If you’ve had a child in the last ten years or so – or rather, if you’ve seriously contemplated having a child for more than about fifteen minutes of your life – there’s one fact you’ve probably heard: Caesarean rates in the first world, especially in the US, are too high. Every few months brings along another article like this one, deploring the Caesarean rate and explaining (1) why it’s so high and (2) what doctors and patients should be doing to solve it, and aren’t. In many circles, unmedicated natural childbirth is held to be the best possible birthing experience — “our birthright” according to one midwife — and women who end up having a Caesarean for causes which aren’t immediately and obviously life-threatening for the baby (for instance, prolapsed cord) quite often feel that they’ve somehow been denied a good birth, or that they have let themselves or the baby down. On Plans, we were discussing how “birth is not a competition”, but human nature is such that some people will inevitably regard it as one; to have had an unmedicated birth somehow gives you a head start in the Good Parenting Stakes, and to have had a Caesarean shows lamentable weakness.
This is not to argue that Caesareans are indeed riskier than (most) natural deliveries, and that there are possible far-reaching complications; the risk of placenta accreta in a subsequent pregnancy rises with each Caesarean birth, and the uterus can begin to weaken if it’s repeatedly cut into. The writers or these articles are also correct that the rate of Caesareans could be reduced; the main problem here is that many hospitals refuse to allow women to try for natural deliveries if they’ve already had a c-section, and many midwives won’t take them as homebirths because of the higher risks involved. So while I don’t particularly care for the tone of some of the “Down with C-sections” articles, especially since I’ve had one myself, they do have a lot of valid points about letting women try for natural births, how moving around during labour can encourage progress, how induced labour can backfire, and so forth.
What I find fascinating here is how familiarity has come to breed contempt; though you wouldn’t know it from reading the more hardcore literature, c-sections have been around at least as long as people have been able to write about them. Back in the day, a child born by c-section was seen as almost mystically affected by it; it meant that you were truly strange and special, marked from your birth by the fact that you were “not born”. How much respect their mothers received for having undergone it is hard to say, since these women invariably died. However, since they had made the ultimate sacrifice for their children (an unpleasant sort of apotheosis of motherhood, but still an apotheosis of a sort) it’s safe to assume that they weren’t denigrated.
Of course, caesareans were very rarely done; they were performed only when the mother was obviously either close to death or already dead. (Antonia Fraser, in The Wives of Henry VIII cites a 17th century Venetian law which mandated Caesareans for women who had just died in advanced pregnancy). While mythology teems with figures born in odd ways (Athena springing from the head of Zeus, the five children of Saturn being rescued from his stomach by Zeus), it’s impossible to know who was the first real child born by Caesarean. It certainly was not Julius Caesar, despite the occasional claim that the procedure was named after him, since as his mother lived a good many years after his birth. According to this interesting article, a number of major Roman figures were rumoured to have been C-section children; the vagueness of the reports (as well as the statistical unlikelihood of all of these reports being true) makes you wonder if some of these stories were invented after the fact, as supposed early indicators of the person’s fated life. It’s worth noting that the story about Queen Jane Seymour being delivered by Caesarean is almost certainly untrue; as Antonia Fraser points out, she was well enough a few days after her son’s birth to be sitting up and receiving visitors after the christening; a very unlikely occupation for a woman who had just been c-sectioned without the benefit of either antiseptics or sutures).
A likely-authentic Caesarean baby was St. Raymond Nonnatus, whose manner of birth was considered sufficiently notable to be incorporated into his name, as the “Not Born”. Another interesting, possibly-authentic case is that of Robert II of Scotland. All accounts of his birth agree that his mother, Marjorie Bruce, was thrown from her horse while riding in late pregnancy, and that her son’s delivery and her death had occurred within the next few hours. The high-colour version of the story has Marjorie being delivered by Caesarean at the roadside, and declaring her son to be the future king before dying. The more cautious state simply that she died after a fall from her horse and that the baby may have been delivered at Paisley Abbey (which doesn’t rule out a Caesarean, of course). Certainly the story of Robert II’s miraculous delivery became well-known; it’s hard to believe that Shakespeare didn’t have it in mind when MacDuff, who was not “born” due to a posthumous Caesarean, turned out to be the one person able to kill Macbeth. Incidentally, Robert II was the founder of the Stuart dynasty, and Shakespeare wrote Macbeth to be performed for the first Stuart king of both Scotland and England – James VI/I. Shakespeare, like any long-lasting courtier, had to have flattery down to a science.
It’s tempting to think that the story of Robert II’s delivery is just a post-hoc invention designed to show that he was fated for greatness in founding a dynasty (he wasn’t in direct line for the throne originally, after all). The thing that makes me think it may be true is the nature of his mother’s injury; thrown from her horse and badly injured. It’s not unlikely that her pelvis was injured in some way, and that could make a natural delivery very difficult, and a live birth unlikely. The Caesarean story may, after all, be true.
There are a lot of odds and ends of legend surrounding Caesareans; they became more common in the nineteenth century but still had an appalling mortality rate. Nobody can be certain, but it seems to have hovered around 80%. With the discovery – and consistent use – of antiseptics and suturing, c-sections became survivable both for mother and child. These may not have been the earliest survived Caesareans – there’s an interesting factoid which pops up in the Wikipedia entry on the subject and in a number of other places; supposedly the nineteenth-century “indigenous healers of Kahura, Uganda” routinely performed c-sections which were survived by both parties, and which were observed by “a number of European travelers.” This statement is duplicated in any number of places but I can’t find an original source to track it down to, so I’ll admit to being somewhat skeptical. Stories of the fabulous medical achievements of “primitives” were common in the days when travelling was a rare and rough activity, but if the healers of Kahura really did manage these rough-and-ready Caesareans without harm, there doesn’t seem to be any record of their passing the art down. This is not to say that they never attempted a c-section, or that some mothers may not have survived. But the reports of their operations being routine and safe asks for closer examination.
With the increasing safety of Caesareans came a concurrent decrease in status for the Caesarean baby; once regarded as potential saints, mystics, rulers, or at least marked for distinction in some way (and being “not born” had its own inherent status) they’ve dwindled to being ordinary babies born in an ordinary way. But in compensation, their mothers are usually around to watch them grow up, and it’s hard to imagine too many infants wanting to trade the one for the other!