[podcast theme music opens]

Emily Chesley: Welcome to Women Who Went Before,  a gynocentric quest into the ancient world! I’m Emily Chesley.

Rebekah Haigh: And I’m Rebekah Haigh.

Emily: Scholars, friends, and your hosts. 

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Emily: In today’s episode, “The Pee Test: Pregnancy and Childbirth in Ancient Egypt,” we talk with Dr. Ada Nifosì about the gymnastics of ancient Egyptian birth, why Egyptian women ate donkey balls and their cats ate penis cakes,  and why the god Seth should be avoided at all costs. 

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Rebekah: Becoming a mother is a meaningful and maybe magical experience, an experience many women long for. It’s also a scary business—entering the unknown, no matter how many times you’ve done it. In September 1777, a Philadelphia Quaker woman named Sarah Logan Fisher prayed for peace through her approaching labor: “Be a stay & support to my mind during this fiery trial, which sometimes appears to be more than my nature can support.”[1]  

Emily: In 1908, archeologists excavated an unusual mummy in El Bagawat, Egypt. She was a fourteen-to seventeen-year-old girl, who died during a breech childbirth sometime in the Late Dynastic or Coptic period. The girl was found with the wrapped body of one infant nestled between her legs and the placenta still in her birth canal. A hundred years later, a CT scan of the girl’s pelvis revealed a second child inside her. Francine Margolis and David R. Hunt speculate that one of the contributing factors to her death was her underdeveloped body. She was shorter and her pubic length smaller than other mummies.[2]  Our unnamed mother did not survive the dangers of childbirth. Of the graves discovered around her and her children in El Bagawat, almost a third belonged to infants. 

Rebekah: Today we’re journeying to ancient Egypt to study pregnancy and childbirth. Lots of the practices, mythologies, and beliefs from earlier centuries carried on. That means we get to look at both Pharaonic Egypt (the time of the Pharaohs)  and Ptolemaic Egypt (when Egypt was run by the Ptolemies, the Greek colonizers). To give the world’s fastest history lesson of Egypt: The Pharaohs ruled in 31 dynasties that scholars group into several kingdoms with intermediary periods of conflict. The Old Kingdom (c. 2613–2181 BCE) was the age of the great pyramids and the Sphinx. The Middle Kingdom (c. 2040–1782 BCE) is known as the height of art and literature—Egypt’s Classical age. During the New Kingdom (c. 1570–c. 1069 BCE), under rulers like Hatshepsut, Nefertiti, and Tutankhamun Egypt truly became an empire. It sent diplomats to Assyria and expanded its territory in the Mediterranean. Indigenous pharaohs ruled Egypt for an astonishing 2,600 years, until the Persians invaded in 525 BCE. Two hundred years later, Alexander the Great conquered, ushering in Greek rule. When a general named Octavian defeated Ptolemaic ruler Cleopatra VII and Marc Antony, power transferred to the Romans for more than six hundred years.

Emily: No matter the dynasty, reproduction was key to the survival of the family unit. Carol Meyers points out that in agrarian societies, survival depends on family growth: producing enough children who would live to adulthood and help with the labor of sowing and harvesting.[3] To have three children survive beyond the age of five, a woman would have had to support at least six pregnancies.[4] The pressure was on.

Rebekah: In such a context, the hard physical labor, nutritional deficiencies, and disease made reproduction an all-the-more-hazardous affair, both for women and the children they carried. Skeletal remains across the ancient Mediterranean show that men, on average, outlived women.[5]Bioarchaeologist Sandra Wheeler identified pregnant women in the cemetery of Egypt’s Dakhleh Oasis by comparing nitrogen levels in their hair with modern clinical data. Like their modern counterparts, some fatalities were caused by lack of prenatal care and frequent, consecutive births without time to recover.[6] We see deaths like these in the literary record too. In a letter, Pliny the Younger mourned the death of two sisters who, in a heartbreaking coincidence, both died in childbirth after bearing daughters (Epist. 4.21.1-3). They left only one living sibling. 

Emily: Malnutrition also jeopardized motherhood.  A recent study shows that it takes almost 50,000 added calories on top of your normal caloric intake to sustain a healthy pregnancy.[7] But the average woman (and man) in the premodern Mediterranean lived with deficient nutrient levels to begin with. Because of the overall lack of nutritious food, Egyptian women nursed for three years, providing their children antibodies and protections from food-born diseases.[8] As an added plus, nursing was a form of birth control.

Another reason why childbirth was so dangerous, was that many mothers were physically underdeveloped, like our teenaged mother of twins. Egyptian women married young, but generally after they reached puberty. In one text, Ptahhotep cautions, “Do not sleep with a woman [who] is [still] a child.”[9]  Yet, according to the Teaching of Ani, women should marry relatively young to increase their child-bearing years: “Take a wife while you’re young so that she may bear your sons for you” (Teaching of Ani 16.1).[10]  

Rebekah: Childbirth brought much to fear for ancient women. Perhaps this is why it was less a medical event than a religious one in Egypt.[11] Families prayed to Taweret, the protective hippopotamus-headed goddess, and to the dwarf god Bes. Pregnant and birthing women gathered amulets and other magical technologies for protection. One such amulet prays, “We shall keep her safe from a Horus-birth, from a miscarriage and from giving birth to twins.”[12] 

Emily: Egyptians’ search for reassurance was reflected in their mythologies. One of several legendary stories comes from the Westcar Papyrus, written around the 17th c. BCE.[13] This old tradition tells the story of a woman named Rededjet and her difficult labor. The god Ra sends the goddesses Isis, Nephthys, Meskhenet, Heqet, and Khnum to help Rededjet give birth to triplets. The five goddesses disguise themselves as human musicians, enter her room, and lock themselves in with her to help her deliver her infants, three future kings of Egypt. Mythical stories like these offer a window into the practices surrounding birth in Pharaonic and Ptolemaic Egypt. It happened in the home, with the help of attendants, and required the intervention of the gods. 

Rebekah: Talking with us more about fertility, pregnancy, and birth is Dr. Ada Nifosì, Lecturer in Ancient History at the University of Kent. Ada researches and publishes on the social and legal status of women in the Egyptian and Greco-Roman world, as well as topics like religious ritual, children, and toys. In 2009 she published a book on Ptolemaic- and Roman-period amulets, Catalogo degli amuleti di Bakchias. Her newest monograph, Becoming a Woman and Mother in Greco-Roman Egypt ( 2019), explores the life-cycle of women in that period. She has a book on funerary commemorations of young, unmarried women across the Mediterranean coming out with Liverpool University Press (2025). Let’s continue our journey into Egypt! 

