Came home from a placental abruption resulting in a horrifying emergency c section and 2 week hospital stay and made a bad choice to watch House of the Dragon where cesareans are a death sentence. I did a bit of research and found out medieval c sections did happen but were only performed if the mother was dying anyway as it was always fatal. I understand that infection would’ve killed any surviving women back then but apparently they died during the operation anyway. So I’m confused about what killed women during the procedure it’s self? As far as I’m aware I did not receive a blood transfusion so it can’t have been blood loss which would’ve been my guess pre my own experience. Did they not have the medical tools necessary to put those women back together afterwards eg stitches? Or did they not know how to make insicions in a non fatal way?
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One thing other people haven’t mentioned is that we have anaesthetic these days.
So not only did they have to contend with the complications of the surgery itself, they also had to deal with a patient who could feel every cut and movement inside them they made, meaning they likely moved around a lot, bled a lot more and caused far more trauma than a medicated person today.
By anaesthetic/medicated I mean epidurals as well a sedatives as most women often can’t be put to sleep in the usual way people are for surgeries during c sections.
It is blood loss.
With today’s technology and education, doctors can prevent huge blood loss (before a transfusion is necessary). They know where and how to cut. They know where and how to clamp. They can use modern tools to cauterize.
Before extensive education on the female anatomy, many women died due to blood loss during cesarean.
Since you are already a fan of HBO shows, watch the show The Knick. The very first scene and then multiple episodes throughout the first season of the show deal with the struggle to perform a successful C-section and keeping mother alive. It’s fantastic historically accurate medical show set in the early 20th century. Yes, even just about 100 years ago a C-section was fatal for the mother.
Toxic shock is a big killer in operations without an anaethetic. Sepsis is the next problem. You might have heard of the term Dutch Courage. Fun fact then. In times gone by, soldiers and sailors were given a pint of neat Sloe Gin, or Rum, thats 80% proof rotgut stuff, before going into battle. Naval and land battles resulted in horrendous injuries, and the effect of the alchohol was to account for shock for injuries. Surgeons of those days were Barbers and Butchers, and hacked off limbs and fingers without asking. Speed was essential, an amputation of the leg took twenty seconds with a skilled surgeon. DEath cmae late when shock and finally gangrene set in. MOst of the deaths in the Civil wars were wounded soldiers left on the battlefield for days without water and food. Then the corpses were picked clean by the peasants. In the Crimean war, Generakl Buller had both legs blown off by a Cannon Ball. He instructed his surgeon to cauterise the legs by standing him in a barrel of boiling Pitch, then mounting his torso on an upturned barrel, where he directed his troops for two hours, winning the battle. He survived to old age, history tells us.
Obgyn here. Deadliest part of c-section is blood loss. There are lots of ways to control blood loss, but it is normal to lose up to 20% of your total blood volume, even today. No need to transfuse unless it’s greater than that or severely anemic afterward. An abruption increases blood loss for sure, but if the surgery is done quickly then you may not need a transfusion. Especially if your starting hemoglobin is adequate.
Back then they didn’t have the tools to control blood loss. Absorbable suture wasn’t invented until the late 1800s and the non-absorbable stuff like metal wires which they used back the are not adequate at control bleeding from the uterus, and they have used some rudimentary cautery (ie branding tools), but clearly that’s not a good way to control bleeding.
Other things like infection, operative risks (ie stroke, MI, DVT/PE), post op complications (hematoma, abscess, unrecognized visceral injury or ongoing bleeding) are also very likely to cause mortality. These we can monitor for now with advanced imaging and labs… physical exam is just not adequate enough.
Medieval C section… Underlying maternal hypertension or high blood pressure (eclampsia / pre eclampsia) causes you to hemorrhage faster or stroke via vessel ruptute. Especially in the presence of no anesthetics.
Presence of underlying anemia.
Presence of blood dyscrasia, HELLP syndrome, von willebrands, hemophilia A etc etc…
Anatomical variations in arteries supplying the uterus.
Amniotic fluid embolisms, Sepsis, septic emboli, disseminated intravascular coagulation.
This is the tip of the iceberg of complications associated with pregnancy, surgery and in particular cesarean sections.
I mean, by today’s standards it’s a high risk surgery and we have CENTURIES of knowledge, can test for this stuff and monitor/treat it. A C section in the dark ages would be a Hail Mary toss for the parturient to survive. Because you didn’t know about any of this stuff.
A few basic things right off the bat.
1 – scalpels were not really a thing. Sure you can get a knife pretty sharp. But you were not getting super thin surgical steel with a sharper than razor edge. Without modern tooling, you just cannot pump out tools like scalpels. So to withstand a coal forge, you have heavier thicker knives, that do not have edges as sharp as a razor. Plus without stainless steel, you have bacteria, rust and other foreign bodies that can get into the wound.
And instead of having a small, light, sharp, manageable tool you are using a much heavier knife. Which gives you much less control. So the incisions will be much more jagged, which can bleed more, and it is easy to cut deeper than intended.
2 – medical textbooks as we know them now were just not a thing. Instead of having very detailed pictures that show you exactly where to cut, what the layers of skin, muscle, fat, and everything look like. You have hand drawn pictures that even if done by an expert, are not going to be very precise.
3- anesthesia was not a thing yet. And we didn’t know nearly as much about dosing as we know today. So either the mother wouldn’t be awake, and squirming and struggling against people holding her down. Or you tried to pump them with enough opium that they pass out, but not enough that you kill them. And without monitoring devices, it is extremely difficult to keep a patient right on that edge.
And these are just 3 very basic things that we take for granted now, but we’re life threatening back then.
While medieval cesareans were incredibly risky, there are reports of African tribes doing it with the mother and child surviving during colonial times. Pretty incredible read.
I just want to add this because I haven’t seen it in the comments, and it’s so cool – cesareans were actually performed successfully in Uganda and Rwanda way before Europeans figured out to wash their fucking hands.
https://www.nlm.nih.gov/exhibition/cesarean/part2.html
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