Baby care simulator backfires

This week, the BBC headline Concerns raised over teenage pregnancy ‘magic dolls’ caught my attention. In a course of a programme to prevent teenage pregnancy, Western Australian girls were given baby dolls to look after that simulate the needs of a new baby. The baby simulator programme, which was meant to put girls off having a baby, however, backfired. Rather than making it less likely for girls to have a baby or an abortion by the age of 20, the programme made both more likely.

The only thing I found strange about this finding is that some people apparently thought it would work in the first place! (My husband immediately suggested the idea could have only come from male researchers…). If the experience of looking after a baby would be that off-putting, our species would have gone extinct a long time ago. There is no immediate, measurable benefit of raising a child, and yet it is in our instinct – rewarding enough to keep us all going.

Nothing in Biology Makes Sense Except in the Light of Evolution” (Dobzhansky 1973) springs to mind….

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European Reasearch Council project start

Today is the official start date of my ERC Starting Grant project “The value of mothers to society: responses to motherhood and child rearing practices in prehistoric Europe”.

ERCThe European Research Council offers competitive grants for top researchers from all over the world. There are programs for all stages of career, Starting Grants (2-7 years after completion of the PhD), Consolidator Grants (7-12 years after PhD) and Advanced Grants for the most senior scientists. Competition is open for all disciplines. The host institution must be located in one of the 28 EU Member States or associated countries. As of 2016, the list of associated countries includes Iceland, Norway, Albania, Bosnia and Herzegovina, the former Yugoslav Republic of Macedonia, Montenegro, Serbia, Turkey, Israel, Moldova, Switzerland (partial association), Faroe Islands, Ukraine, Tunisia and Georgia.

The Austrian Research Fund supported my FWF-pilot project that started in January 2015 and focussed on developing methodology. From this platform, I was in the position to apply for an ERC Starting Grant to significantly expand my research chronologically and thematically.

Although the completion of my PhD dates back to 2005, I could still apply for the Starting Grant scheme because my two children extend the eligibility window by 1.5 years each. This seems a fair solution for working mothers, at least it has worked for me!

The ERC grant scheme is competitive, but is one of the most generous one out there. It gives the principal investigator the chance to build a research group and focus extensively on the research topic for several years. Ideally, it builds the solid foundation of a scientific career, as well as advancing knowledge in all disciplines.

This, too, is my personal answer to the question “What has the EU ever done for us?”.

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Motherhood and marginality

Last week, I attended the workshop The End of the Spectrum: Towards an Archaeology of Marginality at UCL London, organized by my lovely colleague Elisa Perego.

The marginality network is especially interested in social exclusion in present and past societies. Traditional archaeological approaches have often focussed on wealthy elites, and in turn, the economically disadvantaged. Marginalisation, however, may have many different roots and causes, including gender, age, disability, ethnicity, and others.

It was a good opportunity to think about how motherhood intersects with social marginalisation in the past and present. Perhaps the most recent example I came across is this:

Nursing pod

Nursing Pod, Newark Airport

I have recently travelled from New York to Vienna and discovered Nursing Pods on Newark Airport. These are small cabins placed at the flight gate, equipped with a bench and mirror (not 100% sure what the mirror is for, exactly). As someone who has breastfed her babies on several airports, my first thought was – great! Finally a peaceful, quiet, comfortable place for breastfeeding. I remember that my babies were often too distracted to eat on the buzzing airport, but were then easily soothed by breastfeeding on the plane. But then I though – wait a minute. Why should mothers be excluded from participating in society, and attend their baby’s needs hidden from everyone’s view? Social marginalisation because of motherhood happens in our own society on a daily basis.

Motherhood, and conversely, infertility and childlessness may have led to social exclusion in the past, too, on a temporary or permanent basis. Taboos and regulations of female participation in society during the post-partum and lactation period may govern a substantial part of women’s lives. Many traditional societies, for example, have a period of confinement for mother and baby several weeks to months after birth, in which the mother is exempt from certain kinds of work and supposed to rest, focussing on the new member of society.

In Austria, where I live, there is a six week period before and again after birth in which mothers are not allowed to work (luckily, the pay is usually continued). In the UK, where I used to work, women are not allowed to work only for two weeks after childbirth (with no guaranteed pay, although many employers provide maternity allowances). There is an interesting ambiguity and tension between the thought of protecting mothers and allowing well-deserved rest, and preventing them from doing what they themselves decide to do. In the case of financial implications, decisions are even tougher. And not all births are equal – some women feel fine soon after, some suffer for a long time from the repercussions of childbirth.

