Medical history for writers is a series I’ve been planning to write for FOUR YEARS and never got around to until now. I was supposed to start by writing about plague but I figured I might as well start from something instead of waiting to do more research on that, so here we are, talking about pregnancy and birth.
Let’s not be silly: pregnancy and birth are very much part of the modern world as well and not just “history”. But when you’re writing contemporary fiction, it’s very easy to be like “okay so the character goes to the hospital and comes back with a baby, cool” and call it a day. With historical fiction and fantasy and perhaps even with dystopian fiction, it’s not quite that easy.
Naturally, you can leave out any details you want, but since you’re here, I assume you want to include at least some of the details surrounding bringing new humans into this world. Doing research for stories that take place centuries back can be difficult, though, because history has typically been written by men who wouldn’t find this sort of business interesting or appropriate to talk about and they were hardly involved in the process after conception anyway.
RELATED READING: Fantasy novel writing tips – Doing research for historical fiction
Disclaimer: I’m not a historian or a doctor, I’m simply a writer with a nursing degree, two children and an interest for medical history. The purpose of this post is to give authors things to consider when they’re writing about pregnancy and childbirth in a historical or fantasy setting and hopefully help them make fewer mistakes.
Warning: This post is also going to talk about abortion, stillbirth and maternal death, so if you don’t want to read about any of those things, feel free to click away to somewhere else.
With that out of the way, let’s begin.
You know where babies come from, right?
If you go back in time far enough, you’ll find that people weren’t completely clear on how, exactly, babies were made. They couldn’t exactly go on Yahoo Answers and ask “how is babby formed?” Even if they knew that if you insert this into that, then you might get someone pregnant, the exact mechanics might not have been familiar. Even now, with all the information of the world at your fingertips, there are people who think a woman can’t get pregnant without consent. Yikes.
Even if people with medical education know how you get up the duff, it doesn’t mean it’s clear to everyone. Getting pregnant does, after all, involve sex (that’s a Wikipedia link, in case you’re concerned), so it might have been a taboo to talk about it. You don’t have to go that many decades back for it to be normal to warn your daughters against kissing boys because that will get you in trouble, and then they get pregnant because there wasn’t any kissing involved.
When you’re considering whether your characters know how to get pregnant, consider the medical advancements of the time and how acceptable it was to talk about sex, periods and pregnancy. You need to consider the location of your story as well, and remember that none of these things are linear. Just because 70 years ago people were very conservative about something doesn’t always mean they were twice as conservative 140 years earlier.
Avoiding pregnancy in historical times
When it comes to avoiding pregnancy, the most basic method is not having sex when you might be fertile. According to my brief research, they didn’t officially learn about ovulation until 1920s, but that doesn’t mean that people who were very in tune with women’s health didn’t know that you’re more likely to get pregnant at certain times of the month.
(For the uninitiated: Sperm can live up to 5 days inside the body, waiting for the 12-24h ovulation window that happens roughly 12-16 days into your cycle. That means you’re in danger of getting pregnant very soon after your period but you can’t get pregnant after ovulation and before your period. Knowing when you ovulate is possible even without tests or tracking.)
Midwives and other “wise women” likely knew a lot more about getting pregnant than doctors at certain times of history. Women’s health wasn’t necessarily of interest to male doctors and they might not have wanted to talk about such unsavoury things. Shame on them, but what can you do.
People have used different methods of preventing pregnancies before proper contraception was invented. They could have been ingesting medicinal herbs or they could have used cleaning solutions and other chemicals as a douche to flush out the offending sperm. These methods were, of course, unreliable at best and lethal at worst. When your story calls for some kind of contraception, you can choose to use something that could have conceivably worked or something that your characters only believe is going to work.
Types of condoms might have also been an option, but the materials that they were made of probably weren’t flawless. Don’t be afraid to include a bit of lamb intestine in the bedroom scenes if your time period calls for that, though. (I can’t believe the things I’m saying in my blog today, guys.)
Writing about abortion in historical times
The attitudes towards abortion change depending on the time period and the location, but one thing is certain: abortions outside the hospital are and have always been dangerous. You could die from bleeding after something perforates your uterus, you could get a bacterial infection from dirty instruments or you could go into sepsis after they leave a bit of placenta inside you. That’s not even mentioning ingesting something that is poisonous to you or trying to induce abortion by falling down the stairs.
You can see how non-medical abortions can be fatal, but not everyone died, of course, or people wouldn’t have been doing them. Depending on your location and time period, your unwillinly pregnant person could have tried to find the right herbs that may or may not work, or they could have gone to a “professional” who would mechanically remove the fetus. Abortion has not always been illegal and frowned upon in historical times, so make sure to check before you write.
