Abstract
It is commonly believed that the placenta and umbilical cord gained significance for the first time within medical discourse in the 1980s, since they contain blood-forming stem cells. This paper looks at how birthing ‘by-products,’ namely, the placenta and cord blood, have long histories of shifting relations between bodily ‘waste’ and ‘value.’ A critical reading of germinal medical manuals on midwifery, circulating in early modern Europe between sixteenth and eighteenth century, demonstrates that the placenta and umbilical cord first transitioned from ‘value’ to ‘waste,’ much like they turned from ‘waste’ to ‘gold’ in late twentieth century biomedical discourse of the Global North. The paper proposes that the relationship between ‘waste’ and ‘value’ at the site of birthing, can only be can only be understood by mapping them onto the larger epistemic shifts that occurred in the field of medicine, therapeutics and knowledge about the body, in early modern Europe, alongside questioning our own conceptual categories through which we know the past.
Introduction
Human placenta and umbilical cord blood, both by-products of the birthing process, have come to occupy central place in cutting-edge medical research and therapies today, on account of their regenerative abilities as well as its unique epigenomic features (Chia et al., 2021; Lesch, 2021). Of the five types (based on origin) of stem cells known to us today, two originate in the placenta and the umbilical cord (Charitos et al., 2021). The human placenta contains stem cells that demonstrate a tendency to self-renew and differentiate into any type of human cell much like embryonic stem cells, and it comes with none of the controversy that shrouds the use of embryos for harvesting stem cells. It is also preferred over the more conventional source, namely the bone marrow, with placentas being obtained through a non-invasive procedure.
These birthing by-products, today, have assumed high ‘value’ status, which is all the more striking, since these substances are mostly ‘discarded’ (Malek and Bersinger, 2011) as biological ‘waste’: once the birthing process is complete, they land up in the incinerators of hospital waste management systems. Articles written on the theme, in both popular science magazines and peer-reviewed journals carry dramatic titles such as Umbilical Cords: Turning Garbage into Clinical Gold (Thompson, 1995) indicating the self-evident status of the placenta and cord blood as ‘waste’ in contemporary biomedical narratives. ‘Turning garbage’ into something of therapeutic ‘value’ speaks to the recycling and revaluing ethos of our present moment.
It is this present moment that I use as my point of departure for this paper. I demonstrate that the above narrative of the placenta and cord blood moving from ‘waste’ to ‘value’ is only one story, which begins in the twentieth century. The other part is a story of how these biological substances were thought of within the therapeutics of birthing in late antiquity and early modern Europe, including disposal practices. In these periods the placenta and cord were perceived to be potent and continued to wield a strong influence on the life and wellbeing of both, the mother and her offspring, long after the completion of the birthing process. Judging from medical texts that circulated across various regions of Europe, the placenta, umbilical cord, and cord blood were rarely, if at all, thought of as ‘waste’ or devoid of ‘value.’ It was almost always the responsibility of midwives, other female relatives and/or neighbours, or the husband, to dispense with these substances in their proper way. How were these biological substances perceived, both during and after birth, and what was the source of their potency and value? This is the topic of the present study.
The discussion of placental afterlives in early modern Europe entails addressing questions about expertise on birth, particularly during the moments after the foetus had been delivered or what has come to be known as the ‘third stage of labour.’ To make sense of the ways in which specific practices were being altered, it is critical to understand how ideas about the birthing body circulated within the community of learned practitioners of the time. In this period, birthing came to be the site of strife: not only did the practice of midwifery gradually change hands from female to male practitioners, but also the epistemic foundations that governed birthing were undergoing significant shifts, especially with the rise of anatomical knowledge in the sixteenth century (Cody, 1999; Kosmin, 2014, 2018; Filippini, 2021; Davis, 2017). Seventeenth century witnessed the birth of a new genre of scientific writing–midwifery treatises. Eventually, they were translated into vernacular languages and widely printed across Europe. These manuals impacted the practice of midwifery on the ground, evident from the extensive documentation of how renowned practitioners of the time would act in the birthing room, in the instance of both ‘normal’ as well as difficult deliveries. These texts often also became the means through which competition, contestation and alliances between different practitioners were played out as ‘public performances’ (Keller, 2003: 67).
