Caesarean section

“ In the Cæsarean section, also, it is quite clear that the life of the embryo does not immediately depend upon the mother, and that the spirits do not proceed from her; for I have often seen the fœtus extracted alive from the uterus when the mother has been dead some hours. I have also known the rabbit and hare survive when extracted from the uterus of the dead mother. Besides, in a tedious labour we learn whether the infant is alive or not by the pulsation of the umbilical arteries ”

“ Should a physician be present when a pregnant woman has recently expired, and the child may still be living in the womb, it will be an easy and important task to perform the Cesarean section as soon as possible, and baptize the little one before it dies. ”

“ For childbirth, only rich women were attended by physicians. Most physicians used talismen such as the eagle stone at deliveries. Caesarian section almost always led to the death of the mother. Midwives were licensed by the church and could baptize babies. ”

“ There is also the method of birth through the soft part of the body, avoiding the birth of the child through the bony structure altogether. This operation is described as Cesarean section, and involves incision both through the abdominal walls and through the walls of the womb. For some women with very small bones Cesarean section is necessary if they are to produce living children. Even for women who, by paying the price of agony, can produce children by normal birth, this method may be found very advantageous. ”

“ Provided, That no physician shall be effected by the last clause of this section who in the discharge of his professional duties, deems it necessary to produce the miscarriage of any woman in order to save her life. ”

“ A long labor, much handling and manipulation, especially in the presence of ruptured membranes, predispose the patient to infection of the peritoneal cavity, and fifth, therefore, intraperitoneal abdominal Cesarean section should not be undertaken under those conditions, with one exception, namely when the religious prejudices of the family demand the saving of the child at the expense of the mother, and then only in the presence of and with the advice of a consultant and a clergyman, after carefully explaining the situation to the family and obtaining their written consent to the procedure. ”

“ Where the female cannot be in a state of pregnancy without the most intense and excruciating suffering during such period, endangering her own future health, and perhaps that of her offspring.
Where an incapacity exists to give birth 108to living children, either in consequence of malformation of the pelvis, or other deformity; and where, from the same, or other causes, recourse is necessarily had to the Cæsarean operation. All which causes have either the health or the life of the female in view. ”

“ What circumstances will justify the Cesarean Operation, and of what value is the section of the Symphysis Pubis, or Sigaultian operation? Where the size of the pelvis [449] will not admit the passage of the child, surgical aid is indispensably necessary; but, says Dr. Merriman, [450] it becomes every man to set out with a determination that he will not hastily, nor without due cause, have recourse to instrumental assistance ”

“ During pregnancy, the patient has a rapid pulse, often with high tension, and attacks of breathlessness and syncope, and intense nervousness. When uterine contractions begin, the action of the heart becomes exceedingly rapid; there is difficulty in breathing and the patient is brought into great distress. It is often necessary to give prompt assistance in labor, and this may require the performance of cesarean section. The child is exposed to the risks of rapid delivery, although, if section be performed, the risk to the child is reduced to the lowest point. ”

“ Suffice it to say, further, that while they enjoin the Cæsarean and vaginal sections, in preference to craniotomy and in cases of extra-uterine fœtation, yet turning, the use of forceps, and the induction of premature labor, where such are indicated, are distinctly allowed by them. ”

“ In the event of a woman, near the full time of pregnancy, dying undelivered, the Cæsarean operation ought always to be performed with as little loss of time as possible; since by this measure a chance of preserving the child will be afforded, and Dr. Merriman states that several cases of such an operation, after the death of the mother, have been recorded, with the desired effect of saving the infant. [460] 280Numa Pompilius prohibited the burial of a pregnant woman until the fœtus shall have been extracted. ”

“ Advanced obstetricians advocate the performance of the Cesarian section or its modification—the Porro operation—in preference to craniotomy, because nearly all the children are saved, and the unavoidable mortality among mothers is not much higher than that which attends craniotomy. Of one hundred women on whom Cesarian section is performed under favorable conditions and with attainable skill, about ninety-five mothers should recover and fully the same number of children. ”

“ Munde speaks of twins being delivered by Cesarean section. Franklin gives the instance of a woman delivered at full term of a living child by this means, in whom was also found a dead fetus. It lay behind the stump of the amputated cervix, in the culdesac of Douglas. The patient died of hemorrhage.
Croston reports a case of Cesarean section on a primipara of twenty-four at full term, with the delivery of a double female monster weighing 12 1/2 pounds. This monster consisted of two females of about the same size, united from the sternal notch to the navel, having one cord and one placenta. ”

“ This procedure, which is used only rarely, is performed on mid- to late-second-trimester (and sometimes third-trimester) fetuses. [6] Although there are variations, it is generally performed as follows: After dilating the cervix, the physician will grab the fetus by its feet and pull the fetal body out of the uterus into the vaginal cavity. 11 F. Supp. 2d, at 1106. At this stage of development, the head is the largest part of the body. Assuming the physician has performed the dilation procedure correctly, the head will be held inside the uterus by the woman's cervix. ”

“ Duty of Nurse Immediately Following Birth of Child.—As soon as the child is born the nurse should sit by the side of the mother and hold the womb until the after-birth is expelled. The womb can be easily felt in the lower part of the woman's abdomen as a hard mass. ”

“ At about the Fourth month after conception, that stage of utero-gestation arrives, which enables us, by means of an external examination, to place the fact beyond the reach of conjecture; for at this stage the uterus may be distinctly felt through the integuments of the abdomen; nor are we able before this period to determine the question by any examination per vaginam, for the fundus uteri is the portion first distended in consequence of conception; while the cervix, the only part that we can feel, does not begin to shorten to any appreciable extent, before the period just stated. ”

