Why Pregnant Women with Previous Caesarean Sections Should Avoid PHCs for Antenatal Care

Maternal health experts have advised pregnant women with a history of one or more caesarean sections to seek antenatal care at secondary or tertiary hospitals rather than Primary Health Centres (PHCs).

According to specialists who spoke with Punch Healthwise, such pregnancies are classified as high-risk and require expert monitoring and emergency facilities that are often unavailable at PHCs.

Professor Chris Aimakhu, an obstetrician and gynaecologist at the University College Hospital, Ibadan, explained that while low-risk pregnancies can be safely managed at primary health centres, women with prior caesarean deliveries, hypertension, or diabetes should receive care in hospitals equipped to handle complications.

“A primary health centre does not have the capacity to perform a caesarean section. If women with previous CS register there, both the mother and baby are at serious risk,” Aimakhu warned.

He added that most PHCs, especially in rural areas, lack adequate personnel and operate without doctors, midwives, or 24-hour services, leading to dangerous delays in emergency referrals.

The World Health Organisation identifies severe bleeding after childbirth as the leading cause of maternal deaths globally. Other major contributors include pregnancy-induced hypertension, infections, and unsafe abortions. Nigeria’s maternal mortality rate remains high—512 deaths per 100,000 live births—according to the 2018 National Demographic and Health Survey.

Aimakhu further stressed that antenatal care is essential for all pregnant women, and those with high-risk conditions should register early at facilities that can handle emergencies. He also noted that timely referrals between health centres are crucial to preventing avoidable deaths.

“Low-risk patients can safely receive care in PHCs, but once a woman has had a caesarean section, she is high-risk. The key is timely access to appropriate care,” he said.

Echoing this, Professor Preye Fiebai, President of the Association for Fertility and Reproductive Health, clarified that not all women must attend tertiary hospitals for antenatal care. However, he stressed the importance of well-equipped PHCs and trained staff who can identify and refer high-risk cases promptly.

“Antenatal care doesn’t have to be in a tertiary hospital if your primary centre is well-staffed and functional. The goal of primary care is to detect those who need higher-level management and refer them early,” Fiebai explained.

Both experts agreed that expectant mothers with prior caesarean deliveries should not attempt vaginal birth, as it increases the risk of uterine rupture and life-threatening bleeding. They urged women to register for antenatal care as soon as pregnancy is confirmed—ideally within the first 8 to 12 weeks—to ensure safe delivery and reduce the country’s high maternal mortality rate.