I'm not sure what the message is in the history of cesareans, but I know there is something important there. Every time I delve deeper into studying the history of surgical birth I sleep better, feel clearer, and have brighter thoughts. So, now I have with a birth history book with two whole post-it packs marking pages in it. (beg's the question- if I put a sticky on every page what's the point of any stickies at all?)
As it's now overdue at the library so I thought I would take another turn at summarizing some of it's amazing depth before I have to give it back. Here is my second installment from:
Not of Woman Born, Representations of Caesarean Birth in Medieval and Renaissance Culture, by Renate Blumenfeld-Kosinski
I'd recommend this book to anyone curious about the politicizing of birth and it traces this origin. Blumenfeld-Kosinski has done a thorough investigation of many ancient documents including early European medical treatises, clerical writing, court proceedings and visual representations. All of which depict a time when birth changed from being seen as an everyday activity done by women, to a time when a birthing women was attended by male medical attendants.
I am going to offer the following notes on Blumenfeld-Kosinski's first chapter titled:
Cesarean Birth in Medical Thought
Early Medieval thought was thick with religious connotations. Sex and birth were linked through the idea of virgin birth, the rejection of sexual pleasure of the clergy, and the belief that procreation was the only way to sanctify the sexual act. Infant and early childhood mortality was high. Birthing took place at home, attended by midwives and was considered a non-medical procedure. Cesareans, in the popular mind, were legends of miracles or whispered tales of horrors and mutilations. Cesareans were thought to be preformed only in the case of maternal death in an attempt to baptize the unborn child. They rarely resulted in a live child.
1100Ad the church was intertwined with everyday medical procedures. Priests preformed surgeries and nuns were often midwives. This changed after the pope warned clerical members from interfering with the ways of the world and body. In 1200AD deacons and priest were formally forbade from practicing surgeries. Lay professionals were the only ones preforming the tasks of surgeons, physicians and midwifes.
In 1236AD The Council of Canterbury decreed that cesareans be preformed in order to baptize an infant if the mother dies. The church was both limiting birth attendants to lay midwifes, but then requiring them to preform the clerical job of baptisms. During the 1300's confusion ruled as to how to insure the child's salvation. Generally, if the child died before the mother, or if it was born live and baptized it was saved, but if it died in it's deceased mother it was dammed. Midwives were forced to be not only birth attendants but also caretakers of the child's immortal soul. If a birth proved deadly for the mother they were charged to cut the baby out at just the right moment, to late and the baby would be already dead and it's soul would be doomed. (Wow, now that's pressure!) Too early and they risked killing the mother needlessly.
1400's brought with it a Renaissance of dissection and medical writings including:
"Lilium" by Bernard of Gordon was the first western medical text that included a written account of a cesarean resulting in a live baby. Bernard gathered advice from "old wives" that the baby can survive for a short time after the death of the mother and can be out of mother live.
1423 Piero d'Argella of Bologna authored "Chirurgia" and writes the first male obstetrical first-person account of a post-mortum cesarean.
In Germany in the mid 1400s Midwifery came under official control for the first time. Many statues to govern their procedures were written.
In 1480 a southern German statute contains the following:
"Many mother's ask, when they feel that they are dying, to liberate the child by an incision. In that case, the skillful midwife has to open up one side and pull out the baby. If the woman is still alive, the wound is to be closed with three or four lignatures, and a plaster of eggs and strong hemp fabric. Give the woman a sip of the best wine, and a drink made of salsifry and mountain albanum. The woman will recover, with God's help."
1513 Eucharius Roesslin wrote
"Der Swangern Frawen und Hebammen Rosegarten" (The Pregnant Women's and Midwives Rose Garden) which contains many instructions for the female midwifes but tellingly directs the instructions for cesarean to male surgeons. Birth has entered the realm of male practitioners through cesarean procedures.
1581 Francois Rousset wrote
Traitte Nouveau de l'Hysterotomotokie. ou enfantement Caesarien
Subtitle:The extraction of the child through lateral incision of the abdomen and uterus of a pregnant woman who cannot otherwise give birth.