In the following sections of the paper, I discuss the trajectories taken, as well as the messages transmitted, by these treatises, so as to contextualise my argument about a ‘European’ history of birthing at an epistemic level without losing the dissimilarities in regional formations and temporalities in the application of this new obstetric knowledge. The most noteworthy among these treatises, published between sixteenth and eighteenth centuries, constitute my primary sources, an anthropological reading of which reveals how the placenta and umbilical cord were managed and understood in early modern Europe.
In the concluding section, I further speculate on ‘waste’ and ‘value’ relationships, spun around the placenta and umbilical cord, both in the past and present, to argue that the double transformation these substances undergo, from ‘value’ to ‘waste’ (in the eighteenth century) and then again, from ‘waste’ to ‘value’ (twentieth century) can only be understood by mapping them onto the larger epistemic shifts that occurred in the field of medicine, therapeutics and knowledge about the body, in early modern Europe, alongside questioning our own conceptual categories through which we know the past.
Vernacular movements: The circulation of midwifery manuals in early modern Europe
An overall picture of the context within which midwifery manuals, and later obstetric treatises, were being produced in Europe, allows us to locate these writings within larger trends of the time in the Continent (Cody, 1999: 479–480). Between the sixteenth and eighteenth centuries, midwifery treatises were being written in Latin, French, Dutch, and English by leading male practitioners. Latin texts circulated within the European republic of letters, and many manuals were translated to English as well as into other vernacular languages of the Continent, soon after the originals had been published. We can assume that the foundational ideas, of what was to later culminate into the formal discipline of obstetrics, were very much in circulation across Europe.
In their discussion of the history of obstetrics and childbirth, historians and sociologists tended to focus on how male practitioners gradually ousted female midwives from the scene of birth. This change in gendered patterns of the profession contributed to the setting up of lying-in hospitals across different regions of Europe. It also led to perceptions of an excessive medicalisation of birthing, which was seen to have its roots in these early modern historical moments (Ehrenreich and English 1973; Donnison, 1977; Oakley, 1984). Recently, however, more nuanced historical narratives attempt to shed light on regional dynamics, with scholars posing more specific questions (Marland, 1993; Wilson, 1995; Green, 2008; Kosmin, 2014; Fillippini, 2021; McClive, 2022). For instance, they explored when exactly birthing had been medicalised at the local level, which factors eventually had helped the medical men enter and dominate the sphere of childbirth, what resistance had been forged by midwives during this tussle for authority over the body of the pregnant woman, and the like. Such research questions help demonstrate that there are insights to be gained by looking at these different formations and trajectories, and that the developments in early modern Europe could not simply be singularly read either as the triumph of medicine or the delegitimisation of the midwife. On the whole, the history of obstetric expertise and authority was a far more complex one, even though gendered bodies and gendered forms of labour were a critical component of it (Keller, 2003: 63–64).
Nevertheless, despite these regional variations, both in terms of practice and temporality of the medicalisation process in birthing, we can still pan out our lens of analysis and make a claim that there might indeed be something called a ‘European’ history of midwifery (that eventually culminates into the discipline of obstetrics), in terms of a formal codified body of knowledge that was establishing itself as the ‘authoritative’ voice in matters of reproduction; vernacular practices were both shaped by and also contributing to this proliferating form of scientific writing. Cathy McClive, in her recently published translation of Marie Baudoin's writings, observes that ‘scientists and medical practitioners engaged in the Enlightenment project of observing, recording, and discussing all things reproductive’–an enterprise in which the author contends that accomplished female midwives, from different parts of Europe, participated in as enthusiastically as their male counterparts, in their attempt to stake claim over the highly competitive and contested sphere of birthing (McClive, 2022: 61–62). Yet, it would be far from historically accurate to make claims about female midwives having wielded the same kind of influence as male practitioners of early modern Europe, at a time that witnessed the burgeoning of midwifery writings; the former predominantly relied on the works of more established male practitioners, who were well-versed in anatomy, and there is no real ‘evidence for a ‘parallel universe’ where women created their own medical traditions completely separate from men's’ (Green, 2008: 308).
