Byzantine families regarded the birth of a child as a happy event that made marriage complete. For women, who were generally responsible for the fertility of the couple, marriage and procreation fulfilled their social purpose and lent them recognition. In contrast, childlessness was at the very least embarrassing, and in conservative circles was even looked on as divine punishment.

Although the birth of a child was an undeniable source of joy for parents, the Byzantines followed in the footsteps of the Ancient Greeks and Romans in showing a clear preference for boys, regardless of social status. According to Euripides, boys were the pillars of the family. In Roman society men were trained to become the pater familias when they married: they had absolute authority over the entire household, decided whether family members should live or die, married off children, adopted new members, released slaves and managed their property as they wished. In contrast, girls were seen as a burden to their parents, especially if they were not wealthy.

Since birth was risky for both the mother and the baby, women about to give birth would say their confession and receive Communion. Most women gave birth at home, though maternity hospitals did exist (for example, the Life of St. John the Merciful makes mention of seven hospitals for pregnant women in Alexandria). Childbirth was usually supervised by midwifes, who were old and experienced women.  In case of complications such as dystocia , a doctor would be called upon to decide whether to perform a caesarean section to save the lives of both mother and child, or an embryotomy to save the mother. Rare manuscript illustrations show women in various birthing positions: some gave birth lying down on a bed (like nowadays), others sitting on a stool, the so called lochaios, maieutikos or teknophoros diphros, while others were held upright by the armpits, supported by other women. Immediately after the baby was born the midwife would cut both the umbilical cord and the placenta, check the baby’s senses and confirm that it was healthy. The baby was then washed in lukewarm water, salted or perfumed with herbs such as myrtle and mastic , which were believed to strengthen the body. After the bath the baby was wrapped in swaddling clothes, which were thought to help the limbs to grow straight, though this practice is now considered unhealthy and damaging. Finally the amnion, the membrane that may have stuck to the baby’s face, was carefully preserved as a sign of good luck.

The postpartum period lasted seven days and, according to a rule by St. Nicephorus the Confessor, the mother and baby were not even allowed to be in the same room. The new mother was considered polluted and therefore vulnerable to attacks by demonic forces: the puerperal fever that may affect many women in this situation was attributed to a demonic presence called Gello or Gyllo, believed to be bent on harming women and infants. As ancient tradition held, women were considered completely clean on the 40^th day after birth, when they would take their baby to church to receive a blessing. To recover and produce milk for breastfeeding the mother followed a special, mainly liquid diet, consisting of wet rusk, eggs, and “confinement soup” (lochozema), which was either wine mixed with sugar and lime pieces, or baked semolina with butter and honey. Well-wishers would call on the couple to congratulate them on the birth of the new baby, bringing gifts like fruit, nuts, candies and even coins if there were well off. Shortly afterwards, the child's birth was celebrated with feasting, dances and songs. It seems that birthdays were also celebrated with presents and parties.

Similar customs were followed when a prince was born. When the empress was ready to give birth she would be taken to a special room in the palace called Purpura (“the Purple Room”), which is why children born there were called Porphyrogeniti (“Purple-born”). When the successor to the throne was born, messengers would be sent all over the empire to spread the good news. The citizens of Byzantium would send gifts and good wishes to suit a girl or a boy. One of the first people to visit the baby was the Patriarch, to bring it the wishes and blessings of the clergy. Banquets, festivals and chariot races would be organized to mark the event, accompanied by an official announcement of the new heir’s name.

In humbler or superstitious environments, women would resort to concoctions, medicines, amulets and witchcraft to boost their fertility or use folk medication to conceive the son they so desired. Financial and other reasons led some women to use contraceptives or employ various methods to induce miscarriage. Abortion was strictly condemned by church and state, which imposed severe punishments (excommunication, exile, death), not only for the mother but also for doctors or midwifes involved.

In the Middle and Late Byzantine periods parents were usually informed of their child’s horoscope and future immediately after birth. Affluent families with the financials means paid mathematician-astronomers to draw their infant’s birth chart, which gave its horoscope and foretold its fortune. Poorer families resorted to folklore or quacks and charlatans.