Published On: Tue, Dec 11th, 2012

Australia’s Very First Caesarean Sections

jaiden 5min after birthThere is a lot of discussion at the moment in the media, about the high rates of caesarean section in Australian hospitals. The World Health Organisation recommends rates of caesareans should be under 10%, while in many private hospitals in Sydney, the rate is over 50%.  Well, if we think caesarean is troubling today, spare a thought for the women having caesareans in Australia in the late nineteenth century.

In September of 1883, Mary, a small, fair woman aged 21, went to the Prince Alfred Hospital in Sydney, concerned about her swelling stomach. Mary was single, but feared the rather prominent lump may have been a pregnancy, as she had been ‘indiscreet’ on a number of occasions. For two years, she had suffered from pain in the pelvic region, especially over the right ovary, and for the past months she had noticed some swelling. The lump had rapidly grown, the pain had become more acute and her periods had stopped. The Honorary Surgeon George Fortescue examined MN and an ovarian cyst was diagnosed. Pregnancy was deemed unlikely and the cyst was tapped, causing great pain and weakness to the patient. She was told to go home and convalesce.

In January, she returned to the hospital to be operated upon for the cyst. Again, pregnancy was ruled out. During the surgery, however, it became clear that the cyst was not alone: there was a foetus of some size. It as a crisis! A hurried consultation of the surgeons occurred and together they decided the best treatment was to remove both the child and the uterus, in an attempt to prevent infection. The operation, lasting one and a half hours and performed without antiseptic (!), was deemed a success. The infant was too young to survive but Mary made a full and fairly speedy recovery.

This was one of the first caesarean sections performed in Australia. It is like a comedy of errors. First, no one knows she’s pregnant, and her own fears are overruled b y the doctor. Second, when pregnancy is diagnosed during surgery, no one knows quite what to do. Fortunately it works out reasonably well for Mary, all things considered. These early caesarean sections were very difficult operations, and 50% of mothers did not survive the surgery. Many other women ended up with substantial injuries, which would have long lasting impacts on their health. The risks, indeed, were high.

So what could go wrong?  First, and foremost, women could get infections. Doctors in this time did not necessarily understand germ theory, and many if not most did not apply antisepsis processes. Some did not even wash their hands properly, let alone take on full antisepsis. And many of theseearly surgeries were done outside the hospital, as most women gave birth at home. I’ve seen reports of many caesareans done in poor homes, on the kitchen table, with no nursing assistance, and sometimes no proper tools. One operation went badly wrong when as evening approached: poor women did not have adequate lighting in their homes, and the doctor could not see to finish the surgery. Other times, they would run out of necessary supplies, such as catgut, which was used to suture the section. Under these conditions, it is unsurprising that infection was a problem, and in a time before the invention of antibiotics, these women would generally die. Other women suffered from haemorrhages, and again, without blood transfusions, it was difficult to save them. Other women simply had the surgery too late. I’ve seen cases where women – especially in rural areas – had been in labour for five or seven days before the doctor was called. For these women, it was asking too much for recovery from such difficult, complicated surgery.

So women really had caesareans when circumstances were already dire. There was no such thing as an elective caesarean! And often the doctor would try other preventative means instead of the caesarean, including early induction, totry and get a child birthed before it got too big to pass through the birth canal. This was not good for the baby, but it was easier and safer for the mother. With the caesarean, the infant mortality slowly improved, but it remained a risky surgery for women well into the twentieth century.

Next time we hear discussions about caesareans and women who were “too posh to push”, I think we should pause for a moment and remember women like Mary. For women in this time frame, every birth had the potential to end badly, and we are now lucky to have a range of medical options, even if they are imperfect.

By Dr. Lisa Featherstone
University Of Newcastle
Copyright 2012

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Dr. Lisa Featherstone is  an Australian historian primarily interested in the history of bodies, especially the history of sexuality and the history of reproduction. She is published widely on sexuality, masculinity, childbirth, race and medicine, and child health. Her book, Let’s Talk About Sex (2011) explores a range of Australian sexualities in early twentieth century Australia.

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