A bit of history…
Today, 33% of births in the US are cesarean sections or “c-sections” and the global trend has been increasing. The reasons for performing a c-section versus a vaginal delivery may vary.
The various reasons could include, but are not limited to the following:
- Medical necessity: During delivery your doctor may find the umbilical cord is wrapped around your baby’s neck, your baby won’t engage or other emergency circumstances.
- Vaginal birth may be too risky: Your doctor may pre-determine based on risk factors (e.g. obesity, narrow pelvis, etc.) that a c-section may be safer than vaginal birth.1
- You have twins: If you are carrying twins or triplets and the leading baby is in an abnormal position then a c-section may be necessary. 2
It is important to note that the decision made by you and your doctor should not be taken lightly. Like all major surgeries, c-section procedures come with some risks. The good news is that since the 19th century, there have been numerous medical advancements in performing c-section procedures (read further in the text “The great progress of the 19th & 20th century”).
When did the first c-sections begin and how?
According to legend, the famous Roman dictator Julius Caesar was supposedly born by “caesarean section” in 100 B.C, ‘caesus’ being the latin word for ‘cut.’ However at the time, there were no known surgical techniques to extract the baby from the mother’s womb without being fatal to the mother. Thus ‘Caesarean section’ was performed only as a last resort to save the baby. Caesar’s mother lived until 53 B.C. (47 more years after Caesar’s birth) therefore disproving the legend that she had a c-section, but rather a vaginal birth.
The confusion may be explained by the 8th century BC law, ‘lex Caesarea’, established by Roman King Numa Pompillus, which prohibited the joint burial of mother and child. The law stated that a baby must be extracted from the mother’s body before her burial. Caesarea was an ancient Roman port city establish in the 22nd century BC and located in current day Israel.
It was not until the 16th century A.D. that the first book on a viable c-section procedure was published. It was entitled ” L’hysterotomotokie ou enfantement caesarien ” by François Rousset, a Parisian theorist. His procedure, followed by many surgeons at the time, was to save the mother’s life by opening the belly from the navel to the right flank. Once the baby was extracted, one would only suture the outer wound of the belly. The results were catastrophic as women would die of internal bleeding. In the 17th and 18th century, surgeons could not reach an agreement on best c-section method after many unsuccessful attempts.
The great progress of the 19th & 20th century
After centuries of violent tensions and fiery debates, the procedure significantly improved in the 19th century. In 1823, Auguste Baudelocque, a French doctor, discovered that it was possible to perform a c-section without cutting the peritoneum. This discovery clearly limited haemorrhages and infections.
The Hungarian obstetrician, Ignace Philippe Semmelweis (1818-1865), set out the basic principles of asepticia — or aseptic technique – to limit the introduction of microbes into the body. He felt there was link between the fatal accidents caused by cadaveric cuts during dissections and the death of women in childbirth so he asked his students (University of Vienna) to wash their hands before returning to the delivery room.4
In 1878, Louis Pasteur, a French biologist, microbiologist and chemist, published a thesis entitled “La théorie des germes et ses applications à la médecine et à la chirurgie” which taught surgeons that their hands and their instruments were carrying germs from sick and infected patients to healthy, non-infected patients. He taught them not only how to properly wash their hands, but also to wash or sterilize their instruments and other materials used to perform surgeries.5 In 1876, Edoardo Porro, an Italian obstetrician, proposed to systematically remove the uterus after the baby was extracted to avoid haemorrhages and infections. This method saved many women, but it also made them infertile. A few years later, in 1882, Max Sänger, a German obstetrician and gynecologist, introduced the practice of sutural closure of the uterus, which led to a survival rate of 90%.Over the following decades, the incision techniques and anesthesia slowly improved. 6
By the 1990s, c-section began to be a much more common procedure. Today, almost 30% of all births is by c-section. And c-section rates by country vary widely from about 20% of births in France to more than 50% of births in Turkey. 7
How safe are c-sections today?
