Cesarean Section Through the Ages: A Journey of Medical Pioneers, Epidemics, and Heroic Triumphs

By: Anna K. Bergendy

Twitter: @annakleopatra.art

Introduction: Early C-Sections

Cesarean section surgeries, or c-sections, have a long history dating back to 320 BC, with the first recorded successful procedure in 1500 AD. The practice may be as old as mankind. Before the advent of modern surgical techniques, anesthesia, and antiseptic practices, cesarean sections were primarily used as a last resort in situations where the mother had died, or was dying during childbirth, and the primary goal was to save the life of the infant. C-sections often appear in myths, reflecting the fascination with saving both mother and baby through miracles or medical intervention. The term "cesarean" likely comes from the Roman term caeso matris, meaning “cutting a fetus from the maternal womb,” and is often mistakenly attributed to Julius Caesar. Numa Pompilius, the second king of Rome, enacted the Lex Cesarea, a law mandating fetal extraction from the maternal uterus in cases of maternal death. This law aimed to provide a chance for the baby to survive and, if not, to ensure an individual burial.  In this article, we primarily focus on European history in the 19th and 20th centuries.

An illustration of the birth of Julius Caesar from 1506

Despite a popular legend suggesting Caesar's birth via c-section, historical evidence indicates it is highly unlikely, as his mother, Aurelia Cotta, lived many years in good health after his birth.  

Source: Wikipedia

The earliest explicit record of a cesarean surgery is found in the Persian national epic, the Shahnameh. The epic, covering the history of ancient Persia, recounts the poetic, yet realistic, story of Princess Rudaba giving birth to her exceptionally large son, Rustam. 

"Birth of Rustam", detail of an illustration

Source: The Metropolitan Museum of Art

The reasons for performing cesarean sections were explained by a combination of medical, cultural, and religious factors. The 19th and 20th centuries were marked by a significant scientific boom, which transformed various fields. Medical science progressed significantly during the 19th century, with notable achievements such as the introduction of anesthesia, the formulation of the germ theory of disease, and the recognition of bacteria as the culprits behind infections. The 20th century brought about a revolutionary shift in medicine with groundbreaking discoveries like antibiotics, including penicillin, fundamentally altering healthcare practices. 

The tuberculosis epidemic across Europe was a major public health concern in the 19th and early 20th centuries. The physical symptoms of tuberculosis on women were absurdly romanticized as pale skin and fragility were sought after traits at the time.

Tuberculosis can sometimes affect reproductive organs, including the deformation of the pelvic area. Pelvic tuberculosis can lead to inflammation, scarring, and damage to the fallopian tubes or uterus. In severe cases, it may result in pelvic adhesions or obstruction, potentially affecting fertility or complicating pregnancy. A generation of women having been affected by tuberculosis called for a desperate need to significantly improve the efficiency of c-section procedures. Birth by cesarean section became increasingly common in the 19th century. Up until the 20th century, the number one reason for its use was underdeveloped pelvises as a result of tuberculosis:society could no longer afford cesarean section to be nothing more than a last resort. 

The story of Anna Margaretha Adametz 

 This story serves as a poignant illustration of the resilience of both mothers and medical practitioners amidst the challenges posed by tuberculosis. Anna Margaretha Adametz was born in 1795 in the Duchy of Holstein, and she was the wife of a Bohemian tailor. Due to childhood tuberculosis, she couldn't walk until she was 12 years old, and she had an extremely narrow pelvis. Despite all the potential risks, it's safe to assume that she desired to become a mother more than anything in the world and would do anything to make her dream happen. She first got pregnant at the age of thirty and, within the next eleven years, underwent a total of four c-sections without any form of anesthesia. 

She went into labor for the first time on June 16, 1826. For two days, she could not birth her baby, and her midwife called for a local team of doctors who could not help her despite their best efforts. In the end, with Mrs. Adametz’s consent, Dr. Zwanck, a surgeon from a nearby town, performed a cesarean section on her on the morning of June 18. Unfortunately, her baby did not survive. Despite having a high fever, it’s been noted that she was able to do the laundry by July 20. Dr. Zwanck advised her not to get pregnant again, as it would certainly be fatal. Three years later, she was expecting another baby. 

Dr. Zwanck would not perform another surgery, so he recommended Professor Christian Rudolf Wilhelm Wiedemann in Kiel. At this time, Wiedemann was already planning his retirement, but learning about this case, he was ready to perform her now-second c-section with the help of his nephew and assistant Gustav Adolph Michaelis. Michaelis was a true pioneer of scientific obstetrics with great empathy for pregnant women. He performed extensive research on birth difficulties associated with a narrow pelvis. Walking in the footsteps of Ignác Semmelweis, Michaelis was one of the first obstetricians to implement the practice of chlorine handwashing to prevent childbed fever. 

On a candle-lit night on January 20, 1830, Mrs. Adametz’s second surgery began. Despite the lack of anesthesia, she fearlessly rejected her limbs getting tied down. During the five-minute surgery, attendees noted that she did not make a sound. The surgery was successful, but the baby girl tragically passed away when she was 32 days old. 

Two years after the second surgery, on March 28, 1832, she was ready to undergo the procedure for a third time. The surgery was successfully performed by Michaelis, but the baby boy passed away in infancy, too, due to scarlet fever. 

Her last and final cesarean section took place on June 27, 1836. Mrs. Adametz was 41 years old at the time. The medical team was certain that she would not survive another procedure. A couple of doctors and twenty students witnessed Michaelis perform a medical miracle by candlelight. This time the surgery took 29 minutes. A perfectly healthy, nearly 9 lbs baby girl was born. Mrs. Adametz’s incredible struggle had finally paid off: she could raise her baby to adulthood. The baby girl was baptized on July 24th. She was given the name Frederike Caroline Luise Cäsarine. Christian VII, King of Denmark and Norway and Duke of Schleswig and Holstein, upon hearing about the incredible birth story, became the godfather and sponsor of Frederike. She lived a long life and got to tell her mother’s heroic story to her grandchildren. 

Sometimes, there is unfair societal pressure on women that potentially lead to feelings of inadequacy or judgment for those who undergo cesarean sections. By sharing forgotten stories of medical pioneers and fearless mothers, we would like to challenge the invalidating idea that women who undergo them are less committed or strong. In tracing the historical journey of cesarean sections, we discover the indomitable spirit of individuals facing extraordinary challenges.  

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