The obstetric theatre is a high-risk environment where both mother and newborn are vulnerable to healthcare-associated infections. Postpartum and postoperative sepsis remain major contributors to maternal morbidity and mortality across Nigeria. Infection control aims to break the chain of infection by eliminating pathogenic microorganisms before they reach a susceptible host. Midwives working in the theatre must understand that infection prevention is not merely a bureaucratic requirement, but a fundamental clinical duty. Every member of the surgical team shares responsibility for maintaining environmental and procedural safety from the moment a patient enters the suite until they are transferred to the recovery ward.
Aseptic technique refers to a set of specific practices and procedures performed under carefully controlled conditions to minimize contamination by pathogens. It differs from medical asepsis, which aims to reduce the overall number of microorganisms, by striving for an environment completely free of spores, bacteria, and viruses. In obstetric practice, aseptic techniques are applied during caesarean sections, episiotomy repairs, and catheterizations. Maintaining this state requires constant situational awareness, as even a brief lapse in technique can introduce bacteria into deep surgical wound sites.
Infection control relies on a tiered approach to processing instruments and surfaces.
Operating room equipment requires standardized protocols to ensure that every instrument used in a cavity is safe. Steam sterilization via an autoclave is the gold standard in Nigerian healthcare facilities because it uses moist heat under pressure to denature microbial proteins. Chemical indicators and biological spore tests must be used regularly to verify that the autoclave reaches the required temperature and pressure parameters. Midwives should inspect packaging indicators, such as autoclave tape, before opening any sterile kit to confirm that proper sterilization cycles were completed.
Before participating directly in a sterile obstetric procedure, midwives must undergo surgical scrubbing to reduce the resident and transient microbial flora of their hands and forearms. The scrub starts from the fingertips and proceeds systematically toward the elbows, keeping the hands elevated above the elbows at all times. Once scrubbed, personnel enter the theatre and dry with a sterile towel using a blotting motion. Gowning and closed-gloving techniques follow, ensuring that the sterile gown and gloves are handled only on their inner surfaces to prevent contamination from unsterilized skin.
A sterile field is an area created around the surgical site that is free from all microorganisms. Midwives must guard this boundary vigilantly throughout the procedure. Sterile drapes should be placed on dry surfaces, and any drape that becomes wet is considered contaminated because moisture allows bacteria to wick through from non-sterile tables underneath. Personnel must face the sterile field when moving around it, never turn their backs, and keep their hands between shoulder and waist level. Items of questionable sterility must always be treated as contaminated.
Contamination in the operating theatre often happens through subtle lapses rather than major accidents. Common culprits include punctured sterile gloves, unsterilized equipment edges touching sterile tables, and air currents caused by excessive movement of personnel in the room. Midwives must immediately speak up if they witness a break in technique, regardless of the seniority of the person involved. Preventing breaches relies on teamwork, strict adherence to traffic flow patterns within the theatre suite, and maintaining quiet discipline during surgical deliveries.