How Did C-Sections Begin? Why are they so Common?

How did c-sections begin, and why are they so common? This is a question on the minds of many, including healthcare professionals, lawmakers, and individuals like you. If you are planning to become pregnant or are pregnant and are looking toward your birth experience, you may have some questions and concerns about c-sections.  A recent article published in Slate online provides some answers and information. The study examines the origins of c-sections in the United States, as well as various factors that may have contributed to steady increases in the procedure’s use.

At Birth Injury Guide, we like to provide information that is useful and interesting. Read on to learn more about the history of c-sections, what factors may have led to its rise, and what you need to know about making healthcare choices that are best for you and your family.

A History of Cesarean Sections

A Cesarean section, or C-section as it is commonly known, originated in the U.S. in the early 19th century, and continued to become more common as medical advances made the procedure safer.  Prior to this time, vaginal delivery was the standard. As the standard, vaginal birth was generally performed without much assistance in the way of medication or anesthesia. Over time, vaginal birth practices evolved as science and medicine did as well.

The first recorded account of a c-section in U.S. history was in 1830.  Dr. John L. Richmond went to the rural home of an Ohio family to assist in delivering their child.  The woman had been in labor for hours and had fits of convulsions and fainting between contractions.  Dr. Richmond administered laudanum and sulphuric ether to help with the convulsions, but was unable to determine why labor was not progressing.

Dr. Richmond decided that a c-section was the best course of action to hopefully save the mother and child.  As friends and family watched, Dr. Richmond made an abdominal incision, but couldn’t pull the baby out.  In intense pain, the mother begged for him to stop searching through her uterus to locate the baby.  Based on the ethics of the time, a horrifying decision was made.  Dr. Richmond delivered the baby in pieces through the c-section incision, opting to save the mother’s life.

The horrifying ordeal did save the mother’s life, and she returned to work in less than one month following the procedure.  A thorough examination after she healed revealed that she had an “abnormally shallow vagina with no discernible cervical opening”. As one can imagine, that would certainly be enough reason to take more invasive action in an effort to save lives.

During the 19th century, physicians were trained to allow childbirth to happen as naturally as possible.  Medical intervention was to be facilitated as needed.  Physicians were also trained on the premise that saving the mother’s life was paramount to that of the child.  C-sections were only to be used in dire circumstances and as a last resort.

The 20th century brought about a shift in mindset.  A greater focus was placed on saving the life of the child, as well as the mother.  Physicians became increasingly concerned with infant mortality rates, and the federal government became more involved.  Physicians developed diagnostic tools like the Bishop and Apgar scores.  Advances in medicine had changed the way that women were treated during childbirth, including medications administered.

C-Sections Become Increasingly Common

In the early days of the 20th century, c-sections were still very rare. Most cases were emergency c-sections. By the 1960’s, however, there was a stark increase in the number of c-sections performed in the U.S.  Between 1965 and 1987, c-section rates had increased by 455 percent.  Today, an estimated one in every three babies are born via c-section – a number which is twice the recommended 10-15 percent established by the World Health Organization (WHO).

During the mid 20th century there was also an increase in public attention to issues like childbirth and c-sections, largely thanks to the media who covered notable medical events among people like Jackie Kennedy.  Some people believe that increased attention and cultural factors may be part of the reason why the number of c-sections began to increase during these years.

Another possible reason why c-sections have increased is advances in technology.  As electronic fetal monitoring (EFM) became a standard in hospitals, the decision to perform a c-section or not was determined by doctors’ interpretation of the monitor results.  EFM monitors the baby’s vital signs and can indicate fetal distress. Over time, doctors relied on the information provided by EFM in making their decisions about labor and delivery.

Advances in technology have come a long way toward identifying possible health risks to mother and child, however, which can help doctors determine when a c-section is medically necessary.  Today, doctors can use innovative diagnostic tools to monitor pregnancy, test for possible diseases, and administer treatments during pregnancy. Doctors also have many more tools at their disposal in terms of helping the childbirth process proceed in the safest way possible.  Doctors and mothers have much greater information and control over the entire childbirth process.

C-Sections in Today’s Medical Environment

Today, c-sections are so common they have been called “unremarkable”.  Many women are given the option of an elective c-section, meaning that they can choose to have a c-section rather than allowing labor and delivery to occur naturally.  There are supporters and opponents to this idea, but many believe the decision should be left up to the woman. Ultimately, the vast majority of c-sections performed in the U.S. today are out of medical necessity. There are cases where women with a previous history of complications can schedule a c-section in advance, but most cases are emergent.