The circulation of medical writings across Europe, by way of vernacular translations, was not an unknown phenomenon in the early modern period as well as earlier 1 , even though there was very little available literature specifically on the practice of midwifery before the mid-sixteenth century (Green, 2008: 247). Then on, however, a new genre of midwifery treatises emerged. It had a uniform structure as well as format in order to transmit a specific kind of knowledge in a specific manner. The information captured in these ‘epistemic genres,’ Pomata (2011: 48) argues, ‘is seen by authors and readers as primarily cognitive in character.’ The ‘textual conventions’ of the genre were also ‘intrinsically social’: medical practitioners formed a scholarly community of its own kind. In order for new ideas about the body and its functions to be established as the dominant discourse, particularly in the field of birthing, it would first need to be accepted by practitioners, or the ‘thought collective,’ 2 which adhered to and shared the common representations of corporeality.
The evolution of the cognitive dimensions of the practice of midwifery, from sixteenth century onward, is key to unpacking the epistemic shift that occurs in the how the body itself was perceived, and in turn, its impact on how bodily substances, namely the cord and the placenta, transitioned in status from ‘value’ to ‘waste.’ This was the period when the thought collective, comprising predominantly of learned and trained male medical practitioners, wrote and published on midwifery to and for themselves. By doing so, they advanced a particular kind of knowledge which was very different from the one that lay midwives had access to and had drawn on in their practice, namely, embodied ways of knowing. Kosmin argues that starting from the sixteenth century, European physicians translated new anatomical knowledge into vernacular treatises on midwifery; these can be viewed as an emblem of a new experimental and observational science (Kosmin, 2014: 77). While the genre of midwifery manual evolved from ‘popular’ writings to more technical and anatomy-oriented ones, the ideas contained in them certainly circulated across Europe (Fissel, 2004; Kosmin, 2014: 78).
As printing techniques became more sophisticated over the sixteenth century, medical treatises on midwifery began to proliferate across Europe. But it was not simply the printing press that led to the burgeoning of this genre of writing. It was also a time when ‘male surgeons were expanding their expertise in obstetrical emergencies’ (Green, 2008: 248). Over the next two centuries, this trend of producing midwifery manuals for surgeons strengthened. In her work on ‘popular’ printed materials on the theme of childbirth in early modern Europe, Mary Fissel notes that a French midwifery treatise De l'heureux accouchement des femmes (1609) by Jacques Guillemeau (1550–1613) was only the second midwifery treatise to be translated to English after Rösslin. Titled Child-birth Or, the Happy Deliverie of Women, the English version appeared in 1612. Despite not considering Guillemeau's work as part of the late-seventeenth century genre of ‘midwifery treatises,’ Fissel uses its English translation to demonstrate how writings on female bodies and parturition were still not readily acceptable in European society at the time, contrary to how things developed in the later part of the century (Fissel 2004: 71).
The eighteenth century witnessed different but related developments across Europe, both in writing and in practice, leading to the changing of hands, from female to male, in the birthing chamber. An expanding anatomical knowledge about women's bodies, paved the way for male anatomists and university physicians to put their knowledge to practice. Moreover, surgeons and physicians were not just competing with lay midwives but also with each other. In their presentations of exceptional and complicated cases in the treatises from sixteenth and seventeenth century, medical men urged the community to distinguish between ‘good’ and ‘bad’ surgeons, or those in possession of ‘true’ knowledge of childbirth and those lacking it (McTavish, 2006: 450–452).
This was also the century when obstetrical instruments, most importantly the forceps, began to take on a life of their own publicly as opposed to in ‘secret’ which had been the case in the previous century. The use of instruments became the crux of many professional debates, which split male practitioners into two camps–those of the ‘artful hand’ to expedite the ‘work of nature,’ such as Dutch obstetrician Hendrik van Deventer (1651–1724) and his followers, and those who actively supported the use of obstetrical tools. Despite these debates, by the 1730s, forceps were widely used in the Netherlands, France and England (Wilson, 1995: 58). The contention around its use occurred alongside the translation of obstetrical treatises from other European languages to English. For example, in 1716, Deventer's treatise on midwifery, published in Dutch and Latin in 1701, was translated to English as a pronounced ‘anti-forceps move.’ In the same decade, an anonymous English translation of the French treatise by Pierre Dionis (1643–1718) appeared. In contrast to Deventer, Dionis called for the use of instruments in difficult births (Wilson, 1995: 88). These spirited debates on obstetrical instruments, in turn, contributed to the ways in which the discipline of obstetrics was developing over the course of the century.
