The Saving Mothers Reports have consistently shown that, out

of all the provinces of South Africa, the Free State has one of the highest rates of maternal deaths arising from anaesthesia.1,2 The province’s Department of Health requested the University of the Free State’s Department of Anaesthesiology to investigate the problem. We examined possible factors, including training and experience of doctors administering anaesthesia, availability of suitable anaesthetic drugs and equipment, and use of regional anaesthesia. All the level 1 and 2 hospitals in which caesarean sections (CSs) were being performed were investigated. The foremost problems identified were lack of training and experience in administering obstetric anaesthesia, and lack of senior anaesthetic assistance. Study findings Experience and training in obstetric anaesthesia was assesse