Increased use of caesarean section (CS) as a mode of delivery is of concern for
maternal and child health in many countries. The World Health Organization (WHO) has
set guideline of population caesarean section rate between 5% - 15% for CS deliveries.
Accordingly the South African National Department of Health (NDOH) has set a national
target for district hospitals, that no more than 10% of all deliveries should be by CS.
Standerton District Hospital experienced a sudden increase in the caesarean section
rate (CSR), from 17.5% in 2004 to 30.8% in 2007. The reasons for this increase are not
Purpose of the study
This study aims to investigate factors which contributed to the sudden increase of CSR
from 17.5% in 2004 to 30.8% in 2007 at Standerton District Hospital, Gert Sibande
A retrospective record review of 790 women who delivered at Standerton District
Hospital by caesarean section from January 2004 to December 2007 was done. Fifty
percent of the total number of records for each year was retrieved and to achieve this
every second record was selected from the maternity and theatre registers for patients
who have undergone CS. Systematic sampling selection of records of all women who
have undergone CS was conducted during the identified period.
Data on patient demographics, the reasons for the CS, the maternal and neonatal
outcomes achieved, antenatal care profile, the employment status and the responsible
medical practitioner were extracted from existing records maintained by the hospital.
Analysis ascertained factors associated with increased CSR.
The Caesarean section rate at Standerton District Hospital has increased annually since
2004. The factors contributed to the increase include medical indications, clients who
are primigravida and the less experienced community service doctors who performed
the CS. There was no evidence that education, high income clients, or maternal request
contributed to the increase of Caesarean Section rate (CSR). The outcome of mother
and baby were positive except for 1% of babies who were not alive. Robson’s group
classification (classification system which defines 10 groups of women according to
obstetric record, category of pregnancy, the presence of previous uterine scar, the
course of labour, delivery and gestational age), revealed that groups two and four
played a major role.
CSR has increased over the years and strategies needs to be developed to reduce this
by having experienced doctors supervising community service doctors, training of
professionals working in maternity and monitoring of labour by midwives.
Standerton District Hospital management should intensify recruitment and retention of
experienced medical officers, train additional midwives on advanced courses, intensify
ante natal care, establish a high risk clinic at the hospital, review hospital policies on
maternal care and monitoring of compliance to mother and baby’s national and