Rural Community Based Caesarean Section Ratesin A Resource Poor Region

Abstract

Background: Tremendous increase in caesarean section rates (CSR) is reported with controversial relationship between CSR and maternal-perinatal outcome.

Objective: was to know rural community based CSR, spill over effects of institutional practices and maternal, perinatal outcome in low resource region.

Material Methods: Nurse Midwives based at institute visit each village, five times a year, provide home based prenatal care, advocacy for intranatal, postnatal care, create awareness in women, communities about emergencies in high, low risk, action needed. Records of pregnancy outcome, collected on regular basis were analysed irrespective of place, delivery mode.

Results: CSR was 4.8% between1987- 1990,( base information), 11.6% between 2008 - 2011, in villages within 25-35 kms from institute, being served since 26 years (old), 1.2% between 1996 - 1999, 5.4% between 2008 - 2011 in villages 75-85 kms from institute, being served since 1996 (new). Perinatal mortality rates (PMR) have decreased, 62 between 1987 - 1990, 26 between 2008 - 2011 (2.38 times reduction) in old villages, 42 between 1996 - 1999 and 23 between 2008 - 2011 (1.82 times reduction) in new villages, with no maternal death due to pregnancy, labour specific disorders, one death each due to sickle cell disease, murder, suicide in 15 years in this small population. There was disproportionate increase in CSR midway, parallel to institute's CSR.

While nurse midwives can do a lot for maternal care in community, facility’s everyday practices affect community’s CSR. Periodic audit is essential at health facility, community for possibilities of improving maternal perinatal outcome, curtailing CSR.