'Ript from the womb' : the medical, social and political history of caesarean section

Abstract

What is a caesarean section? In 1790 Jean-Louis Baudelocque, regarded as the most eminent French obstetrician of his time, wrote: “That operation is called Caesarean by which any way is opened for the child than that destined for it by nature. For that purpose we cut through the common and proper coverings of the abdomen, we are obliged to open the uterus also.”] In the era in which Baudelocque practised, the “Caesarean operation” was rarely performed, usually only after protracted labour had failed to deliver the infant, and usually resulting in the deaths of both mother and child. It was a medical curiosity, little known among medical practitioners and even less so among the lay public. In 1993, in Birth ’s labour ’s lost, an article in the Guardian Weekly that addressed the general public, writer Heather Welford gave a succinct description of the contemporary practice of the surgery. “Caesarean section is done under general anaesthetic or epidural anaesthetic, which leaves one fully conscious but numb from the waist down. The surgeon makes a six-inch cut in the abdomen, almost always horizontal, across the top of the pubic hairline (‘a bikini cut’). A similar cut is then made in the uterus and the baby is delivered through the opening. The placenta and membranes follow. That takes about ten minutes; the stitching up takes about 30.”2 While most obstetricians would agree with the basic description of the surgery, they would be quick to point out that the operation is often complicated, that it may be technically difficult, and that there are always at least some risks for the patient. Techniques and management of various aspects of caesarean surgery form a large part of the current obstetric literature.3 By the end of the twentieth century when Welford was writing, the caesarean section had become a generally known and frequently applied medical procedure.