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An author’s memories of surgery

Title: Knives & Nappies

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Author: Haleemah Alli Bankole

Pages: 164 

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Publisher: Pen Publishers 

Year: 2018

Reviewer: Dr. Wale Okediran

Surgical operations are usually challenging mentally, physically, and spiritually. For women, going through a Caesarean Section (C/S) is one of these momentous experiences.

C/S, also known as C-section or caesarean delivery, is the use of surgery would put the baby or mother at risk.

C/S has been part of human culture since ancient times and there are tales in both Western and non-Western cultures of this procedure resulting in live mothers and offspring. According to Greek mythology, Apollo removed Asclepius, founder of the famous cult of religious medicine, from his mother’s abdomen. Numerous references to C/S appear in ancient Hindu, Egyptian, Grecian, Roman, and other European folklore. Ancient Chinese etchings depict the procedure on apparently living women. The Mischnagoth and Talmud prohibited primogeniture when twins were born by C/S and waived the purification rituals for women delivered by surgery.

Yet, the early history of C/S remains shrouded in myth and is of dubious accuracy. Even the origin of ‘caesarean’ has apparently been distorted over time. It is commonly believed to be derived from the surgical birth of Julius Caesar, however this seems unlikely since his mother Aurelia is reputed to have lived to hear of her son’s invasion of Britain. At that time, the procedure was performed only when the mother was dead or dying, as an attempt to save the child for a state wishing to increase its population. Roman law under Caesar decreed that all women who were so fated by childbirth must be cut open; hence, caesarean. Other possible Latin origins include the verb ‘caedare,’ meaning to cut, and the term ‘caesones’ that was applied to infants born by post-mortem operations. Ultimately, though, we cannot be sure of where or when the term caesarean was derived. Until the sixteenth and seventeenth centuries the procedure was known as caesarean operation. This began to change following the publication in 1598 of Jacques Guillimeau’s book on midwifery in which he introduced the term ‘section’. Increasingly thereafter ‘section’ replaced ‘operation.’

During its evolution C/S has meant different things to different people at different times. The indications for it have changed dramatically from ancient to modern times. Despite rare references to the operation on living women, the initial purpose was essentially to retrieve the infant from a dead or dying mother; this was conducted either in the rather vain hope of saving the baby’s life, or as commonly required by religious edicts, so the infant might be buried separately from the mother. Above all, it was a measure of last resort, and the operation was not intended to preserve the mother’s life. It was not until the nineteenth century that such a possibility really came within the grasp of the medical profession.

Perhaps the first written record we have of a mother and baby surviving a C/S comes from Switzerland in 1500 when a sow gelder, Jacob Nufer, performed the operation on his wife. After several days in labor and help from thirteen midwives, the woman was unable to deliver her baby. Her desperate husband eventually gained permission from the local authorities to attempt a caesarean. The mother lived and subsequently gave birth normally to five children, including twins. The caesarean baby lived to be 77 years old. Since this story was not recorded until 82 years later historians question its accuracy. Similar skepticism might be applied to other early reports of abdominal delivery þ those performed by women on themselves and births resulting from attacks by horned livestock, during which the peritoneal cavity was ripped open.

Hospital stories are famous in Literature for their large followership. The reason for this could be because people generally love to know how other people are faring with their health concerns or how they too will cope when in such a situation. Yet, for some, it is just curiosity or that unexplainable human behaviour of sadism, joy from other people’s suffering. Whatever it may be, the truth is that people just enjoy reading about other people’s health concerns. I should know this, after more than ten years of running my ‘Ask the Doctor’ column in one of Nigeria’s oldest and largest circulating newspapers. I am often surprised when people accost me at social events and shower me with compliments about my column.

In Knives & Nappies, the author, who is a multiple C/S recipient tells her story in simple and easily accessible language. 

The 164-page book, which is well produced in a neat and easily readable style, is divided into three main sections. While Section One ‘The Caesarean Section Handbook’ tells the reader all he/ she needs to know about C/S, Section Two ‘The A, B, C of Caesarean Sections’ contains the various explanations about C/S by doctors and Section Three, ‘Our Caesarean Birth Stories’ enumerates personal stories by those who have gone through the rigours of Caesarean Sections.

While many of such stories are very engrossing and educative, I was particularly touched by the experience of Mama Mercy:

Everything just happened so fast. The entire team was immediately at hand and I was swiftly prepared for the caesarean section and wheeled off to the theatre. At the theatre, the whole thing went on as usual until the surgeon exclaimed “I can see the head!”. If it weren’t for the tone of his voice- the sound of surprise, I wouldn’t have been startled. Why should the surgeon be surprised to see the head when seeing the head and the entire body was the goal of the surgery? I was very grateful to God that I wasn’t on the anaesthesia that would have made me unconscious. So I asked the nurse what the surgeon meant. She told me that my uterus had ruptured and it was only the amniotic sack that separated my baby from dropping out of the uterus into my stomach, which would have been a disaster for the baby and I.

We both could have lost our lives if this operation hadn’t been carried out timely before my sack broke.

I can’t describe how it felt knowing that I had been that close to death. My husband was equally stunned when I told him later. We were deeply grateful to God who had inspired us to opt for an elective at that time.

We felt it was also divine that the surgeon had given in and promptly carried it out. During my recovery at the hospital I experienced a moment of piercing headache.

The nurses said it was because I had been raising my head up too early. At some point the nurses had to get me injected.. Unfortunately the journey to recovery was marred by coming down with malaria. After I recovered from that, everything just went on fine. I am really grateful to God for everything. I believe He was merciful to me.

In addition to the above-named sections, the Appendix is full of information for patients preparing for C/S, from how to prepare for child birth, a check list of what things are needed for a C/S to the kinds of foods and drugs to consume during child birth. So rich and educative is the book that apart from telling her story, Haleemah has successfully given us a book that can be useful not only to prospective patients, but also to health workers, researchers and students alike.

Dr. Wale Okediran is a former President of the Association of Nigerian Authors


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