Who invented the cesarean

A 10th century Byzantine-Greek historical encyclopedia called The Suda is one of the earliest records citing that the C-section was indeed named after Caesar. However, the likelihood of this theory is slim. Thus, even if Caesar was born through C-section, he was definitely not the first. If the term's origin story is false, why are C-sections still associated with Julius Caesar today?

Roman author Pliny the Elder explored the origin of C-sections in his book Historia Naturalis , suggesting that Julius Caesar was named after an ancestor who was born via cesarean. But over time, this conclusion may have been misconstrued. Pliny was clearly referring to the ancestors of Julius Caesar, though today many believe the procedure to be a reference to the well-known emperor himself.

For centuries, delivery by cesarean section remained a dangerous procedure. During the first half of the 19th century, surgical delivery almost always resulted in death of the mother from infection or bleeding. Even in the Bennetts' time, the cesarean section was not new. What was new was the idea that both mother and child could survive the ordeal. The operation itself dated from antiquity , but with very few exceptions was only performed when the mother was dead or dying.

The first recorded cesarean where both mother and child survived was done in Switzerland, in That was also a husband-wife affair, although in this case Jacob Nufer was a swine gelder, not a doctor. Before the 19th century, the success rate for physicians performing C-sections in the hope of saving both mother and child was very low.

Even with advances in medicine it remained a relatively high-risk procedure into the 20th century. Times have sure changed. Racial and ethnic disparities are a significant factor in these higher mortality rates.

Black and African American women are three to four times more likely to die during childbirth than women in all other racial and ethnic groups. The most recently published statistics for identified The rate for black women The rate of severe maternal morbidity has also increased in recent years and had affected more than 50, American women in [ ].

Racial and ethnic disparities are also substantially prevalent in severe maternal morbidity. Maternal comorbidities, including hypertension, diabetes, obesity and cesarean birth are frequently identified as significant contributors to the growing morbidity [ ], [ ] Racial and ethnic disparities in both maternal mortality and morbidity involved cesarean birth.

These disparities, which extend farther back in time, were highlighted in a trend analysis from , the inception of Title V of the Social Security Act, to [ ]. Recognizing the multifactorial character of this discrepancy, improving health care outcomes for women of color begins with equitable, high-quality health care services which take into account co-morbid health conditions and socio-economic status, and foremost the need for respect, dignity and communication in providing care.

The recognition of individual and structural racism on maternal health is crucial to reducing maternal deaths and improving outcomes for women of color. Racial disparity and its impact on the health care of black women have led to the creation in New York State of the Taskforce on Maternal Mortality and Disparate Racial Outcomes.

Similar taskforces have been established throughout the United States to provide and implement recommendations to address the multiple factors, including racial bias and institutional barriers, which compromise health leading to poorer outcomes for black women. Currently investigators have focused on the increasing prevalence of PAS; its prenatal diagnosis, epidemiology, and on various approaches towards optimizing maternal outcomes [ 63 ], [ ], [ ]. Research focusing on identifying and preventing novel risk factors in addition to CD may further decrease the severe morbidities and economic burden associated with PA [ 33 ].

There are no studies of cesarean surgical techniques and maternal long-term outcomes. Recommendations have been made by several investigators to determine whether a modification of surgical techniques can lower the incidence of abnormal implantation in subsequent pregnancies [ ].

When EFCT is combined with peritoneal closure, unlike previously published data, preliminary review suggests that a reduction in incidence of debilitating conditions, such as infertility, chronic pelvic pain, irregular bleeding, dyspareunia and dysmenorrhea is possible.

Uterine closure technique appears to influence the origin of niche formation, which concludes its ultimate shape with healing [ ]. Uterine scar defect and damaged endometrium have long been implicated in the pathophysiology of CS related abnormal placentation [ 63 ], [ ]. This emerging research paves the way for continuing investigation of the role of cesarean technique, in particular of the endometrium or decidua, on remote obstetrical and gynecological conditions seen in women with prior CDs.

Hence, Sholapurkar advised focused research on the finer details of surgical technique to identify and formulate preventive strategies [ 61 ]. Individual cesarean techniques are not monitored by any local or national bureaus, even as related long-term risks and complications are skyrocketing. There are neither protocols nor standard techniques for the performance of a CD.

At present, the operation relies completely on individual autonomy and preference. Vast circumstances shape the choice of individual physician technique. The type of practice private solo or group , faculty group practice, hospital employees, insurance plan in and out of network , and patient preference are all factors contributing to cost and operating time.

