ABSTRACT
Ceserean Section has been over the year a life-saving surgical procedure performed in the industrialized world so as to save the life of the mother and the child during childbirth or delivery is referred to as the cesarean section.
The rate of caesarean section in developed countries is increasing as there has been a higher rate of acceptability over time while developing countries are struggling with the issue of non-acceptance of Caesarean section even in the face of inherent danger/risks. This negative perception has led to the underutilization of the procedure.
This study investigates the perception and attitude pregnant woman towards cesarean section at Babcock University teaching hospital in Ogun state. This study will be guided by 3 research questions and 2 hypothesis.
This study adopted descriptive design. A total of 154 questionnaire were administered to pregnant women that attended pre-natal treatment in Babcock University teaching hospital in Ogun state for a period of 1 month. Results from the study shows that majority (39.5%) of the respondents are above 36 years and 69.35% are Christians. 95.16% have appreciable knowledge of Cesarean section even though 86.29% of them said they have not experienced Cesarean section before. Majority of the respondents 97.58% decline the acceptance of Cesarean section because they feel vaginal delivery will not be possible again after Cesarean section. Also, the study verified that the leading factors that prevent the acceptance of Cesarean section shows that 56.41% of the respondents believe “It’s not God’s will” and 40.32% believe it is fear of dying. One of the hypothesis shows that the knowledge of caesarean section have effect on the level of acceptance of caesarean section.The second hypothesis shows that perception of caesarean section have effect on the level of acceptance of caesarean section.
The study concludes that there is a good level of knowledge and understanding about Cesarean section in general amongst respondents (especially women) who are mostly at risk of finding themselves in need of it. As a result of this knowledge is important as many women are generally unwilling to take part in the process or even encourage others close to them to do the same. The study recommends that public health education on cesarean section should be intensified amongst women in general and pregnant women in particular and that improvement of hospital facilities to enable efficient and effective delivery of these Cesarean sections when the need unavoidably arises.
TABLE OF CONTENTS
ABSTRACT
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
1.2 Statement of the Problem
1.3 Objectives 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 Delimitation of the Study
1.9 Operational Definition of Terms
References
CHAPTER TWO
REVIEW OF LITERATURE
2.0 Introduction:
2.1 Concept of Cesarean Section
2.1.1 Classification of Cesarean Section (CS)
2.1.3 Complications of Cesarean Section (CS)
2.2 Africa knowledge of Cesarean Section
2.3 Caesarean Section Rates in Developing and Developed Countries
2.4.1 Demographic Factors Associated with High Cesarean Section
2.4.2 Clinical Factors
2.4.3 Non-Clinical Factors
2.5 Theoretical framework
2.5.1 Application of the model to this study
2.6 Conceptual model
References
CHAPTER THREE
METHODOLOGY
3.0Introduction
3.1 Research Design
3.2 Research setting
3.3 Population
3.4 Sample size determination and technique
3.5 Instrument of data collection
3.6 Validity and Reliability of Instrument
3.7 Method of Data Analysis
3.8 Ethical Clearance
References
CHAPTER FOUR
DATA PRESENTATION AND ANALYSIS
4.1 Data Presentation based on sociodemographic factors
4.2 Data Presentation based on research questions
4.4 Test of Hypothesis
CHAPTER FIVE
SUMMARY OF FINDINGS, CONCLUSION, AND RECOMMENDATION
5.1 Summary of Findings
5.2 Conclusion
5.3 Recommendations:
5.4 Limitations of the study
5.5 Suggestion for further research
References
CHAPTER ONE
INTRODUCTION
1.1 Background of the Study
Ceserean Section has been over the year a life-saving surgical procedure performed in the industrialized world so as to save the life of the mother and the child during childbirth or delivery is referred to as the cesarean section. This procedure is ranked number one in the delivery report of the medical home. Cesarean section has added so many controversial stands from different beliefs system. As a result of this, several factors are seen to affect its outcome, hence, the acceptability by different pregnant women.
The increasing rates of cesarean delivery is now a major public concern worldwide. Cesarean rates above 15% have not shown additional benefit for the mother or the baby, and some studies have even shown that high Cesarean section rates could be linked to negative consequences in maternal and child health (Barros, Victora & Barros, 2015). Hence, in 1985, the World Health Organization (WHO) categorically stated that “There is no justification for any region to have Cesarean section rates higher than 10-15% (Ronsmans, Holtz, & Stanton,2016). It was recommended by the World Health Organisation that Cesarean Section utilization should be reduced in most developed countries while its accessibility should improve in low and some middle-income countries, mainly most African countries, to reduce adverse maternal and perinatal outcomes (Klein, Epstein,& Lawrence 2015; WHO Report 2010).
