Editing Caesarean section (section)

==History==
[[File:A baby being removed from its dying mother's womb via Caesar Wellcome V0014915.jpg|thumb|A baby being removed from its dying mother's womb]]
[[File:Uganda cesarean section.gif|thumb|A caesarean section performed by indigenous healers in Kahura, Uganda. As observed by medical missionary [[Robert William Felkin]] in 1879.]]

There are many conflicting stories of the first successful caesarean section (or C-section) in which both mother and baby survived. It is, however, known that the procedure had been attempted for hundreds of years before it became accepted at the beginning of the twentieth century.<ref name=":0" /> While forceps have gone through periods of high popularity, today they are only used in approximately 10% of deliveries. The C-section has become the more popular solution for difficult deliveries. In 2005, one-third of babies were born via C-section.

Historically, caesarean sections performed upon a live woman usually resulted in the death of the mother.<ref name="Shorter">{{cite book | title = A History of Women's Bodies | vauthors = Shorter E | publisher = Basic Books, Inc. Publishers | year = 1982 | isbn = 0-465-03029-7 | page = [https://archive.org/details/historyofwomensb00shor/page/98 98] | url = https://archive.org/details/historyofwomensb00shor/page/98 }}</ref> It was considered an extreme measure, performed only when the mother was already dead or considered to be beyond help. By way of comparison, see the [[resuscitative hysterotomy]] or perimortem caesarean section.

According to the ancient Chinese ''[[Records of the Grand Historian]]'', Luzhong ({{lang|zh|陸終}}), a sixth-generation descendant of the mythical [[Yellow Emperor]], had six sons, all born by "cutting open the body".  The sixth son [[Jilian]] founded the House of Mi that ruled the [[State of Chu]] ({{circa|1030}}–223 BC).<ref name="shiji">{{cite web |url=http://www.guoxue.com/shibu/24shi/shiji/sj_040.htm |title=楚世家 (House of Chu) |work=[[Records of the Grand Historian]] | vauthors = Qian S |language=zh |access-date=3 December 2011 |url-status=dead |archive-url=https://web.archive.org/web/20120310023405/http://www.guoxue.com/shibu/24shi/shiji/sj_040.htm |archive-date=10 March 2012  |author-link=Sima Qian }}</ref>

The [[Sanskrit]] medical treatise ''[[Sushruta Samhita]]'', composed in the early 1st millennium CE, mentions post-mortem caesarean sections.<ref>{{Cite journal |last=Lurie |first=Samuel |date=2005-03-15 |title=The changing motives of cesarean section: from the ancient world to the twenty-first century |url=http://dx.doi.org/10.1007/s00404-005-0724-4 |journal=Archives of Gynecology and Obstetrics |volume=271 |issue=4 |pages=281–285 |doi=10.1007/s00404-005-0724-4 |pmid=15856269 |s2cid=26690619 |issn=0932-0067}}</ref> The first available non-mythical record of a C-section is the mother of [[Bindusara]] (born {{circa|320 BC}}, ruled 298&nbsp;– {{circa|272 BC}}), the second [[Mauryan empire|Mauryan]] ''Samrat'' ([[emperor]]) of India, accidentally consumed poison and died when she was close to delivering him. [[Chanakya]], Chandragupta's teacher and adviser, 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.<ref name="Lurie">{{cite journal | vauthors = Lurie S | title = The changing motives of cesarean section: from the ancient world to the twenty-first century | journal = Archives of Gynecology and Obstetrics | volume = 271 | issue = 4 | pages = 281–285 | date = April 2005 | pmid = 15856269 | doi = 10.1007/s00404-005-0724-4 | s2cid = 26690619 }}</ref>

