Cesarean Sections In the Middle Ages: A History In Maternal Care
Obstetrics has a complicated history that everyone always, for obvious reasons, takes personally. One of those highly personal things is the c-section. When did they become an option?
What We Are Talking About
These days, when we say C-section or cesarean operation, we mean an incision made on the abdominal wall and then the uterine wall to jailbreak a baby who would otherwise be in danger. Breech births, shoulder presentations, kid too big for mom’s pelvis, and a host of other situations could necessitate one.
The general idea dates back to ancient times and was traditionally done in places as diverse as Uganda in the 1800's, to China in the 700’s AD, to Iran in 1000 AD. The Mishnah Torah, written in the 1200’s, even weighs in on whether a kid can be considered the first born if the child was taken out by cesarean. (The cesarean birth doesn’t count, according to this tradition, and the second child gets bumped up to first born if he or she is born vaginally. There is a tragic tale of sibling rivalry and inheritance for the intrepid fiction writer there.)
The story goes that the procedure got its name from Julius Cesar, but that seems to be speculation from Pliny the Elder (who is generally wrong about everything.) Isadore of Seville elaborated on this theme, and people have run with it since.
The First C-section On A Living Woman Who Survived:
The story goes that around 1500, a Mrs. Nufer of Switzerland had been in labor for days and was confounding her 13 midwives. Her husband, a farmer or vet (depending on the teller), cut her open to take the baby out, and we thus have the first recorded C-section in which mother and child survived. Mrs. Nufer, in fact, went on to have five more children and the child saved by the cesarean lived 77 years.
Was this the first women who survived a Cesarean section though? Questions have been raised. Cesarean sections were first described in medical literature in the 1200’s in Europe (Though Iran and India have some decent evidence for successful c-sections predating that.) Beatrice of Bourbon might have successfully birthed Charles IV by c-section and lived to tell the tale too.
The first documented case where we are sure both mom and baby survived took place in 1610 in Wittenburg, Germany. Ursula Opitz had an accident late in her pregnancy that popped her uterus out. After three doctors, several midwives, and some surgeons were consulted, it was agreed that Jeremias Trautman would do the honors. Ursula got sick and died 25 days later, but the baby boy survived until he was nine.
As a rule though, most of the women who delivered by cesarean died of the operation. In 1865, 85% of the women who underwent the operation died in Ireland and England. (Uganda and Rwanda seemed to have their own type of cesarean on living women with some survivals around the same time.) The survival rate didn’t climb until anesthetics, a better type of incision, and antiseptic practices were invented in the later 1800's.
Why Take the Risk Then?
With a such a high mortality rate that Maimonides himself pooh-poohed the idea of a woman surviving, people before the 1200 or 1300’s performed c-sections only if the woman was dead or nearly so.
Then it was hoped that the operation would be in time to baptize the baby before he or she died. Early laws mandated that a priest be present at the operation in order to perform the necessary rite and midwives were supposed to get licenses from the church to baptize an infant against just such occasions. Otherwise, the stillborn infant had to be buried on unsacred ground and was condemned to purgatory/hell. If the kid lived, well, that was unusual but, of course, welcome.
Attitudes:
It is so weird to see these non-vaginal births being treated as somehow not births. Shakespear’s calling MacDuff ‘not born of woman,’ Maimonides claiming you didn’t inherit as the first born, and the many myths that emphasize a person’s specialness and otherness by having them born non-vaginally- it all looks like people’s instinctive reaction is to scream ‘not normal!’
It took a while, but, starting in the 1300’s, the reasoning behind cesareans moved from ‘mom’s doomed, we got to at least save baby’s soul’ to ‘we can save two lives with one surgery, and we should.’ You would think that survival would be the first instinct all along, but apparently not. Death so consistently stalked pregnant women that it seemed to warp people’s priorities.
Conclusion:
Full disclosure: the moggy kitten was born vaginally. But there was a moment when the Ob-Gyn brought out the forceps and explained that she would need help coming out, and I thought, ‘well, if a cesarean is what is best for Liv, then that will have to happen.’
I stand by that conclusion. Cesareans are much safer now, with a high survival rate for mother and child. Adverse outcomes for c-sections for low-risk pregnancies is now 9.2%, which is only 0.8th of a percentage point higher than for vaginal deliveries of the same profile.
We have come a long way, though there are risks involved with cesareans, from amniotic fluid embolisms to post-partum bleeding. I don’t want to pretend otherwise, even in an article that is just touching on the historical aspect.
But that moment and conclusion stayed with me. In my first book in my Wolfsburg Adventure series, there is a woman and her infant who die in childbirth because the midwife refuses to perform a C-section while she is still alive. The plot point comes from my gratitude that I didn’t have to worry as much as my medieval forbears, that I wasn’t, in Stanton’s words, ‘going to the gates of death.’ It was gratitude that there was a relatively safe alternative should a vaginal birth go wrong.
Because of this, fewer widowers report ‘sadly and with a bitter heart’ to cemeteries. There are children who grow up with their mother’s resources and help that wouldn’t otherwise. We all owe something to those earlier women who went under the knife for safer births.
Sources:
THE ANTIQUITY OF CAESAREAN SECTION WITH MATERNAL SURVIVAL: THE JEWISH TRADITION — PMC (nih.gov)
The changing motives of cesarean section: from the ancient world to the twenty-first century | SpringerLink
‘A History of Women: Silences of the Middle Ages’ Edited by Georges Duby and Michelle Perrot