The Perception and Attitude of Pregnant Women in Oredo Local Government Towards Cesarean Section
OBJECTIVE 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.
- To assess the perception of Oredo Local Government women of cesarean section
- To determine the attitude of Oredo Local Government women towards C/S
- To assess the possible factors that influence their perception and attitude.
A cesarean section also known as C/S is a surgical procedure used to deliver a baby through an incision in the mother’s abdomen and a second incision in the uterus (www.maysclinic.com).
The cesarean section is a common operative surgical procedure worldwide where the fetus is delivered through an abdominal and uterine incision. (www.merrianwebster.com/sictionary.) The indication can be either based on maternal or fetal complications. The proportion of women giving birth by C/S has increased with the time in all developed countries over the past decades. (Haliniton et al). The level of C/S acceptance as risen above the prescribed 15%.0 (WHO 1985) mark of the countries is still increasing. (Declearq et al 2013).
On the other hand, the rate of C/S in the developing countries has been low over the same period of time. C/S is still being perceived as an abnormal means of delivery of some women based on factors like in adequate facilities and medicine. (Sunday I et al 2011)., therefore, the C/S rate in some sub-Saharan African countries (like Burkina-Faso and Niger) is as low as 2% and consumes less time physicians priontize C/S due to convenient and quick handling than attending a normal vaginal delivery (Banigboye, AA Hofmeyr, GJ 2014).
In wast Africa-Ghana, a study was carried out among antenatal clinic women in a Goninan teaching hospital (KongoAntoye teaching hospital KATH) Kumasi Ghana by (RK, Adageba-Kokore 2009). The study was carried out to determine the knowledge, perceptions,and to determine the knowledge, perceptions, and attitude towards cesarean delivery.
The results showed that amongst the 317 women interviewd, 304 (96%) had head of the operation, however only 43 (13.5%) could mention specific indications for it. Vaginal delivery was preferred by 296 (93.3%), while 11 (3.5%) preferred planed C/S. the remaining 10 (3.2%) were undecided. Although 164 (51.7%) perceived it as being dangerous to the mother and baby, 287 (90.5%) were willing to undergo the operation when indicated. 19 (6%) would refuse the operation even when indicated. Almost all the women, 311 (98.1%) wanted C/S to be part of client education at the antenatal clinic and 314 (99.1%) wanted to be informed about the specific indication before surgery. (RK-Adegba et al).
Majority of the women, 287 (90.5%) said they would agree to the operation of it was indicated. 247 (78%) of the women felt that one C/S delivery did not preclude vaginal delivery was not possible again. 311 (98.1%) of the women wanted C/S to be part of antenatal clinic educational topics (KA Danso et al.) which study that majority of pregnant women attending the antenatal clinic were aware of C/S as the alternative to vaginal delivery but perceives it as being dangerous for them and their babies compared to what other women in the western countries like Australia perceive.
(RK Adaegba et al) concluded that majority of women in this study prefer vaginal delivery even though they had high awareness of C/S as an alternative to vaginal delivery.
Furthermore, according to the study carried out by (Sunday I et al 2011) in the Eboyi state University teaching hospital, Abakaliki (EBSUTA) south west Nigeria, 300 questionnaire were shared, 225 (81.2%) of the women viewed C/S as good if their baby was in great danger only, 4 women (1.4%) viewed C/S as very good and elected to undergo C/S to avoid pains and complications of labour, 34 (12.3%) thought C?S is bad and would only reluctantly undergo the procedure if the doctors taught it would be necessary to save their lives and the baby’s. 3 (1.1%) viewed C/S as being very bad and will not accept the procedure for any reason. 34% of the respondents indicated that cultural perception of C/S was negative and it was for women who are weaklings.
Which study (Sunday et al) Affirms previous suspicion that a significant proportion of antenatal clients are averse to C/S and the cultural perception may have further reinforced this aversion.
Perceived Reasons why C/S is Rejected?
According Fabieme Richard, Sylvie Zongo and FatoumataOuattara 2004, the perceived reason why west African women perceive C/S neglectively are as follows:
- Lack of understanding about C/S: They complain that professionals do not explain vividly what C/S entails.
- Economical burden of C/S compared to normal delivery.
- Belief that C/S is for weaklings that is those who are not women enough.
- Fear of C/S,it’s unpredictability and consequences, eg pain and death.
- Feeling of failure of not being a good mother
- It is noteworthy that in Nigeria, women who cannot deliver virginally are believed to have not prayed enough (Aziken Michael, Omo-Ajogha 2011).
- Believed that the hospital and staffs only want to make money.
For others, hearing other peoples horror stories about C/S e.g paralysis of lower limbs, tearing wounds after sutures, infertility e.t.c are reasons why they would not consider a C/S.
Types of C/S and their Indication
There are four types of C/S (Dahlke Joshua, Mendez Figueroa Hector, Rouse Dwigat, Jason 2013).
- Classical cesarean: Here the upper portion of the uterus is opened by an incision on the baby is extracted. This is not practiced anymore due to higher incidence of complications.
- Beech or transverse lie
- Genital herpes in mother
- Diabetes (large babies)
- Severe cardiac diseases/high blood pressure
- Triplet or more babies
- HIV infections e.t.c.
This chapter essentially deals with research method and procedures employed therein.
