In many cultures and religions in the ancient world – from China to India, Egypt to Rome – we find accounts of an exceptional caesarean operation delivering the hero or prince of a nation, but it is almost impossible to determine their historical foundations. It was even a recent plot point in the first episode of HBO’s new series House of the Dragon.

The Latin author and naturalist Pliny the Elder reported that a Roman emperor was delivered by a caesarean; later authors assumed this may have referred to the birth of Julius Caesar. However, since his mother, Aurelia, survived for more than 40 years, this is probably another legend. What is certain is that ancient Roman law required, under the lex caesarea, that if a mother died while pregnant or giving birth, the foetus should be cut from her womb. The term “caesarean” may derive from the Latin verb to cut (caedere) or from the imperial title (Caesar).

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With the development of anatomical dissections in early modern Europe, there was renewed interest in the viability of caesarean sections in extreme cases to save the life of the mother and unborn child. A Swiss pig gelder, Jacob Nufer, was reported to have undertaken one in 1500 to save his wife and child. In the 1580s, there was a vigorous debate about their viability headed by the physician François Rousset, who toured France interview- ing surgeons and women to collect evidence of rare but successful caesarean sections.

However, in an age without anaesthetics or regular antiseptic measures, most attempts ended in the death of the mother, and so the procedure was almost universally abandoned – particularly when the introduction of forceps in the 17th century offered an alternative for obstructed labours. It was not until the late 19th century that caesareans re-emerged in western medicine. There were also contemporary reports of local surgeons practising them successfully in Uganda and Rwanda, using herb-based medicines and alcoholic anaesthetics derived from local plants.