Childbirth also took place in people’s homes. For many poor women and those who lived in isolated villages, childbirth was handled by female relatives and friends, and perhaps a woman known to be knowledgeable about the process of delivery. By the early sixteenth century, urban women in many parts of Europe could call on the services of a professional midwife, trained through an apprenticeship system and often licensed and regulated by the city or by church authorities. She was generally literate, and perhaps had read one of the many printed midwives’ manuals available in most European languages, though most of her training was through assisting at actual deliveries. Her services would fi rst be sought when a woman wanted to know whether she was really pregnant. Without home pregnancy tests and ultrasound screening, determining whether the cessation of menstruation, nausea, breast enlargement, and thickening around the middle were the result of pregnancy or illness was diffi cult. Only at quickening – that is, when the mother could feel the child move within her body – was a woman regarded as verifi ably pregnant. Like physicians, midwives varied in their techniques. Some midwives and mothers preferred to use a birthing stool, a special padded stool with handles which tipped the mother back slightly; other mothers lay in bed, kneeled, stood, or sat in another woman’s lap. Midwives tended to intervene only if something was going wrong, usually a case of abnormal presentation. If the child was emerging feet or knees fi rst (breech), it could usually be delivered, but if it emerged arm or face fi rst it generally needed to be turned. Until the invention of the forceps, the best way to do this was to reach inside the uterus and grasp the feet, turning the child by the feet to effect a feet-fi rst birth (this technique is termed podalic version). Midwives’ manuals beginning in the sixteenth century recommend this, and records of births handled by professional midwives throughout the early modern period indicate they handled this technique successfully. Until the mid-seventeenth century for all women, and until the twentieth in many parts of Europe for most women, childbirth was strictly a female affair. The husband was not present unless his wife was dying, and male medical practitioners took little interest in delivery. Male physicians were only called in if the child or mother or both were dead or dying, so their presence was dreaded. This began to change in France in the mid-seventeenth century, when some male barber-surgeons began to advertise their services for childbirth as well, and the use of “man-midwives” came to be fashionable among the wealthy. At fi rst the techniques of these men differed little from those of educated urban female midwives, for both read the same books and had the same concepts of anatomy and the birth process, but gradually the training of male midwives improved as they took part in dissections and anatomical classes, from which women were excluded. Male midwifery spread to England, where, sometime in the seventeenth century, forceps were invented by the Chamberlen brothers, who kept the design a family secret for nearly a century and then revealed it only to other male midwives. Forceps allow a midwife to grasp the head of a child which has become lodged in the birth passage and pull it out, a procedure that is not usually possible with the hands alone and had been accomplished earlier only on dead children with hooks stuck in their mouths or eyes. A higher level of training and more use of instruments made male midwives appear more scientifi c and “modern” to middle- and upper-class English and French women. Rural residents and lower-class urban dwellers retained a strong sense of the impropriety of male practitioners touching women in childbirth, and they could not pay the fees demanded by male midwives in any case. Male midwives were not very common in the early modern period in central Europe, and were not found at all in eastern and southern Europe, where female urban midwives were much more likely to be granted access to formal training in female anatomy and physiology than they were in France or England. In northern Italy in particular, midwifery schools were founded in the mid-eighteenth century to teach women anatomy, though most midwives continued to be educated through apprenticeship. Childbirth was an event with many meanings: at once a source of joy and the cause of deep foreboding. Most women experienced multiple childbirths successfully, but all knew someone who had died in childbed and many had watched this happen. Using English statistics, it has been estimated that the maternal mortality rate in the seventeenth century was about 1 percent for each birth, which would make a lifetime risk of 5 to 7 percent. Women knew these risks, which is why they attempted to obtain the services of the midwife or other woman they regarded as the most skilled. Many women also recognized that the dangers of childbirth might be intensifi ed when children were born too close together, and they attempted to space births through a variety of means. Many nursed their children until they were over two years old, which acted as a contraceptive, for suckling encourages the release of the hormone prolactin, which promotes the production of milk and inhibits the function of the ovaries. They sought to abstain from sexual relations during the time of their monthly cycle, which was regarded as the most fertile time, though this “rhythm method,” based on an incorrect view of the menstrual cycle, was even less effective than that practiced in the twentieth century. Couples practiced coitus interruptus, or used magical charms during sexual relations. Condoms made from animal intestines or bladders were available to those who could afford them by the mid-sixteenth century, but they were originally designed to protect men from venereal disease carried by prostitutes and were only slowly seen as a possible means of fertility control for married couples. As noted in chapter 2 , some women used herbal mixtures, especially ones containing savin, rue, and pennyroyal, regarded as effective in preventing conception or causing the uterus to expel its contents, what was termed “bringing on the monthlies” or “inducing the menses.” Medical texts and midwives’ manuals often include recipes for such “menstrual regulators,” in dosages probably strong enough to cause what would now be considered an early-term abortion in a pregnant woman, though it was diffi cult to control the amount of active ingredients such medicines contained. Historians differ on how effective contraceptive or abortive measures would have been or how widely they were used. Limiting births was theoretically at odds with government aims of increasing population size, and there were occasional trials for using or providing abortifacients, but offi cial response was sporadic. Laws prohibiting the distribution of birth-control information and devices were not passed until the later nineteenth century, at which point Pope Pius IX also declared that the fetus acquires a soul at conception rather than quickening.