The history of caesarean section (C-section) dates back as far as Ancient Roman times. Pliny the Elder suggested that Julius Caesar was named after an ancestor who was born by C-section.
During this era, the C-section procedure was used to save a baby from the womb of a mother who had died while giving birth.
The mother of Julius Caesar himself, lived through childbirth, therefore eliminating the possibility that the ruler was himself born by C-section.
Ancient Jewish literature from Maimonides suggests that the surgical delivery of a baby was possible without killing the mother, but the surgery was rarely performed.
Survival rates would have been low after the procedure, due to the risk of bleeding and infection.
Historically, the surgery has always been performed to save the baby rather than the mother.
The first recorded case of a mother surviving the surgery was in the 1580s in Siegersausen, Switzerland where Jacob Nufer who was a pig gelder is said to have performed the operation on his wife when her labour was not progressing. The mother survived the operation and went on to have five more successful deliveries naturally.
The availability of cadavers during the seventeenth century and the development of anaesthesia in the nineteenth century both helped to enhance medical techniques, including the C-section procedure.
Queen Victoria used chloroform as an anesthetic during the birth of Prince Leopoldo in 1853 and this paved the way for its use in obstetrics and C-section.
Until the 1870s, the C-section technique remained relatively crude and the practice did not include surgical suture (stitches) to close the opened womb.
In 1876, Eduardo Porro, Professor of Obstetrics at Pavia advocated removal of the womb itself after C-section as a way of controlling bleeding. Following this, the first caesarean hysterectomy was performed in the United States by Richardson in 1881.
In 1882, however, German obstetricians, Adolf Kehrer and Max Sänger each developed methods for preventing uterine bleeding by using suture to close the wound.
Silver wire was developed by J. Marion Sims in the USA as a material that could be used for the suturing technique.
Sänger performed his surgeries using the classical vertical incision, while Kehrer advocated the low horizontal incision that is still being practised today.
Kehrer suggested that a low incision would aid recovery and reduce the risk of death and his incision method became popular in the early twentieth century.
With the advent of sterilization, hand washing and antibiotics, the surgical outcomes of C-section improved further still. For example, Joseph Lister introduced carbolic spray in 1867 for disinfecting the operative area.
In 1926, James Munro Kerr, Professor of Obstetrics at Glasgow re-introduced the transverse incision, which was preferred to the longitudinal incision and in the USA, the procedure was also popularized by Beck and DeLee in the 1920s.
Oxytocin, a natural hormone secreted after birth was synthesized in 1951 at Cornell.
The hormone was found to reduce bleeding after C-section and is still used routinely today.
Regional anesthesia including spinal and epidural anesthesia have also been developed and become popular methods of relieving pain and improving outcomes after C-section.
Reviewed by Sally Robertson, BSc