About Postpartum Care

Historical European Traditions of the Postpartum Period
by Bethany Stricker, Charis Midwifery Student

Historically and traditionally, all over the world, women have had a season of rest and recuperation after birthing a baby.  Family and friends offered support and care so that the mother could adequately recover and establish breastfeeding.  Studies show, and physiology tells us that breastfeeding rates are higher when these practices are kept.  In turn, this lowers women’s diseases like breast cancer and improves the infant’s health while lowering infant mortality.  When a mother has a healthy, fulfilling breastfeeding relationship with her child, postpartum depression rates are also lowered.  For example, in Medieval and Reformation era Europe, adequate postpartum care and traditional practices were considered to be very important to ensure the health of mother and baby.  Over time, we have learned that there are benefits to their practices.  We have a lot to learn from the past in order to secure the future health of our childbearing women and their babies.

Between the 5th and 17th centuries, European women had an important role in familial and societal function.  In agrarian societies, children were seen as beneficial to the family’s way of life because larger families had more workers.  More hands meant lighter work and therefore, increased productivity and wealth.  In addition, the Catholic church and then the Reformers encouraged married couples to have many children and breastfeed.  Contraception was discouraged and considered to be an ungodly, sinful practice.  Having more children, often every two years, meant women spent more time postpartum,  often called the lying-in. (Yalom, 70)  During labor and birth it was very common for a midwife to be hired, if she could be afforded.   Further, additional female relatives, friends and neighbors would come to support the mother, the household and the midwife. (Ulrich, 162-163, 183, 184-189)  Before the midwife left, she would perform a variety of activities as discussed below.

Immediately after the birth, the mother’s vulva, buttocks and thighs would be cleaned of any blood or other fluids using warm water.  This was performed quickly, especially in the winter, to avoid chills.  Her sheets and other clothing would be changed.  Then, the midwife would wrap the mother’s abdomen in a clean cloth, all the way up to her chest to keep the skin on her abdomen from becoming ‘wrinkled and loose’.  The end of the cloth wrap would be left in a triangular flap covering the entrance of her womb to avoid ‘cold air finding its way inside’.

Since constipation could be an issue, it was wide-spread practice for midwives to give two spoonfuls of olive oil with sugar. This prompted the bowels to move before it became an issue. Lastly, it was proper to arrange the mother so that she was ‘neither lying, nor sitting...with her head and body a little more upright than if she were lying, so that the cleansings [lochia] can flow more easily.’ Guillemeau’s 1609 manual entitled De l’Heureux Accouchement or, the Happy Birth of Women, also advised the midwife to ‘put under her calves a rolled-up pillow, so as to keep her knees up and so that the thighs and legs are nowhere lower than horizontal.’
After the birth, it was a recommended practice to immediately give the mother something to eat. The selection of food was variable with the season and the family’s economic status. Some common items included broth, stewed meat, squabs of partridges, or soups of bread, vegetables and fat or other easily digested foods. White wine or claret was recommended or also walnut liqueur or brandy. When doctors came on the scene, they often protested such heartiness so soon after delivery for fear of vomiting. However, midwives encouraged the practice to ‘repair the blood’, presumably to build iron, and to ‘repair the languishing faculties, both vital, animal and natural’ of the woman. (Gelis, 178-181)

Once the midwife left, the lying-in officially began. It was called this because in Medieval Europe, the wealthy thought of it as a special time for the mother to rest in bed, receive visitors and generally, be doted upon. In Italian families, game boards, with a beautiful painting on the other side, were commissioned as a gift to the mother to help her enjoy her time of confinement. Per Old Testament teaching, mothers were considered impure for six weeks, or 40 days after birth and could not attend church or go about society until the time had passed. To allow a postpartum woman back into the Catholic church and society in general, a ‘churching’ service was held. Beginning outside the church, the woman was blessed, her body was sprinkled with holy water by the priest and then, she was led, by the right hand, inside. (Yalom, 71)

In Colonial America, midwife Martha Ballard chronicles the ritual practice of a celebration to begin the lying-in. The female entourage that attended the woman in labor, sometimes up to 22 in number, stayed to have a meal with the amount of food dependent on the wealth of the family. If appropriate for the hour of day, the helpers were welcomed to stay the night. Martha writes that there would be a ‘clutter’ of beds in the kitchen, chambers and niches of busy households.

