C-Section History: Caesar Myth, Banana Wine Surgery and Placenta Accreta

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The caesarean section is the most common abdominal surgery in the world, with roughly 23 million performed globally in 2012, yet it has nothing to do with Julius Caesar. His mother Aurelia lived for nearly 50 years after his birth, something no woman could have survived in 100 BC. This episode traces the likelier origins of the name, from the Roman Lex Regia, later the Lex Caesarea, which required a baby to be cut from a mother who died before burial, to the Latin verb for cutting. It follows early accounts from India around 320 BC, where the advisor Chanakya cut the future emperor Bindusara from his dying, poisoned mother, and from Switzerland around 1500, where a veterinarian named Jacob Nufer is said to have operated on his own wife, who survived.

In 1879 the medical missionary Robert William Felkin watched indigenous surgeons in Uganda perform a successful caesarean using banana wine to sedate the mother and clean hands and skin, then sealing the wound with a paste of chewed roots. The episode moves to the modern operation, the low transverse incision and the Misgav Ladach method from Jerusalem, where surgeons stretch tissue apart with their fingers instead of cutting. It then lays out the trade offs the transcript describes: wet lung in babies who skip labor's hormone surge, higher maternal mortality in low risk pregnancies, the rising risk of placenta accreta with each scar, and the gap between countries under 7.5 percent and the United States at about 32 percent.

• How labor's surge of cortisol and epinephrine reverses the pumps that fill a baby's lungs with fluid
• Newborn mortality at 37 weeks by elective caesarean is triple the rate at 40 weeks
• Placenta accreta risk climbs from about 0.13 percent after two caesareans to 6.74 percent after six or more
• VBAC succeeds for 60 to 80 percent of women who try it, with uterine rupture in about 5 of 1,000 cases
• Hospital scheduling, lawsuit fears and false alarms from continuous fetal monitoring as drivers of high rates