Ah, the wonders of social media. For all its drawbacks, there are always positives: connectivity, confrontation, community, learning of the silenced history of successful C-sections in Africa, the correlation of colonization with said silencing…all of the above. Some great positives, I would say.
I first learned of this innovation of African midwives from TikTok educator Habari Njema. Her brief overview immediately piqued my curiosity, and I had to delve in more. Before I begin my bullet points, I encourage you (as I do every time) to really look into the sources I provide at the bottom of the post. They’ll give you so much more than I can in this brief space of time.
African midwives surrounding modern-day Lake Victoria and Lake Tanganyika have been performing successful C-sections for centuries, long before the Western world adopted the practices we have. Prior to the twentieth century, even vaginal childbirth in European countries offered a high mortality rate. Obstetrics and gynecology were nowhere near understanding the feminine anatomy. Surgical practices, even less so. C-sections in the Western world had a near-100% mortality rate: it was largely understood that, should a woman undergo surgery for the birth, only the baby would survive.
This was not the case in Africa. In the nations we now call Uganda, Tanzania, and Burundi, nearly every woman survived a C-section.
The practitioners had a process we would call rather progressive today (to them, it would’ve just been common sense). First, the birthing person would be sedated using banana wine, and tied to the bed for their own safety. The knife would be sharpened, then sterilized using heat. The surgeon would make a quick midline incision, avoiding excessive blood loss and ensuring all other organs remained intact. The bleeding points were cauterized with a pre-prepared hot iron. Following the removal of the baby, the uterus was massaged to contract it, allowing the birthing person to avoid sutures. Finally, antiseptic tinctures and salves were applied, and careful stitches (crafted of iron needles) were made.
There are so many things to admire about this process. The birthing person’s pain was lessened due to sedation and sterilization. That comprehension of antiseptic practices led to the rarefying of infections. Shock and extreme blood loss were incredibly uncommon, as were deaths. The only issue reported with any frequency was the breasts taking longer to produce milk, and that was easily remedied by friends and family. It’s not all that dissimilar from the C-section process we have in the 21st century.
Though Ugandan C-sections were typically performed by male healers, it was female midwives who practiced the surgery in Tanzania and Burundi. This region was where Dr. Robert W. Felkin, a Scottish “medical missionary” (self-proclaimed), observed a successful C-section in 1879. He was so flabbergasted by the safety of the process that he wrote on a book on it: The Development of Scientific Medicine in the African Kingdom of Bunyoro Kitara. It was here, with this report, that European nations began performing successful C-sections. At first, of course, the observations were met with skepticism: after all, how could “savages” accomplish something their skilled doctors could not? Their efficiency and safety was quickly proven, of course, though white, male doctors would claim ownership of it.
That, my friends, is where our modern-day problem finds its catalyst. If you Google contemporary childbirth mortality rates, you’ll find that Sub-Saharan and rural Africa have the worst in the world, at over 50%. This is the continent, these are the nations, that provided the rest of the world with safe medical practice, and yet, they face the most death.
We have colonization to thank for that. The establishment of white supremacy, rigid patriarchy, and inherent socioeconomic disparity led to the ousting of midwifery and its traditional practices. That process had begun before Felkin’s report, of course; however, once white doctors realized how effective this surgery was, how it revolutionized female healthcare, they snatched it out of the black women’s hands. Only schooled surgeons or the white-dubbed “medicine man” could perform it, and those folks tended to be racist or uninformed. That—along with its subsequent problems—began a spiral that leads to the deaths of more black women every year than any other demographic.
And we still use their wisdom. Obstetrics, gynecology, and practitioners (of all sorts) of childbirth still have a long way to go in the understanding and implementation of the science of birth. But we would be centuries behind, with a still-horrific mortality rate worldwide, if it weren’t for the open surgical door of black midwives. In a world where women of color experience far higher mortality rates in childbirth than white women, in a world where medical treatment for women of color is severely lacking, and in a world where women’s health practitioners are still looked down upon as lesser, we would do good to remember that.
Here's to you, Bunyoro. Here’s to you, women.
Sources/For More Info: “Caesarian Sections Were Performed In Africa Long Before They Were Standardized Across The World” by Takudzwa Hillary Chiwanza, ““Learning the African history of caesarean sections will help us better challenge stigma” by Annabel Sowemimo, “Successful C-Sections in Pre-Colonial Africa: Surgery in Bunyoro Kingdom” by Dr. Y, “Cesarean Section – A Brief History” from the National Institute of Health, Notes on Labour in Central Africa by Dr. R.W. Felkin