“ She forgets all her suffering, when she clasps the little innocent to her breast. In ancient times, miscarriage was thought to be a curse on the female, as it endangers her life, by bringing on hemorrhage, from the adhesion of the placenta. There is a difference between miscarriage and abortion: an exclusion of the fœtus six, and sometimes seven weeks after the cessation of the menses, is termed miscarriage; between that and six months, an abortion; and between that and nine months, premature labor. Sometimes the fault lies in some deficiency on the part of the ovum. ”

“ How many females marry, who, in becoming pregnant, jeopardize their life, xiiiwould learn, if they perused these pages, of the discovery by which pregnancy can be prevented, by means at once safe, simple, certain, and healthy, and thus many a victim would not fall a sacrifice to the Cæsarean operation. ”

“ The disturbance of uterine existence between conception and birth is that which has engaged most attention, and the fact that such disturbances can take place requires that the expectant mother should be protected from anything that can so act on her own organism as to prevent the due operation of the law of heredity. ”

“ When we cannot prevent abortion, the next thing is to conduct the patient safely through the process; and the first point which naturally claims our attention is the hemorrhage. Many practitioners, upon a general principle, bleed, in order to check this, and prevent miscarriage: but miscarriage cannot be prevented, if the uterine contraction have commenced; and the discharge cannot be prudently moderated by venesection, unless there be undue or strong action in the vessels. ”

“ Every woman who shall solicit of any person any medicine, drug or substance, or thing whatever and shall take the same, or shall submit to any operation or other means whatever with intent thereby to procure a miscarriage, except when done by a physician for the purpose of saving the life of the mother or child, shall, on conviction, be fined not less than ten dollars, and be imprisoned in the county jail not less than thirty days nor more than one year. ”

“ The general assembly finds that the method or technique of abortion known as saline amniocentesis whereby the amniotic fluid is withdrawn and a saline or other fluid is inserted into the amniotic sac for the purpose of killing the fetus and artificially inducing labor is deleterious to maternal health and is hereby prohibited after the first twelve weeks of pregnancy. ”

“ For practical reasons and simplicity's sake we will distinguish only between abortion and premature labor—miscarriage, abortion, abortus, being the expulsion of a non-viable foetus, of the ovum before the time of complete placental development, in the first seven months of pregnancy ”

“ The signs of delivery that are well marked at the full period, the general symptoms then obtaining, the size of the uterus, ascertained by the hand and sound, lacerations of the perineum and cervix, the lochia, the state of the breasts, abdomen, vagina, and vulva, all of little value except in conjunction with each other, are proportionately less defined as we go back, until near the commencement of pregnancy it becomes impossible to distinguish the abortion from severe hemorrhage or from menorrhagia, unless by detecting the impregnated ovum. ”

“ When the child cannot be born in the natural way, and the life of both mother and child is in danger, Caesarian section or some similar operation may be, and should be, performed, by which the lives of both may very probably be saved. ”

“ If the expulsion takes place within four months after impregnation, it is termed abortion; if between the fourth and seventh month, miscarriage; if after the seventh month, but before the completion of the full period of gestation, premature labor.
Abortion may be due to those agents which act directly upon the uterus and cause the expulsion of the foetus; to those which occasion the death of the foetus, thereby effecting its ejection; and it may be criminal, that is, produced intentionally by direct agencies intended for that purpose.
Symptoms. ”

“ If a single lady, who is about to be married, have painful menstruation, it is incumbent on either her mother or a female friend to consult, two or three months before the marriage takes place, an experienced medical man, on her case; if this be not done, she will most likely, after marriage, either labor under ill health, or be afflicted with barrenness, or, if she do conceive, be prone to miscarry. ”

“ But the aggravated horrors of childbirth, and the alarming increase in the performance of the Cæsarian section, together with the general surfeit of the body and the intensified loathing of men, will cause these retrograde movements to diminish, and very soon such a clamour will arise for extra-corporeal gestation that science will be allowed no rest until a technique is discovered that will meet the public demand. ”

“ It is because so many women fail to appreciate this that abortions and premature births are often followed by ill health and invalidism. Under proper care, an abortion 80or premature labor is not, of itself, any more serious for a woman than a normal delivery.
Bleeding from the vagina, or a sudden increase in the size of the abdomen with perspiration and a sudden feeling of faintness, may be the beginning of severe bleeding, or hemorrhage, from any one of a number of causes, and in such a case the expectant mother should notify her doctor, go to bed at once and keep quiet until he arrives. ”

“ We shall therefore pass over the question without farther discussion, and proceed to the investigation of those practical parts of the subject, which are highly interesting on account of their numerous and important relations to medical jurisprudence; we propose, therefore, to discuss the following questions in succession:
1. Whether a woman can be delivered during a state of insensibility, and remain unconscious of the event?
2422. How far the term of utero-gestation can be shortened, to be compatible with the life of the offspring? ”

“ Often the obstruction is so dense as to require a large bistoury to divide it, and even that is not always sufficient, and the Cesarean operation only can terminate the obstructed delivery; we cannot surmise how conception could have been possible. Staples records a case of pregnancy and parturition with congenital stricture of the vagina. Maisonneuve mentions the successful practice of a Cesarean operation in a case of congenital occlusion of the vagina forming a complete obstruction to delivery. ”