Perception and attitude of pregnant women attending antenatal clinic towards cesarean section in civil service hospital

Social Issues

  • Author Olaboopo Mubarakat Opeyemi
  • Published October 9, 2022
  • Word count 6,558

CHAPTER 1

1.1 INTRODUCTION

BACKGROUND OF STUDY

Caesarean section rates are increasing worldwide, and since the 2000s, several researchers have investigated women’s demand for caesarean sections. It is one of the most commonly performed surgical procedures the world over. Despite the well-documented record of safety, the strong aversion of women in sub-Saharan Africa to the procedure, especially in the presence of life-threatening indications, is of great concern to many obstetricians ( Vogel, Betrán, Vindevoghel , Souza, Torloni and Zhang,2015).

Caesarean section (C/S) is still being perceived as an abnormal means of delivery by many antenatal women in Nigeria. Since 1985, The World Health Organization (WHO) has considered the ideal rate for caesarean sections to be between 10% and 15%. Since then, caesarean sections have become increasingly common in both developed and developing countries. When medically justified, a caesarean section can effectively prevent maternal and perinatal mortality and morbidity. However, there is no evidence showing the benefits of caesarean delivery for women or infants who do not require the procedure. As with any surgery, caesarean sections are associated with short and long term risk which can extend many years beyond the current delivery and affect the health of the woman, her child, and future pregnancies. These risks are higher in women with limited access to comprehensive obstetric care (WHO, 2015).

Globally, the CS rate is estimated at 15%, with an average rate of 3.5% in Africa. Burkina Faso, Mali, and Nigeria all show CS rates below 2%. More developed regions, including Europe, Northern America, Japan, Australia, and New Zealand, have an average of 21.1% ,the rates of C/S in Europe and North America have been increasing; United States of America currently has an average rate of 26.1%. Despite the above figures, there has been a rising trend in CS within Nigeria, a developing nation in West Africa, with rates from 9.4% in the 1970s and 34.6% currently, mainly from unbooked emergency cases. Women in developing countries, however, remain averse to CS, notwithstanding its ability to save life. Studies among other cultures show a preference for CS because they view it as being safer, as well as due to obstetrician bias.

Some studies of developing nations, especially in West Africa, emphasize the necessity for women to seek spousal or family member's permission before being able to seek obstetric care (Vogel et al, 2015).

Brazil has significantly increased the rates of cesarean section in recent decades. Estimates from 1970 indicate that this rate was approximately 15%, rising to 38% in 2001 and to 48.8% in 2008; cesarean sections represented 35% of the deliveries in the Brazilian Unified Health System (SUS) and 80% of the deliveries in the private sector. In 2009, the rate was 50.1%, surpassing, for the first time, the number of vaginal deliveries. This number continues to increase, and cesarean sections represented 55.7% of the births in 2012 (Ye J, Betrán, Guerrero Vela, Souza and Zhang, 2014).

1.2 STATEMENT OF RESEARCH PROBLEM

What really instigated this research is the increasing mortality and morbidity rate of women during delivery. Aversion for caesarean delivery from diverse factors remain a major cause of death during delivery especially among women with an absolute indication for caesarean section .

Caesarean sections can cause significant and sometimes permanent complications, disability or death particularly in settings that lack the facilities and/or capacity to properly conduct safe surgery and treat surgical complications. Caesarean sections should ideally only be undertaken when medically necessary. In developed countries the incidence of caesarean section is on the increase unlike developing nations. Women in less developed countries often think that caesarean section signifies reproductive failure. It is usually bad news for them when they told that they will be delivered through caesarean section. For those that will eventually give their consent, it is done with so much unnecessary delay. This little time between counselling and giving consent for caesarean section may be important in clinical practice for conditions such as foetal distress and antepartum heamorrhage that require emergency caesarean section.

1.3 OBJECTIVES OF THE STUDY

  1. To assess the perception of pregnant women attending antenatal clinic towards caesarean section in Civil Service Hospital,Ilorin.

  2. To assess the attitude of pregnant women attending antenatal clinic towards caesarean section in Civil Service Hospital Ilorin.

  3. To assess the possible factors influencing consent uptake of caesarean section.

1.4 RESEARCH QUESTIONS

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

  1. Do pregnant women have positive or negative perception toward caesarean section?

  2. What is the attitude of pregnant women attending antenatal clinic towards caesarean section in Civil Service Hospital Ilorin.

  3. What are the factors influencing consent uptake of caesarean section?

1.5 RESEARCH HYPOTHESES

The research hypotheses are:

Null hypothesis 1 (H0): There is no significant association between educational status of pregnant women and their attitude towards caesarean section.

Null hypothesis 2 (H0): There is no significant association between socio-economic status of the respondents and their attitude towards caesarean section

1.6 SIGNIFICANCE OF THE STUDY

This study will spawn information on the perception and attitude of pregnant women attending antenatal clinic towards caesarean section in Civil Service Hospital, Ilorin.

Caesarean section has been helpful in increasing maternal and child survival.

It will improve women’s knowledge and perception towards caesarean section as a procedure

It will also promote positive perception toward caesarean section among pregnant women attending antenatal clinic in Civil Service Hospital, Ilorin especially when indicated.

It will also help nurses and other health professionals identify areas where health education can be relevant.

Furthermore the health risks and complications arising from non-utilization of caesarean section as one of the health care services will reduce.

