Surgery & Salvation: The Roots of Reproductive Injustice in Mexico , 1770–1940, by Elizabeth O’Brien

In May 2025, the story of thirty-year-old Adriana Smith, a Black registered nurse, drew the attention of news outlets across the United States. Smith was tragically declared brain dead at Emory University Hospital in Atlanta after suffering multiple blood clots in her brain. She was then forced to carry her unborn child for four months, a decision made by her doctors and not her family. Her doctors determined that they needed to keep her alive until they could deliver her child via cesarean section to comply with Georgia’s heartbeat law, which bans abortion after about six weeks of pregnancy.1 Who determines maternal and fetal life policies and on what authority? When do surgeons challenge or comply with these laws? When is the unborn product of conception considered a person, ensouled, or alive and what role do spiritual and medical authorities play in these debates? These are the questions at the heart of Elizabeth O’Brien’s Surgery and Salvation, a book that holds profound relevance for understanding contemporary issues tied to reproductive autonomy, obstetric violence, religion, and authority.Grounded in Mexico, O’Brien offers a harrowing history of obstetric surgery from 1745 to the 1930s. The book argues that modern claims about fetal personhood emerged from the use of surgical force against marginalized and racialized women in the mid- eighteenth century. Using obstetric interventions, medical and religious authorities criminalized women’s behavior, weaponized surgery, and sought to save fetal souls at all costs, even at the expense of their mothers. The author demonstrates that colonial and postcolonial Mexico served as an important site of surgical practice that is key for understanding how “medical ideologies come to reify, or contest, multiple forms of marginalization and exclusion” (8).Divided into five parts, the book traces how authorities envisioned obstetric interventions as a means for moral salvation and biological regeneration over a longue durée. The book begins with the religious use of the cesarean section in colonial Mexico, where priests were required to perform the surgery on dead and dying women to extract and baptize even the most miniscule fetuses. Catholic authorities radically claimed that the unborn were ensouled and had spiritual personhood, so the cesarean section transformed into a dual attempt to save embryonic souls and the broader Spanish colony under the rubric of Enlightenment science. Using theological, mission, and baptismal records, Part I demonstrates that missionaries used the threat of violent surgery to coercively Christianize Indigenous peoples during the late colonial period.Following Mexico’s independence, the increasingly secular state continued to use surgery, specifically therapeutic abortions, to enact moral salvation by alleviating hysteria. Part II traces the intertwined medicalization and secularization of obstetric care that relegated female medical authorities to the margins. Most pertinent to nursing history, this section centers the Hermanas de la Caridad (Sisters of Charity), a volunteer religious association whose members worked as apothecaries, nurses, and administrative heads in Mexico’s hospitals beginning in the mid-1840s. O’Brien shows that by the 1860s, male physicians viewed these highly skilled women as irrational, hysterical, and “problematic and capricious administrators” who were generally incapable of practicing scientific medicine (93). Male physicians confined them to labor only as nurses “who acquiesced to a patriarchal medical agenda” in the years leading to their expulsion from Mexico in 1874 (104). This history reveals the gendered process through which nursing labor became subordinate in patriarchal clinical spaces, a process which occurred ten years earlier in Mexico than France.By the end of the nineteenth century, the Hermanas’ evangelizing style of soothing ailments had been replaced by male physicians and the Sanitary Police who detained women and forcibly treated them in hospitals. In Part III, O’Brien details the deeply unsettling ways that surgeons enacted harm in the Hospital Morelos in Mexico City, a space used to imprison, inspect, and experiment on women’s bodies while policing their sexual behavior. In Part IV, the author makes an important contribution to the history of eugenics by arguing that women were targeted for coercive sterilization in Mexico at rates much higher than previously thought. Using hospital records and medical students’ theses, this section shows how doctors subverted the law to perform permanent and temporary sterilizations “frequently, clandestinely, and as a kind of open secret” (191). Doctors reserved temporary sterilizations, including a procedure original to Mexico called vaginal bifurcation, for light-skinned elite women, which is just one example of how racism and class-based prejudices became embedded in surgical decision-making and practice in the early twentieth century.In the final section, O’Brien examines the systematic complaints that women made against Mexico City’s General Hospital in the 1930s. Diverging from the intellectual and clinical histories of earlier chapters, Part V reveals the everyday experiences of women who suffered collectively in the underfunded and overwhelmed hospital. They often complained about nurses’ negligence, which speaks to an embattled hospital environment with poor working conditions, one in which “an authoritarian clinical elite . . . viewed patients as an expendable resource” (254). This section invites further research on nursing labor in Mexico in the 1930s and the ways in which women articulated rights-based claims to health resources following the revolution.Surgery and Salvation is a thought-provoking and much needed addition to the history of surgery, reproduction, eugenics, nursing, and religion. Where possible, it carefully and attentively considers individual circumstance to understand how women experienced and contested increasingly patriarchal medical authority and obstetric violence. The book is foundational for understanding the ideas, policies, and clinical practice that shaped scientific and religious debates surrounding pregnancy and abortion. Inspired by studies in reproductive justice and anti-Black racism, the book will certainly encourage future research on the history of surgery in Latin America, especially as we seek to better understand how racialized women experienced and resisted surgical practice and experimentation on their bodies over the past three centuries.