Caesarean Birth

After this first proof by case histories comes the second, by logical argument; this considers the nature or substance of the subject, examined systematically for each of the three parts that must be incised in order to deliver the child. These are:

The muscles of the anterior abdominal wall, called epigastric in Greek and abdominal in Latin.

The peritoneum, which is the membrane of the abdomen, found below the muscles described above.

The uterine body. As far as the bladder is concerned, although it lies naturally between the peritoneum and the uterus, it does not present at the site of the caesarean incision – being caudal to the hypogastrium, particularly in women about to deliver, in whom the distended uterus pushes it downward. Especially during labour, at which time it is almost always empty as a result of the urinary frequency experienced by these women; it is consequently even further away from the site of the incision.

The muscles of the abdominal wall

The first part to incise; size of the incision

In the first place, it seems that these muscles can be incised without any danger of death – if only because Galen describes in his ‘Method’ how to suture the wound by careful gastrorrhaphy.

It may be objected that the size of the incision poses an obvious danger; the same author demonstrates that an incision of this size is not dangerous, advising that such abdominal wounds be enlarged if they appear too small to allow reduction of any bowel or omentum that might have protruded through the incision.