the history of

CAESAREAN SECTION

Muhammad Redzwan

081303583

Batch 25 Group E2

Introduction

• Numerous references to Caesarean Section appear in ancient Chinese, Persian, Hindu, Egyptian, Grecian, Roman, and other European folklore.

• Early time, C-sections are performed on dying or dead women.

• The purpose of C-section is differ from time to time as the technique advanced.

Why ‘CAESAREAN’?

1. Commonly known that Julius Caesar was born from C-section. But…… his mother, Aurelia lived long enough until he invaded Britain.

2. Pliny the Elder theory: Julius Caesar’s ancestor was born from the procedure. Ab utero caeso (to cut open uterus) surname Caesar

3. Lex Caesarea, Caesar’s Law decreed that dying or dead pregnant mother must be cut open to save the infant. To increase population, and for religious view.

4. Derived from term caedere (to cut), caesones(children from C-section)

1598: Jacques Guillimeau in his Book on Midwifery introduced the term ‘section’ to replace ‘operation’.

‘The birth of Julius Caesar’. A live infant being surgically removed from a dead woman.

Ancient C-section

• To retrieve infant from dying or dead mother.

• 1000 BC: Jilian, ruler of State of Chu in China.

• 320 BC: mother of Bindusara (second emperor of India) accidentally drank poison. Advisor and teacher of first emperor, Chanakya made up his mind and perform C-section to save the infant.

• <100 BC: Julius Caesar’s Ancestor

• 1204 AC: Raymond Nonnatus, a Catalan Saint. His mother died during labour.

Pre-modern C-Section

• It is suggested that there were women alive after the operation during Roman time.

• 1580s: First recorded woman surviving the procedure.Jakob Nufer, a pig gelder from Switzerland performed C-section on his wife after prolonged labour. His wife and his child was alived.

• Between 1815 and 1821, James Miranda Stuart Barry (born Margaret Ann Bulkler) performed the first successful C-section in British Empire.

• 1865: In Great Britain and Ireland, mortality rate for C-section is as high as 85%.

Challenges

• When to perform C-section?

• Who?

• Bleeding and haemorrhage

• Infections and Sepsis

• Incidence of uterine rupture

• No method to monitor mother and infant post-operatively

Why Jacob Nufer Succeed?

• C-section was done at an earlier stage in failing labor when the mother was not near death and the fetus was less distressed. Chances of one or both surviving were greater.

• These operations were performed in the house, without access to hospital facilities as surgery in hospitals was affected by infections passed between patients, or unclean hands of medical attendants.

• Jakob Nufer’s anatomical and physiological knowledge as he is a pig gelder (castrating pig).

African C-Section

• 1879 R.W. Felkin witnessed cesarean section performed by Ugandans.

• Banana wine is used to semi-intoxicate the woman and to cleanse hands and her abdomen. (anaesthesia/aseptic)

• A midline incision and applied cautery to minimize hemorrhaging. (bloodless surgery)

• Massaging the uterus to make it contract but did not suture it; the abdominal wound was pinned with iron needles and dressed with a paste prepared from roots.

• The patient recovered well and Felkin concluded that this technique was well-developed and had clearly been employed for a long time.

• Similar reports come from Rwanda, where botanical preparations were also used to anesthetize the patient and promote wound healing.

C-section performed by Ugandan as depicted by RW Felkin (1879)

Modern C-Section

• 1881 First modern C-section performed by German Gynaecologist, Ferdinand Adolf Kehrer. He introduced transverse incision of Uterus.

• 1882 Max Saenger introduced uterine suture, and Saenger’s Operation*. Kehrer and other surgeons later applied this operation.

• 1888: First C-section under modern antiseptic condition was done by Murdoch Cameron.

• 1900 Hermann Johannes Pfannenstiel introduced Pfannenstiel’s incision (bikini-line incision)

• Anesthesia, aseptic technique, antibiotic and blood transfusion was developed later, thus improving the outcome of C-section.

*Cesarean section followed by careful closure of the uterine wound by three tiers of sutures

First description of Pfannenstiel'sincision

Modern C-Section

• Early 20th century, British Obstetrician, Munro Kerr advocated Low Cervical C-Section. Joseph B DeLee and Alfred C Beck then popularize the technique in the United States.

• This technique reduced the rates of infection and uterine rupture and is still used today.

• Advancement in C-section, and surgery has change this procedure to be one of the safest and most successful surgical operation.

Ancient to Modern Purpose

• C-section was originated from attempts to save the life of a fetus whose mother was dead or dying.

• During the 19th century, C-section done to those in which her life was immediately at stake

• Early 20th century, operation was performed in cases where the mother's health was considered endangered.

• Nowadays, C-section can be planned early in pregnancy. And sometimes, performed without any significant indications (e.g. to avoid labourpain).

TriviaMarch 5, 2000: The one and only woman that performed Caesarean Section on herself: Ines Ramirez Perez. She and her son, Orlando are still alive today.

Picture of Ines and Orlando, 2004.

References

1. JE Sewell (2013) “Caesarean Section A Brief History”.NationalLibrary of Medicine. http://www.nlm.nih.gov/exhibition/cesarean/preface.html

2. Caesarean Section History (2011) News Medical. http://www.news-medical.net/health/Cesarean-Section-History.aspx

3. Lurie, Samuel (2005). "The changing motives of cesarean section: from the ancient world to the twenty-first century". Archives of Gynecology and Obstetrics(Springer) 271 (4): 281–285.

4. RV Higgins et al.(2014)."Abdominal Incisions and Sutures in Gynecologic Oncological Surgery". medscape.com. WebMD LLC. Retrieved 17 February 2014.http://emedicine.medscape.com/article/271349-overview#showall

5. “True grit: the mum who delivered her own baby”(2004) The Sydney Morning Herald. http://www.smh.com.au/articles/2004/06/01/1086037758224.html

Q & A