In the mid-nineteenth century surgery was a rapidly evolving field. Those who practised it successfully found growing prestige and authority in both the medical world and among the wider public. ‘Diseases of women’ were a central component to the profession’s changing identity. Theories and practices of surgery and obstetrics blended to form a suite of increasingly invasive procedures to treat conditions of the female reproductive system. In the middle decades of the century the justifiability of performing the caesarean operation began to be widely discussed. Some doctors turned to the procedure in desperate cases of obstructed labour as an alternative to the craniotomy procedure. This talk seeks to illuminate the ethical dialogue which emerged around its practice at this time. Its discussion was underpinned by changes in print culture and attendant notions of accountability, assertions about the national identity of medical practice, theological discourse, perceptions of the ‘deformed’ pregnant body and its risks, and the fraught meaning of ‘necessity’ in guiding whether to operate. Ultimately what emerged was a debate fuelled by cultural anxieties around the relative value of maternal and foetal life, female autonomy in reproductive choice and the extent of doctors’ authority to choose when to operate.