A multifaceted approach towards investigating childbirth deaths in double burials: Anthropology, paleopathology and ancient DNA

Evidence of maternal care and childbirth events in the past are rare in the archaeological record and are difficult to recognize. To combat this, we analyzed thirteen double burials potentially related to childbirth death events, thereby containing an adult and a perinate. The specimens were excavated from the archaeological area identified as “Forlì Campus” (Forlì, Italy), that dated to 17th-18th centuries AD and was adjacent to a hospital in use at that time. This period witnessed the development of medical techniques and novel approaches in obstetrics in Europe, with the introduction of lying-in hospitals and maternity wards. We here tested if the double burials were ascribable to childbirth death events and thus represent the first reported cases of the hospitalization of childbirth in the history of medicine. A multidisciplinary analysis was undertaken to achieve this aim, combining anthropology, archaeology, paleopathology and archaeogenetics. In five burials the adult individual was recognized as a female in fertile age and the non-adult individual was assigned as perinate. Mitochondrial DNA analysis highlighted different haplotypes among the individuals of these burials, and these results, combined with the archaeological and anthropological data do not support a possible maternal relationship between them. This study is novel in testing the hypotheses of childbirth deaths, through a reliable approach in the interpretation of these archaeological contexts. The analysis of ancient DNA in this particular application proves a useful strategy to support and complete the interpretation of archaeological and anthropological data, showing that a general assumption of mother/child relations within such burials can be misleading.