Research into midwives' perceptions of loss in childbearing (Sheen et al, 2015) has shown that midwives who have not experienced the death of a woman in childbirth (maternal death) are unlikely to contemplate that such a tragedy might happen (Mander, 2001). It is not unreasonable to assume that in Western settings, where maternal death is thankfully rare, this observation also applies to childbearing women themselves. This article will examine historical perceptions and how women's fears of what was known as ‘childbed death’ have been recognised or dismissed by historians. To explore the existence of women's fears, the authors draw on documentary evidence which demonstrates the preparations and precautions that women made and took prior to labour and the birth. The article focuses mainly on Scottish artefacts because the situation in Scotland has been largely neglected in the literature, unlike that in England (Penny, 1975; Hurtig, 1983). The exception is the work of Anne Cameron (2013), but the focus of her work is on customs and rationale. Cameron makes no mention of maternal death except for when the death of a woman in childbirth was blamed on supernatural agents (2013).
That childbed death was widely recognised historically is evidenced by the existence of memorials (Penny, 1975; Hurtig, 1983; Wilson, 1993b; Warner, 2011; Mander and Marshall, in press); but few 17th-century gravestones and memorials have survived to this day, and those that have tend not to state the cause of death. Portraits of the time tended to be commissioned by the upper classes and are limited in number, and it is extremely difficult to match them up with other visual evidence of the person concerned.
What may be an unusual form of memorial, which may also serve to demonstrate the childbearing woman's state of mind, has attracted some publicity (Kennedy, 2002). Some 17th-century portraits painted in London include an acquisition by the Tate Gallery (2016); the portrait by Marcus Gheeraerts II, a Flemish painter, shows a wealthy woman nearing the end of her pregnancy. Kennedy (2002) reports the hypothesis advanced by the curator, Karen Hearn, suggesting that such paintings were a form of ‘antenatal memorial’. It is hypothesised that they helped the woman to prepare for not surviving her labour and the birth, as indicated by the expression of ‘haunting anxiety’ on many of the sitters' faces. The significance of these women's facial expressions is questionable, however, as people in portraits during this period never smiled; these images were not photographs, and a sitter could not keep up a smile for all the time involved in having the portrait painted. More importantly, smiling in a portrait would have been regarded as undignified, which was anathema to those who commissioned portraits, as the sitter was keen to be shown with a serious, contemplative expression.
It has not been possible to locate any such ‘antenatal memorials’ in Scotland; this may be because Scottish noblewomen spent such a large amoung of time during their lives being pregnant, that they rarely travelled to London during their childbearing years—such aversion may have been caused by anticipation of the 2 weeks in a jolting coach necessary to get there. Additionally, there were not the artists available in Scotland who could produce such portraits; thus, it is likely that the heavily pregnant English sitters in portraits such as that by Gheeraerts lived in, or close to, London.
Ballads as memorials
As well as a range of artworks and other artefacts, childbed death has been recognised—and, effectively, memorialised—in popular ballads such as ‘Fair Mary of Wallington’ (alternatively ‘Fair Maisry of Wallington’) (Kerrigan, 1991). This song constitutes a dire warning of maternal death, with equivalents found in other languages and cultures (McCulloch, 2003). It is generally believed, on a linguistic basis, that the Scottish song ‘The Bonny Earl of Lindsay’ was the original version of the ballad. The song's name was changed when it spread across the border to the north of England, rather than originating there, to the ‘Fair Mary of Wallington’ version (Lyle, personal communication).
The woman who was the subject of the ballad was the wife of the ‘Bonny Earl’, although there was actually no peer of that name in the country. The ballad relates how the seven sisters are destined to die in childbirth. Not unreasonably, ‘Mary’ endeavours to avoid marriage and the apparently inevitable consequences, but eventually she deigns to accept a husband and her fate. This woman's feelings of foreboding, her suffering and demise, as well as her mother's enthusiastic encouragement, are recounted in colourfully explicit verse.
How much do the artefacts tell us?
It is necessary to admit that the artefacts, such as works of art, recording childbed death were able to be created only by those with sufficient education and/or funds to produce them. Despite this, there is no reason to believe that the experience of loss was any different among those who would have been too poor to pay for memorials (Marshall, 1983). This is apparent in a newspaper report regarding the impoverished John Arnott, a mineworker in Fife, whose grief at the death in childbed of his unnamed wife caused him to neglect the welfare of his six surviving children (The Scotsman, 1930). It is difficult to imagine how his consequent prison sentence was intended to improve matters.