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Rebekah: In a world without IVF or apps that track your fertility cycle, women in Greco-Roman and Egypt nevertheless developed their own methods and practices for trying to achieve pregnancy. What did Egyptian women do to overcome infertility and get pregnant, whether rituals or practices or objects?

Dr. Ada Nifosì: So, thank you very much. This is a very interesting question to start. And I would say that it's very interesting to think about infertility because women theoretically were not too considered responsible for infertility, which is something quite interesting and quite positive about ancient Egypt. 

First, because fertility for the Egyptians was in the male sense, basically. All the fertility gods were considered males, and they didn't believe in, for example, in eggs [chuckles] so that basically all the conception came from the male seed. So women didn't have an active role in conception and they didn't have a responsibility if infertility occurred. So there was no guilt in a way. And this is quite nice. 

But having said that, there was a problem that could cause infertility, even though obviously women were not active in the process. So the womb, the uterus, had to open at the right time. So in order to receive the seed it had to open at the time of intercourse, and it also had to close at the right time in order to retain the semen. We can see this in various spells, in the medical papyri. It's a concept that doesn't make women responsible, but obviously women have to be assessed because there could be some problems with the women's body in the opening of the womb. 

So the womb is considered a bit [chuckles] temperamental—not quite as much as in the Greek and Roman medicine, where we have a wandering womb going around. But also in Egyptian medicine we find papyri that say you have to assess whether the channel that connects actually the mouth with the genitals—so including the womb, of course; this is like a tube [laughs] or something —is open, and so this allows the conception to happen properly.

And so one of the strangest spells is to put basically a piece of garlic in the vagina and see whether the day after you can smell the garlic from the mouth. So in this way you can see whether there is a direct connection between the two parts. [laughs]

So you can see that there are some methods, very empirical methods. Some of them worked, [laughs] some of them probably didn't.

Sometimes we talk about these Egyptian papyri thinking about fertility tests. So, for example, the pee on the grain (you might have heard about it) is reported on the Kahun Papyrus. And that is also a fertility test, not just a pregnancy test, because it was believed to be a way to see whether a woman would conceive, would be able to conceive. 

So there were various texts. And they were saying, if a woman sits, for example, on a mash of dates and beers and starts vomiting many times (I apologize for the crude descriptions here), but then she will conceive because— I don't know, to be honest why. [all laugh]. You know, this is what the Egyptians tell us!

And then women are normally the ones that go and ask for fertility. They ask to be impregnated in ritual prayers. So we don't see the men going, we see the women. So that is more like a desire. It's not like a sense of guilt or sense of responsibility for the fact. And so we see, for example, prayers to the dead, dead relatives. And these prayers are not written on a letter or on a papyrus. They're written on fertility figurines that are women that hold the children. We have two examples of that, one that says, “May a birth be given to your daughter Seh.” And it's basically a little statue of a woman holding a child, and the prayer is written on the thigh of the little statue. 

And we have this a similar thing again, an offering which the king gives for the cow of Khonsu, a birth for Tita. So in this case we don't have a prayer to the father, because the previous one is actually this Seh who is praying to her dead father. And this second one is more of a normal prayer, you know. These prayers are very personal and very heartfelt. 

Lots and lots of these figurines were dedicated to temples, especially the Temple of Hathor. It's possible that this was like a very widespread practice and we just don't have many written sources about it. 

These little statues are from the Middle Kingdom — so we're talking about the second millennium BC. So very early times! But these prayers for fertility continue into Greco-Roman Egypt. And we have an amazing story from the Roman period, the story of Setna, basically a son of Ramesses. And there's a cycle of stories. In this story, there is a woman that is infertile: the wife of Setna. And in order to achieve fertility she spends the night in a sanctuary. And then this works!

We don't have, unfortunately, a description of these kind of places. But we do have attestations of annexes to sanctuaries where incubation was occurring. They didn't say, “Here, this was for women.” It was for various types of ailments. But people spent the night and waited for the god to arrive and solve the situation in some way.

Rebekah: I did have another question which sort of relates to conception. So in terms of actually getting pregnant, how did they think about sex? Right, is it just sort of traditional? Or since women's organs are essentially like a tube, like how did that work functionally? [chuckles] 

Ada: One thing that I noticed writing this book is that there isn't really a strong concept of virginity and chastity, which is something quite important when you assess sexuality. Because if there isn't a real concern for chastity before marriage… Why don't they even have the word for virginity, you know? They say about women that they have “never been opened by childbirth.” That's the only expression that I found to say, “hadn't gone through intercourse.” 

In terms of biology they knew perfectly well how things worked, you know. [chuckles] But in terms of conception, they believed that the role of the woman was very important in terms of stimulating the man. So the man was the essential part for conception because the seed had to be there. But the woman had to be the one who seduced the man. 

So there was this trope in literature of the woman seductress, and you know, [the goddess] Hathor is fundamental for creation because she's the one that stimulates sexual arousal in men. And you also find the figurines of naked women in tombs because that sexual stimulation, that sexual arousal, is  life-affirming, and it induces rebirth into the afterlife as well. So you know, the role of women is not secondary, is actually fundamental. 

Emily: What was the scientific or bodily knowledge in Greco-Roman Egypt about women's bodies and pregnancy, especially? How did women learn about and manage their pregnancies? How did they know when they were pregnant beyond, you know, noticing that their menstrual cycles stopped or sensing when the fetus was moving?

Ada: Most women were noticing that they were pregnant because their cycle stopped. That was a type of knowledge that didn't require any particular medical experience, and it was probably passed from grandmother to, you know, child and… within the family, anyway. And so we see this in the story of Setna, the wife who goes to this incubation place. And then she does all the things recommended by the god, and then she gets pregnant. The text clearly says, she noticed that no menstruation came. So we have a clear answer there. They are aware, also, of pregnancy, of movements in the womb, and they do have some sort of interpretation as well about what is going on in the womb. We don't actually know whether they practiced dissection and they could see dead bodies from within. We don't know this until the Greco-Roman period where we know that some medical practitioners did that on dead bodies. But in the Dynastic Period, we don't know. But they had a very empirical, scientific knowledge.

So on one side we have the knowledge of the medical papyri. So they did think that the child was a chick inside an egg. This is, may sound a bit strange, but this is exactly the type of word that they were using: chick and egg. 