Rousset coined the term "enfantement Caesarien" ("cesarean birth"). He named it after the first of the Caesars, Scipio Africanus, who was supposedly born this way(often confused with Julius Caesar who was not born by Caesarean)
This writing was, for it's time, radical as he suggested cesarean birth to be preformed on live women in order to save both mother and child.
His reason for this is that he has gathered case histories from "trustworthy" people who reported witnessing cesareans. He also examined women who had abdominal scars they reported to be from Cesareans. One such case was Anne Godart who is reported to have had 6 cesareans before dying during an attempted 7th birth, because her surgeon had died and no one could do the cesarean.
Roussset witnessed the performance of an operation he himself advised for prolonged labour. a young surgeon made an "incision on the woman's right side just lower then the naval, little blood was shed, and a living child was pulled out and the afterbirth. The wound was closed with 5 stitches. After 40 days of bed rest the woman was well again"
Rousset was passionate about innovation and active intervention in childbirth. He professed that surgeons should be "quick to act" but he was disputed by many who believed that his methods would result in the death of women who would have given birth naturally if given enough time (hmm... the first debate about failure to progress?)
Jacques Marchant was probably Rousset's biggest opponent siting many cases of failed cesarean and coining the term "natural versus unnatural" childbirth. He wrote:
"How can a surgeon plunge his hands into the side of a pregnant woman when there is a natural exit? Better to wait for nature then rush into a desperate and doomed operation"
Despite the debate, abdominal surgeries for bladder stones were being done successfully and it is sure that some cesareans were being done with good outcomes for mother's and babies during this time.
It wasn't until the late 1500s that cesareans were accepted by a broader number of medical professionals and were done in attempt to save both the mother and child. It was during this time that women were formally forbade from handling surgical instruments. This meant that birth,in western culture, had moved totally from women's world into male medical realm.
Blumenfeld-Kosinski sums up this chapter by relating the significance of cesarean procedure in bringing birthing into the realm of male obstetrical practice and away from female birth attendants.
There you have it, my attempt to sum up this extremely complex chapter. I'd guess that I included only about 1/100th of the information contained with in the original work.
I find it particularly telling that cesarean procedures were immediately the subject of great debate as to how they affect the preservation of the body and the salvation of the soul.
I believe that many women who have had cesareans will agree that they are a profound experience that affects their heart, body, and soul.
Another thing that struck me was that successful cesareans were most likely first done by women midwives and only later were they attempted by male counterparts. I wonder how birth would look now if we had been able to have both the world wise women and the book wise men work together instead of becoming adversaries. Instead, this time in history led to the vast persecution of women healers and over 150 000 of them were killed during the witch hunts.
We humans are so counterintuitive on so many levels.
Now I best get this book back to the library, I'm sure there are others wanting to read it (maybe?) I'll try again another time to relate more about it's general themes as they are so profound they keep me thinking.
Monday, February 15, 2010
Tuesday, January 26, 2010
Placental Thoughts
I've been thinking about placentas. I realized I missed "viewing my placenta" from the list of things I wish I'd been able to do during my cesarean birth. It's been bothering me that I forgot that one. I have the most beautiful pictures of my first placenta, but sadly didn't see my cesarean placenta before it went to pathology
I think they are important links to our animal self. I've lived on a farm, watched new mama animals eating their placentas. They are these unique, one time use organs, that our bodies create.
I see that the placenta is the living tie between mother and babe. I also think it's interesting that the placenta loses it's life at every birth as it is shed from both bodies.
I thought about consuming my own placenta. My uninformed idea was that I would have had to eat two pounds of placenta stir-fry. I just could quite see myself doing that no matter how good it is for me!
Turns out I should have looked in to it more.
I've been learning about placental encapsulation and it sounds super cool. I t allows the placenta to be stored and consumed easily. The benefits are reported as preventing postpartum depression, helping with milk supply and even help with menopause hormone changes.
