The Perception and Attitude of Pregnant Women Towards Caesarean Section

1.1 Introduction

Caesarean section is a surgical procedure in which one or more incisions are made through a mother’s abdomen (laparotomy) and uterus (hysterectomy) to deliver one or more babies, or to remove a dead fetus. It is one of the most important operations performed in obstetrics and gynaecology. Pregnant women who gave birth through Caesarean section are believed to be weak as undergoing a Caesarean section traditionally portrays a sign of failure (Adeoye et al., 2011 and Mboho, Christine & Heather, 2011). Perhaps this could be attributed to the fact that it is surrounded by fear, suspicion, aversion, misconception, guilt, misery and anger (Adeoye et al., 2011). Also Ugwu et al., (2015) in a study observed that women refuse Caesarean section due to fear of abandonment by their husband and in-laws, inability to have desired number of children as a result of previous use of Caesarean section and cost of the surgery.

This chapter will address the background information that motivated this study, the challenges that prompted it, its aim, and its objectives as a preface to subsequent sections of the study. Additional factors include the study's significance, scope, limitations, research questions and hypotheses, and the definition of technical terms.

1.2 Background of Study

Caesarean section (CS) is one of the most commonly performed surgical procedures in obstetrics and is certainly one of the oldest surgeries (Chaser, 2011). Probably the term Caesarean was derived from the decree in Roman law, which made it mandatory for the operation to be performed on women dying during child birth, a term called Lex Caesarean (Kwawukume, 2012). This surgery has been reported throughout medical history and has steadily 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 (Kwawukume, 2012). Caesarean section has greatly contributed to improved obstetric care throughout the world (Nkwo & Onah, 2012). Even though there is an increased rate of caesarian section in both developed and developing countries, there is a widely held belief than African women have an aversion for it and is perceived as a “curse” of an unfaithful woman. It is therefore accepted reluctantly even in the face of obvious clinical indications (Adeoye & Kalu 2011). 

Shearer El (2010) said 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. If there are no complications, a vaginal birth is a 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, uttering rupture and increased probability of complications(Kwawukume, 2012).

Pregnancy as a physiologic state is expected to lead to a process of delivery within thirty six weeks (36) of gestation in a normal delivery but due to the different reasons such as variation in human body, sizes, races, external factors e.t.c, it can be a very unpleasant experience as women may have difficulties in being delivered of the pregnancy they have carried over many weeks. Hence, to save the life of both mother and child in some cases, a cesarean section. A cesarean section also known as C/S is an operation technique by which a fetus is delivered through an indications can either be maternal or fetal. The trend of acceptability and the rate of C/S has been on the increase in the developed countries in the past two decades. in the United State of America, it has revolved off a 32.8% in 2010 and 2011 (Hamilton BE, Martin JA, Ventura SJ, 2010). Several cesarean sections are sometimes done for justifiable medical and non-medical indications sequently the rate of C/S in Europe and North America have been increasing (Declercq ER, Sakela C, Corry MP, 2013).

Conversely, in the developing countries, the change in C/S rate has been dramatic during the same period. This results from negative perception of C/S among women in the developing countries. C/S is still being perceived as an abnormal means of delivery by some women in developing countries, hence C/S rate in Sub-Saharan African Country like Burkina Faso and Niger is as low as 2% (Sunday Adeoje I, Kalu CA, 2011). Among women in the developing countries, C/S is still being perceived as a curse on an unfruitful women and the lot of weak women. In a study among Yoruba women of South western Nigeria, C/S was viewed with suspicious, aversion, misconception, fear, guilt misery and anger. (Sunday-Adeoje et al, 2011).

In Nigeria, as in most sub-Saharan African countries, it has been suggested that women reluctantly accept C/S even in the face of obvious clinical indications. Also, negative view and perception of C/S by women in the developing country has led to gross underathizetlien of the procedure compared to the large burden of obstetric morbid requiring resolution by C/S (AzikenMicheal, Lawrence Omo-Aghoja 2010). Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Perception and Attitude of Pregnant Women towards Caesarean Section.