Emily: Adorable!

Ada: It's quite cute, isn't it? Basically, the egg was within the womb. So the egg was not the womb itself; it was within the womb, so probably they thought [it was] the placenta. This might suggest that they had some knowledge of how things worked. And as a chick it developed gradually. They believed that initially there was basically nothing, and by the end of the pregnancy there was a fully-formed child. So they knew that there were stages in the pregnancy—which is incredible, because the gradualist view of the development of the fetus is something that we find later in the Hippocratic treatises as well. So I wonder whether they were influenced by this knowledge of the Egyptians about pregnancy.

And we even have ostraca and representations of the fetus inside the womb that looks — It looks like, you know, an ultrasound scan, and you see the little fetus inside. Having this knowledge meant that they could visualize, women could have an idea about what was going on, and they knew what they were praying for. They knew what they were protecting. 

And on the other side we have all the magical spells that are made to protect the pregnancy. And these two spheres, the medical and the magical, we tend to separate them, but for the Egyptians they were one and only. And this is the case both in the Dynastic period but also in the Greco-Roman period, because medicine is mixed with magic. You have amulets used together with medical instruments. And you can see in the temple of Kom Ombo, which is a Roman temple, you see a display of medical instruments (people can Google this if they want). And there are some instruments also for birth, childbirth, instruments of midwives and so on. But among these very advanced medical instruments from the Roman period there is an amulet as well, an Udjat eye. So you just think, why? Why on earth there is a, there is an amulet? Didn't they know any better? But actually, yeah, that’s how they consider things. And the Udjat eye is not just an amulet anyway.

But going back to managing pregnancy. There are spells that are aimed at protecting the mother and the child within her, and this is very, very clear. And the main principle for protecting pregnancy is identification with the most powerful goddesses—so in particular, I would say Isis, because Isis was the goddess who had the most difficult childbirth herself. Not because she had medical complications in her pregnancy, but because she was hunted around by Seth, who wanted to kill her son. She has to hide and give birth on her own in the middle of the marshes. And so, you know, you can imagine, the most important goddess of Egypt gave birth alone and almost lost her child. If she made it—and she was the most important goddess–then every mother can make it. And so it's a very important identification for women, so brave and strong at that moment.

Emily: That's beautiful. And I love hearing all of these details that they did know. I think sometimes people can assume that our medical knowledge today is so far advanced what ancient peoples might have known, but the fact that they knew the position of a fetus and…

Ada: Yeah.

Emily: …Erika Feucht, I was fascinated to read in one of her books that they knew about nausea in the early stages of pregnancy, and that pregnancy would change the shape of your face and make women very sensitive to smell–you know, things that we obviously know happen, but they knew very early as well.[14]

Ada: Absolutely. And this is quite incredible. 

Obviously then there are some things that are not entirely accurate, but you know it's nice to see how they conceive the uterus itself. Because, as I said at the beginning, the timely opening of the uterus had to also play a role in retaining the seed that then became the chick at some point. In the Roman period this is really clear in these uterine gems. These magical gems represent the uterus itself in a quite precise way, with the fallopian tubes as well. And this uterus is, in order to show that it is closed in a timely way, it has a key, a seven-bitted key underneath. And on top of the fallopian tubes, on either side, you have an army of gods—all the most important gods of Egypt on top of the tubes guarding the uterus. 

And the uterus is obviously mainly a good entity because it's the thing that needs to be protected, but it also needs to be kept quiet in a way. [chuckles] So because it needs not to move too much. It's not clear whether they believed in the wandering uterus or womb. Certainly they did in the Greco-Roman period, of course, thanks to the connection with Greco-Roman medicine. But the main reason was to protect it and to keep it regulated, let's say. So we even have a spell that threatens the uterus, that says, “You will have to be quiet, otherwise Seth will get you!” 

Rebekah: If only spells like that actually worked, in terms of like menstrual cramps. I mean, I would be behind that all day! [all laugh] Like just write a curse and be like, “You will be quiet!” [all laugh]

Ada: Exactly, exactly! “Be quiet!” And in fact, there are some gems that have the letters K, K, K, and actually K, K, K was for the pain, to stop the contractions, the cramps! So yes. [laughs]

Rebekah: I need to get me some of those! [chuckles] So, letters tell us a lot about birth in Greco-Roman Egypt, families made sure their house was in order, hired doctors and midwives, ordered ointments and birthing stools.[15] What do we know about the practicalities of the birthing process in Greco-Roman Egypt? Where did women go to give birth, and who attended them, and all of these things?

Ada: Yeah so I would start from who attended them and then we'll go to the where, because I think the two things are connected.

So who attended them is a difficult question when we think about Dynastic Egypt because we don't really have attestations of midwives or names of midwives or female doctors at all. We do have one, but I'm a bit, you know, cautious, let's say—not skeptical, because I really want to believe that this person existed—but cautious. This is called the lady Peseshet. And she was the female overseer of the female doctors. So this is one of her titles. She was also a funerary priestess. And her name is attested in a mastaba [a type of Egyptian tomb] of the Old Kingdom. (We are talking about the third millennium BC here. So very, very early times.) And I'm particularly fascinated by this woman, not only because she's a female doctor and a funerary priestess. So very high-, you know, level person, highly trained. But also because her name basically means, “the woman who divides.” 

There was a knife, the peseshkef, which is believed to be the knife of the midwife.[16] The actual knife has never been found, but as an item in the funerary context. But I've always found it very fascinating because you can see that the tools of the midwife are somehow ritualized and transferred also in the funerary context where you have a rebirth into the afterlife. So birth and rebirth are connected.

But to go back to Lady Peseshet. So she's a female doctor, perhaps a midwife among her many functions. But after that we don't have any attestations for a very long time. We do have basically some village women who had this title of “knowledgeable women.” “Knowledgeable women” could mean a lot, but obviously when we think about “midwife,” that comes from a wise woman. There is a connection there between the woman that knows, has some sort of hidden knowledge not accessible to others. These knowledgeable women were trained by their parents, normally, because we have Isis herself that sometimes in spells declares to be a “knowledgeable woman” herself and trained by her own father. And we also have these knowledgeable women being goddesses and performing childbirth as midwives. We know that there is a connection between knowledgeable women and childbirth, we just don't know whether these were exclusively midwives or were also something else. 

