MUST READ [YOUR HEALTH]...Caesarean Section: Historical view

Caesarean section — also known as C-Section or Caesar — is a surgical procedure in which incision is made through a mother’s abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies.

Most early history of CS remains shrouded in myth and is of dubious accuracy.

Many theories came up from the history to explain the word “caesarean.” Of all the theories, three are most consistent. The first is from the Roman legal code, called Lex caesarea, which allegedly contained a prescription that the baby be cut out of its mother’s womb if she dies before giving birth.

The second is from an ancient story, told in the first century AD by Pliny the Elder, who claimed that an ancestor of Caesar was delivered in this manner. The theory that the word ‘cesarean’ was derived from the surgical birth of Julius Caesar, however, seems unlikely,  since his mother, Aurelia, is reputed to have lived to hear her son’s invasion of Britain. At that time, the procedure was performed only when the mother was dead or dying, as an attempt to save the child for a state wishing to increase its population, hence all the mothers died.

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Thirdly, an alternative etymology suggests that the procedure’s name derives from the Latin verb caedere — to cut — in which case the term ‘Caesarean section’” and the term ‘caesones’ were applied to infants born by post-mortem operations. Ultimately, though, we cannot be sure of where or when the term ‘cesarean’ was coined.

The evolution of cesarean section has meant different things to different people at different times. The indications for it have changed dramatically from ancient to modern times.

Despite rare references to the operation of living women, the initial purpose was, essentially, to retrieve an infant from a dead or dying mother. This was conducted either in the rather vain hope of saving the baby’s life, or, as commonly required by religious edict, so the infant might be buried separately from the mother.

Above all, it was a measure of last resort, and the operation was not intended to preserve the mother’s life. It was not until the 19th Century that such a possibility really came with the grasp of the medical profession.

First successful CS

There were, though, sporadic early reports of heroic efforts to save women’s lives. While the middle ages have been largely viewed as a period of stagnation in science and medicine, some of the stories of caesarean section actually helped to develop and sustain hopes that the operation could ultimately be accomplished.

Perhaps the first written record we have of a mother and baby surviving a CS came from Switzerland in 1500 when a sow gilder, Jacob Nufer, who had operated on many pigs having difficulty during labour in his farm, performed the operation on his wife.

According to the story, when after several days in labour and despite help from 13 midwives, the woman was unable to deliver her baby, the desperate husband eventually gained permission from the local authorities to attempt a caesarean. The mother lived and subsequently gave birth normally to five children, including twins.

The caesarean baby allegedly lived to be 77 years old. But since this story was not recorded until 82 years later, historians question its accuracy.

However, it was the first ray of hope that baby and mother could survive caesarean surgery.

Many of the earliest successful caesarean sections took place in remote rural areas lacking in medical staff and facilities. These operations were performed on kitchen tables and beds, with ordinary knives, or even kitchen knives. Without access to hospital facilities, operations could be carried out without professional consultation.

The history of caesarean section can be understood best in the broader context of the history of childbirth and general medicine histories that also have been characterised by dramatic changes.

Self-inflicted CS

The first woman to perform a CS on herself was 40-year-old Ines Ramirez Perez, a Mexican from the state of Oaxaca, in a rural setting of about 500 people. She had had eight children, seven alive, but the last baby died during labour three years before the pregnancy.

At midnight on March 5, 2000, after 12 hours of continual labour pain, Ramirez sat down on a bench and drank three hard liquors, before she used a 15cm kitchen knife to cut open her abdomen in a total of three attempts from the bottom of her ribs to her pubic area.

The slash was 17cm long. After operating on herself for about an hour, she reached the inside of her womb and pulled out her baby — a boy. Afterwards, she cut the umbilical cord with scissors.

Though the baby was in good condition, she became unconscious. Miraculously, a few hours later, she regained consciousness and used a bandage to cover her wound. She slid into unconsciousness again, but she was discovered by the village health assistant who helped to stitch her wound with needle and thread.

Sixteen hours after her self-inflicted injury, she had a surgical repair of her wound site. After a week, she underwent a second surgery to repair the damage to her intestine during her attempt at a CS. She was discharged on the 10th day with her baby.

- Dr  Samuel Adebayo (dayspringsk05@yahoo.com)

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