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Oct. 29, 2021

62: Childbirth

62: Childbirth

An episode on the wonder and woes of childbirth in the medieval period.


Today’s episode has our first content warning, since I am going to talk about potentially upsetting subjects. Namely, miscarriage, abortion and infanticide. If this sounds too disturbing you can skip this episode; if not I encourage you to listen since these are essential topics to understanding pre-modern society and are often sorely under-studied.

[Intro Music]

Chapter 1: Creating Life

16 Unto the woman he said, I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children; and thy desire shall be to thy husband, and he shall rule over thee.

17 And unto Adam he said, Because thou hast hearkened unto the voice of thy wife, and hast eaten of the tree, of which I commanded thee, saying, Thou shalt not eat of it: cursed is the ground for thy sake; in sorrow shalt thou eat of it all the days of thy life;

18 Thorns also and thistles shall it bring forth to thee; and thou shalt eat the herb of the field;

19 In the sweat of thy face shalt thou eat bread, till thou return unto the ground; for out of it wast thou taken: for dust thou art, and unto dust shalt thou return.

20 And Adam called his wife’s name Eve; because she was the mother of all living.

-Genesis Chapter 3, verses 16 and 20 KJV

According to the Bible after Adam and Eve disobeyed God’s order not to eat the fruit of the Tree of Knowledge of Good and Evil, God laid down a punishment for his children and a path to redemption. To men, God gave labor, specifically agricultural labor, which would break his back until he was one with the Earth again. Yet, labor would also keep men occupied and ward away sin. To women, God gave the punishment of childbirth and all the pain associated with it. Pregnancy also occupied women, warding off temptation. Finally, through childbirth humanity would be redeemed through the Virgin Mary giving birth to Jesus Christ.

It’s no surprise that humans have used religious explanations for pregnancy and childbirth. Before modern times conception through birth was a mysterious, seemingly miraculous process. Yet, it was also an incredibly dangerous one and childbirth was probably the leading cause of death for women between 12 and 40.

We know relatively little about childbirth during the Carolingian period since nearly all written works were by elite men. Furthermore, most scholarly writing occurred in monasteries, where women weren’t supposed to give birth and men were supposed to be chaste. Midwives and mothers passed on their practical skills orally, leaving little of their knowledge behind for historians. Yet, historians have uncovered a surprising amount about child birthing using scientific and statistical data.

Girls first menstruated at 12, at which point society recognized them as women. While boys became men at 15 when they could work and fight, girls became women as soon as they could have children. The prime birthing ages were between 12-30. Birth control was largely unavailable and considered a sin, meaning that women were near-constantly pregnant from the start of their marriage until they reached menopause. Birth control had been common in the Roman empire and still irregularly practiced in the Merovingian period, though in the ninth century priests began to strictly condemn contraception, claiming that sex was only for procreation. Contraception of all kinds was punished by ten years of penance, including pulling out. Frequent childbirth and poor diet prematurely aged women, who experienced menopause between the ages of 40 and 50; compare this to the current developed world average, which is 45 to 55. Lack of iron in women’s diets frequently led to anemia, and lack of calcium, combined with the stresses of childbirth, meant women as young as 30 experienced osteoporosis.

All these stresses meant that pre-modern women had lower life expectancies than men. Carolingian female life expectancy at birth was 32.6 years old, unless they lived past infancy in which case it was 40.5. Men lived to 33.5 at birth, or 39.6 after infancy. Women regularly gave birth until they died, as was the case with Charlemagne’s wife Hildegard who died at 25 after birthing nine children while he lived to be at least 66. This phenomenon is shocking considering that in our time women in every country on Earth live longer than men. Testosterone weakens the immune system and increases the likelihood of cardiovascular disease. Thus, in 2019 male life expectancy in France was 80 years old, while female life expectancy was 85.6.