After this celebration, the afternurse arrived, for those who could pay such a person, and the midwife left. Afternurses stayed with the mother in her lying-in, specialized in nursing, and could handle common complications of the postpartum period. This could include breastfeeding issues, fevers, cramps, hemorrhoids and phlebitis. The length of their stay depended on what the family could afford and the other engagements and personal duties of the afternurse. Often, the afternurse was a single woman, whether very young or much older, a widow, or another experienced woman with time to serve mothers in their postpartum. If a complication arose where the afternurse could not manage the case, the midwife would be called. However, it was rare for the midwife to be called in the postpartum period, testifying to the help of the afternurse and the health of the women. (Ulrich, 188-191)

The length of the lying-in depended on the level of difficulty experienced by the mother during her labor and birth. Additionally, the economic status of the mother affected the length of time. Some mothers would need to return to the care of the household and other children if she could not pay hired help. The diary of Martha Ballard records that it was common for the new mother to stay in her chambers for one week. Martha then indicates that the woman gradually assumed increased responsibility until she was able to ‘return to her kitchen.’ Martha did record a case where a woman, after the birth of her seventh child, stayed in her chambers for three weeks.(Ulrich, 189-190)
A family’s view on breastfeeding was determined by their economic status, what their neighbors were doing, and what their religious views dictated. Plutarch stated that the woman’s breasts were placed high upon her body so she could embrace and hold her child while she fed him, developing affection for him. Saint Brigid of Ireland encouraged breastfeeding by saying, “for so it is arranged by nature that nurses always bestow the affection of their spirit on those to whom they provide the milk of their flesh.” (Herlihy, 120) Both of these statements point to our current medical knowledge on the hormone oxytocin. Anne Bradstreet, a godly, puritan woman, breast-fed her babies when her peers were employing wet-nurses in wealthy England. The Puritans considered it to be a mother’s religious duty to nurse her own babies and did so in the presence of visitors. (Yalom, 128) Medieval nobility in France and Italy often employed wet-nurses that lived with their family. At other times, the children were sent away to be nursed by others until they were weaned. (Yalom, 71-72) If breastfeeding was not possible for the mother, the wealthy would hire a wet-nurse andwhile others would feed the child animal milk (Marland, 143-144) or find a friend to nurse their baby (Ulrich, 246). In general, both the rich and the poor nursed their babies, sometimes for economic reasons and at other times, for religious conviction or simply for the love of their child.

Throughout history, it was customary for women to rest as much as they could after childbirth. They knew that once they began working in their household again and reentered society, there was no going back. The transition from pregnancy to adding a new family member had finished and now they had all of their duties to keep. The lying-in was wise for the mother’s emotional and physical health and recovery, and also allowed for breastfeeding to be established. This lowered postpartum depression rates to such an extent that it is not mentioned in this time period. The mother had an incredible support network. Her female friends, relatives and neighbors descended upon her house when she had a baby, making the lying-in possible and encouraged. Even more, when breastfeeding was not possible, even with all of this support, it was common for healthy alternatives to be accepted by society instead of the formula we have today. Our current culture has much to learn from the past in order for mothers to have less stressful postpartums, ease back into their usual lives, and have healthy breastfeeding relationships.

©Bethany Stricker

Works Cited 

Gelis, Jaques. History of Childbirth. Boston, MA. NorthEastern University Press. 1991. Print.

Herlihy, David. Medieval Households. Cambridge, MA. Harvard University Press. 1985. Print.

Marland, Hilary. The Art of Midwifery: Early Modern Midwives in Europe. New York and England. Routledge. 1993. Print.

Ulrich, Laurel Thatcher. A Midwife’s Tale: The Life of Martha Ballard, Based on Her Diary, 1785-1812. New York, New York. Vintage Books. 1991. Print

Yalom, Marilyn. A History of the Wife. New York, New York. Perennial HarperCollins Publishers. 2001. Print

Bethany Stricker lives in Northern Virginia.  Working on her goal of becoming a midwife has been rewarding!  She's excelling in her Charis midwifery course studies and is blessing her community as a doula.  Bethany also has the pleasure of assisting a CPM in solo practice at home and birth center births.  In her spare time, she enjoys friends, family, being mentored, sewing, gardening, real food cooking, knitting, building her library and permaculture.