Caesarean section--past and present.

Prior to 1500, postmortem Caesarean section was advocated and occasionally carried out as an effort to save the child. Caesarean section on the living woman was first advocated during the 16th and 17th centuries but was opposed by the leading authorities of the day. During the 18th century and the first half of the 19th, understanding of the mechanism of labour improved. Caesarean section was advocated when a woman could not be delivered by any other means. However, many opposed Caesarean section because of the maternal mortality associated with this procedure. Important developments during the last half of the 19th century included anaesthesia, improved surgical techniques, and the introduction of asepsis and antiseptic procedures. A gradual reduction in maternal mortality followed, with a striking decrease throughout the 20th century. This has been associated with an increased reliance on Caesarean section, with rates that vary widely by country, health care facility, and delivering physician. The optimal role of Caesarean section for the benefit of both mother and child has yet to be determined.