Debates on ‘best practice’ as well as its regional variations still do not exhaustively account for the epistemic shift that was taking place from the late sixteenth century onward. It was not merely a matter of changing hands, from lay female midwives to accoucheurs or the men-midwives. These two personas, the ‘lay midwife’ and her male counterparts, embodied two different epistemes on which their practices were established. In her edited volume on the Art of Midwifery, a compilation of Continental works from the fifteenth and nineteenth century, Marland asserts that ‘midwifery was a skill to be learned by experience and passed on without formal instruction…often grounded in long apprenticeship with a senior midwife and years of experience’ (Marland, 1993: 3–4).
As mentioned, despite early midwifery treatises and manuals being addressed to female midwives, rarely were women the real benefactors of printed knowledge. With some notable exceptions, midwives were neither literate, nor trained within written traditions. Midwifery was primarily an oral and embodied knowledge, which women had gained through their own subjective experiences of childbirth as well as by being present at births of family members, neighbours, and eventually, clients. It was from this that they derived their ‘authority over generative matters’ (Cody, 1999: 479). In the second half of the seventeenth century, their epistemic basis came to be undercut by new scientific knowledge based on the analogies made between human bodies and ‘lower-life forms,’ such as dogs or rats that were subjected to dissection. In turn, this knowledge sought to interrupt the ‘intellectual and emotional connection between midwives and maternity’ (ibid: 479–480). 3
Discussing the spread of man-midwives from northern Europe to other regions in the seventeenth and eighteenth century, Filippini relates this phenomenon to changes both in ethical codes and therapeutic practices (Filippini, 2021: 42). These new ‘therapeutic practices’ were increasingly based on a nuanced anatomical understanding of the female body, a process that had begun long before the seventeenth century, that culminated in this turning point.
When and How: Management of human birthing by-products
As knowledge about birthing bodies circulated across the Continent, the manner by which the umbilical cord and placenta were treated changed as well, as is evident through an analysis of medical treatises during this period of transformation in Europe. The changing practices around their management were as much about the ‘profession’ changing hands–from female midwives to male surgeons and physicians–as it was about changes in midwifery practice itself. Evolving perceptions and practices related to umbilical cord and placenta can be mapped onto certain significant developments in medicine, namely, new anatomical studies that yielded technical knowledge about the mechanisms of labour. These are often attributed to the pioneering work of Ambroise Paré (1510–1590), surgeon to the King of France, and connected to later developments in surgical obstetrics.
In recent years, as cord blood and the placenta have gained great ‘value’ due to their ability to generate stem cells, sufficient amounts of blood are necessary to remain in the umbilical cord for storing. Early cord clamping is hence encouraged, making ‘time' an emerging focus of biomedical discussions. Yet as early modern European midwifery treatises demonstrate, debates about when and how the cord should be severed were ongoing. Much like the question of time, a nuanced discussion about the value of the placenta and umbilical cord to the foetus, the new mother, and the community at large, is evident from these accounts. These focus on how the placenta and cord were put to use to resuscitate ‘weak’ or stillborn babies, and suggest that prescriptions for their disposal were meticulously followed.
In his voluminous work, Alfred Velpeau (1795–1867), a prolific and greatly respected French surgeon of the nineteenth century, intricately documented the history of midwifery and obstetrical practices before describing his own recommendations (Velpeau, 1852 [1835]). In the section titled ‘On Tying and Cutting the Cord’ in his treatise, he began with discussing Hippocrates's approach to what happens once the child had been delivered. Velpeau claimed that Hippocrates waited for the placenta to be delivered before cutting the cord. In cases when it took long to detach, Hippocrates would place the infant on a pile of wool, or goatskin with small holes in it. With the passage of time, the infant weighed down on the pile, due to which a traction was exerted on the umbilical cord. The pull on the cord, to bring out the placenta, was meant to be so gentle that it was ‘almost insensible,’ in order to ‘extract it without any violence’ (Velpeau, 1852 [1835]: 608). For Hippocrates, according to this account, it was important that the placenta is delivered before the cord was severed so as to secure the vitality of the child as well as to ensure the least intrusive and ‘hurtful’ way to bring it forth.