An early account of caesarean section in Iran (Persia) is mentioned in the book of ''[[Shahnameh]]'', written around 1000 AD, and relates to the birth of [[Rostam]], the legendary hero of that country.<ref>{{cite encyclopedia | vauthors = Shahbazi AS |title=RUDABA |encyclopedia=Encyclopedia Iranica |access-date=19 July 2009 |url=http://www.iranica.com/newsite/index.isc?Article=http://www.iranica.com/newsite/articles/sup/Rudaba.html }}{{dead link|date=September 2017 |bot=Level C |fix-attempted=yes }}</ref><ref name="pmid13777540">{{cite journal | vauthors = Torpin R, Vafaie I | title = The birth of Rustam. An early account of cesarean section in Iran | journal = American Journal of Obstetrics and Gynecology | volume = 81 | pages = 185–189 | date = January 1961 | pmid = 13777540 | doi = 10.1016/S0002-9378(16)36323-2 }}</ref> According to the ''Shahnameh'', the [[Simurgh]] instructed [[Zal]] upon how to perform a caesarean section, thus saving [[Rudaba]] and the child Rostam. In Persian literature caesarean section is known as ''Rostamina'' ({{Lang|fa|رستمینه|rtl=yes}}).<ref>Wikipedia [[Rostam]]</ref>

In the [[Irish mythology|Irish mythological]] text the [[Ulster Cycle]], the character [[Furbaide Ferbend]] is said to have been born by posthumous caesarean section, after his mother was murdered by his evil aunt [[Medb]].

The [[Babylonian Talmud]], an ancient [[Jew]]ish religious text, mentions a procedure similar to the caesarean section. The procedure is termed {{Lang|he-latn|yotzei dofen}}. It also discusses at length the permissibility of performing a C-section on a dying or dead mother.<ref name="Lurie"/> [[Rabbi]]nical reports from the 2nd century AD about discussions that took place even earlier suggested that Jewish women regularly survived the operation in Roman times, but this conflicts with the general view that caesarean sections were always fatal to the mother in the pre-[[modern era]].<ref>{{cite journal | vauthors = Boss J | title = The Antiquity of Caesarean Section with Maternal Survival: The Jewish Tradition | journal = Medical History | volume = 5 | issue = 2 | pages = 117–131 | date = April 1961 | pmid = 16562221 | pmc = 1034600 | doi = 10.1017/S0025727300026089 }}</ref>

[[Pliny the Elder]] theorized that Julius Caesar's (born 100 BC) name came from an ancestor who was born by caesarean section, but the truth of this is debated (see the discussion of [[Gaius Julius Caesar (name)#The cognomen Caesar|the etymology of ''Caesar'']]). Some popular misconceptions involve Caesar himself being born from the procedure; which is considered false because the procedure was lethal to mothers in ancient Rome and Caesar's mother [[Aurelia Cotta]] lived until he was an adult.<ref>{{Citation |last1=Jauniaux |first1=Eric |title=Caesarean section |date=April 2016 |url=http://dx.doi.org/10.1093/med/9780198758563.003.0001 |work=Textbook of Caesarean Section |pages=9–24 |access-date=2023-08-19 |publisher=Oxford University Press |last2=Grobman |first2=William A.|doi=10.1093/med/9780198758563.003.0001 |isbn=978-0-19-875856-3 }}</ref><ref name=":0" /> The Ancient Roman caesarean section was first performed to remove a baby from the womb of a mother who died during childbirth, a practice sometimes called the ''Caesarean law''.<ref>{{Cite web|date=2013-10-25|title=The Truth About Julius Caesar and "Caesarean" Sections|url=http://www.todayifoundout.com/index.php/2013/10/caesarean-sections-named-emperor-julius-caesar/|access-date=2020-10-09|website=Today I Found Out|language=en-US}}</ref>

The [[Spain|Spanish]] saint [[Raymond Nonnatus]] (1204–1240) received his surname—from the [[Latin]] {{Lang|la|non-natus}} ('not born')—because he was born by caesarean section. His mother died while giving birth to him.<ref>{{cite web |url=http://www.catholic.org/saints/saint.php?saint_id=314 |title=St. Raymond Nonnatus |publisher=Catholic Online |access-date=26 July 2006 |url-status=dead |archive-url=https://web.archive.org/web/20060719195735/http://www.catholic.org/saints/saint.php?saint_id=314 |archive-date=19 July 2006 }}</ref>

