Cesarean Section Rates, Indications, and Immediate Outcomes at a National Referral Hospital in Botswana: A Retrospective Study

Cesarean Section (CS) is essential for saving the lives of women and their newborns from pregnancy and childbirth-related complications, but inappropriate use of CS may have potential adverse effects on maternal and neonatal health outcomes. However, there is a paucity of evidence regarding the rate, indications, and immediate outcomes of CS in Botswana. This study aimed to determine the rate, main indications, and immediate outcomes of CS deliveries conducted in Botswana.

A facility-based, retrospective, cross-sectional study design was employed, including a review of total deliveries attended over 12 months at Princess Marina Hospital (PMH), a National Referral Hospital in Botswana. The rate of CS was determined from the total number of deliveries attended in 12 months. Furthermore, 794 CS deliveries were randomly selected from a registry of total CS deliveries to characterize the indications and immediate outcomes. Data extraction was conducted via structured, pretested instruments. Descriptive statistics were used and are presented in tables, charts, and figures.

The rate of CS delivery among total deliveries attended for 12 months was 28.5% (1918/6737). The main indications for CS were fetal distress (23.6%, 187), one previous CS (13.7%, 109), malpresentation (11.4%, 90), two previous CSs (10.8%, 86), and Cephalopelvic Disproportion (CPD) (6.7%, 53). Adverse maternal outcomes accounted for 19 (2.4%) of the reported maternal complications; almost all (18, 95%) of these complications were related to Peripartum Hemorrhage (PPH). A total of 156, 19.6% of CS deliveries, with perinatal adverse outcomes, 3.8% stillborn, and 15.9% presented with complications, which accounted for 93,74.0% of CS deliveries due to a low APGAR score and birth asphyxia (14, 11.0%).

The high cesarean section rate (28.5%) suggests possible overuse or a high-risk population, highlighting the need to promote safe vaginal deliveries. Common CS indications—like fetal distress and previous CS—point to challenges in labor management and the importance of considering vaginal birth after cesarean (VBAC). Maternal complications (2.4%), mainly due to hemorrhage, call for better emergency preparedness. Perinatal adverse outcomes (19.6%), including stillbirths and birth asphyxia, suggest delays in care and gaps in neonatal resuscitation. Overall, the findings emphasize improving labor monitoring, emergency response, and evidence-based CS use.

The CS rate identified in this study was higher than the World Health Organization (WHO) standard recommendation. The main indications for CS were fetal distress and one previous CS. Comprehensively addressing the CS issue needs attention in Botswana to improve maternal and perinatal outcomes. The Ministry of Health in Botswana and healthcare providers need to emphasize strengthening antenatal care services, ensuring that more women have access to skilled healthcare professionals during childbirth, providing appropriate interventions, and reducing the need for emergency and unnecessary CSs. The development of national guidelines on appropriate indications for CS delivery, training healthcare workers, and creating community awareness are recommended.