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Throughout Time, Throughout the World: Birth Partners

Posted Mar 20 2011 4:56pm
This is the fourth installation of our Throughout Time, Throughout the World Series. The other posts can be found here Childbirth Practices
Breastfeeding
Baby Wearing


Since the dawning of time, it has been the traditional role of women to attend other women in labor and birth. 
2100 to 2000 BC Cyprus birth and breastfeeding vessel
Midwives were the doctors, the counselors, the shaman, the healers, the pediatricians, the birth professionals, the mashkiki and the midewikwe. Doulas were the women-helpers; women of age who had been-there-done-that, were old enough to understand the work being done, the servants of the heart and body.
Midwives and Doulas are the two roles as taken by the women attending other women during their labor and birthing times. From the earliest manuscripts and portrayals of birth, we see one, if not more, women attending the woman in labor. In this post, we are going to look at the global and historical roles of these beloved women.

Birth of Edmund c 1433
Midwives
The Hebrew people called her yalad - meaning 'bringing forth'. The Latin term cum-mater, along with the Spanish/Portuguese term comadre, all mean 'with woman'.
Childbirth from Al Maqamat by Al-Hariri circa 1054-1122
"The ancient Jews called her the 'wise woman', just as she is known in France as the sage-femme, and in Germany, the weise frau and also Hebamme or 'mother's adviser, helper, or friend'. The English 'midwife' is derived from mid wif, or 'with-woman'" - J.H. Aveling
References to midwives are found in ancient Hindu records, in Greek and Roman manuscripts, and even in the Bible
"And when she (Rachel) was in her hard labor, the midwife said to her, 'Fear not, for now you will have another son.'" - Genesis 35:17

"Therefore God dealt well with the midwives: and the people multiplied, and waxed very mighty." - Exodus 1:20
In ancient times, a midwife was considered both the magical/mystical/holistical practitioner, and the medical/herbal practitioner. She was often revered as a necessary part of the community, sometimes considered a leader in the community. Other times, depending on the social and political climate, she was considered someone to be feared, tortured, or even killed.
Angkor Wat Cambodia
Early civilizations always had a resident female healer to attend to colds, infections, birthing women, newborns, and more. They were knowledgeable of plants, herbs, poultices, and, most importantly, the human body - what was right, normal, and good, and what needed to be remedied. They were responsible for the health and well being of their communities.
Nativity, Antonio Veneziano
For this reason, leaders often sought their advice on planting, moving, marriages, remedies, and the like. They had influence. They were often compensated for their time and help by communities building them homes, offerings of crops, meats, chopped wood, bolts of cloth, and heirloom trinkets. They were, by no means, rich, but they were taken care of by the people in their communities.

"Childbirth" Antonio pur Gonzalez, Mayan painting
They were herbal and medicinal healers, knew how to bring down fevers, slow a hurried pulse, set a bone, bring forth a stubborn baby from labor, diminish rashes, stop diarrhea, and bring on periods. And they did it all while counseling the families personal and emotional needs as well.

Der Frauen 1513 book by Eucharius Roeslin Renaissance


Unfortunately, the Middle Ages brought the infamous witch hunts of Europe. These spread, primarily, from Germany through to England. The Medieval Church and civic authorities (often one and the same) mandated that citizens turn in anyone suspected of 'witch-like' behavior. In fact, if you lived during that time and you did not accuse at least one person of witchcraft, you were at risk of accusation, excommunication, or banishment.
"... Because the Medieval Church, with the support of kings, princes and secular authorities, controlled medical education and practice, the Inquisition  constitutes, among other things, an early instance of the "professional" repudiating the skills and interfering with the rights of the "nonprofessional" to minister to the poor." - Thomas Szasz
Medieval artwork of midwife preparing pennyroyal

From the standpoint of the Medieval Church, they touted that witches, those deserving of death, were not only those known to murder and poison, commit sex crimes and conspiracy ( which included 'thinking independent of a man'), but even those who were known to help the less fortunate and needy, those known to be healers. 
Cypress Childbirth Statuette
""And if it is asked how it is possible to distinguish whether an illness is caused by witchcraft or by some natural physical defect, we answer that the first is by means of the judgement of doctors..."... Whereas, "If a woman dare to cure without having studied she is a witch and must die." - Malleus Maleficarum
Because midwives were not from rich families, and their knowledge passed down from woman to woman, generation to generation, and because the majority of midwives were illiterate and willing to barter their wisdom for food and clothing, midwives served the people, regardless of class or wealth.
Roman 4 AD
Likewise, they were also usually not in high esteem with those who refused to serve and heal the community if the community could not pay. As such, the wealthy and influential church and government at their day with midwives. 

Chinese print of women attending mother
Although Europe eventually gave up the hunt for witches, lay-healers, literate women, and the like, the damage was done. We were already on to the Age of Enlightenment.This time was marked with a desire to know all that could be known and, as the Medieval Church had already put strict manacles on the feminine sex, women were not invited to this party.

