International Journal of Osteoarchaeology

Int. J. Osteoarchaeol. 14: 98–103 (2004)

Published online 10 March 2004 in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/oa.714

A Dystocic Childbirth in the Spanish

Bronze Age
A. MALGOSA,a,* A. ALESAN,a S. SAFONT,a M. BALLBÉb
AND M. M. AYALAc
a
Unitat d’Antropologia, Dept. Biologia Animal, Biologia Vegetal i Ecologia,
Universitat Autònoma de Barcelona, Spain
b
Rambla d’Egara 63–65, 08221 Terrassa, Spain
c
Dept. Arqueologı´a, Prehistoria, Historia Antigua e Historia Medieval, Universidad de Murcia,
Spain

ABSTRACT Prehistoric cases of maternal and fetal death during labour are difficult to document.
However, this must have been a frequent cause of death among young women who lived
in hard circumstances and precarious health conditions. In this paper, a case of a Bronze Age
woman who probably died during childbirth due to unavoidable reasons is presented: her
baby was lying transversely with the right fetal arm protracted. Death of both mother and child
was inevitable. Copyright ß 2004 John Wiley & Sons, Ltd.

Key words: pregnancy; dystocia; death during childbirth; burial; Bronze Age

Introduction in a few cases. Even in these cases the cause of

death could be unrelated to childbirth (but rather
There are a lot of references in anthropological to violence, sacrifice, illness or accidents among
and palaeopathological literature about the high others) or the individuals could even have been
mortality rate in young women in ancient times. buried at different times. In spite of the lack of real
Actually, the majority of authors establish a link evidence, all considerations about the high mor-
between the death of young women and serious tality rate of women related to their reproductive
problems related to motherhood: pregnancy, function are based on health and sanitary condi-
childbirth, and breast-feeding. This relationship tions but are probably reasonably valid.
has been inferred from palaeodemographic data, However, there is not a complete lack of direct
ethnographic references, and the bad health con- archaeological evidences. A few cases of preg-
ditions attributed to ancient human groups. nant women with fetus in utero have been reported
Therefore, all considerations about the causes of (Møller-Christensen, 1958; Hawkes & Wells,
death of females during their reproductive years 1975; Sjøvold et al., 1974 cited in Wells, 1978;
come from indirect data: the high frequency of Wells, 1978; Pounder et al., 1983; White &
skeletons of young women and perinatal indivi- Folkens, 1991; Agustı́ & Codina, 1992; Campillo
duals, extrapolation from ethnographic data, etc. et al., 1998). There are also other cases related to
The most suggestive evidence is the double bur- obstetric problems but without evidence of fetal
ials, which contain a woman and a child, but the remains inside the mother’s pelvic girdle. This is
mother-child relationship has only been proved the case of a skeleton of a young woman who
suffered a surgical ligature possibly performed
* Correspondence to: Unitat d’Antropologia, Dept. Biologia Ani- after a laceration of the pubic symphysis and
mal, Biologia Vegetal i Ecologia, Universitat Autònoma de
Barcelona, 08103 Bellaterra-Cerdanyola del Vallès. Spain. the rupture of the right sacro-ileal joint after
e-mail: [email protected] she gave birth (Capasso et al., 1992).
Copyright # 2004 John Wiley & Sons, Ltd. Received 11 July 2003
Revised 5 August 2003
Accepted 7 October 2003
Ancient Dystocic Childbirth 99