These ideas seem to prevail for several centuries, appearing in some form in the works of Jacques Guillemeau, a favoured student and son-in-law of Ambroise Paré. Guillimeau, practicing in the second half of the sixteenth century, wrote in his midwifery manual that Hippocrates further believed that if a woman had experienced a long and painful labour and the foetus had to be brought out with the help of a surgeon and his medical instruments, then ‘such children are not long lived.’ In such cases, the midwife should wait till the child had ‘sneezed, pissed, or cryed’ before tying navel-string (Guillemeau, 1635 [1612]: 99), in order to conclusively establish signs of life in the foetus, and make sure they are capable of breathing on their own and no longer dependent on placental respiration outside the womb. Maintaining the placenta and the child as a singular unit was thought to be of great value, especially in cases where the newborn was ‘weak’ or not robust in the moments after birth.
François Mauriceau (1637–1709), a leading accoucheur practicing in the mid-seventeenth century, did not see value in burdening the child with the weight of the placenta on its chest soon after birth, nor in milking the cord into the child, and the contrary, thought it did more harm than good (Lloyd, 2001: 650). He nevertheless advocated to wait till the placenta had been delivered to tie and cut the cord. For him, the navel-string provided a critical link, which informed the surgeon about the position of the placenta inside the womb, even if the woman's uterus began to constrict, shutting off the internal orifices of the womb. Tying the navel-string first would make it harder to deliver the after-birth (Dionis, 1719: 183). Mauriceau, in his Diseases of Women with Child, And in Child-Bed, originally published in French in 1668, describes the suitable time and process to sever the umbilical cord in the following words: As soon then as all is come away from the Woman, she must immediately close up the Womb with Clouts, according to Directions already given, and then carry away the Child and Burden to the Fire; having put it into a warm Bed and Blanket, let her take a brown Thread four or five double, of a quarter of an Ell long or thereabouts, ty’d with a single Knot at each of the Ends, to prevent their entangling: and with this Thread so accommodated (which the Midwife must have in a readiness before Labour, as also a good pair of Scissors, that so no time may be lost) let her tie the String within an Inch of the Belly, with a double Knot; and turning about the Ends of the Thread, let her tie two or more on the other side of the String, reiterating it again, if it be necessary, for greater Security (Mauriceau, 1673: 301).
These views were contrasted by ones by Julien Clément (1649–1728), the French royal surgeon and a contemporary of Mauriceau. For both physiological and emotional reasons, he advocated for separating the newborn from the mother, by immediately tying the cord and moving the baby elsewhere, allowing the surgeon to get back to the mother.
In the later decades of the seventeenth century, Pierre Dionis compared instructions given by Mauriceau and Clément in his treatise on midwifery. Instead of choosing the ‘better’ technique between the two, he wrote that each surgeon had had his own reason for following a particular course of action. He, in turn, suggested, that a middle ground may be sought between Mauriceau and Clément: That as soon as the Child is born, and laid on its Side, he [obstetrician–SM] should slide his Hand along the Navel-String, and bring away the After-Birth before he ties it, if it does not adhere to the Womb. But if he finds it difficult to separate it from the Uterus, let him first tie the Navel-String, and cut it, and give the Child to one of the Assistants and then do his best to fetch away the After-Burden according to Art, and as the Circumstances of the Woman require it (Dionis, 1719: 184). When things succeed by the usual helps, the child and after-birth must be given to hold to the nurse, on whose lap there should be, if possible, a soft cushion; then the surgeon is to tie up the chord at a finger's breadth from the child's belly, with a waxed thread of a middling bigness, the ligature must be neither too tight nor too loose, the first would cut the chord [sic] too soon, the other would not stop the bleeding at all (de La Motte, 1746 [1715]: 124).
These views were completely unacceptable for his contemporary Hendrik van Deventer. Known both for championing the ‘artful hand’ in deliveries and his criticism of the use of obstetric instruments, the Dutch surgeon was convinced that the cord ought to be tied as soon as the infant was delivered. He postulated that ‘the hand should immediately be passed into the womb to draw out the after-birth’ (van Deventer, 1716: 138). Curiously though, the only condition that justified delayed tying was for assisting another attendant. This extra pair of hands could hold the baby, while the midwife drew out the after-birth. However, if the infant was weak or needed attention, this was to be abandoned. He further explained, in response to questions raised by his contemporaries, that immediately after the foetus had been delivered was the best time to introduce the artful hand, since the ‘womb was open’ at that point, and the hand would slip in painlessly.
