Midwifery in the Middle Ages

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Midwifery in the Middle Ages was important to women's lives and health prior to the professionalization of medicine. During the Middle Ages in Western Europe, the medical knowledge and understanding that people relied on was from the Roman and Greek understanding of medicine, specifically Galen, Hippocrates, and Aristotle. These medical minds avoided women's health issues, specifically pregnancy because they believed that women handled women's issues; as William L. Minkowski explains, "men believed their dignity and self-esteem were diminished by the manual nature of care for the pregnant patient." Myriam Greilsammer notes that medieval "society's reluctance to let men deal with women is largely bound up with the taboos surrounding the 'secret' parts of their bodies," and the prevalence of this mindset allowed women to continue the art of midwifery throughout most of the Medieval era with little or no male influence on their affairs. Minkowski writes that in Guy de Chauliac's fourteenth-century work Chirurgia magna, "he wrote that he was unwilling to discourse on midwifery because the field was dominated by women." However, changing views of medicine would cause the women's role as midwife to be pushed aside as the professionalization of medical practitioners began to rise.

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Background

Most midwives came from the lower classes and were illiterate. Monica H. Green writes that "if midwives were literate, it seems to have been coincidental rather than a prerequisite of their work." Green notes that unlike "female surgeons and barbers... [midwives] do not seem to be regularly married to men in the medical trades." During the late Middle Ages a few books were written for teaching midwifery for both women and men. Prior to this point, midwife manuals were not written by practitioners or their teachers but by people who knew medical theory or outdated information.

Midwives learned their craft from other women and from having their own children. Minkowski writes that "without formal training, and because texts on midwifery were ancient and rare, midwives learned their skills as a craft from family or friends." From the time they were small girls, women who would later become midwives would have been present at the births of other siblings and would have been able to see what was done during the birthing process by the midwife or other female family members. Greilsammer writes that the midwife in Medieval art was "often portrayed in the act of setting out the instruments of her profession, the symbols of her qualifications - scissors, linens, a tray which she places in a box or wraps in a large basket, a birthing stool." Men were not allowed to view this birthing process. Greilsammer notes Belgian historian Louis Théo Maes' record of a fifteenth-century fine: "One Henne Vanden Damme, for having hid behind a staircase to eavesdrop upon his wife, she being in labour of childbirth, which thing doth not befit a man, for the said eavesdropping was fined 15 livres."

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Role of the midwife

Midwives were involved with births from all social classes to various degrees. The poorest women were typically helped by the women in their family and their neighbors more than the midwives from the towns. In towns and cities the midwives were more prevalent which placed a lot of emphasis on reputation. Minkowski elaborates that "many midwives served communities in a semiofficial capacity, delivering newborns, guarding access to their profession, and protecting its standards. Their usefulness was partially compensated by special privileges, such as a tax-exempt status or a small pension." Beginning in the early fourteenth century, town officials started recording some midwife activities in municipal account books; for example, Greilsammer cites a 1312 record from Bruges stating "Communal expenses - Item, by Copp. Voers. Two midwives who were called to see a newborn infant found in front of the city walls on Christmas Eve, 20 solidi." In more exceptional situations, if the midwife had a much respected reputation, they may also serve as court midwife. Green writes that in France in the early fifteenth century, "Bourgot L'Oubliere... served as both midwife and gardener to the French queen."

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Midwifery as a career

Midwives did not participate in guilds or attempt to organize themselves on their own like male medical practitioners did. Green writes that such organization and "licensing, which apparently began in the mid-fifteenth century (the earliest known example is from Regensburg in 1452), was imposed on midwives from the outside, either by local municipal or ecclesiastical authorities, or by both." Minkowski writes that through the late Middle Ages, "the medical community throughout Europe was organizing into a strict hierarchy, with male doctors at the top." Greilsammer notes that the early fifteenth century saw towns introducing "laws aimed at regulating the professions and incorporating midwives within official structures. In principle, the aim was to prevent the delivery of an infant by unqualified people or charlatans." Greilsammer further notes that "Brussels was in 1424 the first town in Europe to enact detailed regulations regarding the functions of midwives," with "similar measures... enacted in Bruges in 1509 and in Mechelen in 1536."

