Midwives were known by many different titles in antiquity, ranging from  iatrinē  (Gr.  nurse ),  maia  (Gr., midwife),  obstetrix  (Lat.,  obstetrician ), and  medica  (Lat.,  doctor ). [ 37 ]  It appears as though midwifery was treated differently in the Eastern end of the  Mediterranean basin  as opposed to the West. In the East, some women advanced beyond the profession of  midwife  ( maia ) to that of gynaecologist ( iatros gynaikeios , translated as  women's doctor ), for which formal training was required. Also, there were some gynecological tracts circulating in the medical and educated circles of the East that were written by women with Greek names, although these women were few in number. Based on these facts, it would appear that midwifery in the East was a respectable profession in which respectable women could earn their livelihoods and enough esteem to publish works read and cited by male physicians. In fact, a number of Roman legal provisions strongly suggest that midwives enjoyed status and remuneration comparable to that of male doctors. [ 33 ]  One example of such a midwife is  Salpe of Lemnos , who wrote on women's diseases and was mentioned several times in the works of Pliny. [ 34 ]


However, in the Roman West, information about practicing midwives comes mainly from funerary epitaphs. Two hypotheses are suggested by looking at a small sample of these epitaphs. The first is the midwifery was not a profession to which freeborn women of families that had enjoyed free status of several generations were attracted; therefore it seems that most midwives were of servile origin. Second, since most of these funeral epitaphs describe the women as freed, it can be proposed that midwives were generally valued enough, and earned enough income, to be able to gain their freedom. It is not known from these epitaphs how certain slave women were selected for training as midwives.  Slave  girls may have been apprenticed, and it is most likely that mothers taught their daughters. [ 33 ]


The actual duties of the  midwife  in antiquity consisted mainly of assisting in the birthing process, although they may also have helped with other medical problems relating to women when needed. Often, the midwife would call for the assistance of a  physician  when a more difficult birth was anticipated. In many cases the midwife brought along two or three assistants. [ 38 ]  In antiquity, it was believed by both midwives and physicians that a normal delivery was made easier when a woman sat upright. Therefore, during parturition, midwives brought a stool to the home where the delivery was to take place. In the seat of the birthstool was a crescent-shaped hole through which the baby would be delivered. The birthstool or chair often had armrests for the mother to grasp during the delivery. Most birthstools or chairs had backs which the patient could press against, but Soranus suggests that in some cases the chairs were backless and an assistant would stand behind the mother to support her. [ 33 ]  The midwife sat facing the mother, encouraging and supporting her through the birth, perhaps offering instruction on breathing and pushing, sometimes massaging her vaginal opening, and supporting her perineum during the delivery of the baby. The assistants may have helped by pushing downwards on the top of the mother's abdomen.


Finally, the  midwife  received the infant, placed it in pieces of cloth, cut the  umbilical cord , and cleansed the baby. [ 34 ]  The child was sprinkled with "fine and powdery salt, or natron or aphronitre" to soak up the birth residue, rinsed, and then powdered and rinsed again. Next, the midwives cleared away any and all mucus present from the nose, mouth, ears, or anus. Midwives were encouraged by Soranus to put  olive oil  in the baby's eyes to cleanse away any birth residue, and to place a piece of wool soaked in olive oil over the umbilical cord. After the delivery, the midwife made the initial call on whether or not an infant was healthy and fit to rear. She inspected the newborn for  congenital deformities  and testing its cry to hear whether or not it was robust and hearty. Ultimately, midwives made a determination about the chances for an infant's survival and likely recommended that a newborn with any severe deformities be exposed. [ 33 ]


A 2nd-century terracotta relief from the Ostian tomb of  Scribonia Attice , wife of physician-surgeon M. Ulpius Amerimnus, details a childbirth scene. Scribonia was a midwife and the relief shows her in the midst of a delivery. A patient sits in the birth chair, gripping the handles and the midwife's assistant stands behind her providing support. Scribonia sits on a low stool in front of the woman, modestly looking away while also assisting the delivery by dilating and massaging the vagina, as encouraged by Soranus. [ 34 ]


The services of a midwife were not inexpensive; this fact that suggests poorer women who could not afford the services of a professional midwife often had to make do with female relatives. Many wealthier families had their own midwives. However, the vast majority of women in the Greco-Roman world very likely received their maternity care from hired midwives. They may have been highly trained or possessed only a rudimentary knowledge of obstetrics. Also, many families had a choice of whether or not they wanted to employ a midwife who practiced the  traditional folk medicine  or the newer methods of professional parturition. [ 33 ]  Like a lot of other factors in antiquity, quality gynecological care often depended heavily on the socioeconomic status of the patient.


[ 39 ] [ 40 ]


From the 18th century, a conflict between  surgeons  and midwives arose, as medical men began to assert that their modern scientific techniques were better for mothers and infants than the  folk medicine  practiced by midwives. [ 41 ] [ 42 ]
As doctors and medical associations pushed for a legal monopoly on obstetrical care, midwifery became outlawed or heavily regulated throughout the United States and Canada. [ 43 ] [ 44 ]  In Northern Europe and Russia, the situation for midwives was a little easier - in the Duchy of Estonia in  Imperial Russia , Professor Christian Friedrich Deutsch established a midwifery school for women at the  University of Dorpat  in 1811, which existed until World War I. It was the predecessor for the  Tartu Health Care College . Training lasted for 7 months and in the end a certificate for practice was issued to the female students.  Despite accusations that midwives were "incompetent and ignorant", [ 45 ]  some argued that poorly trained surgeons were far more of a danger to pregnant women. [ 46 ]  In 1846, the physician  Ignaz Semmelweiss  observed that more women died in maternity wards staffed by male surgeons than by female midwives, and traced these outbreaks of  puerperal fever  back to (then all-male) medical students not washing their hands properly after  dissecting cadavers , but his sanitary recommendations were ignored until acceptance of  germ theory  became widespread. [ 47 ] [ 48 ]


The argument that surgeons were more dangerous than midwives lasted until the study of bacteriology became popular in the early 1900s and hospital hygiene was improved. Women began to feel safer in the setting of the hospitals with the amount of aid and the ease of birth that they experienced with doctors. [ citation needed ]  "Physicians trained in the new century found a great contrast between their hospital and obstetrics practice in women's homes where they could not maintain sterile conditions or have trained help." [ 49 ]  German  social scientists   Gunnar Heinsohn  and Otto Steiger theorize that midwifery became a target of persecution and repression by public authorities because midwives possessed highly specialized knowledge and skills regarding not only assisting birth, but also contraception and abortion. [ 50 ]


At late 20th century, midwives were already recognized as highly trained and specialized professionals in obstetrics. However, at the beginning of the 21st century, the medical perception of pregnancy and childbirth as potentially pathological and dangerous still dominates Western culture. Midwives who work in hospital settings also have been influenced by this view, although by and large they are trained to view birth as a normal and healthy process. While midwives play a much larger role in the care of pregnant mothers in Europe than in America, the medicalized model of birth still has influence in those countries, even though the World Health Organization recommends a natural, normal and humanized birth. [ 51 ]


The midwifery model of pregnancy and childbirth as a normal and healthy process plays a much larger role in Sweden and the Netherlands than the rest of Europe, however. Swedish midwives stand out, since they administer 80 percent of prenatal care and more than 80 percent of family planning services in Sweden. Midwives in Sweden attend all normal births in public hospitals and Swedish women tend to have fewer interventions in hospitals than American women. The Dutch  infant mortality rate  is one of the lowest rate in the world, at 4.0 deaths per thousand births, while the United States ranked twenty-second. Midwives in the Netherlands and Sweden owe a great deal of their success to supportive government policies. [ 52 ]


Miraculous births  are a common theme in mythological, religious and legendary narratives and traditions. They often include conceptions by  miraculous  circumstances and features such as intervention by a  deity ,  supernatural  elements,  astronomical  signs, hardship or, in the case of some mythologies, complex plots related to creation.


The  Assyrian  and  Babylonian  concept of origins expressed procreation first in "relationships between gods and goddesses resulting in other gods and goddesses", [ This quote needs a citation ]  such as  Ea  and  Damkina  assisted by  Apsu  giving birth to  Marduk . The  Akkadian   Enûma Eliš  describes the birth of Marduk as follows: "Ea, having overheard the plan of the primordial deities to destroy the other gods, deceived  Apsu  and  Mummu  and put them to death. 'Ea, his triumph over his enemies secured, in his sacred chamber in profound peace he rested.' (ANET, p. 61, lines 74—75.) Then he took over the place which Apsu had used for his cult and dwelt there with his spouse, Damkina." [ This quote needs a citation ]  It was here that Marduk, the "most potent and wisest of gods" was created in the heart of Apsu and "He who begot him was Ea, his father, she who conceived him was Damkina, his mother". [ 1 ]


According to  Norman Lockyer , Ea, Ia, or  Oannes  was the primal god of Babylon. He was a ‘Great God, Maker of Men, Potter, Artist and Workman.’ He formed a Triad with  Anu  and  Bil —the two poles of heaven and the equator. [ 2 ]  Oannes first appeared from the sea to teach the Babylonians the art of writing, sciences and crafts, the building of cities, the surveying of land, the observation of the stars, and the sowing and harvesting of all kinds of grains and plants. He was believed to have been reincarnated several times.  Berossos , priest of the Temple of  Bel , in Babylon, knew of as many as six such reincarnations. [ 3 ]


In addition, "procreative deities, either male or female, played a part in the birth of other deities or great personages, such as the  Ugaritic  tradition of Lady  Asherah , 'the Progenitress of the gods';  Mami , 'the Mother-womb, the one who creates mankind'; Father  Nanna , the 'begetter of gods and men'; the Assyrian traditions that Tukulti-Urta was created by the gods in the womb of his mother and that  Sennacherib 's birth was assisted by Ea, who provided a 'spacious womb', and  Assur , 'the god, my begetter'; and the North Arabian myth of the mother goddess who was responsible for  Dusares ." [ 4 ] [ page needed ]


In  Hittite mythology , the god  Anu  was overthrown by his cupbearer  Kumarbi ; [ 5 ] : 25  [ 6 ]  Anu attempted to flee, but Kumarbi  bit off Anu's genitals  and swallowed them, and banished him to the underworld. [ 5 ] : 25   As a consequence of swallowing Anu's genitals, Kumarbi became impregnated with Anu's son  Teshub  and four other offspring. [ 5 ] : 25   Teshub overthrew his father Kumarbi, thus avenging his other father Anu's overthrow and mutilation. [ 5 ] : 25   This account later became the basis for the Greek story of  Uranus 's castration by his son  Cronus , resulting in the birth of  Aphrodite , described in  Hesiod 's  Theogony . [ 5 ] : 25–27


