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Training Nurses to Perform Cesareans Could Save Lives Across Africa

In many African countries, women who are in need of C-sections aren’t able to get them, causing some to die in labor. Researchers have found that enlisting nurses to carry out the procedure could save lives across the continent.

Written by Rumbi Chakamba Published on Read time Approx. 3 minutes
Due to the lack of surgeons in Mozambique, midwives have been taught to perform emergency cesarians.AFP/John Wessels

When 27-year-old Chisom Anekwe died during childbirth in April, her story reverberated across Nigeria, leading many to question the safety and efficiency of the country’s healthcare system. In particular, her death highlighted how difficult it is for many women to get necessary – and sometimes lifesaving – cesarean sections.

Her husband Valentine told a reporter that his heavily pregnant wife had been admitted to hospital with high blood pressure four days before she died. Doctors told Valentine that this made a natural birth risky, so they planned to perform a C-section. But the gynecologist who was supposed to perform the procedure was unavailable, and Chisom went into labor.

When the gynecologist eventually arrived, Valentine said, the baby had already died. He asked doctors to go ahead with the C-section to remove the stillborn child, and paid for the procedure. Instead, hospital staff induced Chisom, who died from complications soon after.

Maple Dappa, a family friend and former colleague of Chisom’s, says he believes that if the hospital had carried out the procedure before or during the early stages of Chisom’s labor, both she and her baby would still be alive.

“Things were taken for granted, forgetting that it’s a millisecond between life and death,” he said.

Dappa and some of Chisom’s other friends have started the social media campaigns #justice4chisom and #savethenextvictim to alert women to Chisom’s story, inform them of their rights when it comes to healthcare and, they hope, finally trigger reforms of the country’s healthcare system.

Chisom’s case is not unique. Health experts say many women across the region who are medically required to have cesareans are not able to access them, due to weak healthcare systems and a lack of resources.

In their research, Dr. Salome Maswime and Dr. Gwinyai Masukume, from the University of the Witwatersrand, note that Africa currently has the world’s lowest C-section rate, at 7.3 percent. By comparison, the rate of C-section is 25 percent in Europe and 40.5 percent in Latin America and the Caribbean.

There are many reasons why women in Africa have such limited access to the procedure, Maswime and Masukume say. These include a shortage of midwives, obstetricians, anesthetists, laboratory and other allied personnel; limited access to healthcare information for the general public; and a lack of equipment.

“There are also factors that are largely beyond the conventional healthcare system,” Masukume explained. “For a C-section to take place, electricity is generally required – about two thirds of people in sub-Saharan Africa do not have access to electricity.”

“In addition after one decides to seek care, finding one’s way to a healthcare centre in a timely manner can be challenging because of transportation challenges – about 80 percent of roads in sub-Saharan Africa are not paved,” he said.

It’s hard to overcome the infrastructure challenges of providing electricity, transport and sanitation. But Maswime and Masukume say there is a way to resolve some of the human resources challenges: Teach non-physicians to carry out C-sections.

Caroline Schneeberger and Professor Matthew Mathai write in a research paper on the topic: “Moving tasks to healthcare workers with shorter training [than a surgeon] for emergency obstetric care can potentially improve access to lifesaving interventions and thereby contribute to reducing maternal and neonatal morbidity and mortality.

Mozambique has successfully adopted this method, known as task shifting, for C-sections and other surgical procedures. The country has been using surgically trained nurses, known as técnicos de cirurgia (surgical technicians), since 1984.

Dr. Carlos Funzamo, a researcher with Mozambique’s Ministry of Health, says they started training surgical technicians to make up for a shortage of doctors, as so many had fled the country’s civil war. The problem was particularly bad in rural areas.

“Since the introduction of these technicians, the country has managed to reduce its maternal mortality rate by more than half, as we are now able to offer lifesaving surgical interventions in areas where such services were previously not available,” he said.

He points to research that compared the quality of service provided by these surgical technicians to that provided by doctors, which showed “very few differences in their work.”

“The advantages of using surgical technicians far outweigh the disadvantages,” he said. “It has proven to be a cost-effective solution for our country.”

A previous version of this article stated that a research paper on task-shfiting was written by Dr. Salome Maswime and Dr. Gwinyai Masukume. It was in fact written by  Caroline Schneeberger and Professor Matthew Mathai.

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