Global perspective
Women who lack access to skilled antenatal and intrapartum care are particularly vulnerable to the adverse consequences of malpre- sentation, malposition, and CPD. In low-resource settings, where infrastructure and transport are limited, women may present in advanced obstructed labour.
This may be exacerbated by nutritional compromise, comorbidities such as malaria, and inability to pay for healthcare. It may result in fetal death, maternal death, or delivery with significant morbidity such as a rectovaginal or vesicovaginal fistula. In the emergency care setting, every attempt should be made to complete a safe delivery for the mother and baby with attention to the cultural and personal importance of preserving future fertility.Conversely, in high-resource settings there are women who experience intense disappointment following a first birth experience who are willing to take conventionally unacceptable risks in a subsequent birth; for example, homebirth involving attempted vaginal birth after caesarean section with fetal macrosomia. Every effort should be made to regain the trust of these women so that they access expert obstetric care if complications arise during the course of their pregnancy or labour that predispose them to an adverse delivery outcome (48).