Reproduction of woodcut, 1483. Wikimedia Commons // CC BY 4.0
Reproduction of woodcut, 1483. Wikimedia Commons // CC BY 4.0

Just How Old Is C-Section Birth?

Reproduction of woodcut, 1483. Wikimedia Commons // CC BY 4.0
Reproduction of woodcut, 1483. Wikimedia Commons // CC BY 4.0

An 18th-century Hungarian woman made history this week—her mummified remains preserve the earliest direct evidence of C-section. Sadly, neither she nor her full-term son survived. Which raises the question: Just how old is C-section birth, and when did women and babies start surviving it?


Basically since humans started walking upright, childbirth has been difficult for women. The brains of our hominin ancestors got larger and larger, with the result that today’s average newborn has a head 102 percent the size of its mother’s bony pelvis. Yes, you read that right—our babies’ heads are actually larger than our skeletal anatomy.

Obviously, an evolutionary compromise was worked out, so that humans could have large-brained babies and still walk upright. Babies’ skulls bones can slide around and overlap to help them get out. The fetus also goes through a sort of dance when it’s born, wiggling and turning with the help of contractions to make its way through the bony pelvis. And, perhaps most importantly, towards the end of pregnancy, a hormone is released that weakens the cartilage of the joints of the pelvis, letting it widen just enough for the baby to come out.

But we humans also rely on culture for our existence, and the same is often true for birth. The caesarean section—which includes the Latin root word for cut—involves extraction of a baby through a cut into the mother’s uterus. Although the practice dates back thousands of years, women didn’t survive it until comparatively recently.


Ancient Roman relief carving of a midwife attending a woman giving birth. Wikimedia Commons // CC BY 4.0

There is some argument among scholars that C-sections were performed in Egypt around 3000 BCE, but the earliest clear documentation in ancient texts comes from early Rome. The second king, Numa Pompilius (c. 700 BCE) passed a law called the Lex Regia, later renamed the Lex Caesarea and reported in Justinian’s Digest (11.8.2). This law forbade burying a pregnant woman until her offspring had been excised from her body. The reason stated for the law was that there was a small chance the baby would survive, but it is unclear if the law was religious in nature or whether it simply aimed to increase the population of tax-paying citizens. A similar reference to post-mortem delivery comes from Sage Sustra, a practitioner of Hindu medicine around 600 BCE. But in neither case is it clear how often—if ever—this was carried out.

This means that the first person who was born by C-section is also hotly debated. Julius Caesar is often held up as the most famous example, with the assumption that his cognomen—third name or nickname—resulted from his style of birth. Sadly, it seems that the Roman author Pliny either made this up or was referring to a very distant ancestor of the Julii clan. Since women didn’t survive C-sections in ancient Rome, Caesar’s mother Aurelia, who lived well into her 60s, did not deliver him in that way.

Historical records of famous people born by C-section actually go back further than Caesar, though. Some scholars claim [PDF] that the earliest documented C-section produced the orator Gorgias in the 5th century BCE, but the historical evidence is murky. Although Pliny was wrong about Caesar, in his Historia Naturalis (VII.ix) he wrote that the celebrated Roman general Scipio Africanus was born in this manner in 236 BCE. If either of these cases is correct, there is evidence of viable offspring from C-sections nearly 2500 years ago. But these procedures were certainly only done when the mother died or was about to die in childbirth.

It wasn’t until the 1500s that doctors began to expect women to survive the procedure. French physician François Rousset broke with medical tradition at the time and advocated performing C-sections on living women. In practice, though, it was still only performed as a last-ditch effort to save the newborn. Certainly some women survived C-sections from the 16th to 19th centuries, but it was still a very risky procedure that could easily lead to complications like endometritis or other infection. C-sections didn’t become common until the 1940s, following advances in antibiotics that made them survivable.


Medieval caesarian on a deceased woman. Wikimedia Commons // CC BY 4.0

The infant mortality rate was very high in antiquity, as were rates of mothers dying in childbirth. Consequently, you might expect that archaeologists have found loads of mother-fetus burials. But very few exist. In fact, the number of pregnant female burials in the published archaeological literature from around the world is only about two dozen.

There are several potential reasons for this lack of evidence. First, archaeological methods got significantly more scientific in the 1970s, so more recent excavations are better at finding tiny fetal bones. Second, the mother could outlive the fetus, and the newborn could outlive the mother. Death at different times will not be obvious archaeologically as evidence of childbirth-related complications. Even when the mother and baby both die before birth, though, this may not be evident because of a phenomenon called “coffin birth”—when the gases that build up within a corpse cause post-mortem “birth” of the fetus. And finally, cultural practices could be to blame for our lack of evidence—application of the Roman Lex Caesarea, for example, could result in a woman buried by herself and a viable newborn who grows up and dies much later.