In the pre-modern period frequent childbirth regularly killed women on a scale that is incomparable to modern times. Scientists estimate that the natural maternal mortality rate, that is, death from pregnancy without the use of any modern medicine, might have been around 1.5%. By 1900 improvements in diets and medicine meant that French women’s maternal mortality rate dropped to .7%. In modern-day France 8 women die per 100,000 live births, meaning it is currently .008%. Clearly, 1.5% maternal mortality rate is much higher than .008%. But 1.5% doesn’t seem like a big number, does it? Well, remember that women had a 1.5% chance of dying per every live birth. When we include the average number of births per era we get quite a difference. Let’s compare the numbers in reverse. Modern-day French women give birth to just under 2 children, meaning we have to double the maternal mortality rate to .016% to give us the total number of women who die in childbirth. The result is that .016% of French women today die in childbirth, or 1 per 6,250. A woman in 1900 France gave birth to roughly 3 children. Multiply 3 by the maternal mortality rate of .7% and we get 2.1% of all fin-de-siecle women dying in childbirth, or 1 out of 47. In the Carolingian period women probably gave birth roughly ten times (though often the child didn’t survive, hence why the population wasn’t exploding). So, if we multiply the 1.5% maternal mortality rate by ten that means 15% of all Carolingian women died in childbirth, or roughly 1 in 6. I repeat: 1 in 6 Carolingian women died in childbirth compared to 1 in 47 for fin-de-siecle women and 1 in 6,250 for modern women. Thank goodness for modern medicine! And thank goodness for birth control, as most modern women don’t suffer life-threatening post-pregnancy complications, whereas Carolingian women often did. Thus, while 1 in 6 Carolingian women died in childbirth, even more died due to complications from the strains of frequent pregnancies.

The above figures are just those related to childbirth. In order to understand what medieval women experienced we need to also consider miscarriages. I know this can be a difficult and even painful subject and there is an incredible amount of silence around it even to this day. Many women who have experienced a miscarriage express regret, shame or remorse. While I would never tell a person their feelings are wrong, the idea that they are somehow less of a woman because they had a miscarriage is just false. As tragic as it is, it is part of the human experience and is a lot more common than most people realize. According to the Mayo Clinic in the modern era between 10% to 20% of pregnancies end in miscarriage. However, those figures are just reported miscarriages. The majority of miscarriages occur within the first few weeks, often before a woman even knows she’s pregnant. When factoring in these early miscarriages roughly half of all pregnancies end in miscarriage in the modern era. In the modern era, where women have healthier diets and access to health care roughly half of pregnancies end in miscarriage, but this figure was even higher in premodern times. Mormon women in the 19thcentury US gave birth successfully 8 times and miscarried 16.8 times. According to a researcher at UC Santa Barbara: “miscarriage is ‘the predominant outcome of fertilisation’ and ‘a natural and inevitable part of human reproduction at all ages.’” As painful as miscarriage is, it is nothing to be ashamed of, or feel guilt over. Human bodies evolved for quantity, not quality. For evidence of this, just look at the male body. According to LiveScience “the average male will produce roughly 525 billion sperm cells over a lifetime and shed at least one billion of them per month. A healthy adult male can release between 40 million and 1.2 billion sperm cells in a single ejaculation.” Theoretically if every sperm resulted in a baby one man could populate the entire galaxy. The most successful ejaculation is still a horrendous failure, as more than 99.99999999999% of sperm become useless. Yet, men do not have to suffer mental anguish over these failures because they are less visceral, apparent and physically taxing. Whereas, women have been condemned and shamed on a personal level and as an entire gender due to pregnancy failures.

Even as I talk about Carolingian women I have to pause and mention how this is an area that requires not just an explanation of the past but an unraveling of the ignorance of the present. It’s funny because when I talk about war, politics, the economy, even race most of my audience doesn’t need further clarification. History has illuminated all these subjects and most of us living in the present are capable of looking at facts with some level of objectivity. Yet, there has been a persistent mystification of the female body continuing into the present. Perhaps nowhere is this more apparent than in the case of pregnancy and miscarriage. Today, hardline religious conservatives downplay the regularity of miscarriages and pregnancy complications to justify laws restricting birth control and abortion. Meanwhile, women often play into this through silence regarding miscarriages, which is understandable as miscarriage is a very painful and personal topic. But the result is that so often the conversation regarding women’s bodies is dominated by men who know the least about it, something which certainly hasn’t changed from the medieval period.

