Baptized in blood: Forced cesareans past and present

Apr 03, 2024

Forcing pregnant patients to undergo medically unnecessary, risky, and physiologically transformative, pre-viability cesarean sections is making a historical comeback…

Outline:

Introduction
Major Themes: Past and Present
Forced Cesareans in New Spain
a. ‘Sacred Embryology’
b. Birth as Inconsequential
c. Indoctrination and Necropolitics
d. Eliminating Dissenting Views
e. Surgery for the Sake of Religious Dogma
The Past Becomes the Present

Introduction

Forcing pregnant patients to undergo medically unnecessary, risky, and physiologically transformative, pre-viability cesarean sections is making a historical comeback - this time in states across the country which ban abortions - thanks to language in abortion bans dictating the ways in which a pregnancy must be terminated in cases of catastrophic obstetric emergencies, coupled with doctors’ fears of prosecution.

A recently-released study examining the detrimental effects of overturning Roe v. Wade on maternity care in Louisiana revealed that, “in cases of life-threatening pregnancy complications, such as PPROM (pre-viable preterm premature rupture of membranes), if an abortion is performed, clinicians are more frequently using hysterotomy (cesarean section or c-section), an invasive surgery used to deliver a fetus or baby through an abdominal incision, instead of dilation and evacuation (D&E), a common abortion procedure that is performed vaginally. D&E is a common abortion procedure in part because it has fewer documented complications for patients than c-section or induction.”

One emergency medicine physician told the researchers about “a situation where a colleague performed a c-section on a patient with PPROM at 20 weeks’ gestation, a condition that would not result in a viable pregnancy.” This physician recalled: “She ended up having to take this person for c-section to preserve the appearance of not doing an abortion, even though this is not a viable pregnancy. What that means is now this person has had a c-section, right? And that means that she’s at higher risk for any future pregnancies. She can no longer deliver vaginally … [T]he appropriate thing to do, again would be a D&E… without subjecting the patient to this unnecessary abdominal surgery. But my colleague didn’t feel like she could do that while remaining in compliance with the law or appearing to remain in compliance with the law.”

As the Louisiana study noted, “Having a c-section increases a patient’s risk of morbidity now and may adversely impact their health and reproductive options in the future. Pregnant people who have already had a c-section are at greater risk of complications and are much more likely to have their next pregnancy end in a c-section. Many hospitals do not permit patients to attempt a vaginal birth after cesarean (“VBAC”), and as each repeat c-section becomes more complicated, this may limit the total number of children a patient can safely have.”

Even women whose fetuses have already died are being forced to undergo cesarean operations. For example, details from a recently-filed lawsuit in Texas reveal that a Texas woman was forced to undergo a cesarean section at 19 weeks gestation to remove a dead fetus, instead of a far safer dilation and curettage procedure.

As I documented in a previous newsletter, forcing pregnant people to undergo unnecessary, risky, and physiologically transformative cesarean surgeries is a major goal of the movement against patients’ reproductive health autonomy.

Major Themes: Past and Present

Forcing pregnant people to undergo cesarean surgeries is a recurrent phenomenon within past and present movements against patients’ reproductive health autonomy. When we examine history and compare it to the modern anti-abortion, anti-rights movement, several major themes become apparent. These themes include:

an elevation of the life or soul of the embryo/fetus over the life, health, and well-being of the pregnant human being;
pregnant persons are envisioned as vessels, as opposed to human beings, which buttresses the corporal subjugation thereof;
the religious/cultural domination and colonization of the pregnant body through forced cesarean operations;
the necessary indoctrination of the public in support of forced cesarean surgery;
the ridicule, chastisement, vilification, and/or punishment of dissent; and
the use of forced surgery to advance and to fortify religious dogma regarding the personhood of embryos/fetuses, and the importance/sanctity thereof, at the expense of the personhood of pregnant human beings.

Like the disturbing post-Roe trend of forced cesarean sections, the inevitable harms of such ideologies become apparent when examining history. A review of forced cesarean operations in New Spain is illustrative. In examining forced cesareans in New Spain, the unspeakable harms that inevitably result from ideologies that are opposed to reproductive health autonomy become apparent. The following sections delve deep into this history, thus illuminating the present.

