Health
Gynecologist’s caution pregnant women against Vaginal delivery after two CS
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
Over 2000 Nigerian Resident Doctors Yet To Receive Seven-Month Arrears Under Tinubu Govt
The National Association of Resident Doctors (NARD) has disputed the Nigerian government’s claim that outstanding arrears of the 25–35 per cent Consolidated Medical Salary Structure (CONMESS) adjustment have been fully paid, revealing that thousands of doctors are still owed.
Speaking on Channels Television on Friday, NARD National President, Dr Mohammad Suleman, said more than 2000 resident doctors are yet to receive the seven months’ arrears, despite assurances from the President Bola Tinubu-led government.
“On the seven months’ arrears of 25–35 per cent, we still have over 2,000, almost 3,000 of our members who are yet to be paid those arrears,” Suleman said.
The Nigerian government had earlier stated that seven out of the 19 demands presented by the association had been statutorily addressed, including the payment of the CONMESS adjustment.
However, Suleman described the government’s approach as inconsistent, noting that the issue had repeatedly been pushed into service-wide vote provisions rather than being properly captured in the national budget.
“In 2023, it was said to be put inside the service-wide vote if it wasn’t paid. In 2024, it was put in the service-wide vote; in 2025, it was again put there,” he explained.
According to him, resident doctors should not have to rely on repeated special interventions by the President before their lawful entitlements are honoured.
“The President had to make special provision when doctors agitated for that money to be paid. Are we saying these arrears have to go through that route of waiting for service-wide vote after service-wide vote and waiting for the President of the country to specifically intervene before they are captured in the budget?” he asked.
Suleman confirmed that negotiations were ongoing with the Federal Government and the Ministry of Health, expressing cautious optimism that concrete progress could be achieved before the weekend.
“Right now, we are in discussions with the Federal Government team. I would hope that from tonight to tomorrow, to Sunday, a lot of things are going to be done in the proper way,” he said.
He added that any decision on the planned industrial action would be guided by evidence of government goodwill rather than legal threats.
“So that the National Executive Council will now look at it, not in the context of court injunctions and ‘no work, no pay,’ but in the context of what has been done and the evidence that good faith is on the table,” Suleman stated.
Despite a court injunction restraining the association from proceeding with its planned strike, the NARD president insisted that the resolve of its members remained firm.
“I am making it very clear that the resolve of our members is not shaken by all these. All these were factored into the decision to embark on this strike,” he said.
When asked whether the nationwide strike scheduled to commence on Monday would still hold, Suleman said the final call rested with the association’s leadership.
“Unless the National Executive Council of the Nigerian Association of Resident Doctors says otherwise,” he said.
He also questioned whether the court order adequately addressed the realities facing doctors and patients across the country.
“Are we ignoring the sufferings that doctors are going through in this country? Are we ignoring the suffering that patients go through because doctors are exhausted, frustrated and have difficulties executing their jobs?” he asked.
The National Industrial Court of Nigeria in Abuja had on Friday ordered NARD and its members to suspend the strike slated for January 12. The injunction, granted by Justice Emmanuel Subilim, followed an application filed by the Federal Government and the Attorney General of the Federation after submissions by the Ministry of Justice.
NARD, however, has maintained that it plans to proceed with a total, indefinite strike, citing the Federal Government’s failure to fully implement agreements contained in a Memorandum of Understanding signed after the last strike was suspended on November 29. The association also dismissed allegations that its actions were politically motivated.
Health
Include TXA in delivery kits to reduce maternal deaths, WARDC urges govts
By Francesca Hangeior
The Women Advocates Research and Documentation Centre has called on governments and key stakeholders to urgently integrate tranexamic acid into standard delivery kits across Nigeria to reduce maternal deaths caused by post-partum haemorrhage.
According to the World Health Organisation, PPH, also known as severe bleeding after childbirth, is the leading cause of maternal mortality worldwide.
It noted that every year, about 14 million women experience PPH, resulting in about 70,000 deaths globally.
To reduce the incidence of PPH, the WHO in 2017 recommended the early use of intravenous TXA within three hours of birth, alongside standard care, for women diagnosed with PPH after vaginal or caesarean delivery.
WARDC says PPH remains one of the leading causes of maternal death in Nigeria, contributing significantly (almost 25 per cent) to the country’s unacceptably high maternal mortality ratio.
Speaking at a press briefing marking the closing ceremony of the rights group’s 12-month-long community-focused intervention, the Founding Director of WARDC, Dr Abiola Akiyode-Afolabi, said awareness was insufficient without interventions to ensure lifesaving medicines are readily available where women give birth.
She stressed that tranexamic acid, commonly known as TXA, has been proven to reduce bleeding after childbirth significantly, but remains largely inaccessible to many women due to cost and policy gaps.
“While awareness is critical, awareness alone cannot save lives. For tranexamic acid to truly reduce maternal mortality in Nigeria, system-level action is urgently required,” she said.
In outlining specific demands, Akiyode-Afolabi urged the governments to prioritise public funding and access to the drug across the three healthcare levels.
She said, “Federal and state governments to subsidise and include tranexamic acid in all standard delivery kits in public health facilities, and ensure TXA is consistently available at primary, secondary, and tertiary levels of care.”