Before you immediately turn off this episode and write an angry review about how I should, “stick to history,” and “don’t do politics” just know I always bring the facts. The US National Library of Medicine conducted a study of over 1,000 people, 45% of which were men and 55% were women and asked them what their views on miscarriage were. “Fifty-five percent of respondents believed that miscarriage occurred in 5% or less of all pregnancies,” even though the actual number is ten times that. Moreover, a quarter of people frequently attributed miscarriages to previous use of contraceptives even though using such devices in the past doesn’t cause miscarriages after they are no longer used and most miscarriages are naturally-occurring, and not the choice or fault of the woman. Tragically, of those women who reported a miscarriage “47% felt guilty, 41% reported feeling that they had done something wrong…and 28% felt ashamed,” as it seems these women didn’t know that miscarriage was almost certainly not their fault. Moreover “41% [of women] felt alone.” Again, I would never tell someone how they should feel, but the perception that miscarriages are rare and must be caused by the bad choices of the woman are just wrong. If this study shows anything it is that even in the modern era when all of this information is available it is not widely known. Perhaps if women understood their own bodies more they could be saved from unnecessary trauma and guilt, whereas if men understood them more they might be more compassionate.

Throughout history there has been a mystification of the female body, as scholars and theologians have tried to explain how childbirth could occur and why a just universe could be so cruel. In the medieval period the clergy mystified the female body because they couldn’t know how it works. They claimed that failed pregnancies were not as common as they actually were and when they occurred they were often due to the sins of the mother. A similar mystification continues in the modern period as people have the ability to understand the female body but choose not to for religious or political reasons and continue to blame women for failed pregnancies. If I mention these modern events it is not to try to persuade any person to adopt new political or religious stances; I feel my audience is smart enough to come up with those on their own. I am only talking about modern perceptions to elucidate how false ideas today taint our understanding of the past and that those ideas have historical roots. This need that men have had to make logical and moral sense of the universe at the expense of women’s feelings, health and lives traces its history well into antiquity when mystics claimed that childbirth was punishment for original sin. But if you still want to send me hate-mail, please direct all emails to Jacob Collier at the Podcast on Germany.

Medieval scholars downplayed the frequency of failed pregnancies and regularly blamed women for their occurrence. Yet, they understood that miscarriages did occur, especially early on in the pregnancy. A number of scientific and theological questions stemmed from this dilemma, the most important of which was: when does a fetus become a baby? Theologians were divided on this issue; if they claimed God imbued fetuses with souls upon conception this meant that most beings with souls would never get to live, make choices and accept Christ’s redemption. In fact, hardline clergyman Gregory the Great claimed that fetuses who died before baptism or the acceptance of Christ’s forgiveness went to hell because they were tainted with original sin. Kinder theologians than Gregory didn’t want to claim humanity began at conception as it would mean these fetuses were all in hell. In contrast, some theologians believed fetuses would be resurrected. Saint Augustine questioned though did not confirm that fetuses would be resurrected and he pondered what bodily form they would take. This dilemma over the eternal destination of those who had never made a choice made theologians hesitant to claim fetuses had souls. But they also didn’t want to say that babies got souls at birth either. If they did that, then what was the harm for women to abort a fetus if it wasn’t a person?

These and other questions created a grey area as theologians debated whether a fetus had a soul and when it got a soul.  Most theologians were willing to let this remain one of God’s mysteries. Hincmar, Bishop of Reims, was not one of those people. Hincmar declared that a fetus attained a full human form and thus a soul at 46 days and he could prove it with math. The bishop of Reims began with a story of Jesus Christ in John 2 19-22, which reads: “19 Jesus answered them, ‘Destroy this temple, and I will raise it again in three days.’ 20 They replied, “It has taken forty-six years to build this temple, and you are going to raise it in three days?” 21 But the temple he had spoken of was his body. 22 After he was raised from the dead, his disciples recalled what he had said. Then they believed the scripture and the words that Jesus had spoken.”

