Perception And Acceptance Of Caesarean Section Among Pregnant Women (A Case Study in Iuth Okada, Edo State)

Project and Seminar Material for Nursing (Science)

Abstract

This study was carried out on perception and acceptance of caesarean section among pregnant women in Igbinedion University Teaching Hospital (IUTH), Okada, Edo state. Maternal mortality is unacceptably high in low resource countries. This is disturbing, considering that some of these deaths are preventable through caesarean section.

To determine the perception and factors associated with the acceptance of caesarean section among high-risk pregnant women. A structured interviewer-administered questionnaire was used to assess pregnant women’s knowledge and acceptance to CS.

The study proposal was approved by the Ethics and Research committee of the institution and informed consent was obtained from the participants prior to recruitment into the study. The data obtained was analysed using SPSS version 17.0 statistical software.

Qualitative variables were summarized using frequencies and percentages, while mean and standard deviation were used to summarize quantitative variables. Although this study revealed that 93.8% of the respondents were aware of CS, 40.9% had adequate knowledge of it while 2.7% knew that the woman undergoing CS was required to give consent for the surgery. The study recommended that doctors should actively get involved in the education of pregnant women.

Table Of Contents

Preliminary Page(s)

• Title
• Declaration
• Approval
• Dedication
• Acknowledgement
• Abstract
• Table of Content

Chapter One:

Introduction

• 1.1 Background of study
• 1.2 Statement of problem
• 1.3 Research objectives
• 1.4 Research question
• 1.5 Significance of study
• 1.6 Scope of study
• 1.7 Definition of terms

Chapter Two:

Literature Review

• 2.1 Contributing Factors
• 2.2 Practice Factors
• 2.3 Repeat Cesarean Section versus Vaginal Birth After Cesarean Section
• 2.4 Management of breech presentation
• 2.5 Management of labour /induction
• 2.6 Maternal choice
• 2.7 Population Factors
• 2.8 Maternal confidence in the ability to give birth
• 2.9 System Factors

Chapter Three:

Materials And Method

• 3.1 Setting
• 3.2 Subjects
• 3.3 Study design
• 3.4 Research Instrument
• 3.5 Ethical Consideration
• 3.6 Data Analysis

Chapter Four:

Results And Discussion

• 4.1 Results
• 4.2 Discussions of findings

Chapter Five:

Conclusion And Recommendation

• 5.1 Conclusion
• 5.2 Recommendation
• Reference
• Appendix
• Questionnaire

Chapter One

Introduction

1.1 Background of study

Maternal mortality represents the leading cause of death among the pregnant women in most developing countries including Nigeria (Mekonnen and Mekonnen, 2003; WHO, 2007). Furthermore, it is estimated that one third of all maternal deaths globally occur in just two countries, namely India and Nigeria (Mboho et al 2013). According to UNFPA (2012), in 2010, India was accountable for about 20% of global maternal deaths (56,000) and Nigeria, 14% (40,000). Meanwhile, disease, deformity and death are terms usually employed to describe the experiences of a vast majority of sub-Saharan African women during pregnancy and birthing (Harrison, 2001; Brookman-Amissah and Moyo, 2004; WHO, 2004a).

Similarly, the majority of African women are often viewed as being at high risk of infections, injury and death during pregnancy and the periods surrounding it (Izugbara and Ukwayi, 2007). In recent time women in Nigeria have expressed worries about choices of childbirth especially the issues surrounding vaginal birth. The joy of every woman is to deliver her baby normally. Some decades ago the most available or preferred option for most women was vaginal birth.

Some of the women had their babies at home with traditional birth attendants but quite often with difficult labour resulting from obstruction and the women died before any meaningful interventions. Today, however, many babies have been delivered successfully through caesarean section.

This success story in not without criticism. Among women in the developing countries, caesarean section is still being perceived as a ‘curse’ of an unfaithful woman (Adeoye and Kalu 2011). The authors further assert that caesarean section is seen among weak women. In addition, caesarean section is surrounded with suspicion, aversion, misconception, fear, guilt, misery and anger among the women of South Western Nigeria (Adeoye and Kalu 2011). Furthermore, in most sub-Saharan African countries including Nigeria, caesarean section is being accepted reluctantly even in the face of obvious clinical indication (Adeoye and Kalu 2011).

Despite the causes of maternal mortality often obstetric in origin, underlying cultural factors and beliefs also affect access to and use of health facilities and thus contribute to avoidable maternal deaths (Mboho et al 2013). Several studies have indicated how local beliefs and practices impact general health and childbearing. Some of these beliefs have been identified as contributing to the delays in accessing appropriate skilled help when complications arise in labour (Okafor 2000) It is necessary to note that the issue of vaginal birth is not only peculiar to developing countries but also in some developed countries.

Women still choose vaginal birth after having caesarean section even in the case of post dates slated for elective caesarean section (Clift-Mathews 2010). The author further highlighted the fact that women desperately wished to go into labour before their appointment dates because not giving birth vaginally was a sign of ‘failure’. In addition; vaginal birth is something a number of women look upon as a rite of passage (Clift-Mathews 2010) Obstetrics in modern America is a contentious subject in general (Ecker 2013). Usually childbirth and action surrounding it whether medical or otherwise normally evoke strong emotions where discussion is often framed ideologically as a matter of nature versus technology.

