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 experience.
Surgical removal of a fetus from a dead or dying mother was mandated for religious purposes by several ancient cultures--in Egypt in 3000 b.c. and in India in 1500 b.c. in order to provide separate burial for the two individuals. The ancient Roman law code, known as lex caesaria, mandated this procedure in an attempt to save the baby and is the probable source of the operation's name (not the legend about the unlikely surgical birth of Julius Caesar (100-44 b.c.), whose mother lived for many years after his delivery).
Sporadic attempts to perform cesarean section as a means of saving both mother and baby seem to have occurred in medieval Europe. Records from Frankfurt-am-Main, Germany, claim seven caesareans were performed there before 1411; a French physician reported fifteen cesarean operations by 1581. In this era of incredibly crude surgery, however, it is unlikely that many of these cases could have had nonfatal consequences for the mother.
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 and 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 these and other cases demonstrated that cesarean delivery could be successful, the operation was largely avoided throughout the eighteenth and most of the nineteenth century because of the dreadful maternal mortality rate--between 50 and 75 percent. Before the discovery of anesthesia in 1847, a cesarean was an agonizing procedure for the mother, strictly a last-resort option. Massive infection was an extremely likely outcome until the adoption of antiseptic principles for surgery after 1867. Internal bleeding, too, killed many mothers until two German physicians, Max Sanger and Adolf Kehrer, began to practice uterine suture--previously ignored--in 1882.
Once anesthesia, antisepsis, and uterine suture became standard, cesarean delivery became a viable and sensible option. During the early 1900s cesarean section gradually replaced other alternatives such as high forceps delivery, cutting of the pubic bone, and destruction of the fetus. As the birthplace moved from home to hospital, and the cesarean mortality rate dropped to near zero by 1960, the rate of cesarean delivery rose dramatically. This rate was spurred on by the dictum " Once a cesarean, always a cesarean" and by the fear of today's physicians that they will be sued for malpractice if they fail to perform a cesarean. Cesarean section is the most common major operation performed in the United States. However, in the 1990s, the percentage of cesarean sections in the U.S. has steadily declined from a high of 25 percent in 1990 to approximately 20 percent at the end of the decade. The World Health Organization has set a goal of reducing the use of cesarean sections to 10 to 15 percent, citing that the procedure is costly, often unnecessary, and though largely safe still increases the chances of maternal death by two to four times compared to vaginal births.
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