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Background. The number of maternal deaths from bleeding during and after caesarean section (BDACS) has increased in South Africa. Health-worker training and health-system strengthening are considered important prerequisites for improving maternal health outcomes. Objectives. To determine preparedness for, and health-system constraints to, safe caesarean section in southern Gauteng hospitals. Methods. This was a cross-sectional study in 15 hospitals. Data were collected by questionnaire from clinical heads of department in each hospital. Results. The 15 hospitals included 5 district hospitals, 7 regional hospitals and 3 central (university academic) hospitals. The number of deliveries per hospital ranged from 893 to 44 256 for 2013 - 2014, with a total of 201 314 births and 70 095 caesarean sections (34.8%). Despite similar numbers of births, there were 20 deaths from BDACS at regional hospitals and 6 at central hospitals ( p =0.008). Service delivery constraints included an unequal staff distribution between central hospitals and lower levels of care, as well as non-availability of essential drugs and a lack of surgical capacity to arrest severe haemorrhage at district and regional hospitals. Conclusion. The findings of this study reflect inequity in maternity services. Compared with central academic hospitals, district and regional hospitals are inadequately prepared for the management of complications from BDACS.

Inequities in resources and preparedness for surgical complications of caesarean section in southern Gauteng hospitals