What about fantasy? Or dystopian fiction?
When you’re writing fantasy, you’ve got a lot more options for managing unwanted pregnancies if you can involve magic. What if you knew the exact magical herb to stop you from being or getting pregnant? What if it was just a matter of eating the right fruit on the first day of your period or saying the right spells? It’s up to you, but make sure it’s consistent with the rest of your magic system.
You definitely can include some kind of magical anatomical differences that makes things work differently, but if these differences only affect the wombs and nothing else in the body, it’s a little weird.
When you’re writing dystopian fiction that perhaps takes place in apocalyptic times, you might have access to some remnants of modern medicine. Drugs (and condoms) have an expiration date, though, so your characters might try to use something that used to work just to find out it was ineffective.
A note on class
This disclaimer could be added to any section of this post but I’ll just put a general one here.
When it comes to the history of pregnancy and childbirth, you need to consider what social class your characters are a part of. Working class women would give birth in very different circumstances compared to noble women, but if you do research on this subject, you’ll find that most historical records are about the wealthier women who could afford health care and who historians thought were important enough to mention.
Trying to conceive in historical times
Before contraception became easy to access, people generally weren’t trying to conceive. Often they just got married and started having sex, and babies would hopefully follow eventually. (On Christmas Eve 2016, somewhere around midnight, I told my husband we should have another baby and he said “yeah, probably”. This kind of a conversation would not have been likely even just 60-70 years prior.)
So first there’s marriage and then comes the baby carriage. But what if it doesn’t work out that way? Then what? All too often it was too easy to question the woman’s quality although reasons for infertility could have been anything. It could be malnutrition, physical damage caused by prior illness like tuberculosis or even environmental toxins. If the reason didn’t have an easy fix, it probably was impossible to detect it with the lack of medical advancement.
Since it was so difficult to prevent pregnancy, you might want to have a reason for why your characters don’t have children if they’re married and not separated by something like the war. It could simply be something like “we haven’t been blessed with children” – you don’t need to come up with a specific reason unless it’s something relevant to the character or the plot.
When people couldn’t get pregnant but really wanted to, they could have tried praying or making sacrifices to the gods or they could have paid for some kind of “medical” quackery. You could make this a whole plotline for a character but likely they wouldn’t find actual solutions unless you wanted the gods in your story to actually grant your character’s wished.
Just take someone else’s child
Of course, there’s always the option of adopting or straight up stealing a child. The further back in time you go, the easier this is. There were a lot more orphans and the system didn’t care quite as much about where those children ended up. Tracking missing children was also a lot harder even if they had a family.
Because having illegitimate children has been frowned upon in many times and cultures, as dumb as that sounds to us modern people, offering to take a single mother’s child after it’s born could be an option for your characters. It could also be an interesting part of backstory, whether you’re writing about the child, the adoptive mother or the bio mother.
So your character got knocked up – now what?
Okay, so now your character is pregnant. How does she know? If she keeps track of her period in her little calendar, she might realise she’s late. Maybe she has weird symptoms and someone who knows things better points it out that she might be preganté. (If you haven’t seen the “how is pragnent formed” video yet, what have you been doing with your life? Have you been outside??)
Olden times pregnancy tests
Remember that it’s also possible that your pregnant person doesn’t realise they’re “with child” or “in the family way” until months in. She might not realise what all the symptoms add up to and she might not have the time to think about such things. Even in modern days, someone might not realise they’re pregnant until they’re literally giving birth, so it’s not too “out there” at all that your character wouldn’t know about it either.
Even going back just a few decades, you couldn’t get a pregnancy test from a store or pharmacy but a doctor could still take your urine sample and send it to be tested. Although it was possible to detect a pregnancy with ultrasound technology, it didn’t become commonplace until much later and even now it isn’t common in every country of the world. And even if it was possible, it might not have been medically necessary for someone to find out if they were pregnant and they might not have had the funds for the test.
Regardless of the lack of reliable testing, people have always been keen on finding out if they’re pregnant or not. These antiquated “tests” include peeing on different types of seeds to see if they sprout, peeing on needles, peeing on toads, peeing on nettles and, well, peeing on a lot of different things. It’s interesting how they already knew that pregnancy changes urine somehow and actually some of these tests have later been found to have some legitimacy.
If you’re writing fantasy, you have a lot more options. Perhaps the concoction you’re making a pregnant character drink really does turn their skin purple for a while and maybe the toad they pee on starts talking. Maybe you can detect a fetus with magic.
