A Caesarean section (CS) involves delivering a baby through surgical incisions made in the abdominal wall and the uterus. Across Nigeria, the rate of caesarean births has been rising, especially in urban tertiary health centers. Midwives encounter this procedure frequently, serving as the first point of contact for women who present with pregnancy complications. While a vaginal birth remains the primary goal for most healthy pregnancies, a timely CS saves lives when complications arise that threaten the mother or the baby.
Access to safe surgical delivery varies widely between rural primary health posts and well-equipped urban teaching hospitals. Midwives working in secondary and tertiary facilities must understand the local factors influencing surgical uptake, including religious beliefs, cultural perceptions surrounding surgical delivery, and financial constraints under the National Health Insurance Authority or out-of-pocket payment systems. Recognizing these barriers helps midwives provide empathetic counseling that eases fear and encourages prompt acceptance of medical advice.
Caesarean sections are categorized based on urgency and clinical necessity. An elective CS is planned well in advance for specific maternal or fetal conditions where labor is either unsafe or contraindicated. An emergency CS is performed when unexpected complications arise during pregnancy or labor that demand immediate delivery.
Common indications fall into distinct clinical categories:
Thorough pre-operative preparation reduces surgical risks and ensures the mother is physically and mentally ready. The midwife coordinates baseline investigations, including a packed cell volume to check for anemia, blood grouping and cross-matching in case a transfusion is needed, and urinalysis.
Key steps in pre-operative care include:
The operating theater is a multidisciplinary environment where the midwife acts as a vital advocate for both mother and baby. Once the patient is positioned on the operating table with a slight left lateral tilt to prevent aortocaval compression, the anesthesia team administers either regional anesthesia, such as spinal or epidural, or general anesthesia.
The surgical team creates a transverse lower uterine segment incision, known as a Kerr incision, because it heals well and carries a lower risk of rupture in future pregnancies. As soon as the baby is delivered, the midwife receives the newborn, clears the airway if necessary, assesses the Apgar score, and initiates immediate thermal care. Meanwhile, the surgical team repairs the uterine and abdominal layers while administering oxytocin to encourage uterine contraction and minimize blood loss.
Post-operative recovery begins in the recovery room or high-dependency unit, where vital signs are monitored every fifteen minutes until stable. Midwives watch closely for primary postpartum hemorrhage by checking the firmness of the uterine fundus and the amount of vaginal bleeding.
Routine post-operative monitoring includes:
Although routine in modern practice, a caesarean section is major abdominal surgery carrying inherent risks. Midwives must remain vigilant to detect early signs of complications so that medical interventions can start promptly.
| Complication Type | Common Warning Signs | Initial Midwifery Action |
|---|---|---|
| Hemorrhage | Heavy vaginal bleeding, boggy uterus, falling blood pressure | Massage fundus, call doctor, give oxytocics |
| Infection | Fever, foul-smelling lochia, severe wound tenderness | Check temperature, report findings, collect wound swabs |
| Thromboembolism | Calf pain, leg swelling, sudden shortness of breath | Elevate leg, give oxygen, alert medical team immediately |
| Urinary Injury | Inability to void, hematuria, leaking fluid from wound | Check catheter patency, measure output accurately |
Recovery continues after the mother leaves the hospital. Midwives guide the mother through wound care, dietary advice rich in iron and protein, and emotional adjustments. Establishing successful breastfeeding soon after surgery helps promote infant bonding and stimulates uterine contraction through natural oxytocin release.
Comprehensive discharge planning addresses several practical needs: