Scholion. On Caesarean Section and Other Incisions

Besides Caesarean section, symphysiotomy, pubiotomy, and combined operations are distinguished.¹

¹ Cf. Antonelli, Medicina pastoralis, I, n. 308 and following; Capelmann-Bergmann, Pastoral-Medizin, p. 57 and following.

I. Notions. 1. Caesarean section is an operation by which, the maternal womb having been cut, the fetus is extracted from the womb. It is called Caesarean section from Julius, who was brought into the light by cutting and thence was called Caesar. Now Caesarean section can be done either on a living mother or on the body of a mother recently dead.

2. Symphysiotomy is an operation by which the cartilage, the symphysis, which joins the two pubic bones, is cut, whereby it happens that the width of the pelvis is increased and the fetus can more easily come forth into the light.

3. Pubiotomy is an operation by which one or both pubic bones are cut, and in that way the exit of the fetus is rendered easier.

4. Combined operations are constituted by symphysiotomy together with artificial premature delivery.¹

¹ Cf. Antonelli, loc. cit.

II. Morality. 1. Caesarean section or another incision of the living mother, according to the circumstances:

a) Is licit if there is a well-founded hope of saving both the mother and the offspring, and by the section the hope of baptizing the offspring is increased.¹ It is said:

1. If there is a well-founded hope of saving both the mother and the offspring; for otherwise the section would involve homicide. "Evils are not to be done," says St. Thomas, "that goods may come, as is said in Romans 3:8; and therefore a man ought not to kill the mother in order to baptize the child" (III, q. 68, a. 11, ad 3; St. Alphonsus, VI, 106). Now hope of saving the offspring is not present except after 28 weeks from conception; before that he is not viable. For the rest, observe that hope of performing the operation with a happy outcome is present today much more easily than formerly because of the progress of surgical art.²

2. And by the section the hope of baptizing the offspring is increased. For it is licit for the mother to expose herself to danger of death so that the spiritual salvation of the offspring may be better provided for.

b) It is obligatory, that is, it must be sustained by the mother, if: 1. there is a well-founded hope of saving the mother and the offspring; and 2. by the section the hope of baptizing the offspring is notably increased. The reason is that the mother is bound to prefer the eternal life of the offspring to her own temporal life. Now since the infant can commonly be baptized either in the womb of the living mother, or after, the mother being dead, he has been cut out, therefore section of the living mother will very rarely be obligatory. If the case obtains, prudence will commonly require that the section be urged upon the mother rather than imposed.

2. Section on the body of a dead mother:³

a) Is laudably done whenever there is even the least hope of extracting a living fetus. Now some hope is already had about the fortieth day from conception, indeed even before, since they narrate that it has happened that fetuses have been extracted alive at the assigned time.⁴

b) Is obligatory, and indeed under grave obligation, whenever there is probable hope of extracting a living fetus. Now probable hope seems to be present after about the completed fourth month from conception.⁵ But the obligation once begun "perseveres until the morally certain death of the offspring... How long life can be preserved for infants in the womb of a deceased mother cannot be determined: this depends much on the character of the illness from which the pregnant mother died; but there is no doubt that a fetus can survive the mother for an hour, indeed for several."⁶

¹ It suffices practically to note this; for there are also other cases in which the section is licit, for example if not only is there a well-founded hope of saving the mother and the offspring, but by the section the hope of saving the mother is increased, while the hope of baptizing the offspring is not diminished, etc.; but these cases cause no difficulty.

² Nederlandsche Katholieke Stemmen, 1907, p. 15.

³ Note that the death of the mother is not certainly established unless the first signs of putrefaction are present.

⁴ Cangiamilla, Embryologia sacra, book II, chapter 5.

⁵ Cf. Capelmann-Bergmann, op. cit., p. 62.

⁶ De Smet, De Sacramentis, n. 313. Cf. Ferreres, Mort reelle et mort apparente.

III. By whom is it to be performed? 1. Section of a living mother, as is clear, belongs only to an expert; one who is not an expert would become guilty of homicide.

