Mariam N., 37

Mariam Nyamvula is a 37-year-old mother of seven living in severe financial hardship. She has had nine pregnancies, including three miscarriages, four vaginal deliveries and two previous Caesarean sections for obstetric complications. She is currently 37 weeks pregnant and requires close medical care because of her two previous Caesarean scars. Her doctors have recommended a repeat Caesarean section, as attempting vaginal delivery may expose her and the baby to serious complications, including uterine rupture, severe bleeding, fetal distress and emergency surgery. Mariam’s family relies on very limited resources to meet basic daily needs, and the cost of surgery, medicines and hospital care is beyond their means. With seven children depending on her, the financial burden of this delivery is overwhelming. In her previous caeserean section, extraction of the baby was difficult and an inverted T section was done, and this always has a very high risk of rupture.

Mariam is a high-risk obstetric patient with two previous Caesarean sections, including a T-shaped uterine scar. Allowing her to progress into labour carries a significant risk of scar dehiscence or uterine rupture, which may cause catastrophic haemorrhage, fetal distress or death, maternal shock, emergency hysterectomy, and maternal death. A planned repeat Caesarean section before the onset of labour is therefore strongly indicated. With timely delivery in a well-equipped hospital with blood, theatre and experienced surgical care available, the prognosis for both mother and baby is generally favourable.