Living with a non‐healing caesarean section wound: A mini‐review

Maternity statistics indicate that caesarean section (CS) rates exceed the 15% rate advocated by the World Health Organisation. It is observed that CS rates that go beyond this figure are indicative of unnecessary surgery that poses a risk to maternal health. Risk factors associated with poor CS outcomes are also on the rise, along with underlying medical comorbidities such as obesity and diabetes. Currently, there is a lack of information regarding the prognosis of slow to heal CS wounds; the experiences and perspectives of the women living with these wounds; and viable intervention programmes designed to cater to these needs. This is an important area of research as poor postnatal prognosis has been linked to long-term physical and psychological mother-infant outcomes, for example, reduced capacity to breastfeed resulting in the loss of protective factors associated with breastfeeding. On a wider scale, this has significant implications on health service resources with regard to treating chronic conditions and acute/secondary care setting readmissions related to poor post-CS surgery wound healing. We propose that new research is vital for a better understanding of the intricacies and challenges faced by women who are mothering a newbornwhile recovering from a slow to heal CSwound. CS is a surgery that typically involves making an incision on the mother's lower abdomen and uterus in order to deliver one or more babies. As is the case with all types of surgical procedures, there are major risks associated with CS. Some postoperative complications associated with CS include infection and wound dehiscence, which will require further medical attention and stages of disruption to patient lives. One of the key challenges faced by health professionals lies in auditing CS results in order to set national level guidelines and policies. Acute settings vary in birthing practices with CS rates ranging between 10% and 30%, therefore inequalities in maternal outcomes across localities will be inevitable. In a study of maternity units in the United Kingdom, prevalence of CS wound-related complications was reported at 14% with an 84% occurrence following discharge, suggesting a need for improved prevention strategies. Considering costs associated with the increasing demand for CS surgery (£5 million per year for 1% increase) and chronic wound management, it is substantial to argue that more should be done to investigate this gap in knowledge regarding CS wound outcomes. Studies investigating factors associated with post-CS morbidity have identified medical (BMI), non-medical determinants (maternal stress), and soci-demographics (immigration status). However, there remains a lack of understanding of how best to cater to the needs of women at risk of or presenting with non-healing CS wounds in a way that is effective and economically viable. In recent studies, qualitative methodologies have been advocated as a way of capturing and understanding the psychosocial experience of the person living with the wound. It can be argued that this direction is relevant in postpartum care: women who are recovering from a CS have complex, multidimensional needs that are often subjugated by social expectations and subjective ideologies of what it means to be a mother. Similarly, qualitative research is a way of exploring postnatal experiences that are subjective (pain perception) and hallmarked by sociocultural indices as a way of opening up discussions surrounding accessible postnatal care. Despite the known health care cost burden and implications associated with poor obstetric outcomes (impaired lacto production), there remains an absence of published research that explains perspectives and attitudes of women who are experiencing complications with CS wound site healing. Studies have focused on patients' experience with chronic wounds such as leg ulcers or acute wounds from general surgery. However, there is a gap in research investigating wound healing in multifaceted samples such as women recovering from CS surgery. This warrants investigation due to the growing trend of birthing by CS procedures and the increase of risk factors associated with unsatisfactory CS outcomes. Statistics show that approximately one in four birth deliveries in the United Kingdom are now performed by CS. Furthermore, figures indicate inequalities in CS outcomes; CS wound site Received: 31 March 2020 Accepted: 2 April 2020