Hence the issue of caesarean section in particular is much contested issue (Ecker 2013). Even so, caesarean section rates are on the increase as evident in a number of western countries such as the United States of America and United Kingdom (McAra-Couper, Jones and Smythe 2010). In 1985, following the increasing disparity rate among nations in the number of caesarean births, the World Health Organisation (WHO) set out to determine an optimal rate of 15 percent as ideal. The postulated 15 percent by WHO would optimally prevent childbirth injuries and deaths. In addition, many women and babies would avoid unnecessary and potentially harmful surgery (Harvard magazine 2013).

However, WHO has since modified this particular recommendation in 2009, stating that ‘the optimum rate is unknown but asserts that both very low and very high rates of caesarean sections can be dangerous’. In other words, the procedure should be done only when it is absolutely necessary. The editorial team of Academic Research International of Harvard Magazine concluded that there is need for a balance to be reached, that is, women should be allowed to have normal vaginal deliveries with as little intervention as possible. However, at the same time, the families, obstetricians will be ready to address any unexpected emergencies.

1.2 Statement Of Problem

Traditionally, Nigerian women are unwilling to have CS because of the general belief that abdominal delivery is reproductive failure on their part regardless of the feasibility of vaginal birth after CS and the decreasing mortality from Caesarean sections. Imperative to the average pregnant woman irrespective of her level of education and parity therefore is CS. Available reports on knowledge of CS amongst women are mainly from tertiary health facilities situated in cities and in the southern parts of the country while little is known about the perception and acceptance of pregnant women towards Caesarean section in Igbinedion University Teaching Hospital in Edo State.

1.3 Research Objectives

1. To explore the perception and acceptance of pregnant women in Igbinedion University Teaching Hospital, Edo State toward caesarean section
2. To ascertain what is known about caesarean section and the reasons for dislike by our women
3. To explore the perception and acceptance of pregnant women in Igbinedion University Teaching Hospital, Edo State state towards caesarean section

1.4 Research Question

1. What is the perception and acceptance of pregnant women in Igbinedion University Teaching Hospital, Edo State toward caesarean section?
2. What is known about caesarean section and the reasons for dislike by our women?
3. What is the perception and acceptance of pregnant women in Igbinedion University Teaching Hospital, Edo State towards caesarean section?

1.5 Significance Of Study

The findings from this study would be used in planning strategies towards improving the knowledge, perception and acceptance towards CS in the community in order to possibly reduce the delay in presentation to the health facility when CS is needed, improve utilization of this mode of delivery and limit the avoidable maternal and foetal complications.

1.6 Scope Of Study

This study focused on the perception and acceptance of pregnant women towards Ceasarean section. It was carried out in Igbinedion University Teaching Hospital (IUTH), Okada in Edo State.

1.7 Definition Of Terms

Perception:

Is the process of recognizing and interpreting sensory stimuli. Learn the definition of perception, how it is related to the five senses, how it differs from reality, and more.

Acceptance:

In human psychology is a person’s assent to the reality of a situation, recognizing a process or condition (often a negative or uncomfortable situation) without attempting to change it or protest it.

Caesarean Section:

Also known as C-section or caesarean delivery is the use of surgery to deliver one or more babies. A caesarean section is often necessary when a vaginal delivery would put the baby or mother at risk.

Chapter Five

Conclusion And Recommendation

5.1 Conclusion

Although all the women were aware of CS there was still a low level of knowledge on the surgery in our setting. Whilst majority of them were willing to undergo the surgery when necessary, some women would still not accept to undergo CS under any circumstances. This brings to light the need to intensify education on CS at the antenatal clinics with a look at the content of such educational messages aimed at addressing the fears being entertained by women about the surgery and also further studies conducted to ascertain the reasons why some women will not accept the surgery even if indicated. Also doctors should actively get involved in the education of pregnant women. Other resources such as DVDs and leaflets could be employed to augment what is done at the antenatal clinics. All these will possibly help pregnant women to be well informed about caesarean section which could be lifesaving and thus be in better positions to make informed decisions about the procedure.

5.2 Recommendation

Consequent upon the findings, the following recommendations are suggested;

Provision of Information

The provision of information during childbirth is paramount to a satisfying birth experience (Beake et al., 2005). 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 (Baxter, 2007). 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.

Vaginal Birth after Caesarean

Section Women who have had a previous caesarean section may have a strong need for information from their midwife and obstetrician during the antenatal period. Couples should be reminded of the reason why the previous caesarean section was necessary. They can use this information with their midwife and obstetrician to make decision about subsequent deliveries. Vaginal birth following caesarean section is safe and there are no absolute contraindications (Baxter 2007). However, recommended practice is that it takes place in the hospital.

Provision of Emotional Support

Some women have been found to fear the prospect of undergoing caesarean as found in this study. Women still choose vaginal birth after having caesarean section even in the case of post dates slated for elective caesarean section (Clift-Mathews 2010). The author further highlighted the fact that women desperately wished to go into labour before their appointment dates because not giving birth vaginally was a sign of ‘failure’. It is therefore, essential that women should receive sufficient psychological and emotional support and encouragement from their husbands. Furthermore, in most sub-Saharan African countries including Nigeria, caesarean section is being accepted reluctantly even in the face of obvious clinical indication (Adeoye and Kalu 2011). Despite the causes of maternal mortality often obstetric in origin, underlying cultural factors and beliefs also affect access to and use of health facilities and thus contribute to avoidable maternal deaths (Mboho et al 2013).

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