🔅As you read the following sections, consider the themes identified and listed above.

Forced Cesareans in New Spain

“Beginning in 1749, Catholic authorities throughout the Spanish empire implemented legislation requiring priests to perform cesarean operations on dead and dying women”— or at least who appeared to be dead or dying. [1] This legislation came at a time when doctors had “no surefire way to determine that [a person was] well and truly dead, rather than just unconscious.” [2] For women who were not dead, cesarean sections were almost certain death sentences. [3] Nevertheless, these surgeries were ordered to enable clerics to baptize embryos and fetuses “who would otherwise have perished in utero without receiving the sacrament [of Baptism].” [4]

“Extracting and baptizing miniscule fetuses was completely novel: never before had authorities required priests to perform surgery to save the spiritual life of an embryonic being.” [5] “Before the eighteenth century, the cesarean operation served a different purpose: for centuries, medical and religious authorities had performed surgery to save the corporal lives of women and infants. Although priests, surgeons, and midwives had baptized the infants they extracted whenever possible, spiritual salvation was not their only― or even their primary-aim. During the eighteenth century, however, Catholic authorities repurposed the surgery and insisted on the removal of small products of conception.” [6]

Hence, “Catholic theologians transformed the cesarean operation into a salvation-based surgery,” and “they did so to advance the then-radical and contentious claim that life begins shortly after fecundation. Such claims gave way to new definitions of personhood, new rituals with which to reform the baptismal sacrament, and new ideas about pregnant women's obligation to undergo surgery. The cesarean operation facilitated Catholic claims that the unborn were ensouled and endowed with spiritual personhood, and that their baptism was of utmost importance even if it entailed the death of their mother.” [7] Some theologians, in fact, “emphasized that a reproductive person's duty was to” carry and “birth the unborn, even at the cost of her own life.” [8]

During this time, theologians “advanced scientific claims about embryology, the study of fetal development. A closely related concept was ensoulment, a term referring to the time at which the unborn are considered to be in possession of their own (human and rational) soul. In Spanish-language writings, ensoulment was referred to as animación, or ‘animation.’ Ensoulment and animation were distinct from quickening, which refers to the time during which women first felt fetal movements in utero. Quickening is a key concept in the history of reproduction due to the fact that pre-modern women frequently practiced menstrual regulation (the restoration of menstruation) and abortion in the months before quickening. Eighteenth-century Catholic authorities shifted their focus from quickening to ensoulment, thereby politicizing matters of maternal and fetal life and death in new ways.” [9]

‘Sacred Embryology’

History “illuminates how religious authorities drew on Enlightenment discourses to argue that surgery, a scientific technology, could perfect the baptismal sacrament” with “[m]any of their ideas stemm[ing] from Enlightenment Catholicism.” [10] “One of the most important theologians to write about religious cesarean surgery was the Italian priest Francesco Emanuele Cangiamila (1702-63), whose book, Sacred Embryology, was first published in 1745. Over the next century, Cangiamila's 120,000-word work was translated into eight languages and distributed throughout the world, sometimes in abridged form. Many historians who have examined cesarean surgery have emphasized the importance of Cangiamila's work, which is widely recognized as one of the most important Enlightenment-era texts on fetal personhood. Sacred Embryology directly influenced the Catholic Church's position on fetal ensoulment.” [11]

Cangiamila maintained “that only surgery offered a path to spiritual regeneration for the unborn trapped in their mother's wombs. The baptismal sacrament provided another kind of deliverance, as well: that which saved souls from the devil and death. This was salvation through surgery indeed.” [12]

Since cesarean operations “rarely produced a living child, Cangiamila proposed the use of conditional baptism, under which a priest would proclaim "if you are human and capable of receiving the sacrament, I baptize you.' Conditional baptism allowed for new flexibility in definitions of life, death, and their interstices.” [13] “Even a miniscule embryo,” Cangiamila insisted, “must be baptized… even if it is no larger than a grain of barley” and “no matter how little time has elapsed since the moment of conception, although it may not show any signs of movement to indicate life." [14] If the embryo was “found within the amniotic sac, priests were to open the sac and perform yet another baptism”; when the embryo was “inseparable from the sac, the products were to be baptized via immersion in a glass of water.” [15]

