Olga Singo, a 26-year-old from the Zimbabwean city of Bulawayo, gave birth to her first child by cesarean section last year.
"It was unplanned. It came as an emergency. I was told that my baby was big and that she was not in a position to follow through the delivery process," she said. "I was so scared I thought I was going to die during the process because I did not have enough information on c-section."
She gave birth to daughter Charlene with few complications, but her fear of the procedure was well-founded, according to a new study.
African mothers who give birth by cesarean section are 50 times more likely to die after the procedure than women living in high-income countries, the research says.
The study, published Thursday in the journal Lancet Global Health, found that the maternal mortality rate in African countries was "substantially higher than expected": 5.43 deaths per 1,000 operations, compared with 0.1 deaths per 1,000 operations in the UK, the authors said.
Similarly, 1 in 6 African women experienced complications during cesarean surgery, three times the rate of women in the United States.
Bruce Biccard, an anesthesiologist and professor at the University of Cape Town who led the research, said that three-quarters of the women in the study had an emergency c-section. "Women can't access care easily, and when they do, they end up in a health care facility that's often inadequate," he said.
The research studied 3,684 women who had elective and non-elective cesarean deliveries, using data from 183 hospitals across 22 countries in Africa. It formed part of the African Surgical Outcomes Study, which measured the outcomes of all patients who received surgery during a seven-day period between February and May 2016.
Cesarean section is a surgical procedure in which a child is removed through a surgical opening in the mother's lower abdomen rather than birthed through the vaginal canal. Procedures can be planned, but many occur when unexpected childbirth problems arise, putting the mother's and/or the infant's life at risk.
Mothers in sub-Saharan Africa are far less likely to give birth via c-section than elsewhere in the world, where c-sections have been on the rise.
Biccard said it was important to increase access to the procedure in parallel with improving the safety of c-sections in Africa
"Paradoxically, while many countries are aiming to reduce the caesarean delivery rate, increasing the rate of caesarean delivery remains a priority in Africa. In sub-Saharan Africa, the caesarean delivery rate is static at 3.5%, despite an increasing pattern in rates globally. "
The results of the study underscored the need for more specialist surgical, obstetrical and anesthetics care, Biccard said.
The study found that there was an average of 0.7 specialists per 100,000 people in the countries in the study. Biccard said that figure should be at least 22 per 100,000 people to obtain a safe minimum standard.
The study had some limitations, the authors noted, with a disproportionate number of participating hospitals university-affiliated rather than district hospitals, which act as first-level providers of care for most African women and typically have fewer resources. Also, two-thirds of patients were from middle-income countries, where better levels of care are available than in Africa's poorest countries.
"The true morbidity and mortality after caesarean section on the continent is therefore likely to be higher than reported," said Anna Dare of the Centre for Global Health Research, St. Michael's Hospital and the Department of Surgery at the University of Toronto.
"Making childbirth safer for African mothers will require dedicated efforts to make caesarean section much safer as well. This improvement in safety must occur while simultaneously striving to avoid the overuse of caesarean section, which many other countries are now grappling with," she said in a commentary published alongside the study in Lancet Global Health.