The operation itself is not as dangerous as it used to be. It does save lives but it is important to note that there are risks. A c-section procedure is an operation and like any surgical procedure, there may be complications afterwards such as post-operative hematomas or wound infections. These risks could include postpartum hemorrhage after surgery, reaction to anesthesia, or risk of wound infection to name a few. Mayo Clinic also notes that “After a C-section, you face a higher risk of potentially serious complications in a subsequent pregnancy than you would after a vaginal delivery.” 8
Doctors are great resources. They can explain their experience with managing these potential risks so that you can make an informed decision. Ultimately, ensuring you are informed and comfortable about the procedure is what matters most. So be sure to discuss all the potential risks with your doctor.
Once a c-section, always a c-section?
No, not at all. However, in the USA you may have a c-section simply because your first delivery was a c-section. According to the American Journal of Public Health (2011): “Repeat cesareans account for an increasing share of all cesarean deliveries; in 1985, one in three cesareans were repeats.”9
Be sure to review the risks and benefits together with your doctor. It is possible that you may give birth by c-section once and next time have a safe vaginal birth. There are situations where the risks are too great, but always weigh all your options. It is important to be ready for the unexpected as well. For example, there may be situations when a vaginal birth is planned but new risks occur during delivery. Ultimately, regardless of which procedure you have, the decision is between you and/or your doctor based on choice or circumstance.
Related post: – Don’t be afraid to massage your c-section scar
#csectionawarenessmonth
References:
- “Medical reasons for a c-section.” March of Dimes. October, 2018, https://www.marchofdimes.org/pregnancy/c-section-medical-reasons.aspx#
- “C-section.” Mayo Clinic. June 9, 2018, https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
- “The Caesarean Section in Ancient Roman Times.” United Nations of Roma Victrix (UNRV). https://www.unrv.com/culture/caesarean-section.php
- Lapaque, Sébastien. “Ignace Philippe Semmelweis, martyr du lavage des mains.” Le Figaro. March 9, 2020, https://www.lefigaro.fr/sciences/ignace-philippe-semmelweis-martyr-du-lavage-des-mains-20200309
- “Portraits de Médecins, Louis Pasteur.” Medarus. October 18, 2017, http://www.medarus.org/Medecins/MedecinsTextes/pasteurl.html
- Harvey, Thierry. “Presentation Petite Histoire de la césarienne.” PowerPoint presentation. https://hospidon.org/les-projets-a-soutenir/bbdiac/
- “Caesarean sections (indicators).” OECD. 2017, https://data.oecd.org/healthcare/caesarean-sections.htm
- “C-section.” Mayo Clinic. June 9, 2018, https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
- S M Taffel, P J Placek, and T Liss “Trends in the United States cesarean section rate and reasons for the 1980-85 rise.”American Journal of Public Health 77, no. 8, August 1, 1987, pp. 955-959. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.77.8.955
Sources :
- Harvey, Thierry. “Presentation Petite Histoire de la césarienne.” PowerPoint presentation. https://hospidon.org/les-projets-a-soutenir/bbdiac/
- “J’ai accouché par césarienne.” Maison des maternelles. October 16, 2016. Youtube video. https://www.youtube.com/watch?v=8lhBUCOu0hg&t=1434s
- “Histoire de la césarienne.” Césarine. September, 2015, https://www.cesarine.org/avant/histoire/
- Pottiee-Sperry, Francis. “’The hysterotomotokie or birth of Caesarian.’ by François Rousset (Paris, 1581)’ The book of an impostor or that of a precursor?” Histoire des sciences médicales Tome XXX, number 2. 1996, pp. 259-257., https://www.biusante.parisdescartes.fr/sfhm/hsm/HSMx1996x030x002/HSMx1996x030x002x0259.pdf
- “Caesarean sections (indicators).” OECD. 2017, https://data.oecd.org/
- “Caesarean sections (indicators).” OECD. 2017, https://data.oecd.org/
Reviewed by Dr. T. Harvey. (obstretician-gynaecologist in Paris)
Today, 33% of births in the US are cesarean sections or “c-sections” and the global trend has been increasing. The reasons for performing a c-section versus a vaginal delivery may vary.
