford UP 1998 Angela A - Amore e sesso nell’antica Roma, Rome 2012 Beard M -Pompeii, London 2008 -SPQR, London 2013 Meet the Romans episode 3, BBC 2012 Birley A - Garrison Life at Vindolanda, Stroud 2002 Life in Roman Britain, London 1976 Birley B & Greene E - Vindolanda Jewellery Report, 2006 Birley R - Vindolanda Bowman AK - Life and Letters on the Roman Frontier, London 1994 Carroll M - Infant Death and Burial in Roman Italy Collins R - Living on the Edge of Empire, Barnsley 2020 Dasen V - Childbirth and Infancy in Greek and Roman Antiquity Hughes B - Pompeii Top 10 treasures, Channel 5 2019 Riddle JM- Contraception and Abortion from the ancient world to the renaissance, Harvard UP 1992 Websites etc Wikipedia alimentarium.org Francesca Fulminante - Webinar Infancy and Childhood in Pre-Roman and Roman Italy Isotopic and Dental Evidence for Infant and Young Child Feeding Practices in an Imperial Roman Skeletal Sample Elite Child’s Grave Discovered in Central France Vox Populi Thanks to Marta Alberti and Barbara Birley for information/clarification and Katy Barke for general comments.