The history of the Caesarean section
Despite the urban myth, this form of childbirth has
nothing to do with Julius Caesar, although it is thought that the
name derives from the lex Caesare (the Roman legal code), which
prescribed that a baby should be surgically removed from its
mother's body if she died before childbirth. The roots of the word
Caesarean do, however, mean "to cut".
It was not until the year 1500 in Switzerland that the first
recorded case of both a mother and baby surviving after a Caesarean
took place. The woman's husband was a pig gelder who reportedly
obtained permission from religious authorities and then undertook
the surgery himself. By then, his wife had been in labour for
several days. The wife reportedly went on to have another five
vaginal births and the baby lived until he was 77 years old.
In the 1800s, James Simpson, an obstetrician in Scotland,
discovered chloroform as an anaesthetic for surgery and, although
there was an initial resistance to it being used for the pain of
labour and childbirth (so-called "moral" reasons), after Queen
Victoria had used chloroform for labour, it became widely accepted.
The operation remained highly risky, however, due to major problems
with both severe haemorrhage (bleeding) and infection. By 1880, the
chance of the mother surviving a Caesarean section was still only
around four women in 10 (40%).
A major advance took place in 1882 due to a German doctor called
Kehrer, who started using silver-wire stitches to actually close
the incision on the uterus. Kehrer also experimented with a low
uterine incision, which is a less bloody area of the uterus. With
further discoveries such as washing of the hands and the use of
antiseptic sprays, the operation became much safer.
The advances in anaesthesia, antisepsis and stitching led to the
dropping of maternal deaths from the operation from seven in 10
women who had the operation (70%) in 1800, to one in 10 (10%) in
1900. By the 1940s, the low sideways uterine incision had become
widely accepted thanks to another Scottish doctor called Kerr and,
subsequently, a sideways skin incision also became accepted.
The other main advances in the early 20th century included the
use of drugs to make the uterus contract after the operation to
reduce blood loss, the use of blood transfusion, and
antibiotics.
More recently, the advent and development of epidural and spinal
anaesthesia has made the operation very safe. In 2007, the overall
chances of severe illness from complications from a Caesarean in
the developed world were reported to be only three times higher
than from a vaginal birth (27 per 1000 deliveries for a Caesarean,
versus 9 per 1000 for a vaginal birth) and not at least 10 times
higher, as was previously thought.