The Caesarean Section (C-section) is the surgical delivery of an infant through an incision made in the mother’s abdomen and uterus. Today, the procedure is performed when a vaginal birth poses a risk to the health of the mother, the infant, or both. While surgical birth has a history stretching back into antiquity, a “successful” C-section—meaning the survival of both the person giving birth and the baby—required centuries of medical progress. For much of its history, the operation was a desperate measure that rarely resulted in dual survival.
Early Attempts and Non-Viability
For a long period in history, the C-section was performed almost exclusively under grim circumstances, typically when the mother was dying or already deceased. Ancient Roman law, known as Lex Caesaria or Lex Regia, mandated that the procedure be carried out on any woman who died during childbirth. This was done primarily to save the infant or for religious custom, as the burial of pregnant women was often prohibited. The procedure was not intended to preserve the mother’s life.
During the medieval era and well into the Renaissance, if the procedure was attempted on a living woman, the outcome was almost certainly fatal for the mother. The two primary causes of death were massive hemorrhage and overwhelming infection. Surgeons lacked the knowledge to effectively control the profuse bleeding from the highly vascular uterus.
The unsterile conditions meant that any abdominal incision was a direct pathway for bacteria, leading to lethal peritonitis and sepsis. Anecdotal accounts of successful operations exist, such as the widely cited case of Jacob Nufer, a swine gelder in Switzerland who reportedly performed the C-section on his wife in 1500. Both his wife and child allegedly survived, but historians treat this account with skepticism, as it was not recorded until many decades later. These isolated cases did not lead to a repeatable, safe surgical practice and remained rare exceptions to a nearly universal maternal death rate.
Necessary Medical Advancements for Safety
The high mortality rate persisted until medical breakthroughs in the late 19th century created the conditions for routine success. The lack of an effective method to close the uterine incision was a major obstacle, as the wound was often left to heal naturally, resulting in fatal blood loss. This problem was addressed in 1882 by the German gynecologist Max Sänger, who introduced uterine suturing.
Sänger advocated for the careful, layered closure of the uterine wall with sutures, a technique essential to control bleeding and prevent internal leakage. His method, which often used materials like silver wire, quickly became the standard and led to a noticeable reduction in maternal deaths from hemorrhage. This innovation was paired with the work of British surgeon Joseph Lister, who applied Louis Pasteur’s germ theory to surgery.
Lister’s work in the 1860s on antiseptic principles involved using carbolic acid to sterilize surgical instruments, dressings, and the operating environment. By preventing infection, Lister’s methods drastically lowered the incidence of sepsis, which had been a death sentence for most patients undergoing abdominal surgery. Simultaneously, the introduction of anesthesia, such as chloroform and ether, reduced patient pain and shock, making longer, more complex surgeries manageable.
The First Confirmed Successful C-Section (Mother and Infant)
The true turning point for the C-section was not a single event but the widespread adoption of the advancements developed by Lister and Sänger. While the Nufer case is the earliest recorded claim of dual survival, the procedure only became medically repeatable and safe after the 1880s. The immediate effect of Sänger’s suturing technique, combined with antiseptic care, was a dramatic drop in maternal mortality rates, falling from nearly 100% to below 10% in some European clinics by the end of the 19th century.
Because of varied and often poor record-keeping, medical historians generally do not point to a single case as “the first” after all modern techniques were in place. However, the first medically documented case of dual survival in the British Empire, which predated the widespread use of Sänger’s suturing and Lister’s full antiseptic system, occurred in 1826.
Surgeon James Barry performed the operation on Wilhelmina Munnik in Cape Town, South Africa. This exceptional case, occurring decades before the critical advancements, demonstrated that survival was possible, but it remained a rarity until new surgical and antiseptic principles became standard practice.
The systematic success that defines the modern procedure was established not by a single medical first, but by the collective efforts of late 19th-century surgeons who implemented uterine suturing and antiseptic protocols. These innovations transitioned the C-section from a last resort to a life-saving option for both mother and child.