The Cesarean section (C-section) is a common, life-saving surgical procedure used globally to deliver babies when a vaginal birth poses risks to the mother, the infant, or both. Today, the procedure is highly standardized and safe, a stark contrast to its origins as a measure of last resort. Defining the “first successful” C-section is difficult because the definition of success has shifted dramatically, moving from merely saving the infant to ensuring the survival of the mother as well.
Early History and Defining Success
The practice of delivering a baby through an incision in the mother’s abdomen stretches back to ancient times. Roman law, often cited as the Lex Caesarea, mandated that if a pregnant woman died, the fetus had to be cut from her womb before burial. This illustrates that the procedure was initially performed only post-mortem, with no expectation that the mother would survive.
The term “Cesarean” is popularly, but incorrectly, linked to Julius Caesar. The name is likely derived from the Latin verb caedere, meaning “to cut,” or the Roman law itself. Throughout the Middle Ages and into the early modern era, C-sections on living women almost certainly resulted in death, primarily due to catastrophic hemorrhage and subsequent infection. The historical hurdle for defining a truly “successful” C-section was the mother’s survival, which remained a near impossibility for centuries.
The Landmark Case of Maternal Survival
The case most widely cited as the first documented successful C-section where the mother survived occurred in Switzerland around 1500. A sow gelder named Jacob Nufer reportedly performed the operation on his wife, who had been in prolonged labor. After gaining permission from local authorities, Nufer performed the surgery, and the mother survived the procedure.
This account, while not recorded until 82 years after the fact, suggests the mother went on to have five subsequent natural births, and the child lived to the age of 77. While some historians question the accuracy of this narrative, it represents the earliest written record of a mother and infant both surviving the abdominal delivery. This isolated event did not immediately transform the procedure into a safe medical option; the maternal mortality rate remained around 75% even into the first half of the 19th century.
Surgical Advancements Leading to Modern Safety
The C-section did not become reliably safe until systemic medical advancements were implemented in the 19th century. A major factor in the high mortality rate was the failure to close the uterine incision, which led to fatal hemorrhage and peritonitis. Surgeons often left the uterus to contract and heal on its own, a practice that proved deadly.
The introduction of effective uterine suturing techniques, especially by figures like Max Sänger in the late 1800s, was a turning point for controlling bleeding. The adoption of anesthesia, such as ether in the mid-1840s, was also transformative, reducing the shock and pain that contributed to maternal death. Furthermore, the implementation of antisepsis and asepsis principles by pioneers like Joseph Lister drastically lowered the risk of life-threatening infections.
These combined advancements—anesthesia, infection control, and improved surgical technique, particularly closing the uterine wound—transformed the C-section from a desperate, high-risk measure into a controlled, routine surgical procedure. Today, the procedure is the most common surgery performed in the United States, marking the endpoint of a long historical journey toward safety.