The burden of caesarean section refusal in a developing country setting.

Objective  To investigate the prevalence, aetiology and outcomes of caesarean section refusal in pregnant women. Design  A prospective controlled study. Setting  University of Nigeria Teaching Hospital and Aghaeze Hospital, Enugu, Nigeria. Population  A total of 62 Nigerian women who declined elective caesarean section. Method  Interviewer-administered questionnaires at the time of caesarean section refusal and postdelivery. The delivery outcomes of the subjects were compared with that of a matched control group of women who accepted caesarean section. Main outcome measures  Prevalence, maternal reasons for caesarean section refusal and the resultant maternal and perinatal mortality. Results  The prevalence of caesarean section refusal was 11.6% of all caesarean deliveries. Maternal reasons for refusing caesarean section include fear of death, economic reasons, desire to experience vaginal delivery and inadequate counselling. Outcomes were significantly worse among women who refused elective caesarean section than in the controls with a maternal mortality of 15% (versus 2%, P = 0.008) and a perinatal mortality of 34% (versus 5%, P < 0.001). Conclusion  There is a high prevalence of caesarean section refusal in south-eastern Nigeria. Women declining caesareans have very poor maternal and perinatal outcomes and need extra support.