The Cesarean section is a surgical procedure to deliver a baby from its mother’s womb that has a long and fascinating evolution. Today, nearly 1 in 3 U.S. women have a C-section. Here’s how the C-section began, how it evolved, and why it became so prevalent, particularly in the U.S.
When Did C-Sections Start?
It may surprise you to learn that the Cesarean section has been practiced since ancient times, — for at least 2,000 years. Many references to it appear in Hindu, Egyptian, Grecian, Roman, and European folklore. But the intentions of the procedure have changed dramatically over time.
The C-section of ancient times is not the one we know today. Before the 19th century, the procedure was performed on dead or dying mothers in a last-ditch attempt to save the soul, if not the life, of the fetus. Rarely did either survive.
The reasons women have C-sections have varied tremendously throughout documented history, shaped by religious, cultural, economic, professional, and technological developments. And that has shaped the procedure itself.
Why Is It Called a Cesarean Section?
Prior to a medical text published in 1598, we know that the C-section was called the Cesarean operation. Beyond that, the origins of the name are mysterious. Some claim the Cesarean section was named for Julius Caesar, but if that was the case, it’s unlikely it was because Caesar was actually born via Cesarean; Caesar’s mother, Aurelia, is said to have lived to hear of her son’s invasion of Britain, and women didn’t survive the Cesarean operation in ancient times.
The name Cesarean might have come from Caesar’s decree that all women who were unable to give birth when the time came must be cut open; He decreed this to increase the population of Rome.
It’s also possible the name was taken from the Latin caedere, to cut, and caesones, a term applied to infants born by postmortem operations.
When Was the First C-Section?
C-section history is difficult to quantify accurately, as facts intertwined with myth over time. The first written record of a mother surviving a C-section dates back to 1500 when Jacob Nufer, a Swedish sow gelder, performed the operation on his wife, who had been in labor for several days. The story goes that none of the 13 midwives attending could help. Nufer’s wife lived and went on to give birth naturally to five more children, including twins, and the child delivered via C-section is said to have lived to be 77 [*].
In fact, many of the earliest successful C-sections — those saving mother and baby — occurred in remote rural areas lacking medical staff and facilities. It is thought that the absence of medical supervision may have increased the chances of the mother and baby surviving the C-section because the procedure could be done at an earlier stage when the mother and baby were not on death’s door. Further, surgery in hospitals at this time was barbarous and fraught with infection passed between patients, often at the hands of medical attendants [*].
What Happened Before C-Sections Were Invented?
C-section history includes some truly unsavory facts. Before C-sections, doctors performed a craniotomy, an utterly gruesome procedure that involved the piecemeal extraction of the entire fetus vaginally. The craniotomy was performed in the first half of the 19th century to save the mother from an extremely painful death, and at this time, it presented less risk to the mother than an abdominal incision, which had a mortality rate of about 50%.
Craniotomy vs. Cesarean was hotly debated by doctors across the continent and Britain for several decades. By the end of the 19th century, the craniotomy was abandoned for ethical reasons as well as technological advances that vastly improved Cesarean outcomes.
When Did C-Sections Become Safe?
Technical innovations in surgery — like anesthetic, and in the 1860s, antiseptic — improved fetal outcomes but the maternal mortality rates were still appallingly high because surgeons were afraid to suture the uterine incision. This led to the mother’s death either from blood loss or infection. For a short time, physicians even performed hysterectomy at the time of Cesarean to mitigate these issues [*].
Systematic improvement of Cesarean section techniques in the late 19th century and early 20th century (especially where to make the uterine incision and the decision to suture it) eventually led to lower mortality for women and their babies, and the C-section was increasingly performed in cases where the mother's health was endangered, or her life was at stake.
Penicillin was discovered in 1928 and refined as a drug in 1940, further improving the chances of women who had succumbed to infection as a result of Cesarean delivery.
When Did C-Sections Become Common?
By the late 19th century, as doctors realized the goal of saving both mother and child, the craniotomy was relegated to the dustbin and C-sections became the procedure of choice.
In the late 20th century in mainstream Western medical society, once labor began, the fetus became the primary patient. As a result, there has been a marked increase in resort to C-sections over the last 30 years on the basis of fetal health indications [*].
Evolution of the C-Section
There are many reasons for the evolution of the C-section and its increasing use, among them:
- More hospitals, surgical advances, and a trend toward more medically managed pregnancies and fewer at-home births. By 1938, about half of U.S. births were taking place in hospitals. By 1955, this figure had risen to 99% percent.
- Religion. For instance, in early to mid-19th Century France, Roman Catholics wanted to see the infant removed from the mother so it could be baptized, but Protestant Britain avoided C-sections during this same period to save the mother (half of whom died from C-sections), opting instead for craniotomy [*].
- Urbanization across Britain, Europe, and the U.S. at the turn of the century led to a sharp rise in rickets, a nutritional disease-causing improper bone growth, among city children cut off from fresh produce and sunlight. As these children grew to be women, their malformed pelvises often mandated Cesarean section and the rates rose markedly and never came back down, in spite of improvements to nutritional health in the 1930s.
Modern Prevalence of C-Sections
In the U.S. today, almost one in three babies are born via Cesarean section, for both elective and medical reasons. That’s a lot.
With a culture looking increasingly to more natural childbirth methods and experiences, like opting for midwives and doulas, and more women taking advantage of prenatal care, many have begun to question why the incidence of C-section is so high in the U.S.
While it’s almost impossible to calculate for certain how many C-sections are really necessary, the World Health Organization at one time suggested the percentage should be closer to 10% or 15% — less than half of what it is today [*].
Economics may play a part. Doctors in many locales are paid significantly more (+15% on average) for C-section deliveries than for vaginal births, even though vaginal births on average take more time. Studies have shown that the more physicians are paid for C-sections relative to vaginal births, the more C-sections get performed. When the differential is reduced, the C-section rates decrease [*].
The Bottom Line
As with the journey of the Cesarean section from ancient times to today, the desire to help mothers and their children lead healthier lives continues to spur stem cell research forward to improve survival among children born with life-threatening genetic disorders.
Trust MiracleCord to always use the latest technology to collect, process and preserve your baby’s precious cord blood, and stay tuned for continuing advancements.