Around 100 CE, a Greek physician of the Roman Empire known as Soranus of Ephesus wrote several books on medicine, compiling the knowledge of the day into volumes on anatomy, disease, surgery, and pharmacology, among other subjects. His most enduring work, On Midwifery and the Diseases of Women, covered female reproduction from conception through newborn care, including new solutions to old problems. It would remain the gold standard for obstetrics and gynecology until significant scientific strides were made during the Enlightenment 1,500 years later.
Prior to Soranus’s writings, childbirth wasn’t viewed as an event that “needed medical intervention in terms of helping a baby come out,” explains physician and medical writer Randi Hutter Epstein. Laboring mothers were attended by midwives who themselves had given birth and gained knowledge through experience. Doctors were rarely involved in the birthing process, even in complicated cases, because gynecology was considered beneath them. But Soranus argued that, in addition to being clean and literate, midwives should be trained in basic medicine in order to properly care for an expectant mother and her child.
Soranus’s book was divided into four sections, the first of which dealt with midwifery, menstruation, contraceptives, abortive procedures, and virginity. The others focused on newborn care, gynecological maladies, and healing herbs. His is the first known description of a technique for turning a baby whose back is covering the birth canal, a situation known as a transverse position that until that point had nearly always ended in the baby’s death. By reaching into the uterus and pulling on the baby’s legs to manipulate it into a breech, or feet-first, position, the delivery became merely tricky, rather than impossible.
Among his other innovations, Soranus developed a birthing chair with stirrups, and protocols for cutting the umbilical cord and cleaning the stump and for removing blood clots from the uterus following delivery of the placenta. He recommended an examination of the newborn to determine overall health, similar to the Apgar tests infants receive today, to determine which babies were “worth rearing.”
Soranus also advised against some common practices of the day, particularly that of immediately placing a newborn in cold water to “firm it up.” Soranus denounced the practice, noting that everyone is negatively affected by cold, but newborns would be especially, given that they had only known a warm uterus.
One area that hasn’t aged as well is the burden Soranos placed on mothers. He asserted that even a mother’s thoughts or whether she looked at the moon could influence the outcome of the birth, and wrote, “Even if a woman transgress some or all of the rules mentioned and yet miscarriage of the fetus does not take place, let no one therefore assume that the fetus has not been injured at all.”
Originally written in Greek, On Midwifery was translated into many other languages, including Arabic, German, and Latin. Its guidelines remained standard practice through Europe and the Middle East for roughly 1,500 years, until formalized training for midwifery began and obstetrics became a recognized medical field. This brought about more interaction between midwives and doctors, and the invention of forceps allowed for babies to be extracted during difficult births, lowering infant mortality rates.