Some of the reasons suggested for the increasing Cesarean section rates include increasing mother’s age at the first child, increasing birth weight, socioeconomic factors, reduced parity, improvements in surgical techniques, perceived relative safety of Cesarean Section, falling threshold of clinicians for Cesarean Section and increasing maternal request ( Leonie, &Penna, 2014). Historically, vaginal delivery has always been perceived as safer than cesarean section and requests for elective cesarean section without any medical indication have usually been refused. However, this view is changing as advances in obstetrics, surgical and anesthetic techniques, the availability of blood and blood products, as well as antibiotics and thrombo-prophylaxis, have made cesarean section much safer; for the average woman, the difference in risk between a vaginal and cesarean delivery is very small. Labour and vaginal delivery have been shown to have more benefits for the average woman and her baby compared to the pre-labor cesarean section (PLCS) (Goodin, Malcolm, & Griffiths, 2013).
In developed countries, studies have been done to show reasons for the high and increasing Caesarean section rates as well as efforts to reduce the Caesarean section rates. Some of the identified factors are, demographics such as maternal age and parity, others are obstetric such as failure to progress in labor and yet other factors are non-obstetric such as a maternal request for Caesarean delivery (Barber, Lundsberg, Belanger, Pettker, Funai, &Illuzzi, 2015).
Cesarean Section has been associated with an increased risk of neonatal asthma hospitalization, in particular in premature infants, which confers the respiratory advantages of labour to neonates (Grant, 2015). Furthermore, a number of epidemiological publications suggest that PLCS (pre-labor caesarean section) is related to higher chances of the child having type-1 diabetes or adolescent obesity compared to vaginal delivery, which may add substantially to poor population health. Also, it has been shown that maternal mortality and morbidity is 2-3 times and 5-7 times higher, respectively, in cesarean section than vaginal delivery and cesarean section is 2-3 times more expensive than vaginal delivery. It is then possible that the general public has shown increased acceptance of caesarean delivery without being aware of its adverse consequence (Grant, 2015). However, despite the increasing cesarean section rates, most women in developing countries are still averse to cesarean section, which is perceived as a curse on an unfaithful woman and as the lot of the weak women (Deb, 2016). Also, patients in Nigeria have aversion to the procedure for many socio-cultural reasons, among which is the feeling that caesarean section represents a form of failure of the woman’s reproductive capability (Anjita Sinha, Susan & Bewley, 2015). Hence cesarean section in Nigeria is viewed with suspicion, misconception, fear, guilt, misery and anger and very few women in Nigeria would, therefore, accept the procedure even in the face of obvious clinical indications (Goodin, 2015).
In developing countries, women and those who make decisions for them such as husbands, mothers in law and local authority figures are reluctant to accept CS because of the traditional beliefs and sociocultural norms. Some women even see delivery by CS as reproductive failure on their part (Ilesanmi, Odukogbe and Olaleye, 2015). As a result of these they engage untrained and unskilled providers, they only report to the hospital when life threatening complications set in (Lumbiganon, Laopaiboon, Gulmezoglu, Soura, 2016).
This negative view and perception of cesarean section by women in the developing countries has led to gross underutilization of the procedure compared to the large burden of Obstetric morbidity requiring resolution by ceserean section (Okonofua 2014). Therefore, this will add to the compendium of knowledge by mirroring out the the perception and attitude pregnant woman towards cesarean section using pregnant women attending antenatal at Babcock University Teaching Hospital Ogun State
1.2 Statement of the Problem
Cesarean section (CS) is one of the oldest surgeries and in history, it is known as one of the most commonly performed surgical procedures in the Obstetric Ceserean section. Although the Caesarean section has greatly contributed to improved obstetric care throughout the world (Eni-Olorunda, Otito, Akinbode, Akinbode, 2015) it has been reported throughout medical history that the surgery has gradually progressed from being fatal resulting in mortality for the mother or the child to being rendered safe for both mother and fetus during the 20th century as cited by (Anjita, Sinha & Bewley, 2015).
The rate of Caesarean section in developed countries is increasing as there has been a higher rate of acceptability over time while developing countries are struggling with the issue of non-acceptance of Caesarean section even in the face of inherent danger/risks. This negative perception has led to the underutilization of the procedure (Nzewi, Leonie & Penna, 2015).
