The Caesarean section (C-section) is a surgical procedure where a baby is delivered through incisions made in the mother’s abdomen and uterus. This intervention has a complex history, evolving from an ancient, nearly fatal operation into a modern, life-saving procedure. Its origins do not point to a single inventor but rather to centuries of medical breakthroughs. The common belief that the procedure is named after the Roman emperor Julius Caesar is a persistent myth.
Mythological and Pre-Surgical Origins
The earliest references to surgical delivery appear in ancient folklore, such as Greek mythology where the god Apollo removed his son Asclepius from his mother’s abdomen. The popular connection to Julius Caesar is historically inaccurate; his mother, Aurelia, survived his birth and lived into his adulthood. Before the modern era, a mother’s survival after this abdominal surgery was nearly impossible, primarily due to massive hemorrhage and infection.
The term “Caesarean” most likely derives from the Latin verb caedere, meaning “to cut,” or possibly from the Roman law Lex Caesarea or Lex Regia. This ancient law, which predates Julius Caesar, mandated that if a pregnant woman died, the child must be surgically removed from the womb before burial. This requirement was a civic obligation, intended to salvage a living infant or ensure separate burial. The procedure was thus a post-mortem event, performed when the mother was deceased or dying, with the sole intent of saving the child.
The Transition to Maternal Survival
For centuries, the C-section carried an almost 100% mortality rate for the mother, making it a procedure of last resort performed only when maternal death was imminent. The narrative shifted in the 16th century with the first documented cases of maternal survival, though these early accounts are often debated. One famous, yet unverified, case is that of Jacob Nufer, a pig gelder in Switzerland, who allegedly performed the operation on his wife in 1500 after a prolonged labor.
Nufer’s wife is said to have survived and later delivered five more children vaginally. Historians question the accuracy of this story, which was not recorded until 82 years after the event. However, it suggests that the first successful attempts may have occurred in rural, non-medical settings. The first well-documented case where both mother and child survived is credited to the surgeon Jeremiah Trautmann in Wittenberg in 1610.
By the 18th century, sporadic successes began to be recorded, but the maternal mortality rate remained high, often around 75% into the early 19th century. The primary causes of death were uncontrolled bleeding and sepsis. Without the knowledge of germ theory or effective surgical techniques, surgeons struggled to manage internal contamination. The procedure was so dangerous that sacrificing the life of the child through methods like fetal craniotomy was often the preferred choice to save the mother.
Key Medical Innovations That Made the Procedure Safe
The C-section could not become a routine, life-saving procedure until three major medical advancements were introduced in the 19th century: anesthesia, antisepsis, and proper uterine suturing. The introduction of effective anesthesia, such as ether in 1847, made the lengthy abdominal surgery tolerable for the patient. Anesthesia allowed surgeons the necessary time to operate with greater care and precision, rather than rushing the procedure.
The development of germ theory and antiseptic techniques by figures like Joseph Lister drastically reduced the threat of infection. Before this, peritonitis, an infection of the abdominal lining, was almost inevitable because surgeons were unaware that unwashed hands, instruments, and operating theaters spread deadly pathogens. The adoption of antiseptic practices, including the use of carbolic acid, began to curb the rampant post-operative sepsis that killed most mothers.
A pivotal technical breakthrough came in 1882 when German gynecologist Max Sänger introduced the method of properly closing the uterine wound with sutures. Prior to Sänger, many surgeons did not suture the uterus, believing the muscle would heal itself, or they performed a full hysterectomy (Porro operation) to prevent bleeding and infection. Sänger’s technique, which involved closing the uterine incision with multiple layers of sutures, dramatically reduced both hemorrhage and the risk of fatal infection. This innovation quickly became the standard of care, transforming the C-section into a viable and safe medical option.