Not of Woman Born

Representations of Caesarean Birth in Medieval and Renaissance Culture

Renate Blumenfeld-Kosinski

• Publisher: Cornell University Press
• Year: 2019
• ISBN:
  9781501740497
• Topic: Literature
• Subtopic: Medieval & Early Modern Literary Criticism
• Index: Literature

"Not of woman born, the Fortunate, the Unborn"—the terms designating those born by Caesarean section in medieval and Renaissance Europe were mysterious and ambiguous. Examining representations of Caesarean birth in legend and art and tracing its history in medical writing, Renate Blumenfeld-Kosinski addresses the web of religious, ethical, and cultural questions concerning abdominal delivery in the Middle Ages and the Renaissance. Not of Woman Born increases our understanding of the history of the medical profession, of medical iconography, and of ideas surrounding "unnatural" childbirth.

Blumenfeld-Kosinski compares texts and visual images in order to trace the evolution of Caesarean birth as it was perceived by the main actors involved—pregnant women, medical practitioners, and artistic or literary interpreters. Bringing together medical treatises and texts as well as hitherto unexplored primary sources such as manuscript illuminations, she provides a fresh perspective on attitudes toward pregnancy and birth in the Middle Ages and the Renaissance; the meaning and consequences of medieval medicine for women as both patients and practitioners, and the professionalization of medicine. She discusses writings on Caesarean birth from the twelfth and thirteenth centuries, when Church Councils ordered midwives to perform the operation if a mother died during childbirth in order that the child might be baptized; to the fourteenth century, when the first medical text, Bernard of Gordon's Lilium medicinae, mentioned the operation; up to the gradual replacement of midwives by male surgeons in the fifteenth and sixteenth centuries. Not of Woman Born offers the first close analysis of Frarnois Rousset's 1581 treatise on the operation as an example of sixteenth-century medical discourse. It also considers the ambiguous nature of Caesarean birth, drawing on accounts of such miraculous examples as the birth of the Antichrist. An appendix reviews the complex etymological history of the term "Caesarean section."

Richly interdisciplinary, Not of Woman Born will enliven discussions of the controversial issues surrounding Caesarean delivery today. Medical, social, and cultural historians interested in the Middle Ages and the Renaissance, historians, literary scholars, midwives, obstetricians, nurses, and others concerned with women's history will want to read it.

1 CAESAREAN BIRTH IN MEDICAL THOUGHT

Caesarean birth had a place in medieval culture before it began to interest learned physicians. Medieval scholars interested in the ancient Romans and in the intricate problems of etymology occupied themselves with the question of the origin of Julius Caesar’s name and whether he was born by Caesarean section; in addition, legends and miracles concerning Caesarean birth became part of the popular imagination.¹ Since the medieval ideas on Caesarean birth inherited from antiquity came from nonmedical sources, the operation did not appear in the canon of medical texts used by medieval physicians. It was not until the early fourteenth century that remarks on postmortem Caesarean sections began to emerge in medical treatises.

Pregnancy, Childbirth, and Obstetrics

She twisted and turned and writhed, this way, that way, to and fro, and continued so until, with much labour she bore a little son. But see, it lived, and she lay dead.²

Madame saincte Marguerite,

digne vierge de Dieu eslite,

qui Dieu servis dés ta jeunesse,

plaine de grace et de sagesse,

qui pour l’amour de Nostre Sire

souffris maint grant et grief martire,

qui le dragon parmi fendis

et du tirant te deffendis,

qui vainquis l’ennemy d’enfer,

enchartree et liee en fer,

qui a Dieu feiz mainte requeste

quant on te voult couper la teste,

et par especial que femme

grosse d’enfant qui a toy, dame,

de cuer devot retoumeroit,

et humblement te requerroit,

que Dieu de peril la gardast

et luy aider point ne tardast,

si te prie, vierge honoree,

noble martire et bieneuree,

par ta benoiste passion,

par ta sainte peticion,

que Dieu vueilles pour moy prier

et doulcement luy supplier

que par pitié il me conforte

es douleurs qu’i fault que je porte,

et sans peril d’ame et de corps

face mon enfant yssir hors

sain et sauf, si que je le voye

baptizé a bien et a joye.

Et se de vivre il a espace,

luy ottroye s’amour et sa grace,

par quoy si sainctement le serve

que la gloire des cieulx desserve.

Et aux autres, en cas semblable,

par toy soit doulx et favourable.

