Smile of the Day Friday January 14, 2022: The Cesarean Section

On this Day:

In 1794 Dr Jessee Bennet of Edom, Virginia, performed the 1st successful Cesarean section operation in the US on his wife. Ahhh but children were being brought into the world by C-Section for hundreds of years before, but the procedures were, unfortunately not always so successful for their mothers…

Caesarean section, also known as C-section, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother’s abdomen, often performed because vaginal delivery would put the baby or mother at risk. Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, and problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother’s pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary. Some C-sections are performed without a medical reason, upon request by someone, usually the mother.

A C-section typically takes 45 minutes to an hour. It may be done with a spinal block, where the woman is awake, or under general anesthesia. A urinary catheter is used to drain the bladder, and the skin of the abdomen is then cleaned with an antiseptic. An incision of about 15 cm (6 inches) is then typically made through the mother’s lower abdomen. The uterus is then opened with a second incision and the baby delivered. The incisions are then stitched closed. A woman can typically begin breastfeeding as soon as she is out of the operating room and awake.

C-sections result in a small overall increase in poor outcomes in low-risk pregnancies. They also typically take longer to heal from, about six weeks, as compared to vaginal birth. The increased risks include breathing problems in the baby and amniotic fluid embolism and postpartum bleeding in the mother. Established guidelines recommend that caesarean sections not be used before 39 weeks of pregnancy without a medical reason. The method of delivery does not appear to have an effect on subsequent sexual function.

In 2012, about 23 million C-sections were done globally. The international healthcare community has previously considered the rate of 10% and 15% to be ideal for caesarean sections. Some evidence finds a higher rate of 19% may result in better outcomes. More than 45 countries globally have C-section rates less than 7.5%, while more than 50 have rates greater than 27%. Efforts are being made to both improve access to and reduce the use of C-section. In the United States as of 2017, about 32% of deliveries are by C-section. The surgery has been performed at least as far back as 715 BC following the death of the mother, with the baby occasionally surviving. Descriptions of mothers surviving date back to 1500, with earlier attests to ancient times (including the apocryphal account of Julius Caesar being born by Caesarean section, a commonly stated origin of the term). With the introduction of antiseptics and anesthetics in the 19th century, survival of both the mother and baby, and thus the procedure, became significantly more common.

Historically, caesarean sections performed upon a live woman usually resulted in the death of the mother. It was considered an extreme measure, performed only when the mother was already dead or considered to be beyond help.

According to the ancient Chinese Records of the Grand Historian, Luzhong, a sixth-generation descendant of the mythical Yellow Emperor, had six sons, all born by “cutting open the body”. The sixth son Jilian founded the House of Mi that ruled the State of Chu (c. 1030–223 BC)

The mother of Bindusara (born c. 320 BC, ruled 298 – c. 272 BC), the second Mauryan Samrat (emperor) of India, accidentally consumed poison and died when she was close to delivering him. Chanakya, the Chandragupta’s teacher and adviser, made up his mind that the baby should survive. He cut open the belly of the queen and took out the baby, thus saving the baby’s life.

An early account of caesarean section in Iran (Persia) is mentioned in the book of Shahnameh, written around 1000 AD, and relates to the birth of Rostam, the legendary hero of that country. According to the Shahnameh, the Simurgh instructed Zal upon how to perform a caesarean section, thus saving Rudaba and the child Rostam. In Persian literature ceaserean section is known as Rostamina (رستمینه).

In the Irish mythological text the Ulster Cycle, the character Furbaide Ferbend is said to have been born by posthumous caesarean section, after his mother was murdered by his evil Aunt Medb.

The Babylonian Talmud, an ancient Jewish religious text, mentions a procedure similar to the caesarean section. The procedure is termed yotzei dofen. It also discusses at length the permissibility of performing a c-section on a dying or dead mother. There is also some basis for supposing that Jewish women regularly survived the operation in Roman times (as early as the 2nd century AD).

