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

The symptoms depend on the particular condition that is being indicative of the c-section. Usually the doctor schedules a c-section because she anticipates complications closer to the time of labor. A common reason for c-section is a previous c-section, which can make a vaginal birth more difficult. The previous c-section may have been performed as an emergency, for fetal distress, if the mother's pelvis is too small, or if there was a previous or current complication of pregnancy. A more complete set of indications for a c-section includes: 1. Breech presentation- position in which the feet or buttocks appear first during birth 2. Diabetes in childbirth/Gestational diabetes - in pregnant women who have never had diabetes before caused by improper insulin responses, can lead to macrosomia (large baby) and making vaginal birth difficult. 3. Ectopic pregnancy - a pregnancy in which the fetus develops outside the uterus, typically in a fallopian tube 4. History of molar/ectopic pregnancy- previous pregnancy(cies) in which the fetus develops outside the uterus, typically in a fallopian tube. 5. History of pre-term labor - Previous regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy. 6. Multiple gestation - carrying two or more fetuses simultaneously. 7. Oligohydramnios - a condition in which not enough amniotic fluid, which surrounds the fetus, is produced. 8. Pre-eclampsia - high blood pressure in pregnancy characterized sometimes with fluid retention and proteinuria (abnormal quantities of protein in the urine). 9. Pre-term labor - regular contractions of the uterus resulting in changes in the cervix that start before 37 weeks of pregnancy. 10. Rupture of uterus before labor - A full thickness disruption of the uterine wall before labor resulting in life threatening maternal and fetal compromise. 11. Rupture of uterus during labor- A full thickness disruption of the uterine wall during labor resulting in life threatening maternal and fetal compromise. 12. Suspicion of chorioamnionitis - intra amniotic infection. Typically results from bacteria ascending into the uterus from the vagina and is most often associated with prolonged labor. 13. Suspicion of cord compression - obstruction of blood flow through the umbilical cord secondary to pressure from an external object or misalignment of the cord itself. 14. Suspicion of morphological/functional placental abnormality - abnormal structure (as with twinning) and functioning of the placenta. Other abnormalities of placenta are degree or site of inplantation and mechanical abnormalities. 15. Suspicion of other membrane abnormality. 16. Suspicion of other umbilical cord condition - the cord that connects the fetus to the placenta during gestation. It could be infected or have another condition. 17. Suspicion of placenta previa - A condition in which the placenta partially or wholly blocks the neck of the uterus, thus interfering with normal delivery of the baby. 18. Suspicion of placental separation/hemorrhage - a pregnancy complication where placental lining has separated from the uterus of the mother prior to delivery. It is the most common pathological cause of late pregnancy bleeding. 19. Suspicion of placental transfusion syndromes - a disease of the placenta or afterbirth that affects identical twins or higher multiple gestations pregnancies who share a common monochorionic placenta. Causes disproportionate blood supply resulting in high morbidity and mortality. 20. Suspicion of prolapsed cord - umbilical cord prolapse is where the umbilical cord comes out of the uterus before the baby's head and can cause still birth as it cuts off blood flow and oxygen to the baby. 21. Suspicion of unspecified membrane abnormality. 22. Unspecified high risk pregnancy - when there are potential complications that could affect the mother, the baby or both. Example maternal age, medical conditions that exist before pregnancy or occur during pregnancy. 23. Unspecified obstetric trauma - injuries suffered by women during delivery, usually refers to perineal lacerations/ tears- the perineum separates the vagina from the anus.

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

Puts the mother's and baby's health and survival at 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, maternal mortality continues to be high. According to WHO, every year in the world, there is an additional need for 0.8-3.2 million c-sections in low income countries where 60% of the world's births occur.

What does the treatment process look like?

Please refer to the AMHF treatment process document.

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

Safe delivery. A healthy baby and mother. Prevention of mortality and complications, such as vesico-vaginal fistulae (VVF).

What potential side effects or risks come with this treatment?

Elective c-sections are considered relatively safe. But it does pose a higher risk of some complications than does a vaginal delivery. Example: a longer recovery time needed, heavy 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 centers with qualified personnel and adequate equipment to perform a c-section.

What are the alternatives to this treatment?

Trials of vaginal delivery can be tried in some women but for many expectant mothers an elective c-section is planned because the doctor deems a trial of vaginal delivery unsafe or even impossible.