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OUR PEOPLE, OUR MISSION Global Health eMagazine June 2023 Women’s Health Education Section Editor: Sarah Cordisco, RN Staff Nurse at the University of Vermont Cesarean Sections Written by Sarah Cordisco, RN Perspective Global Health Academy Highlights Reflections Welcome Global Local Hispanic and Latinx Communities Voices of Ugandan Students Global Health Mental Health Art to Rwmind Us of Who We Can Be Our Beautiful Planet Innovation and Technology Across the globe, the maternal mortality rate is decreasing, yet remains extremely high. In 2020, about 287,000 women died during and after pregnancy and childbirth (WHO), most of which could have been prevented. An analysis published in The Lancet, found that maternal deaths in LMIC are 100x higher than those in high income countries, and a 1/3rd of all babies in some regions do not survive cesarean section. The use of cesarean sections has continued to rise globally and now they account for more than 1 in 5 childbirths (or 21% of all births). By 2030, this number is expected to reach nearly a third or 29% of all births (WHO, 2021). In LMIC countries, about 8% of women give birth via cesarean section, which indicates a lack of access to this type of surgery compared to MHIC countries where rates are as high as 43% of all births. Maternal death rates may be high in LMIC where the cesarean section rate is low due to lack of access to resources and care, and lack of surgical intervention in a timely manner. Cesarean sections are often lifesaving procedures when vaginal delivery would pose great risks, but it is important that health care systems are doing these operations appropriately and safely with the proper post-op care; as well as, having the proper indications for this procedure. Cesarean sections are typically indicated during labor dystocia, abnormal or intermediate fetal heart rate tracing, fetal malpresentation, multiple gestation or suspected fetal macrosomia (Safe Prevention of the Primary Cesarean Delivery, 2014.). Some women may also choose to have a cesarean section due to their own medical history (such as thrombocytopenia), having previous traumatic births, or in cases where a vaginal birth is unwanted. While this procedure may be elective or emergent, it is important for women to understand the risks and benefits, as well as, the outcomes, specifically in the realm of maternal and natal deaths. In LMIC the risk of death while undergoing a cesarean section was 7.6 per 1000 procedures, the highest burden being in Sub-Saharan Africa. The overall rate of stillbirths in babies born via C-section was about 56 per 1000, with the highest rates in sub-Saharan African (82.5/1000). The risk of infant death (stillbirths Nursing Division Women’s Health Education Among the Letters Announcements Article of the Month Video of the Month Congratulations Phoro News Calendar of Events Resources or deaths within the first week of life) is about 84 per 1000 C-sections, with the highest rates in the Middle East and North Africa (Study, 2019). Women undergoing emergency C-sections are also twice as likely to die compared to those who had elected to have a C-section, and this risk increased 12x when the surgery was performed during the second stage of labor. Similarly, the risk of neonatal deaths increased 5x with emergency C-sections compared to 32
OUR PEOPLE, OUR MISSION Global Health eMagazine June 2023 elective and 10x when the procedure happened during the second stage of labor, compared to the first. About a third of all maternal deaths associated with a cesarean section occur due to postpartum hemorrhage (32%), pre-eclampsia (19%), sepsis (22%) and anesthesia-related causes (14%) (Study, 2019). Through the research on the outcomes of this procedure, the gaps in resources, skill and knowledge about C-sections are seen and highlight the need for more training and education. There is a high need for interventions and implementation strategies to be put in place to ensure that this life saving procedure is done correctly and has the appropriate health outcomes. References Caesarean section rates continue to rise, amid growing inequalities in access. (n.d.). Retrieved April 24, 2023, from https://www.who.int/news/item/16-06-2021-caesarean-section-ratescontinue-to-rise-amid-growing-inequalities-in-access Maternal mortality. (n.d.). Retrieved April 24, 2023, from https://www.who.int/news room/factsheets/detail/maternal-mortality Perspective Global Health Academy Highlights Reflections Welcome Study: Maternal deaths from cesarean sections far higher in low and middle-income countries. (2019, March 29). News-Medical.Net. https://www.newsmedical.net/news/20190329/Study- Maternal-deaths-from-cesarean-sections-farhigher-in-low-and-middle-income-countries.aspx Study: Maternal deaths from cesarean sections far higher in low and middle-income countries. (2019, March 29). News-Medical.Net. https://www.news-medical.net/news/20190329/Study- Maternal-deaths-from-cesarean-sections-far-higher-in-low-and-middle-income-countries. aspx Safe Prevention of the Primary Cesarean Delivery. (2014). Retrieved April 24, 2023, from https:// www.acog.org/en/clinical/clinical-guidance/obstetric-careconsensus/articles/2014/03/safeprevention-of-the-primary-cesarean-delivery Global Local Hispanic and Latinx Communities Voices of Ugandan Students Global Health Mental Health Art to Rwmind Us of Who We Can Be Our Beautiful Planet Innovation and Technology Nursing Division Women’s Health Education Among the Letters Announcements Article of the Month Video of the Month Congratulations Phoro News Calendar of Events Nantucket (Michelle Connor) Resources 33
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