Nothing instills a fear of pregnancy more than watching childbirth scenes that take place during the Medieval period… or the Renaissance… or during the Enlightenment… or any time, really, before the twentieth century. Screaming mistresses/courtesans/queens/princesses lay flushed in their canopied doily beds as frantic women flutter about the room, dipping cloths in hot water. Onscreen stories from the olden days are generally about royal or famously wealthy and powerful families, so the message we get is that childbirth was a horrifying pursuit, even for the always-beautiful progeny of the upper classes.
The birth of Lucrezia Borgia’s first child during the recent first season of Showtime’s The Borgias is a good example. For no explicitly stated reason, everyone thought she would probably die. The scene commences with Lucrezia’s powerful scream. She’s in a shadowed room, accompanied by three somber nuns. “I will die on this bed,” is the first thing she says, followed by Lamaze-style breathing (a modern technique, incidentally), more screaming, and more mentions of death. The scene cuts out to the hallway, where Lucrezia’s brother Cesare paces. Lucrezia’s mom bursts in. “How is she?” she inquires. “Alive still, at least,” Cesare answers.
Oh God. The very least they expect is that she survives? The business of birthing must have been truly dire in the late fifteenth century.
Death in childbirth is a common theme in popular novels, plays, and now movies and television. From War and Peace to Wuthering Heights to Oliver Twist to Gone With the Wind to contemporary examples (Star Wars, Angel, My Girl, Lost), maternal death is an admittedly convenient plot twist that later results in widowers who marry witches/rebellious teenaged sons/mournful teenaged daughters. Jane Austen poked fun at the clichéd maternal death plot in her novel Northanger Abbey: “She had three sons before Catherine was born; and instead of dying bringing the latter into the world, as anybody might expect, she still lived on—lived to have six children more—to see them growing up around her, and to enjoy excellent health herself.”
Once upon a time, death in childbirth was indeed more common than today in developed countries, but not as common as Hollywood would have you believe. The number one cause of maternal death in Europe from the seventeenth all the way through the twentieth century was puerperal fever, a communicable bacterial infection also known as “the doctor’s plague” and “childbed fever.” Doctors or other caretakers transmitted the disease to the woman when they touched her vagina. As a result, maternal death rates were lowest in villages with trained midwives, who were more likely to wash their hands and less likely to touch the vagina. On average, puerperal fever accounted for 40% of maternal deaths until the late nineteenth century. Beginning in the 1930s, maternal death rates dropped dramatically throughout the developed world due to professionally enforced use and better types of antiseptics, blood transfusions, improved sutures for C-sections, penicillin, and better anesthesia.
But back to ye olden days. The maternal death rate in fifteenth century Italy was somewhere around 1.4 deaths for every 100 births, with regional variation. A meta-analysis of European death rates from the sixteenth to nineteenth centuries calculated an average death rate of 1.3%, which is similar to the World Health Organization’s current estimate of the “natural” maternal death rate, meaning the death rate in the absence of intervention (good or bad) of any kind.
So while a 1-2% chance of death is terrifying, does it justify the portrayal of birthing women as imminent corpses? Curiously enough, the preponderance of wealthy historical figures in period dramas lends some justification to chronic displays of childbirth death. Maternal mortality was higher for the upper classes, especially in England, because rich women were more likely to employ physicians, and physicians were more likely to spread disease or use forceps. Did I mention that Lucrezia Borgias did die in childbirth? She contracted puerperal fever during the birth of her eighth child. Hollywood’s obsession with the kings and queens of England does nothing to lesson the perception that childbearing is profoundly dangerous; England’s female royalty had almost unbelievably bad luck in childbearing. Queen Anne had 18 pregnancies and zero surviving heirs.
Don’t get me wrong—I’m not downplaying the potential dangers of childbirth. But exaggerating, fetishizing and sexualizing these dangers for entertainment purposes amounts, in my opinion, to some form of pornographication. To be clear, these scenes aren’t about puerperal fever. In period dramas, writers feel they can legitimately play up the dangers of childbirth—because women always died in childbirth “back then”—and thus they indulge in graphic scenes of sweaty, young, rosy-cheeked women in pain.