The gruesome origins of the C-section

For a while now I have been collecting archaeological evidence for pregnant women of the Iron Age, as I proposed to speak on this topic at an Iron Age conference in November.

As it turns out, graves of pregnant women are quite rare in Bronze and Iron Age Europe. This is slightly odd, as we do know that pregnancy and childbirth posed a considerable risk for prehistoric women. Cemetery demography (e.g. Chamberlain 2006) tells us that up to twice as many women died between the ages of 20 and 40, the fertile years, compared to men. Women must have had on average about 4 successful pregnancies to sustain the population level, so they did spend at least 2 years of their adult lives visibly pregnant. Any yet, women discovered with foetal remains in the pelvic area are incredibly scarce.

One common explanation is that foetal bones are just very small and do not preserve well; if archaeologists and anthropologist do not specifically look for them at excavations and sieve the soil carefully, they can be lost; further, foetal bones are easily mistaken for the bones of small animals (Lewis 2006). Whilst it easy to accept this explanations for antiquarian excavations, excavations today are normally run well enough that this cannot be the full explanation.

The other explanation is that women who died during late pregnancy and childbirth were not buried in regular cemeteries, but in settlement pits or other locations away from the settlement. Or they were not buried at all, and hence we do not find any evidence for what happened to their bodies. This is certainly a possibility; the higher number of females dying in the prime of life could be explained by heath problems that occurred after birth, such as haemorrhage, infections or mastitis.

But, there is one more possibility: the foetus may have been cut out of the woman’s body before she was buried. This seems to have been an almost universal custom in the first millennium BC: Roman Law (Lex Regia of Numa Pompilius, c. 700 BC) states that no woman shall be buried without having cut the foetus out first. A similar custom is documented in the Talmud and was practised even on sabbath (Caselitz 1980).

In the European Middle Ages this practice is less common, although the guidelines of an Augustinian canon dating to the 15th century in England state that “A woman that dies in childing shall not be buried in church, but in the churchyard, so that child should first be taken out of her and buried outwith the churchyard” (Gilchrist and Slone 2005: 71).

Medieval Caesarean section, c. 1400 BC © The British Library Board

Medieval Caesarean section, c. 1400 BC © The British Library Board

The woman’s life was prioritised over that of the foetus in antiquity, but if it was clear that the woman was dying or had died during birth, the babies were cut out. After the oxygen supply from the mother via the placenta is cut off, the unborn foetus dies within minutes. But already in antiquity, the timing of the cut was sometimes right and babies were successfully born via C-section. Allegedly, Apollo removed Asclepius from his mother’s abdomen. That Julius Caesar was delivered via C-section is likely a myth, as historical sources attest his mother Aurelia lived to see her son conquer Europe (Sewell 1993).

As unlikely as it seems, some women may have even survived the surgical procedure. From the Renaissance to the 19th century, as medical knowledge increased, the survival rate of C-sections for mothers improved. With the introduction of anesthesia, antisepsis and asepsis the tables finally turned. Today, C-sections save the lives of many, and are no longer associated with certain death.

References

Caselitz, P. 1980. Schwangerschaft im archäologischen Befund. The Archaeological Advertiser 1980: 20-26.

Chamberlain, A. 2006. Demography in Archaeology. Cambridge Manuals in Archaeology. Cambridge: Cambridge University Press.

Lewis, M. E. 2007. The Bioarchaeology of Children. Perspectives from Biological and Forensic Anthropology. Cambridge: Cambridge University Press.

Gilchrist, R., and B. Sloane. 2005. Requiem. The Medieval Monastic Cemetery in Britain. London: Museum of London Archaeology Service.

Sewell, J. E. 1993. Cesarean Section – a brief history. A brochure to accompany an exhibition on the history of Cesarean Section at the National Library of Medicine in Bethesda. Washington: American College of Obstetricians and Gynecologists.

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About Katharina

Katharina is a prehistoric archaeologist working at the Austrian Academy of Sciences. Her main research interests include the archaeology of the human body, gender, identity and personhood as expressed through funerary practices and art. She specialises in the Bronze and Iron Ages of Europe. As a mother of two young boys, she gathered some practical experience in addition to her theoretical interest in motherhood.
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5 Responses to The gruesome origins of the C-section

  1. This was a very cool read this morning. I appreciate the academic tone of this piece. I read a book that included a chapter on this topic, more for a lay audience. It’s called “Birth: The surprising history of how we are born” by Tina Cassidy. It was a very accessible read–maybe you’d like it!

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  2. Ali Isaac says:

    Very interesting, Katharina, but do you have any idea why the women could not be buried until the foetus had first been removed?

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    • Katharina says:

      Wondering about the reasons, too. I can do no more but speculate: First, pure curiosity – what was it that killed? Some societies remove organs that are believed to be responsible for death. Perhaps the baby showed signs of movement in the end. Second, all sorts of beliefs about purity, danger, and appropriateness; for instance the belief that unbaptised, dead babies could not be buried in consecrated grounds, but mothers could. Birth makes two individuals out of one – and death in the transitional phase was particularly hard to understand, I think. Different treatment of mother and stillborn baby/dead fetus underlines the different ontological status they probably had.

      Liked by 1 person

  3. Pingback: Embryotomy – Fetotomy | Motherhood in prehistory

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