Birth as Inconsequential

“A key point in Cangiamila's text was that baptized people experienced not two births (birth and regeneration) but three: ensoulment, birth, and regeneration. The first, ensoulment, was a metaphysical occurrence in the womb; this was the ‘real’ birth because it represented the child's spiritual creation: ‘In this moment,’ Cangiamila insisted, ‘God creates a body that is rational, meaning that is it well- organized enough to receive a soul.’ Less important was the physical act of birth, which simply took place when the fetus emerged into the light. This meant that women did not give birth; rather, birth was given by God and facilitated either by nature (natural birth) or science (cesarean operation). Women were passive participants, while ‘men, so vigorous and healthy, climb out of the prison of their mothers’ wombs without any assistance.’” [16]

Indoctrination and Necropolitics

Crucial to Cangiamila and other Catholic proponents of salvation through surgery “was a person's willingness to die during a cesarean operation to save the spiritual life of her unborn child. Refusing to do so, Cangiamila insisted, would constitute ‘spiritual homicide,’ which was ‘just as bad as corporal homicide.’” [17] To emphasize this point, Cangiamila declared, "Important authors have defended the idea that a woman is obligated to suffer through the cesarean operation, even when it presents a risk to her life." [18] The risks of this major surgery were, therefore, "acceptable as long as it [was] not sure to kill her, and as long as the risk might mitigate the possibility that her fruit will die unbaptized.” [19] Because no one could be 100 percent certain at the time that any given woman would die from a cesarean section, the spiritual well-being of the embryo or fetus took precedence over the woman’s life.

Thus, “priests became responsible for impressing this new social dynamic upon the women in their communities. They instructed pregnant women to confess regularly to avoid dying in a state of sin, to participate enthusiastically in pious rituals, and ‘to make a daily offering to God, by means of the Holy Virgin, that they should offer him the fruit they carry in their wombs.’ Mandates such as these did not just seek to alter women's religious practices, they sought to change how women approached childbirth.” [20] Women were instructed “to seek out a priest and receive [the] Eucharist” upon going into labor. [21] This would, according to Cangiamila, ensure “that a priest was nearby in case a cesarean operation became necessary.” [22]

As the fate of an embryo’s or fetus's soul took precedence over a woman’s life, “priests sought to execute the cesarean prior to a woman's death. And more disturbingly, some proposed that authorities should allow women to perish without medical assistance so that their children could receive baptism.” [23]

Unsurprisingly, some of Cangiamila’s contemporaries were horrified by the notion of allowing women to die by withholding medical aid. [24] Cangiamila acknowledged this in his book: "Many will voice the objection, perhaps, that it is cruel that a pregnant woman should die while deprived of the assistance that a doctor could well provide. I confess that this is cruel, yes.” [25] Cangiamila “conceded that it was ‘violent, and [therefore] impractical’ to obligate surgeons to ‘tie a woman to a table to practice the operation against her will.’ Yet [he] believed [that] it was God's will for some women to perish without medical assistance; that the ‘eternal salvation of a child is of such superior importance to the life of a mother, that we must prioritize the former over the latter’; and that women should model themselves after the sacrifices of Virgin Mary and uphold their public honor by living for their children and not themselves.” [26]

Henceforth, “the rationalization of the embryonic soul prompted a brand of necropolitics in which the church claimed the right to alter women's corporeal and spiritual subjectivities by taking their lives. Surgery ultimately facilitated a new era in the relationship between the Spanish empire, religious corporations, and their subjects.” [27]

Eliminating Dissenting Views

Also crucial to proponents of salvation through surgery was stamping out dissent. For example, when one priest of high standing in New Spain “was not convinced by the literature” that forced cesarean surgery was all it was cracked up to be, and "spurned the entire endeavor for the sole reason that it may be difficult to ascertain the true point of [a woman's] physical death," he was made the subject of public reprimand in La Gazeta de México, a newspaper publication in New Spain. [28]