The problem of counting
The memorials and other artefacts provide little indication of the numbers of maternal deaths in the early modern period (Loudon, 1992). Irving Loudon considers that maternal deaths have always been different from other deaths, not only because of the family disturbance which inevitably ensued, but also because ‘Childbirth was the only cause of mortality that was not a disease’ (Loudon, 1992: 164). In his authoritative magnum opus, Loudon seeks to persuade readers of the relatively small numbers of childbed deaths in pre-industrial England and, hence, their limited impact on other childbearing women. It is necessary to question, however, the statistics on which Loudon relies. First, by whom were such deaths diagnosed and reported? Secondly, could those attending and reporting such a birth and death have had some pecuniary interest in avoiding publicising the fact that the woman's death was caused by childbirth? It is worth considering that, until accurate methods of recording deaths were introduced in the 19th century, maternal deaths could easily be passed off as resulting from incidental causes, such as phthisis (pulmonary tuberculosis), rather than being childbearing-related. Thus a practitioner's standing in a local community, and their income, would be safeguarded.
The woman's anticipation of birth
In the 21st century, childbirth education is freely available through a wide range of interpersonal, broadcast, print and digital media. It may be difficult to imagine that, in earlier times, a woman contemplating childbearing and birth was not at least disconcerted by reports of childbed mortality and the prospect of death which they carried. Evidence of women's reactions to such artefacts would be difficult to find. As these artefacts would have been highly visible to a profoundly religious, churchgoing population, it may be presumed that they aggravated any apprehension that the woman may already have been experiencing. On the other hand, the woman's reaction may have been more fatalistic, being one of ‘que sera, sera’ (Marshall, 1983: xiv); some women may have viewed death in childbirth as God's will, to which they would have to submit.
The view advanced by Loudon (1992) refutes such suggestions. His contention is based on two suppositions. First, Loudon argues the limited possibility of maternal death—although, as mentioned, the statistics are questionable. Second, the prevalence of death throughout the population due to many other (non childbearing-related) causes, Loudon maintains, made it less significant. Such prevalence, though, is unlikely to have diminished anxiety about birth, which was a frequent and largely domestic and social event. For these reasons, Loudon argues that the possibility of maternal death was a matter of little, if any, significance to the childbearing woman in the early modern period—a view also advanced by Roger Schofield (1986) and Adrian Wilson (1993a). Historian Lawrence Stone (1977: 79), however, admits that childbirth ‘was a very dangerous experience’ blaming ‘ignorant and ill-trained’ midwives.
‘Childbearing women in Scotland would endeavour to avoid childbed death by making suitable preparations and taking appropriate precautions’
As has previously been indicated in an English context (Hurtig, 1983), this article will now discuss Scottish evidence demonstrating that women's anxiety about childbed death was real. Thus, the childbearing woman in Scotland would endeavour to avoid such a tragic outcome by making suitable preparations and taking appropriate precautions.
Childbed death anxiety
Because of the difficulty, already mentioned, of identifying relevant early modern gravestones, the evidence on which we need to draw must be documentary sources. Such correspondence allows us to enter the minds of these long-gone childbearing women, whose thoughts and apprehensions were very understandable in the days when medicine was far less sophisticated than it is now. The childbearing woman, who was able to write and whose letters are available, articulated very real fears. For some women, such as Anne, Lady Elcho, writing in the late 17th century to her sister-in-law the Countess of Leven—who also received much advice from her mother, Margaret Countess of Wemyss—the nature of those fears was unspecified. She simply mentioned that:
‘I begin now to be a little afraid, my time being so near.’
The Countess of Dalhousie wrote in similarly non-specific terms to the Countess of Leven in about 1696, earnestly hoping:
‘I could wish to be well quit of my big belly… for I am in great feare.’
Other women wrote quite explicitly of their apprehension that they would not survive childbirth. Anna Livingstone, Countess of Eglinton, wrote to Mrs John Murray in 1616:
‘I expect you will pray for me, that I may bring forth this child and live to deserve your innumerable kindnesses.’
Such anxieties about childbed death were also mentioned by those close to the childbearing woman, as James Smith wrote to the Countess of Leven in 1695:
‘…he prays God to preserve the Countess.’
The conviction of her forthcoming death was expressed by Lady Margaret Stewart, the wife of the eminent polymath Sir John Clerk of Penicuik, in the journal which he kept throughout his remarkable life, recording all of his achievements and other momentous events (Gray, 1892). She died of a primary postpartum haemorrhage despite the ministrations of three eminent medical practitioners, including James Hamilton, who subsequently became President of the Royal College of Surgeons, Edinburgh (1702–3). After her death, her grieving husband stated:
‘She sent for [her father-in-law] and beged he would pray for her, since she was assured that she was dying… Still she persisted that she was steping into Eternity…’
Following the birth of her son, her condition deteriorated further:
‘She fell into fainting Fits, … she sent to acquaint me that she found her self dying, [saying] My dear I must leave you but I am hopeful that I shall be happy whatever hapns [May God be merciful] to my Soul. Live and take care a poor young [baby].’