And my opinion is that they were a bigger figure than just midwives. They were also performing childbirth, but they could do spells, they could see the future. And so they were really the core of spirituality in the village. And so we have a very important passage in the Papyrus Westcar from the 20th Dynasty. And in this papyrus, we have the childbirth of some future pharaohs of the 5th Dynasty. But this woman, who is the wife of an important priest, is, she's having a very, very difficult childbirth. Basically, the gods decided to help out here because otherwise there wouldn’t be a future for the pharaohs of Egypt. And they send these goddesses—Isis and Nephthys, Heqet, Meskhenet—and the god Khnum. They arrive. The husband, he's very distressed; but they try to calm him and say, “Don't worry, guy, she will be fine because we are knowledgeable about birth. We are knowledgeable women.” So they use this title that was actually attested among normal women. And then they go inside, they lock the room, they kick him out. So even if he's stressed, he cannot be in the room. So it's almost like a sacred ritual. And the knowledgeable women perform their ritual and medical act. It's a ritualized act in the Dynastic Period. 

So mainly the childbirth happened in the house with the people from the same city or village. Sometimes, the birth was performed by relatives, very simply. You know, this is something that we can see in the Greco-Roman period. We have even a brother that says, “Oh, I'm coming to you, my sister, to perform your delivery.” This guy could have been a doctor, but he could also not have been. It was simply the brother so he could have helped. Or maybe he was just bringing the stuff to perform the delivery and then someone else was helping. This is not clear, but why not? I mean, it's something that we can see in early modern cultures that sometimes it's just your relatives that help you out.

And in terms of medical knowledge in relation to midwifery, we also have, as I said, attestations in temples of these medical tools of the midwives in the Roman period. So at least in theory midwifery was studied in temples. So we don't know whether there were priests or priestesses that studied in temples and then went around and performed childbirth. 

To complicate things further, we also have Greek and Roman medicine becoming more and more popular from the Ptolemaic period onwards, and this medicine changed things and perspective on childbirth. But not completely. So people, I think, could choose what to believe and what to use—whether they wanted the Hippocratic doctor and the new techniques, or whether they wanted the knowledgeable woman. (We don't have attestations of knowledgeable women, to be fair, in the Greco-Roman period; they become more sort of religious figures.) And so there is a sort of multicultural, Greco-Egyptian medicine. 

The Egyptian medicine is not snubbed by the Romans and by the Hippocratics. So the two combine together. And we have male doctors in the birthing room in the Greco-Roman period. I think this is quite important to stress, because things change. You know, women are not particularly happy to have male doctors dealing with childbirth. The maia (μαῖα) was there to make sure there was a bit of a protection for women.[17] Sometimes women were the ones— We have a papyrus where a woman asks for a maia instead, to have an examination after a violence. (So this is not childbirth.) So, you  know, women were trying to go with other women.

Okay, so this is just for the midwives. Sorry, I spoke a lot about just about midwives! [all chuckle]

But in terms of where, I can say that we don't have any other context preserved in evidence, that they went elsewhere. There was no hospital. In the Papyrus Westcar there is the bedroom, presumably, because they lock the room of the house. 

I have to mention—because this is something that has been written by Egyptologists over the years—the birth arbor or the birth pavilion, which is a theory that has been going on. And I was reading when I was also very young and a student, “Ah the birth pavilion!” And I was thinking, “This doesn't make any sense!” Because you know there is this attestation of these women under this sort of lovely tent, basically (it's like a tiny, very, very light structure) with their child. And I kept reading, “Oh yeah, they were giving birth in this thing.” And I was thinking, “No, this doesn't make any sense.” Because you know a woman wants to have a quiet place and not a place where everybody can look at her, right? So [all laugh] These were nice tents, nice structures that were probably built on the roof or in the garden, but they were made for women to rest afterwards, after they had given birth. Because in the climate of Egypt, you know, it's very hot and you wanted to rest in a fresh place. 

Rebekah: In terms of birth positioning, so for our listeners, if they've watched any sort of historical kind of movies, they always picture the woman lying on her back in bed. Is that how ancient Egyptian women gave birth? 

Ada: Okay, so definitely not! This is something we know for sure that they were not giving birth lying down, except for when they were not feeling very well. 

The super traditional way to give birth in ancient Egypt was using the birth bricks. And luckily they changed their mind because it was the most uncomfortable way ever! They were either squatting on the birth bricks, so— and you can see this in the hieroglyph of birth where there is a woman squatting on top of bricks with the child coming out. So it's probably the most gruesome and visual version of childbirth that the Dynastic Egyptians give us. Anyway, on bricks, kneeling or squatting on bricks. 

And then they introduce, luckily, this birth stool. We have an attestation of one that was found in a tomb. They were made of wood, normally, and then later in the Greco-Roman period they also had some sort of armlets where the woman could hold. But initially they were just very simple wooden stools with a hole in the middle. So the midwife presumably was kneeling and receiving the child through the hole. So not very different from a potty chair really. This is the main item. 

Then we also have a mention from Deir el-Medina, this village from the New Kingdom, of “female beds.” And the female beds were sort of beds, really, that could be like, dismantled. So that suggests a sort of temporary use because you put it up, used it for childbirth, and then put it away. And then Soranus also talks about the use of beds at some point. So if things didn't go as well you could lie on a bed, but not always.

Emily: I am so struck by the comment you made earlier about the space of birth being a sacred space. That's so profound and poignant, this conception of the gods being very close and very present in this moment. We know that the gods were central players in ancient Egyptian births on the ritual level that you've talked about and on the mythological level. 

The sun God Ra’s daily journey across the sky is often imagined as a trip through the body of the sky goddess Nut. The sun God enters her mouth every night, and then is reborn in the morning. A vivid passage from the Book of Nut reads, “He opened the thighs of his mother, Nut. He withdraws to the sky. He opens his amnion. He swims in his redness, the redness after birth.”[18] And this symbolic representation of a biological process is one of many that connected the world of humans to the very physical life moments of the gods. Can you say more about how Egyptian people in the centuries you study saw these stories of the gods as reflecting or explaining their own lives, connecting the world of the living to the world beyond?

 Ada: I'm glad that you mentioned Nut actually, because Nut is one of the main goddesses that we find both at the big cosmic level and we find representations in temples, which are mostly not accessible to common people in ancient Egypt. 

