Basically since we started walking upright, childbirth has been difficult for women. Evolution selected for larger and larger brains in our hominin ancestors such that today our newborns have heads roughly 102% the size of the mother's pelvic inlet width (Rosenberg 1992).
Yes, you read that right. Our babies' heads are actually two percent larger than our skeletal anatomy.
|Fetal head and mother's pelvic inlet width|
Photo credit: Evolution-of-man.info
Up until the 20th century, childbirth was dangerous. Even today, in some less developed countries, roughly 1 maternal death occurs for every 100 live births, most of those related to obstructed labor or hemorrhage (WHO Fact Sheet 2010). If we project these figures back into the past, millions of women must have died during or just after childbirth over the last several millennia. You would think, then, that the discovery of childbirth-related burial - that is, of a woman with a fetal skeleton within her pelvis - would be common in the archaeological record. It's not.
Archaeological Evidence of Death in Childbirth
Two recent articles in the International Journal of Osteoarchaeology start the exact same way, by explaining that "despite this general acceptance of the vulnerability of young females in the past, there are very few cases of pregnant woman (sic) reported from archaeological contexts" (Willis & Oxenham, In Press) and "archaeological evidence for such causes of death is scarce and therefore unlikely to reflect the high incidence of mortality during and after labour" (Cruz & Codinha 2010:491).
The examples of burials of pregnant women that tend to get cited include two from Britain (both published in the 1970s), four from Scandinavia (published in the 1970s and 1980s), three from North America (published in the 1980s), one from Australia (1980s), one from Israel (1990s), six from Spain (1990s and 2000s), one from Portugal (2010), and one from Vietnam (2011) (most of these are cited in Willis & Oxenham). Additionally, I found some unpublished reports: a skeleton from Egypt, a body from the Yorkshire Wolds in England, and a skeleton from England.
The images of these burials are impressive: even more than child skeletons, these tableaux are pathos-triggering, they're snapshots of two lives cut short because of an evolutionary trade-off.
Where are all the mother-fetus burials?
- Archaeological Theory and Methodology. From the dates of discovery of maternal-fetal death cited above, it's obvious that these examples weren't discovered until the 1970s. Why the 70s? It could be that the rise of feminist archaeology focused new attention on the graves of females, with archaeologists realizing the possibility that they would find maternal-fetal burials. Or it could be that the methods employed got better around this time: archaeologists began to sift dirt with smaller mesh screens and float it for small particles like seeds and fetal bones.
- Death at Different Times. Although some women surely perished in the middle of childbirth, along with a fetus that was obstructed, in many cases delivery likely occurred, after which the mother, fetus, or both died. In modern medical literature, there are direct maternal deaths (complications of pregnancy, delivery, or recovery) and indirect maternal deaths (pregnancy-related death of a woman with preexisting or newly arisen health problems) recorded up to about 42 days postpartum. An infection related to delivery or severe postpartum hemorraging could easily have killed a woman in antiquity, leaving a viable newborn. Similarly, newborns can develop infections and other conditions once outside the womb, and infant mortality was high in preindustrial societies. With a difference between the time of death of the mother and child, a bioarchaeologist can't say for sure that these deaths were related to childbirth. Even finding a female skeleton with a fetal skeleton inside it is not always a clear example, as there are forensic cases of coffin birth or postmortem fetal extrusion, when the non-viable fetus is spontaneously delivered after the death of the mother.
- Cultural Practices. Another condition of being human is the ability to modify and mediate our biology through culture. So the final possibility for the lack of mother-fetus burials is a specific society's cultural practices in terms of childbirth and burial. In the case of complicated childbirth (called dystocia in the medical literature), this is done through caesarean section (or C-section), a surgical procedure that dates back at least to the origins of ancient Rome.
Negat lex regia mulierem, quae praegnas mortua sit, humari, antequam partus ei excidatur: qui contra fecerit, spem animantis cum gravida peremisse videtur.
