Health & Fitness

How Kenya can lower deaths tied to C-section deliveries

CSection

:Early identification of those at risk of bleeding is one of the ways of cutting the deaths. PHOTO | COURTESY

Summary

  • Pregnancy is a source of joy for many families.
  • And most people wait eagerly for the nine-month pregnancy duration to end so they can hold their babies in their arms.
  • During delivery, most women give birth naturally.
  • However, Caesarean sections (C-section) or surgical delivery is recommended for mothers considered to be at risk of certain complications that may harm them and their babies if they undergo vaginal births.

Pregnancy is a source of joy for many families. And most people wait eagerly for the nine-month pregnancy duration to end so they can hold their babies in their arms.

During delivery, most women give birth naturally. However, Caesarean sections (C-section) or surgical delivery is recommended for mothers considered to be at risk of certain complications that may harm them and their babies if they undergo vaginal births.

These include mothers with big babies, women carrying babies that are not in ideal positions, mothers with placental problems or those carrying more than one baby.

Surgical delivery can also be a safer option for mothers with certain medical conditions like heart disease, high blood pressure, kidney disease and diabetes that can make vaginal delivery dangerously stressful.

For women in Africa, research shows that they are highly likely to die from C-sections compared to mothers in high-income nations such as the UK as well as the US.

A study published in the Lancet Global Health Journal shows maternal deaths following C-sections are 50 times higher in Africa compared to high-income countries.

The study titled Maternal and Neonatal Outcomes after Caesarean delivery in the African Surgical Outcomes Study: a 7-day Prospective Observational Cohort Study involved more than 3,500 mothers from 22 African countries, including Kenya.

Based on the findings, the most common contributors to the maternal deaths were severe bleeding before, during or after surgery.

Others were a raptured uterus, placental problems as well as anaesthesia complications.

The study also found that the neonatal mortality rate (death of children in the first 28 days of life) after C-section in Africa was at a high of 44 deaths per 1,000 deliveries. This is close to double the global average rate of 19 per 1,000 births as recorded in the study.

According to the researchers, the findings highlight the urgent need for improved safety of surgical deliveries in African countries like Kenya.

“Improvement of C-section surgical outcomes could substantially improve both maternal and neonatal mortality, which would lead to key global health gains,” said Bruce Biccard, the lead author of the study from the University of Cape Town in South Africa.

To improve the safety of C-sections for both the mother and her baby, the study recommends early identification of women at risk of bleeding as well as the use of drugs that prevent excessive bleeding (post-partum haemorrhage) after birth, especially where the availability of blood is low.

“We should consider novel methods of training of non-physician anaesthetists, including online support and mobile-based applications,” he said.

Dr Marleen Temmerman, a gynaecologist and head of the Centre of Excellence in Women and Child Health at Aga Khan University Hospital in Nairobi, notes that a key step to averting maternal deaths is to ensure that mothers are monitored throughout their pregnancy.

This will enable doctors to detect complications (such as eclampsia or high blood pressure during pregnancy) early and address them before they harm.

The condition is a major cause of death among affected women during delivery or following a C-section. Yet in most cases, it can be treated and managed with recommended medication before it gets out of hand.

Pregnancy check-ups also enable doctors to schedule surgical deliveries upon identifying need.

This averts unnecessary cases of emergency CSs that usually increase the risk of death, following the procedure among affected mothers. Through ultrasounds, for example, doctors can tell if babies are in breech position (taking a bottom-down position instead of the recommended head-down that eases delivery).

Such cases usually require C-sections, which can be scheduled before they harm.

Based on the Ministry of Health (MOH) guidelines, expectant women should go for at least four antenatal care (ANC) visits or pregnancy check-ups before delivery.

Yet, government statistics from the Kenya Demographic and Health Survey (KDHS) show that only 58 percent of expectant women meet those targets.

"We should continue creating awareness and empowering mothers to understand the significant role that the check-ups play in promoting healthy pregnancies and preventing maternal deaths," said Dr Temmerman.

According to her, access to quality healthcare services during delivery is also important.

"We need to ensure that hospitals are well equipped with skilled health workers on standby such as gynaecologists that can safely conduct C-sections when the need arises," she noted.

Since not all health facilities have the capacity to perform C-sections, health experts note that appropriate referral systems should be put in place to ensure mothers in need of the procedure can be transferred to high-level hospitals in times of emergency.