Pliny the Elder theorized that Julius Caesar’s name came from an ancestor who was born by caesarean section, but the truth of this is debated. Some stories involve Caesar himself being born from the procedure; this is almost certainly false, as Caesar’s mother Aurelia Cotta lived until Caesar’s mid-40s. The Ancient Roman caesarean section was first performed to remove a baby from the womb of a mother who died during childbirth, a practice sometimes called the Caesarean law.

The Catalan saint Raymond Nonnatus (1204–1240) received his surname—from the Latin non-natus (“not born”)—because he was born by caesarean section. His mother died while giving birth to him.

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, the second wife of the King of Bohemia John of Luxembourg. Beatrice gave birth to the king’s son Wenceslaus I, 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.

In an account from the 1580s, Jakob Nufer, a pig gelder in Siegershausen, Switzerland, is supposed to have performed the operation on his wife after a prolonged labour, with her surviving. His wife allegedly bore five more children, including twins, and the baby delivered by caesarean section purportedly lived to the age of 77.

For most of the time since the 16th century, the procedure had a high mortality rate. In Great Britain and Ireland, the mortality rate in 1865 was 85%. Key steps in reducing mortality were:

• Introduction of the transverse incision technique to minimize bleeding by Ferdinand Adolf Kehrer in 1881 is thought to be first modern CS performed.
• The introduction of uterine suturing by Max Sänger in 1882
• Modification by Hermann Johannes Pfannenstiel in 1900, see Pfannenstiel incision
• Extraperitoneal CS and then moving to low transverse incision (Krönig, 1912)
• Adherence to principles of asepsis
• Anesthesia advances
• Blood transfusion
• Antibiotics

European travellers in the Great Lakes region of Africa during the 19th century observed caesarean sections being performed on a regular basis. The expectant mother was normally anesthetized with alcohol, and herbal mixtures were used to encourage healing. From the well-developed nature of the procedures employed, European observers concluded they had been employed for some time. Robert William Felkin provided a detailed description. James Barry was the first European doctor to carry out a successful caesarean in Africa, while posted in Cape Town between 1817 and 1828.

The first successful caesarean section to be performed in the United States took place in Mason County, Virginia (now Mason County, West Virginia), in 1794. The procedure was performed by Dr. Jesse Bennett on his wife Elizabeth.

First, a Story:

A very pregnant woman walked into a library and asked for a book on childbirth.

The Librarian looks at her and says: “Try over there in the C section.”

Second, a Song:

The Avett Brothers are an American folk rock band from Concord, North Carolina. The band is made up of two brothers, Scott Avett (banjo, lead vocals, guitar, piano, kick-drum) and Seth Avett (guitar, lead vocals, piano, hi-hat) along with Bob Crawford (double bass, electric bass, violin, backing vocals) and Joe Kwon (cello, backing vocals). Mike Marsh (drums), Tania Elizabeth (fiddle) and Bonnie Avett-Rini (piano) are touring members of the band.

Following on from Seth and Scott’s former rock band Nemo, The Avett Brothers combine bluegrass, country, punk, pop melodies, folk, rock and roll, indie rock, honky tonk, and ragtime to produce a novel sound described by the San Francisco Chronicle as having the “heavy sadness of Townes Van Zandt, the light pop concision of Buddy Holly, the tuneful jangle of the Beatles, the raw energy of the Ramones.”

“C-Sections and Railway Trestles” is written by Seth about his experience of he and his wife’s son’s birth. It is a loving, fatherly description of Isaac (Seth’s son) as well as a vague, figurative description of the birth. Seth throws out all sorts of ideas in this song, and in some ways it is a message to Isaac about what life is like, what’s important, and what he has to look forward to. The song gives a sense of a raw look at all of Seth’s wild, racing thoughts that he has experienced as a new father (per https://genius.com/The-avett-brothers-c-sections-and-railway-trestles-lyrics).

Here are The Avett Brothers performing “C Sections And Railway Trestles” live at the Fishcenter on Adult Swim. I hope you enjoy this!

(https://www.youtube.com/watch?v=vGlUrb3RkKE)

Thought for the Day:

“The pain of childbirth is not remembered. It’s the child that’s remembered.” – Freeman Dyson

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Have a great day!

Dave & Colleen

© 2021 David J. Bilinsky and Colleen E. Bilinsky