Known for short as a CSection A surgical

� Known for short as a C-Section � A surgical procedure in which one or more incisions are made through a mother's abdomen and uterus to deliver one or more babies � The initial purpose was essentially to retrieve the infant from a dead or dying mother

� Tales in both Western and non-Western cultures � Greek mythology: Apollo removed Asclepius from mother’s abdomen � References appear in Hindu, Egyptian, Grecian, Roman, and other European folklore � Some say Julius Caesar was the first born of it hence the name Cesarean � Only performed when mother was dead or dying � First written record of a mother and baby surviving comes from Switzerland in 1500

Many of the earliest successful cesarean sections took place in remote rural areas lacking in medical staff and facilities � Jacob Nufer- very knowledgeable in anatomy and was one of the reasons surgeries weren’t performed in the hospital because he knew infections were passed between patients. � its practitioners were dreaded and viewed by the public as little better than barbers, butchers, and tooth pullers �

Someone with understanding of the organs and tissues involved � In the 16 th century, numerous works illustrated human anatomy in detail � Vesalius’s anatomical text De Corporis Humani Fabrica depicts female genital and abdominal structures � Later human cadavers helped in understanding � Usually performed on the kitchen table or on beds; not in hospitals � In Western society women for the most part were barred from carrying out cesarean sections until the late nineteenth century, because they were largely denied admission to medical schools. �

� Midwives were usually the ones assisting in births � Professional midwives were competent, have primacy for the sake of safety of woman and child, wise, can communicate well.

Destructive scissors and crotchets. From William Smellie's A Sett of Anatomical Tables, 1754

� These instruments were associated with high levels of fetal damage, infection, and serious lacerations to the woman � Obstetrical forceps helped to remove the fetus in some cases, but they had limitations

From André Levret's Observations sur les causes et les accidens de plusieurs accouchemens laborieux, 1750.

� Were distinguished from other healers because they possessed a university degree � Degree identified their middle-class status � Nobility drew on them; the poor distrusted them � Once they graduated, usually returned home to try and set up a practice � District physicians answered to the mayor or town council of a village � Highest positions would be a personal physician to a nobleman or the court physician to royalty.

� Included pharmacists, midwives, and surgeons � They required little if any formal education other than through the apprenticeship. � Surgeons did more than operate, they treated fractured bones, burns, knife and gunshot wounds, tumors, ulcers, and skin disease. � Many who couldn’t afford or didn’t trust physicians saw other healers like corn doctors, oculist, dentists, etc. � A board of physicians regulated governing the activities of healers.

� Quacks are those whose motivation is to practice medicine in order to make money � Don’t care if they actually provide healing or not � Determining who was a quack and who wasn’t was a hard task � Itinerants were most suspect � Wasn’t just restricted to healers but physicians too � Resulted in condemnation in economic, social, and moral terms.

� Good health depended on the common sense maintenance of balance among bodily fluids and a list of non-naturals � Humoralism- the body contained four humors: black bile, yellow bile, blood, and phlegm. � The six non-naturals: fresh air, fresh food, exercise, sleep, evacuations, and passion � Most common illness was hampered evacuations

� In The Trotula, female genitalia are referred to as “the genital members” or “hidden places” � References to “secret diseases” and “secret medicine” and “secret places” of women � Said to be men’s perspective of a woman’s body as secret � These phrases usually stand for reproductive organs or gynecological and obstetrical disorders

� Surgeons and Physicians were supposed to know which signs of the zodiac governed which body parts.

mortality rates for the operation remained high, with the infections septicemia and peritonitis accounting for a large percentage of post-operative deaths � surgeons wore their street clothes to operate and washed their hands infrequently while passing from one patient to another � surgical techniques of that day also contributed to the appallingly high maternal mortality rates. � According to one estimate not a single woman survived cesarean section in Paris between 1787 and 1876 � Surgeons were afraid to suture the uterine incision because they thought internal stitches, which could not be removed, might set up infections and cause uterine rupture in subsequent pregnancies �

� Today, it is a much more safe procedure � Some mothers even want to have it done which is called a CDMR (Cesarean Delivery on Maternal Request) � The cesarean rate rose by 53% from 1996 to 2007, reaching 32%, the highest rate ever reported in the United States. � Cesarean rates also increased for infants at all gestational ages; from 1996 to 2006 preterm infants had the highest rates.