Childbirth and death in Bioarchaeology

From the moment we began to walk upright, childbirth has been a difficult time for women as evolution selected larger and larger brains in our hominin ancestors so that today our newborns have heads roughly 102% the size of the mother’s pelvic inlet width (Rosenberg 1992).

Two recent articles in the International Journal of Osteoarchaeology both start 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 Additionally, there were unpublished reports: including a skeleton from Egypt, a bog body from England, and a skeleton from England.

Where are all the mother-foetus burials?

As with any bioarchaeological question, there are a number of reasons that we may or may not find evidence of practices we know to have existed in the past. Some key issues at play in recovering evidence of death in childbirth include:

Archaeological Theory and Methodology – From the dates of discovery of maternal-foetal death cited above, it’s obvious that these examples weren’t discovered until the 1970s.

Death at Different Times – Although some women surely perished in the middle of childbirth, along with a foetus that was obstructed, in many cases delivery likely occurred, after which the mother, foetus, or both died. 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. This can be carried out through caesarean section, a surgical procedure that dates back at least to the origins of ancient Rome.

Cultural interventions in childbirth

It’s often assumed that the term caesarean section comes from the manner of birth of Julius Caesar, but it seems that the Roman author Pliny may have just made this up. The written record of the surgical practice originated as the Lex Regia (royal law) with the second king of Rome, Numa Pompilius (c. 700 BC), and was renamed the Lex Caesarea (imperial law) during the Empire. The law is passed down through Justinian’s Digest (11.8.2) and reads:

“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 by K Killgrove]

Caesarean sections and Roman burials

In spite of the Romans’ passion for record keeping, there’s very little evidence of Caesarean-sections. It’s unclear how religiously the Lex Regia/Caesarea was followed in Roman times, which means it’s unclear how often the practice of C-section occurred. Would all women have been subject to these laws? Just the elite or just citizens? How often did the section result in a viable newborn? Who performed the surgery? It probably wasn’t a physician (since men didn’t generally attend births), but a midwife wouldn’t have been trained to do it either (Turfa 1994).

Only two Roman-era examples involving young women are known, and it is quite interesting that they were already fertile. Age at menarche in the Roman world depended on health, which in turn depended on status, but it’s generally accepted that menarche happened around 14-15 years old and that fertility lagged behind until 16-17, meaning for the majority of the Roman female population, first birth would not occur until at least 17-19 years of age (Hopkins 1965, Amundsen & Diers 1969). These numbers have led demographers like Tim Parkin (1992:104-5) to note that pregnancy was likely not a major contributor to premature death among Roman women. But the female pelvis doesn’t reach skeletal maturity until the late teens or early 20s, so complications from the incompatibility in pelvis size versus foetal head size are not uncommon in teen pregnancies, even today (Gilbert et al. 2004).

More interesting than the young age at parturition is the fact that both of these young women were likely buried with their foetuses still inside them, in direct violation of the Lex Caesarea.

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References:

Killgrove, Kristina. 2012. "Childbirth and death in Bioarchaeology". Past Horizons. Posted: Available online: http://www.pasthorizonspr.com/index.php/archives/06/2012/childbirth-and-c-sections-in-bioarchaeology