From Embryotomy to Cesarean: Changes in Obstetric Operatory Techniques in Nineteenth- and Twentieth-Century Urban Brazil

This article traces the historical processes by which Brazil became a world leader in cesarean sections. It demonstrates that physicians changed their position toward and use of different obstetric surgeries, in particular embryotomies and cesarean sections, over the course of the nineteenth and twentieth centuries. The authors demonstrate that Catholic obstetricians, building upon both advancements in cesarean section techniques and new civil legislation that gave some personhood to fetuses, began arguing that fetal life was on par with its maternal counterpart in the early twentieth century, a shift that had a lasting impact on obstetric practice for decades to come. In the second half of the twentieth century, cesarean sections proliferated in clinical practice, but abortions remained illegal. Most importantly, women remained patients to be worked on rather than active participants in their reproductive lives.

From the Ancient Myth of the Caesars to the Medieval and Renaissance Tradition: The Practice of Caesarean Section in De universa mulierum medicina by Rodrigo de Castro

The caesarean section performed on a living woman to save both mother and baby is first considered in gynaecological texts in the late sixteenth century after the treatise by the French physician François Rousset. It is included alongside descriptions of the post-mortem caesarean section, already practised in the Middle Ages in order to save the baby. The early seventeenth-century work by the Lusitanian physician Rodrigo de Castro is often referenced on this subject, seen as critical of Rousset's theory. Castro is cited above all for formulating a new suggestion - operating on a woman in the throes of death - because he was convinced that the post-mortem caesarean section was pointless. This article provides thorough analysis of Castro's work, comparing it to Rousset's treatise and medical texts by other authors to reveal its originality and its real contribution to the interpretation of the two different caesarean sections.

Cesarean section one hundred years 1920-2020: the Good, the Bad and the Ugly

In present-day obstetrics, cesarean delivery occurs in one in three women in the United States, and in up to four of five women in some regions of the world. The history of cesarean section extends well over four centuries. Up until the end of the nineteenth century, the operation was avoided because of its high mortality rate. In 1926, the Munro Kerr low transverse uterine incision was introduced and became the standard method for the next 50 years. Since the 1970's, newer surgical techniques gradually became the most commonly used method today because of intraoperative and postpartum benefits. Concurrently, despite attempts to encourage vaginal birth after previous cesareans, the cesarean delivery rate increased steadily from 5 to 30-32% over the last 10 years, with a parallel increase in costs as well as short- and long-term maternal, neonatal and childhood complications. Attempts to reduce the rate of cesarean deliveries have been largely unsuccessful because of the perceived safety of the operation, short-term postpartum benefits, the legal climate and maternal request in the absence of indications. In the United States, as the cesarean delivery rate has increased, maternal mortality and morbidity have also risen steadily over the last three decades, disproportionately impacting black women as compared to other races. Extensive data on the prenatal diagnosis and management of cesarean-related abnormal placentation have improved outcomes of affected women. Fewer data are available however for the improvement of outcomes of cesarean-related gynecological conditions. In this review, the authors address the challenges and opportunities to research, educate and change health effects associated with cesarean delivery for all women.

Medical Compromise and Its Limits: Religious Concerns and the Postmortem Caesarean Section in Nineteenth-Century Belgium

Situated on the intersection of medicine and religion, postmortem caesarean sections exposed ideological boundaries in nineteenth-century medicine. According to clerical guidelines circulating in Catholic territories, Catholics who had not necessarily received medical training had to perform operations on deceased women in the absence of medical staff. Most doctors, on the other hand, objected to surgical interventions by unqualified Catholics. This article uses the Belgian debates about the postmortem caesarean section as a means to investigate methods of negotiation between liberal and Catholic doctors. The article analyzes, first, how doctors incorporated religious concerns such as baptism in the medical profession. Second, physicians' strategies to come to a compromise in ideologically diverse settings are examined. Overall, this article casts light on the dynamics of medical debate in times of both ideological rapprochement and polarization.

