Caesarean section (also known as c-section) is arguably one of the earliest operations performed in human history. Its origins, however, are shrouded in mystery.
Although people regard it as a lifesaving procedure, few are aware of the history of the surgery.
The Origin Of C-Section Birth
In ancient times, cutting a fetus from a woman’s body had almost nothing to do with providing life saving assistance for the mother. Instead, the surgery was usually performed when a woman was dying, or had already died, during childbirth.
While birth has remained biologically unchanged, the cultural factors that influence birth practices have varied over the millennia. It is only in very recent history that approaches to c-section have changed – from a procedure that was a last attempt to save an infant, to a controlled operation where mothers were expected to survive.
Today, c-section surgery is one of the most common procedures performed in the world.
History Of C-Section
The early history of c-section procedure is shrouded in myth. It is difficult to tell the difference between fact and folklore. According to Greek mythology and poetry, both Aesculapius, the god of physic, and Bacchus, the god of wine, are said to have come into being through abdominal birth.
There are some historical scholars who argue c-sections were performed in Egypt around 3000BCE.
Sage Sustra, one of the founders of ancient Hindu medicine, from about 600BCE, referred to postmortem abdominal delivery in his medical treatise Sustra Samhita.
The earliest documentation of c-section comes from early Rome. A Roman king, Numa Pompilius (716-673 BCE), proclaimed a law called the Lex Regia (later renamed the Lex Caesarea).
If a pregnant woman died, the law forbade burying her with her fetus still in her body.
The reason given for this law was there might be some chance of saving the baby. It isn’t clear whether the law was religious, or simply aimed to increase the population of tax paying citizens.
A document from the second millennium BCE deals with the adoption of a two year old boy, whose name translates to “pulled out of the womb”; he was born via c-section (ref: A. Leo Oppenheim, ‘A Caesarian Section in the Second Millennium B.C.’ Journal of the History of Medicine and Allied Sciences 15 (1960): 292-294).
The Mishna, a collection of ancient Jewish laws (2nd century BCE – 6th century CE), also makes mention of abdominal birth.
What Was The Historical Purpose Of A C-Section?
The antiquity of the operation has been established, but it’s still very difficult to determine whether it was performed on women who had already died or were still living at the time of the operation. There are rare references to the surgery being performed on living women. The main purpose of a c-section, however, appeared to be to take an infant from a dead or dying mother.
This might have been done in the hope of saving the baby’s life, particularly if the infant was of some value, such as the heir of a noble or royal family. In later times, performing a c-section was more for religious reasons. In 1280, the Roman Catholic Church decreed abdominal delivery of a dead woman’s infant was mandatory, after six months gestation.
This was in order to offer the soul of the unborn baby the chance of salvation through baptism, and so it might be properly buried, separately from its mother. Failure to perform the abdominal delivery was a punishable offence.
When Did We Start Doing C-Sections For Medical Assistance?
In the 1500s, François Rousset, a 16th-century French physician, moved away from medical opinion and advocated for c-section to be performed on living women if there were no other options available for safe birth.
Rare reports indicate some women survived c-sections from the 16th to the 19th centuries. It was still a very risky procedure, however, and usually performed as a last ditch effort to save the baby’s life.
A famous tale of a woman and her baby surviving a c-section comes from Switzerland in 1500. A sow gelder performed the operation on his own wife. She had laboured for several days and 13 midwives were unable to help her give birth.
Her husband allegedly gained permission from local authorities to try a c-section. The mother lived and went on to give birth normally to five more children, including twins. This story was not recorded until some 80 years later, so historians question its authenticity.
How Would A C-Section Be Performed?
In ancient times, birth was a very vulnerable time for mothers and babies. We know, from prehistoric evidence, twice as many women as men died between the ages of 20 and 40 (the childbearing years).
There have been very few discoveries of mother-fetus burials, where it was evident the mother was pregnant at the time of burial. This could be because, until recently, technology wasn’t advanced enough to discover fetal bones, which are very small.
Babies and mothers might have been buried separately, depending on religious and cultural beliefs. And it’s possible babies were born quickly enough to survive, even though their mother didn’t live.
C-section surgery involves soft tissue, so it would be rare to find direct archaeological evidence of it. Hungarian researchers, however, recently found the first genuine evidence of a c-section performed on a mother.
The researchers discovered a mummified body of a mother buried with her baby. They found traces of a sharp-edged cut, 5.7 inch in length, from the umbilical ring to the pubic symphysis.
The mother, Terézia Borsodi, had died in 1794, while giving birth to her sixth baby. Her infant son was born by c-section and baptised while still alive. He died shortly afterwards.
Legal regulations in Hungary at that time required the removal of an unborn infant if a mother had died.
In the late 1800s, better education allowed medical students to improve their understanding of and preparation for performing operations. They also had a more detailed knowledge of the female anatomy.
Advancements in anaesthesia and improvements in sanitation gave more women safe access to medical intervention. This meant they and their babies had a better chance of surviving birth.
Today, we associate c-section surgery with life saving medical assistance. We no longer regard it as merely a last ditch attempt to save a baby.
Many people believe the word ‘caesarean’ originated because Julius Caesar was born by abdominal surgery.
It’s unlikely he really was born in this way. Caesar died at the age of 55, and his mother Aurelia lived long enough to bury him. It’s extremely unlikely she would have survived a c-section, given he was born in 100BCE.
The term probably originated from the Latin verb caedere, which mean ‘to cut’. The Latin term caesones referred to babies born by postmortem operations.