AMEN

([Medieval women in the throes of childbirth prayed to Saint Margaret:] Madame, Saint Margaret, / worthy virgin, elected by God, / who served God from her youth, / frill of grace and wisdom, / who for the love of Our Lord / suffered such a great and painful martyrdom, / who cut the dragon in half / and defended yourself against the tyrant, / who vanquished the enemy from hell / who was imprisoned and bound with iron, / who made many a request to God / when they wanted to cut off your head, / and especially when a woman / big with child who turns her devout heart towards you / and humbly begs you / that God may save her from peril, / and may not delay His help to her, / this is when I pray to you honored virgin / noble and blessed martyr / through your blessed passion, / through your saintly petition / may you pray to God for me / and sweetly ask Him / that He may comfort me through His pity / in the pain which I have to undergo / and that He—without danger to soul or body—make my child come out / safe and sound, so that I can see him / baptized joyously. / And so that he has room to live / may He give him His love and His Grace / for which he will serve Him in such a saintly way / that he may deserve the glory of the heavens. / And to others, in similar cases, through you, be sweet and favorable. Amen.)³

A fifteen-year old woman gives birth to a dead baby girl. Despite the devoted help of her chambermaid and a neighbor, after the birth she loses all sensation in her body below the waist. Burning candles and glowing coals are applied to her feet to test the insensitivity of her body—to no avail. For one and a half years no change in her condition occurs. It is only when she hears of the miracles that are happening at the tomb of Saint Louis (whose bones had been translated on that very day [May 22, 1281] to Saint Denis) that she envisions a possible cure for her ailment. She promises to attend mass every year at his anniversary, not to work on that day, and to become his pilgrim. After she touches the tomb and then the sick parts of her body, she lies down beside the tomb. Nine days later after having performed this ritual daily she feels how the bones in her body start banging together and on the tenth day she regains feeling in the lower part of her body. At the inquiry during Saint Louis’s canonization trial her case is examined and witnesses state that she is still healthy (May 1282).

The first example above is Gottfried von Strassburg’s early thirteenth-century description of Tristan’s birth. Blancheflor, Tristan’s mother, weakened through grief over the recent slaying of her husband, Riwalin, dies while giving birth. This scene undoubtedly reproduces many a medieval birth. Although medieval midwives were aware that emotional stress could result in difficult labor, they had few resources at their disposal that would allow them to prevent the tragic results of such complications.

The second example evokes Saint Margaret. Her story tells how she refused the Roman prefect Olibrius and rather than give up her virginity submitted to hideous tortures. She was then imprisoned and attacked in her prison by a terrifying dragon. When the monster did not manage to devour her, Olibrius finally had her burned with flaming torches and submerged in tubs of water. But she remained unharmed, and the crowd watching her began to be converted. Olibrius then decided to have her beheaded, and a moment before her death she prayed to God not only for herself and her executioners but also for any woman in labor: if the woman addressed herself to Saint Margaret for help the birth would have a happy outcome. A voice from heaven promised Margaret that her prayers would be fulfilled, and she went to her death reassured.

Saint Margaret’s story was extraordinarily popular in the Middle Ages (it was included in Jacobus of Voragine’s Golden Legend), but it is not obvious at first sight which elements in her life predestined her to become the patroness of women in labor. The mixture of ideals of virginity and extreme violence in her story parallels that in the lives of many other virgin martyrs who were raped, mutilated, or forced to enter bordellos before their execution. What distinguishes Saint Margaret’s story is the presence and function of the dragon. In different versions of the legend Saint Margaret either avoids being swallowed by the dragon or emerges unharmed from its belly. Given the sexual connotations of the dragon— the Antichrist is often called a lascivious dragon and seducer, for example—and the beliefs that the dragon-viper gives birth by splitting open (the violent and deadly consequences of sexual activity, as Rabanus Maurus pointed out),⁴ Saint Margaret’s martyrdom evokes both sexual violence and the pains of childbirth, and it is perhaps for this reason that she offered a prayer for women in labor before her death. Birth, in an age before systematized contraception, was the natural consequence of sexual relations and, for some women at least, must have seemed to be a punishment for the pleasure they experienced during conception.⁵ The violence connected with Saint Margaret’s death must have recalled, for many medieval women, the violence they had experienced, either themselves or as witnesses, during childbirth.