Unfortunately for archaeologists, C-sections usually involve soft tissue only, so it is unlikely that we will ever find direct ancient evidence of it in a skeleton. There are two possible ways to see physical evidence of ancient C-sections. One is cut marks on the pelvis made around the time of the mother’s death by a surgeon. (Normally, C-sections don’t involve cut bones, but symphysiotomies—cutting through the front of the pelvis—can be done with or without accompanying C-sections to aid in delivering a baby.) The second is a mummy with an incision into the uterus and other physical changes associated with pregnancy and labor. At the International Conference on Comparative Mummy Studies earlier in April, the first-ever direct evidence of an early C-section was presented. The case study, presented by anthropologist Ildikó Szikossy of the Hungarian Natural History Museum, involves a woman named Terézia Borsodi, who died in December 1794 during the birth of her sixth child. While historical records suggest that the baby boy was delivered alive, Terézia’s mummy shows she was likely already dead when the C-section was performed. The baby also did not survive, and they were buried together.


Successful Caesarean section performed by indigenous healers in Kahura, Uganda (1879). Wikimedia Commons // Public Domain

Childbirth is both a biological and a cultural process, today and in the past. But while biological variation is consistent across all human populations, the cultural processes that can facilitate childbirth are quite varied. A quick glance at the rates of elective C-section around the world demonstrates this easily. So archaeologically, we should also expect to see variation in the lives, deaths, and burials of women and infants.

Archaeologists use skeletons, historical records, medical artifacts, and other clues from burials to reconstruct childbirth practices and interventions in the past. New advances in microscopic analysis of the bones of ancient fetuses are also revealing whether or not the baby was alive or stillborn. As the archaeological record gets better, and as excavation, recording, and analysis techniques advance, we should soon have better methods for understanding this key time in the lives of mothers and infants, and for figuring out when the earliest C-sections occurred.

Romano D’Agostini, Giorgio Cargnel, Soprintendenza Speciale di Roma
Utility Workers May Have Found One of Rome’s First Churches
Romano D’Agostini, Giorgio Cargnel, Soprintendenza Speciale di Roma
Romano D’Agostini, Giorgio Cargnel, Soprintendenza Speciale di Roma

The remains of what may have been one of Rome’s earliest Christian churches were accidentally discovered along the Tiber River during construction, The Local reports. The four-room structure, which could have been built as early as the 1st century CE, was unearthed by electrical technicians who were laying cables along the Ponte Milvio.

The newly discovered structure next to the river
Romano D’Agostini, Giorgio Cargnel, Soprintendenza Speciale di Roma

No one is sure what to make of this “archaeological enigma shrouded in mystery,” in the words of Rome’s Archaeological Superintendency. Although there’s no definitive theory as of yet, experts have a few ideas.

The use of colorful African marble for the floors and walls has led archaeologists to believe that the building probably served a prestigious—or perhaps holy—function as the villa of a noble family or as a Christian place of worship. Its proximity to an early cemetery spawned the latter theory, since it's common for churches to have mausoleums attached to them. Several tombs were found in that cemetery, including one containing the intact skeleton of a Roman man.

Marble flooring
Romano D’Agostini, Giorgio Cargnel, Soprintendenza Speciale di Roma

A tomb
Romano D’Agostini, Giorgio Cargnel, Soprintendenza Speciale di Roma1

The walls are made of brick, and the red, green, and beige marble had been imported from Sparta (Greece), Egypt, and present-day Tunisia, The Telegraph reports.

As The Local points out, it’s not all that unusual in Rome for archaeological discoveries to be made by unsuspecting people going about their day. Rome’s oldest aqueduct was found by Metro workers, and an ancient bath house and tombs were found during construction on a new church.

[h/t The Local]

Alexis Pantos, University of Copenhagen
Scientists Just Found the Oldest Known Piece of Bread
Alexis Pantos, University of Copenhagen
Alexis Pantos, University of Copenhagen

An old, charred piece of long-forgotten flatbread has captured the interest of archaeologists, anthropologists, and historians around the world. Found in a stone fireplace in Jordan’s Black Desert, this proto-pita dates back 14,400 years, making it the oldest known example of bread, Reuters reports.

To put the significance of this discovery in context: the flatbread predates the advent of agriculture by 4000 years, leading researchers to theorize that the laborious process of making the bread from wild cereals may have inspired early hunter-gatherers to cultivate grain and save themselves a whole lot of trouble.

“We now have to assess whether there was a relationship between bread production and the origins of agriculture,” Amaia Arranz-Otaegui, a researcher with the University of Copenhagen, told Reuters. “It is possible that bread may have provided an incentive for people to take up plant cultivation and farming, if it became a desirable or much-sought-after food.”

A report on these findings—written by researchers from the University of Copenhagen, University College London, and University of Cambridge—was published in the journal Proceedings of the National Academy of Sciences.

It was once thought that bread was an invention of early farming civilizations. A 9100-year-old piece of bread from Turkey was previously regarded as the oldest of its kind. However, the Jordanian flatbread was made by a group of hunter-gatherers called the Natufians, who lived during a transitional period from nomadic to sedentary ways of life, at which time diets also started to change.

Similar to a pita, this unleavened bread was made from wild cereals akin to barley, einkorn, and oats. These were “ground, sieved, and kneaded prior to cooking,” according to a statement from the University of Copenhagen. The ancient recipe also called for tubers from an aquatic plant, which Arranz-Otaegui described as tasting “gritty and salty."

[h/t Reuters]


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