A mid-century perspective on cesarean childbirth (1959)

Good news about cesarean childbirth

How did cesareans come to be among the safest of all major operations? Here’s a fascinating account of these baby-deliveries — plus practical advice

by Ruth and Edward Brecher

When a young woman finds that she is pregnant and visits her family doctor or an obstetrician, the first or second examination she undergoes almost always includes a measurement of her pelvic region.

While this examination is being made, it’s a rare woman who — perhaps with considerable anxiety – doesn’t ask herself: “Is my pelvis big enough to let the baby through – or will I need a cesarean?” (A cesarean operation, as almost every woman knows, is the delivery of a baby through a surgical opening in the abdomen instead of down the usual birth canal.)

Then other questions are likely to follow: Are cesareans performed for the sake of the mother or the baby? Is a mother conscious during the operation? After it, can she care for and breastfeed her baby? Above all, how serious is the risk — to mother and baby — of a cesarean?

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Doctors are eager to offer reassurance. As one obstetrician told us, “If all wives and husbands knew the facts about present-day cesareans, instead of worrying over the legends handed down from preceding generations, they would feel greatly relieved.”

Here, then, are those facts — gleaned from talks with half a dozen of the nation’s foremost obstetricians as well as from medical reports on tens of thousands of cesareans. Here, too, is some practical advice to women who may have to undergo a cesarean.

Common fears about this operation are easy to understand. Two or three generations ago the cesarean was an “operation of last resort” — an emergency effort in cases where the outlook for both mother and baby seemed hopeless.

Most of the women delivered by cesarean died. This was hardly surprising, for most of them were on the brink of death before the operation, and few physicians had learned how to sew up the uterus after the baby was delivered.

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The cesarean as it is now performed has almost nothing in common with those early, desperate efforts. Yet old-time attitudes towards cesareans still persist.

Today cesareans [1959] are among the safest of all major operations. Leading medical centers report 1,000, 1,500, or even 2,000 consecutive cesareans without the loss of a single mother.

Some of the mothers in these series were seriously ill before the operation; cesareans unquestionably saved their life. Countless babies, too, are saved each year by the operation.

This true story of the Burke family provides a heart-warming illustration of the safety of present-day cesarean childbirth:

About 17 years ago, Mrs Burke became pregnant for the first time, but she lost her baby following a prolonged and hard labor. After losing two more babies under the same circumstances, the Burkes sadly gave up hope of having a child.

A decade passed. During those years doctors learned how to make cesareans safer than they had ever been. The Burkes’ obstetrician told them this, and with his full approval they resolved to have a cesarean-delivered baby.

This time Mrs Burke had her baby in the specially-equipped obstetrical operating room of a large hospital. A trained anesthesiologist gave her a spinal anesthetic that eliminated painful sensations in the lower portion of her body but left her fully conscious.

A skilled obstetrician, assisted by two resident physicians and two nurses, made an incision in Mrs Burke’s abdomen and in the lower portion of her uterus. In less than 10 minutes after the first incision was made, the baby was delivered and held up for Mrs Burke to see.

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Then the baby was handed to an attending pediatrician for immediate care, while the obstetrician proceeded to the important task of sewing up the uterus in a way that would provide the greatest strength for subsequent pregnancies.

To prevent infection, the utmost surgical cleanliness was maintained throughout the delivery, and antibiotics were available as a further safeguard. Had the baby needed an incubator, one was ready. And from the hospital’s blood bank an adequate supply of blood, carefully matched in advance to Mrs Burke’s, was on tap to replace any she might lose.

Everything went smoothly, and today the Burke family includes three bouncing children, each born by cesarean. A fourth is on the way. “Not bad,” says Mrs Burke, “for a couple who were convinced that they couldn’t have children at all!”

As cesarean have become safer over the past 10 to 15 years, they have also become commoner. An obstetrician no longer need ask himself, “Is this birth problem so serious that a cesarean is the only hope?”

Instead, he can now put this question: “Of the two methods available, ordinary delivery and cesarean delivery, which in this case is likely to produce the most satisfactory results for both mother and baby?” The doctor knows that wisely-chosen cesarean deliveries account for a considerable part of the encouraging childbirth statistics during recent years.

What are the chances of a prospective mother’s having a cesarean baby?

A reasonable estimate is that 19 million babies born during the next five years in the United States will emerge uneventfully down the birth canal in the usual way. About one million will be cesarean births. Thus the odds are about one in 20.

If a mother has already had one baby through the birth canal without difficulty, the likelihood of a cesarean is slight; but occasionally, even among women who have had several babies by ordinary delivery, cesareans are necessary.

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