The idealization of virginity and the consequent rejection of sexual pleasure, so prevalent in medieval art and theological writings, have their roots in antiquity. Philo of Alexandria (first century a.d.) exalted virginity as a way for women to approach the male level of rationality.⁶ A few centuries later, Saint Jerome (340-420) confirmed this idea when he wrote that “as long as woman is for birth and children, she is different from man as body is from soul. But if she wishes to serve Christ more than the world, she will cease to be a woman and will be called a man.”⁷ And almost eleven centuries after Jerome, when the chancellor of the University of Paris wanted to bestow praise on Christine de Pizan he called her “distinguished woman, manly female” (insignis femina, virilis femina).⁸

It would be simplistic to see only male oppression and arrogance in this type of statement. As Margaret Miles states with regard to the depiction of women in fourteenth-century Tuscan painting: “The idealization of the virginal woman . . . may have symbolized to medieval women freedom from the burden of frequent childbearing and nursing in an age in which these natural processes were highly dangerous.” Idealizing virginity may thus have helped women to master the “brutish” aspect of their biologically determined lives.⁹

We can now understand better why the Virgin Mary and Saint Margaret were invoked during childbirth. One gave birth without encountering any of the physical suffering related to it; the other sacrificed her life for her virginity but before her death had to undergo torments not unlike those experienced during childbirth. Through her ability to sympathize with tormented women she became their ideal intercessor.

The third example, the case history of a young medieval woman, is the third miracle in the collection of the Miracles de Saint Louis, by Guillaume de Saint-Pathus. It dramatizes the aftermath of a dead birth as a precarious condition for a woman. The symptoms, a type of paralysis (possibly of hysterical origin) resulting in a partial depersonalization, help the woman deny the existence of that part of her body connected with sex and reproduction. It is remarkable that neither the account of the cure nor the final testimony a year later even mentions the possibility of her having more children; nor does the husband appear. This absence is very telling for, as we will see later, medieval birth was entirely in the hands of women. The young woman’s symptoms vanished, but the underlying causes—sexuality represented by the absent husband who could have caused another birth—continue to be denied and passed over in silence.

From these three examples medieval birth emerges with all its frightening and often fatal consequences. Where could medieval women find help and comfort in their trials? Before turning to some concrete examples let us briefly examine attitudes toward pregnancy and childhood (necessarily related to those toward motherhood) and what we can know about them in the Middle Ages in order to understand the feelings with which pregnant women and midwives approached the critical moment of childbirth.

Only one passage from the New Testament puts some value on childbearing: “Yet woman will be saved through bearing children, if she continues in faith and love and holiness, with modesty” (1 Tim. 2:15). We should not forget the context of this passage, however, which emphasizes women’s duty to be submissive to men, their guilt as descendants of Eve, as well as the interdiction “I permit no woman to teach” (verse 12). Procreation here is seen as a way of salvation, albeit an inferior one. Even the command of Genesis “Be fruitful and multiply” was not generally interpreted, in the medieval period, as expressing a positive attitude toward childbirth. Not bodily reproduction but spiritual advancement was the real meaning of this command, according to Saint Thomas Aquinas (1225-74).¹⁰ In general, the church’s attitude toward marriage, sexuality, and pregnancy was negative.¹¹ There were some notable exceptions, such as Duns Scotus, who seems to have favored “limitless procreation” in order to restore the city of supernatural citizens in human nature.¹² But even here children are seen in a spiritual context and not as a value in themselves.

The teachings of the church do not always directly reflect contemporary reality, of course. It would be absurd to say that in the Middle Ages no one enjoyed sex and that parents did not want and love their children. Nevertheless, church teachings posit an ideal that Christians are urged to pursue. And, as Vem Bullough points out, “Church sexual ideals remained much the same at the end of the Middle Ages as they were at the beginning. Although . . . Church officials dealt with the world as they found it, the ascetic ideal still dominated, and at best, sexual activity was only to be tolerated providing it resulted in procreation.”¹³ Although childlessness may have serious consequences for noble families, such as disputes over inheritance and succession rights,¹⁴ the general spiritual climate of the age did not favor ideas on childbearing as an important social function. In the hierarchy of medieval values, then, proc...

Table of contents

• Acknowledgments
• Introduction
• 1 Caesarean Birth in Medical Thought
• 2 Caesarean Birth in the Artistic Imagination
• 3 The Marginalization of Women in Obstetrics
• 4 Saintly and Satanic Obstetricians
• Appendix Creative Etymology: Creative Etymology: “Caesarean Section” from pliny to Rousset
• Annotated List of Illustrations
• Notes
• Bibliography
• Index