Maternal health experts have urged pregnant women with a history of two caesarean sections to register and receive antenatal care in secondary and tertiary health facilities rather than in Primary Healthcare Centres.

They noted that pregnant women with such a history have a high-risk pregnancy and need expert care and facilities that the PHCs do not have.

The gynaecologists, in separate interviews with PUNCH Healthwise, emphasised that early antenatal registration at the appropriate centre would help to prevent delays and complications, which could be life-threatening for both mother and baby.

The reproductive health experts also urge expectant mothers with hypertension, diabetes before or during pregnancy or a history of miscarriages to register and attend antenatal care in higher-level facilities such as general and tertiary hospitals.

They urged every pregnant woman to register and attend antenatal care in registered hospitals to ensure they receive the best care and prevent avoidable complications and deaths.

PUNCH Healthwise reports that pregnant women should register and begin antenatal care as soon as pregnancy is confirmed with a positive test, ideally within the first eight to 12 weeks.

PUNCH Healthwise also reports that expectant mothers who have undergone two caesarean sections should not attempt vaginal birth to prevent the rupture of the uterus and bleeding.

Severe bleeding after childbirth is the leading cause of maternal mortality worldwide, according to the World Health Organisation.

High blood pressure disorders during pregnancy, infections and complications from unsafe abortions are contributors to maternal deaths.

The 2018 National Demographic and Health Survey puts Nigeria’s maternal mortality rate at 512 deaths per 100,000 live births.

Speaking with PUNCH Healthwise on the matter, a professor of Obstetrics and Gynaecology at the University College Hospital, Ibadan, Oyo State, Chris Aimakhu, explained that while low-risk pregnancies could be safely managed at primary healthcare facilities, women with high risk pregnancies, including those who have previously undergone caesarean deliveries, need specialist care, which is available in general and tertiary healthcare centres.

Aimakhu said, “Every pregnant woman should access antenatal care. But those with high-risk conditions such as previous CS, hypertension or diabetes must be managed in facilities that can handle emergencies. A primary health centre does not have the capacity to perform a caesarean section. If such women are booked there, it puts both mother and child at serious risk.”

He noted that many primary healthcare centres, especially in rural communities, are poorly staffed and often run without doctors, midwives or round-the-clock services, leaving them unequipped to handle obstetric emergencies.

“In situations where a woman with a previous CS registers in a PHC, and complications arise, delays in referral may lead to avoidable maternal or neonatal deaths,” the don added.

The gynaecologist further asserted that antenatal care was not optional, lamenting that Nigeria still records high maternal mortality due to preventable causes such as postpartum bleeding and pregnancy-induced hypertension.

The maternal expert, however, clarified that not all pregnant women need to register at teaching hospitals, stating that women who register in PHCs and are in need of specialist care should be immediately referred to the appropriate centres.

“Low-risk patients can safely receive care in PHCs or secondary hospitals if those centres know what they can handle. But once a patient has a history of caesarean deliveries, she belongs to the high-risk category.

“The key is not only access but timely access. If a facility knows it cannot handle a case, it must not keep the woman until it is too late,” Aimakhu asserted.

Also, the president of the Association for Fertility and Reproductive Health, Professor Preye Fiebai, dispelled the notion that all pregnant women must seek antenatal care in tertiary hospitals, stressing that well-equipped primary health centres can effectively manage uncomplicated pregnancies.

“Antenatal care doesn’t have to be in a tertiary hospital. If we have good primary health care, you can start from there. Ideally, the essence of primary care is to identify those who require higher care and then refer them, but most people go straight to the teaching hospital. However, you can still receive good antenatal care if the setup of your primary healthcare system is good and you have qualified people to run it, and you can start from there.

“Mind you, some people go to private hospitals also and if you can afford it, why not?” the reproductive health expert said.

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