Abstract:
Unnecessary Caesarean Section (CS) can have adverse effects on women and their newborn. 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
justification for, and outcomes of second stage CS (SSCS) and reasons for low levels of use of AVB, in Kenya.
Using a mixed methods study design, we reviewed case-notes from women having AVB and second-stage CS
births, and conducted key informant interviews with healthcare 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 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 excessive delay following initial CS decision.
Outcomes following SSCS showed perinatal mortality 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. Twenty interviews
were conducted with obstetricians, medical officers and midwives. The findings 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 departments.
Reasons for non-performance of AVB were complex and often multiple. Any solutions to these problems will
need to address various local, regional and national issues.