The royal law forbids burying a woman who died pregnant until her offspring has been excised from her; anyone who does otherwise is seen to have killed the hope of the offspring with the pregnant woman. [Translation mine]
|Example of Roman gynaecological equipment: speculum|
From the House of the Surgeon, Pompeii (1st c AD)
Photo credit: UVa Health Sciences Library
Caesarean Sections and Roman Burials
|Roman relief showing a birthing scene|
Tomb of a Midwife (Tomb 100), Isola Sacra
Photo credit: magistrahf on Flickr
Interestingly, the Jerusalem find was studied and reported by Joe Zias, who also analyzed the only known case of crucifixion to date. Zias and colleagues report on the find in Nature (1993) and in an edited volume (1995), but their primary goal was to disseminate information about the presence of cannabis in the tomb (and its supposed role in facilitating childbirth), so there's no picture and the information about the skeletons is severely lacking:
We found the skeletal remains of a girl (sic) aged about 14 at death in an undisturbed family burial tomb in Beit Shemesh, near Jerusalem. Three bronze coins found in the tomb dating to AD 315-392 indicate that the tomb was in use during the fourth century AD. We found the skeletal remains of a full-term (40-week) fetus in the pelvic area of the girl, who was lying on her back in an extended position, apparently in the last stages of pregnancy or giving birth at the time of her death... It seems likely that the immature pelvic structure through which the full-term fetus was required to pass was the cause of death in this case, due to rupture of the cervix and eventual haemorrhage (Zias et al. 1993:215).
More interesting than the young age at parturition is the fact that both of these young women were likely buried with their fetuses still inside them, in direct violation of the Lex Caesarea. So it remains unclear whether this law was ever prosecuted, or if the application of the law varied based on location (these young women were both from the provinces), social status (both young women were likely higher status), or time period. Why wasn't medical intervention, namely C-section, attempted on these young women? It's possible that further context clues from the cemeteries and associated settlements could give us more information about medical practices in these specific locales, but neither the Zias articles nor the Kent report make this information available.
Childbirth - Biological or Cultural?
Childbirth is both a biological and a cultural process. While biological variation is consistent across all human populations, the cultural processes that can facilitate childbirth are quite varied. The evidence that bioarchaeologists use to reconstruct childbirth in the past includes skeletons of mothers and their fetuses; historical records of births, deaths, and interventions; artifacts that facilitate delivery; and context clues from burials. The brief case study of death in childbirth in the Roman world further shows that history alone is insufficient to understand the process of childbirth, the complications inherent in it, and the form of burial that results. In order to develop a better understanding of childbirth through time, it's imperative that archaeologists pay close attention when excavating graves, meticulously document their findings, and publish any evidence of death in childbirth.
- Coffin Birth, aka Postmortem Fetal Extrusion (Wikipedia)
- Using Votives to Visualize Reproductive Anatomy in Antiquity (Powered by Osteons, 17 Feb 2012)
- The Bioarchaeology of Crucifixion (Powered by Osteons, 4 Nov 2011)
- Prehistoric Grave May Be Earliest Example of Death During Childbirth (Live Science, 4 February 2015)
J.P. Boley (1991). The history of caesarean section. Canadian Medical Association Journal, 145 (4), 319-322. [PDF]
K. Hopkins (1965). The age of Roman girls at marriage. Population Studies, 18 (3), 309-327. DOI: 10.2307/2173291.
K. Rosenberg (1992). The evolution of modern human childbirth. American Journal of Physical Anthropology, 35 (S15), 89-124. DOI: 10.1002/ajpa.1330350605.
J.M. Turfa (1994). Anatomical votives and Italian medical traditions. In: Murlo and the Etruscans, edited by R.D. DePuma and J.P. Small. University of Wisconsin Press.
J. Zias, H. Stark, J. Seligman, R. Levy, E. Werker, A. Breuer & R. Mechoulam (1993). Early medical use of cannabis. Nature, 363 (6426), 215-215. DOI: 10.1038/363215a0.
J. Zias (1995). Cannabis sativa (hashish) as an effective medication in antiquity: the anthropological evidence. In: S. Campbell & A. Green, eds., The Archaeology of Death in the Ancient Near East, pp. 232-234.
Note: Thanks to Marta Sobur for helping me gain access to the Zias 1995 article, and thanks to Sarah Bond for helping me track down the Justinian reference.