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.
