Artwork: Santi Pérez
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A tlamatlquiticitl washes a newborn in cold water in an illustration adapted from the 16th-century compendium on Aztec customs, the General History of the Things of New Spain.
Artwork: Santi Pérez

Call the Aztec Midwife: Childbirth in the 16th Century

Hygiene and ritual marked every moment of life for pregnant Aztec women. The tlamatlquiticitl—midwife—offered those in her charge a remarkable 16th-century birthing plan, combining practical care, drugs for pain relief, and religious ceremonies.

This story appears in the January/February 2017 issue of National Geographic History magazine.

Where do babies come from? The Aztecs’ answer to the classic child’s question was that they came from the 13th heaven—the highest heaven of all. Here, in this store of unborn souls, they waited until the gods decided to place them in their mother’s belly.

Aztec adults also firmly believed in the divine supervision of childbirth, and that from the moment of conception, a fetus’s healthy development depended on the will of the gods. Aztec society, whose powerful empire stretched over what is now southern Mexico from the 14th through 16th centuries, was suffused with religious customs. It was also highly practical and had devised a remarkable series of systems to monitor the mother and her unborn child.

Homely Wisdom

Much of what is known of Aztec society comes from a book written by Bernardino de Sahagún, a Spanish friar living near what is now Mexico City. During the second part of the 16th century, Sahagún compiled a vast compendium on Aztec customs, entitled the General History of the Things of New Spain. The lavishly illustrated manuscript, whose three volumes are now kept in Florence, Italy, dealt in its sixth book with the complex methods and rituals of Aztec childbirth.

Central to Aztec obstetrics, the General History explains, was the tlamatlquiticitl, or midwife. While noblewomen could expect to be cared for by a midwifery team, women lower down the social scale would also have access to the services of this key figure in Aztec society, who would monitor the pregnancy.

The tlamatlquiticitl paid regular visits to the pregnant woman in her home, where she would conduct gynecological examinations. If there was anything untoward, “she put the pregnant girl in a bath and pressed her belly to turn the baby if it was in the wrong position, moving it from one part to another.”

In the case of a first-time mother, the midwife would also advise her on diet and other habits, such as making sure the water was not too hot when taking baths. She would recommend her charge to continue having sex until the seventh month of pregnancy “because if she abstained entirely from the carnal act, the baby would be born sickly and weak.”

A mentor and wise confidante, the tlamatlquiticitl would prevent the future mother from lifting excess weight that could endanger the fetus, as well as recommending her “to avoid sorrow, anger and surprises so as not to miscarry or damage the baby.”

As the birth approached, the midwife would stay in the woman’s home for four or five days to prepare the mother-to-be. The orderliness and cleanliness of Aztec society observed by the Spanish since their arrival featured strongly in childbirth customs, too. The woman’s body, her hair, and the birthing room were all thoroughly cleaned. The tlamatlquiticitl would then prepare a steam bath in the temazcal—a kind of sauna with a low roof, located just outside the home—using special smoke-free firewood and aromatic plants. This would help the woman relax while the midwife checked the fetus’s condition. Aztec skill with herbal medicine did much to reduce the trauma and pain of childbirth. Once the contractions started, a woman might be given tea made of cioapatli, an herb “that had the virtue of impelling or pushing the baby out.” If, in spite of this, the woman was still in pain and not dilating, “they gave her half a finger of the tail of the animal called tlacuatzin. Then she would give birth easily.”

The woman squatted to give birth with the midwife behind her, holding her heels, so gravity would do some of the work of pushing the baby out and minimize the mother’s effort. Sahagún notes admiringly that indigenous women seemed to give birth with much less effort and pain than Spanish women, and recovered so quickly that many quickly fell pregnant again soon afterward.

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Aztec temples form the base of the Square of Three Cultures in Mexico City, a monument marking the Aztec, Spanish colonial, and modern period in Mexico’s rich history.

First Days of Life

Once the baby was welcomed into the world, the tlamatlquiticitl looked to the hygiene of the mother and the newborn. First she took the mother back to the temazcal so she would sweat out toxins. Resins and aromatic plants both relaxed the mother and helped start milk production. Babies were washed so that Chalchiuhtlicue, goddess of the waters, would “cleanse his heart and make him good and clean.”

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Cihuacoatl, aspect of the goddess of fertility. Quai Branly Museum, Paris

After delivery, the midwife stayed on for four more days to monitor the mother’s milk supply. This was an essential precaution, as weaning would not take place until the child was two years or older, and the Aztec had no animals whose milk could be used as a substitute.

During those four days, practical tasks were carried out along with pious rituals. The placenta was buried in a corner of the home. If the newborn was a boy, the umbilical cord was given to a warrior to bury in enemy territory. Since the main occupation of Aztec men was war, this rite was supposed to fill the future warrior with strength and courage.

The relevant passages from the Huehuetlatolli, a collection of sayings, speeches, and advice from Aztec elders, was quoted soon after birth, including the words of welcome with which a midwife and grandparents should greet a newborn boy: “Your trade and skill is war; your role is to give the sun the blood of your enemies to drink and feed the earth, Tlaltecuhtli, with the bodies of your enemies.” If the newborn baby was a girl, the umbilical cord was buried next to the fireplace to make her a good wife and mother. She was urged to “be to the home what the heart is to the body.”

The naming ceremony was a key ritual in Aztec society. It was the solemn duty of the father to inform the priests of the day and time of birth, and they in turn consulted the Tonalamatl, a kind of almanac structured around the 260-day Aztec year, to discern the most appropriate name. The purpose of this, Sahagún records, “was to predict his good or ill fortune based on the qualities of the sign he was born under.” The Aztec regarded the last five days of the year as a bad omen, so parents did all they could to ensure children born on those days were named after that period ended.

Cradle to Grave

Despite the care provided throughout the pregnancy, childbirth was often lethal. If, in spite of all the effort made, the mother died in labor, she was regarded as a warrior who had died in combat. She was buried in a special temple at twilight, and her soul traveled to the house of the sun.

If the fetus was stillborn, “the midwife took a stone knife, called an itztli, cut the dead body up inside the mother and removed it in pieces,” a grisly procedure that nevertheless “saved the mother from death.” The Aztec believed babies who died during labor traveled to a place called Chichiualcuauhco, where a wet-nurse tree would feed them with its milk. There they would remain, until the gods sent them back to be born of another mother, and the cycle of birth and death turned once more.