Childbirth and its complications have always intrigued man. The challenge is to save the life of both the mother and the child. Experiments and experience have taught us methods of achieving the same. Cesarean section is one of them.
During ancient times, C-section was done on the dying mother as a “last resort” to keep the baby alive.
But today, birth by C-section has started to increase globally. Almost one out of every five births in urban India is through a C-section.
How did this change take place between then and now?
To understand this we need to travel back time and trace the history of the Cesarean Section.
Switzerland, 1500
The story goes that there was a sow gelder named Jacob Nufer whose wife had a prolonged labor. To relieve her pain he supposedly cut open her uterus and pulled out the baby. The mother was alive and the child lived till the age of 77. The accuracy of this incident has often been questioned. But nevertheless the story spread and this novel method set the physicians thinking.
1543
The period of Renaissance.
Andreas Versalius published De Corpus Humani Fabrica. The book explained the anatomy of the female genital system. Aspiring surgeons began to study the human cadaver in detail.
But on the darker side, women were not allowed to attend schools of medicine till the late 19th century.
Here comes the interesting story of Miranda Stuart Barry who disguised herself as a man and performed one of the most successful C-sections in the history of the British Empire.
Around the same time, travelers to Uganda were spectators to a procedure that increased the curiosity of the Western world.
Each tribe in Uganda had a Healer. Whenever a woman went into prolonged labor, the Healer would semi-intoxicate her with banana wine and make a mid line incision on her abdomen to gain access to her uterus. He would then massage the uterus and take the baby out. The incision was then sutured using iron needles and the wound was dressed using a paste obtained from indigenous roots.
This was one of those rare incidents in history when the civilized world seemed to be way behind times.
1800-1875
Back in the Western World surgeons now had a thorough knowledge about the anatomical structures within the female body. But C-section still did not make any progress because of 2 reasons:
-Pain. C-section was a very painful procedure and the people looked at the surgeons as butchers and barbarians.
-Infection. Sterile practices were not known then and opening the peritoneal cavity naturally gave rise to many infectious diseases.
Anesthetics were invented in 1846 and this helped the surgeons operate with precision. It also helped them record the details of the surgery.
Soon antiseptics came into picture and the situation seemed ideal for the much dreaded C-section to become widely accepted.
But this did not happen.
And this time it was because the surgeons were afraid to suture the uterus after childbirth. They thought it would lead to infections; they also believed that the uterine muscles would contract spontaneously and stop the bleed. Thus, many young women died due to hemorrhage and shock.
To overcome this, hysterectomy was suggested by a few doctors. But the idea was discarded for obvious reasons.
1882
Max Sauminger introduced the silver wire stitches and a few years later surgeons started experimenting with transverse incisions on the lower segment of the uterus. This greatly reduced the chances of scar rupture in subsequent pregnancies which was a common occurrence with the previously employed mid line incisions.
1928
Discovery of Penicillin. Antibiotics were used to prevent many hospital-acquired infections.
1950 onwards..
Heart monitors and Ultrasound scan were invented. This helped to foresee the complications that might arise during the course of labor. Patients with pelvic abnormalities, placenta praevia, etc. were advised to get a C-section done.
Thus, The Cesarean section is not a procedure that evolved overnight. It had its own history. Mistakes were committed. Lives were lost.
But it has taken a giant leap from being a near-death or postmortem operation to a life saving one. And to the family of the mother and the operating surgeon, it makes all the difference in the world…