The various reasons could include, but are not limited to the following:
- Medical necessity: During delivery your doctor may find the umbilical cord is wrapped around your baby’s neck, your baby won’t engage or other emergency circumstances.
- Vaginal birth may be too risky: Your doctor may pre-determine based on risk factors (e.g. obesity, narrow pelvis, etc.) that a c-section may be safer than vaginal birth.1
- You have twins: If you are carrying twins or triplets and the leading baby is in an abnormal position then a c-section may be necessary. 2
It is important to note that the decision made by you and your doctor should not be taken lightly. Like all major surgeries, c-section procedures come with some risks. The good news is that since the 19th century, there have been numerous medical advancements in performing c-section procedures (read further in the text “The great progress of the 19th & 20th century”).
When did the first c-sections begin and how?
According to legend, the famous Roman dictator Julius Caesar was supposedly born by “caesarean section” in 100 B.C, ‘caesus’ being the latin word for ‘cut.’ However at the time, there were no known surgical techniques to extract the baby from the mother’s womb without being fatal to the mother. Thus ‘Caesarean section’ was performed only as a last resort to save the baby. Caesar’s mother lived until 53 B.C. (47 more years after Caesar’s birth) therefore disproving the legend that she had a c-section, but rather a vaginal birth.
The confusion may be explained by the 8th century BC law, ‘lex Caesarea’, established by Roman King Numa Pompillus, which prohibited the joint burial of mother and child. The law stated that a baby must be extracted from the mother’s body before her burial. Caesarea was an ancient Roman port city establish in the 22nd century BC and located in current day Israel.
It was not until the 16th century A.D. that the first book on a viable c-section procedure was published. It was entitled ” L’hysterotomotokie ou enfantement caesarien ” by François Rousset, a Parisian theorist. His procedure, followed by many surgeons at the time, was to save the mother’s life by opening the belly from the navel to the right flank. Once the baby was extracted, one would only suture the outer wound of the belly. The results were catastrophic as women would die of internal bleeding. In the 17th and 18th century, surgeons could not reach an agreement on best c-section method after many unsuccessful attempts.
The great progress of the 19th & 20th century
After centuries of violent tensions and fiery debates, the procedure significantly improved in the 19th century. In 1823, Auguste Baudelocque, a French doctor, discovered that it was possible to perform a c-section without cutting the peritoneum. This discovery clearly limited haemorrhages and infections.
The Hungarian obstetrician, Ignace Philippe Semmelweis (1818-1865), set out the basic principles of asepticia — or aseptic technique – to limit the introduction of microbes into the body. He felt there was link between the fatal accidents caused by cadaveric cuts during dissections and the death of women in childbirth so he asked his students (University of Vienna) to wash their hands before returning to the delivery room.4
In 1878, Louis Pasteur, a French biologist, microbiologist and chemist, published a thesis entitled “La théorie des germes et ses applications à la médecine et à la chirurgie” which taught surgeons that their hands and their instruments were carrying germs from sick and infected patients to healthy, non-infected patients. He taught them not only how to properly wash their hands, but also to wash or sterilize their instruments and other materials used to perform surgeries.5 In 1876, Edoardo Porro, an Italian obstetrician, proposed to systematically remove the uterus after the baby was extracted to avoid haemorrhages and infections. This method saved many women, but it also made them infertile. A few years later, in 1882, Max Sänger, a German obstetrician and gynecologist, introduced the practice of sutural closure of the uterus, which led to a survival rate of 90%.Over the following decades, the incision techniques and anesthesia slowly improved. 6
By the 1990s, c-section began to be a much more common procedure. Today, almost 30% of all births is by c-section. And c-section rates by country vary widely from about 20% of births in France to more than 50% of births in Turkey. 7
How safe are c-sections today?