Finding out the sex of the baby
Here’s how you found out the sex of the baby before ultrasounds: you waited until birth.
Sure, people did try finding out if they were having a boy or a girl, and sometimes that also involved peeing on things, but none of things things worked. There are also plenty of old wives’ tales that people still like to repeat, like looking at the shape of the pregnant person’s stomach. There’s also a saying that girls take their mother’s beauty, so if you look particularly awful during pregnancy, you might just be having a girl. Fun!
If your character has had multiple children of the same sex and now their pregnancy feels different, they could assume it means the new child is of different sex. It could be relevant to the story if they’re hoping for a male heir, for example. Personally, I have two children of different sexes (but same gender – funny how things work out despite modern testing and ultrasounds) and the pregnancies were extremely different, and if I was a character in a book, I could conceivably (heh) “know” that my child is of different sex this time.
Talking about pregnancy in your story
Talking about pregnancy hasn’t always been something that people did openly even if the parents were outstanding married citizens. In some cultures, it still isn’t something that is mentioned outside the family. People also used different euphemisms, some of which I’ve already used in this post. Doesn’t it sound grand to be “great with child”?
If you want to be accurate, do some research on this, or at the very least throw in some appropriate euphemisms that make your story sound more authentic.
Historical fiction and miscarriage
Just like your character might now know they’re pregnant, they might not know they’re miscarrying. There can be some minor bleeding in an otherwise viable pregnancy and your character could just assume it’s normal.
A miscarriage is often a devastating incident to a mother who was excited to be pregnant but it might be that talking about it wasn’t encouraged in the time period that you’re writing about and it could have been a taboo. People could have believed that it was better for the mother not to talk about it.
Here’s something a little distressing that you might not want to read if you’re squeamish: If the miscarriage happened later in the pregnancy, your character might have to figure out what to do with the remains of the fetus. Some kind of burial might be in order, most likely in an unnamed grave without anyone seeing.
How your historical fiction characters prepare for the baby
Your pregnant character from the 1800s most likely doesn’t start their pregnancy journey by planning their baby shower but that doesn’t mean she doesn’t have work to do. Because she couldn’t just pop into Baby Gap or H&M, she’d have to make all the baby clothes herself with perhaps some help from family members.
This preparation of clothes, possibly by knitting or crocheting, could be the only way your character actually shows she’s really expecting. When the survival of both mother and baby was far from given, you didn’t tend to gush over what to call the baby and how cute they were going to look. It didn’t mean you didn’t care, just that anything else would have been seen as impractical or downright foolish.
Prenatal care – as in getting checked by a doctor or a nurse/midwife just because you had a bun in the oven – didn’t become commonplace until some time in the 1900s. Until then, pregnancy was seen more as a social issue rather than medical, but they did eventually realise that they could prevent some of the related deaths with a measure of preventative health care. What this meant, of course, depends on the time period and location of your story.
Even if you were writing from first-person point of view, you could still keep it a secret that your character is pregnant until they were giving birth. There would be signs, of course, but it would be up to your reader to put two and two together. Even if you don’t go this route, your character would likely take being pregnant less as a full-time job as expectant mothers in the 2000s might.
Working while pregnant
I’m grateful to live in a country with an abundant maternity leave but it’s still a fairly modern invention and it can be severely lacking in some countries even now. (Looking at you, USA.)
Your pregnant character would likely be working all throughout her pregnancy unless there was some sort of an issue that held them back like low blood pressure resulting in dizziness or debilitating pain. The women of my grandma’s generation worked in the fields until it was time to give birth, and then they just popped indoors for a bit to squeeze the baby out and then went back to work. Of course, if you’re writing about a rich or a noble woman, she wouldn’t be working at all.
If your character does something dangerous for living, assuming those kinds of jobs were accessible for women, she might quit working sooner if she could afford it and if it was common knowledge that the kind of work could be dangerous. Working with radiation or dangerous chemicals might not have been seen as bad for the fetus in the beginning.
If you’re writing fantasy, you might want to consider if there’s something dangerous about your character’s work. Perhaps necromancy causes the fetus deveop really ugly ears.
The perils of being pregnant
Although being pregnant is natural, it doesn’t mean it can’t be uncomfortable, debilitating or even lethal. There are people who can sail through their pregnancies like nothing’s wrong, but if your character is like that, it might seem a little unrealistic to your readers. Just so you know.
When you’re pregnant, you don’t just get larger, your bones also shift. That can be painful as heck. Your centre of gravity also shifts, so if your character has been ninja-kicking bad guys up until now, it might become impossible now that they’re in a different kind of “trouble”.
