History & Culture
The story of Jesus’ birth is celebrated, manger and all. But historical texts suggest deliveries during that time were surprisingly hygienic.
ByDina Fine Maron
Published December 18, 2023
• 8 min read
Every year, Christians around the world mark Jesus’ traditional birth story with Nativity plays and Christmas festivities. The celebrated event is described in the Book of Luke, stating Mary, “gave birth to her firstborn son and wrapped him in bands of cloth, and laid him in a manger, because there was no place for them in the inn.” Yet specific details about Mary’s delivery are lacking in the biblical account, so scholars must look for them elsewhere. Contemporary births in ancient Rome provide some intriguing insights about the era’s practices—including some surprisingly hygienic customs that remain commonplace today.
Call the Midwives
Biblical scholars place the birth of Jesus sometime between 6 and 4 B.C.E., when Judea and Bethlehem were part of the Roman Empire. In ancient Rome, the actual birthing event was attended by women—with neighbors, kin, friends, and enslaved people assisting the woman giving birth, depending on her resources and social status, says Anna Bonnell Freidin, a historian at the University of Michigan and author of the forthcoming book Birthing Romans: Childbearing and Its Risks in Imperial Rome.
“If you look at our few images of birthing from the Roman Empire, you’ll notice that the scenes often emphasize a community of women—and I think that perspective is absolutely central to understanding the social nature of childbirth in the Roman world,” says Freidin.
Midwives of the era, if a family could afford them, were often women who dispensed routine medical care to women and children, though in the cities of the Roman Empire there were also elite, educated, midwives, she adds.
The ancient Roman Empire was vast, and though each province was required to adhere to Roman law, specific cultural or religious practices were not typically imposed on communities. As a result, birthing practices and pre-birth customs may still have differed. Leading up to a birth, expectant parents may have worshipped different deities or offered varied sacrifices depending on their religion. Jewish mothers, like Mary, would have also sought out a Jewish midwife if the family had the monies due to the period’s antisemitism and related concerns for the safety of mom and baby, says University of British Columbia historian Tara Mulder.
Midwives were even viewed as experts in the Roman legal system though there was no formal certification or oversight of doctors or midwives, Mulder says. When there were disputes about issues like child support, for example, midwives would be called upon to offer expert testimony about if a woman was truly pregnant or had given birth.
(Read more: How did Jesus’ parents become a couple? Here’s what biblical scholars say.)
Doctor’s orders
Midwives of the period were advised to keep their fingernails short, wash their hands, and engage in some birthing practices that still remain standard in hospitals and home births.
Much of what historians know comes from funerary art and epigraphs, as well as correspondence and medical texts of the time. Gynecology, the most comprehensive childbirth compendium of the day, was written by physician and medical author Soranus of Ephesus who collated existing midwife knowledge and added his own insights. It remains unclear if female midwives authored any of their own works since none of those texts, if they exist, have yet been discovered.
Some of the prenatal care features hygienic practices, though there were also others that put both mother and fetus at risk. Soranus’ guidelines, for example, stated that in the eighth month of pregnancy midwives should help “relax the parts” of expectant mothers with “vaginal suppositories of goose fat and marrow” and engage in injections of sweet olive oil. To the modern eye it may be of little comfort that the text noted that the oils used on the expectant mother should be clean rather than re-used cooking oil.
In general, Mulder notes, there were many suggested insertions of materials and instruments that would have heightened infection risk, and although Soranus does mention hand washing in the text there also wasn’t any specific discussion of what that meant—say, a simple rinse, soap, or lathering with oil and then scraping off any dirt.
(Related: Wash your hand was once controversial advice.)
Delivery rooms
The ideal midwife, Soranus wrote, would be: literate, someone with a good memory, respectable, robust, and “endowed with long slim fingers and short nails at her fingertips.”
Ideally there would be “three woman helpers” assisting during the labor, two by her sides and one behind to hold her and coach her through the pain.
They all performed tasks including directing her breathing and keeping her as comfortable as possible. His writing advises that for “normal labor” a midwife must have on hand items including: olive oil, warm water, bandages, and smelling substances to revive a laboring woman. During childbirth, he recommended mothers sit on a midwife’s stool, a special high-sided chair with an opening in the seat for the delivery of the newborn.
If something went very wrong during labor, however, a physician—usually male—would be summoned. Yet at the point the physician was called, Mulder says, it was likely that the fetus could not be saved, and the clinician was just trying to preserve the life of the mother. “Anything happening prior to that to aid a difficult birth was most likely being done by the midwife,” she adds.
Newborn care
Soranus also detailed how to examine and care for newborns after they are born, in practices that resemble many modern ones. First, they determined the sex of the baby, next assessed its “vigor” by the strength of its first cries, and then examined its limbs and joints and overall shape. Finally, the midwife would cut the umbilical cord “at a distance of four fingerbreadths from the abdomen.”
Then the baby was cleansed by sprinkling it with fine salt (taking care to avoid the eyes and mouth) and rinsed with lukewarm water. Soft woolen cloths swaddled the newborn, who Soranus recommended be laid upon a hollowed-out mattress (“like a channel”) to keep the baby from rolling over, with a firm pillow of hay tucked under his head. Soranus wrote that the head should be slightly upraised and noted that some people had put “bedding in troughs” for this purpose, a practice which may have been echoed in the Book of Luke’s description of Jesus’ nursery.
(Read more: While Rome was falling, these powers were on the rise)
Deaths and dangers
Infant mortality was high across the ancient Roman Empire, and children deemed unhealthy by midwives and families were also sometimes left outside to die or be adopted. Maternal mortality is estimated to have been perhaps more than 20 times higher than the current U.S. rates, with estimates ranging from 500 to 2,000 deaths per 100,000 live births. Vitamin and mineral deficiencies were particularly concerning—and deadly—issues of the time. “We see this in bio-archeological studies, studies of the remains of bones, teeth, and hair from women who had just given birth,” says Mulder.
Moreover, women would get pregnant and give birth too young and too frequently, she says. The problem was exacerbated by the widespread practice of using a wet nurse rather than mothers breastfeeding their children. Though someone can still get pregnant while breastfeeding, when a mom is exclusively breastfeeding it reduces the chance of becoming pregnant because the body may stop ovulating during that time. Repeated pregnancies with little recovery time are extremely taxing on the body.
Even though historians have Soranus’ text as a reference it remains difficult to discern what were instructions for best practices of the day versus what truly occurred for many families across the Roman Empire. The small amount of climate-preserved correspondence from the time and ancient epitaphs paint a grim picture of how risky childbirth was, for mothers and infants alike, as detailed in Freidin’s book publishing in spring 2024. One woman she focuses on in the book was married off at age 11 and died at age 27. She’d birthed six children, yet when she died only one remained alive. With such troubling figures in Mary’s day, the long-term survival of any child was cause for celebration.
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