Here is a link to a youtube video of a reporter following a professional "placenta-lady"
http://www.youtube.com/watch?v=uuxeAbeDcU0
And here's a blog post, with pictures, of a mama doing it herself.
http://mamamojo.wordpress.com/2008/06/10/placenta-dehydrationencapsulation-phase-one-complete/
Before I had a cesarean I had never thought of not seeing my placenta. Giving birth vaginally it's just not something you would miss, 'cause you have to push it out. It wasn't until the day after my cesarean that I thought about it at all.
If I had it to do over I'd encapsulate mine, or at least think to ask to see it.
p.s. just found this great site with lots of info:
http://www.placentabenefits.info/
I think they are important links to our animal self. I've lived on a farm, watched new mama animals eating their placentas. They are these unique, one time use organs, that our bodies create.
I see that the placenta is the living tie between mother and babe. I also think it's interesting that the placenta loses it's life at every birth as it is shed from both bodies.
I thought about consuming my own placenta. My uninformed idea was that I would have had to eat two pounds of placenta stir-fry. I just could quite see myself doing that no matter how good it is for me!
Turns out I should have looked in to it more.
I've been learning about placental encapsulation and it sounds super cool. I t allows the placenta to be stored and consumed easily. The benefits are reported as preventing postpartum depression, helping with milk supply and even help with menopause hormone changes.
Here is a link to a youtube video of a reporter following a professional "placenta-lady"
http://www.youtube.com/watch?v=uuxeAbeDcU0
And here's a blog post, with pictures, of a mama doing it herself.
http://mamamojo.wordpress.com/2008/06/10/placenta-dehydrationencapsulation-phase-one-complete/
Before I had a cesarean I had never thought of not seeing my placenta. Giving birth vaginally it's just not something you would miss, 'cause you have to push it out. It wasn't until the day after my cesarean that I thought about it at all.
If I had it to do over I'd encapsulate mine, or at least think to ask to see it.
p.s. just found this great site with lots of info:
http://www.placentabenefits.info/
Sunday, January 17, 2010
History of Cesareans
So, I've been facing a few fears lately...
One being that I went to search out this book who's title so haunted me the first time I saw it.
Not of Women Born
Representations of Cesarean Birth in Medieval and Renaissance Culture
by Renate Blumenfeld-Kosinski
Well I've read it through now, it's a true academic read, made me put to use my high school Latin and wade through 40 pages of footnotes! -It's also totally fascinating.
It documents the time in the history of western civilization when cesarean births entered medical texts. A time when women healers and midwives were forced from the birthing room and their male counter parts took over with scalpels and forceps at the ready.
There is so much information in this book I'm going to have to divide it up into a few post topics to do it any justice.
I thought I would start by summing up the ancient history of cesareans that Blumenfeld-Kosinski includes:
2000BC Mesopotamian Cuneiform tablet references a child "pulled from the womb" and then adopted.
715BC the "lex regia" proclaimed by Roman king Numa Pompilius decreeing it unlawful to bury a undelivered women. Anyone doing this would be guilty of causing the death of the child.
3rd Century BC -3rd Century AD Two Ancient Jewish Texts reference Cesarean births:
Mishna text includes reference that twins brought forth by cut in the abdomen must share right of succession.
Nidda appendix to Talmud refers to women who bring forth children by cut in their abdomen not needing to observe the traditional days of purification, This text is
particularly interesting as it suggests that the mother has survived.
5th Century BC- 2nd Century AD an Indian doctor named Susruta writes medical text
Nidanasthana includes urgings for doctors to preform an abdominal delivery quickly in
the event of the death of the mother.
23-79 AD Roman Scholar
Pliny the Elder discusses the auspiciousness of a cesarean birth. The idea that the person
cheated death at birth.
These ancient references brought the context of the modern cesarean to a new place for me. These seeds in history, these ancient mothers, most who did not survive the births of their children, I feel the need to honour their sacrifice. While the risk of death during cesarean birth is still much higher then vaginal birth, I am so grateful for these thousands of years of learning that helped keep me and my baby safe.