Childbirth Scene of Or San Michele Florence, Italy © David Lees
Men dominated a new formal education program called the University. This 'place of higher learning' delved into the mysteries of mathematics, astronomy, astrology, alchemy, theology, geography, and politics.

Subversively, midwives still practiced their craft, as there were still those who did not have the means to pay the wealthy, male professionals. And, even when they did, generations of midwifery-attended birthers refused to go quietly into the night as more aggressive and less educated 'doctors' sought to lift the skirts of local women.
Roman Relief
There were glimmers of hope, during this time, as the story of Louise Bourgeois shows us.
"Louyse (or Louise) Bourgeois (c. 1563 - 1636) was a medical pioneer who paved the way for the modern profession of nurse - midwifery. As royal midwife in the early 16th century to King Henry IV of France and his wife Marie de Médicis, Bourgeois raised midwifery from folklore to science. For many years she delivered the babies of the top echelons of the French aristocracy, accumulating knowledge of the anatomy of childbirth and asserting the value of the knowledge of midwives as compared with that of the male surgeons who controlled the childbirth setting. Possessed of strong scientific instincts, she wrote voluminously, making important contributions to obstetrics. But at the root of her methods were common - sense convictions: each birth, she felt, was an individual experience unlike any other, and natural processes ought to be trusted, with birth attendants in most cases intervening, if at all, only to help nature along." - Encyclopedia.com
Roman birth sculpture

As the new doctoring professionals started to realize that they would not be able to take over this profession, instead they began taking charge of the profession. Governments and universities began regulating the education and training of midwives. Even though most of the knowledge continued to be passed through apprenticeship, early licensing and training began to take a more formal route - which, duplicitly, allowed for the male-dominated field of sciences to begin to get a glimpse into the world of birthing women.

chinese home birth

As early as 1560, Parisian midwives had to pass a licensing examination and abide by regulations to practice. During the 17th Century, France started a school for midwifery, while dutch midwives were held in high esteem, protected by surgeon's guilds and practicing under strict rules and regulations.

Juedisches Ceremoniel J. G. Puschner 1716  Germany
In 1671, Jane Sharp became the first woman to publish a midwifery manual in English, explicitly addressed her guide to her “sisters,” the “midwives of England,” and, while she
“cannot deny, that men in some things may come to a greater perfection of knowledge than women ordinarily can by reason of the former helps that women want, yet the holy scriptures hath recorded midwives to the perpetual hour of the female sex. There being not so much as one word concerning men-midwives mentioned there that we can find, it being the natural propriety of women to be much seeing into that art…" - The Midwife's Book.
Italian scodella, Francesco Xanto Avelli, ca 1486-1582
England began requiring a more strict and verifiable apprenticeship before allowing a fledgling midwife to be on her own. Midwives also began to slowly win the favor of the church, as the Bishop's Court began appointing midwives to baptise infants not expected to survive. Likewise the church admonished that midwives should be women of utmost character, being neither too old or too young, be willing to denounce sin, and to stand as a witness to the mothers testimony of the child's father, at the height of labor.
Hindu birth art
Many midwives followed the ships bound for America, and colonial midwives found a high place in early American society. Likewise, they found that their Native American counterparts were just as prevalent in their respected cultures.
Indian Birth Art from Kalpa Sutra The Birth of Mahavira, c 1375-1400
As Europe was already formalizing training of midwives, but European colonized America was still in it's infancy, midwives once again found themselves the settlements first go-to for ailments, bumps and bruises, and, most of all, births.
Gustave Witkowski, Pioneer Birth Scene, 1877
One American midwife by the name of Martha Ballard practiced midwifery in Main between 1785 and 1812.  Her detailed diary gave us great insight into the magnitude of a midwife's multifaceted role in her community.

Wisconsin College of Midwifery
In 1716, New York City became the first part of America to require a midwife to be licensed; and, in late 1700's, the first large city hospitals opened. Also in the late 1700's, doctors began opening midwifery courses. Very few women attended, as it was deemed socially improper for them to do so, but many aspiring male-midwives did.
French oil painting c 1800
As colonies became cities, and cities became overpopulated, doctors began marketing themselves as the safer route to go. Doctors of the 'New World' followed suite from their European counterparts, but much more aggressively, and, in a male-dominated society, once again men were calling on other men, who were considered more educated and more competent, to deliver their wives.

The 17th Century Birthing Chamber - by Lawrence Alma Tadema
By the early 18th century, obstetricians were beginning to dominate the field of childbirth, as populations became larger cities, and the affluent were seen as the most knowledgeable. The advent of pain medicine for birth, forceps, and obstetrical training meant that midwives were paid less and less. Midwifery payment was unregulated and the amount equated to what level of expertise the man of the house thought the service-person possessed.