Motherhood bears considerable risks to the health of women and may lead to death and disability. Only in very rare cases we are able to pick this up archaeologically, as traces on skeletons or through archaeological findings. Prolapse of the uterus, caused by strain through pregnancies and birth, is likely to have been a common condition, but as it affects only the soft parts of anatomy, it is hard to find in the archaeological record.

A common treatment of prolapse, however, is the use of pessaries, and this technique, in which a ring is used to hold the womb in place, seems to go back at least to 600 BC. At Stuttgart, Germany, a 30-40 year-old woman was found with a ceramic ring in the pelvic area. She was buried off the regular cemetery, in a settlement pit, perhaps because of her disabling condition. Diane Scherzler documented about a dozed similar cases from Germany. It is likely that more such cases exist – archaeologists need to know what to look for to document them properly.

Pessary

Scherzler, D. 1998. Der tönerne Ring vom Viesenhäuser Hof – Ein Hinweis auf medizinische Versorgung in der Vorrömischen Eisenzeit? Fundberichte aus Baden Württemberg 22(1): 237-294.

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Embryotomy – Fetotomy

If you are squeamish, you may want to skip this blog post. For those of you, who love gruesome stories, here you are: Not too long ago I reported on the origins of the C-section in this blog post. Meanwhile, an 18th century mummy kept at the Natural History Museum in Budapest (Hungary) was presented as the oldest direct evidence of a C-section performed on a deceased mother. The incision was made vertically between the umbilical ring and the pubic symphysis and was c. 15 cm long. Cutting the baby out of the womb of the dead mother to baptize the child in time was certainly a Christian motive. In Antiquity, the life of the mother was privileged over that of the child.

Let me introduce you to embryotomy, or, more fittingly, fetotomy. This term refers to cutting a foetus into pieces within the womb so it can be removed. Still used in veteriary medicine, this procedure was carried out in humans when it was foreseeable that a vaginal birth would not be possible and the only way to fit the foetus through the birth canal would be a reduction in size. At that point, the foetus may have already died in the womb due to a long, unsuccessful birth.

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Set of obstetrical tools, 19th/20th century, Budapest veterinary museum

Soranus of Ephesus, a Greek physician practicing around AD 100 in Rome described the process as following in his gynaecology (Molleson and Cox 1988: 58):

If the foetus is already dead, one should throw a piece of cloth over it to prevent it slipping and draw it forward slightly. Then, depressing it in order that the ports lying above may become more visible, one should amputate at the shoulder joints… Then one should turn the rest of the body with the fingers and deliver by inserting the hooks… If, however, the impaction is caused by too big a head … one should split it with on embryotome or a knife for removing polypi…. If, however, because of the large size of the whole body, the foetus does not respond even if so pulled … one must plunge the knife into the jugular region until it has penetrated deeply into the foetus. For when the blood is drained off, the body becomes thin. If the foetus is dead and of excessive size, it is dangerous to morcellate it entirely within the uterus. It is better to cut each of the parts as it presents. In theses cases amputations of the joints are indicated, for at their ends even the bones are easily freed from their connections.

Archaeological finds of foetal bones with cut marks from Roman contexts, for instance from Poundbury (Molleson and Cox 1988) and Hambleden in England (Mays et al. 2014) demonstrate that fetotomy was indeed practiced as described.

Really surprising is the recent find of parts of a foetus from Cagny, Département Calvados in France (Corde et al. 2015). It was found in the top layer of a ditch complex near some late Iron Age graves and radiocarbon dating confirmed and age of 399 to 303 cal. BC. The foetus’ age is estimated at 36 to 37 gestational weeks and bore cut marks on the bones as well as signs of inflammatory processes. Most likely, the foetus had died in the womb and was surgically removed. Whether or not the mother survived remains unclear.

This find suggests that fetotomy is several hundred years older than Soranus’ description. It was practiced in a pre- or protohistoric context – far away from contemporary civilisations of the Mediterranean, in a society we usually do not attribute this kind of medical knowledge. Perhaps this ancient case of fetotomy also shows how well-connected societies were in the past. The social networks of antiquity enabled knowledge transfer across wide regions, and proof of this turns up in the most unexpected places.

Corde, D., L. Laquay, A. Augias, J. Poupon, J.-M. Dewitte, and P. Charlier. 2015. “Un cas ancien de foetotomie, La Tène (399-303 av. J.-C.),” in P. Charlier and D. Gourevitch (eds) Colloque international de pathographie – Mai 2013. Paris: De Boccard: 21-31.