One being that I went to search out this book who's title so haunted me the first time I saw it.
Not of Women Born
Representations of Cesarean Birth in Medieval and Renaissance Culture
by Renate Blumenfeld-Kosinski
Well I've read it through now, it's a true academic read, made me put to use my high school Latin and wade through 40 pages of footnotes! -It's also totally fascinating.
It documents the time in the history of western civilization when cesarean births entered medical texts. A time when women healers and midwives were forced from the birthing room and their male counter parts took over with scalpels and forceps at the ready.
There is so much information in this book I'm going to have to divide it up into a few post topics to do it any justice.
I thought I would start by summing up the ancient history of cesareans that Blumenfeld-Kosinski includes:
2000BC Mesopotamian Cuneiform tablet references a child "pulled from the womb" and then adopted.
715BC the "lex regia" proclaimed by Roman king Numa Pompilius decreeing it unlawful to bury a undelivered women. Anyone doing this would be guilty of causing the death of the child.
3rd Century BC -3rd Century AD Two Ancient Jewish Texts reference Cesarean births:
Mishna text includes reference that twins brought forth by cut in the abdomen must share right of succession.
Nidda appendix to Talmud refers to women who bring forth children by cut in their abdomen not needing to observe the traditional days of purification, This text is
particularly interesting as it suggests that the mother has survived.
5th Century BC- 2nd Century AD an Indian doctor named Susruta writes medical text
Nidanasthana includes urgings for doctors to preform an abdominal delivery quickly in
the event of the death of the mother.
23-79 AD Roman Scholar
Pliny the Elder discusses the auspiciousness of a cesarean birth. The idea that the person
cheated death at birth.
These ancient references brought the context of the modern cesarean to a new place for me. These seeds in history, these ancient mothers, most who did not survive the births of their children, I feel the need to honour their sacrifice. While the risk of death during cesarean birth is still much higher then vaginal birth, I am so grateful for these thousands of years of learning that helped keep me and my baby safe.
Monday, November 30, 2009
Summary
I thought I'd take a few minutes to summarize the previous five posts as they have all been links.
The links are to numerous writers including a doula, a birth educator, academics and patients all suggesting that cesarean sections can be done in a way that results in a better experience for the birthing woman.
Based on the reading I have done, links mentioned and my personal experience would like to suggest that all women considering childbearing give at least a little thought to the potential of having a cesarean in order to advocate for their wishes should one become necessary.
In hindsight it would have been helpful for me to have thought about the following so that I could have advocated for myself:
My wish to view the birth by mirror or lowering the screen.
Asking to have the surgery described for me.
How I wished to have the moment of birth announced.
Asking for a view to the pediatric area.
Asking to have the newborn exam delayed until I had met my baby.
Also I feel extremely lucky that I was allowed the chance to:
Have skin to skin contact in the OR.
Breastfeed in the OR.
I'm sure not everyone wants the same things as me. Maybe the last thing some women would like is to have surgery described to them. Still having considered that in advance and being able to ask the attendants to use distraction techniques would help personal choice enter a situation where loss of control can be very overwhelming.
I know I spent more time considering genetic testing then I did having a cesarean, yet my risk of baby having a genetic abnormality was significantly less then the more then 1 in 4 chance Canadian women have of having a cesarean.
For me it came down to an emergency situation, everything moved very quickly and now I see how a little more prep could have saved me much heartache.
The links are to numerous writers including a doula, a birth educator, academics and patients all suggesting that cesarean sections can be done in a way that results in a better experience for the birthing woman.
Based on the reading I have done, links mentioned and my personal experience would like to suggest that all women considering childbearing give at least a little thought to the potential of having a cesarean in order to advocate for their wishes should one become necessary.
In hindsight it would have been helpful for me to have thought about the following so that I could have advocated for myself:
My wish to view the birth by mirror or lowering the screen.
Asking to have the surgery described for me.
How I wished to have the moment of birth announced.
