A caesarean section in 18th-century Ireland

Irish midwife Mary Donally saved a woman's life by performing a c-section in 1738.

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Alice O’Neal was the 33-year-old wife of a poor farmer in Charlemont, Armagh. In January 1738 (1739 in the Gregorian calendar), she went into labour.

She had older children, but this time it wasn’t to be. Mrs O’Neal had the support and assistance of other women, but the baby could not be delivered. At one point a leg became visible in the vagina, suggesting that it was a footling breech presentation. After three days, any hope for the child’s survival faded.

Photo by Tim Mossholder on Unsplash

This was sadly not an uncommon situation and Mrs O’Neal’s life hung in the balance too. She continued in labour for a further nine days, and one can only imagine the physical and psychological agony she endured.

A local midwife, Mary Donally, was considered ‘eminent among the common People for extracting dead Births.’ She attended Mrs O’Neal on the twelfth day of labour and tried to deliver the baby vaginally, but quickly realised that this was not going to happen. The only chance of saving Mrs O’Neal’s life was to perform a caesarean section.

Donally used a razor to make a vertical incision of about six inches in the abdominal wall and the uterus, and extracted the child and afterbirth, bringing an end to the acute part of Mrs O’Neal’s ordeal. She held the edges of the wound together while an attendant hot-footed it a mile to obtain some silk and tailor’s needles, with which Donally sewed up the incision. This is the first known caesarean section, resulting in survival of the mother, to take place in Ireland.¹

It is possible, of course, that Mary Donally’s excellent reputation for resolving similar situations meant that she had used this method before. She was reportedly illiterate, so the case is only known now because it was written up by surgeon Duncan Stewart of Dungannon, who submitted it to Medical Essays and Observations, published by the Edinburgh Philosophical Society in 1742.²

Stewart had visited Mrs O’Neal a few days after the operation – mainly for curiosity’s sake rather than to offer surgical advice – and found her doing well. He learnt that Mary Donally had used egg whites to dress the stitched wound, and later applied salves made to her own recipes.

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Almost a month later, Mrs O’Neal walked a mile to another farm, where Mr Stewart was in attendance. Her wound was healing well but she had difficulties with a large lump on her abdomen – presumably a hernia. Stewart advised her to use a bandage to support the side of her belly and to drink decoctions of vulnerary plants – herbs such as plantain leaf and marigold that are reputed to promote healing and reduce inflammation. Stewart’s account ended with the happy news that Mrs O’Neal had:

…enjoyed very good Health ever since, manages her Family-affairs, and has frequently walked to Market in this Town, which is six miles Distance from her own House.

Another Armagh physician, Dr Gabriel King, mentioned the operation in the same volume of Medical Essays and Observations. He does not name either the patient or the midwife but, as the editor says in a footnote, the location and date point to it being the same case. King, too, had visited Mrs O’Neal in the aftermath of the operation and ‘drew out the Needles which the Midwife had left to keep the Lips of the Wound together.’ King perceived the abdominal lump, which ‘increased and at last broke and run considerably.’ His update is less cheery than Duncan Stewart’s, as he says:

This Woman is capable of doing something for her Family, with the Assistance of a large Bandage, which keeps in her Intestines.

Mrs O’Neal presumably experienced long-term issues with her hernia but there was not much she could do other than be stoical about it.

Dr Gabriel King gives another case of an unusual birth at Augher, County Tyrone, a few years before Mrs O’Neal’s caesarean. In 1726, a woman (whose name is not given) was sickly throughout the nine months of her pregnancy, but when labour pains started she did not give birth and her midwives concluded that there was no child. The swelling of her abdomen subsided and she carried on with her life, albeit suffering from regular sickness. Six years later (1732), she conceived again, but at eight months of pregnancy:

…she felt extraordinary Pain in the anterior Part of her Belly, and in few Days a small Ulcer broke out below her Navel; in some days more the Elbow of a Child appeared at this Orifice; she brought out the whole arm with her Bodkin and got it cut off.

The woman remained in great misery until a relative had the courage to pull out the rest of the child’s body. The wound closed up over the next few weeks, although the woman was still very ill. Gabriel King visited her and found that an area near the wound felt as though it contained a sac of small bones. The woman also showed him several decayed foetal bones that she had excreted via her bowels.

Although King did not expect her to survive, she did. He shortly afterwards met her walking in the fields near her home. She was still alive seven years later, ‘her Viscera often falling out at the old wound.’ King believed that there had been two foetuses – both of them extrauterine, with the one from the 1726 pregnancy having been partially reabsorbed.

These cases are not pleasant to read but for me they highlight the remarkable toughness of the human body – specifically, in this instance, women’s bodies. For the rest of their lives, Mrs O’Neal and the woman from Augher probably suffered pain and discomfort, perhaps shame at embarrassing symptoms, and a constant reminder of the children they had lost. Yet they had to carry on – going to market, walking in the fields, caring for their families. And they are just two who happened to be written about by curious doctors.

Their stories, though harrowing, represent the resilience and strength of countless women throughout history, who met – and continue to meet – unimaginable hardships with a fortitude that is often underestimated.

1. The location is in present-day Northern Ireland.

2. Medical essays and observations, Volume 5 (Part 1), 1742.