The operation itself is not as dangerous as it used to be. It does save lives but it is important to note that there are risks. A c-section procedure is an operation and like any surgical procedure, there may be complications afterwards such as post-operative hematomas or wound infections. These risks could include postpartum hemorrhage after surgery, reaction to anesthesia, or risk of wound infection to name a few. Mayo Clinic also notes that “After a C-section, you face a higher risk of potentially serious complications in a subsequent pregnancy than you would after a vaginal delivery.” 8
Doctors are great resources. They can explain their experience with managing these potential risks so that you can make an informed decision. Ultimately, ensuring you are informed and comfortable about the procedure is what matters most. So be sure to discuss all the potential risks with your doctor.
Once a c-section, always a c-section?
No, not at all. However, in the USA you may have a c-section simply because your first delivery was a c-section. According to the American Journal of Public Health (2011): “Repeat cesareans account for an increasing share of all cesarean deliveries; in 1985, one in three cesareans were repeats.”9
Be sure to review the risks and benefits together with your doctor. It is possible that you may give birth by c-section once and next time have a safe vaginal birth. There are situations where the risks are too great, but always weigh all your options. It is important to be ready for the unexpected as well. For example, there may be situations when a vaginal birth is planned but new risks occur during delivery. Ultimately, regardless of which procedure you have, the decision is between you and/or your doctor based on choice or circumstance.
Related post: – Don’t be afraid to massage your c-section scar
#csectionawarenessmonth
References:
- “Medical reasons for a c-section.” March of Dimes. October, 2018, https://www.marchofdimes.org/pregnancy/c-section-medical-reasons.aspx#
- “C-section.” Mayo Clinic. June 9, 2018, https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
- “The Caesarean Section in Ancient Roman Times.” United Nations of Roma Victrix (UNRV). https://www.unrv.com/culture/caesarean-section.php
- Lapaque, Sébastien. “Ignace Philippe Semmelweis, martyr du lavage des mains.” Le Figaro. March 9, 2020, https://www.lefigaro.fr/sciences/ignace-philippe-semmelweis-martyr-du-lavage-des-mains-20200309
- “Portraits de Médecins, Louis Pasteur.” Medarus. October 18, 2017, http://www.medarus.org/Medecins/MedecinsTextes/pasteurl.html
- Harvey, Thierry. “Presentation Petite Histoire de la césarienne.” PowerPoint presentation. https://hospidon.org/les-projets-a-soutenir/bbdiac/
- “Caesarean sections (indicators).” OECD. 2017, https://data.oecd.org/healthcare/caesarean-sections.htm
- “C-section.” Mayo Clinic. June 9, 2018, https://www.mayoclinic.org/tests-procedures/c-section/about/pac-20393655
- S M Taffel, P J Placek, and T Liss “Trends in the United States cesarean section rate and reasons for the 1980-85 rise.”American Journal of Public Health 77, no. 8, August 1, 1987, pp. 955-959. https://ajph.aphapublications.org/doi/abs/10.2105/AJPH.77.8.955
Sources :
- Harvey, Thierry. “Presentation Petite Histoire de la césarienne.” PowerPoint presentation. https://hospidon.org/les-projets-a-soutenir/bbdiac/
- “J’ai accouché par césarienne.” Maison des maternelles. October 16, 2016. Youtube video. https://www.youtube.com/watch?v=8lhBUCOu0hg&t=1434s
- “Histoire de la césarienne.” Césarine. September, 2015, https://www.cesarine.org/avant/histoire/
- Pottiee-Sperry, Francis. “’The hysterotomotokie or birth of Caesarian.’ by François Rousset (Paris, 1581)’ The book of an impostor or that of a precursor?” Histoire des sciences médicales Tome XXX, number 2. 1996, pp. 259-257., https://www.biusante.parisdescartes.fr/sfhm/hsm/HSMx1996x030x002/HSMx1996x030x002x0259.pdf
- “Caesarean sections (indicators).” OECD. 2017, https://data.oecd.org/
- “Caesarean sections (indicators).” OECD. 2017, https://data.oecd.org/
Reviewed by Dr. T. Harvey. (obstretician-gynaecologist in Paris)
