Full Project – Perception and attitude of women of childbearing age towards caesarian delivery

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CHAPTER ONE

INTRODUCTION

• Background of the study

Delivery is one of the most important issues for human beings and generations in the world. Decades ago, the most available or preferred option for most women was a vaginal birth. Some women had their babies at home with traditional birth attendants but often had difficult labour resulting from obstruction and the women died before any meaningful interventions. Today, however, many babies have been delivered successfully through caesarean section (Mboho, 2013). This success story is not without criticism. However, the perceptions surrounding caesarean section may have a significant role in the attitude towards decision making process which is influenced by multiple complex factors such as the reason for which the caesarean was performed, her cultural values, her beliefs and anticipations of the birth, possible traumatic events in her life, available social support, and her personal sense of control, are only a few.

Caesarean section (CS) is the birth of a foetus through surgical incisions in the anterior abdominal wall and the uterine wall after the age of viability. 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. Molina et al., (2015) identify caesarean section as surgical procedure which could be scheduled ahead of time and most arranged for medical indications which have been developed before or during the pregnancy. For so long, 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 foetus from subtle dangers. According to the World Health Organization (WHO, 2015), it is the most common abdominal surgical procedure performed around the world. This is considered safer for both mother and foetus compared to emerging counterpart.

Approximately 585,000 women die each year from complications of pregnancy and delivery with another 17.5 million suffering significant birth injuries or humiliating painful disabilities (Etuk and Ekanem, 2011). More than 98% of these deaths and disabilities occur in developing countries (World Health Organization, 2008). Nigeria has one of the highest maternal mortality rates in the world. It is between 1000 and 1500 per 100,000 births (Jeremiah, Nonye-Enyidah & Fiebai, 2011). In Nigeria, the national C/S rate is 1.8% (World Health Report, 2015). 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 (Jido and Garba, 2012), 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 (Ugwu, Obioha and Ugwu, 2011), 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.

Furthermore, in most sub-Saharan African countries, including Nigeria, caesarean section is being accepted reluctantly, even in the face of obvious clinical indication (Mboho et al., 2013). Several studies have indicated how poor attitude and negative perception have impacted general health and childbearing. Attitude and perception have been identified as contributing to the delays in accessing appropriate skilled help when complications arise in labour (Okafor, 2010).  Adeoye and Kalu (2011) also opine that, among women in the developing countries, caesarean section is still being perceived as a ‘curse’ of an unfaithful woman. The authors further noted that, caesarean section is carried out 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 & Kalu, 2011). It is not strange to hear many women of childbearing age exhibiting wrong attitude and negative perception towards caesarean section as an alternative method of birth. In the developing countries including Nigeria, a few women believe CS is a last resort used to deliver a pregnant woman of her baby. Yet, there is no doubt that caesarean section has contributed immensely to improve obstetric care throughout the world.  It is against this backdrop this study is set to examine the perception and attitude of women childbearing age towards caesarian delivery in Ede-South Local Government Area, Osun State.

• STATEMENT OF THE PROBLEM

Evidences have shown that women still choose vaginal birth after having a caesarean section even in the case of post-date slated for caesarean section (Clift-Mathews, 2010). The author further highlighted the fact that women desperately wished to go into labour before their appointment dates because they perceived that, not giving birth vaginally was a sign of ‘failure’. In addition, vaginal birth is something a few women perceived as a rite of passage (Clift-Mathews 2010). However, Nigeria is a country where nearly 20% of all global maternal deaths occur (WHO 2017).  Also, between 2005 and 2015, it was estimated that over 600,000 maternal deaths and no less than 900,000 maternal near-miss cases occurred in the country (WHO 2017). In 2015, Nigeria’s estimated maternal mortality ratio was over 800 maternal deaths per 100,000 live births, with approximately 58,000 maternal deaths during that year. By comparison, the total number of maternal deaths in 2015 in the 46 most developed countries was 1,700, resulting in a maternal mortality ratio of 12 maternal deaths per 100,000 live births. In fact, a Nigerian woman has a 1 in 22 lifetime risk of dying during pregnancy, childbirth, or postpartum/post-abortion, whereas in the most developed countries, the lifetime risk is 1 in 4,900 (WHO 2017). It is therefore important to note thatnow, some women still perceive CS as a last resort, therefore having a negative attitude towards it. This study would therefore examine the perception and attitude of women childbearing age towards caesarian delivery in Ede-South Local Government Area, Osun State.