Although in both developed and developing countries there is an increased rate of Caesarean section, there is a widely held belief that African women have an aversion for it. According to Molina, Esquivel, Uribe-Leitz, Lipsitz, 2015), cesarean section is perceived by African women as a “curse” of an unfaithful woman. It is therefore accepted reluctantly even in the face of obvious clinical indications. Previous studies conducted among women (Nzewi, Leonie & Penna, 2015; Molina, Esquivel, Uribe-Leitz, Lipsitz, 2015) indicated that the majority of women prefer vaginal delivery to cesarean section and there are some who will not accept the surgery even if indicated. There is evidence to show that pregnant women who are knowledgeable about their condition are able to participate in shared decision-making (Coulter, Parsons, &Askham, as cited by Nzewi, Leonie & Penna (2015).
These problems necessitate the need to carry out a study on the factors associated with the acceptance of cesarean section among pregnant women attending Antenatal at Babcock University Teaching Hospital in Ogun state.
1.3 Objectives of the Study
The general objective of this study is to examine the factors associated with the acceptance of cesarean section among pregnant women attending antenatal at Babcock University Teaching Hospital Ogun State. In order to achieve this objective, the following specific objectives are required:
1. Assess the knowledge of cesarean section among pregnant women attending antenatal at BUTH.
2. Assess the level of acceptance of cesarean section among pregnant women attending antenatal at BUTH.
3. To ascertain the factors associated with acceptance of cesarean section among pregnant women
1.4 Research Questions
The relevant research questions related to this study include the following:
1. What is the knowledge of pregnant women on cesarean section?
2. What is the level of acceptance of cesarean section among pregnant women attending antenatal at BUTH?
3. What are the factors associated with the acceptance of cesarean section among pregnant women?
1.5 Research Hypothesis
Ho1: There is no significant difference between knowledge and level of acceptance of cesarean section among pregnant women attending antenatal at Babcock University Teaching Hospital.
Ho2: There is no significant difference between perception and level of acceptance of cesarean section among pregnant women attending antenatal at Babcock University Teaching Hospital.
1.6 Significance of the Study
This study will be relevant to pregnant women, husbands, healthcare providers, government and researchers.
To pregnant women,the findings in this study will effectively debunk the wrong rumors and misconception of pregnant women on cesarean section and will also increase their knowledge on the importance of cesarean sectionand how it can help to prevent avoidable complications during childbirth.
To husbands, this study will succinctly elucidate the factors that influences the acceptance of cesarean section and how those factors can be channeled towards ensuring certain complications during childbirth are avoided.
To health care providers, this study will extensively discuss their roles in educating pregnant women who come for antenatal on the relevance of cesarean section and how it can prevent avoidable complications during childbirth. They also expected to ensure that the healthcare centers are well equipped in order to reduce the number of complications during cesarean section.
To government, this study will effectively discuss the role of the government in making provision of adequate medical equipment in ensuring that the process of cesarean section is effectively carried out. The provision of adequate medical personnel to hospitals is also important in order to strengthen the manpower in the health care centers across the country.
To researchers, this study will enhance the existing body of literature by contemplating the areas of the literature that have not yet been examined or considered and incorporating these factors into the current study. The study will thus form the basis for further studies in the field.
1.7 Scope of the Study
The scope of this study is restricted to the factors associated with the acceptability of pregnant women towards cesarean section among pregnant women attending antenatal at Babcock University Teaching Hospital Ogun State. A questionnaire will be used for the purpose of this study and the sample population are pregnant women attending antenatal at Babcock University Teaching Hospital Ogun state. The researchers restrict this study to the pregnant women attending antenatal at Babcock University Teaching Hospital because to the limited resources available and the time constraints.
1.8 Delimitation of the Study
Some of the major constraints the researchers encountered in putting up this research include religious bias, language barrier and lack of willingness to give information by respondents and also limited resources.
1.9 Operational Definition of Terms
Antenatal: means relating to the medical care of women when they are expecting a baby.
Attitude: is a predisposition or a tendency to respond positively or negatively towards a certain idea, object, person, or situation.
Acceptance:The action of consenting to receive or undertake something offered.
Cesarean section: is a surgical procedure used to deliver a baby through incisions in the abdomen and uterus.
Knowledge: Knowledge is a familiarity, awareness, or understanding of someone or something, such as facts, information, descriptions, or skills, which is acquired through experience or education by perceiving, discovering, or learning.
Pregnancy: is the time during which one or more offspring develops for 9 months inside a woman until the baby is delivered.
Pregnant women: A group of people pregnant (ages 16-40) and expecting their babies to be delivered after 9months