For the good of the nation: scientific discourses endorsing the medicalization of childbirth in Peru, 1900-1940

Over the course of the twentieth century, a series of changes occurred in the understanding of childbirth, which went from being a natural reproductive phenomenon belonging to the female, domestic sphere to a professional medical matter handled in an institutional setting. Through procedures like the use of anesthesia, Cesarean sections, ultrasound and other techno-scientific interventions, rapid and significant improvements and changes took place in the health and life of society and of women. The medicalization of childbirth in the early twentieth century was part of a broader process of constructing the state and institutionalizing the patriarchy that was common throughout the region.

Risk and Reputation: Obstetricians, Cesareans, and Consent

When physicians performed cesarean sections in the nineteenth century, they customarily sought agreement from all present before proceeding. In contrast, after the introduction of electronic fetal monitoring in the late 1960s, obstetricians obtained permission for a cesarean by offering a choice that ensured consent-give birth by cesarean or give birth vaginally to a damaged or dead baby. This article argues that the manner in which physicians obtained consent for cesareans in the nineteenth century was one factor that kept the cesarean rate low, while the manner in which physicians obtained consent in the late twentieth and early twenty-first centuries was one factor driving up the cesarean rate. The dissimilar approaches to consent did serve a common purpose, however. Each preserved physicians' reputations. With the surgery likely to end in a woman's death in the nineteenth century, consensus ensured that a bad outcome would be a shared burden. And because the fetal monitor, in exaggerating the risks of vaginal birth, changed the nature of the malpractice climate for obstetricians, the late-twentieth-century approach to consent similarly protected physicians. As one early twenty-first-century obstetrician quipped, "You don't get sued for doing a C-section. You get sued for not doing a C-section."

Was Queen Jane Seymour (1509-1537) Delivered by a Cesarean Section?

No direct evidence documents exactly how Jane Seymour gave birth on October 12, 1537. Several later commentators have raised cesarean birth as an option. This paper tries to establish the probable cause of Jane Seymour's death in accordance with present-day knowledge of obstetrics and whether or not a cesarean section could have been actually performed in sixteenth-century England. It appears almost certainly that there were no obstetrical indications that would have led the Queen's physicians to operate on her, a surgeon was not present at her delivery, cesarean section on a living woman was not regularly performed in England in 1537, puerperium events do not support surgery, and the existing pro-cesarean confirmation was politically motivated. Therefore, the most likely mode of Jane Seymour's delivery was vaginal rather than cesarean.

[Outline of the history of caesarean section – from ancient times to the end of 17th Century]

Problems with the childbirth accompanied the human civilization since its beginning. From the ancient times, physicians and other people specializing in healing, tried to help women in this special moment of life. At the base of this exceptional meaning of childbirth for humans lies the fact, that if something is going wrong there are two victims - mother and the child. As a result, many times there had been very dramatic attempts of help in this the most difficult journey which in his life every man is undergoing. In this paper a comprehensive review of literature about the history of caesarean section from ancient times to the end of 17th century was done.

[Historical Review of Cesarean Section at King's Maternity Hospital and Midwifery School Zagreb 1908-1918]

This article presents a historical review of the performance of 23 cesarean sections at the King’s Maternity Hospital and Midwifery School in Zagreb during the 1908-1918 period. Following prenatal screening by midwives and doctors in the hospital, deliveries in high risk pregnant women were performed at maternity hospitals, not at home. The most common indication for cesarean section was narrowed pelvis in 65.2% of women, while postpartum febrile condition was the most common complication in the puerperium. Maternal mortality due to sepsis after the procedure was 8.69% and overall perinatal mortality was 36.3% (stillbirths and early neonatal deaths).