But we also find her in the most intimate space, in a way, that we can possibly imagine. Everybody will feel very sad at the moment, but the coffin. Nut is there waiting to embrace you, again, to receive your body. She's depicted in the floor of many coffins. She's the sky goddess, and she gives birth to the  sun, as you rightly said, and as it appears in the Book of Nut, every day. And she swallows him again. It is a cycle that allows the sky to be there every day. But it allows also for every person to be there every day, to be reborn every day, because life for every human being is considered as a cycle. So Egyptians must have been very happy people because they were very conscious of the fact that our life was not over. It was just continuing as a cycle.  So I think that the myth of Nut was the one that provided the most reassurance in a way, because it was such  a positive myth of continuity.

And so, the myths were not something that was far away, written in temples. But they were known by people. We don't know exactly how, probably through representations because people had access to images. Domestic cults are very, very strong and very represented also in the walls of the houses. 

And I would say that the most visible way in which myths find their way into the lives of people are spells. Because of the myths, what happens in the myths, that spells work in a certain way.  I think that we need an example here. Because obviously myths can be both positive, provide salvation, but they can also be very negative, so they can show violence, killing. And so they can present the enemy. 

So Nut is obviously a very positive goddess, and she was one of the main goddesses that protected the mothers. And she was said to arrive with her army of stars, which is beautiful. All of these gods are presented as her stars because she's the sky goddess. 

But for example, we have seen Seth, and Seth is an enemy, potentially, of especially women in childbirth. And when he’s the enemy of women in childbirth he assumes a particular shape, which is also reflected in the spells, which is the donkey. So Seth the donkey is the enemy of women in general, but really especially pregnant women. Because he is represented as a ithyphallic donkey, so he can rape a woman, and through his poisonous seed he can actually kill the child. So this is a very scary idea. 

So where does it come from? It comes from a myth (so just to show you how the myths have an impact in what people believed). And it is the story, The Contendings of Horus and Seth, which are basically, Horus has to become heir to the throne, has to fight Seth. And Seth at some point assaults him sexually. Because of this bad assault, his seed is believed to be poisonous, and this has an impact in the spells. You see lots of spells against the phallus of Seth and the seed of Seth. And these spells are connected with the protection of the bedchamber of the pregnant woman. And you can see also in gems. I mentioned with the uterus, sometimes on the other side there is a woman who is giving birth represented and below her there is this donkey with an erected phallus. So you can see that all the imagery is connected here: so the uterus, the pregnant woman, and the donkey, Seth donkey. 

This is quite funny: What do they do to fight the donkey? They eat the donkey's testicles and the phallus. They eat the phalluses! So we have also [all laugh] where the women have to eat the donkey testicles before going to bed. There was an alternative for probably the most squeamish Egyptian women, which was to feed the donkey meat to the cat. Actually, the cat was treated better because the woman had to eat the actual testicles, and the cat ate a cake shaped like a phallus, together with some meat. 

Emily: [laughing] Come on!

Ada: So yeah, it went better for the cat! 

There's lots of crazy spells. 

This thing is very interesting because you don't have just Egyptian myths having an impact on these practices, but also the Greek myths. So one of the main heroines in these fertility rituals fighting this donkey, terrible donkey, is actually Omphale. She is the queen of Lydia, and she was the lover of Heracles. And on the other side of some of the gems where Omphale appears (dressed like Heracles because she took his clothes), we find Heracles as well, fighting a lion which represents the evil forces that attack the uterus. So we have a mix of Greek heroes and Egyptian gods that are all fighting together to protect the mothers and children.

Rebekah: Well that leads very naturally into our next question. So childbirth is a risky business. 

Ada: Mhm!

Rebekah: According to the American Pregnancy Association, even today a healthy woman has a 15 to 20% chance of miscarrying,[19] and the odds were higher in the ancient world with its widespread malnutrition and lack of modern medicine. A variety of birth rituals, spells, and potions were used to protect women. For instance, some women inserted linen knots into the vagina, believing them imbued with magical protection against external threats.[20] So what ritual methods or practices did they rely on to ward off bodily or supernatural threats? [Editor’s Note: since this episode was recorded, the APA has updated its statistics. The current estimation is that “10–25% of all clinically recognized pregnancies will end in miscarriage.”[21]] 

Ada: Absolutely, yes. So just to give a bit more detail about these rituals. A Demotic spell from the 7th century BC that talks about the anointing of the vagina. So this was a ritual that was made to protect the two entrances, the entrance of the body and the entrance of the room where the woman is, are both anointed with a sacred potion. It's all a matter of cardinal points, borders. So we have spells to protect the bed chamber, to protect the entrances. Birth bricks—this then is also used in the funerary context where we find the birth bricks also used, but in tombs. You can see that there are the same spells to protect the birthing room but also the tomb. 

So birth bricks, things to anoint the rooms, and obviously amulets, which we haven't mentioned at all, but they were everywhere. They were used to protect mainly the body, but also presumably the space. 

And we have spells that invoke, for example the gods, but they also ask for an intermediary sometimes. The Egyptians say, “Okay, we know you’re busy. Hathor has to go to everyone. So instead of Hathor we can be happy with the intermediary, the helper,” which is a little dwarf that we find throughout the Egyptian history. It's called the Bes from a certain point onwards, but we find him forever. And he is represented under the shape of an amulet that I dug in a village in Fayyum in Egypt a few years ago, and you could find this amulet of Bes everywhere—in temples, in houses. This guy was worn by absolutely everyone. Because he protected women, he was put on the belly of the woman to accelerate birth, to make it less painful. Then we find him represented enormous in temples dedicated to the birth of gods because he was so loved by women. Nowadays, we love our painkillers when we feel bad. [chuckles] Back in the day, they loved Bes because they believed that he was the one taking the pain away. He was the one that helped. 

Sometimes there was also some tough love. So for example, instead of asking the gods to come over to help, there is a gem that says,  “On your feet.” And it has been interpreted by a scholar as a way to ask the fetus himself to come out and stay on his feet. [everyone laughs]

Probably my favorite is the apotropaic wand, which is a bit of a mysterious object from ancient Egypt, which hasn't been entirely interpreted really. But it represents all the gods that you will see throughout the history until the Greco-Roman period in this sort of boomerang, this sort of knife, curved knife that was presumably used originally for hunting, like the boomerang itself. And it's made of ivory—so obviously a ritual, not the original hunting knife. The top is a bit ruined, so perhaps it was actually used to trace a circle or something around the mother. 

And we do have the spells that say that they are for the protection of the mother and the child. And if they provide the protection behind and around. It's quite explicit in a way—it's the gods themselves represented on the wand that say, “We're coming to protect you.” Yeah, you have an army of gods coming to protect the mother and the child. So it's quite cool.

