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As with many occupational categories in the Middle Ages, the line between domestic work and the full-fledged occupation of midwifery is difficult to draw.  Just as no society could survive without cooks even though professional cooks are few, so in medieval Europe we find nearly universal assistance in childbirth even if there were not always professional midwives. 
In Antiquity, midwives (called, in Greek, maiai, and in Latin, obstetrices or more generically medicae) were the normative caretakers of both the gynecological and obstetrical needs of Greek and Roman women.  Medical writers from at least the third century BCE to the sixth century CE composed texts specifically for midwives’ use, and there is ample evidence (such as inscriptions and artwork) that midwifery was professionalized in larger urban communities.  Ancient writings on gynecology and obstetrics conceived of the ideal midwife as not simply literate and competent in medical theory, but as responsible for all disorders of the reproductive organs as well as routine assistance in childbirth.  In the scope of her practice, at least, she was fully the equivalent of modern obstetrician/gynecologists and not simply a birth attendant.

With the decline of ancient urban communities, the literate midwife of Antiquity disappeared.  Between the sixth and the thirteenth centuries, neighbors and kinswomen generally seem to have assisted each other in their births, none necessarily claiming any more expertise than the others.  This explains why it is so difficult even to find mention of the word “midwife.” Anglo-Saxon seems never to have produced a stable term for “midwife,” which is actually a Middle English term not documented prior to ca. 1300.  The same is true for all the other medieval vernacular languages save German, which can trace forms of the term Hebamme back to the eighth century.  Ecclesiastical law had itself differentiated between midwives and “matrons” in late Antiquity, preferring that determinations of virginity, rape, and pregnancy be made by groups of upstanding women of the community rather than midwives, whose individual eyes and hands were subject to error.  This distinction between “matrons” (who had no particular medical expertise) and midwives seems to have continued into the later Middle Ages; for example, the women who examined Joan of Arc to assess her claims of virginity were laywomen rather than medical specialists.  It was probably only with the gradual legal regulation of midwifery that midwives took over these tasks.

The transition of midwifery from a neighborly, shared task to a formal occupation was slow.  Northern Europe was the earliest to establish formal licensing.  In France, the church initiated licensing due to its concern that birth attendants know how to perform a valid emergency baptism if the newborn seemed likely to die.  (This same concern would also lead to the practice of Caesarean section, which in the Middle Ages was performed only on dead women in order to baptize the fetus.)  In Germany and the Low Countries, concern for poor women led certain municipalities to appoint town midwives.  By the early fifteenth century, midwives were being licensed, their oaths demanding that they treat rich and poor alike and uphold proper morals. 

It remains unclear what the actual medical knowledge of midwives was or how they passed that knowledge on to others.  Aside from a thirteenth-century Hebrew circumcisor’s manual which describes some practices of Jewish midwives, there is very little extant testimony about the manual procedures or medicinal substances employed by midwives.  Even Trota of Salerno, a twelfth-century medical writer, has little to say about attendance on normal birth. An extraordinary eyewitness account of a birth made by a Spanish notary in the fifteenth century reflects a rather unusual situation because of the presence of several men.  We have no evidence that medieval midwives undertook formal apprenticeships nor (unlike Antiquity) were any instructional manuals written for them.  (The texts on women’s medicine that are actually addressed to female audiences address women generically, not midwives.) 

By the time midwives did re-emerge as a specialized profession in the late Middle Ages, male practitioners had taken over primary responsibility for diagnosing and treating gynecological conditions (including menstrual difficulties and, of particular concern, infertility). When visual inspection of or manual applications to the genitalia were needed, a female assistant was called in.  By the end of the Middle Ages, male surgeons were commonly relied on for assistance in difficult births and for treating conditions of the external genitalia and vagina.  Thus, when the first texts addressed specifically to midwives were composed in the mid-fifteenth century and early sixteenth century, they limited the scope of midwives’ practice to supervision of pregnancy and childbirth; more difficult conditions were referred to the male physician or surgeon. Still, because of midwives’ increased identity as professionals, midwifery remained an important and (usually) well-respected occupation for women throughout the early modern period.  Despite the rather hysterical accusations against “witch-midwives” by the authors of the witch-hunters’ manual, the Hammer of Witches (Malleus maleficarum, 1496), formally licensed midwives were hardly ever accused of witchcraft.

Monica Green

References and Further Reading

Cabré, Montserrat, trans.  “Public Record of the Labour of Isabel de la Cavalleria.  January 10, 1490, Zaragoza.” The Online Reference Book for Medieval Studies. (December 2004).

Flemming, Rebecca.  Medicine and the Making of Roman Women:  Gender, Nature, and Authority from Celsus to Galen.  Oxford:  Oxford University Press, 2001.

Flugge, Sibylla.  Hebammen und heilkundige Frauen:  Recht und Rechtswirklichkeit im 15. und 16. Jahrhundert, 2nd ed.  Frankfurt am Main:  Stroenfeld, 2000.

Green, Monica H.  “Bodies, Gender, Health, Disease: Recent Work on Medieval Women’s Medicine.” Studies in Medieval and Renaissance History, n.s. 3, vol. 2 (2005): 1-46.

Harley, David.  “Historians as Demonologists:  The Myth of the Midwife-witch.” Social History of Medicine 3, no. 1 (April 1990): 1-26. 

Taglia, Kathryn.  “Delivering a Christian Identity:  Midwives in Northern French Synodal Legislation, c. 1200-1500.”  In Religion and Medicine in the Middle Ages.  Ed. Peter Biller and Joseph Ziegler.  York Studies in Medieval Theology, 3. York:  York Medieval Press, 2001, pp. 77-90.

See also:Caesarean Section; Doctors and Healers; Gynecology; Pregnancy and Childbirth: Christian Women; Pregnancy and Childbirth: Jewish Women; Trota of Salerno.

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