There are also many doctors who prefer c-section deliveries, as well as some hospitals with higher rates of c-sections than others.  There are many reasons for these variables, and it can be difficult to make sense of all the information. Many experts believe that hospitals should be required to release information about c-sections to the public, including the types of conditions that led to the surgery taking place. This information could better help women understand their options and the rates of procedures like c-sections in their local hospitals.

Preparing Women for Labor and Delivery

With such a great focus on increases in c-sections and questions of whether the procedure is overused, many women have questions about how to prepare for labor and delivery, and what choices they should make.  One maternal-fetal medicine specialist offers the following advice:

  • Remember that when you choose a doctor, you are also choosing a hospital. Doctors may be affiliated with one or more hospitals, so you should ask upfront what you can expect.
  • Research and evaluate available information about your doctor and his or her hospital of choice for deliveries. Look at reviews, c-section rates, and other information about their services.
  • When choosing a doctor or hospital, Recognize that some hospitals are better equipped than others in terms of labor and delivery, availability of specialists, and specialized departments like a neonatal intensive care unit (NICU).
  • If you have a “high-risk” pregnancy, you may want to choose a larger hospital that has better resources and access to an on-site NICU.
  • If you are determined to have a vaginal or natural birth, make sure your doctor knows your wishes and plans immediately. Together, you should create a birth plan that is on par with evidence-based practice, but is tailored to your individual situation and healthcare needs.
  • Remember that there are no guarantees when making a birthing plan. Complications can always happen, and often, they cannot be foreseen. Be mindful of that and the fact that your initial plans may have to change. An emergency c-section is a possibility with many pregnancy complications.
  • If your baby is unusually large, they may have trouble moving down the birth canal. This can make vaginal delivery difficult or dangerous. If the baby stays in the birth canal too long, they can suffer from oxygen deprivation and are at risk for birth injuries.
  • Be aware that your decisions and outcomes of your current pregnancy may affect future pregnancies. Talk to your doctor about any concerns you have related to fertility.

Examples of Birth Injuries During Labor and Delivery

Whether you attempt a vaginal delivery or have a scheduled c-section, there is always a risk of complications or injuries. Vaginal delivery, in particular, can become dangerous quickly if there are complications related to the baby’s size or the mother’s health.

A few examples of the types of birth injuries that can occur include:

Brachial Plexus Injury

If the baby becomes stuck in the birth canal, or the doctor uses forceps or vacuum extraction, there may be injuries to the nerves in the baby’s shoulder. The brachial plexus network of nerves runs from the neck, down the shoulder and down the arm and hand. Injury to these nerves can cause problems with movement and sensation.

Infant Brain Damage

Baby’s can suffer brain damage for a variety of reasons during labor and delivery. Some of the most common causes are untreated jaundice, maternal infections, birth trauma or oxygen deprivation. Brain damage during birth can lead to permanent disorders like seizures and cerebral palsy.

Fetal Lacerations

During a c-section, the baby is at risk for fetal lacerations. Cuts and scrapes from the surgical tools can cause injuries to the baby. In many cases, these are minor and heal without treatment. However, if the surgeon is not particularly careful, more serious injuries can occur. Lacerations can affect the skin, muscle and nerves, and can lead to more serious health issues.

C-Sections and Your Legal Rights

While society may see c-sections as commonplace and elective, they are still a major surgery with risks and consequences.  Healthcare providers are required to perform c-sections in an appropriate way that meets medical standards. When they fail to do that, they may be guilty of medical negligence.

medical negligence, pregnancy, childbirth, c-section

Some examples of medical negligence related to pregnancy, childbirth and c-sections include:

  • Improper administration of medications, including anesthesia
  • Failure to properly monitor maternal and fetal vital signs
  • Failure to order an emergency c-section when necessary
  • Inadequate infection control during the procedure and in recovery
  • Failure to recognize or treat an infection
  • Failure to properly monitor for blood clots and take measures to reduce the risk of a blood clot
  • Inadequate measures to prevent bleeding or hemorrhaging

As a patient, you have certain legal rights, and you deserve to know what they are, and how they may affect you as you make important healthcare decisions. If your doctor or another healthcare provider acted negligently during labor and/or delivery, you may qualify for compensation. To learn more about your rights and see if you qualify for compensation, contact Birth Injury Guide today.  Fill out our online form to schedule a free consultation with one of our skilled birth injury attorneys.

Maia Watkins

Page Medically Reviewed By Maia McSwiggan, MS, OTR/L

Maia McSwiggan, MS, OTR/L, is an occupational therapist with experience in the clinical and hospital settings. Maia has extensive experience working with children. She is a regular medical reviewer for Birth Injury Guide.

Meagan Cline

Written By Meagan Cline

Meagan Cline is a professional legal researcher and writer. She lends her expertise to the team at Birth Injury Guide to provide up-to-date and relevant content that clients can count on.