See, in the Bible days and years are sometimes interchangeable. In Genesis 29:27 Laban required Jacob to work seven years for him before he could marry Rachel, which the Bible referred to as a week. In Numbers 14:34 the Israelites were punished with wandering in the wilderness for 40 years, one year for every day spent by the spies in Canaan. In Ezekiel 4:5-6 the prophet Ezekiel had to lie on his left side for 390 days, followed by his right side for 40 days, to symbolize the equivalent number of years of punishment on the nations of Israel and Judah, respectively. Famously, Daniel 9:24-27 has the Prophecy of Seventy Weeks, wherein the angel Gabriel tells Daniel that Jerusalem will be rebuilt and everlasting righteousness will take hold in Seventy Weeks, which many interpreted as seventy times seven years, equaling 490 years which was roughly the time that Jesus Christ was born.

After Hincmar established that a year could mean a day and vice-versa, he returned to the parable of the temple. The crowd told Jesus it took 46 years to build the Temple. But Jesus wasn’t referring to the Temple in Jerusalem but his body. According to the book of Genesis God made humans in his image, meaning that our bodies are temples as well. And the Temple in Jerusalem, which is symbolic of Christ’s body and by extension our body, took 46 years to build, but since a year can be a day then our body could be made in 46 days; therefore, according to Hincmar the Bible clearly and unequivocally shows that a fetus, after spending 46 days forming the womb, becomes a full human being and is imbued with a soul.

…This is the kind of medicine you get before x-rays.

Hincmar’s theories didn’t become standard in the Frankish church, despite his incredible power and influence. Instead, the question of when a person received a soul remained a mystery. While theologians failed to determine when soulhood began they did agree that whatever was inside a woman needed to be protected and ending pregnancy was a sin.

Chapter 2: Abortion and Infanticide

The Classical Romans discouraged abortion but not because the Romans held that all life was sacred. God knows, all their conquering campaigns and slavery proved otherwise. In the words of Cicero, abortion was immoral because it cheated, “‘[a father]’s hope, the memory of his name, the provisions of a race, the heir of a family and a future citizen of the republic.’” As historian Zubin Mistry notes, Roman law forbid abortion for harming men’s interests or threatening a woman’s life but not because of endangerment of the fetus. To the Romans a fetus did not have ‘personhood,’ to use a modern term. Later on, Emperor Septimius Severus decreed that a woman who had an abortion faced temporary exile for the crime of cheating her husband of children.

However, there were exceptions to these rules. Classical medical texts included prescriptions for abortion and removing dead fetuses from the womb to save the life of the mother. Third century Roman Christian author Tertullian argued that embryotomy, the removal of a dead fetus from a woman, proved the soul was not imparted in conception but upon birth. While Tertullian hated the idea of abortion he admitted that pregnancy complications offered a difficult choice since it could result in the death of the mother.

Medieval, Christian Europe was far more anti-abortion than the Roman Empire. Christian writers viewed abortion as an inversion of the natural order. Instead of a mother giving life to a child, she was taking it. Moreover, abortion was associated with infidelity as Christian authors assumed that when women got abortions it was to hide the product of an affair. Despite these prohibitions, abortions may have increased with the spread of Christianity. Women went to nunneries, where sex was prohibited and if they became pregnant they would induce an abortion.

Merovingian clergy were strictly anti-abortion. Abortion was always assumed to be the woman’s choice and a sin. Priests believed induced abortions damaged a woman’s internal organs, making them less capable of being a mother in future. Simultaneously, they held that contraception was unnatural and that married women had to continually be in a state of pregnancy until old age or death. The only alternative to constant childbirth the church allowed was total abstinence in nunneries.

