Self-inflicted caesarean section

Last updated March 21, 2024

A self-performed caesarean section is a form of self-surgery where a woman attempts to perform a caesarean section on herself. Cases of self-inflicted caesarean section have been reported since the 18th and 19th century. While mostly deadly to either the woman, the child, or both, there are at least five known documented successful cases.^[1]^[2]

Notable case

Inés Ramírez Pérez

In March 2000, Inés Ramírez Pérez, a Mexican woman from the state of Oaxaca, gained media attention after performing a caesarean section on herself. Despite having no medical training, the operation was successful and both she and her baby survived.

At midnight, on 5 March 2000, after 12 hours of continual pain, Ramírez sat down on a bench^[3] and drank three small glasses of hard liquor.^[4] She then used a 15 centimetres (5.9 in)^[3] kitchen knife to cut open her abdomen in a total of three attempts.^[4] Ramírez cut through her skin in a 17 centimetres (6.7 in)^[3] vertical line several centimeters to the right of her navel, starting near the bottom of the ribs and ending near the pubic area. (For comparison: a typical C-section incision is 10 centimetres (3.9 in) long, horizontal and well below the navel, the Pfannenstiel incision.) After operating on herself for an hour, she reached inside her uterus and pulled out her baby boy.^[3] She then severed the umbilical cord with a pair of scissors and became unconscious.^[3] She used clothes to bandage her wound after regaining consciousness, and sent one of her older sons to find help.^[3]

Several hours later, the village health assistant and a second man found Ramírez conscious and alert, along with her live baby.^[3] He sewed her incision with an available needle and thread.^[3]

Ramírez was eventually taken to the local clinic, 2.5 miles (4.0 km) away in San Lorenzo Texmelucan, and then to the nearest hospital, eight hours away by car. Sixteen hours thereafter she underwent surgical repair of the incision site. On the seventh post-operative day, she underwent a second surgery to repair complications resulting from damage to her intestines incurred during her C-section. She was released from the hospital on the tenth day post-surgery, and went on to make a complete recovery.

Describing her experience, Ramírez said, "I couldn't stand the pain anymore. If my baby was going to die, then I decided I would have to die, too. But if he was going to grow up, I was going to see him grow up, and I was going to be with my child. I thought that God would save both our lives."^[3]

The case was written up in the March 2004 issue of the International Journal of Gynecology & Obstetrics .^[4]

She is also believed to have been profoundly lucky in several ways: to have put herself in the position she chose, which put her uterus – rather than her intestines – against the abdominal wall under the incision site; to have not succumbed to infection from the large open wound in a non-sterile environment; to have not passed out from the pain part-way through, bled to death, or died from shock. She did say, afterward, that she did not advise other women to follow her example.^[3]

In popular culture

In the science fiction film Prometheus , by Ridley Scott, the character Elizabeth Shaw gives herself a caesarean section using a "MedPod", a fictional medical device that is able to diagnose illnesses and robotically perform the procedure. The "baby" is revealed to be a "trilobite" alien that has been growing inside her as a parasite.

The scene has been discussed,^[5] drawing parallels with the xenomorph birth scene in the original Alien 1979 movie.^[6]

Related Research Articles

Caesarean section, also known as C-section or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother's abdomen. It is often performed because vaginal delivery would put the mother or fetus at risk. Reasons for the operation include obstructed labor, twin pregnancy, high blood pressure in the mother, breech birth, shoulder presentation, and problems with the placenta or umbilical cord. A caesarean delivery may be performed based upon the shape of the mother's pelvis or history of a previous C-section. A trial of vaginal birth after C-section may be possible. The World Health Organization recommends that caesarean section be performed only when medically necessary.

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions, the fetus is unable to survive.

Childbirth, also known as labour, parturition and delivery, is the completion of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million human births globally. In the developed countries, most deliveries occur in hospitals, while in the developing countries most are home births.

Hysterectomy is the surgical removal of the uterus and cervix. Supracervical hysterectomy refers to removal of the uterus while the cervix is spared. These procedures may also involve removal of the ovaries (oophorectomy), fallopian tubes (salpingectomy), and other surrounding structures. The term “partial” or “total” hysterectomy are lay-terms that incorrectly describe the addition or omission of oophorectomy at the time of hysterectomy. These procedures are usually performed by a gynecologist. Removal of the uterus renders the patient unable to bear children and has surgical risks as well as long-term effects, so the surgery is normally recommended only when other treatment options are not available or have failed. It is the second most commonly performed gynecological surgical procedure, after cesarean section, in the United States. Nearly 68 percent were performed for conditions such as endometriosis, irregular bleeding, and uterine fibroids. It is expected that the frequency of hysterectomies for non-malignant indications will continue to fall given the development of alternative treatment options.

Placenta praevia is when the placenta attaches inside the uterus but in a position near or over the cervical opening. Symptoms include vaginal bleeding in the second half of pregnancy. The bleeding is bright red and tends not to be associated with pain. Complications may include placenta accreta, dangerously low blood pressure, or bleeding after delivery. Complications for the baby may include fetal growth restriction.

