General anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. From May 2017 to August 2018, 3115 consenting patients receiving general anaesthesia for obstetric surgery in 72 hospitals in England were recruited to the study. Patients received three repetitions of standardised questioning over 30 days, with responses indicating memories during general anaesthesia that were verified using interviews and record interrogation. A total of 12 patients had certain/ probable or possible awareness, an incidence of 1 in 256 (95%CI 149-500) for all obstetric surgery. The incidence was 1 in 212 (95%CI 122-417) for caesarean section surgery. Distressing experiences were reported by seven (58.3%) patients, paralysis by five (41.7%) and paralysis with pain by two (16.7%). Accidental awareness occurred during induction and emergence in nine (75%) of the patients who reported awareness. Factors associated with accidental awareness during general anaesthesia were: high BMI (25-30 kg.m -2 ); low BMI (<18.5 kg.m -2 ); out-of-hours surgery; and use of ketamine or thiopental for induction. Standardised psychological impact scores at 30 days were significantly higher in awareness patients (median (IQR [range]) 15 (2.7-52.0 [2-56]) than in patients without awareness 3 (1-9 [0-64]), p = 0.010. Four patients had a provisional diagnosis of post-traumatic stress disorder. We conclude that direct postoperative questioning reveals high rates of accidental awareness during general anaesthesia for obstetric surgery, which has implications for anaesthetic practice, consent and follow-up.

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In 1522, Marie Quatrelivres, accused of adultery by her husband and found guilty, was condemned to be beaten with sticks on three Fridays and afterwards enclosed in a convent. The court allotted her husband 2 years to decide if he wanted to take her back. If he did not choose to reconcile with her, she was to be enclosed for life and lose all of her property. So wrote eminent jurist Jean Papon (1505–1590) in his collection of notable cases heard before the royal courts of France. Papon described a handful of other sixteenth century adultery cases similarly decided, and then cited a contemporary and fellow eminent jurist, Nicolas Bohier, as having stated that another common punishment for adultery in France was to cut off an adulterous woman's hair, tear her clothes, and parade her in shame throughout the town or city in which she lived.

Georges Duby described medieval, Catholic marriage as the product of two competing groups of people, clergy and nobles, each with their own conflicting ideas of marriage. Clergy wanted indissoluble and monogamous marriage, while nobles wanted to divorce and remarry at will. This widely influential idea of marriage is extremely misleading. Clergy and nobles did not comprise distinct and competing camps, nor did they have opposing ideas of marriage. Instead, together, as members of the powerful families that dominated medieval Europe, these men and women created and implemented Christian marriage as monogamous and indissoluble. Using as a case study the scandalous marriage of a twelfth-century abbess, this article will demonstrate the flaws in Duby's argument, and also we can learn about medieval marriage, and medieval society more broadly, by applying this new approach.

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