Rebekah: I'm curious, having read your work, you mention votive depictions of women. Can you say something about this? I mean, some of those depictions are pretty graphic, and I'm curious what these depictions of birthing women reveal about notions of the body, reproductive organs, and the divine.

Ada: Absolutely. So yes, so basically what I wanted to do in the book was to try to connect the representations, votive representations, of women from the Dynastic period to the Greco-Roman period, because that had never been done. And I understand why that had never been done, because in the Dynastic period we have a very Egyptian way of representing women: so they are definitely naked, but they're not showing their nakedness. They don't have spread legs. They have a different attitude. And also the iconography is fully Egyptian. Sometimes we can say “Near Eastern,” but it's fully Egyptian.

While in the Greco-Roman period, we do have some sort of syncretism with Greek iconography, and we start having figurines mainly made of terracotta rather than other materials such as limestone for example. The material changes. The iconography changes. But in my opinion, the fundamental meaning of these figurines doesn't change. And this is the important thing. 

And they're mainly found in the funerary context, the context of stimulating the fecundity, the fertility in the afterlife. In the Greco-Roman period, we have also a big problem of interpretation. In general terms, these figurines represent fertility. But depending on the attributes that they have and the context where they are found, they can be interpreted in different ways. So for example, sometimes they’re represented with a club in their hands, the Greco-Roman figurines, so we can say these are figurines of Omphale, the Greek heroine. But not always [do] we have these attributes. So we have a very preliminary names, and my favorites are Isis, Aphrodite, and Baubo  because of their iconographic characteristics.

Emily: A lot of the evidence that we have for ancient Egyptian society comes from funerary contexts. We learn people's ages, what their bodies were going through at time of death, and as you talk about, they tell us social ideas about women as mothers. In your book, you write about a mummy from the 2nd century CE where the body is that of a girl, maybe ages five or seven, but in her tomb archaeologists found a painted tablet that depicts an adult woman sitting on a birthing stool.[22] Can you talk about this? And more broadly, what does tomb evidence tell us about childbirth and the expectations around it? When women were getting pregnant, the causes of their deaths, or their families’ desires for them to give birth?

Ada: Absolutely. That's a great question. So yes, so we have this amazing tomb from Haware, and it's actually one of a group of tombs because we have other tombs in Haware that are extremely interesting, and they're also belonging to girls, presumably.  But this one, we have this sarcophagus that contains the remains of the little girl. So this girl was accompanied by a little painted tablet, which was presumably the equivalent of a mummy tablet, which were normally inscribed with the name of the mummy. Because once the mummy was wrapped, you couldn't tell who they were.

And in this case for this girl, they decided instead of putting a name or a patronymic, they decided to put this image of a childbearing woman sitting on a birth stool. The image couldn't be her because she was a child. It could be, perhaps, an idealized version of her, but also defied version of her. She also has the attributes of Aphrodite. We don't know exactly who she is, but she definitely has some sort of a ritual, but also a meaning of compensating this woman, this young girl who has never reached this stage of giving birth. The coffin represents the little girl as an adult woman, both in the representation of the face, which is gilded with gold (so it's not very realistic) but it's definitely an adult woman, but especially the breasts, the naked breasts, which depict her as an adult woman fully mature. Whoever buried her, presumably the parents, wanted to say, “Okay, we've never had a daughter that managed to become an adult, to give birth, but we are going to give this to her.” 

Women who died just before marriage, they die normally in their early 20s, so they married quite late compared to, for example, classical Greece. There isn't a general rule because these are epigrams and epitaphs, so they don't really talk about what happened. But definitely we can see the attitudes also of the parents towards this loss. And we can see that sometimes they say, “You didn't give us a grandchild. So we just raised you to no purpose.” And this sounds so tough. And I just think, “Gosh, I mean that's horrible to say.” But actually this is like, it's a trope that you find in Hellenistic funerary literature and also in Attica, for example. So, it's a way to express the frustration not towards the girl, but towards the fates who allowed this to happen. Yeah, so it's probably the worst thing that could happen really, to die before fulfilling these things.

[podcast theme music plays]

Rebekah: In the 1760s, Connecticut doctor Edward Bancroft traveled to Guyana, and described in some racist and patently absurd terms how local women gave birth: “A difficult or painful birth is scarce ever known,” he proclaimed, “the women suffer so little, that they seem to have been exempted from the sentence of bringing forth in sorrow, which was pronounced on Eve, and is inflicted on all the females of civilised countries.”[23] In his prejudice, Bancroft echoed a myth that Black women don’t feel pain to the same levels as white women.[24] The myth persisted. A century after Bancroft, Joseph Taber Johnson published a study of more than two thousand births of American Black women that essentially ignored the women’s reports of physical agony: he claimed they didn’t know enough about how the body works.[25] Miriam Rich has shown that these tendencies to ignore the birth pains of women of color have long roots. At least as far back as the Romans, authors invented stories about foreigners to stress their supposed inferiority. [26] Rich explains, “From the first, painless birth functioned in these stories as a mark of alterity: specifically, it signified a foreign people’s lack of civilisation.” [27]

Emily: According to the Exodus story in the Torah, the foreign Israelites were enslaved in Egypt for several hundred years. The Israelite women were having so many children that the pharaoh feared revolt. He demanded that midwives attending women on their birth stools were to kill the male children.[28] The midwives dodged, claiming that “the Hebrew women are not like the Egyptian women; for they are vigorous and give birth before the midwife comes to them” (Ex 1:19, NRSV). Clearly the pharaoh had never attended a birth. 

Rebekah: In Egypt a successful birth was a communal affair. It involved other women and family, and it happened in the home. It required the right preparations: right nutrition and the right medical care and ritual practices. Letters from Roman Egypt preserve the tender preparations families made for their loved ones’ births. In one, a son asks a friend to watch over his mother’s labor.[29]  In another, a brother writes to his sister Theonilla about myrrh ointment and supplies for her delivery.[30]

Emily: The wisdom that a successful birth needs communal preparation and systemic care remains wise today. When that care is missing, pregnancy, birth, and childcare can become overwhelming obstacles. For instance, Black women (especially those living in rural southern areas) are three times more likely to die in childbirth. There are lots of factors at play, but one of them is the lack of financial and medical resources.[31] The United States is grappling with rising rates of maternal mortality: as of 2021, more than ten times higher than other high-income countries.[32] More and more women are asking for midwives and doulas to attend them because they have been shown to increase positive outcomes in birth and postpartum care.[33] Mothers want more care from their community, and it can take many forms. After the birth: bringing food, maternity leave, supporting the family, more hands to hold the baby, protections for nursing mothers, financial incentives, protections on jobs.

