Tuesday, June 30, 2015

HNS 2015 Denver presentation: Midwifery in Moorish Spain

This past weekend, I had the pleasure of speaking at the Historical Novel Society's Denver conference. Joining me were excellent fellow panelists Sam Thomas (The Midwife's Tale), Kim Rendfeld (The Cross and The Dragon), and Judith Starkston (Hand of Fire), with Diana Gabaldon (Outlander - but I didn't really need to tell you that!) serving as our gracious moderator. Sam spoke about the practice in England during the 17th century (where midwives rooted out witches - betcha thought different), Kim covered 8th century France (childbirth was a dangerous business), and Judith focused on the 13th century BC (so unfortunate she couldn't demonstrate the importance of livestock in the ancient birthing ritual). Learn more of Kim and Judith's presentations at the links above. One good guess as to my presentation:


But first some trivia:

QUESTION 1: How did families select their midwives and who paid the fees – the mother or father-to-be?

QUESTION 2: How long did new mothers undergo confinement – 0, 7, 40 or 60 days?

QUESTION 3: Which of the following types of metals and materials held magical properties as amulets for the protection of mothers and newborns – gold, silver, leather or all of the above?

Here's my full presentation, which was condensed down to 10 minutes and major pints:


·         The Islamic religion, tradition, and culture influenced the fictional portrayal of mothers and their roles.
·         Religion: In religious views of women’s bodies, blood was one of the impure substances, so any show of blood through menstruation or at childbirth meant women had to undergo a period of confinement, just like their Jewish and Christian counterparts, followed by ritual purification through a full bath. Midwives were on hand to verify that a woman’s confinement period, her bleeding, had ended.
·         Tradition: In the Prophetic tradition attributed to Muhammad regarding mothers, there is the belief that ‘Paradise lies beneath her feet.”
·         Culture: The concept of women’s modesty in the Islamic religion also influenced me, because only women should see other women’s bodies, which would have required a midwife’s presence.


·         The right sources are important for providing a sense of time and setting in historical fiction. There are so few sources, which detail Islamic practices and of those available, men have provided the information on midwifery practices; how is that possible especially if they were not in the birthing room?

·         The Sultana series includes child-birthing practices in Islamic Spain from minimal sources on medieval midwifery practices. Initial research reflected practices in Christian and sometimes Jewish settings, but what did the Moors do? They were Islamic rulers, who governed most of Spain and Portugal and part of Sicily during a 700-year period, which meant lots of time for their Moorish, Christian, and Jewish wives to have many babies!

·         Religion influenced so many aspects of Islamic life. One of the first rituals a father performed upon the presentation of his newborn would be to whisper in the baby’s ear the Adhan or call to prayer and the Shahadah or profession of faith. In keeping with practice of the time, none of the new fathers in the series has their child or mother attended by a non-Muslim midwife.

·         Where sources come from: Luckily, the surviving records from Islamic writers who detailed the practices of midwifery served as guides for writing about the period. Most of the literature is from the Golden Age of Islam, a period covering the 8th to 13th centuries of the Common Era. Scholars throughout the Islamic East and West trained at Islamic universities in Baghdad, Iraq to Fez, Morocco, men like the 10th century Persian doctor we call Avicenna, the Spanish-born doctor Averroes from the 12th century, and the 14th century Yemenite Ibn Khaldun, who was not a doctor, but provided extensive details about Islamic life.

·         Accuracy: While women did receive education in Muslim societies, but male doctors received training in gynecology and obstetrics. The absence of men from the birthing rituals begs the question of the accuracy of male sources on women’s roles as midwives. Where Avicenna and Averroes mention midwives, they were professionally inferior to male doctors, trained to aid easy deliveries. In complex deliveries, such as breech babies or extracting stillbirths, midwives were subordinate to doctors, who would attend difficult cases. Although Ibn Khaldun was not a doctor, he gave information about female anatomy and physiology, as well areas in which a midwife would have had expertise; he likely gained such details from midwives or their assistants.

Societal views of midwives

If a family found a good midwife, they retained her services. The majority of the male and female characters of the Sultana series valued the midwives who attended them, consulting them on everything from conception to child rearing. In general, midwives commanded respect in their communities. However, that wasn’t always the most prevalent view at the time the novels take place.

·         Views of midwifery in Muslim sources: Two different views of midwifery in medieval Muslim society helped illustrate how fictional fathers regarded midwives in the Sultana series and show the extremes; I'm betting the most common view fell in the middle. Compare Ibn Khaldun’s Introduction to History or al- Muqadimmah, specifically the section on the craft of midwifery with the writing of his contemporary, the jurist Ibn al-Hajj from Cairo who wrote Introduction to Religious Law or al-Madkhal.

·         The noble art: Ibn Khaldun viewed midwifery as not only a necessary but noble art, because it was so important to ensure the life of mother and child for the survival of the human race. Midwifery was the exclusive domain of women, in part because of female modesty as mentioned earlier, but also midwives were better acquainted with treating childhood illnesses children might develop before their weaning around two years of age. Without university training, midwives gained expertise in gynecology, obstetrics, and pediatrics.

