APPENDIX: ON THE CAESAREAN OPERATION IN ORDER TO BAPTIZING AN INFANT NOT YET BORN

The operation or Caesarean section consists in this, that the womb of the pregnant mother is opened, so that the fetus may be extracted. A twofold principal question occurs, namely whether, or when, it can be done, or ought to be done.

1269. Questions. - Query 1° Whether, or when, can it be done?

Resp. The following rules seem to have to be established:

Rule I. When the mother is dead, it is certain that the Caesarean operation can be done, and indeed immediately, as soon as her death is established. Nevertheless he whom it concerns by law is to be warned, lest perhaps the author of the operation be made liable to penalties. - But the reason why it can be done is evident: for if anything stood in the way, it would be danger to the mother; but from the hypothesis her death is certainly established; and from another side the spiritual, indeed perhaps also temporal, life of the infant can be saved. - See Cangiamila in the work whose title is: Sacred Embryology.

Rule II. While the mother is living, the Caesarean operation can never licitly be done, as often as there is present a proximate or probable danger of the mother's death to follow from it, although, if it is not done, the mother and the offspring are certainly going to perish. The reason is, because this would be just the same as directly to kill the mother, which is never lawful. - Thus St. Thomas, who says: "A man ought not to kill the mother, in order that he may baptize the child."¹ Hence the operation cannot be done when a very skilled surgeon is lacking, nor when the mother is so weakened by disease that the operation, otherwise not dangerous, would from the circumstances induce proximate danger of death, etc.

Rule III. While the mother is living, the Caesarean operation can licitly be done in these circumstances, namely 1° if by no other licit means the living offspring can be extracted, or the mother is going to die before she gives birth, with the greatest danger of the infant's death before he can be baptized; 2° if, by the judgment of a skilled surgeon, proximate danger of the mother's death is absent. But such danger can be absent if the mother is robust, as is established from innumerable examples, and from the more common opinion of physicians and surgeons, whose art, especially in our times, has become much more advanced and perfect. - See Sacred Embryology,² Elbel,³ etc. - The reason is plain; for there is no danger,

or at least it is very slight and remote, and thus, if perhaps death follows, it will seem to follow only accidentally.

Query 2° Whether, or when, ought it to be done?

Resp. 1° When the mother is dead it is certainly to be done under grave obligation, even against the will or resistance of parents or relatives, if it can be done; because by the law of charity, with every care and labor, the eternal salvation of the infant must be procured. - Thus St. Thomas.¹ Thus also the Roman Ritual, On Baptism, establishes.

Nevertheless there must be present hope of extracting the infant alive, which hope is scarcely present in the first months of pregnancy; but, unless some special grave reason suggests that he has already died before the mother or together with her, after the fourth month of gestation this hope seems to be present (Capellmann, Med. Past. p. 23. 24). In doubt concerning the life of the infant it is always to be done. See Marc,² and cf. n. 474, I.

Furthermore diligent care is to be employed that the region of the womb of the deceased woman be kept warm until the operation has been done; otherwise the infant would more easily depart from life before he could be baptized.

Resp. 2° The operation is to be done also while the mother is living, if by the judgment of experts the infant cannot otherwise be baptized. But the mother is held, per se and speaking speculatively, under grave obligation to suffer it, if it can be done without proximate danger of death. The reason is, because she is held to suffer any temporal inconvenience whatever for preserving the spiritual and eternal life of the infant. This follows from the general law of charity. - Thus commonly with Elbel,³ St. Alphonsus,⁴ Sacred Embryology.⁵

I said: per se and speaking speculatively; for in practice the confessor must beware lest he urge the mother under grave obligation, on account of too great danger, lest by denying consent she die in the state of mortal sin; and thus, while he wishes to save the spiritual life of the infant, the mother herself be damned. Therefore it will be enough to exhort her to consent to the incision.

Besides, since it is established that the fetus very often survives the deceased mother, great hope shines forth of baptizing him after she is dead, and therefore a lesser obligation of incision presses.

The mother is not held to undergo the operation if, the operation being omitted, she alone is judged to be going to perish; because no one is held to preserve life by extraordinary and such arduous means. - But if there were only a slight hope of saving the offspring, the mother could indeed, but would not be held to, undergo the operation, because charity does not urge to such a degree in so great uncertainty of the outcome. - Thus commonly with St. Alphonsus.¹

Query 3° Is a girl, dishonestly and secretly pregnant, and near to death, if on account of advanced pregnancy it is probable that Baptism can be conferred upon the fetus, to be obligated to disclose her state outside Confession, so that the operation may be done when she is dead?

Resp. Distinguish. Negatively, if she is living in good faith, nor is fruit hoped for from an admonition. Otherwise, affirmatively; for the eternal life of the fetus is to be preferred to the reputation of the mother.

Query 4° Is a priest held to perform the operation on a dead mother, if there is lacking someone who is willing or able to perform it?

Resp. It is controverted. See the arguments of those disputing at Marc.² It is certain that one must abstain from it if damage to Religion is to be feared from it, lest "while we seek a few, we lose many:"³ likewise, as is plain, if the relatives dissent. But the damage to be feared for Religion must be judged especially from the circumstances of various places. - Nevertheless then let him at least strive to obtain that Baptism be conferred within the mother's womb by someone through an instrument.

Query 5° In what manner is that operation to be performed?

Resp. 1° Let the section be made from the navel down to the pudendum or pubic bone; but lest the intestines be injured, let this caution be employed: after a small opening has been made, the one operating immediately inserts into it the index finger placed under the back of the scalpel or knife, and in the aforesaid way cuts first the skin, then the other coverings which cover the intestines. When this has been done, the womb, if the pregnancy is more advanced, will appear of itself; otherwise it will be found behind, after the bladder. If this is filled with urine, and impedes the finding of the womb, let it be compressed by the hand and emptied.

2° When the womb has been found, it is immediately cut, proceeding from the upper and anterior part to the lower; then also the membranes of the afterbirth, by which the fetus is enveloped, are cut or ruptured.

3° The infant or fetus is extracted, and if certain or doubtful signs of life appear, he is to be baptized without delay. But if it is thought or feared that danger of death is present, the fetus is to be baptized before he is extracted.

4° After Baptism has been conferred, if certainly or probably the infant still survives, the umbilical cord is cut at the distance of two or three inches from the belly, and is tightly tied with a thread at the distance of one inch from the same belly; when these things have been done, he is handed over to be nourished.