The belief in the conception of  Horus  by  Isis  is traced to the beginning of Egyptian history. Horus' conception and birth were understood in terms of the Egyptian doctrine of  parthenogenesis , which was connected with the goddess Neith of Sais. (page 220) [ 8 ]  In Upper Egypt, Net was worshipped at Seni and represented with the head of a lioness painted green, with the titles: "Father of fathers and Mother of mothers," and "net-Menhit, the great lady, lady of the south, the great cow who gave birth to the sun, who made the germ of gods and men, the mother of  Ra , who raised up  Tem  in primeval time, who existed when nothing else had being, and who created that which exists after she had come into being." [ 9 ] : 150


Egyptian texts mention numerous forms of Horus. In one he is "Heru-sa Ast, sa-Asar, or Horus, son of Isis, son of  Osiris ." Isis is described in the Hymn to Osiris, as finding and restoring the body of her dead husband, and using magical words given her by  Thoth  to restore him to life. Then, by uniting with Osiris she conceives Horus. Horus represented the rising sun and in this respect was comparable to the Greek  Apollo . [ 10 ]


There were at least fifteen other Horuses in the Egyptian pantheon, [ 11 ]  so in the story of Isis and Osiris Horus is "sometimes known as Harsiesis, to distinguish him from the others. He is depicted as a falcon, or with a falcon's head. He eventually avenged Osiris' death and reclaimed the throne, ruling peacefully...Herakhty, or 'Horus of the Horizon', was a sun god who rose each morning on the eastern horizon. He was often identified with the sun god, Ra, and was eventually absorbed by him, forming Ra-Herakhty." [ 11 ]


Lineal descent from Ra, whether by birth or by marriage, was claimed by all kings of Egypt at least since User-ka-f, first king of the V Dynasty, who was high priest of Ra at  Heliopolis . An important part of this tradition was the legend of the God Re generating with the wife of a priest. "The newborn child was regarded as a god incarnate, and later with appropriate ceremonies he was presented to  Re  or Amen-Re, in his temple, where the god accepted it and acknowledged it to be his child." This tradition was later inscribed in a stereotyped form in temple reliefs. [ 4 ]


Many texts mention different attributes of Isis. These were combined into a single narrative by  Plutarch  in the 1st century AD. In her aspect of protector of Egypt and its people, Isis is depicted with huge outspread wings. She taught women to grind corn, to spin and to weave, and she taught the people how to cure illnesses. She instituted the rite of marriage. When her consort, Osiris, left Egypt to travel the world, Isis ruled the country in his absence. "The  hieroglyph  for her name is the image of a throne, and her lap came to be seen as the throne of Egypt. Because of her fame Isis eventually absorbed the qualities of almost all the other goddesses; "she was a great mother goddess, a bird goddess, a goddess of the underworld who brought life to the dead, and a goddess of the primeval waters...Her following spread beyond Egypt to Greece and throughout the Roman Empire...(lasting) from before 3000 BC until well into Christian times. [ 12 ] [ 13 ]


There is a myth on the birth of  Hatshepsut . In this myth,  Amun  goes to  Queen Ahmose  in the form of the Pharaoh  Thutmose I  and awakens her with pleasant odors. At this point Amun places the  ankh , a symbol of life, to Ahmose's nose, and Hatshepsut is conceived by Ahmose. [ 14 ]  Another myth on divine birth concerns  Amenhotep III : he is conceived by  Amun  which has gone to queen  Mutemwiya  in form of  Thutmosis IV . [ 15 ] [ 16 ]


In the  Hebrew Bible , and in later Jewish tradition there are stories of matriarchs giving birth where the God of Israel miraculously intervenes. For example, within the Rabbinic literature expansions were made on the birth of the matriarch  Sarah  on the earlier Old Testament traditions.


Due to her old age, Sarai was infertile, but a miracle was vouchsafed to her ( Genesis Rabbah  xlvii. 3) after her name was changed from "Sarai" to "Sarah" (R. H. 16b). When her youth had been restored and she had given birth to  Isaac  the people would not believe in the miracle, saying that the patriarch and his wife had adopted a foundling and pretended that it was their own son. Abraham thereupon invited all the notables to a banquet on the day when Isaac was to be weaned. Sarah invited the women, who brought their infants with them, and on this occasion she gave milk from her breasts to all the children, thus convincing the guests of the miracle (B. M. 87a; comp. Gen. R. liii. 13).


According to  Isaiah 7:14 , around 735 BC King  Ahaz  of Judah received a message from the prophet  Isaiah  during the  Syro-Ephraimite War  with Aram (Syria) and Israel, "Therefore, the Lord, of His own, shall give you a sign; behold, the young woman is with child, and she shall bear a son, and she shall call his name Immanuel." [ 17 ]  This is generally taken by Judaic commentators to be a reference to the non-miraculous birth of  Hezekiah  or another contemporary child, as indicated in Isaiah's following indication of the timing.


The Greek  Septuagint  and some later Christian translations, following the application of Isaiah 7 in Matthew 1, use the word "virgin". The Hebrew word  alma  actually translates as a young woman of childbearing age who had not yet given birth and who might or might not be a virgin, whereas the Hebrew  betulah , used elsewhere in Isaiah, is the word that means "virgin." If the reference is to Ahaz's betrothed,  Abi , daughter of the  High Priest , no miraculous birth is implied, merely chastity. The Christian world believes that the verse is a messianic prediction of the miraculous birth of Jesus, as described in various gospels of the New Testament of the Bible.


The  Second Book of Enoch  contains a section, called  Exaltation of Melchizedek , which says that  Melchizedek  was born of a virgin, Sofonim (or Sopanima), the wife of Nir, a brother of  Noah . The child came out from his mother after she had died and sat on the bed beside her corpse, already physically developed, clothed, speaking and blessing the Lord, and marked with the badge of priesthood. Forty days later, Melchizedek was taken by the archangel  Gabriel  ( Michael  in some manuscripts) to the  Garden of Eden  and was thus preserved from the  Deluge  without having to be in  Noah's Ark . [ 18 ] [ 19 ]


Zoroaster's name has been adopted from the Greek and  Latin  Zoroastres. The ancient form of his name in the Avesta is Zarathustra. His native country was probably  Media  in Western Iran (possibly in modern  Azerbaijan ), but his ministry took place in eastern Iran, especially in the region of  Bactria , about 1200 BC.  Zoroaster  was originally a Magian priest, and under the reforms he instituted, Mithra became one of the  Yazatas  (Worshipful Ones), the angels or lesser divine beings.


"It was said that (Zoroaster's) birth was foretold from the beginning of time, and that the moment he was born, he burst out laughing and the whole universe rejoiced with him." [ This quote needs a citation ]  After his birth evil demons tried to destroy him, but with Ahura Mazda's protection, he survived all attempts on his life. [ 20 ]  The Zoroastrian tradition differs from the Christian one because the divine only assists in the preservation of Zoroaster’s seed. "The central scripture, the  Avesta  and also the Pahlavi texts include the tradition that the 'kingly glory' is handed onward from ruler to ruler and from saint to saint for the purpose of illuminating ultimately the soul of the Zarathushtra." Also the scriptures clearly allude to conjugal relations between his parents, during which evil spirits try to prevent his conception. [ 4 ]  But according to later tradition, Zoroaster's mother, Dughdova, was a virgin when she conceived Zoroaster by a shaft of light. [ 20 ]


Greco-Roman  and  Hellenistic  literature is rich in the tradition of birth among the gods. In his poem  Theogony , the Greek poet  Hesiod  tells a story that Zeus had once lain with the goddess  Metis , impregnating her, but, fearing that she might bear a child mightier than he himself, he swallowed her. [ 21 ]  Their daughter  Athena  was born fully grown from Zeus's forehead, fully armed and clad in armor. [ 22 ]  Hesiod also relates that the goddess  Aphrodite  was born from the foam of the sea after  Ouranos 's castrated testicles were thrown into it. [ 23 ]


Helios  was a child of Zeus by  Euryphaessa . He was also called "the son of Earth and starry Heaven," and the son of  Hyperion .  Dionysus  was dithyrambus, "he who entered life by a double door." His first birth took place prematurely. His mother, Semele, died when Zeus appeared to her in a flash of lightning, and so Zeus opened his own flesh and enclosed the infant. In time, Dionysus was born "perfect" from Zeus' thigh. Dionysus  Zagreus  was important in Orphic theology. In Protrepticus ii. 14 ff. by Clement of Alexandria, this child had the form of a bull. Zeus intended to make him the ruler of the universe but the jealous Titans lured the child away, tore him to pieces, cooked him and ate him. Athena preserved his heart, however, which Zeus swallowed. According to Boslooper, Clement omitted one part of the myth that forms a connection between his account and the Theban legend of Dionysus. Because Zeus swallowed the heart of Dionysus Zagreus, when Semele bore Dionysus the new god was Zagreus reborn. [ 4 ]


In Indian mythology,  Mithra  is known as Mitra. He was originally a god of contracts and friendship and was a forerunner of the Graeco-Roman god  Mithras . In  Iran , he developed into the protector of truth. Before the time of Zoroaster, he was associated with  Ahura Mazda , the principle of good. As a consequence of Zoroaster's reforms to Iranian religion, Mithra was ousted from power and Ahura Mazda became supreme. [ 20 ]  In the more ancient Indian  Vedas  Mithra was the god of light, invoked under the name of  Varuna , and was called "the Light of the World." He was the mediator between heaven and Earth.


"The light bursting from the heavens, which were conceived as a solid vault, became, in the mythology of the  Magi , Mithra born from the rock." [ 24 ]


Mithraism absorbed  astrology  from the  Chaldeans  after the Chaldean conquest, and continued as an astronomical religion. In the Hellenistic period it took on its final form. Mithra was assimilated into  Graeco-Roman  beliefs in the 1st century BC as Mithras. He was an ancient and highly honored god of  Roman  Paganism, where he was worshipped for more than 300 years as "the soldier's god." [ 25 ]


The love of a god for a mortal, resulting in the birth of a hero, is one notable deviation from the tradition of the origin of gods. The legend of  Perseus , whose mother conceived him when  Jupiter  came to her in the form of a shower of gold, is one example of this type (cf. Ovid, Metamorphoses, Book IV). The  Greek Anthology  has the following:  Zeus , turned to gold, piercing the brazen chamber of Danae, cut the knot of intact virginity.


Heroes created by generation of a god with a mortal include  Ion  by Apollo and  Creusa ,  Romulus  by Mars and Aemila,  Asclepius  by Apollo and  Coronis , and  Helen  by Zeus and  Leda .  Plutarch  records how Theseus and  Romulus  were both born out of wedlock and of uncertain parentage and at the same time had the reputation of being sprung from the gods. He said that Theseus' grandfather  Pittheus  invented the story that Theseus was the child of  Neptune  to conceal Theseus' lineage as the son of Pittheus' daughter  Aethra  and  Aegeus  ("Lives", Vol. 1, p. 2; pp. 3 ff.). But there were other stories about the birth of Romulus and his brother Remus. The story of Romulus' divine origin says that his mother was the mortal daughter of Aeneas and Lavinia, and his father was Mars.


