Attitude Of Women Of Childbearing Age Towards Cesarean Section In Anambra State

Project and Seminar Material for Nursing (Science)

Attitude Of Women Of Childbearing Age Towards Cesarean Section In Anambra State


Abstract


This study was carried out to evaluate the attitude of women of childbearing age towards cesarean section in Anambra State. The study was specifically set to determine the level of knowledge of women towards caesarean section in Anambra State, determine the attitude of women of childbearing age towards cesarean section in Anambra State, and ascertain the factors influencing women’s attitude towards cesarean section in Anambra State. The survey design was adopted and the simple random sampling techniques were employed in this study. The population size comprised of women of childbearing age from age 18 – 40years in Anambra State. In determining the sample size, the researcher purposefully selected 147 respondents and 141 were validated. Self-constructed and validated questionnaire was used for data collection. The collected and validated questionnaires were analyzed using frequency tables and mean scores. The hypotheses was tested using Chi-square Statistical tool. The result of the findings reveals that the level of knowledge of women towards caesarean section in Anambra State is low. Furthermore, the study revealed the factors influencing women’s attitude towards cesarean section in Anambra State includes: cost, custom/culture, husband disapprove, religion, educational status, fear of death, and fear of pain. Therefore, it is recommended that teaching on caesarean section should be included in the Ante Natal health education. To mention but few.


Table of Content


  • Title Page
  • Certification
  • Dedication
  • Acknowledgement
  • Table of Content
  • List of Tables
  • Abstract

Chapter One:

Introduction

  • 1.1 Background of the Study
  • 1.2 Statement of the Problem
  • 1.3 Objective of the Study
  • 1.4 Research Questions
  • 1.5 Research Hypothesis
  • 1.6 Significance of the Study
  • 1.7 Scope of the Study
  • 1.8 Limitation of the Study
  • 1.9 Definition of Terms
  • 1.10 Organisations of the Study

Chapter Two:

Review of Literature

  • 2.1 Conceptual Framework
  • 2.2 Theoretical Framework
  • 2.3 Empirical Review

Chapter Three:

Research Methodology

  • 3.1 Research Design
  • 3.2 Population of the Study
  • 3.3 Sample Size Determination
  • 3.4 Sample Size Selection Technique and Procedure
  • 3.5 Research Instrument and Administration
  • 3.6 Method of Data Collection
  • 3.7 Method of Data Analysis
  • 3.8 Validity of the Study
  • 3.9 Reliability of the Study
  • 3.10 Ethical Consideration

Chapter Four:

Data Presentation and Analysis

  • 4.1 Data Presentation
  • 4.2 Analysis of Data
  • 4.3 Answering Research Questions
  • 4.4 Test of Hypotheses
  • 4.5 Findings

Chapter Five:

Summary, Conclusion and Recommendation

  • 5.1 Summary
  • 5.2 Conclusion
  • 5.3 Recommendation
  • References
  • APPENDIX
  • QUESTIONNAIRE

Chapter One


Introduction

1.1 Background of the Study

Caesarean section [CS] is the most common obstetric operation performed worldwide (1). The origin of the procedure dates back to 100 BC, but authoritative evidence about the early use of the operation by obstetricians did not appear in the literature until the mid-17th century, when the classical work of Francois Mauriceau was published (1).

At the onset, the operation was associated with high rates of morbidity and mortality, largely because of the low level of medical science available at the time. Consequently, its introduction into obstetric practice was greeted with misgivings and, in some instances, outright rejection. However, with advances in medical practice, there has been considerable improvement in maternal safety and neonatal outcome associated with caesarean delivery. Caesarean section is now the recommended method of delivery in several obstetric complications (2). While acknowledging the general concern about the rising rates of CS worldwide (3), CS still remains the most appropriate option for several obstetric situations (4).

In developed countries, women often accept CS because of their improved understanding of its role and safety (5,6). By contrast, in many sub-Saharan African countries, several reports indicate that women are often reluctant to accept caesarean delivery (7,8). Indeed, a recent study (9) reported a gross underutilisation of CS throughout West Africa, compared to the large burden of obstetrics morbidity requiring resolution by CS. The inadequate use of early CS in African countries has been identified as a key factor in the continuing high rates of maternal and perinatal morbidity in the region (10).

