History of Cesarean Section

Oxford English dictionary defines Caesarean birth as “the delivery of a child by cutting through the walls of the abdomen when delivery cannot take place in the natural way”, as was supposedly done in the case of Julius Cæsar’s birth.

Bindusar, the second Emperor of Mauryan dynasty of India is said to be the first child born by surgery. His mother, wife of Chandragupta Maurya, accidentally consumed poison and died when she was close to delivering him. Chanakya, the Chandragupta’s teacher and advisor, made up his mind that the baby should survive. He cut open the belly of the queen and took out the baby, thus saving the baby’s life.

Those days, Caesarean section usually resulted in the death of the mother; the first recorded incidence of a woman surviving a Caesarean section was in the 1580s, in  Switzerland Jacob Nufer, a pig gelder, is supposed to have performed the operation on his wife after a prolonged labour.

However, there is some basis for supposing that women regularly survived the operation in Roman times. For most of the time since the 16th century, the procedure had a high mortality rate. However, it was long considered an extreme measure, performed only when the mother was already dead or considered to be beyond help.

In Great Britain and Ireland, the mortality rate in 1865 was 85%. It is less than 200/100,000 (<2%) in India.

Key steps in reducing mortality were:

  1. Introduction of the transverse incision technique to minimize bleeding by Ferdinad Adolf Kehrer in 1881 is thought to be first modern CS performed.
  2. The introduction of uterine suturing by Max Saenger in 1882
  3. Extraperitoneal CS and then moving to low transverse incision (Krönig, 1912)
  4. Adherence to principles of Asepsis
  5. Advanced Anesthesia
  6. Blood Transfusion
  7. Antibiotics