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Tuesday, June 01, 2004 - Page updated at 12:00 A.M.

Woman describes self-Caesarean

By Lisa J. Adams
The Associated Press

Ines Ramirez Perez holds her son Orlando, 4. She performed a successful Caesarean section on herself in March 2000 to deliver Orlando.
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RIO TALEA, Mexico — Alone in her one-room cabin high in the mountains of southern Mexico, Ines Ramirez Perez felt the pounding pains of a child insistent on entering the world.

Three years earlier, she had given birth to a dead baby girl. As her labor intensified, so did her concern for this unborn child.

The sun had set hours earlier. The nearest clinic was more than 50 miles away over rough terrain and inhospitable roads, and her husband, her only assistant during a half-dozen previous births, was drinking at a cantina. She had no phone and neither did the cantina.

So at midnight, after 12 hours of constant pain, the petite, 40-year-old mother of six sat down on a low wooden bench. She took several gulps from a bottle of rubbing alcohol, grabbed the 6-inch knife she used for butchering animals and pointed it at her belly.

And then she began to cut.

Under the light of a single dim bulb, Ramirez sawed through skin, fat and muscle before reaching inside her uterus and pulling out her baby boy. She says she cut his umbilical cord with a pair of scissors, then passed out.

That was March 5, 2000. Today, the baby she delivered, Orlando Ruiz Ramirez, is a rambunctious, playful 4-year-old.

And, because of an article in the March issue of the International Journal of Gynecology and Obstetrics, Ines Ramirez is recognized internationally as a modern miracle: the only woman known to have performed a successful Caesarean section on herself.

In an interview in front of her isolated, wood-plank home, she described her experience in halting Spanish, heavily accented by her native Zapotec language.

"I couldn't stand the pain anymore," she said. "And if my baby was going to die, then I decided I would have to die, too. But if he was going to grow up, I was going to see him grow up, and I was going to be with my child. I thought that God would save both our lives."

Though there were no witnesses available to confirm her account, the two obstetricians who examined her 12 hours after the birth are wholly convinced. And no one in her village challenges her story.
"We were astonished," Dr. Honorio Galvan said in an interview at the San Pablo Huixtepec hospital south of Oaxaca City, where Ramirez was taken.

"I couldn't believe that someone without anesthesia could operate on herself and still be alive. To me, it is incredible."

Doctors rushed the mother and child into the operating room. Galvan took photographs while his colleague, Dr. Jesus Guzman, opened Ramirez up to find that her uterus had returned to its normal size and stopped bleeding and that she showed no signs of infection. Galvan doesn't know if Ramirez tried to sterilize the knife before she operated.

Galvan acknowledges that there may be skeptics, but he has heard Ramirez give her account several times, "always with the same details."

Galvan also relied on the testimony of the village health assistant, Leon Cruz, who initially was summoned to help Ramirez and who described in detail what he saw when he arrived. It was not possible during a recent visit to contact Cruz in Rio Talea, a town of about 500 people where there is only one phone.

"From what we saw, it was evident this surgery was not done by anyone with medical knowledge," Galvan said. "There is no doctor or healer in the village, and it is highly doubtful that anyone would have been able to do this to her. If they had, it is such a small town, the word would have spread quickly, and we would have known. A whole village can't lie. What would they have to gain?"

Two town residents who were asked for directions to Ramirez's house referred to her as the woman who had given herself a Caesarean section.

A diminutive woman who stands about 5 feet 2, Ramirez displayed the 6-inch knife she used to perform the operation. As she spoke, 4-year-old Orlando hugged her legs and flashed a white, baby-toothed grin.

Ramirez believes that she operated on herself for about an hour before extricating her child and then fainting. When she regained consciousness, she wrapped a sweater around her bleeding abdomen and asked her 6-year-old son, Benito, to run for help.

Several hours later, Cruz and a second health worker — whose combined medical knowledge was limited to handing out medicines — found Ramirez alert and lying beside her live baby.

Cruz sewed her 7-inch incision together with a regular needle and thread. A professional C-section incision measures about 4 inches, Galvan said.

The two men lifted mother and child onto a thin straw mat, lugged them up vertical rock-strewn horse paths to the town's only road, and drove them to the clinic 2-1/2 hours away.

Ramirez was given basic emergency medical attention before she was transferred with Orlando in the backs of two different pickups. They bounced for eight hours over winding, hole-riddled dirt roads before making it to the hospital in San Pablo Huixtepec, about 240 miles southeast of Mexico City.

"When she arrived, she was conscious, with no signs of shock, perfectly fine," Galvan said. "Considering what she had put her body through, she at least should have been unconscious from the blood loss and the pain."

Ramirez left the hospital after four days, and today her scar is almost invisible.

By sitting forward in the traditional Indian birthing position instead of lying down, Ramirez unknowingly ensured that her uterus was directly under the skin and that she would not cut her intestines. Her incision was considerably higher than the one a doctor would make, and Galvan believes she was very lucky she didn't do serious damage.

Asked what guided her in the operation, she replied, "I had slaughtered chickens and other animals."

That she survived so much pain and developed no infections "may tell us that there are populations with an innate resistance so strong that they can tolerate what urban groups can't," Galvan said. "It is an incredible response of the human body."

Ramirez, who had her tubes tied to prevent additional pregnancies, says she would never recommend her desperate action to other women.

"It was very painful, and people could die," she said.

Copyright © 2004 The Seattle Times Company

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