Midwife Mary Gerrard, 1886, at her clinic - http://ebling.library.wisc.edu/historical/wi-women/index.cfm
At the same time, infection ran rampant for lack of knowledge of microbiology and such life saving measures as washing of hands, and the public suddenly viewed childbirth as an ailment, something to be saved from.
Granny Hill, 1920's, midwife, photo courtesy of Mrs. Echol Smith

By 1900, physicians attended around half of the nation's births. Midwives were reserved for those who could not afford a doctor. Prejudices ran rampant and the name of midwifery once again became muddied by bigotry, greed, and hatred. Doctors soon saw that there was much money in the field of childbirth, not just a science to conquer, and began a smear campaign, building on the prejudices already in place.


Granny Midwife Albany, GA, 1952. Courtesy Robert Galbraith
By the early 1900's, public health and medical partnerships saw an increase in the amount of people now able to afford the 'painless' childbirth offered only in hospitals. As the Victorian age saw women as frail (and kept them as such), midwifery faded into the background, with only a small following continuing to use the ancient art of woman to woman care.
1944 midwife in FL
It wasn't until 1944 that America began taking a critical look at it's childbirth practices and looked, once again, to Europe for guidance. 11 years later, the ACNM was founded, and, between 1963 and 1969, a large resurgence of midwifery was marked, although it was still only a pebble in the pond of American obstetrical medicine. The 'hippy' generation rekindled the desire of women to take care of one another through a holistic approach.

The Renaissance of the Apprentice-trained Midwife in North America ~ One Midwife’s Saga, Carol Leonard
From that point forward, midwifery has slowly been making a come-back in America. Working diligently to dismantle the prejudices that have been in place since Medieval times, women who believe in the ancient art of woman to woman care are teaching their daughters, once again, to trust their bodies, the process, and the womanly art of birth.


Doulas
I have heard many women talk about how doulas are a new fad in our culture. Yet, when you look at the artwork throughout this post, you will see that women surrounded themselves with other women during labor and birth. They had a midwife there, yes, but they also had other women there to help them on the journey.
Hellenistic Cypriot from the temple at Golgoi ca 310 30 BC (see the hands at her head and at baby)
These women were always there to set food on the fire, take care of the other children, give massage or apply a cool washcloth, help in and out of positions to labor in, fetch the midwife's tools or herbs, give emotional support and encouragement, and give tips and tricks for what had worked for them during their labors.
Isola Dell'Sacra Ostia 1st Century AD
Oftentimes, these women were sisters, mothers, grandmothers, cousins, neighbors, friends - any woman who understood birth and could help another woman through it. 
"You are a birth servant. Do good without show or fuss. If you must take the lead, lead so that the mother is helped, yet still free and in charge. When the baby is born, they will rightly say: "We did it ourselves!"' - Lao Tzu, "Tao Te Ching", 6th Century BC 
Italian The Birth of Cupid School of Fontainebleau ca 16th century
The modern doula takes her name from the ancient Greek term, originally 'female slave'. Interestingly, Grecian doulas call themselves birthworkers or labor companion. Old English termed the women godsibs. Women from the community ( good neighbors ) would converge on the house and keep the house in order while the woman labored. And, just as women do when they get together, they would talk and talk and talk - which is where the term gossip comes from, godsib.
Hellenistic relief from late 4th early 3rd century BC Ibrahimieh Necropolis Alexandria
This same practice was common from the times of ancient Egypt, as we can see when Mary went to be with Elizabeth as her time drew near (sometime in her 6th month), on through to the age of Colonial America (emphasis' mine)
"at Cowens Still, Shee unwell yet. Jonas Clearks infant had a fitt; they Calld me to See it. mrs Cowen Calld her women together this Eving. was Safely Delivd of a Dafter about ye middle of ye night & is Comfortable. fee & medisin 10/. May 5, 18001 recd 10/ by his Dagt [bitsy]." - Martha Ballard
isis giving birth with the help of demi gods
Doulas, by any name, have been at women's sides as long as midwives. Nurturing, loving, and providing complementary companionship to the midwife's skills of herbs, measurements, holistic introspection, emotional counseling, anatomy, and biology.

In Conclusion
Science, again, is slowly coming full circle to realize what we, as women, have known since women first squatted in the dust of the earth. Women who are supported, encouraged, and educated by other women have the healthiest and safest outcomes.
Indian Matrika
When women can be caressed, loved, whispered to, touched, massaged, protected, and coaxed - women open willingly and easily, uninhibited, to the birth rhythms necessary to promote safer and more productive labor and birth. This occurs, most easily, with other women who understand normal, physiological labor and birth and trust it themselves.

Further Reading:
Witches, Midwives, and Nurses
History of Midwifery
Renaissance Woman: A Sourcebook
The History of Midwifery and Childbirth in America: A Time Line
A Short History of Midwifery
No Catty Bitches
Doula Support and Attitudes of Intrapartum Nurses: A Qualitative Study from the Patient's Perspective
Normal Childbirth
Birth Psychology
Womb Ecology - The Masculinisation of the Birth Environment
Womb Ecology - the physiological reference

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