Regulation of midwifery was also an ecclesiastical concern: Kathryn Taglia writes that "by the fourteenth century legislators from dioceses in central and eastern regions of northern France were issuing instructions about how to baptize correctly specifically to midwives." This reflected, Taglia notes, "the increasing interest that ecclesiastical authorities showed in pastoral care and the education of clergy and the laity" and the laity's understanding of the sacrament of baptism, "the one sacrament in the Middle Ages that could be performed by anyone - cleric or lay person, man or woman." Such ecclesiastical and secular regulatory introductions, Greilsammer writes, led to a "reduction in the status and role of the midwives" that "was part of a more general degradation of attitudes toward women, and women in command of some knowledge and power in particular." Greilsammer notes that this change in perception can "be placed in its urban context and related to the general decline in women's employment throughout Europe at the end of the Middle Ages." Such developments forced many midwives out of the craft and were replaced by men.

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Medieval midwives of note

Only a handful of medieval midwives have thus far been identified for whom we have anything more than a name. Besides Bourgot L'Obliere noted above, for example, Green has identified such women as Asseline Alexandre, who attended the births of the Duchess of Burgundy in the 1370s, or several women identified in English poll taxes records from the later 14th century, such as Matilda Kembere and Marg[ery?] Josy in Reading and Felicia Tracy in Canterbury. Although often referred to as a midwife, the 12th-century Salernitan medical writer Trota of Salerno was rather a general medical practitioner, who, while specializing in women's conditions and describing postpartum repairs, seems to have seen the supervision of normal birth as the province of others. The practice of licensing of midwives in northern cities in Europe is known from the 14th century, but no extant written licenses from this period have yet been identified. Rather, much of what we know of individual midwives comes from legal records and court proceedings. Thus, for example, we know of the Muslim midwives Blanca and Xenci who were brought from Toledo to serve at the court of King Carlos III of Navarre (r. 1387-1425), as well as a mother and daughter "dynasty" of Muslim midwives, doña Fatima and doña Haxa, who attended the births of, respectively, Catalina, the queen of Castille, and Blanca, daughter of Carlos of Navarre and herself queen of Navarre by 1425. In late 15th- and early 16th-century Brie (a suburb of Paris), midwives can be found using the ecclesiastical courts to secure or confirm their professional advantages. For example, we learn of the midwife Isabelle Rougemaille who brought suit in 1500/1501 against a potential client because that woman had allowed another birth attendant to assist her in a recent delivery. Although midwives were occasionally chastened for such offenses as baptizing fetuses that seem to have been born dead (likely because of Christian parental concerns for the child's immortal soul), thus far the only known case of a midwife being prosecuted for the death of a woman under her care is the 1403 trial of a Jewish midwife in the French city of Marseille, Floreta d'Ays. That case involves a level of anti-Semitism otherwise undocumented in Marseille in this period.

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Questions of witchcraft

Green notes that "the timing of these midwifery regulations, which coincide with the first stirrings of the early modern wave of witch persecutions, has prompted several theses that argue for a direct connection between the two phenomena." Several historians have engaged in what Kathryn Taglia describes as "the debate around the issue of witchcraft and midwives." On one side of this debate, citing Thomas R. Forbes' The Midwife and the Witch, Minkowski writes that "there is little question that Western European countries shared a deep concern for the potential of witchcraft practice by midwives," elaborating that "by the late Middle Ages, the church and civil authorities mandated close supervision of midwives, as expressed in required professional and religious instruction and in oaths that explicitly renounced past and present resort to the black arts." Greilsammer cites "recent research on the ointments used by midwives" that "shows that in the Middle Ages they were truly expert herbalists" to argue that "accusations of witchcraft were aimed directly at the knowledge of folk medicine possessed by women." On the other side of this issue, Taglia argues that ecclesiastical legislation in France referencing childbirth and midwives came not out of "concern about midwives performing" witchcraft, but due the legislators' "concern over whether midwives understood when to perform an emergency baptism and how to perform one." David Harley notes that "although the midwife-witch can be found in the writings of some demonologists, influenced by the Malleus Maleficarum, in few of the vast numbers of trials were midwives accused," arguing that "a few spectacular cases have been mistaken for a general pattern and midwife-witches have been seen where none exist."