It really does take a village. 

[Music plays over outro]

Rebekah: If you enjoyed our show, please rate and review us on Apple Podcasts, Spotify, Audible, or wherever you get your podcasts. Check out our website womenwhowentbefore.com, or find us on Twitter @womenbefore. 

This podcast is written, produced, and edited by us, Rebekah Haigh and Emily Chesley. It was fact-checked by Emily Smith-Sangster. Our music is composed and produced by Moses Sun. The podcast is sponsored by the Center for Culture, Society and Religion, the Program in Judaic Studies, the Stanley J. Seeger Center for Hellenic Studies, and the Committee for the Study of Late Antiquity, all at Princeton University. 

Emily: Thanks for listening to Women Who Went Before! And don’t forget:

Both: Women were there!

Footnotes:

[1] September 1777, vol. 3, Sarah Logan Fisher Diaries, 1776–1795, Historical Society of Pennsylvania, Philadelphia, quoted and analyzed in Nora Doyle, “When I Think of It I Awfully Dread It": Conceptualizing Childbirth Pain in Early America,” Bulletin of the History of Medicine 97, no. 2 (2023), 232.

[2] Francine Margolis and David R. Hunt, “Twins found in a Late Dynastic/Coptic Egyptian mummy,” International Journal of Osteoarchaeology 34, no. 1 (2024): 6 pages.

[3] Carol L. Meyers, Rediscovering Eve: Ancient Israelite Women In Context (New York: Oxford University Press, 2012), 97–98.

[4] Meyers, Rediscovering Eve, 99. See also summary in Margolis and Hunt, “Twins found in Late Dynastic.”

[5] Meyers, Rediscovering Eve, 171 epub. See also M. Masali, B. Chiarelli, “Demographic data on the remains of ancient Egyptians,”Journal of Human Evolution 1, no. 2 (1972), 161–169.

[6] Elisha Tisdale, Lana Williams, John J. Schultz, and Sandra M. Wheeler, “Detection of cortisol, estradiol, and testosterone in archaeological human hair from the Dakhleh Oasis, Egypt,” Journal of Archaeological Science: Reports 27 (2019), online identifier 101968, np; and an introduction to Wheeler’s findings in “Another Side of Anthropology: Infants and Children,” COS News, The University of Central Florida, November 22, 2017, accessed December 11, 2024. In addition to the striking number of women of childbearing age and infants buried in the Dakhleh Oasis, several of the skeletons evidence childbirth-related trauma, such as fractured clavicle or cervical fracture. See Tosha L. Dupras et al., “Birth in Ancient Egypt: Timing, Trauma, and Triumph? Evidence from the Dakhleh Oasis” in Egyptian bioarchaeology : humans, animals, and the environment, eds. Salima Ikram, Jessica Kaiser, and Roxie Walker (Leiden: Sidestone Press, 2015), m 53–66.

[7] Samuel C. Ginther, et al, “Metabolic loads and the costs of metazoan reproduction,” Science 384, no. 6697(2024): 763–767; and Madeline Holcombe, “Being pregnant is hard work — even metabolically, study shows,” CNN, updated May 28, 2024, accessed December 11, 2024.

[8] Douglas Brewer and Emily Teeter, Egypt and the Egyptians (Cambridge/New York: Cambridge University Press, 1999), 97–98.

[9] Erika Feucht, Das Kind im Alten Ägypten : die Stellung des Kindes in Familie und Gesellschaft nach altägyptischen Texten und Darstellungen (Frankfurt/New York: Campus, 1995), 32–33, quoting Ptahhotep, 457, German translation by Goedicke in JARCE 6, 1967, 100ff; English translation by Emily Chesley.

[10] Edition and German translation by Joachim Friedrich Quack, Die Lehren des Ani : ein neuägyptischer Weisheitstext in seinem kulturellen Umfeld (Freiburg: Universitaẗsverlag; and Goẗtingen: Vandenhoeck & Ruprecht, 1994), 284–285, cited and translated in Deborah Sweeney, “Women at Deir el-Medîna,” in Women in Antiquity: Real Women across the Ancient World, eds. Stephanie Lynn Budin and Jean Macintosh Turfa (London: Routledge, 2016), 244.

[11] Point made in Margolis and Hunt, “Twins found in Late Dynastic,” 5. For further reading on the religious dynamics of pregnancy and childbirth see Chrystal Elaine Goudsouzian, “Becoming Isis: Myth, Magic, Medicine, and Reproduction in Ancient Egypt,” PhD dissertation, The University of Memphis (2012), Electronic Theses and Dissertations 567; and A. M. Roth, Father Earth, Mother Sky: Ancient Egyptian Beliefs About Conception and Fertility (Philadelphia: University of Pennsylvania Press, 2016).

[12] Translation by Iorwerth E. Edwards, Hieratic papyri in the British Museum Ser. 4. Oracular Amuletic decrees of the late new kingdom (London: British Museum Press, 1960), p. 66, pl. XXIV. Also discussed by Susanne Töpfer, “The physical activity of parturition in ancient Egypt: Textual and epigraphical sources,” Dynamis 34, no. 2 (2014): 317–335; and Margolis and Hunt, “Twins found in a Late Dynastic.”

[13] The Egyptian Museum, Berlin which holds the papyrus (P. Berlin 3033) catalogs it as from the late 17th century BCE, although some scholars like Ada Nifosì date it earlier, to the 20th c. BCE. (“Room 2.11 Documents from Egypt and the Ancient world,” Society for the Promotion of the Egyptian Museum Berlin, accessed December 16, 2024, http://www.egyptian-museum-berlin.com/c54.php; Ada Nifosì, Becoming a Woman and Mother in Greco-Roman Egypt: Women’s Bodies, Society and Domestic Space (Oxford: Routledge, 2019), 51)

[14] Feucht, Das Kind, 98–99.

[15] Nifosì, Becoming a Woman and Mother, 54–56.

[16] Benson W. Harer, Jr. “Peseshkef: the first special-purpose surgical instrument,” Obstetrics & Gynecology 83, no. 6 (1994): 1053–1055.

[17] This is the Greek term for midwife. See Nifosì, Becoming a Woman and Mother, 54.