According to these accounts, time appears to be of vital consequence to how things should be managed after delivery. It was not simply a consideration that kept the needs of the newborn and birthing woman in focus. Apparent from Deventer's treatise, these concerns were increasingly becoming about not wasting the practitioner's time: If the Hand is presently put up into the Womb, I soon perfect the Birth; for it is certain I can sooner extract the After-birth, than another’ who draws it out, or tries other ways; for I do not spend my Time in trying this or that Method, but proceed in that which is the shortest and most certain (ibid: 140–141).
The lasting lives of placentas and cord blood
In his history of obstetrics, Velpeau places both the practice of immediate severing the umbilical cord–as soon as a child ‘passed through the vulva’–and the belief that one should not wait for the delivery of the placenta before cutting the cord–in the mid-eighteenth century (Velpeau, 1852 [1835]: 609). This belief soon came to be established as a general rule. However, despite Velpeau's attempt to present this as the dominant practice in the therapeutics of birthing of the time, several male practitioners still continued to wait till the placenta was delivered before tying the cord. This was the habit of Scottish and British physicians William Smellie, Thomas Denman, Charles White, and others.
Why then well into the eighteenth century did so many surgeons delay severing the cord? This was, in part, due to the rooted belief that if the foetus did not immediately start breathing through its lungs, the placental circulation would enact a transition to independent respiration. In particular, Smellie (1697–1763) believed: If the child has not yet breathed, and a pulsation is felt in the vessels, some people (with good reason) Order the Placenta, and as much as possible of the navel-string, to be thrown into a basin of warm wine or water, in order to promote the circulation between them and the child; others advise us to lay the Placenta on the child's belly, covered with a warm cloth; and a third set order it to be thrown upon hot ashes: but, of these, the warm water seems the most innocent and effectual expedient (Smellie, 1752: 229).
Lay midwifery practices dealing with the placenta and umbilical are much harder to source, since this knowledge did not circulate in written form, but rather through apprenticeships, under more experienced female midwives, who drew on their practical knowledge. Often their understanding of the female body mirrored the Galenic system of physiology, where ‘vital spirit’ or ‘pneuma’ or ‘warm air’ was transmitted from the mother to the foetus through the umbilical arteries while nutrients were carried through the umbilical veins (Obladen, 2018: 458). The fine balance of warm (pneuma) and cold (inspired) air, in the transitory moments right after birth, where the newborn begins to breathe through the lungs, might also constitute the underlying premise on which delayed cord clamping was recommended and practiced by midwives, both lay and learned, and male practitioners alike. This was the dominant epistemic framework prior to the sixteenth century (Davis, 2017: 499). References to the ‘open’ (‘expulsive’) and ‘closed’ (‘retentive’) state of the womb (Flemming, 2000: 298), cited well into the eighteenth century, were also not metaphors but vestiges of earlier epistemic principles, which were preserved within the new practice of midwifery that was increasingly drawing on more advanced anatomical knowledge.
While lay midwifery practices are poorly documented, subtle clues can be found in learned writings. For instance, the anxiety of physicians about the placenta and its parts being retained in the womb had a strong bearing on the practice of midwives. The latter were advised to proceed with utmost caution when it came to managing this stage of labour (Filippini, 2021: 98–99). In turn, learned midwives of sixteenth and seventeenth centuries, who contributed to this genre of medical writing, such as Louise Bourgeois (1563–1636) and Jane Sharp (1641–1672), advocated for delayed cutting of the cord, for reasons similar to ones stated by surgeons like Guillemeau, Smellie, and others (Bourgeois, 1609, quoted in Ploss et al., 1935: 794; Sharp, 1671: 212–216). In the second half of the eighteenth century, Elizabeth Nihell (1723–1776) already saw no value in waiting that long and recommended severing the cord after the delivery, ‘giving the child to be kept warm, and then delivering the mother of the after-birth’ (Nihell, 1760: 258).
