by Valerie Levy
Life went on.
Author's notes.
First, my sincere thanks to you - Pat, Carol, Yvonne, Julie and Sandy for your encouragement, advice and helpful comments. You took the time out of your busy lives to read drafts of MIDWIFE, and I appreciate your friendship and support.
The midwifery procedures are as accurate as historical records will allow, and I have added a brief bibliography at the end of the book that lists some of the sources I consulted. The obstetric and medical conditions suffered by the characters are as authentic as I could make them.
Women usually gave birth sitting upright on a birthing chair. The chair would, of course, be made of wood, with a horseshoe-shaped seat to allow the midwife access, and also to provide room for the baby to pass through. The illustration that appears here and on the front cover is taken from The Rosengarten (its full title roughly translated as The Rose Garden for Pregnant Women and Midwives), written by Eucharius Rosslin, a German physician. He wrote the book in the early 1500s specifically for midwives, in an effort to improve their practice, although he took much of its content from Greek and Roman authors of ancient times.
He instructed that a chair should be made so that the mother might recline in it. The chair should be padded with cloths, and the mother covered. At the right time, the covering should be removed and the mother turned from one side to the other. The midwife is to sit in front of the chair and pay careful attention to how the mother is moving, controlling her legs with her hands previously coated with, for example, white lily oil, or almond oil. The midwife must encourage the mother with gentle words, exerting her to breathe deeply, and ensuring she takes nourishing food and drink, and massaging lightly just above the mother’s navel towards the hips. Rosslin exhorts the midwife to comfort the mother with the happy prospect of birthing a boy.
The theory of humours - developed by Aristotle and Galen – were still followed in medieval times. The four humours that circulated around the body were said to be blood, choler, melancholy and phlegm, and the health of individuals depended upon the balance of these humours. Also, the humours determined the outlook of an individual – for instance, an optimistic person’s temperament may still in this day and age be described as sanguine (or bloody), or people may be said to be choleric or phlegmatic.
The balance of humours was thought to control the heat of the body. Men were thought to be hotter and drier than women, and therefore naturally superior. Indeed, it was the heat of their bodies that forced their genitalia to the outside. Women were colder and therefore their reproductive organs were kept within their bodies. Because of their cold, wet nature, women needed frequent sex. Their lust, it was believed, could be dangerous for men, sapping their strength and threatening their morals.
Regarding the obstetric and medical disorders encountered in MIDWIFE, Isabella was unable to birth more than one healthy child because she became rhesus iso-immunised at the birth of Rosalind. This condition was not recognised or understood until the last century.
The physiology is as follows. The rhesus negative mother carries a rhesus positive child. At birth, small quantities of the fetal blood are forced through the large maternal blood vessels in the mother's uterus, back into her circulation. Her body recognises the foreign rhesus protein in this fetal blood and forms antibodies to it within a few days.
In the next pregnancy, these antibodies are small enough to pass through the placenta into the new fetus. The first baby is fine – it has been born before antibodies can form – and so is the mother as she has no rhesus proteins for the antibodies to attack.
Problems arise, however, if the next fetus is rhesus positive. The antibodies destroy the rhesus protein in the fetal blood, and with it the whole blood cell. The fetus/baby might be too anaemic to survive and will be stillborn or die soon after birth.
If the child survives there is a risk of permanent brain damage from very high levels of bilirubin, a by-product of blood cell destruction. The bilirubin causes severe neonatal jaundice. This condition is called rhesus haemolytic disease (RHD).
Isabella was unlucky enough to be married to a man who could only father rhesus positive babies, and so all but the first, Rosalind, were affected. Isabella could never have had another viable child with Lord Roger as the father.
Until the last thirty years or so of the last century, RHD caused many stillbirths, neonatal deaths and handicap. RHD is now almost unheard of in developed countries nowadays because of the routine administration of an immunoglobulin to rhesus negative women after childbirth or miscarriage, that stops antibodies from forming.
Baby Edward became slightly jaundiced when he was a few days old, desperately worrying Isabella. She need not have been concerned, however. Edward’s mild jaundice was not due to RHD but by a slight and temporary immaturity of his liver that was highly unlikely to cause any serious problem.
