Caesarean Section: Expert Advice on What Africans Need to Know

By: Azuka Ezeike, MBBS, FWACS (Obstetrics and Gynaecology), FMCOG, MSc. (Public Health). Medically reviewed by: ‘Kunle Soyemi. MBBS, FWACS; FRCOG. Consultant Obstetrician & Gynaecologist.

 

Close-up left-sided view of the torso of a pregnant African woman in colourful and patterned yellow gown, Image credit: AI generated from Freepik.

 

Highlights 

• Caesarian section is a safe, lifesaving procedure for mothers and babies when complications are foreseen before or arise at delivery.

• Generally caesarean delivery rates are lower in Africa due to access issues and cultural resistance, despite rising global trends.

• ????Usually doctors will recommend Caesarean section only when vaginal birth is deemed unsafe.

• There are 4 categories of Caesarean section: from emergency to elective/planned, depending on the level of urgency.

• Common myths, such as “not being woman enough,” are unfounded and have harmed health outcomes in African communities.

• Proper preparation, support, and follow-up care ensure smooth recovery and healthy bonding after a Caesarean section.

 

Introduction

“God forbid! It is not my portion”. This was Mrs. Joy’s response when her doctor informed her that she would have a caesarean section. This was her first pregnancy, and she had looked forward to having the experience of labour, so this was devastating news to her. She had also heard some horrible stories about how caesarean section is dangerous and had received some counsel from older mothers on the need to resist caesarean section. Her mother-in-law, who had all her children through vaginal births, had also made her understand that any woman who does not deliver ‘normally’ is not woman enough.

This is a very common scenario that I’ve witnessed in my practice in an African healthcare setting. The doctor advises a patient on the need to have a caesarean section, and the patient vehemently resists it. 

The origin of the caesarean section is not known It was erroneously believed to be associated with the method of birth of the Roman emperor Julius Caesar, but this has been shown to be almost certainly not the case, but thought more likely to be related to the Latin verb ‘caesare’ meaning to cut. The more likely first performance of the operation was in the early 16th century, according to the US National Library of Medicine. 

Over time, caesarean section has become a very safe procedure due to improvements in the state of medical care, such as improved surgical skills, blood availability, anaesthesia, and the use of antibiotics.

Caesarean section can be a life-saving procedure that has significantly helped prevent the deaths of mothers and babies worldwide, especially when complications arise. Some of the major causes of death in African women, like excessive bleeding, hypertension in pregnancy, obstructed labour, and sepsis, can be prevented through a timely caesarean section.

 Despite the procedure's usefulness, it is often resisted by patients in low-resource settings, such as in sub-Saharan Africa. This is because of misconceptions, sometimes a lack of information, and family and societal expectations. Because this very beneficial medical procedure has been resisted by many in the African locality, its usefulness has not been fully maximised

This article is an explainer for Africans about caesarean section, the indications, the benefits, and how to prepare for the procedure.

 

What is a Caesarean Section?

Caesarean section is a type of operation in which the doctor delivers the baby by making a low cut on the front of your abdominal (tummy) wall and uterus (womb) [1] (See fig. 1).

Fig. 1: Cartoon illustration showing the avatar of a pregnant brown skinned woman with a transverse incision (cut) on her lower abdominal (tummy) wall at arrows as placed in a Caesarean section. Image credit: Freepik.

 

Why is a Caesarean Section Performed? 

Your doctor may decide to perform this procedure when vaginal delivery is considered:

• Too difficult
• Impossible
• Too risky

 

How often is a Caesarean Section done in Africa?

Infographics showing average caesarean section rate in Africa. Rates may be much higher in some individual countries and in urban hospitals. Click on the image to enlarge.

 

The percentage of women delivering through caesarean section has been increasing over the years across the world, though the increase is more in Western countries. The World Health Organization (WHO) recommends that the average rate of caesarean sections should be between 10% and 15% of deliveries.

Data from the WHO shows that all over the world, about 18 women in 100 deliver by caesarean section. The highest rate is seen in Latin America and the Caribbean, where up to 40 women in 100 deliver through caesarean section. In most of Africa, the average number is about 7 in 100 women. However, in some urban hospitals, it can be as high as 50%.

Studies in Nigeria and Ghana show rates of up to 17.6% and 14.6%, respectively [2, 3]. However, in rural areas, fewer women have caesarean sections because they often don't have easy access to hospitals or doctors who can perform the surgery.

