Reasons Why Women with Previous C-Sections Should Not Seek Antenatal Care at Primary Health Centers

Maternal health experts have advised that women who have undergone two previous caesarean sections should register for antenatal care at secondary or tertiary hospitals instead of Primary Health Centres (PHCs).

According to them, such pregnancies are considered high-risk and require advanced medical supervision and equipment that PHCs typically lack.

In interviews with PUNCH Healthwise, several gynaecologists highlighted that early antenatal registration in a properly equipped facility can help prevent delays that often lead to serious or fatal complications for both mothers and their babies. They further recommended that women with medical conditions such as hypertension, diabetes (either pre-existing or developed during pregnancy), or a history of miscarriages should receive care at higher-level hospitals where specialist management is available.

The experts reiterated that every expectant mother should register at an accredited hospital as soon as pregnancy is confirmed, ideally within the first eight to twelve weeks, to ensure prompt monitoring and intervention.

Reports by PUNCH Healthwise also caution that women with two previous caesarean deliveries should not attempt vaginal birth because of the increased risk of uterine rupture and heavy bleeding. The World Health Organisation identifies severe bleeding after childbirth as the leading cause of maternal deaths globally, while hypertensive disorders, infections, and unsafe abortions also contribute significantly to maternal mortality.

Data from the 2018 National Demographic and Health Survey show that Nigeria records about 512 maternal deaths per 100,000 live births, one of the highest rates in the world.

Professor Chris Aimakhu, a specialist in Obstetrics and Gynaecology at the University College Hospital, Ibadan, explained that although women with uncomplicated pregnancies can be safely managed at PHCs, those with high-risk conditions—such as a history of caesarean section—should receive care at facilities equipped to handle emergencies.

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 pointed out that many PHCs, especially those in rural areas, lack adequate staffing and essential services. Most do not have doctors, midwives, or 24-hour operations, leaving them ill-prepared to manage 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.

Aimakhu stressed that antenatal care is essential, not optional, and lamented that Nigeria continues to experience high maternal mortality from preventable causes such as postpartum haemorrhage and pregnancy-induced hypertension.

However, he clarified that not all pregnant women need to receive care at tertiary hospitals. Those whose pregnancies are low-risk can safely continue antenatal care in PHCs or secondary hospitals, provided these centres recognize their limits and refer high-risk cases promptly.

“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.

Similarly, Professor Preye Fiebai, President of the Association for Fertility and Reproductive Health, said that while some people believe all pregnant women should attend tertiary hospitals, well-equipped PHCs with qualified staff can still provide quality antenatal care for 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.