A difficult labour

Caesarian sectionThis blog usually takes a fairly light-hearted approach to its subject: I tend to look for cases which arouse amusement as well as horror. While looking through the archives of the Southern Medical and Surgical Journal  I came across this story which is, well, not a barrel of laughs. But I’ve decided to include it, because while the details are at times distressing, it does give an accurate idea of the perils of childbirth in an earlier age. The strapline of this website is ‘Making you grateful for modern medicine’, and if nothing else on the site does, this case surely will.  Those looking for a lighter read may prefer to browse the archives here.

These events were reported in 1851 by Dr H. M. Jeter of Buena Vista in Georgia:

On the night of the 4th of December last, Mrs. B., aged thirty years, was taken in labour with her sixth child. I was called at 3 o’clock in the morning to attend her accouchement. I found her with weak and irregular pains, and was informed that such had been their character from the commencement of labour at 9 o’clock. Soon after, however, her pains began to increase, and upon examination per vaginam, I found the ostineae well dilated and the waters collected in large quantity.

Soon afterwards her pain increased, and it seemed that the birth was imminent.

The back of the foetus presented; I waited until the mouth of the uterus was more completely dilated, and ruptured the membranes, discharging an immense quantity of water. I proceeded immediately to turn, so far as to bring down the breech, making a breech presentation. The difficulty attending the operation of turning was so great, in consequence of the extraordinary size of the child, (it being very large) that I regarded it hazardous to attempt to complete the operation, and left it in this situation to the natural efforts of the womb. After about two hours of very hard labour the breech so far advanced as to enable me to bring down the feet. I essayed by every possible means to assist the efforts of the uterus, by making all the traction upon the inferior extremities of the foetus that was warrantable, being convinced that the foetus was dead.

A tragic end to proceedings. But not quite the end, since the foetus was large and apparently stuck in the birth canal, a circumstance which might quickly prove fatal to the mother. In such circumstances, nineteenth-century doctors sometimes had recourse to a sickening but necessary step: puncturing the skull of the foetus to reduce its diameter and make it easier for the mother to deliver it.

Finding all efforts to make any further advance in its delivery entirely fruitless, I attempted to perforate the cranium, but found it impossible, in consequence of the size of the child, to pass the perforator up to its head.

This is bad enough; but from this point on the operation became only more grisly.

I then eviscerated the foetus, with the view of passing the instrument up within the cavity of the foetal thorax to the base of its cranium. This also failed to make room for the operation, without proceeding at random and great consequent hazard to the mother, as I could not insert the hand to give any certain direction to the instrument, the head still being entirely above the superior strait. Embryotomy was therefore determined upon, and after dissecting away the foetus up to its axillae, which required about two hours, the mother all the while suffering the most severe labour, but which at this time had ceased to make any impression upon the child, and which induced me to conclude that the uterus had probably ruptured, I found her rapidly sinking, so much so, indeed, that we did not think that she could survive fifteen minutes longer. 

The ordeal the poor woman was going through can barely be imagined.

I determined at once to operate on the Caesarian section. I gave my patient a stimulant, and, assisted by Dr. Reese, proceeded to make an incision along the linea alba, six inches in length, cutting down carefully to the peritoneum, upon dividing which, the head of the foetus presented, showing that my apprehensions were correct in the womb’s having ruptured some time previous to the operation. The head of the child was so large that the incision had to be extended to ten inches in length to admit its passage…The head and remaining portion of the body being removed, the placenta was found also without the uterus within the cavity of the abdomen, and the uterus contracted to about the size of a small cocoa-nut. This being also removed, the cavity of the abdomen was left filled with coagulated blood, from the hemorrhage which took place at the time of the rupture of the womb. Having carefully removed the blood as completely as possible, the wound was closed by the interrupted suture and adhesive straps, leaving a space of about two inches at its inferior extremity, for the discharge of the fluids that might remain or collect in the cavity of the abdomen.

It’s a miracle the mother survived this long; the blood loss from the rupture of the womb must have been considerable.

Stimulants were given, and other applications made, to revive the sinking energies of the patient, which had become almost extinct. Reaction soon took place, and she was cleansed and placed in as comfortable a position as the circumstances would admit. The vital energies having been sufficiently resuscitated, opiates were given freely. She was kept quiet, and rested comfortably during the night and the following day, until about 9 o’clock on the succeeding night, (the 6th,) when she was taken with violent vomiting, which continued, with intermissions of not more than half an hour, until 10 o’clock the next day, at which time I arrived, having been called off the evening before, and could not return sooner. We succeeded in soon checking the vomiting, and she rested easy, with occasional return of the vomiting during the day and following night.

What is most extraordinary about this case is that after all this trauma the woman survived.  Dr Jeter concludes:

She continued to improve, and by the 18th day after the operation the wound was entirely healed. I visited her yesterday for the last time, which was the 29th day since the operation, and found her sitting up by the fire, directing the domestic affairs of her family.

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