Women who undergo caesarean section (CS) are likely to have a repeat CS in a subsequent
pregnancy, thus increasing the CS rate in the country, which is not ideal in a resource
constrained setting. The occurrence of high maternal mortality among women who have nonelective
CS is usually due to indications for prior CS such as fetal distress, obstructed labour
and eclampsia. In developing countries, there is a high rate of maternal deaths associated
with major operative complications.
This study was a retrospective, descriptive quantitative, clinical audit. The purpose was to
identify the reasons for non-elective CS in two hospitals namely, the Windhoek Central
hospital and Intermediate Katutura hospital, and the implications for Midwifery clinical
practice. The research question was: What are the indications and intrapartum care factors
for non-elective CS in the two hospitals, and what are the implications for Midwifery
practice? The population consisted of records of women who had given birth by CS between
1st January 2012 and 30th June 2012 in the two hospitals. All available records of women
who had non-elective CS during the study period were reviewed. Data was collected with
individual data collection sheets and analysed using Statistica 11 software.
A total of 838 records were reviewed. The CS rate was 1264/5296 (23.9%), the rate of nonelective
CSs was 912/5296 (17.2%), and the proportion of non-elective CS was 912/1264
(72.2%). A total of 171/838 (20.4%) women were HIV positive. Seventy per cent (634/838)
women had a CS for the first time, of which 290/634 (45.7%) were multigravida. Records
were grouped according to Robson’s classification, a mutually exclusive and totally inclusive
classification of CS. The Robson group making the largest contribution was nulliparous
women with a single cephalic pregnancy, at greater than or equal to 37 weeks gestation in
spontaneous labour (group 1) with 213/838=25.4%. Problems with the progress of labour
were the most common reason why women had non-elective CSs during the study period.
The study findings highlighted a high number of primary CS in low risk women with poor
assessment of maternal wellbeing and progress of labour. Limited documentation of
Midwifery intervention and care was noted suggesting inadequate Midwifery care. Training
is required to render evidence based care.