Health
Gynecologist’s caution pregnant women against Vaginal delivery after two CS
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By Francesca Hangeior
Attempting labour and vaginal delivery after two previous caesarean sections could lead to a rupture of the uterine scar, resulting in severe bleeding and possible death of the expectant mother and her baby, maternal experts have warned.
The gynaecologists further noted that such deliveries posed risks of head compression and low oxygen supply and intake, leading to malformations.
The experts’ warning comes amid the stigma surrounding CS and the insistence of many Nigerian women who have previously undergone the procedure to attempt vaginal delivery in subsequent births.
Bleeding during and after delivery is a major cause of maternal mortality worldwide and in Nigeria.
In fact, it is the leading cause of maternal mortality in Nigeria, a country with one of the highest MMR in Africa.
The Nigeria Demographic and Health Survey, 2018, pegs the MMR at 512 deaths per 100,000 live births.
According to the World Health Organisation, every year, about 14 million women experience postpartum haemorrhage, resulting in about 70,000 maternal deaths globally.
A new study released by the WHO two weeks ago further revealed that severe heavy bleeding and hypertensive disorders like preeclampsia are the leading causes of maternal deaths globally.
It noted that the conditions were responsible for about 80,000 and 50,000 fatalities, respectively, in 2020, indicating that many women still lack access to lifesaving treatments and effective care during and after pregnancy and birth.
The experts urged expectant mothers to register for antenatal care and ensure delivery in healthcare facilities with skilled birth attendants to reduce risks and ensure optimum care for both mother and child.
A recent study on “Trial of labour following two previous caesarean sections – A UK cohort study” concluded that women considering a trial of labour following two caesarean sections had an increased risk of endometritis (infection of the inner lining of the uterus), sepsis and adverse neonatal outcome.
Providing expert insight into the matter, a Professor of Obstetrics Gynaecology at the College of Health Science, University of Uyo, Akwa Ibom State, Aniekan Abasiattai, explained that after a woman undergoes CS, the cut, after healing, forms a scar.
The don added that a woman who has undergone CS twice and in subsequent pregnancy attempts to go into labour and vaginal delivery, had an increased risk of tearing the scar, leading to bleeding.
He further noted that although women who have had one caesarean delivery could be allowed to attempt a vaginal delivery, it was done in specialised units and with close monitoring.
“Now, after two caesarean sections, because of the increased risk of rupture of the scar, which is much more than that of a previous caesarean delivery, in this environment, we usually do not allow our patients to attempt a vaginal delivery after two previous caesarean sections. That’s the standard in this country.
“I’m aware that there are varying publications of successful vaginal deliveries after two previous caesarean sections, both in the developed world, foreign literature, and even among a few of our colleagues, but we usually do not, that is not the accepted practice, basically, because of the increased risk of infection following surgical procedures, deliveries, whether vaginal or caesarean delivery,” Abasiattai said.
Speaking on the impact on the babies, the gynaecologist said, “When the uterus ruptures, it cuts off and the baby becomes affected directly. Low oxygen transfer, hypoxia sets in, and the rate of death or foetal mortality is quite high. Even in some instances, more than 50 per cent following rupture of the scarred uterus.
“So apart from the fact that the woman can have complications from excessive haemorrhage from the torn uterus, the baby, in a significant proportion of cases, dies inside the uterus. Unless surgical intervention is done promptly to arrest the ongoing haemorrhage, repair or stop the bleeding and then deliver the baby.”
The researcher on Community Obstetrics, Fetomaternal Medicine and Reproductive Health urged women who have had previous CS to refrain from having their next delivery at unconventional health facilities, stating that they had an increased risk of a ruptured uterus, among other complications.
Also, a Professor of Obstetrics and Gynaecology at the Obafemi Awolowo University, Ile-Ife, Osun State, Ernest Orji, stated that it was not safe for a woman to attempt labour and vaginal delivery after having two caesarean sections.
He explained, “It’s risky because the womb has been cut two times, and they say you don’t use a wounded soldier to go to battle. The chances of tearing or rupturing during labour are high.
“That’s why we tell women that if you have had caesarean section two times it is not safe to allow you to go into labour because during labour, the womb will be contracting and pushing and so the risk of the womb rupturing and the mother and baby dying is very high.”
The don stated that although there were reports of some women who despite having a history of two CS, tried vaginal delivery and went unscathed, such procedure was not advisable.
