Death during labour in the 16th and 17th centuries: the power of Saints to intercede

«And departing this place, they reached In Spring the land that leads to Ephrath, Rachel went into labour, and she had hard labour. And the midwife said to her, “Do not fear, for you will yet have this son.” And as her soul was departing (for the pain), she called his name Ben-oni, which is son of my sorrow; but his father called him Benjamin, which is son of the right hand. So Rachel died, and she was buried on the way to Ephrath.»

Genesis 35, 16-19.

The death of Rachel narrated in Genesis (from the translation of the Vulgate by father Scio de San Miguel towards the end of the 18th century) depicts a case which seems common in the Old Regime. Maternal death or maternal morbidity-mortality has been defined by the World Health Organisation (WHO) as the death of a woman during pregnancy, during delivery or during the postpartum period within the 42 days following the termination of pregnancy. These deaths have been classified as direct maternal deaths, which means those occasioned by complications during pregnancy, delivery and postpartum; indirect obstetric deaths, caused by an illness which existed before pregnancy but gets worse as a result of it; and non-obstetric deaths, from causes other than pregnancy.

In any case, in Spain, after correcting official estimates, the rate would be at between 7 and 8 deaths of women for every 100,000 live newborns at the beginning of the current, 21st, century, as compared with, for example, 564.7 deaths at the beginning of the 20th century. More recent data, from the Informe Anual del Sistema Nacional de Salud 2018 (Annual Report of the National Health System 2018), and published by the Ministerio de Sanidad, Consumo y Bienestar Social, indicate that the rate of maternal death for every 100,000 live newborns was 3.7 in the period 2000-2016, at a similar level to countries with the best figures worldwide.

Data from the past is much less reliable. But, although many sources (and popular opinion) talk about a high rate of female mortality, the figures for the Old Regime (16th to 18th centuries) in Europe are, as Schofeld highlights, surprisingly low, so that it may have affected between 1% and 2% of pregnant women. Nevertheless, although this fact has been highlighted from a historical demographic, we must not forget, as Steven Pinker warns us, that, for example, «for a woman in the USA a century ago, being pregnant was almost as dangerous as having breast cancer is today», so we should avoid underestimating the phenomenon by virtue of the statistic without bearing other ideas in mind.

However, although we may well have an approximate idea of the rate of maternal mortality, our knowledge of the causes of this phenomenon in bygone centuries is limited. A recent study of the causes of maternal mortality during delivery in the 21st century has identified embolisms, haemorrhages, and hypertensive disorders as the main ones in developed countries. In Africa, Asia and Latin America, haemorrhages are also an important cause, but we need to add causes which are less common in the Western world such as infections, anaemia, or obstructed labour.

So now, what did women die of during labour in previous centuries? It is true that we have no research nor statistically accurate sources, but we do have witness accounts of high qualitative value. These, the majority, can be found in hagiographies, hundreds of volumes which tell of the lives and miracles of saints and virgins, and provide thousands of cases of sick people who were cured or saved through their intercession, among them hundreds of pregnant women. In the case of labour, these narratives give us the date, place, and the protagonists’ names and surnames, and describe the dangerous situations women underwent accompanied by the midwife, sometimes a doctor and also other relatives.

Thus, we have been able to analyse 267 hagiographic works from the 16th and 17th centuries, which describe miracles relating to labour and from these we have extracted around 350 cases of maternal death. What these cases reveal, apart from certain witness accounts of postpartum fever, eclampsia or haemorrhages, is that the main causes of maternal death were two: stillbirth, which is when the foetus died in the womb when pregnancy was very advanced, causing the mother’s death either because it was impossible to extract the dead foetus or for other reasons; and, especially, due to dystocia or obstructed delivery («it was coming foot first», «the baby got stuck crossways», according to these texts).

This is a description of one such case in the miracles of San Ignacio de Loyola by Andrés Lucas de Arcones in Vida de S. Ignacio de Loyola, patriarca y fundador de la Compañía de Jesús, 1633:

«I will tell you only of one miracle with a woman whose pain during the difficult delivery of her son had pushed to the limit. The baby had pushed its feet out, but it was humanly impossible to get the rest out. Danger grew apace, mother and baby were dying without hope. Surgeons were ready to cut up the baby and extract it in pieces, to save its mother’s life. Thanks to the providence of the Almighty, they remembered the great miracle worker. By chance, one of those present had a relic of the veil which had covered the sacred body during its obsequies. Praying for Ignacio’s favour, he placed it on her chest. Immediately the baby turned round and was born headfirst, good and healthy. His parents named him Ignacio, so that they would always remember the miracle worked by the great patriarch.» (p. 739.)

Here, although the facts are not precise, we can see a clear difference with the modern world, as, nowadays, cases of death from obstetric obstruction have practically disappeared from the statistics, this is probably due to the practical application of Caesarean section, developed in particular between 1930 and 1970, and with sufficient technical and hygienic guarantees to ensure the survival of both mother and baby.

Jesús M. Usunáriz is Professor of Early Modern History at the Universidad de Navarra and a member of the Grupo Siglo de Oro (GRISO). In recent years, his research has focussed on the international relations of the Spanish Monarchy and the social and cultural History of the 16th-17th centuries (marriage, the social history of language, rites of passage, superstition and witchcraft). This contribution to the Virtual Museum of Human Ecology is part of the activities for the research project called The Interpretation of Childbirth in Early Modern Spain (FWF Austrian Science Fund, P 3226-G30).

Further reading

Ministerio de Sanidad, Consumo y Bienestar social. 2019. Informe Anual del Sistema Nacional de Salud 2018. Ministerio de Sanidad, Consumo y Bienestar social, Madrid.

Khan KS, Wojdyla D, Say L, Gülmezoglu AM, Van Look PFA. 2006. Who analysis of causes of maternal death: a systematic review. The Lancet, 367: 1066-1074.

Lucas de Arcones A. 1633, Vida de S. Ignacio de Loyola, patriarca y fundador de la Compañía de Jesús. Antonio René de Lazcano y Bartolomé Lorenzana, impresores, Granada. (The full text of this work is available in the UCC Digital Library.)

Pinker S. 2018. En defensa de la Ilustración: por la razón, la ciencia, el humanismo y el progreso, Paidós, Barcelona. (The quotation included from the text is taken from chapter 5.)

Rodríguez Ferrer RM, Feijoo Iglesias MB, Magdalena del Rey G, Pérez-Gay MP, Vivanco Montes ML. 2009. Revisión sobre mortalidad materna en España, en Actas del III Congreso de la Asociación Andaluza de Matronas, Islantilla, Huelva, 22-24 de octubre.

Schofield R.1990. ¿Morían realmente las madres? Tres siglos de mortalidad derivada de la maternidad en “El mundo que hemos perdido”, en L. Bonfield, R. Smith y K. Wrigthson (editores) El mundo que hemos ganado. Estudios sobre población y estructura social. Ministerio de Trabajo y Seguridad Social, Madrid, pp: 287-324.

Usunáriz JM. 2023. La percepción del parto en los siglos XVI y XVII: peligros, milagros y comadres, en J.M. Usunáriz y J. Ruiz Astiz (editores) La mujer y los universos femeninos en las fuentes documentales de la Edad Moderna, Dykinson, Madrid, pp: 273-295.

Usunáriz JM. 2023. Parir con esperanza: milagros y partos en las hagiografías de los siglos XVI y XVII. Avisos de Viena, 6 (in press).