She also called for stronger policy integration and capacity building within the health system to support effective use of the drug.
“Health authorities and regulators to integrate TXA fully into maternal health protocols, emergency obstetric guidelines, and training curricula for healthcare workers. There’s an urgent need to strengthen supply chains so that cost, stock-outs, and access barriers do not continue to cost women their lives,” Akiyode-Afolabi said.
According to her, development partners and donor agencies also have a critical role to play in scaling interventions that have shown measurable impact at the community level.
She said, “Development partners and donors to support scale-up of successful community engagement models like Project TRANSFORM, and invest in sustained advocacy, training, and monitoring to ensure long-term impact.”
She noted that progress in reducing maternal deaths depends on collective responsibility and evidence-driven action.
“When communities are informed, stakeholders collaborate, and evidence guides advocacy, change is possible,” she said.
However, she cautioned that such progress would remain limited without strong political backing and sustained investment.
The WARDC founding director noted, “However, for that change to translate into lives saved, it must be matched with political will, adequate financing, and institutional commitment.”
Akiyode-Afolabi described maternal deaths from post-partum bleeding as unacceptable, given the availability of effective and affordable medical solutions.
“No woman should die while giving birth. No family should lose a mother, daughter, spouse, or sister to a preventable cause.”
She added that denying women access to proven medicines undermines efforts to improve maternal health outcomes nationwide.
“And no proven, affordable medicine like TXA should remain out of reach,” she said.
Akiyode-Afolabi explained that WARDC, with technical and research support from the London School of Hygiene and Tropical Medicine, had, in the last 10 months, embarked on a community-focused intervention aimed at reducing maternal mortality in Nigeria through improved awareness, access, and advocacy for tranexamic acid.
“Over 20,000 people were reached through physical, community-based engagements, including town hall meetings, grassroots dialogues, engagements at primary healthcare centres, faith-based spaces, and market outreaches,” she said.
Through these efforts, she said Project TRANSFORM contributed to increased awareness, improved community knowledge, and stronger public discourse around preventable maternal deaths and evidence-based solutions.
Health
Gynaecologist cautions women against ‘cryptic pregnancy’ fraud
By Francesca Hangeior
A Consultant Gynaecologist and Obstetrician, Dr Abosede Lewu, says cryptic pregnancy is a real medical condition but is often misunderstood and exploited by fraudsters.
According to the American Pregnancy Association, a cryptic pregnancy, also known as a stealth pregnancy, is when a woman doesn’t know she’s pregnant.
Lewu, who is also the Chief Medical Director of ORB Women’s Clinic, Lagos, told the News Agency of Nigeria that cryptic pregnancy referred to a real pregnancy.
She explained that in such cases, a woman would be unaware of her condition until about five months into the pregnancy or beyond and in some cases, women only discovered they were pregnant when they went into labour.
“Cryptic pregnancy is a real pregnancy. The major difference between it and every other pregnancy is awareness.
“The woman is pregnant but does not know,” Lewu said.
According to her, cryptic pregnancy is more likely to occur in women with menstrual irregularities or those who have gone for long periods without menstruation.
She explained that women approaching menopause could also experience cryptic pregnancy, as their menstrual cycles may already be irregular, occurring once in three or six months.
“So, when they become pregnant, they may assume the symptoms they are having are just part of the changes associated with nearing menopause,” she said.
Lewu added that breastfeeding women were also at risk, noting that many new mothers do not resume menstruation until they stop breastfeeding effectively.
“As a result, such women can actually be pregnant without knowing, because they believe their period is yet to return,” she said.
The gynaecologist warned that a cryptic pregnancy had its own dangers because it was usually unplanned, with the woman not preparing for it medically or emotionally.
She also cautioned that some unscrupulous individuals exploited the concept of cryptic pregnancy to scam desperate women trying to conceive.
“Some scammers take advantage of women by claiming to see a pregnancy and continue to pump them with medications to stop their periods.
“When such women visit diagnostic centres for scans, there is usually no evidence of pregnancy, unlike in genuine cryptic pregnancy, where a real pregnancy exists.”
She advised women to be cautious, stressing that if only one person claimed to see a pregnancy, while no independent medical test confirmed it, then it was likely a scam.
“As a woman, if you are working with someone who claims to be helping you get pregnant and only that person can see the pregnancy, then you are being scammed,” she said.
Lewu warned that one of the dangers of receiving care from such scammers was the use of unregulated hormones, which could expose women to severe, life-threatening medical conditions, either immediately or later in life.
She further stressed that there was no secrecy in a genuine cryptic pregnancy and that nobody induces cryptic pregnancy in a woman.
“One way these scammers remain relevant is by forcing women into secrecy.
“The whole experience of the so-called pregnancy and baby delivery is shrouded in secrecy, and the women are discouraged from sharing their experiences,” she said.
Lewu noted that the journey to having children varied from woman to woman and from family to family.
She advised women experiencing delays in achieving pregnancy not to allow desperation to push them into the hands of unqualified persons.
“For women and families facing fertility challenges, it is important to see a qualified gynaecologist for proper evaluation and to explore safe, acceptable and medically sound options to achieve pregnancy,” she said.
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