However limited, the available works of midwives demonstrate that over the course of about a century, a shift in how the placenta is viewed by practitioners, both male and female, occurred. 5 Its implication was profound: the placenta transformed from being an integral source of life, outside the womb, infusing ‘vital spirit’ into newborns, to losing its ‘vital’ status, thus necessitating the severing of the link between it and the foetus at the earliest. Or, in other words, Galen's doctrine of vitalism that had influenced therapeutics for several centuries was finally giving way to newer forms of knowledge about the body, which laid the grounds for the placenta and umbilical cord to move from vital life-source (outside the womb) to ‘medical waste.’
In the early modern era, birth was both a biological as well as social phenomenon (Filippini, 2021; Wilson, 2013). Within this framing, the placenta and umbilical cord were of great significance. The work of a midwife was not complete with the delivery of placenta (Donaghy, 2023: 250); in contrast, for male surgeons, the delivery of after-birth marked the end of the birthing process, after which they exited the birthing room. Lay midwives, in early modern Europe, were responsible for the afterlives of placentas. It is also quite telling that the midwifery treatises, written by learned midwives, did not mention these practices which were considered a necessary part of the lay profession. In this regard, the manuals by Bourgeois and Sharp, who sought to assert their authority in the arena of birthing in the seventeenth century, exemplified an attempt to construct ‘therapeutics’ as opposed to ‘superstition’ or ‘ritual.’ They explicitly distanced themselves from what they considered were merely old wives’ tales. For instance, Sharp saw no value in tying the umbilical cord longer for newborn boys than girls, which was often practiced by lay midwives due to an association between the length of the cord and virility.
Nevertheless, lay midwives had stuck to numerous ‘superstitious’ practices which stirred a vivid interest in the late modern period. One of the most meticulous sources on vernacular practices associated with the placenta and umbilical cord in European communities, is a nineteenth-century German compendium by Hermann Ploss and Max Bartels on historical, anthropological, and medical aspects of womanhood. Between 1885 and 1927 it went through eleven editions; in 1935, E. J. Dingwall translated it to English and expanded it. In line with the nineteenth-century cataloguing drive, this compendium cites numerous uses of bodily substances. For instance, in the Austrian province of Styria the fresh blood from the placenta and cord were used to treat burn scars and remove birthmarks: in Italy, the placenta was applied to swollen glands; in Saxony, a dried placenta of the first-born was sold at ‘chemist’ shops as a remedy against epilepsy etc. (Ploss et al., 1935: 805, 810). This meant that placentas not only had individual value (for a newborn and its mother) but were also ascribed a communal value. In the seventeenth century, Venetian midwives were instructed to burn placentas instead of selling them, suggesting their high monetary value in the community (Filippini, 2021: 100). Ploss and Bartels also cite a Belarusian custom of inserting a stump of the umbilical cord into the ‘knot hole of an oak tree’ to render a child as strong as the tree (Ploss et al., 1935: 802). Burying the placenta and cord in a field, and planting a tree on it was also widely popular, as was putting it in a safe place, under the doorstep or in the cellar (Ploss et al., 1935: 810; Filippini, 2021: 100). In parts of Germany, the midwife would hand over the dried cord to the father, for safekeeping, since its preservation was critically linked to the well-being and health of the child (Frazer, [1922], 1990: p. 40). Birthing by-products were so full vitality that they continued to impact the child, which could be the source of their potency – the fate of both, these substances and the child, were forever interlocked.
Conclusion: Devaluing as an epistemic movement
A gradual shift, from Hippocratic and Galenic knowledge about childbirth, based on the doctrine of vitalism, to one based on dissection and modern anatomy, resulted in discarding practices that did not align with these new modes of knowing. Outdated methods were thought to add no ‘value’ to the knowhow on birthing. Some practices were deemed outright harmful, causing injury to the parturient woman and the foetus, and as such were highly discouraged, at times even by law. Other practices, which were perceived as harmless, were stripped off of their therapeutic status, and, instead, categorised by learned observers as ‘ritual’ 6 or ‘superstition’ – replicated in longstanding academic traditions, especially true of anthropological classics. 7
Similar movements were underway in the seventeenth and eighteenth century in Europe. During this period, as knowledge of midwifery transitioned from an embodied, experience-centric to a more ‘scientifically technical’ one, based on anatomical principles, the handling of the placenta and the umbilical cord underwent transformation. There was no consensus emerging in this period among either male or learned, formally-trained and certified female practitioners, about a ‘standard’ or ‘best practice’ and it remains unclear exactly at what point in history this ‘standardisation’ of clamping and cutting the umbilical cord, immediately after the foetus is delivered, occurs. Yet, the movement away from waiting, for the placenta to be delivered and the newborn to securely begin breathing through its lungs, was full and complete by the twentieth century.