After the Medieval era, midwifery became more structured and professionalized from the influence of legislation passed during the later part of the era and the influence of the medical profession. Over time it became the profession that we know today.

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References

Medieval perspective bibliography

• Flügge, Sibylla (1998). Hebammen und heilkundige Frauen: Recht und Rechtswirklichkeit im 15. und 16. Jahrhundert. Frankfurt: Strömfeld Verlag. 
• Giladi, Avner (2010). "Liminal Craft, Exceptional Law: Preliminary Notes on Midwives in Medieval Islamic Writings". International Journal of Middle East Studies. 42 (2): 185-202. doi:10.1017/s0020743810000012. 
• Green, Monica (1989). "Women's Medical Practice and Health Care in Medieval Europe". Signs. 14 (2): 434-473. doi:10.1086/494516. 
• Green, Monica H. (1994). "Documenting Medieval Women's Medical Practice". In Luis García-Ballester; Roger French; Jon Arrizabalaga; Andrew Cunningham. Practical Medicine from Salerno to the Black Death. Cambridge: Cambridge University Press. pp. 322-52. 
• Green, Monica H. (2008). Making Women's Medicine Masculine: The Rise of Male Authority in Pre-Modern Gynaecology. Oxford: Oxford University Press. 
• Green, Monica H.; Mooney, Linne (2006). "The Sickness of Women". In M. Teresa Tavormina. Sex, Aging, and Death in a Medieval Medical Compendium: Trinity College Cambridge MS R.14.52, Its Texts, Language, and Scribe. 2. Tempe, AZ: Arizona Center for Medieval and Renaissance Studies. pp. 455-568. 
• Green, Monica H.; Smail, Daniel Lord (2008). "The Trial of Floreta d'Ays (1403): Jews, Christians, and Obstetrics in Later Medieval Marseille". Journal of Medieval History. 34 (2): 185-211. doi:10.1016/j.jmedhist.2008.03.001. 
• Greilsammer, Myriam (1991). "The Midwife, the Priest, and the Physician: The Subjugation of Midwives in the Low Countries at the End of the Middle Ages". The Journal of Medieval and Renaissance Studies. 21: 285-329. 
• Harley, David (1999). "Historians As Demonologists: the Myth of the Midwife-Witch". Social History of Medicine. 3: 1-26. doi:10.1093/shm/3.1.1. 
• Minkowski, William L. (1992). "Women Healers of the Middle Ages: Selected Aspects of Their History". American Journal of Public Health. 82 (2): 288-295. doi:10.2105/ajph.82.2.288. 
• Molénat, Jean-Pierre (2003). "Priviligiées ou poursuivies: quatre sages-femmes musulmanes dans la Castille du XVe siècle". In Cristina de la Puente. Identidades marginales, Estudios onomástico-biográficos de al-Andalus, 13. Madrid: Consejo Superior de Investigaciones Científicas. pp. 413-30. 
• Taglia, Kathryn (2001). "Delivering a Christian Identity: Midwives in Northern French Synodal Legislation, c. 1200-1500". In Peter Biller; Joseph Ziegler. Religion and Medicine in the Middle Ages. Woodbridge, Suffolk: York Medieval Press. pp. 77-90. 
• Vann Sprecher, Tiffany D.; Karras, Ruth Mazo (2011). "The Midwife and the Church: Ecclesiastical Regulation of Midwives in Brie, 1499-1504". Bulletin of the History of Medicine. 85 (2): 171-92. doi:10.1353/bhm.2011.0044. 

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