In his "Hymn to Asclepius",  Homer  attributes his origin to the god Apollo and the daughter of a renowned soldier, King Phlegyas. As the divine patron of the healing art,  Asclepius  became the most popular of the hero gods of Greece. The belief that religion was concerned with sickness and disease was central to his cult. His sanctuaries in the Greco-Roman world became so famous there was a movement to make him a god of the first rank and identify him with Zeus himself. Asclepius was "the one who leads and controls all things, the savior of the whole world, and the guardian of mortals."


Helen of Troy was worshiped as a heroine in several parts of the ancient world during the early historical epoch.  Euripides ' play "Helen" depends on a tradition begun in the early 6th century B.C. by the Greek poet Stesichorus that Helen was the daughter of Zeus (who took the form of a swan) and Leda. But this might simply be a poetic way of saying that she was hatched from an egg.


There are two versions of the birth of  Oedipus . He was given a semidivine status in  Sophocles ' "Oedipus the King," where he was said to be the son of either  Pan , Loxias, "or the Bacchants' god, dweller on the hilltops ..." and one of the nymphs of Helicon. But in Euripides' "Phoenissae," his mother, Jocasta, says Oedupus is the son of Laius, a mortal, who was warned by the god Phoebus not to have children.


King of Thebes for horses famed! seek not to beget children against the will of heaven; for if thou beget a son, that child will slay thee, and all thy house shall wade in blood. [ This quote needs a citation ]


Laius ignored the warning, but after the child was born he gave him to shepherds to expose on Mount Cithaeron. The child was found and raised among the keepers of the horses of Polybus. As a grown man, Oedipus did indeed kill his father, not realizing who he was, and then married his mother. When he discovered the truth he blinded himself. In this story, he is clearly considered to be the son of Laius and Jocasta. This is also obvious in Sophocles' "Oedipus the King". [ 26 ]  According to Boslooper, "The two passages indicate that in the Greek mind the thoughts of divine and human paternal participation in conception were not mutually exclusive." [ 4 ]  (p. 178)


Romulus and Remus , the legendary twin founders of the city of  Rome , were said to have been born to a  Vestal Virgin ,  Rhea Silvia . Rhea Silvia had been forced to become a Vestal Virgin against her will and claimed to have been impregnated through divine intervention.  Livy  attests that she was instead raped by an unknown man. In any case  King Amulius  ordered the twins to be drowned as death through the elements would not trigger divine punishment. [ 27 ]


Alexander, the Ptolemies, and the Caesars were said by some scholars to have been "virgin-born."  Alexander the Great , " journeyed to the Oasis of Amon in order that he might be recognized as the god’s son and thus become a legitimate and recognized king of Egypt. Inscriptions show that he and the  Ptolemies  after him had the incidents of their birth regularly depicted in temple reliefs.” [ 28 ]  (As cited by Boslooper) Norden calls this the Hellenistic virgin motif. However, evidence shows that Alexander must have had a double tradition of origin. It is recorded that "Alexander the Great and Augustus are deemed to have been conceived of a serpent god, and they claimed between them  Phoebus  and  Jupiter  as their progenitors." [ 29 ]


“The Emperor  Augustus  was praised as the Savior of the world …[but] the idea of Savior was not unique or original with Augustus himself. Before him the same title was given to  Seleucid  and other Hellenistic kings. Throughout this period there were frequent longings for a savior from the present troubles.” [ This quote needs a citation ]  Augustus was said to have had a miraculous birth and a childhood filled with many portents and signs. A few months before he was born a portent was observed at Rome which gave warning that nature was pregnant with a king for the Roman People. "Thereupon the Senate in consternation decreed that no male child born that year should be reared; but those whose wives were with child saw to it that the decree was not filed in the treasury, since each one appropriated the prediction to his own family." Boslooper relates several additional stories. In one, Suetonius narrates what he learned from Asclepias of Mendes:


When Atia had come in the middle of the night to the solemn service of Apollo, she had her litter set down in the temple and fell asleep, while the rest of the matrons also slept. On a sudden a serpent glided up to her and shortly went away. When she awoke, she purified herself, as if after the embraces of her husband, and at once there appeared on her body a mark in colors like a serpent, and she could never get rid of it; so that presently she ceased ever to go to the public baths. In the tenth month after that Augustus was born and was therefore regarded as the son of Apollo. Atia too, before she gave him birth, dreamed that her vitals were borne up to the stars and spread over the whole extent of land and sea, while Octavius dreamed that the sun rose from Atia's womb. [ 4 ] : 180


The hope for a savior was expressed in  Virgil ’s “Fourth Eclogue". The Church fathers later claimed this was a reference to Jesus Christ, however, the poem was dedicated to Pollio, one of the great influential men at the time of the civil wars and Virgil's patron and friend. The hero of the poem is a child born or to be born in 40 B.C., at the time of Pollio's consulate. A new era was expected, in fulfillment of an older oracle.


... Now the last age by Cumae's Sibyl sung
Has come and gone, and the majestic roll
Of circling centuries begins anew:
Justice returns, returns old Saturn's reign,
With a new breed of men sent down from heaven.
Only do thou, at the boy's birth in whom
The iron shall cease, the golden race arise,
Befriend him, chaste Lucina; 'tis thine own
Apollo reigns ...

For thee, O boy,
First shall the earth, untilled, pour freely forth
Her childish gifts, the gadding ivy-spray
With foxglove and Egyptian bean-flower mixed,
And laughing-eyed acanthus. Of themselves,
Untended, will the she-goats then bring home
Their udders swollen with milk, while flocks afield
Shall of the monstrous lion have no fear... [ 30 ]


In the story of  Krishna  the deity is the agent of conception and also the offspring. Because of his sympathy for the earth, the divine  Vishnu  himself descended into the womb of  Devaki  and was born as her son, Krishna. The Hindu Vishnu Purana relates: "Devaki bore in her womb the lotus-eyed deity...before the birth of Krishna, no one “could bear to gaze upon Devaki, from the light that invested her, and those who contemplated her radiance felt their minds disturbed.” This reference to light is reminiscent of the Vedic hymn "To an Unknown God," which refers to a Golden Child. According to F. M. Müller this term means "the golden germ of child" and is an attempt at naming the sun. [ 4 ]


This is occasionally brought up as evidence for the hypothesis that "virgin birth" tales are a fairly common phenomenon in non-Christian religions around the world. [ 31 ] [ 32 ] [ 33 ]  However, there is nothing in Hindu scriptures to suggest that it was a "virgin" birth. By the time of conception and birth of Krishna, Devaki was married to  Vasudeva  and had already borne seven children. [ 34 ]


In the  Ramayana , Vishnu incarnates himself as a man,  Rama , in the womb of  Kausalya , one of the wives of the king  Dasharatha . [ 35 ]  In the  Mahabharata  epic,  Surya , the god of the sun, impregnates Queen  Kunti  before her marriage to King  Pandu , causing her to give birth to their son  Karna . [ 36 ] [ 37 ]  Surya restores her virginity afterwards, thereby allowing her to marry Pandu, despite having already given birth. [ 38 ]  Also in the  Mahabharata ,  Bharadwaja  řshi goes with his companions to the  Ganga River  to perform his ablutions. [ 39 ]  There, he spots a beautiful  apsara  named Ghritachi, who has come to bathe. [ 39 ]  The sage is overcome by desire, [ 39 ]  causing him to involuntarily  ejaculate  out of excitement. [ 39 ]  Bharadwaja Muni captures the  semen  in a vessel called a Đroņa, [ 39 ]  and  Đroņācharya  himself springs forth from it. [ 39 ]


However, some Hindus believe that when the emanations of the Supreme Being are  pratyaksha , or obvious to the sight, they become sacara, or embodied. Krishna was such an embodiment and usually bore a human form. In that mode of appearance the deities are generally supposed to be born of a woman, but without any carnal intercourse. This belief is not adhered to by those who follow the Purva Mimansa, or the philosophy of Jaimini. They insist that the Devas were mere mortals whom the Supreme Being endowed with qualities similar to his own. In general, the Hindus perform acts of worship to some of their ancient monarchs and sages, who were deified on account of their eminent virtues. [ 40 ]


The stories of Buddha's unusual birth developed through the centuries. Two accounts cited by Boslooper tell of the descent of the future Bodhisattva from the "Tusita Body" into the mother's womb, the appearance of the  Buddha  in the mother as a shining gem, and the accompanying wonders in the natural world. These are the Majjhima-Nikāya, 123 Acchariyabbhutadhammasuta III. 119–124; (I. B. Horner, 1959, pp. 164–169); and Māhapadānasutta, Dīgha ii. 12. [ 41 ]  In the Mahapadana-sutra, Digha ii. 12, is the description of the incarnation of the  Vipassī Buddha .


Now Vipassi, brethren, when, as Bodhisat, he ceased to belong to the hosts of the heaven of Delight, descended into his mother’s womb mindful and self-possessed. [ This quote needs a citation ]


According to this text, the  Vipassī Buddha  was the first of six incarnations to precede  Gautama . The others listed are  Sikhī ,  Vessabhū ,  Kakusandha ,  Koṇāgamana , and  Kassapa . The most popular legendary account of the birth of Buddha is in the Nidanakatha Jataka (see,  Jataka tales ) which accounted for the lives of Buddha in previous incarnations. In this account, the “Great Being” chose the time and place of his birth, the tribe into which he would be born, and who his mother would be. In the time chosen by him, Maya, his mother, fell asleep and dreamed that four archangels carried her to the  Himalayan Mountains  where their queens bathed and dressed her. In her dream the Great Being soon entered her womb from her side, in the form of a white elephant. When she woke, she told her dream to the Raja, who summoned sixty-four eminent  Brahmans  to interpret it.


"Then is described how at his birth he took seven great steps and at the seventh he shouted, 'I am the chief of the world,' how he at birth held in his hand some medicine that became for him the drug by which he later healed the sick and blind and deaf, how at birth he wished to give a gift but was presented one himself by his mother, and how lastly he sang the song of victory.'


In addition to the historical Buddha, the  Vajrayana  tradition of Buddhism includes many accounts of miraculous births. For example,  Guru Padmasambava  (Guru Rinpoche) is considered a second Buddha by  Tibetan Buddhists  and in some accounts is described as having been  born from a lotus .