 

What are the Types of Caesarean Sections?

Infographics showing categories of caesarean sections. Click on image to enlarge.

 

The two main classes of caesarean sections commonly done are: emergency and elective or planned caesarean sections. Your doctor may use these terms when describing a caesarean section to you.

However, caesarean sections are divided into four categories (types):

• Category 1 (Emergency): When there is immediate danger to the mother or baby and should be done within 30 minutes of taking the decision to do the operation.

• Category 2 (Urgent): When there is danger, but it’s not as immediate as in Category 1. Should be performed within 75 minutes of taking decision to do the operation.

• Category 3 (Scheduled): When there is no immediate danger or urgency, but the baby still needs to be delivered early. Should be performed within 24 hours of making call to perform the operation.

• Category 4 (Elective/planned): When vaginal delivery may not be safe but there is no immediate threat. The decision for this may be made at any time during the pregnancy, even as early as at the time of the first antenatal visit. An example would be in a woman who has had 2 or 3 previous caesarian sections, or in whom the baby is found to be in the breech position or it may be at the patient’s request. It is usually prescheduled for a set time.

 

When is a Caesarean Section Needed?

Infographics detailing the two commonest reasons for caesarean section in Nigeria as, a previous section followed by hypertension in pregnancy. Click on image to enlarge.

 

A caesarean section may be done for several reasons, either because of problems in the mother, the baby, or both [1]. In some of these cases, a caesarean section must be done in all situations (absolute indications).

 In other cases, either caesarean section or vaginal delivery may be done (relative indications), depending on what your doctor suggests based on the circumstances and after explaining the reason for his suggestion.

Some of the reasons for caesarean section include:

Problems with the mother:

• Small birth canal
• Distorted birth canal (e.g., from injuries or deficiencies like rickets)
• Placenta praevia (when the placenta extends to the lower part of the womb)
• Tumour (growth) blocking the birth canal (e.g., fibroids, growths in the ovaries)
• Two or more previous caesarean sections
• Previous fibroid operation, especially if extensive
• Any previous surgery in the birth canal (e.g., surgeries for pelvic organ prolapse, vesicovaginal fistula)
• Hypertension with protein in pregnancy, especially if the woman is not in labour or is in early labour
• Some infections like herpes in the vagina or HIV infection
• Poor labour progress

Problems with the baby:

• Abnormal position of the baby in the womb
• Very large baby
• Anomalies in the baby that distort shape or complicate delivery
• Abnormal heart rate
• Early separation of the placenta
• Umbilical cord prolapse
• Some multiple pregnancies

A review of the reasons for caesarean section in Nigeria showed that a previous caesarean section was the most common reason, occurring in about a third (1 in 3) of the cases, and was closely followed by hypertension in pregnancy. [2].

 

How to Prepare for a Caesarean Section

If you are to have a planned caesarean section, your doctor will discuss it with you ahead of time. They will explain the reason for the caesarean section and allow you to ask questions. You may have your husband or any member of your family present during the discussion. A planned caesarean section is usually done around 39 weeks of pregnancy, but may sometimes be earlier as in the case of some multiple pregnancies.

For an emergency caesarean section, the situation is different, as there may not be enough time for an elaborate discussion. However, the doctor will still inform you of the reason for the surgery and obtain your informed consent.

Before the surgery

• Make sure you buy your baby and delivery materials ahead of time.

• Pay for the surgery early, unless it is free or you have insurance coverage.

• Do the tests requested by the doctor. These tests include your blood group, should in case you need a blood transfusion, a haemoglobin test to check your blood level, and sometimes, a kidney function test.

• Arrange to make blood available. This is because a caesarean section may be associated with blood loss that could require transfusion. Your husband or any relative can donate. The amount of blood needed is determined by your doctor.

• You may need to be admitted to the hospital about one or two days before the surgery, so prepare for that; but if things are straightforward you may come to the hospital on the morning of the planned operation.

• The anaesthesiologist (the doctor who puts you to sleep and manages your pain at the caesarean section) will come to check on you and discuss how to manage the pain during the surgery.

• Your doctor will further explain the surgery and give you an informed consent form to sign.

• You are to read the form carefully, ask questions on any content of the form that you do not understand or are unsure about before signing it. You can also ask your husband or a family member to read and sign the form on your behalf.

• You are to stop eating the night before the operation.

• On the morning of the operation, the nurses will prepare you for surgery.