Cesarean sections, perfecting the technique and standardizing the practice: an analysis of the book Obstetrícia, by Jorge de Rezende

This article discusses the development of techniques for cesarean sections by doctors in Brazil, during the 20th century, by analyzing the title "Operação Cesárea" (Cesarean Section), of three editions of the textbookObstetrícia, by Jorge de Rezende. His prominence as an author in obstetrics and his particular style of working, created the groundwork for the normalization of the practice of cesarean sections. The networks of meaning practiced within this scientific community included a "provision for feeling and for action" (Fleck) which established the C-section as a "normal" delivery: showing standards that exclude unpredictability, chaos, and dangers associated with the physiology of childbirth, meeting the demand for control, discipline and safety, qualities associated with practices, techniques and technologies of biomedicine.

Prague 1337, the first successful caesarean section in which both mother and child survived may have occurred in the court of John of Luxembourg, King of Bohemia

OBJECTIVE

An interdisciplinary historical-medical study, analysis of historical sources, and critical interpretation of the indirect evidence surrounding the childbirth of Beatrice of Bourbon, the second wife of the Bohemian King John of Luxembourg.

STUDY TYPE

A material-based study founded on a comparative analysis of available private and public sources, particularly surviving letters, and narrative sources. The conclusions are reached based on a textual interpretation according to historical methods.

SETTINGS

Department of Obstetrics and Gynecology of the First Faculty of Medicine of Charles University and General University Hospital in Prague.

METHODS AND RESULTS

Until the second half of the 19th century, medical knowledge of antiseptics and anesthesia was lacking, and techniques for cleaning wounds and staunching bleeding were primitive.Because no effective anesthetics were known before that time, people did not know how to perform painless abdominal surgery. There are a very few credible reports of caesarean sections performed on living women as early as the 17th century. However, before the 19th century, a caesarean section meant almost certain death for the mother, with related mortality as high as 90%. If the woman did not die of stress from the pain of the abdominal surgery, then she usually died of either bleeding or later of sepsis. However, there is some indirect evidence that the first caesarean section that was survived by both the mother and child was performed in Prague in 1337. The mother was Beatrice of Bourbon (1318-1383), the second wife of the King of Bohemia John of Luxembourg (1296-1346). Beatrice gave birth to the kings son Wenceslaus I (1337-1383), later the duke of Luxembourg, Brabant, and Limburg, and who became the half brother of the later King of Bohemia and Holy Roman Emperor, Charles IV (1316-1378).

CONCLUSIONS

From a historical analysis based on the indirect evidence, it is not possible to unequivocally determine whether a caesarean section that was survived by both the mother and child was actually performed in the 14th century. From a medical standpoint in the context of all the known surrounding circumstances, however, this rare event could indeed have taken place.

[Caesarean section: History, epidemiology, and ethics to diminish its incidence]

Cesarean section has become the most performed surgery and it has been enhanced with the use of antibiotics and improvement in surgical techniques. The aim of this systematic review is to describe and clarify some historical and ethical characteristics of this surgery, pointing out some aspects about its epidemiological behavior, becoming a topic that should be treated globally, giving priority to the prevention and identification of factors that may increase the incidence rates. Today, this "epidemic" reported rates higher than fifty percent, so it is considered a worldwide public health problem. Consequently, in Mexico strategies aimed at its reduction have been implemented. However, sociocultural, economic, medicolegal and biomedical factors are aspects that may difficult this goal. As we decrease the percentage of cesarean section in nulliparous patients, we diminish the number of iterative cesarean and its associated complications. This aim must be achieved through the adherence to the guidelines which promote interest in monitoring and delivery care in health institutions of our country.