There is some indirect evidence that the first caesarean section that was survived by both the mother and child was performed in [[Prague]] in 1337.<ref>{{cite journal | vauthors = Pařízek A, Drška V, Říhová M | title = Prague 1337, the first successful caesarean section in which both mother and child survived may have occurred in the court of John of Luxembourg, King of Bohemia | journal = Ceska Gynekologie | volume = 81 | issue = 4 | pages = 321–330 | date = Summer 2016 | pmid = 27882755 }}</ref><ref>{{Cite news|url=https://www.nytimes.com/2016/11/23/world/what-in-the-world/a-breakthrough-in-c-section-history-beatrice-of-bourbons-survival-in-1337.html|title=A Breakthrough in C-Section History: Beatrice of Bourbon's Survival in 1337| vauthors = de Goeij H |date=23 November 2016|work=[[The New York Times]]|access-date=29 December 2019|language=en-US|issn=0362-4331}}</ref> The mother was [[Beatrice of Bourbon, Queen of Bohemia|Beatrice of Bourbon]], the second wife of the [[John of Bohemia|King of Bohemia John of Luxembourg]]. [[Beatrice of Bourbon, Queen of Bohemia|Beatrice]] gave birth to the king's son [[Wenceslaus I, Duke of Luxembourg|Wenceslaus I]], later the Duke of Luxembourg, Brabant, and Limburg, and who became the half brother of the later [[Charles IV, Holy Roman Emperor|King of Bohemia and Holy Roman Emperor, Charles IV]].

In an account from the 1580s, [[Jakob Nufer]], a [[veterinarian]] in [[Kemmental|Siegershausen]], Switzerland, is supposed to have operated on his wife after a prolonged labour, with her surviving. His wife allegedly bore five more children, including twins, and the baby delivered by caesarean section purportedly lived to the age of 77.<ref>{{Cite book | author = United States Congress House Committee on Appropriations |url=https://books.google.com/books?id=Ixo4AAAAIAAJ&pg=PA539 |title=Hearings, Reports and Prints of the House Committee on Appropriations |date=1970 |publisher=U.S. Government Printing Office |language=en}}</ref><ref>{{cite book | vauthors = Henry J |chapter=Doctors and Healers: Popular Culture and the Medical Profession | veditors = Pumphrey S, Rossi PL, Slawinski M |title=Science, Culture, and Popular Belief in Renaissance Europe |publisher=[[St. Martin's Press]]|year=1991|isbn=0-7190-2925-2 |location=New York|pages=197 }}</ref><ref>{{Citation| vauthors = Sewell JE | url=https://www.nlm.nih.gov/hmd/pdf/cesarean.pdf|publisher=National Library on Medicine]|title=Cesarean Section: A Brief History | work = A Brochure to Accompany an Exhibition on the History of Cesarean Section at the National Library of Medicine |date=1993 |archive-url= https://web.archive.org/web/20041105081735/http://www.nlm.nih.gov/hmd/pdf/cesarean.pdf |archive-date=2004-11-05}}</ref>

For most of the time since the 16th century, the procedure had a high mortality rate by modern standards. Key steps in reducing mortality were:
* Introduction of the transverse incision technique to minimize bleeding by [[Ferdinand Adolf Kehrer]] in 1881 is thought to be the first modern CS performed.
* The introduction of uterine [[suturing]] by [[Max Sänger]] in 1882
* Modification by [[Hermann Johannes Pfannenstiel]] in 1900, see [[Pfannenstiel incision]]
* Extraperitoneal CS and then moving to low transverse incision (Krönig, 1912){{Clarify|date=January 2009}}
* Adherence to principles of [[asepsis]]
* [[Anesthesia]] advances
* [[Blood transfusion]]
* [[Antibiotic]]s

