CHAPTER ONE
INTRODUCTION
Background to the study
Caesarean section (CS) is a surgical procedure in which one or more incisions are made through a mother’s abdomen (laparotomy) and uterus (hysterotomy) to deliver one or more babies, or to remove a dead fetus (Klein and Kaczorowski, 2011). It is one of the most important operations performed in obstetrics and gynaecology. Its life saving value to both mother and fetus has increased over the decades although specific indications for its use have changed. Its purpose of preserving the life of a mother with obstructed labour and delivering a viable infant from a dying mother have gradually expanded to include the rescue of the fetus from subtle dangers (Rozenburg, 2010). If there are no complications, a vaginal birth is safer than a CS. Advantages of having a CS especially when it has been planned over the vaginal births includes: no contraction, minimized risk of prolapse, no vaginal injury and reduced bleeding while its disadvantages includes: increased cost, uterine rupture and increased probability of complications (Nira and Sumita, 2007).
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. Over time caesarean section rates has been on the increase in the whole world (Klein and Kaczorowski, 2011). Both developed and developing nations of the world have their own share of this increase (Behagus and Victoria, 2011).
Epidemiological studies in Brazil and Chile have shown that there is higher caesarean section rate among women who have a higher level of education (Oladapo and Sotunsa, 2012). In some African countries such as Ghana and Nigeria, increase in the rate of caesarean section have been documented. However according to Awoyinka Ayinde and Omigbodun, (2006) there is a broadly held belief that West African women have an aversion for caesarean section delivery. 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 (McGurgan Coulter-Smith and O’Donovan, 2010). 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.
Various reasons for a caesarean section may include prolonged labour, foetal distress, cord prolapse, uterine rupture, placental problems like placenta praevia, placenta accreta, abnormal presentation like breech or transverse positions, failed instrumental delivery, macrosomia, contracted pelvis etc can precipitate caesarean section. Other precipitating factors include lack of obstetric skill in performing breech births, multiple births, and improper use of technology (Electric Fetal Monitoring (EFM) (Kwee and Cohlen, 2010).
However, it is not strange to hear many pregnant women express wrong perception towards caesarean section as an alternative method of birth. Especially in the developing countries like Nigeria, a number of women believe caesarean section is a last resort used to deliver a pregnant women of her baby, many will even say, been told that they are going to deliver their babies through caesarean section is like giving a death warrant. This perception towards caesarean section influence women acceptance of the procedure and resulted in psychological depression that women and their family usually experience when been told that their baby will be delivered through caesarean section, this will have adverse effect on the outcome of the procedure.
Statement of the problem
Women turn down caesarean section for various reasons which includes: maternal fear of death during surgery based on death of close relatives, past unpleasant experiences in previous caesarean sections and unpleasant stories that they had heard from other women, desire to experience vaginal delivery, perception that caesarean section was an indication of reproductive failure, economic factor, inadequate counselling in the course of antenatal care, complaints of uncaring or casual attitude of the doctors when giving the information, religious belief in prophecies given that one would have a normal delivery (Osis, Padua and Duarte, 2011).
Furthermore, in most sub-Saharan African countries including Nigeria, caesarean section is being accepted reluctantly even in the face of obvious clinical indication (Chong and Mongelli, 2003). 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 (Lee, Khang and Lee, 2012).
Also, 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 (Oladapo and Sotunsa, 2010)
Objective of the study
This broad objective of the study is to assess the perception of women of child bearing age towards caesarean section and the specific objective are to:
- To assess the perception of women about caesarean section.
- To determine the attitude of women towards caesarean section.
- To assess the level of acceptance of caesarean section as a method of birth among women
- To determine factors that may limit women’s acceptance of caesarean section
Significance of the study
Having a caesarean birth is one of the most difficult decisions facing pregnant women even when there are obvious reasons to have one. More difficult is trying to convince these women on the safety of the procedure and need to have one to save their lives and that of the unborn child. Convincing them has not been easy for nurses and other health practitioners while some women even still go ahead to have a spontaneous vigina delivery against doctors counsel.
However, this study will play a significant role as it will aid nurses in the counseling of pregnant women who need a caesarean delivery during antenatal session. The result from this study will give the practicing nurse an eye opener into what to expect when interacting with women on their preferred mode of delivery.
Research questions
The following are the questions the researcher puts forward to guide the research:
- What is/are perceptions of women about caesarean section?
- What are the attitude of women towards caesarean section?
- What is the level of acceptance of caesarean section as a method of birth among women?
- What are the factors that may limit women’s acceptance of caesarean section?
Scope of the study
The study will cover all women attending antennal clinic at Irrua Specialist Teaching Hospital. ISTH antenatal clinic days cover from Monday to Thursdays with obstetrics and gynecologists consultant attending to the women.
Operational definition of terms
Perception: perception in this study refers to the way in which caesarean section is regarded, understood, or interpreted by women of Child Bearing Age.
Attitude: in this study attitude refers to a settled way of thinking or feeling about something
Child Bearing Age: Child Bearing Age in this study refers to the age when a women becomes sexually capable of producing a child.
Caesarean section: this is a surgical operation for delivering a child by cutting through the wall of the mother’s abdomen.
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