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Exploring caesarean sections from a training perspective in a low and middle-resource setting
Thesis (PhD)--Stellenbosch University, 2025.
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| Format: | Thesis |
| Language: | English |
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Stellenbosch : Stellenbosch University
2025
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| _version_ | 1867613905449123840 |
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| access_status_str | Open Access |
| author | De Waard, Liesl |
| author2 | Gebhardt, Gabriel Stefanus |
| author_browse | De Waard, Liesl Gebhardt, Gabriel Stefanus |
| author_facet | Gebhardt, Gabriel Stefanus De Waard, Liesl |
| author_sort | De Waard, Liesl |
| collection | Thesis |
| dc_rights_str_mv | Stellenbosch University |
| description | Thesis (PhD)--Stellenbosch University, 2025. |
| format | Thesis |
| id | oai:scholar.sun.ac.za:10019.1/134591 |
| institution | Stellenbosch University (South Africa) |
| language | English |
| last_indexed | 2026-06-10T12:43:34.445Z |
| license_str | Other — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from SUNScholar — Stellenbosch University Repository |
| publishDate | 2025 |
| publishDateRange | 2025 |
| publishDateSort | 2025 |
| publisher | Stellenbosch : Stellenbosch University |
| publisherStr | Stellenbosch : Stellenbosch University |
| record_format | dspace |
| source_str | SUNScholar — Stellenbosch University Repository |
| spelling | oai:scholar.sun.ac.za:10019.1/134591 Exploring caesarean sections from a training perspective in a low and middle-resource setting De Waard, Liesl Gebhardt, Gabriel Stefanus Archer, Elize Chu, Kathryn Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Obstetrics & Gynaecology. Cesarean section -- Complications Obstetrics -- Study and teaching Mothers -- Mortality Thesis (PhD)--Stellenbosch University, 2025. De Waard, L. 2025.Exploring Caesarean Sections from a Training Perspective in a Low and Middle-Resource Setting. Unpublished doctoral dissertation. Stellenbosch: Stellenbosch University [online]. Available: https://scholar.sun.ac.za/items/664c7131-d922-4c13-9fac-facb3293519e ENGLISH ABSTRACT: There is a global concern regarding the poor outcomes and mortality associated with Caesarean Sections (CS) in Low- and Middle-Income Countries (LMIC), with a 100-fold increase in case fatality rates compared to CS conducted in High Income Countries (HIC). CS are the most common surgical procedures globally, yet the way this is taught and learned remains poorly described. This research aimed to explore how CS training can be improved in low-resource settings to ensure patient safety. Four studies were conducted in pursuit of that goal. By means of a scoping review, the available literature on CS training was reviewed. The limited number of relevant articles – only 45 articles published from 2001 onward - points to a significant gap in the literature, particularly in LMIC settings and in research reporting clinical outcomes. Studies that showed promise were those using low-cost simulators, in-situ training and simulation, the use of competency assessment strategies and broader emergency obstetric training programs. The second study, a global survey, compared CS training practices used in HIC with those in LMIC. There were 411 participants representing 42 countries. This study showed that participants from LMIC received less supervision, progressed earlier to independent practice and experienced more complications. Participants expressed the need for formalised training strategies in CS. The third study explored the experiences of obstetric clinicians involved in training junior doctors CS. This cross-sectional qualitative study involved 12 CS trainers, who were interviewed using semi-structured interviews. The study noted that teaching CS is complex and often anxiety-provoking, especially when trainers are still inexperienced. A stepwise teaching approach was favoured by most trainers, mirroring the way they were trained. Several factors influenced the ease of training, including the trainee's attitude and skill level; the theatre environment; particularly case duration and complexity; and the trainer's experience. Suggested strategies for improving training, including standardising CS, incorporating knowledge and skill aspects into undergraduate training, and supporting supervisors. The fourth study, an observational study of intraoperative teaching, focused on understanding instructional methods and pinpointing the surgical steps that trainees struggled with or took the longest to perform. This study demonstrated that teaching was approached stepwise, often beginning with less risky steps, such as skin and rectus sheath closure. The steps trainees struggled with the most were fetal head delivery and adhesiolysis, while rectus sheath closure and uterine incision took significantly longer to complete. These studies revealed several overarching findings. There is a lack of robust research on CS training. Training approaches vary significantly in high-resource settings compared to low-resource settings. Intraoperative learning follows a stepwise process, with some steps being more straightforward to master than others; however, baseline skills are often lacking. Teaching CS is a complex endeavour, hindered by numerous barriers. To improve CS training in low-resource settings, we need to improve research, standardise training, assess competence with validated tools, and challenge the current culture of CS training by committing to an evidence-based approach. Changing the culture of CS training is not just about teaching - it is about saving lives. AFRIKAANSE OPSOMMING: Geen opsomming beskikbaar. Doctoral 2025-12-15T13:33:34Z 2025-12-15T13:33:34Z 2025-12 Thesis https://scholar.sun.ac.za/handle/10019.1/134591 en Stellenbosch University 174 pages : illustrations application/pdf Stellenbosch : Stellenbosch University |
| spellingShingle | Cesarean section -- Complications Obstetrics -- Study and teaching Mothers -- Mortality De Waard, Liesl Exploring caesarean sections from a training perspective in a low and middle-resource setting |
| title | Exploring caesarean sections from a training perspective in a low and middle-resource setting |
| title_full | Exploring caesarean sections from a training perspective in a low and middle-resource setting |
| title_fullStr | Exploring caesarean sections from a training perspective in a low and middle-resource setting |
| title_full_unstemmed | Exploring caesarean sections from a training perspective in a low and middle-resource setting |
| title_short | Exploring caesarean sections from a training perspective in a low and middle-resource setting |
| title_sort | exploring caesarean sections from a training perspective in a low and middle resource setting |
| topic | Cesarean section -- Complications Obstetrics -- Study and teaching Mothers -- Mortality |
| url | https://scholar.sun.ac.za/handle/10019.1/134591 |
| work_keys_str_mv | AT dewaardliesl exploringcaesareansectionsfromatrainingperspectiveinalowandmiddleresourcesetting |