​What kinds of symptoms do patients experience before receiving treatment?

The symptoms depend on the particular condition that is being indicative of either elective or emergency C-section. Usually, the doctor schedules an elective or emergency C-section because she anticipates complications closer to the time of labour. For an emergency C-section, the decision to incision time is often within minutes of reviewing the soon to-be-mother. A common reason for C-section is a high-risk pregnancy including previous C-section, making a vaginal birth more difficult. A previous C-section may have been performed as an emergency, for fetal distress, if the mother's pelvis is small, or if there was a previous or current complication of pregnancy. Additional indications for the need for an Elective/Emergency C-section include breech presentation, gestational diabetes, pre-term labor, and other high-risk pregnancy challenges.

​What is the impact on patients’ lives of living with these conditions?

The conditions which necessitate a C-section usually have put the mother and baby's health and survival at significant risk.

What cultural or regional factors affect the treatment of these conditions?

In low and middle-income countries, large sectors of the population lack access to basic obstetric care. Therefore, infant and maternal mortality continues to be high. In Mali specifically a multitude of factors compound the lack of access to obstetrical surgeries and the need for C-sections. These include high prevalence of home deliveries by traditional birth attendants, female genital mutilation (FGM), early marriages, food taboos or dietary restrictions, low decision-making power of women delaying access to emergency care (delays in antenatal care and other services), religious or syncretic beliefs (preference for traditional remedies, marabouts, or prayer instead of biomedical care), rural living, low income levels, lack of knowledge, clandestine abortions, mistrust and lack of awareness of family planning, unwanted pregnancies (especially among domestic workers), insecurity leading to population displacement and influx into health facilities, insufficient human resources for health, inadequate infrastructure, a weak referral-evacuation system, and insufficient equipment.

What does the treatment process look like?

For an elective C-section procedure, the patient usually has a scheduled day for safe delivery. However, for emergency C-sections, the decision to perform the surgery is usually immediately as the doctor determines the need. If the blood pressure is normal the procedure is carried out as planned. A new mother usually is out of the hospital in less than 5 days if no complications occur.

What is the impact of this treatment on the patient’s life?

A safe delivery. A healthy baby and mother. Prevention of mortality and complications, such as vesicovaginal fistulae (VVF).

What potential side effects or risks come with this treatment?

C-sections are considered relatively safe, but can pose a higher risk of some complications than a vaginal delivery. For example a longer recovery time needed, vesicovaginal blood loss, infection, blood clots in the legs or lungs, bowel problems, fetal injury, placenta complications, breaking open of the incision or scar. However, when a C-section is truly needed, the procedure is life-saving.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

There are few quality centres with qualified personnel and adequate equipment to perform a C-section within the country, especially outside of major urban areas. Additionally, some facilities in Bamako and most in rural areas of Mali lack oxygen and sufficient human resources and have inadequate infrastructure, so cases involving sickle-cell disease, eclampsia, anemia, cardiac failure, or complicated diabetes must be referred to higher lever facilities. There is also a shortage of hospital beds in many facilities in Bamako, and some complementary diagnostic tests cannot be performed on site. Not all medical specialties are available even in higher level university hospitals, and even less so in district hospitals.

What are the alternatives to this treatment?

Vaginal delivery can be tried in some women but for many expectant mothers, a C-section is performed because the doctor deems a trial of vaginal delivery unsafe or even impossible.