• You may be shaved and have a catheter inserted into your bladder (this may be done on the ward, but it is better done in the theatre).

• A germ-free cannula (thin tube) will be inserted into your vein to allow for the infusion of drugs, drips and blood (if necessary) during the surgery.

What to expect during the surgery

• On the morning of surgery, you will be wheeled to the theatre (operating room).

• In the theatre, the theatre nurses will receive you in the outer room of the theatre, and may ask some questions about your identity (name, date of birth, and why you are in the room), etc., before you are taken into the main operating theatre.

• In most cases, you will be awake during the surgery, but you will be given an anaesthetic injection into your back to eliminate pain during the operation (spinal or epidural anaesthesia). In some cases, you may need to be put to sleep (general anaesthesia).

• After that, you will be made to lie down.

• The surgery takes about 45 minutes to one hour in most cases. In difficult cases, it may take longer.

• If you are awake, you will not feel any pain, but you will feel the tugging.

• Your doctor will cut your lower abdomen, then cut into your womb to deliver the baby.

• The nurses will receive and clean up the baby. The baby will later be shown to you.

• The doctor will then close all the cuts and place germ-free gauze pads (dressing) with sticker tapes over the wound.

• You will be cleaned up and taken to the recovery room for observation.

What Happens After the Caesarean Section?

After the surgery, here’s what you should expect:

• From the recovery room, you will be taken back to the ward when your vital signs (pulse, blood pressure, respiration, etc.) have stabilised and you are well oriented in time, place and day.

• You will continue to receive germ-free salt and water or sugar and water fluid preparations (drips) through the tube placed in your vein (blood vessel), antibiotic injections (in some cases), and painkillers.

• Breastfeeding may feel a bit uncomfortable at first, but the nurses will support you to start breastfeeding soon after the surgery.

• In most cases, you will start eating a few hours after the surgery. However, many doctors in African countries prefer to check that your intestines are moving well before allowing you to eat.

• Once you start eating, your medications will be changed to tablets or capsules. This usually happens on the first day after the surgery.

• The catheter inserted into your bladder to collect your urine is usually removed the day after surgery.

• The nurses on the ward will help you start moving around on the first day after surgery. This helps to prevent blood clots in the veins of the legs. You may also be given a special stocking to wear (TED stockings) or some injections if you are at high risk of forming blood clots.

• In most cases, you will be discharged between 3 to 5 days after surgery if everything is okay and the wound is healing well.

• Most times, your doctor uses stitches that dissolve on their own to close the cuts in your womb and abdomen. But if non-dissolvable stitches are used, your doctor will let you know when they will be removed.

 

After discharge: What to do at home

After discharge, you are to do these at home: [4]

• Continue taking your supplements, as they aid in wound healing.
• Watch and keep the wound dry to ensure that it is healing well and not bleeding or infected.
• Continue breastfeeding. It helps your baby and also helps your womb return to its normal size faster.
• Drink plenty of water, up to 3 litres per day, unless your doctor advises otherwise.
• Your doctor will give you follow-up appointments, usually within 6 weeks. Make sure to keep these appointments.
• Ensure you have enough help at home.
• Rest as much as possible. Try to sleep when your baby sleeps.
• Wear loose clothing to avoid irritating the wound.
• Eat a balanced diet to support your recovery.
• You can take a bath, but be sure to pat the wound dry immediately afterwards.
• Avoid submerging yourself in water, such as in a bathtub or swimming pool, until the wound has healed.
• Do not apply traditional ointments or mixtures to the wound.
• Avoid strenuous activities like lifting heavy objects within the first 6 weeks after surgery.
• Support the baby with your arms while breastfeeding to avoid putting pressure on the wound. You can also use pillows or blankets for added support.
• You may resume sex when you feel ready, but it is not advised within the first 6 weeks, as it may disrupt wound healing.
• Discuss family planning options with your doctor. It is possible to get pregnant soon after childbirth, but it is advised to delay pregnancy for at least 18 months. This allows for adequate spacing between your children and proper care and support for each baby.

 

When to See Your Doctor after a Caesarean Section

Seek urgent medical care at the hospital if you experience any of the following:

• Swelling or drainage of pus or blood from the wound
• Fever
• Severe headache
• Foul-smelling discharge from the vagina
• Pain and swelling in the calf
• Excessive vaginal bleeding
• Persistent low mood or tearfulness
• Abdominal swelling and pain, especially if associated with difficulty passing stool

 

What are the Risks of a Caesarean Section?