Mays, S., K. Robson-Brown, S. Vincent, J. Eyers, H. King, and A. Roberts. 2014. An Infant Femur Bearing Cut Marks from Roman Hambleden, England. International Journal of Osteoarchaeology 24(1): 111-115.

Molleson, T., and M. Cox. 1988. A neonate with cut bones from Poundbury Camp, 4th century AD. Bulletin de la Société royale Belge d’Anthropologie et de Préhistoire 99: 53-60.

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Scanning bones

We have been very busy lately – work on our Bronze Age case studies is progressing well, not least because three researchers have joined our team. We are working on all fronts – filling data bases, recording sites in GIS, analysing bones and writing articles. None of this looks very glamourous, but it is essential for good research. Last month we also did some 3-D micro-surface scanning.

3-D scanning is a very useful tool to document and better understand the morphology of human remains. The analysis of human remains within our project is, for the most part, destruction-free and primarily involves a visual evaluation of skeletal features. Building 3D-models of the skeletal indicators of pregnancy and parturition we are studying helps enormously in their accurate description, documentation, scoring and measuring.

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Anna Sonnberger scanning pelvic bones at the Natural History Museum in Vienna

In addition, some of the cutting-edge research methods we employ – DNA, isotope and tooth cementum analysis, involves the sampling and destruction of a small amount of skeletal matter or the thin-sectioning of teeth. We think very carefully about our sampling strategies in order to minimise damage. If we decide to perform analyses on teeth, for example, we do the uttermost to preserve as much information on as possible. 3-D scanning documents the morphology accurately – and future generations of researchers with questions we cannot yet anticipate can go back to the virtual models, if not the original.

Here are a few pictures of the latest scanning sessions at the Natural History Museum in Vienna. We are very lucky to have access to a 3-D micro-surface Scanner (Breuckmann smartSCAN) through our host institution OREA.

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A pelvic bone of our Bronze Age study on the scanning platform. The projection of stripes helps the scanner to measure all features accurately.

Screenshot 2016-04-07 15.50.17

The 3-D model is available as a *.stl file, which can be viewed and printed in any 3-D viewer.

 

The next step will be experimenting with 3-D printing. We will see if the resolution is good enough to replace conventional casting of replicas.

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How many mothers died in childbirth?

An international study recently revealed that a C-section rate of 19 per 100 live births (19%) is correlated with the best outcomes for mothers and children in the modern world. Although I am by no means a supporter of the natural childbirth movement, this high number surprised me. Previous recommendations from the World Health Organization suggested an optimal rate between 10 and 15 %. Perhaps childbirth has become more difficult in the last hundred years. Women who would not have survived childbirth in the past are now in the position to pass on their genes to the next generation, even if they are unfavourable for giving birth.

The World Health Organization defines maternal mortality as “The death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes.“

What is the natural maternal mortality? Estimating the number of mothers who died from complications in pregnancy and birth in prehistory is tricky. When nothing effective is done to avert death, the ‘natural’ maternal mortality is estimated at 1500 per 100000 births (Van Lerberghe and De Brouwere 2001). Women in the poorest nations still face a lifetime risk of one in 16 to die in pregnancy or childbirth. Immediate complications range from obstructed labour to haemorrhage and infection. What is intriguing is that the real underlying cause of maternal mortality today is the social status of women: maternal and infant mortality is the result of factors such as poverty, access to healthcare and female participation in decision-making.

In the past, birth systems with a high rate of interventions did not normally improve things: two-thirds of mothers who gave birth in hospitals in Paris around 1660 died of puerperal fever, and about a quarter of mothers from privileged English households in the 17th and 18th century died of childbirth complications (Shorter 1982). Both delivered under a-typical circumstances, perhaps not representative for prehistoric societies.

At present, the best guess is probably a rate between 1.5 and 25 %. The number of women between the ages of 20 and 40 compared to the number of men in the same age bracket on any given prehistoric cemetery may be an additional clue, although the sex balance in cemeteries is often uneven for unknown reasons. Here is a lot of work for us to collect and evaluate data.

If you think this rate of maternal mortality is bad, it could be worse: rather than homo sapiens, you could be crocuta crocuta, the spotted hyena. This animal has an unusually long gestation and the infant is large and mature, with teeth fully erupted. The mother has to give birth through an ‘extraordinary organ the size and shape of a penis’. This leads to a death rate of 18 % for first-time mothers, and 65-70% for firstborn young.

Spotted hyena

Spotted hyena in the Masai Mara, Kenya

References

 Molina, G., T. G. Weiser, S. R. Lipsitz, and et al. 2015. Relationship between cesarean delivery rate and maternal and neonatal mortality. JAMA 314(21): 2263-2270.