To date, there has been no systematic study exploring women’s attitude and perceptions of CS in Nigeria, and the reasons that women are averse to the procedure. Such data would be relevant for designing programs aimed at increasing women’s uptake of CS, an important intervention necessary to reduce maternal mortality in the country. The aim of this study was to determine women’s attitudes towards CS in Nigeria.


1.2 Statement of the Problem

For a healthy women population, the choice of delivery option is an important decision. Expectant parents make many choices which usually include site for delivery (hospital, birth centre, or home), and the choice between spontaneous vaginal delivery and caesarean section.1 Over time caesarean section rates has been on the increase in the whole world.2 Both developed and developing nations of the world have their own share of this increase.
Epidemiological studies in Brazil and Chile have shown that there is higher caesarean section rate among women who have a higher level of education.4 In some African, increase in the rate of caesarean section have been documented; Ghana5 and Nigeria.6 However there is a broadly held belief that West African women have an aversion for caesarean section delivery.7 Maternal knowledge and occupation has also been seen to influence the attitude of women towards mode of delivery. Many studies have proven women preference for vaginal deliveries over surgical delivery.8-15 Although majority of caesarean sections are emergency caesarean sections especially in developing nations there is also a noticeable increase in the rate of elective surgery of late probably due to increase level of knowledge of women, improvement in medical practice and women higher level of education. It is important to note that elective emergency caesarean section is known to be associated with more maternal and newborn morbidity than planned vaginal birth.16-19. In a study carried out by Nira and colleagues to assess the attitude of women toward caesarean section in Nepal they found out that vaginal delivery was the preferred mode of delivery by 93% of the respondents while 7% preferred caesarean section as mode of delivery.3 Their reasons for these ranges from it been a natural process, been good for mother’s health, safety to been an easy process.

Most of the women thought that caesarean delivery can cause long term ill effect on mother’s health. All the women who preferred elective caesarean delivery initially said that they would rather opt for painless labour and vaginal delivery if offered over caesarean section. Similarly Aziken, Omo-Aghoja, & Okonofua submitted that inaccurate cultural perception about caesarean section delivery account for poor attitude of women towards caesarean section.20 Aali & Motamedi reported that only one third of women demonstrate positive attitude towards caesarean delivery as against 95.5% for vaginal delivery in the same group of respondents. The study concluded no significant differences in attitude and knowledge scores according to women’s levels of education.21 In view of the above, this study seek to examine the attitude of women of childbearing age towards cesarean section in Anambra State.


1.3 Objectives of the Study

The main objective of this study is to investigate the attitude of women of childbearing age towards cesarean section in Anambra State. Other specific objectives are to:

  1. Determine the level of knowledge of women towards caesarean section in Anambra State.
  2. Determine the attitude of women of childbearing age towards cesarean section in Anambra State.
  3. Ascertain the factors influencing women’s attitude towards cesarean section in Anambra State.

1.4 Research Questions

The research will seek to answer the following questions:

  1. What is the level of knowledge of women towards caesarean section in Anambra State?
  2. What is the attitude of women of childbearing age towards cesarean section in Anambra State?
  3. What are the factors influencing women’s attitude towards cesarean section in Anambra State.

1.5 Research Hypotheses

  • Ho: The attitude of women of childbearing age towards cesarean section in Anambra State is negative.
  • Ha: The attitude of women of childbearing age towards cesarean section in Anambra State is positive.

1.6 Significance of the Study

The results of the study will contribute towards identifying strategies for improving the acceptability and uptake of CS, and reducing maternal morbidity and mortality in Nigeria.


1.7 Scope of the Study

This study focuses on the attitude of women of childbearing age towards cesarean section in Anambra State. The study will be delimited to women of childbearing age from age 18 – 40years.


1.8 Limitations of the Study

In the course of carrying out this study, the researcher experienced some constraints, which included time constraints, financial constraints, and the attitude of the respondents. However, the researcher were able to manage these just to ensure the success of this study.

Moreover, the case study method utilized in the study posed some challenges to the investigator including the possibility of biases and poor judgment of issues. However, the investigator relied on respect for the general principles of procedures, justice, fairness, objectivity in observation and recording, and weighing of evidence to overcome the challenges.