The  Nyingma  school asserts the birth of  Garab Dorje  to have been a miraculous birth by a virgin daughter of the king of Odiyana (Uddiyana), and that he recited Dzogchen tantras at his birth. [ 42 ]


A detailed interpretation of the  hagiographic  nativity of Garab Dorje briefly contextualizes his mother, a  bhikṣuṇī  whose  sadhana  was  Yoga tantra , and her parents. The bhiksuni daughter has a dream in which a man holds the vase of the  Astamangala , the ' threefold world ', with the syllables ' oṃ  ā  hūṃ ' and  svāhā :


The Lord of Secrets ( gSang-ba'i-bdag-po ) instructed the Holders of Wisdom (Rig-'dsin) in Dhanakośa in Uḍḍiyāna the contemporary Swat valley. There was a large temple, called bDe-byed-brtsegs-pa; it was surrounded by 1608 smaller chapels. King Uparāja, and Queen sNang-ba-gsal-ba'i-od-ldan-ma resided there. They had a daughter called Sudharmā; she took the novice vows, and soon afterwards the full monastic vows. Sudharmā, together with her maidens, stayed on an island and meditated about the Yoga Tantra ( rnal-'byor-gyi rgyud ). One night the Bhikṣuṇī Sudharmā dreamed that a white man had come, who was utterly pure and beautiful. He held a crystal vessel in his hand which had the letters  oṃ  ā  hūṃ  svāhā  engraved upon it. Three times he set the vessel upon the crown of her head, and light then shone from it. While this happened, she beheld the threefold world perfectly and clearly. Not long after this dream the Bhikṣuṇī gave birth to a true son of the gods. [ 43 ]


The  Yellow Emperor  is sometimes said to have been the fruit of extraordinary birth, as his mother  Fubao  conceived him as she was aroused, while walking in the country, by a lightning bolt from the  Big Dipper . [ 44 ]


Qi, the Abandoned One, who later became known as  Houji  – a  culture hero  or  god of agriculture  – was held in some accounts to have been miraculously conceived when his mother, the consort  Jiang Yuan , stepped into a footprint left by the supreme god  Shangdi . [ 45 ]


Some  Taoist  schools held that  Laozi  was conceived when his mother gazed upon a falling star. He was born while his mother was leaning against a  plum tree . Laozi was said to have emerged as an old man with a full grey beard. This may be because his name – "Old Master" ( 老子 ) – can also be read as "Old Child". [ 46 ]


There are some legends about the birth of  Abaoji  (also known as Yi), the Emperor Taizu of Liao. According to the legends, his mother dreamed that the sun fell from the sky and into her bosom, from which pregnancy followed. When she gave birth, the room is said to have become filled with a mysterious light and extraordinary fragrance. As a newborn, his body was that of a three-year-old, and the legends go on to say that he was walking at the age of three months. [ 47 ]


Mainstream Christian scholars agree that the  nativity of Jesus , if not taken as  historically accurate , should be interpreted within the context of first-century Judaism, not in the context of foreign mythologies, which contain only remote similarities. [ 48 ] [ 49 ]


According to the  first chapter  of the  Gospel of Luke ,  John the Baptist  was born to  Zechariah  and  Elizabeth , who were both very old and had been unable to have a child. An angel appeared to Zechariah and told him that Elizabeth would bear a son named John. Zechariah doubted the angel's words and was struck mute until the child's birth. Despite her advanced age, Elizabeth became pregnant and gave birth to John, and Zechariah's speech was restored after he wrote on a tablet that the child's name was to be John, as the angel had commanded. [ 50 ] [ 51 ]


The modern  Biblical canon  does not record Mary's birth. The earliest known account of Mary's birth is found in the  Gospel of James  (5:2), an  apocryphal  text from the late second century, with her parents known as  Saint Anne  and  Saint Joachim . [ 52 ]  According to tradition of the Catholic church, they were childless when an angel came to them and  told them  they would give birth to a daughter. During the  conception of Mary , she was preserved from the stain of  original sin . [ citation needed ]


The  Gospel of Luke  and the  Gospel of Matthew  describe the nativity of  Jesus . In the account in the Gospel of Luke,  Mary  learns from the  angel   Gabriel  that she will conceive and bear a child. She asks "How this can be, since I am a virgin?". He tells her "The  Holy Spirit  will come upon you … nothing is impossible with God.’ She responds: "Here am I, the servant of the Lord; let it be with me according to your word". [ 53 ]


At the time that Mary is due to give birth, she and her husband  Joseph  travel from their home in  Nazareth  to Joseph's ancestral home in  Bethlehem  to register in the  Census of Quirinius . Finding no place for themselves in the inn, Mary gives birth to Jesus and she places him in a  manger  (feeding trough). [ 54 ]  An  angel of the Lord visits the shepherds  guarding their flocks in nearby fields and brings them "good news of great joy": "to you is born this day in the city of David a Saviour, who is the Messiah, the Lord." The angel tells them they will find a child wrapped in bands of cloth and lying in a manger.


In the Gospel of Matthew, the impending birth is announced to Joseph in a dream, in which he is instructed to name the child Jesus. [ 55 ]  A  star  reveals the birth of Jesus to a number (traditionally three) of  magi , Greek  μάγος , commonly translated as "wise man" but in this context probably meaning "astronomer" or "astrologer", [ 56 ] [ 57 ]  who travel to Jerusalem from an unspecified country "in the east". [ 58 ]


After the 1st century, traditions flourished that represented the thinking of that time, and also preserved source material for many of the ideas in the "theological writings of the church fathers." In their present form the  pseudepigraphal  writings contained in the  Sibylline Oracles  include literature written from the 2nd century BC through the 6th century of the Christian era. They contain some material relevant to the birth and infancy of Jesus. But this passage in the Oracles, Book III, probably represents the hopes of pre-Christian Alexandrian Jews. [ 4 ]


Be of good cheer, O maiden, and exult; for the Eternal, who made heaven and earth,
  has given thee joy, and he will dwell in thee, and for thee shall be an immortal light.
And wolves and lambs promiscuously shall eat grass in the mountains,
  and among the kids shall leopards graze,
And wandering bears shall lodge among the calves, and the carnivorous lion
  shall eat straw in the manger like the ox,
And little children lead them with a band. For tame will be on earth the beasts he made,
And with young babes will dragons fall asleep, and no harm, for God’s hand will be on them. [ 59 ]


Later, the church fathers refer to subsequent books in the Oracles that are clear allusions to Christ, and probably dated from the close of the second or beginning of the 3rd century AD. [ citation needed ]  The first Christian theologians demonstrated in their writings their knowledge of such non-canonical sources.


The  non-canonical gospels  contain much that is pertinent. The apocryphal literature departs from the Christian canon and its legends have many elements similar to  pagan  stories representing popular beliefs of the church from the second Christian century on through the  Middle Ages . [ 4 ]


The  Quran  and other Islamic literature contain reports of a number of miraculous births of biblical characters. The Quran describes  virginal conception  of Jesus by Mary ( Arabic :  مريم ,  romanized :  Maryam ), which is recounted throughout several passages in the Quran. The narrative goes that Mary was visited by the angel Gabriel that she will give birth to a holy son, named Isa' (Jesus), the Messiah and that he will be a great prophet, to whom God will give the Injil (Gospel) and he will speak in infancy and maturity and will be a companion to the most righteous. When this news was given to Mary, she asked the angel how she can have a baby as she was a  virgin . [ 60 ]  To this, the angel replied "Even though when God wants to create a matter, he merely wills (Kun-fa-yakun) it and the things come into being". [ 61 ]


After giving birth, while resting near the trunk of a palm tree Jesus spoke to Mary from the cradle instructing her to shake the tree and obtain its fruits. After showing Jesus as a newborn to her family Jesus again spoke "Lo, I am God's servant; God has given me the Book, and made me a Prophet. Blessed he has made me, wherever I may be; and He has enjoined me to pray, and to give alms, so long as I live and likewise to cherish my mother" in order to dispel rumours of conception. [ 62 ] [ 63 ]  This birth narrative draws strong parallels to the apocryphal tradition of Jesus' birth within the  Infancy Gospel of Thomas  and  Arabic Infancy Gospel .


In 1440, [ 64 ]  the poet  Kabir  was also said to have been born of a virgin widow (a Hindu), through the palm of her hand. Like  Karna , Kabir was sent down the river in a basket; he was found and adopted by a family of Muslim weavers, downstream. [ 65 ] [ 66 ]


The myth of  Huitzilopochtli  is uniquely  Aztec . Huitzilopochtli is therefore considered to be the cult god or the patron god of the  Aztecs . As a solar deity, Huitzilopochtli is closely related to and overlaps with  Tonatiuh . Huitzilopochtli's mother was  Coatlicue , or She of the Serpent Skirt. Coatlicue, known for her devout nature and virtuous qualities, was at Mount Coatepec or Coatepetl ("Serpent Hill"; near  Tula ,  Hidalgo ) one day, sweeping and tending to her penance, when she discovered a bundle of feathers on the ground. She decided to save them and placed them in her bosom. Without her realizing, the feathers impregnated her. [ 67 ] [ 68 ] [ 69 ]


There are several stories about the birth of  Quetzalcoatl . In the first story, Quetzalcoatl was born by a virgin named  Chimalman , to whom the god  Ometeotl  appeared in a dream. [ 70 ]  In another story, the virgin Chimalman conceived Quetzalcoatl by swallowing an emerald. [ 71 ]  A third story narrates that Quetzalcoatl was born from  Coatlicue , who already had four hundred children who formed the stars of the  Milky Way . [ 72 ]


In the  Matter of Britain , the wizard  Merlin  is said to have been born to a royal nun fathered by an  incubus , according to the story as presented by  Geoffrey of Monmouth . [ 73 ] [ 74 ]


According to a legend narrated by  The Secret History of the Mongols , a Mongol woman named  Alan Gua  had a son, named  Bodonchar , some years after her husband has died. She claimed a radiant yellow person visited her at night and impregnated her. She believed the visitor was the god  Tengri . Bodonchar became the founder of the  Borjigin  tribe and a direct ancestor of  Genghis Khan . [ 75 ]


Miraculous births are common in Japanese folklore, and include  Momotarō  the Peach Boy (who was found inside a giant peach floating on a river),  Kintarō  (about whom several origin myths are told), and  Kaguya-hime  (who was born inside the stalk of a glowing bamboo plant).


The  Great Peacemaker , sometimes referred to as Deganawida or Dekanawida ( Iroquois ) was born a  Huron , and by some accounts, his mother was a virgin, so the birth was miraculous. [ 76 ]   [ 77 ]


The Yoruba deity ( orisha ) known as Ẹ̀là, is said to have been born to a virgin, Òyígí, and thus his birth was miraculous. This story is narrated in the Odu  Ifa  Èjì Ogbè. Other stories imply that the father may have been  Orunmila .