• JUSTIFICATION OF THE STUDY

This study will examine the personal perceptions and attitudes of women of childbearing age in Ede South Local Government Area. As women of childbearing age in the society face an increased threat in the normal child delivery process, the other alternative which is C/S, needs to be presented in the best possible way such that the perception about it may be reduced to the barest minimum. Many women perceive the process of not giving birth vaginally as a sign of ‘failure’. A lot of them perceive vaginal birth as a right route of passage hence most of them crave for it (Robinson-Bassey & Uchegbu, 2017). The knowledge of society surrounding CS may have a significant role in the decision-making process of women of childbearing age accepting to undergo the procedure. The lack of knowledge about CS by women in the developing countries has led to underutilization of the procedure compared to the large burden of obstetric morbidity requiring resolution by CS (Qazi et al., 2013). This attitude of some women towards CS influences their acceptance of the procedure and often, results in psychological depression that women and their families usually experience (Faremi, Ibitoye, Olatubi, Koledoye & Ogbeye, 2014). Therefore, this study aims to determine women of childbearing age’s perception and assess their attitudes towards caesarean section.

• GENERAL OBJECTIVE

This study will examine the perception and attitude of women of childbearing age in Ede South Local Government Area about C/S.

• SPECIFIC OBJECTIVES

By the end of this study, it will be possible to:

1. assess the level of knowledge on caesarean delivery among childbearing age women in Ede-South Local Government Area.
2. determine the perception of Ede-South Local Government women of childbearing age about caesarean delivery.
3. evaluate the attitude of Ede-South Local Government women of childbearing age towards caesarean delivery.
4. identify the related factors influencing the perception of Ede-South Local Government women of childbearing age towards caesarean delivery.

• RESEARCH QUESTIONS
  1. What is the level of knowledge on caesarean delivery among childbearing age women in Ede-South Local Government Area?
  2. What is the perception towards caesarean delivery among childbearing age women in Ede-South Local Government Area?
  3. What is the attitude towards caesarean delivery among childbearing age women in Ede-South Local Government Area?
  4. What are the related factors influencing the perception towards caesarean delivery among childbearing age women in Ede-South Local Government Area?
• Research Hypotheses

Ho1: There is no significant relationship between perception and attitude towards caesarean delivery among childbearing age women in Ede-South Local Government Area.

H_A1: There is a significant relationship between perception and attitude towards caesarean delivery among childbearing age women in Ede-South Local Government Area

Ho2: There is no significant relationship between knowledge and attitude towards caesarean delivery among childbearing age women in Ede-South Local Government Area.

H_A2: There is no significant relationship between knowledge and attitude towards caesarean delivery among childbearing age women in Ede-South Local Government Area.

• OPERATIONAL DEFINITION OF TERMS

Anaesthesia:Aloss of sensation with or without loss of consciousness.

Attitude: An attitude is “a settled way of thinking or feeling about something” (Oxford Dictionary   2015). An attitude can also be defined as an organized predisposition to respond in a favorable or unfavorable manner toward a specified class of objects. Attitudes form a significant determinant of behavior and form ‘biases’ to act and behave in a certain way.

Perception: Perception is defined as “the way in which something is regarded, understood or interpreted” (Oxford Dictionary, 2015). Through perception, an individual can create meaning of the world around them, creating subjective and personal inferences. Perception is largely guided by knowledge. For the purposes of this study, perceptions refer to the ways in which teenagers regard, understand and interpret teenage pregnancy within their lived experiences.

Pregnancy: According to the National Institute on Child Health, Pregnancy is the term used to describe the period in which a fetus develops inside a woman’s womb or uterus. Pregnancy usually lasts about 40 weeks or just over 9months as measured from the last menstrual period to delivery and which is classed into 3 trimesters.

Caesarean Section: A surgical procedure involving incision of the walls of the abdomen and uterus for delivery of offspring.

Dystocia:Aslow or difficult labor or delivery

Knowledge: Knowledge is defined as “the facts, feelings or experiences known by a person or group of people; awareness, consciousness, or familiarity gained by experience or learning; specific information about a subject” (Collins English Dictionary, 2014). Knowledge is gained from peers, institutions of socialization such as the school, family and church, the media such as newspapers, magazines, radio, films, television, and the Internet. Knowledge is very important as it is the basis upon which decisions are made. It is also essential as it helps shape an individual’s reality.

Macrosomia: Large babies weighing more than 40 kilogramsat birth, especially in diabetic mothers.

Mortality: The number of deaths in a population during a given time or place; the proportion of deaths to population.

Placenta previa: An abnormal implantation of the placenta at or near the internal opening of the uterine cervix so that it tends to precede the child at birth, usually causing severe maternal hemorrhage.

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Full Project – Perception and attitude of women of childbearing age towards caesarian delivery