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

The symptoms of complications during labour can include labour lasting longer then 20 hours for first time mothers or 14 hours for mothers who have given birth in the past, excessive bleeding, pregnancy-related high blood pressure, lack of oxygen supply to the baby during labour or the baby being in a breech position.

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

Some pregnant women will fall unconscious during labour due to the pain and/or excessive bleeding. Where an emergency C-section needs to be performed, both mother and baby can have loss of life if the C-section is not performed quickly enough.

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

In villages and remote areas, where there are no clinics or hospital nearby, most women do not have the opportunity to receive prenatal care. They do not know whether the baby is in the right position and they do not know if they have high blood pressure or any underlying health condition that could affect their pregnancy and labour. They usually depend on traditional birth attendants, who often do not have formal medical training. If there are complications during labour, many women and babies die because they cannot access treatment at a hospital or clinic fast enough. In refugee camps and in migrant communities in Thailand, most pregnant women are able to access basic prenatal care. During these visits, most pregnant women will be informed by a midwife, nurse or doctor if they will need to give birth via a C-section. Although some women are scared to undergo a C-section, they will usually follow the health workers recommendation if they are told it is because of an underlying condition or for the baby's safety. However, C-sections cannot be performed in refugee camps. If there are any complications during labour, the woman in labour has to be rushed to the nearest general hospital to undergo a C-section. Despite easier access to hospitals and clinics in migrant communities and refugee camps, women often opt to give birth at home with a traditional birth attendant because of potential negative experiences at hospital or clinics.

What does the treatment process look like?

The physician will clean the abdomen of the mother. A tube (catheter) will likely be placed into the bladder to collect urine in a urine bag. An intravenous (IV) line will be placed in a vein in the mother's hand or arm to provide fluids and medication. Most cesarean sections are done under regional anesthesia, which numbs only the lower part of the body, allowing the mother to remain conscious during the procedure. Common choices include a spinal block and an epidural block. During an emergency C-section, general anesthesia is sometimes used, which means that the mother will not be awake to have skin-to-skin contact with the baby right after the birth. If both the mother and baby are healthy after delivery, they will need to stay at the hospital for 2-3 days. In some cases, if there are complications after the procedure, the mother will have to stay at the hospital for 7-10 days.

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

In most cases, without a C-section the mother and/or baby are at risk of loss of life. Undergoing a C-section therefore will often save the mother and/or the baby's lives.

What potential side effects or risks come with this treatment?

Risk to the mother's health include infection inside the womb or at the opening site, postpartum hemorrhage or during the procedure, blood clots, splitting stitches, injury to the organs and/or blood vessels, reaction to anesthesia and the possible inability to deliver vaginally in the future. Risks to the baby include accidental injury during the C-section and temporary breathing problems after the birth.

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

C-sections are performed in most district level hospitals in Thailand. However, it is very expensive and most migrants and refugees, without health insurance, cannot afford to access this care.

What are the alternatives to this treatment?

There is no alternative to an emergency C-section without risking mother and baby's lives. However, it is still common practice to give birth at home with a traditional birth attendant amongst refugee and migrant communities in Thailand. During a home birth, a woman will first try to give birth vaginally. If there are complications, the woman will be rushed to a hospital or clinic for an emergency C-section.