Monogenes  (μονογενής) has two primary definitions, "pertaining to being the only one of its kind within a specific relationship" and "pertaining to being the only one of its kind or class, unique in kind". [ 1 ]   Its Greek meaning is often applied to mean "one of a kind, one and only". [ 2 ]   Monogenēs  may be used as an  adjective .  For example,  monogenēs pais  means only child, only legitimate child or special child. [ 3 ]   Monogenēs  may also be used on its own as a  noun .  For example,  o monogenēs  means "the only one", or "the only legitimate child". [ 4 ]


The word is used in Hebrews 11:17–19 to describe  Isaac , the son of  Abraham . However, Isaac was not the only-begotten son of Abraham, but was the chosen, having special virtue. [ 5 ]  Thus Isaac was "the only legitimate child" of Abraham. That is, Isaac was the only son of Abraham that God acknowledged as the legitimate son of the covenant. It does not mean that Isaac was not literally "begotten" of Abraham, for he indeed was, but that he alone was acknowledged as the son that God had promised.


The term is notable outside normal Greek usage in two special areas: in the cosmology of  Plato  and in the  Gospel of John . As concerns the use by Plato there is broad academic consensus, generally following the understanding of the philosopher  Proclus  (412–485 AD).


Some interpretations of the word "unique" attempt to preclude birth, yet the full Greek meaning is always in the context of a child (genes). A unique child is also a born child, hence the full meaning of the word "begotten" as found in  John 3:16 (KJV) , for example. In applying this to Christ's begottenness, He is unique (virgin birth, for example), but also still the Son of God by birth.


Platonic usage also impacted Christian usage, for example in  Gnosticism . In Tertullian's  Against the  Valentinians , he gives the name to one of their thirty  aeons  as  monogenes  in a  syzygy  with  makaria , Blessedness. [ 6 ]


Similar content is found in:


The problem with magical inscriptions on papyri, walls or ostraca is firstly, dating the source, and secondly, that magical spells by nature tend to be  syncretic . In the example provided above, lovestruck Capitolina summons "all the divinities" to release the spirits of "all who drowned in the Nile, the unmarried dead", et cetera to sway the heart of her young man, and, yet she may not have known enough about Judaism or Christianity, or even Gnostic Christianity, to know whether "YAHWEH SABAOTH" and "the Only-Begotten" were the same god or not.


Some aspects of the meaning, or range of meanings, of  monogenēs  in the New Testament are disputed. Lexicons of the New Testament both reflect and determine debate:


The entrance of "only begotten" into the English Bible was not directly from  mono-genes  but from the Latin of the Vulgate, which had  uni-genitus  (one-begotten): [ 15 ]


The meaning of  monogenēs  was part of early Christian  christological  controversy regarding the  Trinity . It is claimed that  Arian  arguments that used texts that refer to Christ as God's "only begotten Son" are based on a misunderstanding of the Greek word  monogenēs [ 16 ]  and that the Greek word does not mean "begotten" in the sense we beget children but means "having no peer, unique". [ 17 ] [ 18 ]


Alternatively in favour that the word  monogenēs  does carry some meaning related to begetting is the etymological origin  mono-  (only) +  -genes  (born, begotten). [ 19 ]  The question is whether the  etymological origin  was still "live" as part of the meaning when the New Testament was written, or whether  semantic shift  has occurred. Limiting the semantic change of  monogenes  is that the normal word  monos  is still the default word in New Testament times, and that the terms co-exist in Greek, Latin and English:


Also there is a question about how separate from the idea of  -genes  birth and begetting the cited uses of  monogenes  in the sense of "unique" truly are. For example, the ending  -genes  is arguably not redundant even in the sense of "only" as per when  Clement of Rome  (96 AD), and later  Origen , Cyril and others, employ  monogenes  to describe the rebirth of the  phoenix . At issue is whether Clement is merely stressing  monos  unique, or using  monogenes  to indicate unique in its method of rebirth, or possibly that there is only one single bird born and reborn. Likewise in Plato's Timaeus, the "only-begotten and created Heaven", is still unique in how it is begotten, in comparison to the begetting of animals and men, just as Earth and Heaven give birth to Ocean and Tethys. Of the  Liddell Scott  references for "unique" ( monogenes  being used purely as  monos ) that leaves only Parmenides, which (as above) is no longer considered a likely reading of the Greek text.


Additionally the New Testament frame of reference for  monogenes  is established by uses of the main verb "beget", and readings of complementary verses, for example:


This issue overlaps with, and is interrelated with, the question of begetting above. Interpretation of the uniqueness of  monogenes  in New Testament usage partly depends on understanding of Hellenistic Jewish ideas about inheritance.  Philo  stated:


In his 1894 translation of Philo  Charles Duke Yonge  rendered "loved-and-only son" ( agapetos kai monos uios ) as "only legitimate son", which is not unreasonable given Philo's parallel comments in On Sacrifice X.43. It also parallels  Josephus ' use (see above 20:20) for a legitimate son of the main royal wife.


Likewise in the later Jewish Septuagint revisions:


In contrast in Proverbs 4:3 Aquila, Symmachus and Theodotion all have  monogenes  of a mother's only-begotten son where legitimacy is not an issue.


In  textual criticism , opinions are divided on whether Jesus is referred to as "only-begotten God" or "only-begotten Son", in John 1:18. [ 23 ]  According to the majority of modern scholars the external evidence favors  monogenês theos  as the original text. This reading exists primarily in the  Alexandrian text-types .  Textus Receptus , the manuscript tradition behind the KJV and many other Bibles, reads  ho monogenês huios . This reading ranks second in terms of the number of manuscripts containing it, and has a wider distribution among text-types. [ 24 ]


This textual issue is complicated by the scribal abbreviations of  nomina sacra  where "G-d" and "S-n" are abbreviated in the Greek manuscripts by ΘΣ and ΥΣ ( theta - sigma  vs  upsilon - sigma ) increasing the likelihood of scribal error. [ 25 ]


A  monstrous birth , variously defined in history, is a birth in which a  defect  renders the animal or human child malformed to such a degree as to be considered  "monstrous" . Such births were often taken as  omens , signs of God, or moral warnings to be wielded by society at large as a tool for manipulation in various ways. The development of the field of  obstetrics  helped do away with spurious associations with evil but the historical significance of these  fetuses  remains noteworthy. In  early  and  medieval Christianity , monstrous births were presented as and used to pose difficult  theological  problems about humanity and  salvation .


An early reference to monstrous birth is found in the apocryphal biblical text  2 Esdras , where it is linked to  menstruation : "women in their uncleanness will bear monsters." [ 1 ]  Monstrous births are often placed in a religious context and interpreted as signs and symbols, as is evidenced in the 1493  Nuremberg Chronicle . According to  David Hume 's  "The Natural History of Religion" , they are among the first signs that arouse the barbarian's interest. [ 2 ]  Monstrous human births raise the question of the difference between humans and animals, and anthropologists have described different interpretations of and behaviors toward such births. Among the East African  Nuer people , monstrous births are acted on in a way that restores the division between the categories of human and animal: "the Nuer treat monstrous births as baby hippopotamuses, accidentally born to humans, and, with this labelling, the appropriate action is clear. They gently lay them in the river where they belong." [ 3 ]


Whether monstrous births were natural, unnatural, or supernatural remained a topic of discussion.  Saint Augustine  held that nothing "done by the will of God could be contrary to nature," whereas  Thomas Aquinas  considered some miracles to be against nature. [ 4 ]


Reasons for monstrous births given in early medieval  penitentials  (concerned with sexual sin) and thirteenth-century medical texts (concerned with physical purity) include pollution through  menses  and intercourse during menstruation. [ 5 ]  Such explanations are found in many medieval literary texts, including Jean Maillart's fourteenth-century  Roman du Comte Anjou  and  Geoffrey Chaucer 's " Man of Law's Tale ." [ 6 ]


Sixteenth- and seventeenth-century medical texts, which treat  pregnancy  as a disease, [ 7 ]  suggest that monstrous births may be the result of the mother's sickness or distress, and they continue the myth of (bestial) intercourse during pregnancy as a cause. [ 8 ]  The mother's role is of the greatest importance, and what was presupposed was the possibility of an emotional transference from mother to fetus, referred to as the "theory of the maternal imagination":


According to most of the authors of the sixteenth through early eighteenth centuries, an expectant mother's cravings, desires, and experiences--especially experiences that aroused strong passions such as fear and lust--were capable of  directly  inscribing themselves upon the body of the fetus, producing deformities and monstrosities that retained the semantic content of the original impression. [ 8 ]


At the same time, an epistemological shift was taking place, and monstrous births changed from "signs to facts." Such births were now often publicized in pamphlets and broadsides and became the subject of scientific investigation; the early sixteenth century produced an "apparent upsurge of interest in monstrous births." [ 9 ]


Monstrous animal births often figure in times of religious upheaval. Many occurred in the Europe of the Reformation: the advent of Luther was supposedly announced by the 1522 birth of a monstrous calf (a  mooncalf ) in Saxony, [ 10 ]  and the accession of  Elizabeth I of England  was supposedly indicated by monstrous births as well, as a warning to "Catholics and other sinners." [ 11 ]


A misshapen calf, born in  Freiberg, Saxony , on 8 December 1522, quickly became important in the German Reformation. It was born with oddly shaped legs (its hind legs straight as a human's) and with a fold of skin over its head shaped like a  cowl —hence its comparison to a  monk . An illustration made its way to a Prague astrologer, who "discovered that the monster did indeed signify something terrible, indeed the most awful thing possible-- Martin Luther ." [ 10 ]  Luther himself responded quickly with a pamphlet containing a mock  exegesis  of the creature,  Monk Calf , in which the "Monk Calf" stands, in all its monstrosity, for the Catholic church. [ 12 ]  Luther's anti-papist pamphlet appeared together with a tract by  Philipp Melanchthon [ 13 ]  which discussed a fictional monster, the Pope-Ass, a hybrid between a man and a donkey supposedly found near Rome after the 1496 flood. [ 14 ]  Circulated in 1523, Martin Luther and Philipp Melanchthon's pamphlet was titled  The Meaning of Two Horrific Figures, the Papal Ass at Rome and the Monk Calf Found at Freyberg in Meissen . [ 15 ]   Lucas Cranach the Elder  and his workshop provided the illustrations of the Papal Ass and the Monk Calf for the pamphlet. Variations of Luther and Melanchthon's pamphlet eventually were circulated, including one that depicted the Papal Ass and the Monk Calf in "an encounter between the two creatures. This opening page adds a new phrase to the title of the book: 'with signs of the Day of Judgement.'" [ 16 ]


Especially monstrous births among humans were, from the early Middle Ages on, seen as signifying God's interaction with the world: "a monstrous birth  is  the shape of wickedness, not only the result of original sin but of more local and immediate forms as well." [ 17 ]  One of the best known examples of such births was the  Monster of Ravenna .


