Making cesarean delivery SAFE in low- and middle-income countries

Semin Perinatol. 2019 Aug;43(5):260-266. doi: 10.1053/j.semperi.2019.03.015. Epub 2019 Mar 16.


Cesarean birth (CB) rates are rising, globally. The global burden of CB is having a mixed effect on pregnancy outcomes and requires significant clinical and economic resources. The context of CB care in low- and middle-income countries is further complicated by barriers to facility-based care itself, followed by issues with quality and delivery of care in these resource-limited settings. The objective of this commentary is to propose an original, new, flexible, comprehensive care model for delivering SAFE cesarean delivery care in very low-resource settings. This model, the SAFEmodel for cesarean delivery care in low- and middle-income countries, developed by the authors, does not assume the current care model is working. It does not assume that even traditional hospital settings are what is needed to solve the problem of delivering high-quality, easily accessible CB care in the most remote and geographically isolated communities. The novel model promotes a decentralized care program that brings emergency obstetric care to women instead of the converse through four concepts: the care should be cloSe (community-based), it should be very dedicated to Action (transfer of care), it should be Focused on and highly specific to labor and delivery (cesarean birth center), and finally, it should be committed to high-quality care through iterative Evidence-based quality improvement programming and data collection.

Keywords: Cesarean birth; Facility-based care; Low- and middle-income countries; Quality; Safety.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Adult
  • Cesarean Section* / mortality
  • Delivery of Health Care / standards*
  • Developing Countries
  • Female
  • Humans
  • Infant, Newborn
  • Maternal Health Services / organization & administration
  • Maternal Health Services / standards*
  • Patient Safety
  • Pilot Projects
  • Pregnancy
  • Pregnancy Outcome
  • Quality of Health Care / standards*