Cesarean Section

The cesarean section operation has come a long way. Prior to the late 1800s, cesarean section was a last ditch effort to save a baby when the mother had already died or to allow baptism of the baby prior to burial.  Today cesarean, or c-section, is one of the most common, and one of the safest operations women undergo. About 1/3 of all babies in the United States are born by cesarean section and in some places around the world the fraction is up to 80%.

While there is much controversy about when surgical delivery is indicated and almost universal agreement that it is done more often than strictly medically necessary, there is no question that for many women and babies it is a life saving operation.  Conditions like placenta previa (the placenta grows over the opening of the uterus) or mal-presentation (the baby is positioned in such a way that it cannot move down the birth canal) meant almost certain death to a woman and baby in 1800.  Every time I take care of a woman with one of these conditions I am grateful for the evolution and availability of safe cesarean section.

The Cesarean (not, contrary to common myth, named after Julius Cesar) is a very old operation and one done all over the world. Stories of surgical delivery are found in ancient Hindu, Egyptian, Grecian, Roman, Jewish, Chinese and European folklore.  However the first written documentation of a woman and child surviving the operation was of sow gelder, Jacob Nufer, performing the operation on his wife. As the story goes, after several days in labor and help from thirteen midwives, the woman was unable to deliver her baby. Local authorities gave her husband permission to attempt a cesarean. Jacob Nufer’s wife lived to be 77 years old and gave birth to five children vaginally after the cesarean. This occurred in 1500!

In the 1800s, European explorers wrote home of a well established technique for surgical delivery by indigenous people in Uganda. “The healer used banana wine to semi-intoxicate the woman and to cleanse his hands and her abdomen prior to surgery. He used a midline incision and applied cautery to minimize hemorrhaging. He massaged the uterus to make it contract but did not suture it; the abdominal wound was pinned with iron needles and dressed with a paste prepared from roots. The patient recovered well.” It was around the same time that developments in anesthesia, stitches, hand washing and antibiotics in Europe and America lead to the emergence of the operation we know today. In the modern developed world, there is little question that a mom and baby will survive the operation and complications are so infrequent that some women and doctors want to choose c-section as the primary means of having a baby.

But, like many of the benefits of modern life, the benefits of c-section are not evenly distributed. In 2010, 287,000 women died from complications related to pregnancy and birth. 99% of these were in developing countries.  Most of these deaths were preventable and cesarean section would undoubtedly have saved some of these women.

So I can’t help but feel a special gratitude at the end of a c-section, for the combination of scientific discovery, technology, human ingenuity and good fortune that turned a potential tragedy into a healthy mom cooing over her healthy baby.