Cesarean sections have been part of human history for thousands of years, though the procedure barely resembled modern surgery until the late 1800s. Ancient civilizations performed abdominal deliveries on women who had died in childbirth, and it took centuries of surgical advances before both mother and baby could reliably survive.
Ancient Roots in Law and Mythology
References to cesarean delivery appear in ancient Hindu, Egyptian, Greek, and Roman texts. In Greek mythology, Apollo removed Asclepius, the god of medicine, from his mother’s abdomen. Jewish religious law in the Mischnagoth and Talmud addressed the procedure directly, prohibiting firstborn inheritance rights when twins were born by cesarean section and waiving certain purification rituals for women delivered surgically. These weren’t rare footnotes. Multiple ancient cultures had legal and religious frameworks that accounted for surgical birth.
Roman law under Caesar required that women who died in late pregnancy be cut open, giving the baby a chance at survival. This is one likely origin of the name “cesarean,” though the popular story credits Julius Caesar himself. That connection is almost certainly a myth. Caesar’s mother, Aurelia, lived well into his adulthood, and the procedure was not performed on living women until roughly the 17th century. A more probable source is the Latin verb “caedare,” meaning to cut, or “caesones,” a term applied to infants delivered after their mothers died.
The First Surviving Mothers
For most of recorded history, cesarean sections were performed only on dead or dying women. The goal was to save the infant or, in some cases, to allow separate burial as required by religious custom. Survival for the mother was not expected.
The earliest possible case where both mother and child survived dates to 1337 in Prague. The mother was Beatrice of Bourbon, second wife of King John of Luxembourg. Historical analysis supports the claim but relies on indirect evidence, so it can’t be confirmed beyond doubt. What is clear is that successful cesareans on living women remained extraordinarily rare for centuries afterward. Up through the end of the 1800s, surgeons avoided the operation whenever possible because mortality was so high.
Why the Surgery Was So Deadly
Two problems made cesarean sections fatal for most of their history: bleeding and infection. Surgeons did not suture the uterus closed after delivery, which meant uncontrolled hemorrhage. And before germ theory, there was no concept of sterile technique. The non-absorbable sutures that were eventually tried had to be left protruding from the wound for later removal, which dramatically increased the risk of fatal infection.
The turning point came in 1882, when a German surgeon named Max Sänger insisted that closing the uterus with sutures was essential. He introduced a silver suture material that caused minimal tissue reaction, reducing both bleeding and sepsis. This single innovation changed cesarean delivery from a near-certain death sentence into a survivable operation.
Anesthesia Changes Everything
Pain management arrived just a few decades before Sänger’s suturing technique. Modern obstetric anesthesia using ether began in 1847, only three months after the first successful use of surgical anesthetic in any operation. Chloroform and nitrous oxide followed shortly after. Before 1847, women undergoing cesarean delivery experienced the full force of abdominal surgery with nothing to dull it. The combination of reliable pain control and better surgical technique in the second half of the 1800s made cesarean sections a genuinely viable procedure for the first time.
The Modern Technique Takes Shape
Even after suturing and anesthesia, the surgery itself still carried significant risk because of where surgeons cut. Early cesareans used a vertical incision through the upper part of the uterus, which bled heavily and healed poorly. In 1926, a Scottish obstetrician named John Munro Kerr popularized a low transverse incision, cutting horizontally across the thinner lower segment of the uterus. This approach caused less blood loss, healed more reliably, and reduced the chance of the uterus rupturing in future pregnancies.
Kerr’s technique became the standard method for the next 50 years and remains the default approach today. Most people who have had a cesarean delivery carry a horizontal scar low on their abdomen because of a decision made nearly a century ago.
How Rates Have Climbed
Once the procedure became safe, its use expanded rapidly. Cesarean rates hovered around 5% for much of the 20th century but have climbed to 30 to 32% in many countries over the past decade. The World Health Organization has maintained since 1985 that the ideal population-level rate is between 10 and 15%. Large studies show that maternal and newborn deaths decrease as a country’s cesarean rate approaches 10%, but above that threshold, higher rates don’t improve survival. The gap between the recommended rate and the actual rate reflects a mix of factors: defensive medical practice, patient preference, scheduling convenience, and rising rates of conditions like obesity and gestational diabetes that make vaginal delivery riskier.
The procedure that began as a last resort for dying women in the ancient world is now the most common major surgery performed globally. Its history spans millennia, but nearly every advance that makes it safe happened in a remarkably compressed window between the 1840s and the 1920s.