A completely different question is the possibi- rooms of the village houses, mainly fetuses and
lity of finding out the cause of death and if there infants (Ayala et al., 2000). It was in one of these
is a relationship between death and some obste- houses that the double interment of a woman
tric problem. These archaeological cases are with a fetus was found during the field season of
unusual in spite of the following affirmation: 1996.
‘pregnant female skeleton are not exceptionally
rare in ancient burials’ (Wells, 1978). Maybe
these cases are ‘not exceptionally rare’ but they Description of the individuals
are not well reported in the literature either,
therefore they are not actually well known. It is CV 96MN-1
possible that some new cases will appear if
greater attention is paid to more accurate archae- The burial CV 96-MN contains an inhumation of
ological collection of bones during excavations as a woman with a fetus inside the pelvic cavity. The
well as more accurate recording of archaeological female skeleton was buried in a left lateral posi-
and anthropological data in recent archaeological tion, with flexed arms and legs (Figure 1).
research. Decomposition must have taken place in a com-
In this paper a clear case of a pregnant woman pletely filled space as is shown by the integrity of
is presented. In this case, it has been possible to the articulations: the temporomandibular joint
link the burial with her death during dystocic and other weak articulations (phalangeal, feet,
labour due to the advanced state of pregnancy etc) were conserved.
and the position of the fetal bones. In addition, The preservation index based on the number
the time of burial must be considered as it is the of bones (modified from Walker et al., 1988) is
most ancient case found in palaeopathological about 100%. All the bones were well preserved
literature so far. except for the skull. Sex and age were determined
according to skeletal morphological traits
(Ferembach et al., 1980, Krogman & Íşcan,
The site 1986) that suggest a young female individual of
25–26 years of age. The stature of 151 cm was
The skeletal remains of the pregnant woman calculated from the length of the long bones of
analysed here comes from the Argaric site of ‘El both extremities using Pearson formulas (Olivier,
Cerro de las Viñas de Coy’ (Lorca, Murcia, 1960).
Spain), which is located in southeast Spain. The Incomplete coxal bones and sacrum are
prehistoric village was located in a strategically present. Bone reconstruction was not possible,
high place in the confluence of natural routes of therefore obstetric measurements were not reli-
communication. For this reason it was occupied able despite the fact that they could have been
repeatedly from Neolithic to Middle Ages. The important in the interpretation of the individual.
site under study belongs to the Argaric culture. No pathologies related to the pregnancy or
This culture existed during the Bronze Age in the the labour could be diagnosed.
southeast region of the Iberian Peninsula (1500–
1000 BC). There are some ceramic and metal
objects (made of copper, bronze and gold) that CV 96MN-2
characterize the Argaric culture and therefore
allow archaeologists to date sites. The typical The majority of bone remains of this individual
funerary ritual was individual inhumation, but were found inside the pelvic girdle of CV 96MN-
some double and, more unusually, triple burials 1. The individual was well preserved (90.48%)
have been found. Most of these burials were and almost all bones were recovered and could be
commonly performed under the houses or inside analysed (Figure 2).
their perimeter, but always inside the village The fetus was found in a transverse lie, in a
(Ayala, 1991). In the case of Cerro de las Viñas right lateral position. The right arm was
several inhumations have been found inside the extended and located under the pubic symphysis.
Copyright # 2004 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. 14: 98–103 (2004)
100 A. Malgosa et al.

Figure 1. The Argaric woman’s skeleton in situ in the grave.

Therefore the baby’s right arm bones were not calculated according to long bone length. There-
found with the rest but rather outside the fore it can be considered a full term fetus. No
mother’s uterus. Most of the joints were well bone pathology could be diagnosed.
preserved which shows that the process of decay
took place in a completely filled space.
From the degree of development and the Discussion
measurements of the cranial (Redfield, 1970;
Ohtsuki, 1976; Weaver, 1979) and long bones The archaeological work showed that there had
(Fazekas & Kósa, 1979; Scheuer et al., 1980) an been no important post depositional movements
age of 37–39 gestational weeks could be attrib- of the bones. The bone position and the con-
uted to the fetus. A body length of 48.87 cm was servation of the joints offer a ‘photograph’ of the
Copyright # 2004 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. 14: 98–103 (2004)
Ancient Dystocic Childbirth 101

Figure 2. The skeleton of the fetus CV 96MN-2.

moment of the burial. In this image all the fetal of the fetus at the beginning of the labour implies
bones were inside the maternal pelvic girdle lying a dystocic labour (Figure 3). Also, the right arm
in a transverse/oblique position. It is therefore a outside the maternal uterus shows that it was a
clear case of fetus in utero. According to the fetal case of prolapse.
maturity (37–39 gestational weeks) and the The shoulder presentation of the fetus and the
degree of the opening of the pubic symphysis, prolapse of its right arm are the sequence of
labour could have started. This incorrect position events that could have taken place when, at the
Copyright # 2004 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. 14: 98–103 (2004)
102 A. Malgosa et al.

coming this difficulty (Hellman & Pritchard,

1975; Botella & Clavero, 1976; Käser et al.,
1979; Taber, 1979; Iffy & Charles, 1984).
In the case under study and taking into account
the difficulties of the labour, it is very likely that
hyperthermia arose in the mother, due to infec-
tion of the uterine cavity contents, which, if not
expelled early, cause maternal death from sepsis.
Hyperthermia entails maternal and fetal (if the
fetus is still alive) tachycardia and, eventually,
cardiac arrest. In these circumstances, the mother
eventually dies from exhaustion. Whatever way
she died, exhaustion would be an accompanying
factor.
This scenario could be a possible way of
explaining this fatal labour: mainly sepsis, hae-
morrhage and exhaustion were the cause of the
mother’s death. In this case, it is very clear that
this Argaric woman died during labour. This is
perhaps one of the rare archaeological cases in
which the cause of death can be established.

