In low- and middle-income nations, maternal fatalities after caesarean sections are 100 times higher than in high-income ones, with up to a third of all newborns dying, according to a review published in The Lancet. The review titled 12 million pregnancies has considered 196 studies from 67 low- and middle-income countries.
From 1990 to 2017, a quarter of all women who died while giving birth in low- and middle-income nations underwent a caesarean section, according to data. It also revealed that women in low- and middle-income countries who had an emergency caesarean section were twice as likely to die than those who had an elective caesarean section, and when the caesarean section was performed in advanced labour with full cervical dilation (second stage).
Causes of Poor Outcomes of Caesarean section
Inappropriate caesarean sections – ‘too many, too soon’ or ‘too little, too late’
Every year, 300,000 women, 99 percent of them are from low- and middle-income nations, die during childbirth. For a healthy childbirth, timely access to a caesarean section is vital, but ‘too little, too late,’ or ‘too many, too fast,’ are part of the issue, not the solution. While many women in need of caesarean sections still do not have access to them, especially in low-resource countries, many more do so unnecessarily for reasons that are not medically warranted.
Unsafe practices in performing the procedure
Poor hygiene and other unsafe practices while performing the caesarean procedure is another cause that can prove fatal to the patient. It increases a chance of infection which can cause immediate death in certain cases and plethora of health issues in the life of patients in others.
Caesarean birth is linked to short- and long-term hazards that can last for years after delivery, affecting women’s and children’s health as well as future pregnancies. Women who have inadequate access to comprehensive obstetric care are at higher risk. According to the World Health Organization, caesarean sections should only be performed when medically required.
Sub-standard care in labour not ending in vaginal birth
In low- and middle-income countries, care quality is especially important. To help improve baby outcomes, researchers are urging policymakers and health care providers to promote appropriate use of the operation, enhance access to excellent surgery and intrapartum care, and improve neonatal resuscitation services.
Furthermore, attitudes toward caesarean sections and the use of vacuum or forceps, marginalisation of midwives, dysfunctional teamwork, a culture of blame and medico-legal concerns, influence of family members and communities in decision-making, poor communication skills between women and healthcare providers and among clinicians, and the inability to determine why caesarean sections are performed exacerbate the problem.
Initiative by University of Birmingham
Experts from the University of Birmingham are pioneering a new initiative to help save the lives of thousands of women in developing countries who give birth through Caesarean section. The C-Safe project, which is funded by the Medical Research Council (MRC) and will first focus on India and Tanzania, will target healthcare professionals, pregnant women, and health systems.
Backed by £2.2 million, the five-year initiative aims to lower the risk of post-natal death – for both mothers and newborns – as well as long-term health issues that influence women’s quality of life and capacity to safely have additional children.
Shakila Thangaratinam, Professor of Maternal and Perinatal Health at the University of Birmingham, and co-Director of the WHO Collaborating Centre for Global Women’s Health commented: “Many issues contribute to the high burden of unsafe and unnecessary Caesarean sections in LMICs. There is no single solution to this complex problem, and we need a concerted strategy to improve the safety of such procedures and ensure they are only done when needed.
“We will work with women, their support networks, and healthcare providers to develop interventions that reduce the risk of Caesarean sections in LMICs – ultimately helping to save thousands of lives.
“C-Safe will ensure Caesarean sections are done for the right reasons, as well as improving their safety and promoting safe, respectful care in labour resulting in vaginal births, including safe delivery with instruments.”
In four hospitals in India and Tanzania, the intervention will use a thorough training programme for health workers, as well as empowering local opinion leaders and mothers, to cover 30,000 births in total. The five-year plan will promote safe Caesarean sections by enhancing operating room practices and decreasing the frequency of needless procedures by promoting vaginal deliveries.
The research team includes doctors, midwives, experts in study design, patient and public involvement groups, trainers and policymakers. They are supported by members of the World Health Organization, UNICEF, Jhpiego, professional associations and ELLY Charity.