While there may not be any clear indication of the above, what I have demonstrated through the different sections of this paper, helps us comprehend how we may have arrived at this juncture by the twentieth century. My first claim is that, despite the varied scholarly readings of sources to produce nuanced vernacular histories of midwifery in Europe, it is undeniable that learned practitioners across the Continent, who were authoring midwifery treatises, were drawing from a common epistemic source and that there was a circulation of reproductive knowledge between these practitioners, located in different parts of Europe. Second, with the rising anatomical awareness, a shift begins to occur from the seventeenth century onward, in the epistemic framing of the knowledge contained in this genre of scientific writings that has deep implications for how reproduction and the female body were perceived. Third, by focusing specifically on the methods of handling the umbilical cord and placenta in the moment of birthing, something that is extensively documented in these treatises, we can see how these larger processes of medical knowledge production and circulation came to bear on perceptions and practices about bodily substances or birthing by-products, thereby, changing their status from ‘value’ to ‘waste.’
In this gradual transitioning between epistemes in early modern Europe, time gained significance, often over and at the cost of therapeutics. Only once the practice of waiting was replaced by a speedy clamping of the cord, that a cascade of interventions became part of managing and delivering the placenta, while older practices came to occupy the status of ‘waste.’ Wasting time became associated with wasteful practices, and ultimately, with waste materials. Within this new logic, the moment of the delivery of the placenta was when the surgeon could consider his job complete. Or, as noted by van Deventer: ‘for I do not spend my Time in trying this or that Method, but proceed in that which is the shortest and most certain’ (van Deventer, 1716: 140–141).
Today, in the context of cord blood banking and regenerative therapies, delayed or optimal cord clamping (waiting till the pulsations in the umbilical vessels cease) is wasteful both in terms of time and because a highly valuable biological substance is being made unavailable for use in ways deemed ‘proper.’ The longer the cord is kept unclamped, the lesser the amount of blood left behind to bank. Similarly, the myriad practices surrounding placentas and umbilical cords, whether the ways in which they were meant to be ‘properly’ disposed or stored for later individual and/or communal use stand in sharp contrast to how regenerative medicine ascertains placental value. On the one hand, to our modern sensibilities and prominent scholarly strands, the older set of practices will appear as ‘ritual,’ even though they were very much entangled with ideas of health and well-being and for how lives – of mothers, newborns, and by extension, the whole community – would be shaped over time. Regenerative medicine's use of placental stem cells, on the other hand, also shaping lives on an altogether different register, will however, be termed ‘therapeutic.’ By tracing practices pertaining to the placenta, the umbilical cord, and ideas about the management of labour in early modern Europe, I argue that it is impossible for us to fully grasp how notions of ‘waste’ and ‘value’ have evolved, without attending to the larger epistemic shifts that occurred field of medical knowledge but also in the kinds of histories we write about the theory and practice of therapeutics of the past.
Footnotes
Acknowledgements
This paper has been a long time in the making and would not have been possible without the continuous feedback and support I have received over the years, from a very generous group of scholars. I would first like to thank Professor Harish Naraindas, my academic mentor, working with whom was the starting point for the questions this article explores. I would also like to acknowledge the dedicated reading and detailed editing of Tamar Novick and Maria Pirogovskaya, editors of this special issue, from the early days of this article as well as all the discussions I had with fellow participants in the Bodily Waste Reading Group at MPIWG, Berlin - all of which helped me immensely sharpen my arguments. I would like to thank my friends Katyayani Dalmia and Alexios Tsigkas for constantly pushing me to do better and going through several iterations of this article. Finally, I want to thank the two anonymous reviewers whose close reading of my work and comments greatly helped steer the article in the right direction.
Declaration of conflicting interests
The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author received no financial support for the research, authorship, and/or publication of this article.
