You are working as part of a medical team volunteering for a charity in Uganda. Doreen, a 22 year old presents in labour. It is her first pregnancy. She is having very strong contractions and screaming in pain. Because of the nature of the contractions, the midwife suspects she may have been given traditional herbs to stimulate labour. When asked about this she initially denied it but later said her mother and aunty had given her some local herbs so as to avoid a Caesarean section.
Having a child by Caesarean is frowned against in her community. It is believed that not having a vaginal birth makes such child cursed and more prone to ailments.
As she is contracting strongly the midwife informs you as the clinician. Due to the strong contractions, the baby gets distressed and from a clinical point of view she requires a Caesarean Section as she is only 6cm dilated. You inform her of this decision but she blatantly refuses as she thinks she can have a normal delivery like her mum and all her aunts did. When you ask her again, she still refuses and says one of her cousins had problems after a Caesarean section.
You fear that if you do not perform a Caesarean either she or the baby or both will very likely die.
It is proposed that you perform a Caesarean because of the life threatening situation