The burden of caesarean section refusal in a developing country setting

Area of Science:

• Obstetrics and Gynecology
• Public Health
• Maternal-Fetal Medicine

Background:

• Caesarean section refusal presents a complex challenge in obstetric care.
• Understanding the prevalence and reasons behind refusal is crucial for improving maternal and neonatal outcomes.

Purpose of the Study:

• To investigate the prevalence, aetiology, and outcomes of caesarean section refusal among pregnant women.
• To compare maternal and perinatal mortality between women who refused and those who accepted caesarean section.

Main Methods:

• A prospective controlled study was conducted in Enugu, Nigeria.
• 62 women who declined elective caesarean section were compared with a matched control group.
• Data were collected via interviewer-administered questionnaires and delivery outcome analysis.

Main Results:

• The prevalence of caesarean section refusal was 11.6% of all caesarean deliveries.
• Maternal reasons included fear of death, economic factors, desire for vaginal birth, and inadequate counseling.
• Refusal was associated with significantly higher maternal mortality (15% vs. 2%) and perinatal mortality (34% vs. 5%).

Conclusions:

• A high prevalence of caesarean section refusal exists in south-eastern Nigeria.
• Women declining caesarean sections experience substantially worse maternal and perinatal outcomes.
• Enhanced support systems are necessary for women who refuse caesarean sections.