Attitude Of Women Of Childbearing Age Towards Cesarean Section

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:

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.
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:

• What is the level of knowledge of women towards caesarean section in Anambra State?
• What is the attitude of women of childbearing age towards cesarean section in Anambra State?
• 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.