University of Birmingham undertakes project to prevent caesarean section deaths in India and Tanzania

The reasons for poor outcomes after caesarean section in low-and middle-income nations include unsafe practices in performing the procedure and sub-standard care in labour not ending in vaginal birth - leading to complicated caesarean sections in advanced labour, according to the press release.

A research team at the University of Birmingham in the UK is spearheading a pilot project aimed at helping save lives of women giving birth by caesarean section in developing countries like India and Tanzania. 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. Backed by the £2.2 million Medical Research Council funding, the C-Safe project will – target healthcare professionals, pregnant women and health systems – initially focusing on India and Tanzania, a press release issued by the University of Birmingham said on Friday. The five-year programme aims to reduce the risk of post-natal death – for both mothers and babies – as well as life-long health problems that affect women's quality of life and ability to safely have more children, it said. "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," 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 said. "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," she explained. The intervention will use a comprehensive training programme for health workers, whilst empowering local opinion leaders and mothers in four hospitals each in India and Tanzania – covering 30,000 births in total, the release stated. 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 Lancet. The reasons for poor outcomes after caesarean section in low-and middle-income nations include unsafe practices in performing the procedure and sub-standard care in labour not ending in vaginal birth - leading to complicated caesarean sections in advanced labour, according to the press release. Additionally, attitudes towards caesarean section and 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 amongst clinicians, and inability to determine why caesarean sections are performed worsen the problem, it elaborated. The five-year programme will promote safe caesarean section through improving procedures around operations and reducing the number of unnecessary procedures by increasing vaginal births. The research team includes doctors, midwives, experts in study design, patient and public involvement groups, trainers and policymakers, it added.

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