One of the most influential bishops of the 5th-6th centuries, Caesarius of Arles, declared, “no woman should take potions so that she is unable to conceive nor should she harm the nature within her which God has wished to be fruitful; because she will be held guilty of as many murders as [children] she had been able to conceive or give birth to and, unless she has undergone a worthy penance, will be condemned to eternal death in hell. A woman who does not want to have children should enter into a religious pact with her husband: for chastity is the only sterility for the Christian woman.”

Caesarius took a hardline stance against abortion and further claimed that a woman’s sin was often to blame for miscarriage or child death. But he did concede that women were not always to blame for stillbirths or miscarriages since vipers could eat their way out of their mother’s womb; thus he preached that an offspring’s sin could also kill the mother. Again, this is the kind of medical thinking you get before x-rays are invented. Since contraception and abortion were outlawed there was naturally an epidemic of abandoned children as poor women who were unable to feed their babies left them at churches or in the open to die.

The Carolingians were similarly anti-abortion. Missionary manuals claimed that a woman who undergoes an abortion is not a Christian but a pagan due to her denial of Christ’s message and plan. Those who sold abortion-inducing medicines could only be welcomed back into the church if they were on their deathbed and after a lifetime of contrition. The church did offer some leniency in very special cases. Women who accidentally killed their children were not murderers but were often still required to do penance for negligence. Likewise, abortion was permitted if such an operation would save the life of the mother, but even then a woman would have to perform penance. According to one ruling, “If a woman arranges by any maleficium that she can never conceive in order to hide her lust, she should do penance for 10 years in the same way. But women who do this to escape death or narrowness in childbirth should do penance for three years.” [Ref: Mistry Zubin].

A major difference between the Merovingians and Carolingians was their leniency towards poor women. In one medieval manuscript [Oxoniense II] possibly written by Willibrord, if a woman disposes of an infant because she could not feed it, the woman only had to fast for three weeks. Further penitentials argued that women who were raped AND could not care for children were not responsible for a child’s death or abandonment, though they still had to perform penance.

While many law codes from this period survive we don’t know their practical application and if there were punishments for abortion. Law codes primarily acted to mediate disputes between two parties, so it is unlikely that abortion was a legal matter. In cases of a murder, if someone killed a young girl or an old woman they had to pay 200 solidi, but the weregild for an adult woman who could give birth was 600 solidi.

We’ll end today by talking about infanticide. Parents killing their own children was a fact of pre-modern life in most if not all societies. This was especially prevalent in societies where religion dictated that women give birth until death or menopause. Poor peasants struggled to feed their families during normal years. Famines, which occurred roughly every four years in Carolingian Francia, could devastate a family. Rather than let a child starve to death, many parents thought it was more humane to end that child’s life with as little suffering as possible.

Overwhelmingly, infanticide was directed against girls. Boys were physically stronger and could work the fields, while women were a relative burden on their immediate family. A woman’s greatest economic hope was through marriage, which wouldn’t occur until she came of age. Before she could marry or work as an adult she was a drain on a family’s resources. Still, peasants had love and compassion for their children and did not want to end their lives. They could appeal to fellow community members or to the church for welfare, but these were limited.

Infanticide normally occurred right after birth, when parents determined their child’s sex. If the baby was a girl and the family was already struggling with food many children were abandoned or killed. The church condemned infanticide but these were relatively easy to hide as stillbirths were common; thus parents could easily claim the baby did not survive the birthing process and no one had to know.

As with miscarriage and abortion, there is little direct written evidence of infanticide. However, historians such as Emily Coleman employed church records to uncover Francia’s abnormal sex ratio. These figures are incomplete as there was no country-wide survey and instead we have to extrapolate based on what we have. In modern societies the sex ratio at birth is 105-100, i.e., for every 105 male births there are 100 female births. This is because the Y chromosome contains less information than the X chromosome, making Y sperm quicker, which in turn means Y sperm are more likely to fertilize the egg. According to Coleman’s data on Saint Germain-des-Pres the sex ratio was somewhere between 116 to 156 men for every 100 women. In select populations that number varied from 110 to 253 men per 100 women. It’s possible that the recorded sex ratios undercount women because: men may have migrated to an area to work, women were not counted as they were working in the houses of lords, occupied with childbirth, or the counters ignored female children as unimportant. Still, even considering these other factors, it is clear that there was a noticeable gender gap, meaning infanticide was not uncommon, and was mostly against girls.