[Cesarean section through history]

According to historic documents, delivery by abdominal and uterine incision was already known to mankind at the beginning of the second millennium BC. This delivery method was eventually referred to as "Cesarean Section" because it was wrongfully attributed to the way by which Julius Caesar was born. The indications for cesarean sections performed in ancient cultures and to the end of the medieval period were mainly kings law, that mandated burial of the fetus separately from his mother, legal rights regarding inheritance of the father or religious motives mandating baptism of the newborn in order to ensure him eternal life in heaven. As from the second half of the 19th century AD, and with improvement in surgical techniques, as well as in the perioperative environment (asepsis, antibiotics, anaesthesia, blood transfusion, etc.), the obstetric outcome of cesarean sections was dramaticay improved, both in terms of maternal, as well as fetal, outcome. Hence, it became very prevalent throughout the world. The emergence of medico-legal medicine and medical ethics issues, have further contributed to the use of cesarean sections as the ultimate solution of every unusual delivery.

[The incredible story about the cesarean section from ancient times till nowadays]

During its evolution the cesarean section has meant different things to different people. The indications for it have changed throughout the course of history. From the initial purpose to retrieve an infant from a dead or dying mother in order to bury the child separately from his mother, to contemporary indications. This article strives to follow the roots of this common procedure--starting from the descriptions in the ancient Greek mythology, through the imperial Roman law, aspects of Judaism and the evolution of the procedure throughout modern history. Major improvements in the surgical techniques, the introduction of anesthesia and aseptic procedures contributed to the decline in mortality and morbidity rates. We will attempt to find the etymology for the expression "cesarean section" which has commonly been accounted to Julius Caesar's name, although history denies it. This review takes us on a historical journey, from ancient times to nowadays, in which we follow the course and nature of a procedure being performed daily in thousands of hospitals.

[The first labor analgesia with drug was performed in late Meiji Period (1868-1912). Hypnosis also attracted attention as a method of labor analgesia in mid-Meiji Period]

Ether or chloroform, was in use for ambulatory surgery after 1861 in Japan. An inhalational anesthetic, especially chloroform, was administered for cesarean section in early Meiji Period (from 1868) up to 1897. According to an article in 1903, chloroform was recommended as a strategy for internal cephalic version. However, it is uncertain whether inhalational anesthetic had been utilized for vaginal deliveries before 1903. There is evidence that hypnosis had attracted attention as a method of labor analgesia around that time.

The confrontation between the 'pro-cesareans and the 'anti-cesareans' in eighteenth century France

Cesarean section is a one of the earliest and the most fascinating surgical procedures. Descriptions of first authentic successful cases of cesarean delivery of a living woman appeared in the 16th century. Still, mainly due to poor outcome, the performance of cesarean section remained controversial for the next three centuries. In the 18th century France, a hasty debate had commenced between the 'pro-cesareans' (represented by Jean-Louis Baudelocque) and the 'anti-cesareans' (represented by Jean François Sacombe) that involved medical as well as judicial issues. It seems that the 'pro-cesareans' had overcome the 'anti-cesareans' in this debate at that time.

Post-mortem Cesarean section and embryotomy: myth, medicine, and gender in Greco-Roman culture

This article focuses on cesarean section carried out after the mother's death to rescue the living infant and on embryotomy, a medical procedure to save the mother described as early as the Hippocratic writings (5th to 4th century B.C.) and practiced until the times of Paul of Aegina (7th century A.D). The available sources do not mention cesarean section on a living mother to save the infant. On the other side, writings on embryotomy state clearly that Greek and Roman physicians strove hard to save women's lives. Written in ancient, male-centered societies, these texts convey an unequivocal positive attitude towards women, despite current misogynist assessments by philosophers and physicians who considered women inferior, based on their organic and biological features.

[Forced delivery instead of postmortem cesarean section]

The Lex Regia stipulated that no pregnant women shall be buried unless the child has been removed from her womb. The post mortem caesarean delivery was upheld till 1861 by the majority of obstetricians but nevertheless, anterior to the XIXth century, in 1729, Delamotte practiced delivery in the agonising patient in the absence of labour in view to bypass the cesarean section in hope of better child survival. This article describes the beginning of forced ante mortem delivery upon post mortem cesarean section, which contributed to a decrease in child mortality.

