Cesarean sections, more commonly known as C-sections, are surgical procedures used to deliver babies. During a C-section, a doctor makes an incision through the mother’s abdomen and uterus to deliver the baby.
For much of human history, C-sections were extremely dangerous for the mother. However, advances in medical knowledge and surgical techniques over the past few centuries have dramatically improved the safety and outcomes of these procedures.
The origins of C-sections
There is evidence that C-sections have been performed since ancient times. Chinese folklore recounts a legend from the Shang dynasty (1600-1046 BCE) of a woman who was cut open to deliver her baby. Other early accounts of C-sections come from Hindu, Egyptian, Grecian, and Roman sources.
However, in these early eras, C-sections were only performed when a pregnant woman died or was dying, in an attempt to save the unborn baby. The surgery was not intended to preserve the mother’s life and in fact almost certainly hastened her death.
The term “caesarean” likely derives from a Roman law known as Lex Caesarea. This law mandated that any pregnant woman who died during childbirth be cut open to attempt to rescue the baby. As caesars were often born by C-section, the procedure became known as a “caesarean operation.”
C-sections in the Middle Ages and Renaissance
During the Middle Ages and into the Renaissance, C-sections remained extremely risky. They were typically only recommended if a pregnant woman died during labor, as an attempt to baptize or rescue the infant.
Survival of either mother or baby was rare but did occasionally occur. There are a few well-documented cases of women and infants surviving C-section operations during this era:
- In 1500, a Swiss pig gelder named Jacob Nufer performed a C-section on his wife after a prolonged labor. Both she and their son survived.
- In the 16th and 17th centuries, some women survived C-sections long enough to go through multiple successful pregnancies afterwards.
However, most accounts of C-sections from this era end with the death of the mother, even if the baby survived. The most common causes of maternal death were hemorrhage and infection.
Surgical advances: 1700s-1800s
It was not until the 18th and 19th centuries that medical advancements finally made C-sections survivable for most women. Some key innovations and discoveries included:
- Improvements in surgery and suturing technique – Surgeons developed better tools, sutures, and techniques to help control bleeding during and after surgery.
- Adoption of antiseptic practices – Following discoveries that germs cause infection, doctors began washing hands and sterilizing instruments before surgery.
- Anesthesia – The advent of ether, chloroform, and other anesthetics in the 1840s allowed women to undergo surgery unconscious and without pain.
- Blood transfusions – The ability to transfuse blood helped prevent deaths from hemorrhaging.
With these improvements, maternal mortality rates from C-sections finally started to decline. One of the first documented successful planned C-sections with both mother and baby surviving was performed by a Edinburgh obstetrician in 1794.
Maternal mortality rates over time
| Era | Maternal Mortality Rate |
|---|---|
| 1800s | 85-90% |
| Early 1900s | ~50% |
| 1950s | 15-20% |
| Today | <1% in developed countries |
As the table shows, maternal death rates fell dramatically over the 19th and 20th centuries with medical improvements. Today, maternal deaths are exceedingly rare in developed countries.
Modern C-section practices
Nowadays, C-sections are very common and routine procedures. In the United States, about 1 in 3 babies are delivered via C-section. Reasons for planned C-sections include:
- Breech positioning of the baby
- Multiple births (twins, triplets, etc)
- Maternal infections like HIV or genital herpes
- Complications from the mother’s health conditions
- Previous C-sections
- Maternal choice
Many C-sections are also performed when complications arise during labor. With modern medicine, the mortality rate is extremely low in planned C-sections – less than 1 in 2,500 in developed countries. Death is more likely with emergency C-sections, but still quite rare at 1 in 10,000.
While C-sections today are generally very safe, they do carry additional risks compared to vaginal delivery. Possible risks include:
- Infections
- Blood clots
- Surgical injury
- Difficulties with future pregnancies
For this reason, when deemed safe, vaginal delivery is usually still preferred over elective C-sections.
C-section rates by country
| Country | C-section Rate |
|---|---|
| Brazil | 55.5% |
| United States | 32.0% |
| Switzerland | 33.0% |
| Italy | 21.7% |
| Israel | 15.5% |
| Iceland | 16.0% |
| Norway | 16.7% |
There is significant variation globally in C-section utilization. Rates are highest in middle and high-income countries and lower in developing nations.
Conclusion
In summary, C-sections transformed over centuries from a desperate last-ditch effort to save a baby into a common and generally safe procedure. Major advances in surgical techniques, infection control, and anesthesia in the 18th-19th centuries were the breakthroughs that finally made caesarean sections survivable for most women.
While planned C-sections today carry some risks and limitations compared to vaginal birth, they can be lifesaving procedures and enable many women with complicated pregnancies to deliver healthy babies safely.