Nicholas had diabetes, resulting in insatiable thirst, weight loss, tiredness and circulatory problems, resulting in the loss of his toe. He died from a heart attack; a coronary thrombosis aggravated by his diabetes. Today, he would be treated with insulin and dietary control. Diabetes was probably far less common in medieval times than now, most likely because of the simple diet of those times, and less obesity. But Liza's curse, although not the cause of his condition, most likely made it worse - who knows how far the psychological affects the physiological?
The Attwoods suffered from pulmonary tuberculosis (in medieval times known as the white plague); then, as now, mainly a disease of poverty and overcrowding. The symptoms - night sweats, breathlessness and chest pains -were sometimes ascribed by the more superstitious to a witch taking over the individual during the night, and riding him or her like a horse to the point of exhaustion. Was this the origin of the term ‘nightmare’? I do not know.
The medicine Liza’s mother gave to stop Bess Belling’s haemorrhage was ergot; a fungus that lives upon rye. Ergot produces a strong contraction of the uterus, the muscle fibres of which serve as a tourniquet to the large blood vessels of the placental site. It has saved countless lives of women in childbirth and is still used in some form or other today to prevent or treat post partum haemorrhage. And evidence exists that labour was sometimes brought on by tossing the woman in a blanket, as happened to poor Judith.
Incidentally, Gropecunt Lanes were actually documented in medieval times; several existed in London (a source attests one was renamed Threadneedle Street), and more could be found in Oxford and other cities. As the name suggests, they were medieval ‘red light’ districts. Eventually, their names were changed to Grape Lane, Grope Lane, or similar.
Margaret Attwood gave birth to a baby with meningomyelocele (spina bifida) and hydrocephalus. The excess of amniotic fluid that so distended her uterus often accompanies this condition, as it may also do in cases of oesophageal atresia, which happened in the birth of the baby girl Liza remembered. The villagers, including Liza, were unlikely to have experience – or have even heard of – such births and the 'evil eye' was the inevitable culprit for the inexplicable. In medieval England, however, witchcraft – much associated with midwives and wise women - was not perceived as an endemic problem and 'blind eyes' were often turned.
A few centuries later, though …. well, that's a different story.
The next book in the series will be available in early 2013 - look out for “Midwife: Beatrix”, set in Hollingham and London in the 1630s.
Some of the medieval terms used:
Courses or flowers - menstrual period
Gipon - a jacket similar to the doublet of later times
Matrix - the womb’s lining: the endometrium
Red plague - smallpox
Secundines - amniotic membranes
Stones - testicles
Throws - uterine contractions
White plague - tuberculosis
Yard - penis
Bibliography
These are just a very few of the sources I consulted, but I hasten to say that any err
or of fact in MIDWIFE is, of course, down solely to me.
BRAUDEL, Fernand (1981) ‘The Structures of Everyday Life’ William Collins & Sons.
BROOKE, Iris (1972) ‘A History of English Costume’ Eyre Methuen, London.
CONRAD, L; NEVE, M; NUTTON, V; PORTER, R (1995) ‘The Western Medical Tradition Vol 1’ Cambridge.
COPPACK, Glyn (1990) ‘Abbeys and Priories’ English Heritage, Batsford.
CULPEPER, Nicholas (1981) reprinted from 1826 ‘Culpeper’s Complete Herbal’ Harvey Sales.
FURNELL, Dennis (1985) ‘ Health from the Hedgerow’ Batsford.
GIES, Frances and Joseph (1969) ‘Life in a Medieval City’ Harper Perennial.
GIES, Frances and Joseph (1978) ‘Women in the Middle Ages’ Harper Perennial.
GIES, Frances and Joseph (1990) ‘Life in a Medieval Village’ Harper and Row.
KLEINHENZ, Christopher (2003) ‘Medieval Italy: An Encyclopaedia, Vol 2 ’. Routledge.
McKISACK, May (1959) ‘The Fourteenth Century’ Oxford Clarenden.
MORTIMER, Ian (2009) ‘The Time Traveller’s Guide to Medieval England’ Vintage.
ROWLAND, B (translator) (1981) ‘Medieval Woman’s Guide to Health’ Kent State University Press.
SHARP, Jane ‘The Midwives Book, or the whole art of midwifry (sic) discovered’ (1999) Elaine Hobby (Ed) Women Writers in English 1350-1850. OUP.
SHORTER, Edward (1982) ‘A History of Women’s Bodies’ Pelican
SOUTHERN, RW (1970) ‘Western Society and the Church in the Middle Ages’ Pelican.
STOWE, John (1987) ‘The Survey of London’ Everyman’s Classic