History of caesarean hysterectomy

Caesarean hysterectomy evolved as a life-saving procedure following caesarean delivery. The concept underlying caesarean hysterectomy dates back to the mid 1700s and with a description of the procedure performed on laboratory animals. Eduardo Porro of Milan performed the first planned caesarean hysterectomy in which both the infant and the mother survived. He documented his operation in a paper published in 1876. Porro advocated hysterectomy combined with caesarean section to control post partum haemorrhage and to prevent infection. The maternal death rate following the operation remained high, but was substantly below the rate prior to the introduction of the procedure. The Porro procedure contributed to more favourable outcome for both the mother and the infant, having sterility and premature menopause as its side effects. Fortunately, the need for the procedure was soon minimised following the proposal to close the uterine incision with sutures. Although elective caesarean hysterectomy is still a controversial issue, there is no doubt that emergency post partum hysterectomy in case of massive obstetric haemorrhage is potentially life-saving. Over the past decades, the availability of potent uterotonics and broad-spectrum antibiotics, the development of embolisation techniques, and new methods of vessel ligation, have markedly reduced the need for caesarean hysterectomy, which, however, remains an important procedure in modern obstetric practice.

[Section of pubic symphysis and cesarean section. Analysis of a controversy (1765-1830)]

In the eighteenth century many Dutch physicians travelled to Paris, in order to improve their skills in the fields of surgery and obstetrics. Early in 1769, Petrus Camper, who had a lively correspondence with Antoine Louis, was informed by him about the activities of Jean-René Sigault, regarding the symphysiotomy and about the stir his proposition had caused within the Académie Royale de Chirurgie. Camper, who had occupied himself with this aspect of obstetrics since early 1758, proved that both objections made by the opponents, were wrong.

An operation for evangelization: Friar Francisco González Laguna, the cesarean section, and fetal baptism in late colonial Peru

By publishing a medical-theological treatise in 1781, Friar Francisco González Laguna of Lima initiated a campaign to train Andean priests to perform postmortem cesarean sections for the purpose of baptizing the fetus. Linking González Laguna's text to European works on cesarean sections and Peruvian decrees ordering priests to train in surgery, this paper argues the friar saw the operation's utility as extending beyond saving unborn souls. Writing in the aftermath of indigenous and peasant uprisings, he argued the procedure constituted a tool for defeating the devil's presence in the Andes and carrying out evangelization, teaching parishioners by pious example.

Conception, complicated pregnancy, and labour of gods and heroes in Greek mythology

Pregnancy and labour are holy moments in a woman's life. Even in Greek mythology we can find descriptions of them. We searched in the Greek myths to find descriptions of labours of ancient heroes and gods. We identified descriptions of extracorporeal fertilization, superfecundation, ectopic pregnancy, preterm labour, prolonged pregnancy and Caesarean section. The use of imagination could help the reader to find similarities in present or future developments in the field of obstetrics. It could be concluded that various aspects of modern obstetrical practice are described in Greek mythology.

The birth of Caesar and the cesarean misnomer

Although cesarean section is one of the most ancient surgical procedures, the origin of its name remains obscure. The term, however, did not originate because of the birth of the Roman Emperor Julius Caesar through this route. In fact, historians are certain that Julius Caesar was not delivered by the dangerous cesarean section. The evidence for this comes from indirect inferences. Cesarean sections were rarely attempted on living women until the early 17th century, and Julius Caesar's mother was alive and well through her son's adult life. Two other possible reasons for the origin of the term are discussed in this article. Mention is also made of the cesarean birth histories of some mythological characters and a few historical personalities.

