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Optimizing Caesarean Section Practices in Ghana
Caesarean section (CS) rates are rising globally. This study investigates CS practices in low- and middle-income settings, with Korle-Bu Teaching Hospital in Ghana serving as a case study. 

The findings reveal an average CS rate of 47.3%, with a significant number of repeat CS cases. We advocate for evidence-based strategies to ensure CS procedures are only performed when necessary and beneficial.
A review of CS classification reinforced the importance of Robson’s system for accurate data collection. Meanwhile, our study on shared decision-making at CS, found that although most women understood their CS indications, most of them were not involved in the decision-making process, especially among those with limited antenatal care. Hospitals could improve patient engagement through written and audiovisual tools about CS, group counseling, and online information resources.
An audit of surgical techniques in more than 1000 CS in KBTH highlighted a variety of ways, a significant proportion of which are not evidence-based, stressing the need for standardized guidelines and enhanced training for surgeons.  Our literature-analysis revealed that women who are overweight or obese, faced a higher risk of infection, suggesting the need for tailored prevention strategies.
 Finally, complications of CS like pain and surgical site infections remained a concern, underscoring the need for routine pain assessments, improved surgical techniques and targeted care for high-risk patients.
By implementing structured protocols, training of providers and improving patient education, hospitals can enhance CS outcomes and reduce unnecessary procedures in low- and middle-income settings.