2. Section of a mother not certainly dead, but perhaps only apparently dead:

a) If revival, as it is called, is held as possible, the section should be done by an expert if one is present, because otherwise the operation would expose the life of the mother to graver danger without sufficient reason. If an expert is lacking, generally whoever is sufficiently skilled is bound, or at least one who has hope of extracting the fetus; because then there is sufficient reason for admitting the graver danger. Now revival is held as possible if the mother succumbs after a crisis of the nerves, whether induced by vehement pain or by another cause.

b) If revival is held as impossible, namely if the mother is seen to succumb after longer pains, the section again belongs primarily to an expert, who can admit the danger of accelerating death if it is present. If an expert is lacking, generally another is bound, as was said above.

3. If the mother is certainly dead, the things just said under b) hold.

I said above, generally he is bound, etc., because authors do not agree to what extent even a priest must, or licitly can, perform the section, or command that it be performed, that is, by ordering see to it that it is done. Now he certainly cannot proceed to the said operation if the common good stands in the way, namely if, considering the circumstances, it must be feared that by this kind of manner of acting the priest would become less capable of promoting the salvation of people, or that other inconveniences would arise from it for the faithful.¹ If danger to the common good certainly is not imminent, some judge that the priest is bound, because natural law, to which the decrees are not thought to be contrary, imposes the obligation. Others teach that he is prohibited from performing the section. They rely on decrees of the Holy Office.² The first decree indeed regards in itself circumstances in which the common good stood in the way; but the second, they say, which refers the petitioner to the first, seems to signify that a general prohibition is intended. Finally, others hold each opinion as truly doubtful, and consequently think that a priest can perform the section or command that it be performed, but is not bound. The matter seems truly doubtful to me also; but for that reason I think that natural law, as possessing priority, should prevail, or that the section is to be performed, except, of course, in the case in which danger to the common good stands in the way.

Corollary. All to whom the matter becomes known are per se bound prudently to see to it that the section is done, but especially relatives and the pastor. Therefore a surgeon should be called as quickly as possible, and meanwhile the uterus of the deceased mother should be kept warm.³ Nor should the section be omitted, even if a fairly notable time has elapsed from the death of the mother; for they narrate that it has happened that fetuses have survived the mother for 24, indeed for 48 hours and beyond.⁴ Hence a physician asserting that the fetus has certainly died should not easily be believed. Indeed Dr. Brillaud even contends: "Since medical science knows no sign by which it may be judged with certainty that the fetus is dead, the Caesarean operation after death must always be undertaken."⁵

¹ Civil laws commonly stand in the way.

² 15 February 1780 (Collectanea, n. 541) and 13 December 1899.

³ Older authors add that the mouth of the mother is to be opened; but according to physicians the infant does not breathe in the womb of the mother.

⁴ Eschbach, Disputationes physico-theologicae, p. 356.

⁵ In Eschbach, op. cit., p. 363.

IV. The manner of performing the section. 1. The section is made from the navel to the genitals or pubic bone; but lest the intestines be injured, this precaution is to be used: once a small opening has been made, the operator immediately puts into it the index finger placed beneath the back of the scalpel or knife, and in the aforesaid manner cuts first the skin, then the other coverings which cover the intestines. When this has been done, the uterus, if the pregnancy is more advanced, will appear of itself; otherwise it will be found back behind the bladder. If this is filled with urine and impedes the finding of the uterus, let it be compressed by the hand and emptied.

2. The uterus, once found, is immediately cut, proceeding from the upper and anterior part to the lower; then the afterbirth membranes also are cut or ruptured, by which the fetus is enveloped.

3. The infant or fetus is extracted, and if certain or doubtful signs of life appear, he is to be baptized at once. If nevertheless danger of death is thought or feared to be present, the fetus is to be baptized before he is extracted.

4. After Baptism has been conferred, if the infant survives with hope of preservation, the umbilical cord is cut at a distance of two or three inches from the abdomen and is strongly tied with thread at a distance of one inch from the abdomen; when these things have been done, he is handed over to be nourished.¹

Question. What should be done by a confessor who, from the confession of a sick girl, discovers that she is pregnant?

Response 1. If the girl is already pregnant from about the fourth month, she is bound under grave obligation to see to it that after her death she be cut; nor is she excused on account of the loss of reputation. Therefore let the girl reveal her condition to a prudent person either by word of mouth, or let her hand over to him a writing to be read after death, in which she declares her pregnancy and her will that after death the infant be extracted and baptized.

Response 2. If the girl is ignorant of the grave obligation, and it is feared that, once taught, she will not obey it, let the confessor proceed only by persuading.

¹ Aertnys-Damen, Theologia Moralis, II, n. 57.