Something that used to be extremely dangerous to expecting mothers – and still is without medical intervention – is pre-eclampsia also known as toxemia. Symptoms can include headaches, visual disturbances and swelling, and a doctor or midwife could check for high blood pressure and protein in urine – even if your story takes place in the earlier decades of 1900s.
If you can’t induce the birth or perform a C-section, staying pregnant with pre-eclampsia can lead to seizures that could lead to coma or death. It’s how Lady Sybil died in Downton Abbey and I hated watching that episode because the same thing could have happened to me if it wasn’t for modern medicine.
Finally we’re there: Giving birth in your historical fiction novel
Now we’re at the most dangerous part of our journey. Giving birth isn’t just dangerous for the mother but also to the baby, and although it might be the most natural thing in the world, it’s still a huge crisis for the body. Your character giving birth could bring a lot of drama to your story, especially when they don’t have access to modern medicine.
Despite of what you have probably seen on TV, birth doesn’t necessarily start with the waters breaking. It could start with an “off” feeling, slight cramps or straight up contractions, nausea or other intestinal issues. What a magical time! Your character might not realise she’s in labour, especially if she’s living in a time without access to birthing classes
If your character is having their first child, the labour will likely be longer rather than shorter. How long should it be? Shoot for 8 to 12 hours – that just sounds pretty normal and not too quick or slow. Obviously you don’t need to tell your readers the exact time, but it should probably be a different time of day when it starts than when it ends unless you want to go for the full 24 hours. (My first labour lasted 32 hours which is something I could never put my characters through…)
Something to remember if you’ve never given birth: the part with the pushing is the shortest part. If your character is pushing for hours, there’s something seriously wrong. With modern medicine, there are things that can be done to help a prolonged second stage, like c-section or forceps, but without access to those things, the best you can do is probably just to push from the top and hope you can grab and pull the baby somehow. Someone who’s been present at a lot of births might even perform a small cut to help the baby come out. Better put something in the character’s mouth to bite into.
Who’s going to be with your character
Unless there’s a special reason, your character likely wouldn’t give birth on their own. It depends on the time period and location whether the birth would be attended by a doctor or a midwife, or perhaps just the new mother’s own mother or other experienced women from the community. The doctor would likely be a man but he’d usually be the only man present – fathers weren’t expected to be present in most times and societies.
Family members at birth would probably be there just for moral support and to fetch things that are needed (Hot water and towels, anyone?) but someone with more experience whether they’re a doctor or just an elder could be helping get the baby out as well, like we just talked about. Babies can need some maneuvering to get them out of the birth canal, so don’t be afraid to have your characters hands on.
Pain relief
This blog post is already longer than it was supposed to be so I won’t take too long here. Before things like pethidine, gas and air or epidurals, there were still some medical ways of reducing pain during childbirth. You can do some research on what they used during the time you’re writing about, but if you’re unsure, you can always choose nothing. The pain of childbirth was often seen as natural and even desirable.
Blood and other fluids
This is another section you might want to skip if you’re squeamish. First there’s the amniotic fluid (i.e. the “water”) which can resemble regular water or which can be tainted by blood or meconium (as in fetus poop, and it’s a bad sign). Then there’s blood, of course, and you can even evict your bowels during childbirth, not to mention that the fresh new baby can poop on you. And speaking of the baby, it’s going to be covered in blood and in a waxy substance called vernix.
Any of these details might be something you want to include in your story but in the very least you should know that giving birth is going to be messy. Cleanup will be necessary and your character definitely won’t be sleeping in the same bed without at least changing the sheets. Home births used to be commonplace (and of course, they still are in many parts of the world) and women would already know how to get blood stains out of their sheets.
C-section has been used successfully from the 1600s onwards, though obviously it’s safer now than 400 years ago. You could likely include it in your story and be historically accurate, but remember that unless your character with the scalpel really knows what they’re doing, they’re more likely to save the baby than the mother. You need to cut through several layers before you can get to the womb and you need to stitch things up again and hope the mother doesn’t get a deadly infection.
Can your character die during childbirth?
Like I mentioned earlier, childbirth is dangerous. When something goes wrong and you can’t rely on modern medicine, it’s extra dangerous. The most likely cause would probably be bleeding out but you could also have a cardiac arrest if you have underlying heart issues (that you might not even know about). You could even have a stroke, a brain bleed or a seizure – oh my!