A list of the respective risks of caesarian section to baby and mother. Click on image to enlarge.

 

Caesarean section is a major operation and may sometimes be associated with problems [5, 6]. However, complications are no longer common because of the improvement in care.  

The most common complication is infection, but this has reduced remarkably since the introduction of antibiotics.

Risks to the Baby

• The baby may have more breathing problems than a baby delivered vaginally, especially if delivered before 39 weeks
• Increased risk of allergies
• Accidental cuts on the baby’s skin

Risks to the Mother

• Problems from the anaesthesia
• Bleeding
• Unintended damage to organs like the bladder and intestines
• Infections of the lining and muscles of the womb (endomyometritis)
• Infection of the urine (urinary tract infection)
• Wound infection
• Formation of blood clots in the leg (deep venous thrombosis)
• Obstruction to the movement of food through the intestines

There may also be long-term complications, such as an increased risk of having a low-lying placenta (placenta praevia) or the need for another Caesarean section. It is advised that after a Caesarean section, you register your next pregnancy at a hospital, as the pregnancy will require close monitoring.

 

Myths and Facts about Caesarean Section

Myth 1: You can’t have vaginal delivery after a caesarean section.

Fact: Vaginal delivery may be possible after a caesarean section, especially if the present operation was done for a non-recurring cause, but your doctor would assess you and make sure you qualify for it.

Myth 2: Caesarean section is very dangerous.

Fact: Caesarean section is a major operation and can be associated with complications, but with the improvement in medical care, the complications are now rare.

Myth 3: When you deliver by caesarean section, it means you are not woman enough.

Fact: The route of delivery is not what determines your womanhood. Whether you deliver by caesarean section or vaginal delivery, you are still a full-fledged woman.

Myth 4: You can’t breastfeed after a caesarean section.

Fact: Breastfeeding may be more difficult in the early days after a caesarean section, but it is still possible with the right support.

Myth 5: Having a caesarean section is an easy way of escaping the pain of labour.

Fact: Though you will be given an injection to numb the pain during the surgery, caesarean section may be  associated with more pain and discomfort after delivery than vaginal delivery.

 

Conclusion

Caesarean section is not a sign of failure or weakness. It can be a life-saving medical intervention. In most of Africa, cultural expectations, misinformation, and access barriers have contributed to the fear and resistance around this procedure. But times have changed. With better medical care, skilled doctors, and the right support, caesarean section can be a safe and dignified option for delivery. Whether vaginal or surgical, the goal remains the same: a healthy mother and a healthy baby. 

 

References:

1. Sung S, Mikes BA, Martingano DJ, Mahdy H. Cesarean delivery. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025. Last update, Dec. 7 2024. [Cited 2025 Jun 13]. Available from here.

2. Osayande I, Ogunyemi O, Gwacham-Anisiobi U, Olaniran A, Yaya S, Banke-Thomas A. Prevalence, indications, and complications of caesarean section in health facilities across Nigeria: a systematic review and meta-analysis. Reproductive Health. 2023;20(1):81. Available from here.

3. Gyaase D, Enuameh YA, Adjei BN, Gyaase S, Nakua EK, Kabanunye MM, et al. Prevalence and determinants of caesarean section deliveries in the Kintampo Districts of Ghana. BMC Pregnancy and Childbirth. 2023];23(1):286. doi: 10.1186/s12884-023-05622-5. Available from here.

4. Kateera F, Hedt-Gauthier B, Luo A, Niyigena A, Galvin G, Hakizimana S, et al. Safe recovery after cesarean in rural Africa: Technical consensus guidelines for post-discharge care. Int J Gynaecol Obstet. 2023;160(1):12–21. Available from here.

5. Quinlan JD, Murphy NJ. Cesarean delivery: counseling issues and complication management. Am Fam Physician. 2015;91(3):178–84. Available from here. 

6. Kayembe AT, Kapuku SM. Postoperative maternal complications of caesarean section: a cross-sectional study at the Provincial General Hospital of Kananga in the Democratic Republic of Congo. The Pan African Medical Journal. 2024;47(23). Available from here.

 

Related:

Hypertension in Pregnancy in Sub-Saharan Africa – Essential Information for Africans

Essential Guide to Labour for African Women and Men

How to Boost Positive Childbirth Experience in African Women

Why African women die more from birth-related bleeding

Social Factors Shaping African Women’s Health

 

 

Published: July 31, 2025

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