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

Expectant mothers with the following conditions are recommended for C-sections: two previous C-sections, twins in same sack, twins with previous a C-section, pelvic abnormalities, improperly-positioned babies, large babies, prima gravida at a young age, and other uterine conditions or operations. Obstructed labor causes great pain in the mother, and neglected obstructed labor is a major cause of both maternal and newborn morbidity and mortality. At Bwindi Community Hospital, elective Cesarean sections are recommended for expectant mothers who are predicted to have obstructed labor.

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

One of the most severe and distressing long-term conditions following untreated obstructed labor is an obstetric fistula, a hole which forms in the vaginal wall. Fistulas lead to urinary and stool incontinence. In developing countries, fistulas are commonly the result of prolonged obstructed labor, which could have been prevented by a C-section.

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

Malnutrition is common in poor areas of Uganda. A patient with stunting or a contracted pelvis will need a C-section. Additionally, the rate of teenage pregnancy is higher in poor families. A young, first-time mother is more likely to need a C-section because her pelvis is not fully developed.

What does the treatment process look like?

Mothers attending antenatal classes are identified by community health nurses as potentially needing C-sections. As her expected delivery date nears, the mother arrives at the hospital and is seen at outpatient triage. If she arrives before her due date, the mother is sent to the mother's waiting hostel for up to one month. When at term, the mother is sent to obstetrics. The obstetrician takes her history and admits her to the maternity ward. She receives family planning counseling. Blood samples are taken, and surgery is scheduled for the next day. Procedures are explained to the patient and her attendant, and consent for surgery is obtained. An anesthetist reviews the patient's history and determines what type and amount of anesthesia is required. Before surgery, an IV line is inserted. The patient receives the antibiotic Ampicillin and 500 ml of saline IV fluids. A urinary catheter is inserted, and the patient is taken to the operating theater at her scheduled time. The surgery is performed and an IUD is inserted, if requested by the patient. A midwife is present to receive the baby. The baby is examined by the midwife and kept warm. The mother is monitored for 30 minutes in the theater, then returned to the maternity ward. She continues to be monitored. With her new baby, the mother will stay in the hospital approximately 5 to 7 days. She will have a daily review by a medical officer. She will receive antibiotics and painkillers three times a day.

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

This treatment can save the lives of the mother and the baby and prevent long-term complications from obstructed labor.

What potential side effects or risks come with this treatment?

There are always risks to surgery. Possible risks include reactions to medications or anesthesia, blood loss, and infection. However, for mothers who are at risk of obstructed labor, a C-section is the safer alternative.

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

This treatment is not easily accessible. It is only available at our medical partner's care center, Bwindi Community Hospital. The other referral hospital is more than a three-hour drive away. Most expectant mothers who will need C-sections are identified by the community nurses who visit the surrounding villages on a regular basis.

What are the alternatives to this treatment?

Patients who have not been to antenatal care and have not had a scan may not know they are at risk for obstructed labor. They may try to deliver at home or in a local health center.