Cesarean section

Cesarean section is the removal of an unborn child from the uterus by means of surgical incision through the abdominal wall. Originally practiced only on dead women, cesarean section today is a common and relatively safe birth method.

Surgical removal of a fetus (name given to unborn young from the end of the eighth week of development to birth) from a dead or dying mother was mandated for religious purposes by several ancient cultures. Examples of these mandates (or rules) were chronicled in Egypt in 3000 B.C. and in India in 1500 B.C. . In these cases, a cesarean procedure was performed in order to provide separate burials for the mother and the baby. The ancient Roman law code, known as lex caesaria (the "Law of the Caesars"), sometimes ordered this procedure in an attempt to save the baby. It is the law's name that is the probable source of the operation's name, not the legend about the unlikely surgical birth of emperor Julius Caesar (100-144 B.C. ).

Sporadic attempts to perform cesarean sections as a means of saving both mother and baby seem to have occurred in medieval Europe. Records from Frankfurt-am-Main, Germany, claim seven cesareans were performed there before 1411. A French physician reported fifteen cesarean operations by 1581. It is unlikely that many of these cases had nonfatal consequences for the mother because of the incredibly crude surgical practices of the times.

Early Successes

One of the earliest reports of a successful cesarean operation dates to the year 1500, when a Swiss pork butcher or sow gelder named Jacob Nufer used his practiced skills to deliver his own wife of their child. The first reliably documented cesarean section was performed by Jeremiah Trautman in 1610 in Wittenberg, Germany. A renowned Dutch physician, Hendrik van Roonhuyze, championed the procedure. van Roonhuyze included illustrations of his method of cesarean incision in his 1663 book on operative gynecology. Cesarean section came to the British Isles in 1738, when an Irish midwife named Mary Donally performed a successful emergency operation. Cesarean delivery was practiced successfully in the United States by John Lambert of Ohio in 1827 and Francois Prevost in Louisiana before 1832. A patient of William Gibson of Baltimore, Maryland, lived for fifty years after her first delivery of two cesarean births in 1835.

Although cesarean delivery could be successful, the operation was largely avoided throughout the eighteenth and most of the nineteenth century because the maternal (mother's) mortality rate associated with the surgery was between 50 and 75 percent. Also, anesthesia had not been discovered, making the operation an agonizing procedure for the mother. In addition, massive infection was an extremely likely outcome and internal bleeding problems killed many mothers.

Modern Advances

Once anesthesia, antisepsis, and uterine suture (sewing with stitches) became standard, cesarean delivery became a viable and sensible option. During the early 1900s cesarean section gradually replaced other alternatives such as high forceps (an instrument resembling tongs used to help pull a baby from the birth canal) delivery, cutting of the pubic bone, and destruction of the fetus. As the birthplace moved from home to hospital, the cesarean mortality rate dropped to near zero by 1960. The rate of cesarean delivery however, rose dramatically. This rate was spurred on by a doctor's 1916 dictum (saying) "Once a cesarean, always a cesarean". Today, 25 of every 100 births in the United States are by cesarean section.