It is apparent that fear in general—and fear of death, in particular—pervaded childbirth for this woman; this evidence contradicts the views expressed by some eminent historians. That those close to her shared her concerns is also evident, calling into question the assertion by Stone (1977: 102) that ‘relations between spouses in rich families were often fairly remote’.
Preparation for childbirth and death
In a context featuring such fear, the childbearing woman would, as at the present time, prepare for labour and birth both psychologically and through certain activities.
Women have traditionally been brought up to recognise the reality of childbirth and the associated pain. This was exemplified in the colloquial expression ‘When you cry’, meaning ‘When you give birth’. Historically, preparation has involved making the necessary arrangements, such as having sufficient supportive experienced women present, including the woman's mother, mother-in-law, female relatives and friends (Cameron, 2013: 19); this coterie was known as ‘God sibs’, meaning near-relatives, a term corrupted to ‘gossips’. To make these arrangements, and clearly recognising the challenges of childbirth, the Honourable Christian Stuart wrote to her mother-in-law, Mary, Countess of Traquair, in 1744:
‘Your Ladyship's presence will soften the terrors of that dreadfull hour to me.’
These experienced women provided a support system to comfort and encourage the childbearing woman (Cameron, 2013). Such reassurance operated not only through the companions’ actions, but also their presence would provide reassurance that, just as they had survived labour and birth, she could overcome the challenges ahead.
In a society that believed fervently in divine providence, measures to seek the help of the deity would increase the woman's confidence in a successful outcome. Unsurprisingly, prayers featured prominently. Before the Reformation, these prayers also related to activities such as obtaining relics, consecrating objects and making pilgrimage (Box 1).
|Treatment for||Recipes for|
|A hard birth||Pains in the birth|
|Too much milk||Bringing furth the dead chyld|
|Not enough milk||Expelling the secondine|
|Afterbirth symptoms (throws/pains)|
|Hardness of the mother (i.e. womb)|
|Pain of the mother|
|Inflammation of the mother|
Praying or soliciting prayers constitutes an active approach to fear. Less positive is the adoption of the fatalistic orientation whereby childbed death may have been considered and accepted as God's will. Fatalism resounds in the writing of Margaret, Countess of Northesk, seeking the companionship of her sister's daughter. She knew that giving birth in Edinburgh, where she was residing, would not alter her fate one way or the other; Margaret wrote to her brother-in-law asking for his daughter to come and stay with her:
‘…for she will be the only relation I will have by me when I am brought to bed and perhaps may do me the last service.’
There was also a role for her niece to play if the worst did not happen:
‘If I escape this hazard as I have formerly done, Your Lordship I don't doubt will be glad to hear good news of me.’
On the other hand, if the outcome was not good:
‘If otherwise, you'll lose a very affectionate and faithful friend, sister and humble servant, though a very insignificant one.’
Perhaps more surprisingly, evidence of such a fatalistic approach is also found in the preparations that Mary, Queen of Scots made for the birth of her baby, in 1566, who was to become James VI of Scotland and James I of England. She drew up a detailed handwritten list which may be considered to serve as a will. In the event of neither she nor her baby surviving, her most precious jewels would become the property of the Scottish crown and future monarchs, while other valuables were to be shared among a number of lesser beneficiaries (Marshall, 1986).
The documentary evidence shows that women who were literate shared their perceptions about the risks of childbirth through correspondence. Information about childbed death was also recorded and reported through other forms of communication. This sharing assisted other childbearing women in making realistic preparations and taking pragmatic precautions for labour and birth. The material which we have considered, together with certain psychological and other activities, would have facilitated the childbearing woman reaching a suitable frame of mind in which to face the challenges of childbirth. Her fears and efforts to increase her chances of surviving giving birth are shown to have been shared and supported by close family and others.
In spite of fears around childbirth, family members were enthusiastic to encourage the pregnant woman who was ill or who had suffered a miscarriage to keep going and to bear lots of children. This enthusiasm was articulated by James Smith in a letter to the Countess of Leven just after his wife gave birth to a son, saying that he prays God to preserve the Countess and her husband
‘and to make you the mother of a numerous blessed progeny to be patterns of holiness to future generations’
This article has demonstrated that fear of childbirth and realisation of the risk of death in childbirth was, contrary to the opinions of some historians, widespread among childbearing women in the early modern period.