This leaves some obstetricians to complete the operation in the shortest possible timeframe, while others take longer. The lack of surgical standardization, although not yet studied, is most likely a contributing factor to unintended chronic adverse effects after a CD. A call to action is in order to standardize the steps necessary for the most optimal outcomes. It may become necessary to evaluate individual provider and institutional performance nationwide, as well as to monitor complications by an independent committee to include midwives, nurses and doulas, along with operating room technicians, doctors and governmental agents to implement safety parameters and risk-reducing methods.

Video-documentation of CSs is currently being used for research purposes to examine the impact of technique on a repeat CS [ ]. It is used to record and compare surgical techniques at a prior cesarean with intra-abdominal findings at the time of a subsequent CD. In the same individual patient, it is found to be instrumental for transparency, education, documentation and for preparation of a subsequent operation, including repeat CS [ ].

The establishment of a central platform for videos of CS should be considered as a shared learning experience for all obstetrical surgeons. Video documentation may also be an added resource of documentation to the CS operative report. The narrative report, as it is currently used for documentation in the form of handwritten, typed, or multiple choice template, often misses important finer details that may help understand or predict risks of future pregnancy outcomes.

For the past hundred years there has been a continuing evolution of the role of cesarean births in obstetrics.

CSs remain the most common operation performed in women of childbearing age in the world, accounting for one in three American women, and is the leading cause of maternal mortality and morbidity in the US. The operation can be life-saving for the fetus, the mother, or both in rare cases. Before the recommendation of a CS and prior to its performance however, the justification including potential risks and benefits should be provided to the patient and discussed.

Potential injuries should refer to both maternal and fetal risks. The most catastrophic maternal risks are uterine rupture, excessive blood loss that may result in hysterectomy or transfusion, injury to neighboring organs bladder or bowel , and thromboembolic disease. The risk of infant injury is low but not absent. The maternal morbidities may be in great part avoided, with greater awareness during the performance of the operation of the ultimate goal of returning uterine function to normal physiology.

To a large extent, obstetricians hold the solution to the reduction of cesarean-related complications in their hands. The increasing performance of CS should never be regarded as the simplest means to solve most obstetrical difficulties. The relationship of a prior CS and subsequent conditions remotely connected necessitate further studies of various techniques and the adoption of specific surgical features to improve long term outcomes. Cesarean morbidity has predominantly focused on short, rather than long-term maternal risks and outcomes.

Women undergoing a cesarean birth are at increased risk of a variety of chronic and life-threatening conditions. These conditions increase with the increasing number of CDs. In the non-pregnant state, these include pain, adhesions, irregular bleeding and infertility.

The pregnancy related risks include CSP and PAS, which represent the most deadly maternal complications in obstetrics. Increasing attention recently has addressed alterations in the infant microbiota induced by CS compared with vaginal birth, with long term consequences for obesity, and immune disorders such as asthma, allergy and atopic dermatitis.

Over the past years, evolution of cesarean techniques has made it possible to reduce maternal morbidity and mortality.

Despite this decline however, black women continue to experience substantially increased risks of both maternal mortality and morbidity compared to white women. These disparities have been challenging to the health care system and represent inequities in access to high-quality obstetrical care.

Surgical techniques have been implicated to influence the likelihood of all long term complications. Emerging studies have shown sparing the endometrium in the uterine closure may influence a reduction in abnormal placentation in subsequent pregnancies. A most recent study related the origin of cesarean scar defect to the technique of uterine closure after a cesarean birth.

The authors stressed the significant impact of the location of the endometrium during closure of the uterine incision. Further studies are needed to find the optimal surgical techniques that may reduce cesarean scar defects, which is considered the prevailing factor in abnormal placental implantation.

The risk of chronic maternal morbidities is intricately woven in surgical techniques. This promises to eliminate the subjective assessment of complications in research studies.

The autonomy of physician for surgical technique selection must also be reassessed in favor of a more structured, standardized optimal cesarean technique to curb these long-term maternal complications.

Identification of all patients undergoing a cesarean birth and subsequent follow-up would create a registry and database for tracking and a statistic-driven understanding of complications related to CDs. These steps could potentially lead to the discovery of the association between surgical technique and related complications.

Of equal importance, patients must be educated about the risks of a cesarean birth as part of pregnancy education, and providers must factor long term risks in the decision to perform a CD. The education of women about the short and long term potential risks of a CD to both mother and infant is vital for the success of this mission. The optimal cesarean technique will also create an opportunity to level the playing field, where no particular racial or ethnic group will suffer from disparate reduction of cesarean-related complications.

One hundred years later, our mission continues as we pursue a twenty first century solution to the alarming rate of obstetrical hemorrhage, peripartum hysterectomy, maternal mortality and racial inequity for health care.

Author contributions : All authors have accepted responsibility for the entire content of this manuscript and approved its submission. Vital statistics rapid release. Births: provisional data for Centers for Disease Control and Prevention.

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