Evidence map›Paper›PMID 41334611›Full record

ArticleInternational journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics2026

Current practices in caesarean section training: A cross-sectional study comparing high- and low-middle-income countries.

Liesl de Waard, Elize Archer, Kathryn Chu, Christoffel Joseph Brand Muller, Stefan Gebhardt

Abstract readComparative Study
In one paragraph

Article in International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

5 authors.

Liesl de WaardDepartment of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa.ORCID https://orcid.org/0000-0001-9582-7825
Elize ArcherDepartment of Health Professions Education, Stellenbosch University, Cape Town, South Africa.ORCID https://orcid.org/0000-0002-9739-3730
Kathryn ChuCentre for Global Surgery, Stellenbosch University, Cape Town, South Africa.ORCID https://orcid.org/0000-0002-8923-7447
Christoffel Joseph Brand MullerDepartment of Statistics and Actuarial Science, Stellenbosch University, Stellenbosch, South Africa.ORCID https://orcid.org/0000-0002-0942-3478
Stefan GebhardtDepartment of Obstetrics and Gynaecology, Stellenbosch University, Cape Town, South Africa.

Funding

Discovery Foundation
6 · The paper itself

Abstract

objectiveThis study identifies and describes global caesarean section (CS) training practices, comparing high-income countries (HIC) and low- and middle-income countries (LMIC).

methodsA convergent parallel mixed-methods study was conducted with a cross-sectional survey. The survey was distributed through professional networks and social media. Participation was voluntary and anonymous.

resultsA total of 411 participants from 42 countries were included, with 42% (172) representing HIC and 58% (239) LMIC. Most participants were working in obstetrics and gynecology as specialists (52%, 214) or trainees (26%, 107). Participants from LMIC performed more CS annually, with a mean of 138 (±221) cases, compared to those from HIC with 44 (±64) cases (P < 0.001). Most were taught by an apprenticeship model (75%, 310). Feedback practices were predominantly informal, reported by 64% (263), while formal competence assessment was reported by 22% (38/172) of HIC participants and 9% (21/239) from LMIC (P < 0.001). Participants from LMIC completed fewer supervised cases compared to their HIC counterparts, with a median of 10 (interquartile range 5-20) compared to 50 (interquartile range 30-100) (P < 0.001). LMIC participants reported a higher incidence of major complications or mortality during training: 11% (24/202) versus 3% (3/120). Seventy percent (174/250) of the participants advocated for a formal training program for CS, suggesting that it could improve the quality and safety of CS.

conclusionThe study highlights current practices and differences in CS training in LMIC and HIC. The outcomes associated with CS are influenced by multiple patient- and system-level factors, including access to care, patient risk profiles, and resources. However, training remains an essential and modifiable component, which, according to participants in this study, could be strengthened by incorporating evidence-based educational practices.

Indexed as

Cesarean SectionDeveloped CountriesDeveloping CountriesObstetricsAdultClinical CompetenceCross-Sectional StudiesFemaleGynecologyHumansPregnancySurveys and Questionnairesassessmentcaesarean sectioneducationfeedbacktraining

Identifiers

PMID41334611
PMCPMC13094679

What OpenQuestion holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.