Asking for a view to the pediatric area.
Asking to have the newborn exam delayed until I had met my baby.
Also I feel extremely lucky that I was allowed the chance to:
Have skin to skin contact in the OR.
Breastfeed in the OR.
I'm sure not everyone wants the same things as me. Maybe the last thing some women would like is to have surgery described to them. Still having considered that in advance and being able to ask the attendants to use distraction techniques would help personal choice enter a situation where loss of control can be very overwhelming.
I know I spent more time considering genetic testing then I did having a cesarean, yet my risk of baby having a genetic abnormality was significantly less then the more then 1 in 4 chance Canadian women have of having a cesarean.
For me it came down to an emergency situation, everything moved very quickly and now I see how a little more prep could have saved me much heartache.
Sunday, November 29, 2009
The Faceless Caesarean
Above is a call to action to help better cesarean experience from:
The Faceless Caesarean by Caroline Oblasser.
"Caesarean mothers in words and photographs"
I found this book fascinating and I'm glad that it exists because more people need to know the truth about Cesareans. Women's own narrative accounts are so helpful in understanding what it's really like. Also by interviewing 162 women this book is one of the few firsthand authorities I've found on what women want when surgical birth IS necessary.
The photos are also very powerful.
Her book is available at www.caesareanbook.com
Sunday, November 22, 2009
Natural Cesarean
I've got to say there are some things I just love about the web. Thanks to Karen, who left a comment on one of my posts I have been researching Prof. Fisk who is pioneering "Natural Cesareans". Yay! Now all we need to do is get this info out there.
Here is a link to an abstract of his article, and a chance to download to the whole thing:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/
Here is a link to an magazine article about this new procedure.
http://www.timesonline.co.uk/tol/life_and_style/health/article6028478.ece
The natural caesarean: a woman-centred technique
J Smith,a F Plaat,b and NM Fiska"Although much effort has gone into promoting early skin-to-skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding. We describe a ‘natural’ approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother's chest for early skin-to-skin. Studies are required into methods of reforming caesarean section, the most common operation worldwide."
Please cite this paper as: Smith J, Plaat F, Fisk N. The natural caesarean: a woman-centred technique. BJOG 2008;115:1037–1042.
Here is a link to an abstract of his article, and a chance to download to the whole thing:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/
Here is a link to an magazine article about this new procedure.
http://www.timesonline.co.uk/tol/life_and_style/health/article6028478.ece
Monday, November 16, 2009
Planning a Good Cesarean
Here is a link to a
It's amazing how much I can relate to the stories, particularly the first complaint of "Karen, 33"
Who writes:
"Things that didn't help:
Not being given the choice to see my daughter being born. I would have liked the screen to be down so I could see but this wasn't offered - and at the time I was too concerned for my daughter's welfare to even think of it but would have said yes if asked."
Also pretty amazing is the story by "Tikki" she sais:
"I read a magazine article about a woman in the UK who birthed her own baby with a C/S! The surgeon asked her to reach down to feel the baby's head, and she just started to pull, and he let her! There's active involvement."
I am starting to imagine a time when disconnected "sheet-up cesareans" are as passe as lifting the baby up by it's heels and smacking it's bottom!
UK Midwifery Archives page titled "Planning a Good Caesarean Section"
http://www.radmid.demon.co.uk/csgood.htmIt's amazing how much I can relate to the stories, particularly the first complaint of "Karen, 33"
Who writes:
"Things that didn't help:
Not being given the choice to see my daughter being born. I would have liked the screen to be down so I could see but this wasn't offered - and at the time I was too concerned for my daughter's welfare to even think of it but would have said yes if asked."
Also pretty amazing is the story by "Tikki" she sais:
"I read a magazine article about a woman in the UK who birthed her own baby with a C/S! The surgeon asked her to reach down to feel the baby's head, and she just started to pull, and he let her! There's active involvement."
I am starting to imagine a time when disconnected "sheet-up cesareans" are as passe as lifting the baby up by it's heels and smacking it's bottom!
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