A brief history of Caesarean Section from 1000 BC to the modern era, in brief..

1. the history of
CAESAREAN SECTION
Muhammad Redzwan
081303583
Batch 25 Group E2

2. 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.

3. 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’.

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

5. 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.

6. 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%.

7. 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

8. 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).

9. 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.

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

11. 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

12. First description
of Pfannenstiel's
incision

13. 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.

14. 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 labour
pain).

15. Trivia
March 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.

16. References
1. JE Sewell (2013) “Caesarean Section A Brief History”.National
Library 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.ht
ml

17. Q & A