Shorter, E. 1982. A History of Women’s Bodies. New York: Basic Books.

Van Lerberghe, W., and V. De Brouwere. 2001. “Of blind alleys and things that have worked: history’s lessons on reducing maternal mortality,” in V. De Brouwere and W. Van Lerberghe (eds) Safe motherhood strategies: a review of the evidence, Studies in Health Services Organisation and Policy 17. Antwerp: ITG Press: 7-33.

 Save the Children. 2013. Surviving the First Day. State of the World’s Mothers 2013. Retrieved May 2013, from http://www.savethechildrenweb.org/SOWM-2013/files/assets/common/downloads/State%20of%20the%20WorldOWM-2013.pdf

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The gruesome origins of the C-section

For a while now I have been collecting archaeological evidence for pregnant women of the Iron Age, as I proposed to speak on this topic at an Iron Age conference in November.

As it turns out, graves of pregnant women are quite rare in Bronze and Iron Age Europe. This is slightly odd, as we do know that pregnancy and childbirth posed a considerable risk for prehistoric women. Cemetery demography (e.g. Chamberlain 2006) tells us that up to twice as many women died between the ages of 20 and 40, the fertile years, compared to men. Women must have had on average about 4 successful pregnancies to sustain the population level, so they did spend at least 2 years of their adult lives visibly pregnant. Any yet, women discovered with foetal remains in the pelvic area are incredibly scarce.

One common explanation is that foetal bones are just very small and do not preserve well; if archaeologists and anthropologist do not specifically look for them at excavations and sieve the soil carefully, they can be lost; further, foetal bones are easily mistaken for the bones of small animals (Lewis 2006). Whilst it easy to accept this explanations for antiquarian excavations, excavations today are normally run well enough that this cannot be the full explanation.

The other explanation is that women who died during late pregnancy and childbirth were not buried in regular cemeteries, but in settlement pits or other locations away from the settlement. Or they were not buried at all, and hence we do not find any evidence for what happened to their bodies. This is certainly a possibility; the higher number of females dying in the prime of life could be explained by heath problems that occurred after birth, such as haemorrhage, infections or mastitis.

But, there is one more possibility: the foetus may have been cut out of the woman’s body before she was buried. This seems to have been an almost universal custom in the first millennium BC: Roman Law (Lex Regia of Numa Pompilius, c. 700 BC) states that no woman shall be buried without having cut the foetus out first. A similar custom is documented in the Talmud and was practised even on sabbath (Caselitz 1980).

In the European Middle Ages this practice is less common, although the guidelines of an Augustinian canon dating to the 15th century in England state that “A woman that dies in childing shall not be buried in church, but in the churchyard, so that child should first be taken out of her and buried outwith the churchyard” (Gilchrist and Slone 2005: 71).

Medieval Caesarean section, c. 1400 BC © The British Library Board

Medieval Caesarean section, c. 1400 BC © The British Library Board

The woman’s life was prioritised over that of the foetus in antiquity, but if it was clear that the woman was dying or had died during birth, the babies were cut out. After the oxygen supply from the mother via the placenta is cut off, the unborn foetus dies within minutes. But already in antiquity, the timing of the cut was sometimes right and babies were successfully born via C-section. Allegedly, Apollo removed Asclepius from his mother’s abdomen. That Julius Caesar was delivered via C-section is likely a myth, as historical sources attest his mother Aurelia lived to see her son conquer Europe (Sewell 1993).

As unlikely as it seems, some women may have even survived the surgical procedure. From the Renaissance to the 19th century, as medical knowledge increased, the survival rate of C-sections for mothers improved. With the introduction of anesthesia, antisepsis and asepsis the tables finally turned. Today, C-sections save the lives of many, and are no longer associated with certain death.

References

Caselitz, P. 1980. Schwangerschaft im archäologischen Befund. The Archaeological Advertiser 1980: 20-26.

Chamberlain, A. 2006. Demography in Archaeology. Cambridge Manuals in Archaeology. Cambridge: Cambridge University Press.

Lewis, M. E. 2007. The Bioarchaeology of Children. Perspectives from Biological and Forensic Anthropology. Cambridge: Cambridge University Press.

Gilchrist, R., and B. Sloane. 2005. Requiem. The Medieval Monastic Cemetery in Britain. London: Museum of London Archaeology Service.

Sewell, J. E. 1993. Cesarean Section – a brief history. A brochure to accompany an exhibition on the history of Cesarean Section at the National Library of Medicine in Bethesda. Washington: American College of Obstetricians and Gynecologists.

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