Evidently, “the recalcitrant priest [had]emphasized that he was not willing to perform surgery on women while they were still alive.” [29] The uncooperative priest had even “referred to the premortem cesarean as barbarous, cruel, and inhumane.” [30] Manuel Antonio Valdés, the editor of La Gazeta, along with Father José Antonio de Alzate Ramírez admonished the priest's resistance to performing cesarean operations on women who were still alive as “scandalous,” and the pair openly “lamented that this cleric's relatively high status in the Church lent credence to his dissent.” [31]

“Underscoring that the priest's words” of dissent “presented ‘grave harm’ to the crown, Valdés and Alzate Ramírez asked the hypothetical question: ‘If you are not willing to open the womb of a woman to avoid the possibility of killing her, in what conscience, and by what rationale, are you willing to bury her?’ They even insisted that Jesus Christ would support the cesarean operation.” [32] Valdés and Alzate Ramírez claimed that Christ, “in the last throes of His agony,” would say, “From the moment you decided to bury her, you must resolve to open her.” [33] In other words, “Valdés and Alzate Ramírez ventriloquized Jesus Christ to publicly shame a priest for worrying that surgery would kill a woman who may have lived otherwise.” [34]

To further shame the priest for his “scandalous” dissent, “Alzate Ramírez and Valdés advanced a spiritualized definition of the ‘true’ death of a body. They asserted, ‘In opening the womb, there is only a slight fear regarding the death of a body. Yet, by not opening her, you will facilitate the moral death of the child's soul and its body.’ They alleged that in the first scenario-the death of a woman's body—the priest was “clinging to the fear of an imagined truth.’ The irony, of course, is that the body is real and not at all imagined. However, [Valdés and Alzate Ramírez] explained that they ‘called it an “imagined truth” because Bishops in Italy have threatened ecclesiastics with excommunication for refusing to perform the operation... as prudent and wise as they are, prelates would not obligate us to perform an operation that would require us to commit a sin.’ They continued, jesting about the priest's protestations over performing premortem surgery: ‘where is the barbarity, the cruelty, and the inhumanity in he who performs a cesarean section with his heart full of piety, love, and compassion?’” [35]

The duo continued their chastisement of the priest, “explaining that in the second scenario- ‘the moral death of the child's soul and its body’- the priest would be guilty of ‘both a homicide and a true occurrence.’ Alzate Ramírez and Valdés advanced a spiritualized definition of the ‘true’ death of a body. [Their] approach de-emphasized positive definitions of the body as a physical unit comprising flesh and organs; instead, their ‘alternative truth’ prioritized a theologized understanding of life in which corporal death was ‘imagined’- inconsequential, unproven, or unnecessary—and in which only the soul was ‘true’ because it had an eternal life and because it could be saved, and thus perfected, by a familiar, dependable, and enforceable ritual.” [36]

Valdés and Alzate Ramírez “insisted that priests were better off risking the sin of homicide” by killing women “than abandoning an infant's potential life, writing, ‘I declare, and I will repeat, that without hesitation and without fail, we must perform this service [the cesarean operation] because we are charged with responsibility for the corporal and spiritual life of these poor creatures [the unborn].... Sir, you must obey: It is better to risk the sin of homicide than to abandon a [fetal] soul.’” [37]

As regarding the unborn, the logic of salvation through surgery went thus: “first, infants were no longer eligible for limbo; second, a priestly failure to baptize the infant would be homicide, and as such it would be a severe moral crime. This is, perhaps, the most drastic way in which the Bourbon religious reforms intensified priestly responsibilities in life and death matters. Meanwhile, the corporal death of a pregnant woman was merely an ‘imagined truth,’ because the priest might kill her body, but he could not kill her soul.” [38]

As such, “the body's death was of no importance if the soul lived. This meant that, for Valdés and Alzate Ramírez, dissenting priests engaged in ‘impertinent scruples, and childish tantrums.’ It also meant that [the] Crown's new logic regarding infants' souls was intertwined with the use of coercion, and sometimes violence, onto women's bodies.” [39]