The research was carried out on the ante-natal clinic women in the central Hospital Sapele road, Benin city.
This is a non-experimental research using descriptive approach to assess the perception and attitude of Oredo local government women towards C/S.
This research study cuts across the women in the ante-natal clinic at central hospital, Sapele Road Benin city in Edo state.
Ordeo is one of the prominent L.G.As in Edo state, with it’s headquarters as Benin city, the capital of Edo state, Benin city. Oredo local Government ahs many historic houses and buildings which includes the famous Oba palace, Oba marketing ground and central hospital. Oredo has an area of 249km2 and a population of 347,671 at the 2005 census.
Central hospital is a government hospital located in the centre of Benin, along Sapeleroad, it shares boundaries with the federal high court on the east, Ring road on the west, central Baptist Church on the north, and Edo state house of assembly on the south.
The target population for this research consist of pregnant women who attended antenatal clinic at central hospital between January 13th 2014 and November 25th, 2014.
Figures 4a – e showing the socio-demographic characteristics of the respondents.
The study has found out that all the participants 155 (100%) were aware about cesarean section section as a surgical procedure to deliver baabies as an alternative to vaginal delivery but think it is abnormal. This findings was consitent with that of a similar study done in sub-Sharan Africa and Urban Nigeira by (Sunday I. et al. 2011) and (Fabianne Richard et al. 2014) as 96 (61.9%) of the participants believes that C/S is banormal and 98 (63.2%) believed that C/S was for weak women.
Despite the fact that an overwhelming majority of women interviewed 142 (91.6%) believed that C/S can prevent damage to the body such as vaginal tear, 97 (62.6%) the respondents said they would never consent to a cesarean section for any reason. Their attitude towards the procedure was such that it was viewed as either abnormal or unacceptable so it is constantly rejeted by women except at the verge of serious complications or threathened loss of life by the doctor’s indication. 34 (21.9%) of the respondnets even indicated that C/S was just a way medical professionals surp money for themselves without allowing them to try labour long-enough to push the baby out themselves.
The reasons behind the womans attitude towards cesarean section was not far-fetched as 58 (37.4%) of them said it was too expensive, 76 (49.0%) indicated that it was a taboo for their culture or family to give birth through “operation” when even animals give birth safely without the operation, 74 (47.74%) believed that they would not feel woman enough if they did not push the baby out themselves, this is also consistent with the findings from (Nuhu Natie Butawa et al. 2010) with (93.3%) indicating preference for viginal delivery (97.3%) of the paticipants indicating that C/S was for women who have not prayed enough or is a weak woman and (42.7%) gave reasons that the hospital and staff wanted to make profit or that young doctors just wanted to practise performing the procedure (29.3%). In a study of C/S in 145 women from Ghana, women who prefered vaginal deliveries said that “vaginal is best” with no long-term pain, less riisk of dying and less cost.
According to the findings above, underdeveloped countries like Ghana, Burkina Faso or Nigeria, have not been able to general accept or explore the bebefits of a ceserean section optimaly compared to other developed countries like Austrialia where the level of ceserean section has increased above the W.H.O recommended 15% (Halinton Be et al.).
This is a discriptive (non-expereimental) research carried out to assess the perception and attitude of women attending antenatal clinic at central hospital towards ceserean section between September to November, 2014.
Recent related literature was reviewed and questionaires were shared and manually sorted out the entire particiaptants 155 (100%) indicated that they were about C/S as an attendant to vaginal delivery but 96 (61.9%) between it was abnormal while only 59 (38%) thought otherwise 58 (37.4%) believed it was expensive, 76 (49%) viewed the procedure as a cultural taboo while 53 (34.2%) indicated that they could not bear the pains of labour.
Hence, this shows a high level of rejection amongst the women attending the antenatal clinic at central hospital with a high level of misconceptions.
This study affirms previous suspicion that a significant proportion of antenatal clients are averse to C/S 97 (67.6%) and the negative cultural pereception may have further reinforced this aversion 76 (49%). The unacceptable maternal mortality ration in Nigeria may be related to the fear of C/S and association of vaginal birth as a mark of genuie ferminity which makes women reject it 74 (47.74%). If maternal mortality must reduce in Nigeria through the acceptance of C/S, then the misconceptions and fears expressed by the clients should be addressed in addition to modifying the negative perception of the local communities about C/S.
IMPLICATION FOR NURSING
Nurses and midwives should encourage and help educate pregnant women about the benefits of ante-natal clinic as a means of the ensuring a safe delivery and motherhood.
Many of the indications for ceserean sections could be thoroughly explained to expecting mothers so that the physiology can be understood and the procedure can be reasonably acceptable.
Based on the findings of this study, the following recommendations are made:
- There should be awareness about C/S by th governmental institutions that would not only explain the benefits of the procedure but will also modify their misconceptions.
- The procedure should be better subsidized by the governemntal institutions so that the economic implications will be ruled out of the reasons for rejection.
- Midwives and physicians should be properly skilled in providing care for women undergoing C/S to prevent the complications some of the women fear most.
SUGGESTIONS FOR FURTHER STUDIES
Further studies by other researchers should be conducted amongst users of maternity wards and women who have undergone C/S to see if the increased affordability has changed their expreences and perceptions of the procedure.
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