1.9 Definition of Terms

Caesarean Section:

Caesarean section, also known as C-section, or caesarean delivery, is the surgical procedure by which one or more babies are delivered through an incision in the mother’s abdomen, often performed because vaginal delivery would put the baby or mother at risk.

Perception:

The way in which something is regarded, understood, or interpreted, in this case caesarean section.

Attitude:

The way one behave towards somebody or something that shows how you think or feel.

Acceptance:

The action of consenting to receive or undertake something offered, in this case caesarean section.


1.10 Organization of the Studies

The study is categorized into five chapters. The first chapter presents the background of the study, statement of the problem, objective of the study, research questions and hypothesis, the significance of the study, scope/limitations of the study, and definition of terms. The chapter two covers the review of literature with emphasis on conceptual framework, theoretical framework, and empirical review. Likewise, the chapter three which is the research methodology, specifically covers the research design, population of the study, sample size determination, sample size, and selection technique and procedure, research instrument and administration, method of data collection, method of data analysis, validity and reliability of the study, and ethical consideration. The second to last chapter being the chapter four presents the data presentation and analysis, while the last chapter(chapter five) contains the summary, conclusion and recommendation.


Chapter Five


Summary, Conclusions and Recommendations:

5.1 Introduction

This chapter summarizes the findings on the attitude of women of childbearing age towards cesarean section in Anambra State. The chapter consists of summary of the study, conclusions, and recommendations.


5.2 Summary of the Study

In this study, our focus was to evaluate the attitude of women of childbearing age towards cesarean section in Anambra State. The study was specifically set to determine the level of knowledge of women towards caesarean section in Anambra State, determine the attitude of women of childbearing age towards cesarean section in Anambra State, and ascertain the factors influencing women’s attitude towards cesarean section in Anambra State.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 141 responses were validated from the enrolled participants where all respondent are women of childbearing age from age 18 – 40years in Anambra State.


5.3 Conclusions

In the light of the analysis carried out, the following conclusions were drawn.

  1. The level of knowledge of women towards caesarean section in Anambra State is low.
  2. The attitude of women of childbearing age towards cesarean section in Anambra State is negative.
  3. The factors influencing women’s attitude towards cesarean section in Anambra State includes: cost, custom/culture, husband disapprove, religion, educational status, fear of death, and fear of pain.

5.4 Recommendations

In view of the above findings the following recommendations are hereby made;

  1. The provision of information during childbirth is paramount to a satisfying birth experience. Midwives should strive to ensure that women were familiar with the advantages of caesarean section and also the risk associated with the procedure. As almost one in four women will give birth through caesarean section . The information given will empower women to make informed choices either to have or not to have the surgery. Information can be provided for women and couples in group settings as part of a parent education programme during the antenatal period.
  2. All women of reproductive age should be educated on caesarean section as a method of birth.
  3. Teaching on caesarean section should be included in the Ante Natal health education.
  4. Government should encourage caesarean section delivery by subsidizing the cost to encourage women to opt for this method of birth.
  5. Right of women in choosing any preferred method of birth at any level of health care should always be respected.

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Frequently Asked Questions


Do women with cesarean delivery have a positive attitude toward the delivery?

Prepared cesarean women had a significantly greater desire for active participation in the delivery than women unprepared for cesarean delivery. Multiparous cesarean-delivery mothers with previous vaginal deliveries had a significantly more positive attitude than those who had never delivered vaginally.

What is the attitude of respondents to caesarean section (CS)?

Attitude of respondents to Caesarean section (N=376) Questions N (%) Are you willing to undergo CS if indicated? Yes 372(98.9) No 4(1.1)

Why are women’s non-acceptance of indicated caesarean sections increasing?

Analysis showed that this was mainly due to inaccurate cultural perceptions of labour and caesarean section in the cohort of women. Conclusion

Does cesarean section delivery rate affect vaginal delivery rate?

Among the study group, a significant correlation existed between the vaginal delivery rate of the patients and the indication for the primary cesarean section. There was however, no significant difference between the mean parities of the women who were delivered by cesarean section and those who delivered vaginally. 

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