Figure 3. Drawing of the position of fetus CV 96MN-2 during the

labour (modified from Farabeuf & Varnier,1929). References
Agustı́ B, Codina D. 1992. Noves aportacions al
beginning of labour, the fetus was either in an coneixement de les necrópolis emporitanes. Les
oblique or in a transverse lie (in medical practice, restes humanes. Annals de l’Institut d’Estudis Empordane-
the fetal transverse lie and the oblique one may sos (Figueres). 25: 385–397.
be confused because their prognosis and treat- Ayala MM. 1991. El poblamiento argárico en Lorca. Estado de
ment are identical). la cuestión. Real Academia Alfonso X el Sabio:
The probable cause of death of the mother, Murcia.
Ayala MM, Malgosa A, Jiménez S. 2000. La Arqueo-
and consequently the death of the fetus, can be logı́a de la Muerte en el Sureste de la Penı́nsula
discussed according to modern obstetric practice. Ibérica. In Proto-história da Penı´nsula Ibérica. ADECAP:
As mentioned above, the position of the fetal Porto; 113–121.
bones reveals that it was lying obliquely or Botella LJ, Clavero NJ. 1976. Tratado de Ginecologı´a,
transversely when labour began. The only way Vol. II: Patologı́a obstétrica, 10a Ed. Editorial Cien-
of overcoming this incorrect position with suc- tı́fico-Médica: Barcelona.
cess nowadays is by Caesarean section, mainly in Campillo D, Vilaseca A, Casamitjana E, Ayestarán N.
a term pregnancy. Even with a neglected trans- 1998. Esqueleto de una mujer fallecida por distocia,
verse lie and a dead baby, Caesarean section is perteneciente al perı́odo tardorromano (Mas Rim-
usually preferred, since the uterus is tightly con- bau, Tarragona). Empúries 51: 251–256.
tracted around the baby and spontaneous deliv- Capasso L, Musio M. di, Tota G. di, Janssens PA,
Spoletini L. 1992. Un caso di legatura chirurgica
ery is impossible, unless the fetus is very small or sacro-iliaca di epoca rinascimentale dall’Italia Cen-
macerated. In this situation and without perform- trale. Minerva Ginecol. 44: 43–49.
ing a Caesarean section, the uterine muscle con- Farabeuf LH, Varnier E. 1929. Introducción al estudio
tinues to contract for a certain period of time clı́nico y a la práctica de los partos. 3a Ed. Pubul:
(maybe hours or days) and—eventually—it can Barcelona.
rupture or, more likely, it can not perform its Fazekas IGY, Kósa F. 1979. Forensic Fetal Osteology.
function because of the impossibility of over- Akadémiai Kiadó: Budapest.

Copyright # 2004 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. 14: 98–103 (2004)
Ancient Dystocic Childbirth 103

Ferembach D, Schwidetzki I, Stloukal M. 1979. Re- Pounder DJ, Prokopec M, Pretty GL. 1983. A prob-
commandations pour determiner l’âge et le sexe sur able case of Euthanasia among prehistoric abori-
l’esquelette. Bull. et Mém. Soc. d’Anthrop. Paris. 6(XIII): gines at Roonka, South Australia. Forensic Science
7–45. International 23: 99–108.
Hawkes SC, Wells C. 1975. An Anglo-Saxon obstetric Redfield A. 1970. A new aid to aging immature
calamity from Kingsworthy, Hampshire. Medical and skeletons: development of the occipital bone.
Biological Illustration 25: 47–51. American Journal of Physical Anthropology 33: 207–220.
Hellman LM, Pritchard JA. 1975. Williams Obstetricia. Scheuer JL, Musgrave JH, Evans SP. 1980. The
Salvat Editores: Barcelona. estimation of late fetal and perinatal age from
Iffy L, Charles D. 1984. Operative Perinatology. Invasive limb bone length by linear and logarithmic regres-
Obstetric Techniques. Macmillan Publishing Company: sion. Annals of Human Biology 7: 257–265.
New York. Taber BZ. 1979. Manual of Gynecologic and Obstetric
Käser O, Friedberg V, Ober KG, Thomsen K, Zander Emergencies. W.B. Saunders Company: Philadelphia.
J. 1979. Ginecologı́a y Obstetricia. Tomo II: Embarazo y Walker PL, Johnson JR, Lambert PM. 1988. Age and
parto. Salvat Editores: Barcelona. sex biases in the preservation of human skeletal
Krogman WM, Íşçan YM. 1986. The Human Skeleton in remains. American Journal of Physical Anthropology 76:
Forensic Medicine. Ch. C. Thomas: Springfield, 183–188.
Illinois. Weaver DS. 1979. Application of the likelihood ratio
Møller-Christensen V. 1958. Bogen om Æbelholdt kloster. test to age estimation using the infant and child
Dansk Videnskabs forlag: København. temporal bone. American Journal of Physical
Ohtsuki F. 1976. Development changes of the cranial Anthropology 50: 263–270.
bone thickness in the human fetal period. American Wells C. 1978. A mediaeval burial of a pregnant
Journal of Physical Anthropology 46: 107–112. woman. Practitioner 221(1323): 442–444.
Olivier G. 1960. Pratique anthopologique. Vigot Frères: White TD, Folkens PA. 1991. Human Osteology.
Paris. Academic Press, Inc.: San Diego.

Copyright # 2004 John Wiley & Sons, Ltd. Int. J. Osteoarchaeol. 14: 98–103 (2004)