Although the connections between a monstrous birth and improper maternal behavior were eventually dismissed by reliable authorities, a particularly late incident involving such allegations took place in the  Massachusetts Bay Colony .  Mary Dyer , later to become a Quaker martyr, gave birth to a deformed child in October 1637. Noted religious dissenter  Anne Hutchinson , who was acquainted with the Dyer family and was present at that birth, was herself delivered of a "monster" in the next year. Both cases were publicized by  John Winthrop , who was at the time bringing legal proceedings against both women for heresy. [ 18 ]


A  monthly nurse  is a woman who looks after a mother and her baby during the  postpartum or postnatal period . The phrase is now largely obsolete, but the role is still performed under other names and conditions worldwide.


In the past, it was customary for women to  rest in bed  or at home for a prolonged period after  childbirth . Typically, their female relatives, such as their mother or  mother-in-law , would provide care. Alternatively, wealthy families would sometimes hire a monthly nurse. This period, known as confinement or lying-in, would end with the mother's reintroduction to the community during a  Christian  ceremony called the  churching of women . In 18th and 19th century England, the term "monthly nurse" was prevalent since the nurse would usually stay with the patient for four weeks. However, the term "monthly" is not entirely accurate since there was no fixed time or date for the nurse's services to be provided or to end, but rather it was entirely dependent on the arrangement.


The occupation still exists, although now it might be described as "postnatal  doula ", "maternity nurse" or "newborn care specialist", all are  specialist sorts of nannies . A modern version of this rest period has evolved to give maximum support to the new mother, especially if she is recovering from a difficult labor and delivery. It is common in China and its diaspora, where  postpartum confinement  is known as "sitting the month". These workers can visit the new mother's home daily or live in it for a month and look after them whenever the mother needs help. Conversely, they may work in a central setting, where the new mothers come after they leave the hospital. In Korea, these workers are called  Sanhujorisa , and the centers started up in the late 1990s.


Historically,  midwifery  was a skill passed down through generations within families, with the daughter learning from her mother and gaining hands-on experience before becoming a midwife herself. The Church of England supported that by a system of episcopal licensing, which required midwives to swear to some rules regarding contraception, abortion, and concealment of births and also to deliver the  newborn infants for baptism  or, in extreme cases, to perform the ceremony themselves. However the system of episcopal licensing fell into decline over the latter part of the 17th century, ceasing to exist in London by 1720 and not much later in other areas. [ 1 ]


It is unclear exactly when the monthly nurse appeared as an entity. Humfrey commentating in 1891 cites an interplay of factors arising during the 17th and 18th centuries with the advent of instrumentation being used in childbirth and the emergence of "man-midwives". [ 2 ]  Lying-in hospitals were established in the 18th century and  during the 18th/19th centuries  the process of childbirth became more medicalised.  Much of childbirth remained midwife led but the medical profession was becoming more involved with the surgeon's responsibility being vested around the immediate childbirth process. This raised the question of who would take care of the baby after birth whereas hitherto the roles of nurse and midwife were combined in one person.  It was generally thought that the best person to look after her baby was a woman who had had one herself. Often, the task was allotted to motherly or grandmotherly hands, and the "monthly nurse" originated from that requirement for postnatal care.  Humfrey writing in The Nursing Record in 1901 reported that "there was little or no attempt at knowledge or instruction, and we know as a fact that ignorance, prejudice and neglect resulted in a goodly crop of errors, wrongs, and woes as regards the hapless infant". [ 2 ]


The Nursing Record  reported that "nurses who attend the 'artisan' classes in their confinements as a rule pay a visit daily for ten days and then give up the case, as few working class mothers can afford to lie up for longer".


A monthly nurse could earn more than a midwife, as the monthly nurse was employed for periods between 10 days and often much longer and might attend to several women part-time. She often "lived in". The midwife's only duty was perceived as "being trained to assist the parturient  woman while nature does her own work and able to call upon a surgeon who could step in where nature fails and skill and science are required". Many certified midwives transferred to the ranks of monthly nurses to benefit from an increased income.


Although 'registration' was not available for women to act as midwives or monthly nurses, a system of 'certification' existed in the late 19th century and continued into the early 20th century. [ 3 ]  To qualify, a candidate monthly nurse would attend a course in a  lying-in hospital  for four or five weeks and a midwife's office for up to three months. They were not financially supported by the hospital and had to bear their own expenses, but they were also given the freedom to practice independently once they completed their training. In 1893, Miss Gosling reported that "although the certificated monthly nurse could be relied upon as being trustworthy and efficient, there were a number of women who attend lectures for a short time and through one cause or another failed to pass their examination and obtain a certificate nevertheless enter a 'Nurses Home' or open one for themselves". Miss Gosling alludes to difficulty of the public not asking to see certification.  She also advocates Registration for Monthly Nurses. [ 4 ]


As might be expected, rogue institutions issued certificates and diplomas "for a price". Another reporting on a lying in hospital and signing herself a "victim of the system" said that she "witnessed the first phase of the system which turns out yearly hundreds of midwives and monthly nurses on an unsuspecting public. These would be nurses representing almost every grade of the lower classes and every degree of lack of education, and one woman, I remember, could not write. Personally, I found many to be dishonest, untruthful, indescribably dirty in their habits and persons, utterly unprincipled, shockingly coarse and deficient intelligence, and with not the faintest idea of discipline". [ 5 ]


Articles on the subject of monthly nursing provide differing information as to the length of training provided for the monthly nurse. It appears to be in the region of one to four months, with hospital based training and certification. There appear to be different formulations of training with some combined training for monthly nurses and midwives.


An advertisement in the  Nursing Notes and Midwives Chronicle  appearing on 1 January 1908 lists over twenty doctors who provide the LCC with lectures for midwives and monthly nurses. This includes a Dr. Feldman of Myrdle St., Commercial Road who lectured in Yiddish. [ 6 ]


As has already been mentioned a situation arose whereby qualified nurses and midwives who had undertaken hospital training were in a situation where Monthly Nursing employment was more lucrative and thus underwent further short training to obtain a Monthly Nurse certificate. An example of one such nurse is cited below.


On 27 November 1862 Grailey Hewitt (Physician British Lying In Hospital) writes to a Mr. Bowman and asks for assistance in starting a training scheme for monthly nurses at the British Lying In Hospital. [ 7 ]


In 1889 an editorial article appears in  The Nursing Record  alluding to doctors encouraging women in poor circumstances to train as monthly nurses. The writer stresses the need to firstly train as a nurse, otherwise the monthly nurse training is not long enough. The writer states the view that if attending after labour the monthly (untrained) nurse detracts from the value of skilled attendance after labour. In the view of the writer the monthly nurse should be acquainted with at least the basics of "the Obstetric Art". [ 8 ]


In 1903 a letter appears in  The Nursing Record  from the President and Secretaries of the British Gynaecological Society decrying the state of nurse (monthly nurse) training. The article states a much better standard of training is needed for Monthly and Gynaecological Nurses - the authors of the letter propose to offer a training and refer to the successful training of the Obstetrical Society of London. The writers allude to Fellows of the Society employing nurses for gynaecological cases for which they do not have sufficient training. Their remarks seem to encompass nurses who have trained in larger and smaller hospitals. [ 9 ]


Harriett Simpson Cater, monthly nurse, trained at the British Lying-in Hospital. Records pertaining to Harriett Cater  are held in the Royal College of Midwives Archive, based within the Royal College of Obstetricians and Gynaecologists [ 10 ]  These comprise two diaries for which helpfully there is a transcript. These illuminate aspects of her personal and professional life. Harriett was from a poor background and needing to support her wider family she found work as a Monthly Nurse. She worked with affluent famililies and the duration of her engagements often exceeded a month. In addition to her diaries there are certificates also photos and a scrapbook. Harriett initially  trained  as a nurse at University College Hospital London  between 1878 and 1880.  In October 1880 she undertook training at the British Lying-in Hospital as a Monthly Nurse.   In 1883 Harriett trained as a Midwife at the General Lying-in Hospital, York Rd., Lambeth, London. [ 10 ]


Certificates awarded to Dorothy Lizzie Holland are available to view in the London Metropolitan Archives. Holland qualified as a General Nurse on 24 October 1922, then dated 12 June 1923 she has a certificate from The Middlesex Hospital Maternity Department stating she had trained for four months in Monthly Nursing and Midwifery. She subsequently (10 February 1923) obtained a certificate from the Central Midwives Board stating she had passed their examination. [ 11 ]


United Kingdom Reform and the 1902 Act


In the late 19th century, reformers were calling not only for registration and recognition of the profession of a midwife but also for the two functions of midwife and monthly nurse to be amalgamated: "The work of midwives lies, for the most part, amongst the poor and the poor lying-in woman needs not only to be delivered, but to be visited for some ten days subsequent to her confinement". The registration of midwives was opposed by members of the  House of Lords  and  Parliament  in the United Kingdom for many years, who argued that the delivery of infants was the responsibility of trained doctors and to allow women to do the job, even in straightforward cases, would take away doctors' income. It was not until the  Midwives Act 1902 , following 12 years of representation by women, that midwives were "registered", but it would still take several years for it to be accepted. The professional training and formal qualification of midwives, and eventually, the postnatal care offered by the  National Health Service , saw the end of the monthly nurse.


Natural childbirth  is  childbirth  without routine medical interventions, particularly  anesthesia . Natural childbirth arose in opposition to the medical model of childbirth that has recently gained popularity in industrialized societies. Natural childbirth attempts to minimize medical intervention, particularly the use of anesthetic medications and surgical interventions such as  episiotomies , forceps,  ventouse  deliveries, and  caesarean sections . Natural childbirth may occur during a physician or midwife attended  hospital birth , a midwife attended homebirth, or an unassisted birth. The term "natural childbirth" was coined by obstetrician  Grantly Dick-Read  upon publication of his book  Natural Childbirth  in the 1930s, which was followed by the 1942  Childbirth Without Fear .


Historically, most women gave birth at home without emergency medical care available. The "natural" rate of maternal mortality—meaning without surgical or pharmaceutical intervention—has been estimated at 1,500 per 100,000 births. In the United States circa 1900, before the introduction and improvement of modern medical technologies, there were about 700 maternal deaths per 100,000 births (0.7%). [ 1 ]


At the onset of the  Industrial Revolution , giving birth at home became more difficult due to congested living spaces and dirty living conditions. This drove urban and lower-class women to newly available hospitals, while wealthy and middle-class women continued to labor at home. [ 2 ]  In the early 1900s there was an increasing availability of hospitals, and more women began going into the hospital for labor and delivery. In the United States, the middle classes were especially receptive to the medicalization of childbirth, which promised a safer and less painful labor. [ 3 ]  The use of childbirth drugs began in 1847 when Scottish obstetrician  James Young Simpson  introduced  chloroform  as an anesthetic during labor, but only the richest and most powerful women (such as  Queen Victoria ) had access.