The first major question hanging over all these issues was: why did pre-modern women use contraception, induce abortion, abandon or even kill their children, especially since the church claimed that all of these were sin that warranted penance and possible damnation? Ultimately, many women ignored church prohibitions because they viewed these issues as primarily practical, not theological. Moreover, they were not alone. While the church laid near-exclusive blame on women, husbands were certainly part of most of these decisions. As a pair the husband and wife decided if they could properly feed a child. If they decided that the child was destined for painful death by starvation they then weighed their options. In cases where the parents initially decided to keep the child if famine occurred or a Viking raid depleted their food reserves the parents might decide then to abandon or kill the child. Finally, many parents probably didn’t view abortion as losing a child. After all, women could and usually did, have more children at a later date. Contraception, abortion, abandonment and even infanticide were methods of family planning and most couples who engaged in any of these practices went on to have many more children. As brutal as these may seem, pre-modern peoples lived brutal lives and these were the family planning options available to them.

The second question hanging over all of this was: how did medieval people feel about maternal death, miscarriage, abortion and infanticide? Some historians, chief among them Lawrence Stone, argued that pre-modern peoples accustomed themselves to death. Stone theorized that with so much death, particularly the death of women and children, each individual death was less meaningful and thus less emotionally impactful. I tend to disagree. Intellectually, Stone’s argument makes sense, if you think of people in economic terms. In economic terms, a medieval woman with ten children who loses one still has nine children, while a modern woman with two children who loses one only has one left. But the heart has its own reasons. Human sentiments since time immemorial are characterized by immediacy. Our feelings touch upon our immediate kin and community. Moreover, they are trapped in time as our emotions burst to the surface in reaction to cataclysmic events.

Carolingian men mourned the death of their wives and expressed the same grief we would find in the modern age. What little evidence we have of women’s feelings is similar to what we have in the present. Women mourned the loss of each baby after a miscarriage or still-birth. These women were wracked by the same mixture of irrational guilt and shame that modern women feel, as their brains, conditioned by evolution, produced feelings of guilt for failing to produce offspring. This was coupled with religious and societal condemnation, as dogmatists claimed that their sin killed the child; something which is less common but still present in our age. Carolingian women feared for their health each time they were pregnant, knowing that each delivery might mean their death. But they persisted, and if they experienced the heartache of loss, they also felt the joy of raising many children. Pre-modern peoples’ circumstances were different from ours but they were not. They experienced the same joy, suffering and pain that we do, they merely lacked the technological and infrastructural tools to prevent disaster. Tragedy was just as meaningful then, even if it was common. Even as we criticize our ancestors for their harsh actions, we should acknowledge the strength it took to exist in a world filled with death and deprivation.


The Bible, King James Version

Valerie Garver, Women and Aristocratic Culture in the Carolingian World, 2011.

Valerie Garver, “Childbearing and Infancy in the Carolingian World,” Journal of the History of Sexuality, 2012.

Mayo Clinic, Miscarriage.

Zubin Mistry, Abortion in the Early Middle Ages, C. 500-900, 2015.

National Library of Medicine, “A national survey on public perceptions of miscarriage,” 2015.

Jinty Nelson, Frankish World, 750-900, 2003.

Eric Olsen, “Why Are 250 Million Sperm Cells Released During Sex?” 2013.

John M. Riddle, “Oral Contraceptives and Early-Term Abortifacients during Classical Antiquity and the Middle Ages,” Past and Present, 1991.

Sciencealert.com https://www.sciencealert.com/meta-analysis-finds-majority-of-human-pregnancies-end-in-miscarriage-biorxiv

Statista, Life expectancy at birth in metropolitan France from 2004 to 2020, by gender

Ed. Susan Mosher Stuard, Women in Medieval Society, 1973.