Labor induction is the process or treatment that stimulates childbirth and delivery. Inducing (starting) labor can be accomplished with pharmaceutical or non-pharmaceutical methods. In Western countries, it is estimated that one-quarter of pregnant women have their labor medically induced with drug treatment. Inductions are most often performed either with prostaglandin drug treatment alone, or with a combination of prostaglandin and intravenous oxytocin treatment.

A hysterotomy is an incision made in the uterus. This surgical incision is used in several medical procedures, including during termination of pregnancy in the second trimester and delivering the fetus during caesarean section. It is also used to gain access and perform surgery on a fetus during pregnancy to correct birth defects, and it is an option to achieve resuscitation if cardiac arrest occurs during pregnancy and it is necessary to remove the fetus from the uterus.

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.

Uterine rupture is when the muscular wall of the uterus tears during pregnancy or childbirth. Symptoms, while classically including increased pain, vaginal bleeding, or a change in contractions, are not always present. Disability or death of the mother or baby may result.

<span class="mw-page-title-main">Uterine myomectomy</span> Surgical removal of uterine fibroid

Myomectomy, sometimes also called fibroidectomy, refers to the surgical removal of uterine leiomyomas, also known as fibroids. In contrast to a hysterectomy, the uterus remains preserved and the woman retains her reproductive potential. It still may impact hormonal regulation and the menstrual cycle.

Fetal surgery also known as antenatal surgery, prenatal surgery, is a growing branch of maternal-fetal medicine that covers any of a broad range of surgical techniques that are used to treat congenital abnormalities in fetuses who are still in the pregnant uterus. There are three main types: open fetal surgery, which involves completely opening the uterus to operate on the fetus; minimally invasive fetoscopic surgery, which uses small incisions and is guided by fetoscopy and sonography; and percutaneous fetal therapy, which involves placing a catheter under continuous ultrasound guidance.

Caesarean delivery on maternal request (CDMR) is a caesarean section birth requested by the pregnant woman without a medical reason.

In case of a previous caesarean section a subsequent pregnancy can be planned beforehand to be delivered by either of the following two main methods:

Uterus didelphys represents a uterine malformation where the uterus is present as a paired organ when the embryogenetic fusion of the Müllerian ducts fails to occur. As a result, there is a double uterus with two separate cervices, and possibly a double vagina as well. Each uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary.

A uterine transplant is a surgical procedure whereby a healthy uterus is transplanted into an organism of which the uterus is absent or diseased. As part of normal mammalian sexual reproduction, a diseased or absent uterus does not allow normal embryonic implantation, effectively rendering the female infertile. This phenomenon is known as absolute uterine factor infertility (AUFI). Uterine transplant is a potential treatment for this form of infertility.

A vaginal delivery is the birth of offspring in mammals through the vagina. It is the most common method of childbirth worldwide. It is considered the preferred method of delivery, with lower morbidity and mortality than caesarean sections (C-sections).

The following outline is provided as an overview of and topical guide to obstetrics:

A lower (uterine) segment Caesarean section (LSCS) is the most commonly used type of Caesarean section. Most commonly to deliver the baby a transverse incision is made in the lower uterine segment above the attachment of the urinary bladder to the uterus. This type of incision results in less blood loss and is easier to repair than other types of Caesarean sections.

A resuscitative hysterotomy, also referred to as a perimortem Caesarean section (PMCS) or perimortem Caesarean delivery (PMCD), is a hysterotomy performed to resuscitate a woman in middle to late pregnancy who has entered cardiac arrest. Combined with a laparotomy, the procedure results in a Caesarean section that removes the fetus, thereby abolishing the aortocaval compression caused by the pregnant uterus. This improves the mother's chances of return of spontaneous circulation, and may potentially also deliver a viable neonate. The procedure may be performed by obstetricians, emergency physicians or surgeons depending on the situation.

A uterine niche, also known as a Cesarean scar defect or an isthmocele, is an indentation of the myometrium at the site of a cesarean section with a depth of at least 2 mm.

References

↑ Szabó, András; Brockington, Ian (2014). "Auto-Caesarean section: a review of 22 cases". Archives of Women's Mental Health. 17 (1): 79–83. doi:10.1007/s00737-013-0398-z. PMID 24318749. S2CID 10641064.
↑ Morrison, J.; MacKenzie, I. Z. (2003). "Cesarean section on demand". Seminars in Perinatology. 27 (1): 20–33. doi:10.1053/sper.2003.50002. PMID 12641300.
1 2 3 4 5 6 7 8 9 10 "True grit: the mum who delivered her own baby". The Sydney Morning Herald. 1 June 2004. Retrieved 4 November 2010.
1 2 3 Molina-Sosa, A; Galvan-Espinosa, H; Gabriel-Guzman, J; Valle, RF (2004). "Self-inflicted cesarean section with maternal and fetal survival". International Journal of Gynecology & Obstetrics. 84 (3): 287–290. doi:10.1016/j.ijgo.2003.08.018. PMID 15001385. S2CID 38220990.
↑ Kevin P. Sullivan (11 June 2012). "'Prometheus': Secrets Behind The Surgery Scene". MTV News. Retrieved 24 August 2013.
↑ Pierce, Scott (7 July 2012). "Prometheus Crew Spills Its Guts About Movie's Most Shocking Scene". Wired. Retrieved 24 August 2013.