Speaking on the implications for the mother and baby, Orji said, “The first danger is that the womb can tear and when that happens, the baby may die depending on the site of the tear. The tear would make the woman start bleeding and when the bleeding is too much, she can bleed and die.
“When the woman is bleeding and is rushed to the hospital, sometimes, by the time they come to the hospital, it may be too late and you will have to remove the womb.
“So, apart from the risk that the woman may die, another risk is the fact that you may have to remove the womb because the womb may be so damaged that it can no longer be repaired.”
The researcher on Reproductive and Feto-maternal health further stated that the babies born through such a process may have their heads compressed, which could affect the babies’ brain and intellectual performance later in life.
Health
DR Congo Ebola outbreak tops 1,000 cases, kills 254
More than 1,000 Ebola infections have been recorded in the Democratic Republic of Congo, where the latest outbreak has killed more than 250 people, official figures showed Monday.
The country’s National Institute of Public Health (INSP) confirmed 1,003 cases and 254 deaths, with a fatality rate of 25 percent.
The latest outbreak of the deadly haemorrhagic fever was declared on May 15.
Almost all cases are in Ituri province in the northeast, a conflict-weary region plagued by armed groups.
In total, three provinces have been affected: Ituri, neighbouring North Kivu and South Kivu, home to around 15 million people.
The virus has also spread to neighbouring Uganda, where the World Health Organization has recorded 20 cases and two deaths, though Kampala said the situation was “under control” earlier this month.
The outbreak is caused by the rare Bundibugyo strain of the virus, for which there is no vaccine or specific treatment.
Existing Ebola vaccines, developed between 2018 and 2019, are only effective against the Zaire strain, which caused previous major outbreaks.
The World Health Organization has declared an international public health emergency, warning the outbreak could last months.
“The outbreak was declared around two months after the first suspected deaths were reported… During that time, the disease spread unchecked in ways we still don’t fully understand,” an international aid group representative told AFP, speaking anonymously.
AFP
Health
Fed govt moves to prevent Ebola outbreak, sets up presidential task force
The federal government on Thursday inaugurated a Presidential Task Force on Ebola Virus Disease Preparedness, declaring that Nigeria would not wait for an outbreak before taking action and vowing to prevent a repeat of the 2014 Ebola scare.
Chief of Staff to the President, Femi Gbajabiamila, said the task force was established as a proactive measure to ensure the country is fully prepared against any possible outbreak of the deadly disease, even as he confirmed that no case of Ebola has been reported in Nigeria.
Speaking with State House correspondents after inaugurating the task force at the State House, Abuja, Gbajabiamila said the government’s focus is on prevention rather than response, stressing that authorities were determined not to be caught unprepared.
“We did the inauguration today on the preparedness of Nigeria for the Ebola virus disease. We’ve covered a lot of ground. Right now, there’s no reported case, which is good news, and that’s why all hands have to be on deck to make sure the measures we are taking are preventive, not curative.
“We don’t want to be in the situation we were last time, where we had a carrier in the country and we’re all running helter-skelter”, he said.
He disclosed that the task force had established several subcommittees to coordinate critical areas of preparedness, including surveillance, border control, immigration management and emergency response.
According to him, one of the key lessons from the 2014 outbreak is the need for stronger coordination among all stakeholders, particularly between the Federal Government and states with international points of entry.
Gbajabiamila noted that governors and representatives of states hosting international airports, including Lagos, Rivers, Enugu and the Federal Capital Territory, participated in the meeting, describing the collaboration as essential to preventing the virus from entering the country.
He said special attention was also being given to Nigeria’s extensive land borders, warning that disease transmission through informal migration routes posed a significant risk.
“Normally, when people talk about emergency preparedness and cross-border diseases such as this, they think about airports. But now we’re covering not just airports; we’re placing greater emphasis on land borders.
“We have a lot of cross-migration through the land borders, and the Border Control Development Agency is involved, immigration is involved, and a lot of the border communities are involved”, he said.
The Chief of Staff said the government had drawn valuable lessons from the country’s successful containment of the Ebola outbreak in 2014 and was building stronger structures to eliminate gaps in preparedness.
“What we want is a zero case, as we have now. We want to maintain a zero case”, he added.
Also speaking, Director-General of the Nigeria Centre for Disease Control and Prevention (NCDC), Dr. Jide Idris, said surveillance systems had already been strengthened at major points of entry across the country, particularly airports.
He confirmed that Nigeria currently has no recorded case of Ebola but stressed that preparedness remained critical given recent developments in parts of Africa.
