Abstract:
Unnecessary Caesarean Section (CS) can have adverse effects on women and their new-
borns. Assisted vaginal birth/delivery (AVB/AVD) using a suction device or obstetric forceps
is a potential alternative when delays or complications occur in the second stage of labour.
Unlike CS, AVB using a suction device does not require regional or general anaesthesia,
can often be performed by midwives, and does not scar the uterus, lowering the risk of
maternal mortality and morbidity, in this and subsequent pregnancies. This study examined
the appropriateness and outcomes of second stage CS (SSCS), and reasons for low levels
of AVB use, in Kenya. Using a mixed methods study design, we reviewed case notes from
women having SSCS births and AVB, and conducted key informant interviews with health-
care providers, from 8 purposively selected hospitals in Kenya. Randomly selected SSCS
and all AVB case notes were reviewed by a panel of four experienced obstetricians, and
appropriateness of the procedure assessed. Semi-structured interviews were conducted
with obstetricians, medical officers and midwives, and analysed using a thematic approach.
Review of 67 SSCS case notes showed 10% might have been conducted as AVBs, with a
further 58% unable to be classified due to inadequate/inconsistent record keeping or exces-
sive delay following initial CS decision. Outcomes following SSCS showed perinatal mortal-
ity rate of 89.6/1,000 births, with 11% of infants and 9% of mothers experiencing
complications. Non-referred cases of AVB showed good outcomes. The findings of the 20
interviews explored the experience and confidence of healthcare providers in performing
AVBs, and adequacy of the training they received. Key reasons for non-performance
included lack of functioning equipment, lack of trained staff or their rotation to other depart-
ments. Reasons for non-performance of AVB were complex and often multiple. Any solu-
tions to these problems will need to address various local, regional and national issues