The term "natural childbirth" was coined by obstetrician  Grantly Dick-Read  upon publication of his book  Natural Childbirth  in 1933. In the book, Dick-Read defined the term as the absence of any intervention that would otherwise disturb the sequence of labor. The book argued that because of "civilized" British women fear birth the birthrate was dropping, and if women were not to fear birth, birthing would be easier since fear creates tension which, in turn, causes pain. In 1942, Dick-Read published  Revelation of Childbirth  (which was later retitled  Childbirth without Fear ), advocating natural childbirth, which became an international bestseller. In the late 1940s, he brought his ideas to America, but saw similar ideas with differing names – "pain-free birth" and "prepared childbirth" – were already gaining traction. [ 4 ]  The appeal of natural childbirth rested in the idea that merging physiological, psychological, social, and spiritual aspects of reproduction would create the best comprehensive care. [ 5 ]


The  Lamaze method  gained popularity in the United States after Marjorie Karmel wrote about her experiences in her 1959 book  Thank You, Dr. Lamaze , and with the formation of the American Society for Psychoprophylaxis in Obstetrics (currently  Lamaze International ) by Karmel and  Elisabeth Bing . The  Bradley method of natural childbirth  (also known as "husband-coached childbirth"), a method of natural childbirth developed in 1947 by Robert A. Bradley, M.D., was popularized by his book  Husband-Coached Childbirth , first published in 1965. [ citation needed ]


In the 1970s, natural childbirth became a movement associated with feminism and consumerism, stressing obstetrics' lack of concern for the whole person and technology a method for controlling women's bodies. [ 5 ]   Michel Odent  and midwives such as  Ina May Gaskin  promoted  birthing centers ,  water birth , and  homebirth  as alternatives to the hospital model.  Frédérick Leboyer  is often mistakenly believed to have advocated for water births, but he actually rejected the alternative as he felt it was not beneficial to the health of the baby. [ 6 ]  In 1976, Gaskin wrote the book  Spiritual Midwifery , which advocated for natural childbirth. [ 4 ]


Many women consider natural birth empowering and giving women more control in the birth process, pushing against  paternalism  in the care given by medical providers. [ 7 ] [ 4 ]


Instead of medical interventions, a variety of non-invasive methods are employed during natural childbirth to ease the mother's pain. Many of these techniques stress the importance of "a mind-body connection," which the medical model of birth does not. [ citation needed ]  These techniques include  hydrotherapy ,  massage ,  relaxation  therapy,  hypnosis ,  breathing  exercises, acupressure for labor,  transcutaneous electrical nerve stimulation  (TENS),  vocalization ,  visualization ,  mindfulness  and  water birth . Other approaches include movement, walking, and different positions (for example, using a  birthing ball ), hot and cold therapy (for example, using hot compresses and/or cold packs), and receiving one-on-one labor support like that provided by a  midwife  or  doula . However, natural childbirth proponents maintain that pain is a natural and necessary part of the labor process, and should not automatically be regarded as entirely negative. In contrast to the pain of injury and disease, they believe that the pain of childbirth is a sign that the female body is functioning as it is meant to.


Birth positions favored in natural childbirth—including  squatting , hands and knees, or suspension in water—contrast with the supine  lithotomy position  (woman in hospital bed on her back with legs in stirrups). Supine positions, on average, when compared to upright positions, have been shown in a Cochrane review to be associated with a 6.16 minute longer duration of the second stage of labor and an increased incidence of some labor complications but a decreased incidence of other complications. [ 8 ] [ 9 ]


Methods to reduce tearing during natural childbirth (instead of an  episiotomy ) include managing the  perineum  with counter-pressure, [ 10 ]  hot compresses, and pushing the baby out slowly.


Some women take birth education classes to prepare for a natural childbirth. Several books are also available with information to help women prepare. A midwife or  doula  may include preparation for a natural birth as part of the prenatal care services. However, a study published in 2009 suggests that preparation alone is not enough to ensure an intervention-free outcome. [ 11 ]


Women who choose to do home births appear to take more measures in preparation for their birth compared to women who choose to do hospital births. According to a study of 19 women looking at home and hospital births in Australia, the women who participated in home births had more preparation and expectations compared to those who had hospital births. A mother in this study who had a home birth went to two different antenatal classes, read Spiritual Midwifery (Gaskin, 2002) three times, and knew about home birth and its qualities very well. In contrast, another mother in the study who had a hospital birth did not know what a contraction was. Many of the mothers who had home births reported taking pain management classes, and yoga classes to go into the birth having a positive mindset. They also participated in more antenatal classes than women who went through hospital births. This implies a higher sense of responsibility and control for women who go through with home births. [ 12 ]


Some argue that the push towards natural childbirth in  Western countries  has transformed from a way of empowering women into a way of shaming and bullying women who need medical interventions. [ 13 ] [ 14 ] [ 15 ]  Some women express shame when not able to have a "natural birth," feeling that their bodies may be defective or lessen the experiences of individuals using  assisted reproductive technologies , or who are adoptive parents and parents who use surrogates. [ 4 ]


Home birth  specifically, even when attended with a midwife, is associated with risks that are not present in hospital births. A United States study of over 13 million births from 2006 to 2009 found that infants born at home have a fourfold higher chance of death in the first 28 days of life compared to infants born at a hospital, and a sevenfold chance of death for firstborns. [ 16 ]  Another study found that infants born at home have a three times higher chance of death in the first 28 days of life. [ 17 ]  Additionally, it found that up to 37% of first time mothers and 9% of non first time mothers intending home birth must be transferred to a hospital during childbirth.


Postpartum care  or  postnatal care  is a service provided to individuals in the  postpartum period , to help with postpartum recuperation and restoration.


Many traditional forms of  postpartum confinement  exist throughout the world. Chinese  Zuo Yuezi  (sitting the month) and European  Lying-in  are examples. [ citation needed ]


Sanhujori  is Korea's version of postpartum care. It draws on principles that emphasize activities and foods that keep the body warm, rest and relaxation to maximize the body's return to its normal state, maintaining cleanliness, eating nutritious foods, and peace of mind and heart. [ 1 ]  The confinement period is known as  samchil-il  (three seven days). [ 2 ]


Traditionally, women were taken care of by their elders: their mother, mother-in-law, sister, or aunt. The lying-in hospitals provided an institutional variation which gave women weeks of bedrest and a respite from household chores. Increasingly, these older women are unavailable or unwilling to take on this role; given the lingering effects of the  one-child policy , many older Chinese women had limited experience of newborn babies, having only had one themselves. Replacements for this familial help are commercial services, both in the home and at residential centres. [ citation needed ]


Agencies provide specialist carers that come to the new parents' home. This job used to be known as the  monthly nurse , as she came and lived with the family for a month. Now more common terms are maternity nurse, newborn care specialist, or  confinement nanny ; the worker is not a registered health care professional such as the word " nurse " usually implies in current English. In  Indian English  the role is called a " japa  maid". [ citation needed ]


A  doula  is best known as a birth companion, but some provide practical and emotional post-birth support. A  lactation consultant  and a  health visitor  are trained health professionals who may assist the new mother at this time. In the Netherlands, the in-home support is known as  kraamzorg , and standard within the national health insurance system. [ citation needed ]


The use of  yue sao , a specialist carer translated in Canada as "postpartum doula", [ 3 ]  is also very common in China.  Yue sao  typically are live-in domestic helpers who care for both the new mother and baby for the first month after birth. Salaries as at 2017 vary from RMB8000 to RMB20000 per month depending on city and experience. [ 4 ]  They are described as "mothering the mother". [ 5 ]  Australian documentary-maker  Aela Callan  called them "Chinese supermums" but says they are colloquially known as "confinement ladies". [ 6 ]


Postpartum care kits are all-in-one packages that contain several postpartum care essentials that a new mom requires right after delivery. These kits may include items like Maternity Pads, Postpartum Underwear, Peri Bottle & more depending on the brand. Postpartum Kits have become quite popular as a part of hospital bags that expecting parents prepare a few weeks before their due date. One of the major advantages of these kits is that it brings all the essentials items at one place, which makes it a very convenient option. Another benefit is that it makes new moms and expecting mothers feel more confident as they step into motherhood. Some of the popular Postpartum Kits available are as follows:


There are several other companies like  Healofy ,  Mama & Wish  & more offering a range of postpartum essentials varying from skincare and nutrition to physical recovery products


Companies have sprung up to offer extended postpartum care outside the home, sometimes in a hotel-like environment. Luxury options are a business. [ 7 ]  Private postpartum care centres were introduced to Korea in 1996 under the name of  sanhujoriwon . [ 8 ]  Within the Chinese tradition, specialist businesses such as Red Wall Confinement Centre charge up to $27,000 for one month. [ 9 ]  In Taiwan, postpartum nursing centres are popular, for those who can afford them. [ 10 ]


Birth tourism  centres operating under the radar in the United States for Chinese women offer "sitting the month". [ 11 ]


Modern postpartum care in Western countries is typically delivered through family, peers, professional consultants,  coordinated care teams , or via information and communication technology. [ citation needed ]


Outcomes during the postpartum period that have received the most research attention include  breastfeeding , greater attendance at postpartum visits, readmissions and emergency room visits,  anxiety  and  depression ,  oral glucose tolerance  testing,  hemoglobin  A1c testing and  contraceptive use. [ 12 ]


Based on the 2023  meta-analysis  conducted by the Patient-Centered Outcomes Research Institute, in the  United States  more comprehensive  health insurance  is likely associated with greater attendance at postpartum visits and may be associated with fewer preventable readmissions and emergency room visits. [ 12 ]


Evidence suggests that postpartum visits from home/by telephone vs. at the clinic are associated with similar levels of depression or anxiety symptoms up to 1-year post pregnancy. [ citation needed ]


There is also no reliable evidence that integration of care across multiple types of providers has an impact on depression symptoms or substance use up to 1 year post pregnancy. [ citation needed ]


Breastfeeding  support is one of the most common forms of postpartum care in both the US and Canada. Research evaluating its effectiveness has shown that peers as well as professional  lactation consultants  can be effective in promoting breastfeeding during the postpartum period. [ 12 ]  Compared with no peer support, having peer support for breastfeeding has been found to be associated with higher rates of any breastfeeding at 1 month and 3 to 6 months and of exclusive breastfeeding at 1 month. Based on a meta-analysis of  randomized control trials  and  nonrandomized comparison studies , peer support is not related to breastfeeding outcomes past 6 months post pregnancy. [ 12 ]  Compared with no lactation consultant, breastfeeding care provided by a lactation consultant is associated with higher rates of any breastfeeding at 6 months but not at 1 month or 3 months post pregnancy. The use of information or communication technology for the delivery of breastfeeding care is not associated with higher breastfeeding rates in the months following pregnancy. [ 12 ]


Provision of reminders for testing has been found to be associated with greater adherence to  oral   glucose tolerance   testing  up to 1 year postpartum but not  random glucose  testing  or  hemoglobin A1c  testing. [ 12 ]


Research Limitations


Research on postpartum care is almost exclusively based on healthy postpartum individuals. Little is known about the impact of postpartum care on those individuals at high risk of postpartum complications due to chronic conditions, [ 13 ]  pregnancy-related conditions [ 14 ]  or systemic bias in health care provision. [ 15 ]


Postpartum confinement  is a traditional practice following  childbirth . [ 1 ]  Those who follow these customs typically begin immediately after the birth, and the seclusion or special treatment lasts for a culturally variable length: typically for one month or 30 days, [ 2 ]  26 days, up to 40 days, two months, or 100 days. [ 3 ] [ 4 ]  This postnatal recuperation can include  care  practices in regards of "traditional health beliefs, taboos, rituals, and proscriptions." [ 5 ]  The practice used to be known as " lying-in ", which, as the term suggests, centres on  bed rest . In some cultures, it may be connected to taboos concerning  impurity after childbirth .


