This is a sketch of a C-section being performed in Central Africa in 1879. … and if that isn’t hint enough: here’s your warning- If you’re squeamish about medical talk, this probably isn’t the post for you.
It was published in the Edinburgh Medical Journal in 1884, entitled “Some Notes on Labor in Central Africa”, it was a transcript of a presentation for the Edinburgh Obstetrical Society given by Robert W. Felkin, at the time an anthropologist and medical student.
But Felkin hadn’t gone to Central Africa to learn about labor– or for any scientific research– rather, he was on a mission trip led by the Church Missionary Society. One night after a long hike, one of his servants suggested some entertainment in the form of watching a laboring woman “get cut open” in the nearby village. Felkin recounted saving the laboring woman from being cut open “with an ugly looking knife”, impressing the “crowd of natives” with his “white man’s medicine” (a pair of forceps he had brought with him). In turn, he was impressed by the laboring position of the woman and her female companion: sitting back to back.
“This episode made me curious to find out what various positions were occupied by women when in labor”
During the rest of his travels, he tried to get himself into births to watch the positions used, even when he wasn’t welcome:
“Many a time I have been denied admission during a labour; but I must confess that not infrequently I have gone by stealth and acted ‘peeping Tom,’ but I hope with better motives than his.”
He was able to record many laboring positions with rough sketches in his journal, accompanied with notes about local birthing practices.
But it is his sketch of a surgical birth 1879 in Kahura, Uganda that has become the most widely shared (and misrepresented) of his work today.
The woman, estimated to be around 20 yo and her first birth, had been laboring for two days and was completely exhausted. She had been handed over to the men by the women. She was made drunk on banana wine, stripped naked and tied to the bed by a group of men. Felkin was not allowed to examine her (earlier in his writings he explained that Ugandan women were made to cover their entire bodies in clothing when out in public, so just being allowed in the hut while she was naked was pushing it).
It was a crude operation, likely honed through animal husbandry but done with the hope that both mother and baby survive. The operator doused the knife in the wine, chanted, doused it in water (a hint that the wine was a ritual offering and not for sterilization purposes). The operator cut too deep, cutting the baby’s shoulder and the man in charge of holding the abdomen slipped almost letting the bowels spill out, while another dabbed at hemorrhaging points with a hot iron.
No sutures were placed in the uterus, instead, the operator manipulated it until it contracted, then a grass mat was tied around her belly as she was tipped over to let the abdominal fluid leak out, then rolled back so they could place iron spikes to suture the wound. A paste, made by attendants chewing up roots and spitting them into a bowl, was then applied to the wound, covered with a banana cloth and then wrapped in barkcloth. Felkin stayed for two days, watching as the attendants mopped up pus from the wound when changing the cloth. She was too sick to breastfeed so another woman fed her baby. Her baby’s wounded shoulder was treated with the same chewed pulp paste and cloth, healing in four days. Felkin returned eleven days later to inquire after the mother and baby, and it was reported that her wound was completely healed, had normal uterine discharge and that she seemed quite comfortable. (Today a c-section takes around six weeks to heal– and from a considerably smaller incision, if there are no complications, so take this with a large grain of salt).
Of course, c-sections were not unheard of in Europe, the Middle East, or Asia in the 19th century. The history of their use stretches back thousands of years– as it likely did in Africa (but capital H history starts with writing), for example, Felkin’s writings and sketches are some of our only source material on the distinct cultural birthing practices of central African women at the time. In Europe, c-sections were considered so extreme that they had been reserved for women who were dying or dead in order to save the fetus. In the 18-19th century, Edinburgh was the place where the top doctors and surgeons in the world were trained or taught. So for that reason (among others, notably, racism) the obstetricians in attendance at Felkin’s presentation probably did not believe they had anything to learn from remote central African villagers’ surgical techniques, and thus the focus of the presentation was the laboring positions of women.
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Proficient nerd on most things baby/ culture/ history/book related. Disability advocate. Has a penchant for photography, languages, and panics when low on chocolate rations. Will embarrass self in any social situation to point out or pet other people's dogs. Habitual stumbler and tea drinker. People watcher, pizza slayer.