“The pelvic outlet on a girl of 11 or 12 – you could no more get a baby through there than the moon.”

Judy is a registered nurse who has worked for many years with nursing communities across Africa, delivering training and supporting the vital role of nursing in safe surgery.

Why is a C-section necessary?

Surgery is essential because it’s life-saving. Women die without one. But with this one operation you’re saving two lives.

You always need a C-section for obstructed labour or prolonged labour, and sometimes for breech. And of course for the younger ones, whose pelvises are not big enough. The pelvic outlet on a girl of 11 or 12 – you could no more get a baby through there than the moon.

Why don’t women in low-resource countries get the operations they need?
When you look at a C-section it’s a relatively straightforward procedure – incision, muscle, uterus, get the baby out. But so many hospitals don’t have the right equipment, or the only surgeon isn’t there. Or there’s an even worse case ahead of you.

These hospitals deal with a huge catchment area, and the women are far away. They’ve been laboring for days before they walk in – or wheel in, if they’re lucky enough. The mother arrives exhausted (goodness, you try walking a few miles in labour). And the foetus will be incredibly distressed, if not dead.

On my last visit I saw a woman who had been in second stage labour for two days, lying there, saying “that’s it. I can’t push anymore.”

What happens if you can’t get a C-section in time?
After prolonged obstructed labour the baby dies in utero and starts to decompose. The mother becomes toxic and her body tries to push it out.

Depending on how many children she’s had, her uterus may burst, in which case there’s bleeding – so much bleeding their blood won’t clot any more, and without the right transfusion or a hysterectomy they’ll bleed to death.

I saw a case like that recently in Ethiopia. Holding the mother’s hand, I didn’t speak the language – but there’s a body language that is universal, isn’t there.

What happens next?

For the mother? She’s shattered. Nine months of pregnancy and she looses the baby. She cries. She goes home. Life is pitched against you.

And if she dies but the baby survives? Devastation visited on the family. Who is going to look after the children?

What about when it goes right?

When a baby is delivered safely – in two minutes it’s as though it were born with clothes! They wrap it up – nappy, blanket, second blanket, this big rolled wodge, and the mother carries it around with a little face poking out. It’s the start of everything.

So yes, safe surgery is a women’s issue. But really, it’s a world issue.