Postpartum confinement refers both to the mother and the baby. Human newborns are so underdeveloped that pediatricians such as  Harvey Karp  refer to the first three months as the "fourth trimester". [ 6 ]  The weeks of rest while the mother heals also protect the infant as  it adjusts to the world , and both learn the skills of  breastfeeding .


Almost all countries have some form of  maternity leave . Many countries encourage men to take some  paternal leave , but even those that mandate that some of the shared parental leave must be used by the father (" father's quota ") acknowledge that the mother needs time off work to recover from the childbirth and deal with the  postpartum physiological changes .


A 2016 American book describes the difficulties of documenting those "global grandmotherly customs" but asserts that "like a golden rope connecting women from one generation to the next, the protocol of caring for the new mother by unburdening her of responsibilities and ensuring she rests and eats shows up in wildly diverse places". [ 7 ]  These customs have been documented in dozens of academic studies, and commonly include support for the new mother (including a release from household chores), rest, special foods to eat (and ones to avoid), specific hygiene practices, and ways of caring for the newborn. [ 8 ]


Martha Wolfenstein  and  Margaret Mead  wrote in 1955 that the postpartum period meant a "woman can be cherished and pampered without feeling inadequate or shamed". The 2016 review that quoted them cites customs from around the world, from Biblical times to modern Greece:


From the data it seems that women were housebound for a number of days after the birth and the length of this period of seclusion varied by caste or ethnic group [in Nepal]. This is a phenomenon found across the globe, including in high-income countries in the recent past. The length of time a woman is secluded or rested varied across different countries and the principles underpinning this isolation (to heal vs. being unclean) also seem to differ greatly. After the period of seclusion there is often a ceremony to purify women to publicly accept them back into daily life. The literature supports the concept of a resting – a lengthy lie-in or lying-in period, a period of seclusion, as women need to rest in order to heal, yet it may mean that they are neglected. [ 9 ]


One meta-review of studies concluded, "There is little consistent evidence that confinement practices reduce  postpartum depression ." [ 10 ]


Postpartum confinement is well-documented in China, where the tradition is known as "Sitting the month": 坐月子 " Zuò yuè zi " in Mandarin or 坐月 "Co5 Jyut2" in Cantonese. [ 11 ]  The earliest record of the Chinese custom of postpartum confinement dates back over 2,000 years ago in the  Book of Rites , where it was known as y uè nèi  (月内). [ 12 ]  Postpartum confinement is based on  traditional Chinese medicine , with a special focus on eating foods considered to be nourishing for the body and helping with the production of  breastmilk . Women are advised to stay indoors for recovery from the trauma of birth and for feeding the newborn baby.


The diets and traditions involved with postpartum confinement greatly vary across different Chinese cultural regions. The length of Chinese postpartum confinement ranges anywhere between 28 and 100 days. [ 13 ]  Although medical opinion in China today generally recommends a confinement period of at least 42 days. [ 14 ]  In ancient China, the confinement period lasted for 100 days. This custom is still observed in parts of northern China, such as  Shanxi province . [ 15 ] [ 16 ]  After 100 days, the Hundred Days Banquet (百日宴) is held to celebrate the baby reaching 100 days old. In southern China, the confinement period is significantly shorter, and usually lasts 30 days. [ 13 ]


Because Chinese society is  patrilocal , women observing postpartum confinement are traditionally cared for by their mother-in-law. In contemporary times, it is also possible for the woman to be cared for her by her own mother or a hired female worker known as a "confinement nanny" (陪月). In Hong Kong and Taiwan, the mother and baby sometimes spend the month in special postpartum confinement clinics rather than at home. [ 17 ]


In  ancient China , women of certain ethnic groups in the South would resume work right after birth, and allow the men to practice postpartum confinement instead. [ 18 ]  (See  Couvade ).


Traditionally in China, the mother and child were kept separate from the rest of the household. [ 17 ]  The mother was not permitted to bathe, wash her hair, or weep, because these activities were believed to put the mother at risk of falling ill by catching cold and affect the quality of her breast milk. [ 17 ]


Nowadays, however, new mothers may wash their hair or take a bath or shower infrequently during the postpartum period, but it is claimed to be important to dry their body immediately afterwards with a clean towel and their hair properly using a hair dryer. It is also claimed to be important for women to wrap up warm and minimize the amount of skin exposed, as it was believed that they may catch a cold during this vulnerable time. [ citation needed ]  In Dalian, some women even take to wrapping themselves in plastic to avoid the wind.  Ref


The custom of confinement advises new mothers to choose energy and protein-rich foods to recover energy levels, help shrink the  uterus , and for the  perineum  to heal. This is also important for the production of  breastmilk . Among the traditionally recommended  galactogogues  were rich porridge, fish soup, and hard-boiled eggs. [ 17 ]  Sometimes, new mothers only begin to consume special herbal foods after all the  lochia  is discharged.


In Guangdong, a common dish is  pork knuckles with ginger and black vinegar  as pork knuckles are believed to help replenish calcium levels in women. Ginger is featured in many dishes, as it is believed that it can remove the 'wind' accumulated in the body during pregnancy. Meat-based soup broths are also commonly consumed to provide hydration and added nutrients.


In Shanxi, new mothers consume high-quality millet porridge and soup made from chickens at specific ages.


In Singapore, confinement dishes are thoughtfully crafted to support postpartum recovery. Sesame Oil Chicken helps replenish blood and keep the body warm, while Green Papaya Soup is known to boost breast milk supply. Red Dates Tea restores vitality and maintains warmth, and Black Vinegar Pig Trotters provide calcium and collagen to strengthen bones and joints. [ 19 ]


In  Guangdong province , new mothers are barred from visitors until the baby is 12 days old, marked by a celebration called 'Twelve mornings' (known as 十二朝). From this day onwards, Cantonese families with a new baby usually share their joy through giving away food gifts, while some families mark the occasion by  paying tribute to their ancestors . [ citation needed ]  When the "month is fulfilled" ( manyue ) after 30 days, the mother receives relatives and friends who bring special foods such as  Chinese red eggs . [ 17 ]


In parts of India it is called  jaappa  (also  transliterated   japa ); in North India and Pakistan,  sawa mahina  ("five weeks").


Most traditional Indians follow the 40-day confinement and recuperation period also known as the  jaappa  (in Hindi). A special diet to facilitate milk production and increase hemoglobin levels is followed. Sex is not allowed during this time. In Hindu culture, this time after childbirth was traditionally considered a period of relative impurity ( asaucham ), and a period of confinement of 10–40 days (known as  purudu ) was recommended for the mother and the baby. During this period, she was exempted from usual household chores and religious rites. The father was  purified by a ritual bath  before visiting the mother in confinement.


In the event of a  stillbirth , the period of impurity for both parents was 24 hours. [ 20 ]


Many Indian subcultures have their own traditions after birth. This birth period is called Virdi (Marathi), which lasts for 10 days after birth and includes complete abstinence from  puja  or temple visits. [ citation needed ]


In Pakistan, postpartum tradition is known as  sawa mahina  ("five weeks"). [ 21 ]


In Persian culture it is called  chilla , i.e. " forty days ". [ 22 ]


Korean women spend  samchil-il  (three seven days, 21 days) in confinement, receiving  sanhujori  (postpartum care). In the past, during the  samchil-il  period,  geumjul  (taboo rope) made with  saekki  and various symbolic objects, such as chili peppers (for a boy) and coal (for a girl), was hung over the gate to denote the childbirth and restrict visitor access. [ citation needed ]


New mothers used to [ when? ]  be encouraged to lie in a warm bed near the fire for 30 days, a practice known as  yu fai . This has been adapted into a form of  Thai massage .  Kao krachome  is a type of  herbal medicine  in which the steam from the boiled plants is inhaled.  Ya dong  involves herbal medicine taken internally.  Thai immigrants to Sweden  report using the  steam bath  to heal after childbirth, although the correct ingredients are not easy to find. [ 23 ]   Thai Australians  who had had caesarian sections felt that they did not need to – in fact, ought not to – undergo these rituals. [ 24 ]


The term used in English, now old-fashioned or  archaic , was once used to name  maternity hospitals , for example the  General Lying-In Hospital  in London. A 1932 Canadian publication refers to lying-in as ranging from two weeks to two months. [ 25 ]  These weeks ended with the re-introduction of the mother to the community in the Christian ceremony of the  churching of women .


Lying-in features in  Christian art , notably  Birth of Jesus  paintings. One of the gifts presented to the new mother in Renaissance Florence was a  desco da parto , a special form of painted tray. Equivalent presents in contemporary culture include  baby showers  and  push presents . [ citation needed ]


Special foods included  caudle , a restorative drink. "Taking caudle" was a  metonym  for postpartum social visits. [ citation needed ]


In Latin American countries, it is called  la cuarentena  ("forty days," a cognate with the English word " quarantine "). It is practised in parts of Latin America and amongst in communities in the United States. [ 26 ]  It is described as "intergenerational family ritual that facilitated adaptation to parenthood", including some  paternal role reversal . [ 27 ]


A  postpartum disorder  or  puerperal disorder  is a  disease  or condition which presents primarily during the days and weeks after  childbirth  called the  postpartum period . The postpartum period can be divided into three distinct stages: the initial or acute phase, 6–12 hours after childbirth; subacute postpartum period, which lasts two to six weeks, and the delayed postpartum period, which can last up to six months. [ 1 ]  In the subacute postpartum period, 87% to 94% of women report at least one health problem. [ 2 ] [ 3 ]  Long term health problems (persisting after the delayed postpartum period) are reported by 31% of women. [ 4 ]