Safe Surgery in Nakuru Hospitals Saves Mothers and Babies

When the cries of a newborn echo across the wards, in many hospitals they signify new life and bring joy to mothers, who expect their baby is healthy. What many don’t realize is that it is usually the result of a team effort—keen medical personnel observing strict guidelines to safeguard both mother and child beyond the operating room.

To ensure this safety, the team is guided by Obstetric Safe Surgery (OSS) protocols, recently introduced in several hospitals across Nakuru County by Jhpiego, a non-governmental organization founded in 1973 as the Johns Hopkins Program for International Education in Gynecology and Obstetrics. Jhpiego trains medical professionals in reproductive health innovations for low-income countries.

“This marks a transformative milestone in maternal health care, aiming to reach over 25,000 women annually through training, mentorship, and system support to medical personnel,” says Mary Muthengi, technical officer at Jhpiego.

Launched in March 2025, the project focuses on safe cesarean sections in the county. It is funded by the Global Surgery Foundation in close partnership with African Inland Church Kijabe Hospital and spearheaded by Jhpiego. OSS is closing critical gaps in cesarean care by ensuring every procedure is safe, timely, and of high quality.

Muthengi explains that Jhpiego strengthens health systems through evidence-based training, policy advocacy, and practical solutions in maternal and newborn health, family planning, HIV prevention, cervical cancer screening, and infectious disease control. Its central mission is to save lives by equipping frontline health workers with skills that create lasting change.

She emphasizes essential newborn care immediately after birth, noting its importance for health, warmth, bonding, and successful feeding. Practices such as delayed cord clamping, early initiation of breastfeeding—even in the operating theatre during cesarean sections—and skin-to-skin contact are strongly supported by guidelines from the World Health Organization (WHO), the American College of Obstetricians and Gynecologists (ACOG), and other global bodies.

In Nakuru city, the OSS project works closely with the county government to reduce maternal mortality related to cesarean sections by 50%, aiming to improve the quality of maternal health services.

At the heart of the approach is an interdisciplinary training model. Fifteen trainers from five hospitals—Nakuru Level 6 County Referral and Teaching Hospital, Naivasha Sub-County Hospital, Gilgil Sub-County Hospital, Bahati Sub-County Hospital, and Molo Sub-County Hospital—were trained. They in turn trained 25 surgical staff and built a team of 12 specialist mentors across maternity and theatre.

OSS has adopted the WHO Safe Surgery Checklist for childbirth, now the heartbeat of the operating theatre. The checklist promotes teamwork, beginning with sign-in before anesthesia, where the mother’s identity, consent, planned procedure, allergies, expected blood loss, and special needs are openly confirmed.

The involvement of the anesthesia team has fostered stronger communication across surgeons, nurses, and anesthetists, reducing human error, improving hazard detection, and enhancing overall patient safety. Their efforts have led to better adherence to protocols, stronger team coordination, and reduced risks in surgical care.

To prevent wrong-site, wrong-procedure, and wrong-patient operations, the entire team pauses for a surgical time-out before the first incision. This includes introductions, confirming the patient’s identity, surgical site, intended treatment, and consent—ensuring everyone is aligned.

A sign-out follows each procedure, accounting for all instruments and materials used, and noting any postoperative concerns before the mother leaves the operating room.

The checklist also includes a vaginal cleansing routine around the cervix to reduce bacterial load in the lower genital tract, part of infection prevention that has lowered surgical site infections.

Preoperative antibiotics, delivered via IV 30 to 60 minutes before surgery, significantly reduce endometritis and wound infections. Abdominal skin preparation before incision further prevents surgical site infections by eliminating bacteria on the skin.

“Daily safety checks have become routine, unlike before. Now, through teamwork from surgeon to nurse and inclusion of the patient, safety of the mother and child is guaranteed,” says Dorcas Komen, theatre in-charge at Nakuru Level 6 County Referral and Teaching Hospital.

To improve data accuracy, standardized theatre registers and a surgical site infection tracking register were introduced across all five hospitals. Mothers discharged are now followed up—obstetric nurses call them seven days after discharge to monitor healing and offer guidance, closing a once-dangerous gap.

“OSS handles day-to-day coordination and quality checks, keeping the team focused on safer cesarean sections, fewer complications, and better systems for collecting and using data,” says Christine Muia, program manager at Jhpiego.

She adds that a mentorship program using a hub-and-spoke model has made high-quality emergency obstetric care more accessible, consistent, and sustainable in smaller district hospitals and health centers.

According to Christine, ongoing training, in-person and virtual mentorship, and real-time digital guidance have strengthened referral pathways and improved data sharing. The model ensures more consistent care closer to communities, reducing complications and saving lives.

“We teamed up with Nakuru County Health from the beginning. They offered full support as we ran surveys and delivered intensive training that created sustainable change,” says Mary.

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