1.3 Statement of Problems

Investigation revealed that Nigerian has been rated the third country with the highest mortality rate after India and Sierra Leone with over 40,000 dths of pregnant women 2012 (WHO 2013). Unfortunately, despite the well documented record of safety, the strong aversion of women in sub-Saharan Africa tot eh procedure especially in the presence of life threatening indications is a great concern (Awoyinka BS, 2006). Hence the researcher wants to assess the perception and attitude of patients at the antenatal clinic to know if it is accepted or not and the factors that influences their attitudes towards cesarean section.

1.4 Aim and Objectives of Study

This study is aimed at the determination of the possible reasons or factors that influence the perception and attitude of Oredo Local Government women towards cesarean section. In achieving this aim, the following specific objectives were laid out as follows:

1. To assess the perception of Oredo Local Government women of cesarean section;
2. To investigate the possible factors that influence their perception and attitude; and
3. To determine the attitude of Oredo Local Government women towards cesarean section.

1.5 Research Questions

The study came up with research questions so as to be able to ascertain the above stated objectives. The specific research questions for the study are stated below as follows:

• What is the perception of Oredo local government women about C/S?
• What is the attitude of Oredo local government women towards C/S?
• What are the factors that influence the perception and attitude of Oredo local government women towards?

1.6 Research Hypothesis

In order to pursue the objective of this study, the following generalized statements have been designed to guide and aids in obtaining the result for the experiment to be conducted. For this work, the null hypothesis will be represented with H0 while the alternative hypothesis will be represented with hypothesis H1.

• H₀1: There is no significant relationship between cultural beliefs and practice as a factor that influences the perception of Oredo local government women of Cesarean section.
• H₀2: There is no significant relationship between the fear of death and complications of surgery is a factor that influences the attitude of Oredo local government women towards C/S.

1.7 Significance of Study

This study is significant because it will help the women understand the need for C/S especially when a vaginal delivery seem threatening to their health and that of their fetus. It will also help in debunking their various belief and taboo about the procedure which has been one of the reasons why they have been levistant to approve of it so that the rate of maternal and fetal mortality will be reduced to the bearest minimum.

1.8 Scope of Study

The scope of this research is focused on the Perception and Attitude of Pregnant Women towards Caesarean Section using Oredo Local Government Area of Edo State as a case study.

1.9 Limitations of the Study

During the course of this study, many things militated against its completion, some of which are:

1. Time Constraint: The time frame given to accomplish this project was very short due to school academic calendar and it was carried out under pressure which made the researcher not to implement some necessary features.
2. Financial Constraint: Insufficient fund tends to impede the efficiency of the researcher in sourcing for the relevant materials, literature or information and in the process of data collection (internet, questionnaire and interview).

1.10 Definition of Terms

Perception:

It is the process of recognizing and interpreting sensory stimuli. Learn the definition of perception, how it is related to the five senses, how it differs from reality, and more.

Caesarean Section:

It is also known as C-section or caesarean delivery is the use of surgery to deliver one or more babies. A caesarean section is often necessary when a vaginal delivery would put the baby or mother at risk.

Anaesthesia:

The state in which one is unable to feel anything especially pain by injecting drug into the body.

Attitude:

The way one behaves towards somebody or something that shows how you think or feel.

Dystocia:

It implies any form of abnormalities in pregnancy or any deviation from normal during pregnancy.

Knowledge:

To have information about something because you have experience or because you have learned it or be told.

Macrosomia:

It is a large babies weighing more than 40kg at birth especially in diabetic mothers.

Mortality:

It is the number of death in a particular situation or period of time.

Placenta Previa:

This is a condition in which the placenta of a fetus lies where the presenting part of the fetus is supposed to come out (the cervical OS).