In another example of quashing dissent, legislation was passed to punish priests and family members who objected to forced cesarean surgery. “In 1772, Viceroy Bucareli of New Spain (former governor and captain general of Cuba), was the first to require parish priests to perform the operation in Spain's colonial territories. His mandate came shortly after his arrival in New Spain. In support of Bucareli's initiative, Friar Josef Manuel Rodríguez translated parts of Cangiamila's tome into Spanish and offered an introduction tailored to the Latin American context, which essentially extracted and summarized the main ideas from Cangiamila's original. Whereas Viceroy Bucareli's decree had refrained from proposing punishment for priests in New Spain who refused to perform the operation, Rodríguez disagreed. He wrote, ‘I would like to insist that this jurisdiction requires the operation's performance, and that it be practiced as soon as possible [during an obstetric emergency], under penalty of 500 pesos.’” [40]

The Catholic Church “agreed with this proposal. Archbishop Alonso Núñez de Haro y Peralta supported Rodríguez's position, declaring that any person who prevented the performance of surgery should be charged with homicide, and that the individual must also ‘be treated as a criminal.’” [41] Such objections to cesarean surgery “generally came from family members” of women presumed to be dead or dying. [42] Even concerned family members were subject to homicide charges for interfering with or objecting to cesarean operations. [44]

Surgery for the Sake of Religious Dogma

While Cangiamila asserted that Catholic authorities' overarching motivation for performing surgery on women who were assumed to be dead or drying “was to save the souls of unfortunate infants and convert them into angels in heaven,” it’s important to note that “the scientific discussions in Sacred Embryology implied that proponents of salvation through surgery wanted priests to produce scientific research that would bolster Catholic-inspired embryological authority.” [43] Thus, women were forced to undergo cesarean surgeries, in part, to produce scientific “evidence” that supported Catholic dogma regarding embryonic ensoulment and personhood.

The Past Becomes the Present

Today, thanks to the Dobbs decision overturning Roe V. Wade, the past has become the present as the anti-abortion, anti-reproductive health autonomy movement has now seized power over pregnant patients' corporeal existences; a movement which has put this power into action through the religious and cultural colonization of pregnant bodies through forced cesarean surgeries.

Once again, a movement against reproductive health autonomy is actively stripping “women of their humanity and reimagin[ing] them as vessels.” [45] “A vessel is not a person. A vessel has no rights. A vessel is only useful as long as it is functional. When it is no longer fit for purpose, it is cast aside; there are plenty more where it came from.” [46] Most importantly, a vessel has no other purpose than to contain something of higher value within it - the embryo, the fetus.

As such, we again see pregnant persons being stripped of their humanity and of their intrinsic value— their lives, health, and well-being tossed aside as inconsequential, as ready-made sacrifices to “the unborn.”

Any layman can quickly peruse the various media outlets dedicated to opposing reproductive health autonomy will find: the elevation of the life of the embryo/fetus over the life, health, and well-being of the pregnant human being; the promotion of religious/cultural/ideological domination and colonization of the pregnant body through forced cesarean operations; propaganda pieces published for the purpose of indoctrinating the public in support of forced cesarean surgery; the ridicule, chastisement, and vilification of dissent; and the promotion of forced cesarean surgery as a means to advance and to fortify dogma regarding the personhood of embryos/fetuses, and the importance/sanctity thereof.

“The fetal container image of women is evident in cases… in which pregnant women are forced to undergo unwanted surgery on behalf of their fetuses, operations which physicians agree increase the risk of the woman's death. These cases sharply diverge from the general legal doctrine that individuals are not required to undergo any risk of physical harm to help another.” [47] Yet, history is indeed now repeating itself, with pregnant human beings increasingly, forcibly cut open to benefit not only non-viable fetuses, but dead fetuses as well.

What were once “new ideas about pregnant women's obligation to undergo surgery” have now been revivified through legislation and threats of prosecution. [48] And this is just the beginning.

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