By the way, you don’t bleed to death in childbirth because your nether regions tear so badly – it’s because of the placenta and how it’s attached, or not attached, to the uterus. Just wanted to put this out there for the uninitiated. Even with access to blood transfusions now in modern times, you can still die from it.
This paragraph is about babies dying. Skip if you don’t want to read it. There are many reasons why a baby might die during or shortly after labour. Maybe the umbilical cord got stuck between the baby and the birth canal resulting in lack of oxygen, maybe the placenta ruptured (also extremely dangerous to the mother), maybe the baby was born too soon and it wasn’t ready to breathe or maybe it was already dead. The baby could also just get straight up stuck which could be lethal to the mother as well. Some of these things could be prevented with modern health care and medicine.
There’s some death talk in this paragraph as well, just with fewer details. They often didn’t know why a baby died or how to help them live, so it’s not necessarily important for you as a writer to know why it could happen to your character. It could be a combination of many things and just bad luck. My grandma gave birth to undiagnosed twins in 1958 and one of them died just 12 days later – there wasn’t any explanation except “injuries during labour” and she always wondered if knowing she was expecting twins would have helped. (The surviving twin stayed in the hospital for three months and then 30 years later he became my father.)
Don’t forget the afterbirth
Again, this might be a detail you don’t want to specifically mention, but don’t just have your character give birth to a baby and then close her legs. The placenta needs to come out in full, and before that, the umbilical cord needs to be cut. After the placenta has come out, your characters could choose to burn it or even use it as fertilizer in the garden. In a fantasy novel, it could be used for magical rituals, sacrifice or even potions.
Giving birth in your fantasy novel
When it comes to childbirth in your fantasy novel, you can choose who attends the birth and how they can help. Maybe they’ve got magical herbs and potions that can help the mother and baby. They could even use spells, though I have to say that if I read about someone giving birth in two seconds without pain because they said the right incantation, I’d be more likely to think the writer was just lazy, but perhaps that’s just personal preference.
Can magic put the blood back after a hemorrhage? Can a spell break the hip bones so that a child can slide out from the birth canal after being stuck? It’s up to you, but once again, stay consistent with the rest of your magic system.
For anything non-magical, just go with anything that applies to the time period that you’ve modeled your fantasy world after. If there’s no specific time period, make sure what you choose doesn’t clash with the rest of your worldbuilding.
What happens to your character after childbirth
We’re almost done with this post, guys. So your character has given birth and let’s assume both mother and baby are alive. Yay!
In an ideal case, a mother would get to rest at least a few days after giving birth but they might be expected to start toiling away as soon as possible or maybe they simply don’t have a choice. In some Asian cultures, you’re expected to stay in bed quite a long time and in some cultures you’d need to be isolated from other members of the community (or rather, the men). Do your research depending on the time and location of your story.
Even if your character has to start working again right after childbirth, whether it’s paid work or housework, they still wouldn’t be physically back to normal and in the very least they’d be bleeding for at least a couple of weeks, though it’s up to you whether you want to mention that. Since you’re writing a book and not directing a movie, you don’t have to mention they still have a bump after giving birth (the uterus goes back in a few days but the abdominal muscles etc take a while) but in the very least don’t say they went back to having washboard abs the next day because that simply does not happen.
If the child didn’t survive, your character might not get a chance to grieve properly. People didn’t always understand that talking about traumatic events can be helpful and you might be expected to move on without ever mentioning it again. The child might not even get a proper grave, which seems so very cruel writing this in 2024. In any case, the mother would still have the physical symptoms to deal with as well, and her milk would come in despite there being no baby and she’d have to deal with that somehow.
Do you really need all these details in historical fiction or fantasy?
Unless you’re writing about a midwife, you probably don’t need all these details. If you have a pregnant character in a historical fiction story or fantasy novel, you could just pick one thing to include or do research on to make your story more realistic, and that could be enough.
It wholly depends on your genre and your tone what kind of details you want to include. Maybe you want to focus only on the emotional journey or maybe you want to include a few grimy details.
However, if you’ve never given birth and especially if you’re a man, don’t write about it like it’s a scene in a horror novel unless you’re literally writing a horror novel. Although it can be scary and even dangerous, childbirth is still a normal part of life and being all weird about it is just a teeny tiny bit misogynistic. Yes, we know you could never do it, but no need to tell everyone what a wuss you are.
If this post has helped you with doing some background research for your story, then my job here is done. Let me know if there are other medical history subjects for writers you’d like me to cover!
Protagonist Crafts is a blog about writing fiction, written by a published author and creative writing teacher. You can find more writing tips and inspiration in the blog and you can get the best author tools at Writer Lifestyle on Etsy.