Indigenous people in the [[Great Lakes (Africa)|Great Lakes region]] of Africa, including [[Rwanda]] and [[Uganda]], performed caesarean sections which in one account by [[Robert William Felkin]] from 1879 resulted in the survival of both mother and child. Banana wine was used, although the site of the incision was then also washed with water and, post-operation, covered with a paste made by chewing two different roots. From the well-developed nature of the medical procedures employed he concluded that these procedures had been employed for some time.<ref name="nlm.nih.gov_p2">{{cite web |url=https://www.nlm.nih.gov/exhibition/cesarean/part2.html |title=Cesarean Section&nbsp;– A Brief History: Part 2 |publisher=U.S. National Institutes of Health |date=25 June 2009 |access-date=27 November 2010 |url-status=live |archive-url=https://web.archive.org/web/20101221043816/http://www.nlm.nih.gov/exhibition/cesarean/part2.html |archive-date=21 December 2010  }}</ref><ref name="Ellwood">{{cite book | vauthors = Ellwood RS |year=1993 |title=Islands of the Dawn: The Story of Alternative Spirituality in New Zealand |location=Honolulu |publisher=University of Hawaii Press |isbn=0-8248-1487-8}}</ref><ref name="DunnCaes">{{cite journal | vauthors = Dunn PM | title = Robert Felkin MD (1853-1926) and caesarean delivery in Central Africa (1879) | journal = Archives of Disease in Childhood. Fetal and Neonatal Edition | volume = 80 | issue = 3 | pages = F250–F251 | date = May 1999 | pmid = 10212095 | pmc = 1720922 | doi = 10.1136/fn.80.3.F250 }}</ref> [[James Barry (surgeon)|James Barry]] was the first European doctor to carry out a successful caesarean in Africa, while posted to Cape Town between 1817 and 1828.<ref name="New Scientist">{{cite web| vauthors = Pain S |date=6 March 2008|url=https://www.newscientist.com/article/mg19726462.000-histories-the-male-military-surgeon-who-wasnt.html|title=The 'male' military surgeon who wasn't|work=NewScientist.com|access-date=16 March 2008|url-status=live|archive-url=https://web.archive.org/web/20080314230931/http://www.newscientist.com/article/mg19726462.000-histories-the-male-military-surgeon-who-wasnt.html|archive-date=14 March 2008}}</ref>

The first successful caesarean section to be performed in the United States took place in Rockingham County, Virginia in 1794. The procedure was performed by Dr. [[Jesse Bennett]] on his wife Elizabeth.<ref>{{cite magazine|url=http://www.time.com/time/magazine/article/0,9171,815000,00.html|title=Woman's Ills|magazine=[[Time (magazine)|Time]]|access-date=1 April 2009|date=18 June 1951|url-status=dead|archive-url=https://web.archive.org/web/20090413025430/http://www.time.com/time/magazine/article/0,9171,815000,00.html|archive-date=13 April 2009}}</ref>

=== Caesarius of Terracina ===
[[File:Icona Caesarius Diaconus, San Cesario diacono e martire.jpg|thumb|[[Caesarius of Terracina|Saint Caesarius of Terracina]], invoked for the success of caesarean delivery]]
The [[patron saint]] of caesarean section is [[Caesarius of Terracina|Caesarius]], a young deacon martyred at [[Terracina]], who has replaced and Christianized the pagan figure of [[Julius Caesar|Caesar]].<ref>Caesarius Diaconus, testi e illustrazioni di Giovanni Guida, [s.l.: s.n.], 2015</ref> The martyr (Saint Cesareo in Italian) is invoked for the success of this surgical procedure, because it was considered the new "Christian Caesar" – as opposed to the "pagan Caesar" – in the Middle Ages it began to be invoked by pregnant women to wish a physiological birth, for the success of the expulsion of the baby from the uterus and, therefore, for their salvation and that of the unborn. The practice continues, in fact, the martyr Caesarius is invoked by the future mothers who, due to health problems or that of the baby, must give birth to their child by caesarean section.<ref>Pasero Roberta, Cesareo di Terracina, un santo poco conosciuto: è il protettore del parto cesareo, in "DiPiù", anno XIV, n° 48, 3 dicembre 2018.</ref>