A history of caesarean section: From ancient world to the modern era

Caesarean section has been recorded in history since ancient times in both Western and non-Western literature. Although the first use of the term in obstetrics was from the seventeenth century, its early history is obscured by mythology. The origin of the term caesarean is believed to be from the birth of Julius Caesar; however, this is unlikely considering his mother Aurelia Cotta lived for many years afterwards. In ancient times, it was performed only when the woman was dead or dying as an attempt to rescue the fetus. With few exceptions, this was the pattern until the era of anaesthesia in the nineteenth century. Developments in surgical technique from the later nineteenth century and through the twentieth century have refined the procedure, with resulting low morbidity and mortality. As a consequence, the objectives of caesarean section have evolved from rescuing the fetus or for cultural or religious reasons towards concerns for the safety of mother and child as well as considering the mother's preferences.

Childbirth in ancient Rome: From traditional folklore to obstetrics

In ancient Rome, childbirth was a hazardous event for both mother and child with high rates of infant and maternal mortality. Traditional Roman medicine centred on folklore and religious practices, but with the development of Hippocratic medicine came significant advances in the care of women during pregnancy and confinement. Midwives or obstetrices played an important role and applied rational scientific practices to improve outcomes. This evolution from folklore to obstetrics was a pivotal point in the history of childbirth.

[History of the cesarean section "post-mortem"]

During the 18e century the catholic church insisted on christening babies suffering in the womb of their mother. Midwives and doctors were obliged to baptize the children, or inside the uterus, or after cesarian section done after death of the mother. We found 28 cesarian sections done in dead women in Luxembourg by surgeons or by midwives.

John Whitridge Williams, MD (1866-1931) of Baltimore: pioneer of academic obstetrics

Williams was the founder of academic obstetrics in the United States and with his textbook was the recognised leader of this discipline in America during the first 30 years of the 20th century.

Developments in caesarean section techniques: a review

BACKGROUND

Caesarean section is the most common surgical procedure performed on women world-wide. It is recommended when vaginal delivery might pose a risk to the mother or baby. This review examines the history and developments in caesarean section techniques over the years as well as the difficulties that may be encountered in each stage in our environment.

METHOD

A review of relevant literature was conducted using Pubmed and e-medicine websites for computer search. The following keywords were used: history, development, techniques and caesarean section. Relevant review articles, Cochrane database and chapters in text books were also used to extract information.

RESULTS

Though practiced since ancient times, the history of caesarean section remains shrouded in myths as no document describing its indication and techniques is still available. Ancient medical writers like Galen, Hippocrates and Soranus made no mention of the procedure. However, the evidence that it was performed arose from legal texts. The development in its technique was gradual over many years.

CONCLUSION

The development of caesarean section technique occurred with the withdrawal of surgeries from the stronghold of religion in Renaissance time. Operative techniques vary and this has continued to improve through many years of trial and error.

Myth of the ideal cesarean section rate: commentary and historic perspective

Attempts to define, or enforce, an "ideal" cesarean section rate are futile, and should be abandoned. The cesarean rate is a consequence of individual value-laden clinical decisions, and is not amenable to the methods of evidence-based medicine. The influence of academic authority figures on the cesarean rate in the US is placed in historic context. Like other population health indices, the cesarean section rate is an indirect result of American public policy during the last century. Without major changes in the way health and maternity care are delivered in the US, the rate will continue to increase without improving population outcomes.

From innovation to common practice: perinatal nursing pre-1970 to 2005

The history of perinatal nursing from before 1970 to the present is characterized by innovations that became common practice in later years. These innovations include fetal monitoring, mother/baby care, and early postpartum discharge. The driving forces behind changes in care within the social context of the times were scientific/medical developments and families' desires for the best possible childbearing experience. With innovations becoming commonplace, nursing practice became more complex. How nurses approach present-day challenges of increasing technology of birth, looming threats of litigation, and providing care under time and economic restraints is continuing to evolve.

J Clifton Edgar (1859-1939) of New York and his obstetric text

Edgar, a leading academic obstetrician/gynaecologist in the United States at the beginning of the 20th century, explored a number of interesting aspects of pregnancy and childbirth in his 1903 textbook on obstetrics.