·         Not-so noble art: On the extreme opposite, Ibn al-Hajj who actually began his chapter on midwifery by saying he should have placed it before a previous one concerning death, but did not do so because “females were placed behind, just where God placed them.” He said midwives endangered mother and children’s lives, touching newborns even when they had not washed off the bloody secretions of their mothers. He also accused midwives of stealing silk or linen swaddling, ignoring sacred law, resorting to magic and superstition, and ignoring the purification rituals required. As a result, he suggested that males should constantly supervise midwives. In the fifth book of the series, which is the latest available, a father to-be delayed the arrival of a midwife and interfered with her advice, leading to consequences for his wife and first child. 
The role of Ritual and magic in midwifery practicE

Despite the superstitions Ibn al-Hajj feared, magic influenced midwives and the requests of mothers-to-be for treatment. While medieval Islam proscribed magic for evil purposes, Muslims recognized that evil existed. Magic was integral to the practice of midwifery, with no perceived contradiction between science, medicine and the necessity of magical ritual.

·         Harm to mother and baby: Muslim believed pregnant and postpartum mothers remained susceptible in their weakened states as did their children, especially to attacks by the jinn or evil spirits summoned to do another harm. In terms of what could cause harm, there were superstitions about menstrual and childbirth blood, placentas, and umbilical cords used for black magic.

·         Protection: Families sought protections against black magic through the scattering of a handful of salt and the wearing of amulets of blue beads. Blue is a lucky color in Islam. Protection occurred through recitations of individual verses of the Qur’an, spoken aloud or written in saffron, which was a very expensive spice. An expectant mother had the written words tucked next to or under, hung over her bed, or written on her body, as the heroine of the sixth book of the series (in progress) chooses,  to serve as talismans at childbirth and in the weeks afterward. For newborns and young children, the danger of the evil eye loomed. The evil eye derived from two sources, humankind, and the jinn. To ward off the evil eye, mothers and children wore amulets.
Portraying the midwife in her practice

Although cultural behavior varied across regions of the Islamic East and West, there were commonplace practices among midwives. The Sultana novels reflect how the status and wealth of a royal or noblewoman afforded the best care for her and baby.

·         Birthing rituals: required the mother to enter confinement in a room already prepared for her use. Female relatives and friends who had already given birth would have been on hand to offer encouragement. When the midwife arrived, she would examine the expectant mother. When the mother-to-be appeared ready to give birth, she would sit in a birthing chair. The other women in the room assisted or there were one or two assistants of the midwife, who were training to take on the same role. They would sit, kneel, or stand behind the birthing chair to offer support. After delivery, the midwife and any assistants removed all traces of the birth.

·         The unexpected: Midwives also had to deal with unexpected dangers for mother and baby. Death in childbirth or caused by infection after birth could occur. In situations where the mother was too weak to expel afterbirth or it didn’t come out whole, the mother might bleed to death. In such cases, a male doctor attended. During the first book of the series, the heroine’s first child presented as a breech birth. The midwife had the skill to perform delivery on her own as the daughter and wife of doctors through massaging the heroine’s belly and turning the fetus. It’s also the only scene in the series where the father to-be was present during the delivery, as the midwife asked him to make a choice between the life of his wife or their child.

·         After a successful delivery: the midwife lit a fire in the room to keep away evil spirits. No one passed between the fire and the baby’s bed for three days. The midwife helped organize the female-only celebration that typically occurred seven days after the birth of a son. While the father held a public ceremony with the sacrifice of a sheep or goat to express gratitude for the child and affirm a father’s responsibility, the midwife led the women of the household in offering protections for the newborn. On the evening before the festivities, they placed items representing spiritual and material well-being around the baby like a copy of the Qur’an, and inkstands and reeds for writing. On the day of the celebration, the mother would get dressed in all her finery, with lit candles around her and incense burning to ward off evil spirits, while someone sprinkled cumin and saffron over the participants’ heads. 
            What other roles did Moorish midwives undertake: Outside of their practices, midwives came to court as required to give evidence about proof of menstruation, virginity at the time of marriage, fertility problems, and miscarriage and the likely age of the miscarried fetus, as often the female modesty code of Islam would have prevented male doctors from such intimate knowledge. One scene in the fifth book of the series showed the royal midwife in court as part of the defense for the heroine, accused by her husband of secretly using contraception. A midwife’s testimony was one area of Islamic jurisprudence

Now for the answers to those questions above:

ANSWER 1: The influence of religion and culture determined that fathers and male guardians selected midwives and paid all fees beforehand.

ANSWER 2: In the period the novels cover, after the births, the characters have followed the then prevailing Islamic law and custom, which stated mothers had a confinement of typically up to 40 days, paralleling most Christian and Jewish practice of the time. It could not exceed 60 days. If the series had been set earlier, perhaps in the 11th century, scenes would have been different because Muslim jurists believed the confinement should not exceed 7 days and in cases where a woman did not bleed during birth, she had no confinement.

ANSWER 3: All of the above, gold, silver, and leather, served as amulets in the medieval period.

It was great fun to present with such wonderful panelists and to receive the feedback from attendees, who seemed to learn a lot. If anyone's interested in my setting and time for midwifery practices, here's where you can learn more:

resources on Islamic practice of midwifery FOR HISTORICAL FICTION AUTHORS

Muslim Midwives – The Craft of Birthing in the Premodern Middle East by Avner Giladi
Arab Women in the Middle Ages: Private Lives and Public Roles by Shirley Guthrie
The Muqadimmah: An Introduction to History by Ibn Khaldun, translated by Franz Rosenthal

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