birth, death, Hippocrates, midwives, pregnancy

Birth and risk: perceiving risk in historical societies

I’ve been involved in the past year or so with a network funded by the Arts and Humanities Research Council on risk in childbirth. I was very excited when the project, led by Adrian Wilson (Leeds) and Tania Macintosh (Brighton) was given the green light, because projects which bring together historians and practitioners are very much my sort of thing. I was asked to make two short videos for the network’s series of ‘birth stories’, and contributed one on an eighteenth-century woman having her first baby at 42, and a second on how the perception of risk changes at the end of the eighteenth century when networks of knowledge and statistics from lying-in hospitals came together.

When it was time to me to make a contribution to the workshops which the network has been running, however, I thought it would be interesting to see what could be done with the classical rather than the early modern world. This was, to say the least, challenging. So here’s what I came up with!

I started with some comments on context. Consulting someone who practised the medical art was not the only way of responding to issues surrounding reproduction. Esther Eidinow, Oracles, Curses, and Risk Among the Ancient Greeks (OUP, 2007) has shown that a key way in which individuals in ancient Greece managed risk and uncertainty was to consult oracles. Going to the oracle could provide reinforcement for choices you’d already made. Alongside travel, marriage, and setting up a colony, questions to these oracles were posed ‘About the birth of children’. She notes, ‘It is surprising, considering how dangerous childbirth was for mother and child, that there are no questions concerned with the details of birth’ (2007: 89). It was often men who asked these general questions, e.g. ‘will I have children from the wife I have now?’ Men also asked if the child their partner was carrying or had given birth to was theirs or not, or – looking to the future – ‘whether I will have children from this woman/the wife I have now’. This may suggest that the man is willing to dump that particular wife if the union isn’t going to produce children. An example from the city of Dodona: ‘Herakleides asks Zeus and Dione for good fortune and asks the god about offspring. Will there be any from Aigle the (wife) he has now?’ (2007: 90).

While birth concerns appear in this sort of writing, there are no details of birth, no histories of miscarriage brought to the gods. So just how aware were the ancient Greeks of the dangers of birth? We are usually told that, in a pre-modern world, women would know of cases which ended badly, in their village or family, but that this wasn’t a very large sample so many wouldn’t be alarmed. However, alongside this we also have the early modern European examples of women getting their coffins ready before going into labour – what Adrian has called the ‘fear thesis’, in which women swapped horror stories and an unrealistically high perception of risk resulted.[1]

I think these dangers come across very clearly in the short Hippocratic treatises Superfetation and Excision of the Foetus, almost entirely ignored in the scholarly literature. Excision probably dates to the late 5th/early 4th century BCE and may be a lost section of the long treatise Diseases of Women (Craik, The Hippocratic Corpus (Routledge, 2015)). Superfetation is maybe a little later, mid-4th century BCE. Both little treatises have overlap with the main Hippocratic collection on gynaecology, Diseases of Women – the material is being reused with a different focus. Both Superfetation and Excision are named for their first chapter, but contain information on far more birth-related problems than this. Superfetation, for example, deals with methods of begetting a male child or a female child, and has advice on encouraging conception by cleaning out the womb, and positioning its mouth correctly so that it can receive the man’s seed.

Excision concerns a range of serious situations, although the opening section on how, in arm presentation, the arm must be excoriated and then removed by cutting the shoulder joint and using a fish skin to help the grip, is enough to horrify most readers. Unusually, Excision gives us some sense of the reactions of the woman: ‘you must cover her head with a cloth, so that she will not see what you are doing and become frightened (phobêtai)’. Yet the operation ends with the foetus removed, the woman lying with her legs crossed, and the advice ‘Otherwise treat her as you would any other parturient’. This text shows that the male practitioner called in for a birth which would otherwise end in disaster is very much aware of women’s fear. This must be a fear for their own lives, as their babies have almost certainly already died. It also shows us men’s apparent confidence in this potentially fatal situation. Yet this situation of risk is presented as unexceptional and, at the end, the woman who has been through it is treated as any other woman.

In Superfetation, the terminology of birthing suggests the categories of both ‘dangerous’ births and ‘difficult’ births were used. Danger uses words related to kindunos. Difficulty uses the basic birth word – tokos – and adds the prefix dys– to make dystokia.

Superfetation normally starts each section with hokotan, ‘when’: when a woman conceives a superfetation, when a child is born prematurely, when one arm presents. There is no sense of whether all these possible scenarios are equally common. Occasionally, however, the compiler uses mallon, ‘generally’: ‘A woman, in whom the foetus has its membrane torn off in the uterus before it begins to move outward, generally has a difficult and dangerous birth, unless its head leads the way’. There seems to be some sense here of awareness of a pattern and of relative degrees of risk.

In Excision, the categories of ‘normal’ and ‘natural’ appear; mê kata tropon, not in the normal way, and kata physin, in the natural way. The treatise is introduced as being about ‘pregnancies that don’t proceed in the normal way’, by which that opening chapter means those which involve a dead foetus which must be reduced and then pulled out. Even here, though, there is a sense of the ‘natural’: the head of the foetus must be placed in what would be the ‘natural’ position and then, if at all possible, brought out in the ‘natural’ way.

With these very early texts, I suspect that this route of very close reading, and sensitivity to slight changes in wording, is our best way forward. They give us a rare window into the expectations of women and of those who cared for them in birthing.


[1] ‘The perils of early modern procreation: childbirth with or without fear?’, British Journal for Eighteenth-century Studies 16.1 (1993)

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