Prevalence, Indications And Perceptions Of Caesarean Section Delivery Among Pregnant Women In Central Hospital Sapele

Project and Seminar Material for Nursing (Science)

Abstract

In maternal health, though caesarean section (CS) has contributed significantly to reducing maternal morbidity and mortality worldwide, there are still concerns about women’s knowledge on caesarean section. In view of this, the main aim of this study was to assess the prevalence, indications and perceptions of caesarean section delivery among pregnant women in central hospital sapele. This is a descriptive study which targeted pregnant women attending antenatal care at the hospital. 409 respondents were selected using simple random sampling technique. The research instrument was a questionnaire which consisted of four parts that addressed the research questions and objectives. The data was analyzed using descriptive statistical method. Findings revealed that the 73.0% of the respondents consider caesarean section dangerous, 89.0% of the respondents indicated that they are willing to undergo a caesarean section if indicated, 33% indicated that they are willing to undergo a repeat caesarean section, and 34.0% of the respondents indicated that they would view a woman that has delivered through CS as weak. On the level of knowledge about caesarean section indicated by majority of the respondents, the result implies that the respondents’ knowledge towards CS is low and overall, their perception is negative. The study concluded that health facilities and healthcare workers should work towards improving general knowledge, perception and attitude of women especially pregnant women and through services including health literacy and information campaigns through the use of posters, mass media etc., to correct wrong perceptions of the masses about caesarean section. The study recommended that nurses/midwives should health educate the women attending antenatal clinic on indications for caesarean section and all they need to know about caesarean section.

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

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 Study

Maternal mortality represents the leading cause of death among the pregnant women in most developing countries including Nigeria (Eni-Olorunda and Otito(1). Furthermore, it is estimated that one third of all maternal deaths globally occur in just two countries, namely India and Nigeria (Mboho & Moller 2013)2. According to UNFPA (3], 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 (Hogan,[4]; and Gynaecol,[5] . 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 [6]. 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 [7]. 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 [7]. Furthermore, in most sub-Saharan African countries including Nigeria, caesarean section is being accepted reluctantly even in the face of obvious clinical indication [7]. 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 [1]. 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[8]. 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[9]. 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[9] Obstetrics in modern America is a contentious subject in general[10].

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[10]. 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[11]. 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[12]. 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 Trelles 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

Caesarean section (CS) is defined as the delivery of a foetus, placenta and membranes through an abdominal and uterine incision after the age of viability (which is 28 weeks of gestation in developing countries). Caesarean section remains the most common major operation performed on women worldwide and rate is increasing. The indication for CS can be maternal, foetal or both. The rate of CS has been on the increase in the past two decades. Due to the safety of the procedure, several CS have been done for various justifiable medical and non-medical indications. In Nigeria the national CS rate is 1.8%. The rates are relatively higher from tertiary health institution in different parts of the country. Lower rates were reported from northern Nigeria, with 10.1% in Kano, 10.6 in Sokoto, 11.8% in Maiduguri, and 20.3% from Birnin-Kebbi; while higher rates were reported from southern Nigeria as follows; 25% in Sagamu, 27.6% in Enugu, and 34.5% in Abraka. Mortality and morbidity from pregnancy and labour related causes have been observed to be high in developing nations, especially those of sub-Saharan African region.

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 women’s perception and acceptance of caesarean section in Iyamho community in Edo state.

Prolonged obstructed labour, uterine rupture and obstetric fistulae are some of the serious problems that may be averted by timely caesarean section. The place of caesarean section in comprehensive emergency obstetric care and prevention of feto-maternal morbidity and mortality is obvious. There is therefore the need to appraise the procedure frequently especially with a view to evaluating factors militating against the acceptance of this life saving procedure. Hence, this study was conducted to assess the perception and acceptance of caesarean section among pregnant women of child bearing age in central hospital sapele.

1.3 Research Objectives

The main objective of this study is to assess the prevalence, indications and perceptions of caesarean section delivery among pregnant women in central hospital sapele.

The specific objectives are as follows;

To determine the perception of pregnant women towards caesarean section in central hospital sapele
To ascertain the knowledge of caesarean section among pregnant women of child bearing age in central hospital sapele
To explore the acceptance of caesarean section among pregnant women of child bearing age in central hospital sapele

1.4 Research Question

What is the perception of pregnant women towards caesarean section in central hospital sapele?
What is the knowledge of caesarean section among pregnant women of child bearing age in central hospital sapele?
What is the level of acceptance of caesarean section among pregnant women of child bearing age in central hospital sapele?

1.5 Research Hypothesis

HO: There is no significant relationship between perception and acceptance of caesarean section among pregnant women of child bearing age in central hospital sapele
HA: There is a significant relationship between perception and acceptance of caesarean section among pregnant women of child bearing age in central hospital sapele

1.6 Significance of Study

The findings from this study would be used in planning strategies towards improving the knowledge, perception and attitude 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.

1.7 Scope of Study

The study will be conducted in central hospital sapele. The respondents that will be used are the pregnant women of child bearing age in the institution. The focus of the study is to assess the perception and acceptance of caesarean section among pregnant women of child bearing age in central hospital sapele.

1.8 Limitations of the Study

In the process of carrying out the current study, the researcher encountered some limitations. Firstly, since the focus of this study was on ale staff of child bearing age in central hospital sapele, the conclusions drawn from this study cannot be generalized to other populations or areas. Secondly, the researcher faced time constraints and financial constraints.

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.

Acceptance:

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

1.10 Organisation of the Study

This research work is organized in five chapters, for easy understanding it is broken down as follows:

Chapter one kicks off with the introduction, which consists of the background of the study, statement of the problem, objectives of the study, research hypothesis, scope and significance of the study.
Chapter two begins with the conceptual framework on which the study is based, the theoretical literature and also the empirical literature and thus the review of related literature.
Chapter three deals on the research design, the population of the state used as a case study, the sample size and the sampling techniques used, the data collected, data analysis and the limitations of the method used.
Chapter four concentrate on the data collection and analysis, interpretation and presentation of finding.
Chapter five gives summary, conclusion, and recommendations made of the study.

Chapter Five

Summary, Conclusions and Recommendations

5.1 Introduction

This chapter summarizes the findings on the prevalence, indications and perceptions of caesarean section delivery among pregnant women in central hospital sapele. The chapter consists of summary of the study, conclusions, and recommendations.

5.2 Summary of the Study

In this study, our focus was on the prevalence, indications and perceptions of caesarean section delivery among pregnant women in central hospital sapele. The study is was specifically focused on determining the perception of pregnant women towards caesarean section in central hospital sapele, ascertaining the knowledge of caesarean section among pregnant women of child bearing age in central hospital sapele and exploring the acceptance of caesarean section among pregnant women of child bearing age in central hospital sapele.

The study adopted the survey research design and randomly enrolled participants in the study. A total of 401 responses were validated from the enrolled participants where all respondent are pregnant women in central hospital sapele.

5.3 Conclusion

Although all the women were aware of CS there was still a low level of perception 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.

5.4 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 (21). 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 (27). 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 (27). 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 (9). 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 (7). 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 (1).