A Cesarean section, or C-section, is a surgical procedure where a fetus is delivered through incisions made in the mother’s abdomen and uterus. For centuries, this operation was known primarily as a desperate, last-resort measure that rarely allowed the mother to survive. The C-section’s history is a dramatic transformation, moving from a procedure associated with near-certain maternal death to the most commonly performed major surgery in modern obstetrics. This shift was a gradual process, accelerating only after specific medical advancements made the operation reliably safe for both mother and child.
From Fatal Procedure to Viable Option
The Cesarean procedure was practiced for millennia, often out of religious or legal necessity rather than a medical attempt to save the mother. Ancient Roman law, Lex Caesaria, mandated the procedure be performed on a woman who died during childbirth to save the baby, or at least ensure the mother and child were buried separately. For centuries, the operation was primarily a post-mortem event, as the survival of the mother was considered practically impossible.
Before the modern era, survival was extremely rare. A lack of surgical knowledge meant that the uterine incision was often left unsutured after delivery, resulting in fatal hemorrhage or overwhelming infection, such as peritonitis. Consequently, the procedure was reserved only for situations where the mother had no hope of surviving a prolonged, obstructed labor.
The Medical Breakthroughs That Ensured Safety
The procedure’s high mortality rate began to fall only with the convergence of major medical innovations in the late 19th and early 20th centuries. The widespread adoption of anesthesia, such as the use of Ether beginning in the mid-1800s, made the surgery tolerable, allowing surgeons time for more meticulous work. More importantly, the acceptance of germ theory and the practice of antisepsis, which involved sterilizing instruments and the surgical field, drastically reduced the incidence of deadly postpartum infection.
Effective uterine suturing techniques were developed in the 1880s. Previously, surgeons often had to perform a hysterectomy immediately after delivery to control massive bleeding. The shift to closing the uterine incision with multiple layers of stitches was a major step in maternal survival. This was paired with the adoption of the transverse incision in the lower uterine segment, which resulted in less blood loss and reduced the risk of rupture in subsequent pregnancies compared to the vertical “classical” incision.
The Statistical Shift to Common Practice
Despite safety improvements achieved by the 1920s, C-section rates remained low, typically under five percent in developed nations. The rapid, exponential increase that made the C-section a common practice began much later, starting in the mid-1960s and accelerating dramatically through the 1970s and 1980s. This period saw C-section rates increase by over 400 percent in some regions, moving them from a rare event to a routine surgical option.
One primary driver was the widespread introduction of electronic fetal monitoring, which became standard practice during labor. This technology led to a sharp increase in the diagnosis of “fetal distress,” prompting more immediate surgical interventions. Simultaneously, medical practice began to operate under a policy of “once a Cesarean, always a Cesarean,” which contributed substantially to the rising numbers through repeat procedures.
Decreasing tolerance for risk in labor, an aging maternal population, and an increase in multiple fetuses also fueled the statistical shift. Furthermore, socio-legal factors, such as the increased threat of malpractice litigation, incentivized physicians to opt for the procedure as a safer, more predictable course of action. Today, C-section rates hover around 32 percent of all births in many developed countries, establishing the procedure as a common mode of delivery.