Abdominal delivery in the 16th century

Dr Loudon (May 2003 JRSM¹), discussing the operation on Marguerite of Vienna after a 5-year pregnancy, proposes that it was an abdominal delivery rather than a caesarean section. The concept that some of the early so-called caesarean sections were in fact abdominal deliveries of an advanced extrauterine pregnancy is mentioned by O'Dowd and Philipp² in their comprehensive chapter on the history of the operation, and the subject was discussed by Gordon King in an oration 50 years ago. ³ King, who was professor of obstetrics and gynaecology from 1939 to 1954 at the University of Hong Kong, detailed the history and classification of advanced extrauterine pregnancies and of abdominal delivery, and reported his personal experience of 12 cases. Before the advent of modern diagnostic techniques, the history of malpresentation, false labour, abdominal delivery, survival of the mother (and occasionally the baby) and subsequent normal deliveries was all important. Often there had been severe abdominal pain or bleeding in early pregnancy. The history of Elizabeth, wife of the Austrian swineherd Jacob Nufer, in the year 1500 fits these criteria. Used to gelding pigs, Nufer delivered his wife with the tools of his trade, by abdominal section, after ineffectual labour and lack of help from 13 midwives and several lithotomists. This report of abdominal delivery predates Dr Loudon's case by some 50 years. Moreover, it is the first case in which the baby survived as well as the mother, who subsequently gave birth normally to one set of twins and four singletons. Even if a woman had escaped death from haemorrhage or infection to survive caesarean section in those days, it is inconceivable that she could have had so many subsequent vaginal deliveries without uterine rupture.