Midwifery in ancient Greece, midwife or gynaecologist-obstetrician?

Dear Sir

Midwifery is one of the oldest medical professions in the world. In ancient civilisations, the midwife was a woman with personal experience that originally received a little practical training from experienced colleagues, able to bear children of her own, usually within her village or community (Drabkin 1944; Karamanou 2013). There was definitely a family training tradition, either from mother-to-daughter or in some cases, from the lady of the house to female slaves (French 1987). Although many consider all midwives as auxiliary medical personnel, Soranus of Ephesus classified them into three categories: (i) those that had only empirical education; (ii) those that apart from their experiences, had theoretical training in obstetrics and gynaecology; and (iii) those with a higher education, training and skills, ranked as equals between men physicians (Soranus 1927). Midwifery had opened the door for women to enter a male world of physicians and enjoy the respect of society (Fantham 1994).

In his work Gynaecology, Soranus provided us with a unique description of the essential characteristics and skills of a midwife of the era. He had rhetorically asked first, ‘What is a midwife?’, giving the answer, ‘A woman learned in all the causes of female diseases, and also skilled in general medical practice’. The midwives in Ancient Greece should have been able to read and write, have a thorough knowledge of the theory and practice of obstetrics and have experience in all branches of medicine, so as to give dietetic as well as surgical and pharmacological prescriptions. The midwife's nails should be trimmed and rounded ‘so that they will not wound the organs’. They had to have soft hands and long thin fingers; have a good memory, great perception and be hard working. They had to know all kinds of treatment and complications of childbirth, have an adequate knowledge of pharmacology and maintain their composure, as it would be imperative to simultaneously provide psychological support. They had to be discreet, as often, various family secrets were revealed during a childbirth; irreproachable; not bribed to execute illegal abortions and finally, spiritually healthy – always committed on duty away from superstitions, ‘the midwife should be no believer in spirits’. When the delivery was completed, it was necessary for midwives to explore the uterine cavity and remove, with the hooked finger, any adherent blood clots. The midwives had to announce the sex of the newborn, to clean it, to care for its health on the first steps of its life, and above all, to inform the mother about aftercare and the upbringing of the child (Soranus 1927). The midwife was also called the ‘obstetrician’ (Greek: μαιϵύτρια) omfalotomos (the person who cuts the umbilical cord) or ‘healer’ (Ancient Greek: ακέστρις). The more capable midwives, perhaps those with the higher education, were called iatrenes (Greek: γιάτραινϵς) of women's diseases, meaning female physician on gynaecological diseases (Tsoucalas 2012).

The description of the education, skills and personality of the midwives, testified the qualifications of a gynaecologist-obstetrician, even for a modern era physician (Tsoucalas 2012). Rare reports of midwives, only a total of 16 had been referred in Corpus Inscriptionum Latinarum, probably indicate that most midwives were female slaves. On the contrary, those that they have been named as iatrenes, had probably belonged to a higher social class (Jackson 1988). It is almost a certainty that most of the known midwives, iatrenes: Fainareti (5th century bc) (mother of Hippocrates or Socrates, two or maybe the same person); Fanostrati (4th century bc); Elephantis (1st century bc); Olympias of Thebes (1st century ad); Sotira (1st century ad); Salpi (1st century ad); Lais (2nd century ad); Aspasia (2nd century ad); Phavilla (2nd century ad); Maia (2nd century ad); Cleopatra the gynaecologist (4th century ad); Metrodora Cleopatra (7th or 2nd century ad), all with exceptional medical legacy in gynaecology, obstetrics, surgery, genetics, oncology, pathology, aphrodisiology, physiology, pharmacology, votanology, should be classified as expert gynaecologist-obstetricians of the antiquity (Tsoucalas 2012) and should be addressed as such.

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.