Background The fertility rate in Uganda is 6.1.¹ The significance of repeated CS and the risks of labour after caesarean section are well-documented. Often CS is the most appropriate mode of delivery but the decision to operate should be made judiciously to reduce maternal morbidity and mortality.

The CS rate in Kisizii Hospital, previously around 23% (2009–2010), had increased steadily to 41% in July 2012. Retrospective case note examination indicated frequent poor decision-making in labour leading to unnecessary CS. Decisions were often made by very junior staff.

Method The following were implemented in early August:

1. Tutorials on diagnosing & managing progress in labour and fetal distress

2. Tutorials on vacuum deliveries

3. Algorithms to aid decision-making processes

4. Updated induction of labour guidelines

The CS rate for August to October was statistically significantly less than for January to July (p < 0.05, Fisher’s exact test). There were no significant differences observed in the fresh stillbirth or birth asphyxia rates.

Conclusion Simple algorithms with timely tutorials can help junior staff to improve their decision-making processes where the preferable alternative of continual senior support is not feasible.