“The focus is to be prepared. We don’t have any Ebola case here now, but we need to be prepared. We need to ensure that we don’t get that Ebola virus here.
“However, just in case one slips in, we want to be prepared nationally to identify and deal with the case”, Idris said.
The NCDC boss explained that existing disease surveillance and emergency response structures were being upgraded and adapted specifically to address Ebola-related threats.
He said the preparedness framework brings together multiple government institutions, including the ministries of health, interior and education, as well as immigration, border control agencies and state governments.
According to him, emergency preparedness requires a coordinated national response built on teamwork, clearly defined responsibilities and an effective command-and-control structure.
“The bottom line is that the objective is that we do not allow Ebola to come in. If it does come in, we are prepared to rapidly identify and manage the case nationally”, he said.
Idris added that state governments across the federation had already been mobilised as part of the preparedness strategy, with efforts focused on surveillance, early detection, rapid response and public health coordination.
The inauguration of the task force comes amid heightened vigilance across several African countries following renewed concerns over Ebola outbreaks in parts of the continent.
Health
NARD Issues 21-Day Ultimatum To FG Over Attacks On Doctors
The Nigerian Association of Resident Doctors (NARD) has issued a 21-day ultimatum to the Federal Government to start implementing a national framework for the protection of healthcare workers, following a growing wave of attacks on medical personnel across the country.
NARD issued the ultimatum at a press briefing to end its Ordinary General Meeting (OGM), which took place in Kano. It also declared an industrial dispute with the government over 14 unresolved demands affecting the health sector.
According to the union’s president, Mohammad Suleiman, the rising cases of assault, intimidation, harassment and violent attacks on doctors pose a serious threat to Nigeria’s already fragile healthcare system.
“The OGM observed with grave concern the disturbing rise in cases of assault, harassment, intimidation and violent attacks against doctors across the country while discharging their professional duties.”
Suleiman described the trend as “barbaric, unacceptable and a dangerous threat” to the survival of the health system.
As part of its resolutions, the association demanded the immediate investigation, arrest, and prosecution of perpetrators of attacks on health workers, while urging the government and security agencies to strengthen protection for medical personnel and facilities nationwide. He further added that,
“Consequently, the OGM gives the Federal Government a 21-day window to commence concrete actions towards the development and implementation of a National Healthcare Workers Assault Prevention and Response Protocol, as well as the initiation of the necessary legislative process to address this menace.”
These include the immediate release and payment of the 2026 Medical Residency Training Fund (MRTF), which the association noted remains unpaid despite repeated assurances.
“The OGM demands the release and payment of the 2026 Medical Residency Training Fund to all eligible resident doctors nationwide within the next 21 days,” Suleiman said.
The association also demanded payment of outstanding 25/35 per cent CONMESS arrears, settlement of 19 months of unpaid professional allowance arrears, and clearance of salary and promotion arrears across federal and state health institutions.
It called for correction of discrepancies in professional allowance payments made in May 2026 and settlement of all related arrears.
Welfare and Recruitment Concerns
NARD raised concerns over worsening welfare conditions for house officers, including salary delays, unpaid arrears, and challenges in internship placement and onboarding.
It also demanded full implementation of outstanding provisions in the Medical and Health Workers’ Collective Bargaining Agreement (CBA) and urged government action on excessive workload, prolonged call-duty hours, casualisation of doctors, and abusive locum appointments.
Suleiman criticised delays by the Federal Character Commission (FCC) in issuing compliance letters, saying it has stalled recruitment and worsened manpower shortages in the health sector.
“The OGM demands the immediate issuance of a letter of compliance by the Chairperson of the FCC within the next 21 days to facilitate employment of healthcare workers and avert further worsening of the brain drain crisis,” the NARD chief said.
The association also called on federal and state tertiary health institutions to urgently address welfare, remuneration, infrastructure, and staffing challenges.
It specifically highlighted unresolved disputes at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, and the Lagos University Teaching Hospital (LUTH), including provision of call meals and alleged victimisation of doctors.
Industrial Dispute Declared
While commending the governors of Osun and Kano states, Ademola Adeleke and Abba Kabir Yusuf, respectively, for interventions in the health sector, NARD warned that failure to meet its demands could trigger further industrial action.
“The Association hereby declares an industrial dispute with the Federal Government on the outlined matters above and cannot guarantee industrial harmony after the 21-day window,” it said.
He added that the association’s National Officers Committee would engage stakeholders during the ultimatum period, after which the National Executive Council would determine the next line of action.
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