[18] Quoted in Töpfer, “Physical Activity of Parturition,” 325, trans. Töpfer, after Alexandra von Lieven, Grundriss des Laufes der Sterne. Das sogenannte Nutbuch CNI Publications 31 (Copenhagen: Museum Tusculanum Press, 2007), n. 10, p. 51–54. Goudsouzian analyzes the religious symbolism of this myth within Egyptian conceptualizations of the birth process in “Becoming Isis,” 124–128.

[19] American Pregnancy Association, “Miscarriage,” Accessed March 15, 2024, http://www.americanpregnancy.org/pregnancycomplications/miscarriage.html.

[20] Feucht, Das Kind, 98. One recorded spell went: “Another one, for warding off a hemorrhage. Anubis has come forth to keep the Inundation from treading on what is pure – the land of Tait. Beware what is in [it]. This spell to be said over threads of the border of a iAA.t fabric with a knot made in it. To be applied to the inside of her vagina” (Papyrus Leiden I 348, spell 34, trans. J. F. Borghouts, The Magical Texts of Papyrus Leiden I 348 [Leiden: E. J. Brill, 1971], 30–31).

[21] “Symptoms & Signs of Miscarriage,” American Pregnancy Association, accessed December 15, 2024, https://americanpregnancy.org/getting-pregnant/pregnancy-loss/signs-of-miscarriage/.

[22] Nifosì, Becoming a Woman and Mother, 106–107.

[23] Edward Bancroft, Essay on the Natural History of Guiana, in South America (London: Beckert and DeHondt, 1769), p. 330, quoted by Miriam Rich, “The Curse of Civilised Woman: Race, Gender and the Pain of Childbirth in Nineteenth-Century American Medicine,” Gender & History 28, no.1 (2016), 57.

[24] Rich, “Curse of Civilised Woman,” 57–76. In late-eighteenth and early-nineteenth century America, when upper-class white women spoke vocally about the pain they experienced in childbirth, physicians slowly began to believe them. But doctors continued to claim that lower-class women and Black women gave birth easily, because of their so-called active bodies (Doyle, “When I Think of It,” 227–254).

[25] Rich, “Curse of Civilised Woman,” 62–63. Modern medical doctors often continued to ignore reports of pain in their patients of color, and some delayed diagnosing illnesses because they did not recognize symptoms on darker-toned skin. The first medical handbook that focused on how symptoms present differently in black and brown skin was not produced until 2019–2020 by Malone Mukwende, Peter Tamony, and Margaret Turner (Mind the Gap: A handbook of clinical signs in Black and Brown skin, 1st edition, St. George’s University of London, 31 pages, accessed December 11, 2024, https://www.blackandbrownskin.co.uk/mindthegap.)

[26] Strabo attributes high levels of courage to the Cantabrian, Celtic, Thracian, and Scythian tribes, which in women—he asserted—manifested in giving birth independently, outside, and working through their pain: “...in common also the traits relating to courage—I mean the courage of women as well as of men. For example, these women till the soil, and when they have given birth to a child they put their husbands to bed instead of going to bed themselves and minister to them;1 and while at work in the fields, oftentimes, they turn aside to some brook, give birth to a child, and bathe and swaddle it. Poseidonius says that in Liguria his host, Charmoleon, a man of Massilia, narrated to him how he had hired men and women together for ditch-digging; and how one of the women, upon being seized with the pangs of childbirth, went aside from her work to a place near by, and, after having given birth to her child, came back to her work at once in order not to lose her pay; and how he himself saw that she was doing her work painfully, but was not aware of the cause till late in the day, when he learned it and sent her away with her wages; and she carried the infant out to a little spring, bathed it, swaddled it with what she had, and brought it safely home.” Strabo, Geography, Volume II: Books 3-5, tr. Horace Leonard Jones, LCL 50 (Cambridge: Harvard University Press, 1960), pp. 111–13 (Str. 3.4.17).

[27] Rich, “Curse of Civilised Woman,” 57.

[28] This may be a reference to the birthing bricks. The only known birth brick was discovered in Abydos and belonged to Reniseneb, a royal woman from the Middle Kingdom, in the 13th dynasty (1700–1650 BCE). Josef Wegner, “A decorated birth-brick from South Abydos” in eds. DavidSilverman, William Kelly Simpson and Josef Wegner, Archaism and innovation. Studies in the Culture of Middle Kingdom Egypt (New Haven: Yale University Press, 2009), 447–496. There is some debate over whether the midwives were Israelite or Egyptian. See Moshe Lavee and Shana Strauch-Schick, “The ‘Egyptian’ Midwives,” TheTorah.com, accessed December 12, 2024.

[29] P. Oxy LI 3642, 12–16 trans. in Nifosì, Becoming a Woman and Mother, 56.

[30] ​​SB XXII 15560 (provenance unknown, 3rd–4th century ad), 11–12; tr. Hanson 1994: 159, quoted in Nifosi, Becoming a Woman and Mother, 55 and 55n68.

[31] Anuli Njoku, Marian Evans, Lillian Nimo-Sefah, and Jonell Bailey, “Listen to the Whispers before They Become Screams: Addressing Black Maternal Morbidity and Mortality in the United States,” Healthcare (Basel) 11, no. 3 (2023): 438; Donna L. Hoyert, “Maternal Mortality Rates in the United States, 2021,” U.S. Centers for Disease Control and Prevention (CDC)’s National Center for Health Statistics, March 2023, accessed December 11, 2024; and Sarah Jane Tribble, “Black, Rural Southern Women at Gravest Risk From Pregnancy Miss Out on Maternal Health Aid,” KFF Health News, June 22, 2023, accessed December 11, 2024.

[32] Selena Simmons-Duffin and Carmel Wroth, “Maternal deaths in the U.S. spiked in 2021, CDC reports,” NPR, heard on Morning Edition, March 16, 2023, accessed December 11, 2024; and  Hoyert, “Maternal Mortality Rates.”

[33] For increase in use of midwives and doulas see Sutter Health, “Midwives Go Mainstream as Popularity Rises in US,” Vitals, July 19, 2021, accessed December 11, 2024; and Lisa Hart, “Midwife care is growing in popularity as women look for more birthing options,” The Lindsay Advocate, March 15, 2024, accessed December 11, 2024. For positive outcomes see Alexandria Sobczak et al., “The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review,” Cureus 15, no. 5 (2023): e39451; and “Doulas and Midwives Are Key Partners in Improving Maternal and Infant Health Outcomes,” National Academy for State Health Policy, December 23, 2022; accessed December 11, 2024.