Wednesday, 9 November 2011

#9 Grass hut Caesareans

FACT OF THE DAY:  People in Uganda were performing successful Caesareans before they were done in Europe

Seeing as Caesarean sections are in the news at the moment I thought I’d add a Caesarean story to my blog today.
Caesarean or C-section, or just plain old section, I’m never quite sure what to call them (too many ‘a’s and ‘e’s for my spelling ability!).... The NICE (National Institute for Clinical Excellence) is now recommending that women in England and Wales are given the right to choose a C-section on the NHS, whereas currently C-sections are only performed if there is a medical need, or if you are prepared to pay for them privately.

This seems such a strange reversal of attitude, until now we couldn’t even have an epidural on demand with the NHS and they were encouraging us all to have intervention-free births, and now suddenly they are recommending C-sections on demand?

On a scale of natural to unnatural, C-sections are obviously the least ‘natural’ way to give birth. They are the ultimate way to escape the risks of childbirth that nature throws at us (discussed in post #2).

So have any other cultures around the world also come up with the idea of a C-section?

The name Caesarean brings to mind the Roman Emperor Julius Caesar. Whether or not Caesar was born in this way (historians seem to disagree), the Romans did perform C-Sections of a sort – cutting the baby out in an emergency, but not being able to save the mother. Similar operations are recorded in other ancient cultures, and among the Maori in New Zealand and some cultures in Papua New Guinea, but it was always fatal for the mother.

According to Wikipedia, the first 'modern' C-section, with the aim of saving the mother and the baby, was performed by a German gynaecologist in 1881, although with high mortality rates initially.

Unbeknownst to them, far away in Central Africa, people were already performing successful C-sections, where both the mother and baby survived.

An explorer called Robert Felkin wrote a fantastic eye-witness account of such an operation which he saw performed in 1879. Amazing that we consider C-sections to be the height of modern sophistication, yet here were people in what was probably considered "deepest darkest Africa" competently performing these operations over 130 years ago.

To be fair, we don’t know how often, how successful or how widespread the operations were. But the knowledgeable way the operation was performed and the successful outcome suggests it wasn’t the first time that the ‘surgeon’ had done this operation.

This description below is praisied from Felkin's account. The people involved are the Baganda from Uganda. We are not told why the operation is being done, only that the woman is in her early twenties, and this is her first child.

The woman was ‘liberally supplied with banana wine, and was in a state of semi-intoxication’  and then strapped to a bed with cloth ties. The ‘surgeon’ washed his knife and hands and her stomach with water and banana wine, and then he muttered some prayers and uttered a shrill cry which was taken up by the crowd outside, he cut her stomach – abdominal wall and uterus - from belly button downwards which released the amniotic fluid (or liquor amnii as they called it in those days).
Artist's impression of the operation

Bleeding points were touched with a red-hot iron by an assistant, and then the surgeon made a crossways cut and his assistant held the stomach walls open with his hand. The baby was removed and the cord cut, and then the ‘surgeon’ grabbed the contracting uterus and squeezed it a few times, then put his hand inside to remove blood clots and the placenta, and then kept applying pressure with his hands to the uterus until it had fully contracted.

Sounds good so far. Next bit doesn’t sound so great ‘his assistant endeavoured, but not very successfully, to prevent the escape of the intestines through the wound. The red-hot iron being used to check some further haemorrhage’.

When closing up the wound, no stitches were put in the uterus, and the stomach walls were put back in place and a grass mat was strapped over the wound and the woman was turned on her side to allow all the fluid to drain. The stomach wound was pinned in place using seven very thin iron spikes, and a paste prepared from the pulp of two specific roots was plastered all over the open wound, on top of which they put a warmed banana leaf and finally a firm bandage of bark cloth.

Apparently the first time the woman cried out was when the stitches were put in, but an hour after the operation she appeared calm and comfortable and within two hours she was breastfeeding her baby, although for the first week it was mostly suckled by a friend. The woman had a fever for a couple of days. On the third morning the wound was redressed using the same root pulp and one pin was removed, three more were removed on the fifth day and the rest on the sixth day. After eleven days the wound was completely healed.

As an aside he mentions that the baby was wounded on the right shoulder, but this was also dressed with paste and it healed after four days.

If you want to see the full text you can find it here;

And all of that on banana wine....

So, no doubt a few differences in procedure from what would happen in an operating theatre at your local hospital, but it’s pretty impressive stuff.


  1. Wow! That is an amazing account of Ugandan c-sections. I'm in shock after reading that, and we in the modern West really don't know how lucky we are.

  2. Hi Tracey, I agree and often think that when people are romanticising 'natural birth'. Childbirth without many of the interventions and drugs that we take for granted is risky business. Maybe you'd be interested in my previous post #3 about childbirth?