1.7 SCOPE OF THE STUDY

The study assesses perception and attitude of pregnant women towards caesarean section that are attending antenatal clinic in Civil Service Hospital, Ilorin, Kwara state

1.8 LIMITATION OF STUDY

Financial constraint- Insufficient fund impeded 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).

Time constraint- The researcher simultaneously engaged in this study with other academic work. This consequently cut down on the time devoted for the research work.

1.9 DEFINITION OF TERMS

Perception:- the way something is regarded, understood or interpreted.

Attitude:- a way of thinking or feeling about something.

Caesarean section:- this is the use of surgery to deliver babies. It is often necessary when a vagina delivery will put the baby or mother at risk e.g obstructed labour, twin pregnancy, high blood pressure.

Antenatal clinic: this is a part of the hospital that provides care, which is done by skilled health care professionals to pregnant women to ensure the best health conditions for both mother and baby during pregnancy.

Pregnancy: this is also known as gestation, it is the period during which one or more offspring develops inside a woman.

CHAPTER TWO

LITERATURE REVIEW

2.1 INTRODUCTION

From time immemorial, pregnancy and delivery have been regarded as natural physiological processes that requires no medical intervention despite maternal pains and possible complications. Rather, a forceful pulling of the fetus through the vaginal is carried out with resultant maternal uterine and vaginal laceration and fistula formation with possible fetal demise and when baby survives, there may be some mental sub-normality or other handicapped features that make life unfavorable to the young child. Such trends has increase maternal and fetal morbidity with public health concern thus, led to the emergence of caesarean section as an intervention measure to reduce death rate (Aziken, Omo-Aghoyoh, Okonofua, 2011).

The caesarean section rate appears to be on the rise world - wide including developing countries. However, published data from developing countries still report that women in those environment have high aversion for the procedure. It has been observed that the perceived failure of womanhood, stigmatization following caesarean delivery and complication that may be associated with the procedure have been identified as some of the reasons women in developing countries may decline to caesarean delivery (Azinke et al 2011).

Most women feel it’s necessary to seek spousal or family member's permission before being able to seek obstetric care. Most are of the view that the decision on the mode of delivery should be made jointly. Gender roles have been seen to be changing for more equality for young women and men. Many researchers have argued that joint decision-making between husbands and wives may yield better reproductive health outcomes than either the wife or husband making the decision alone. However, majority of pregnant women will agree to a CS birth if their husbands consent, despite their own disapproval. This is because they believe he is the head of the family and will want the best for both mother and baby. This goes to confirm the age-old belief in many developing countries that women and children belong to the husband. This forces the women into a state of dependency on the men, rendering the women powerless to exercise their freewill in matters of reproductive decision-making. Through the process of socialization, women and men are conditioned to behave and play different roles in society. While the African culture “rewards” women who have vaginal birth despite the cost to their health, the burden of subtraction from womanhood (Ezeome, Ezugworie, Udealor, 2018)

Education has been seen as an empowering tool that gives the woman confidence to take personal decisions. However, “classroom” education per se is not enough because despite knowing what will benefit them, they are many times unable to take decisions because of sociocultural traditions, which keep them subjugated and under the control of the male folk. Education should include expunging negative cultural perceptions that hamper women's health. Delivery is one of the most important issues for human being and generation in the world. The process through which childbirth naturally occurs is called natural vaginal delivery 10 whilst caesarean is delivery of child through incisions in abdominal wall (Laparotomy) or uterus (Histrotomy) (International Journal for Research in Health Sciences and Nursing, 2017).

cteristics

2.2 CONCEPT OF PERCEPTION

Perception is determined by both physiological and psychological characteristics of the human being, whereas sensation is conceived with only the physiological features. Thus perception is not just what one sees with the eyes, it is a much more complex process by which an individual selectively absorbs or assimilates the stimuli in the environment, cognitively organizes the perceived information in a specific fashion and then interpret the information to make an assessment about what is going on in one’s environment.

Perception is a subjective process, therefore different people may perceive the same environment differently based on what particular aspects of the situation they choose to selectively absorb, how they organize the information and the manner in which they interprete it to obtain a grasp of the situation (Ajit, 2014).

2.3 CONCEPT OF ATTITUDE

This refers to a set of beliefs, emotions and behaviors toward a particular object, person, thing or event. Attitudes are often the result of experience or upbringing and they can have a powerful influence over behavior and they can change. It has three components;

Cognitive component: an individual thoughts and beliefs about a subject.

Affective component: this is how the person, event, object or issue makes you feel.

Behavioral component: this is how the attitude influences your behavior.

Attitudes can be implicit or explicit. Explicit attitudes are those that we are consciously aware of and that clearly influences our behaviors and beliefs. Implicit attitudes are unconscious but still have an effect on our beliefs and behavior.

There are various factors that can influence how and why attitudes form. They include; Experience

Attitudes form directly as a result of experience. They may emerge due to direct personal experience, or they may result from observation.

Social Factors

Social roles and social norms can have a strong influence on attitudes. Social roles relate to how people are expected to behave in a particular role or context. Social norms involve society's rules for what behaviors are considered appropriate (Kendra, 2019).

2.4 Concept of Caeserean Section

Caesarean section is defined as the delivery of a fetus through incision made in the anterior abdominal wall and the uterine wall after the age of viability. The word, “caesarean” and “section” are both derived from verbs that mean to cut, the phrase “caesarean section is a tautology. Consequently, the terms “caesarean delivery or caesarean birth are preferable (Roe and Chelmow 2011).

Caesarean sections were initially performed to separate the mother and the fetus in an attempt to save the fetus of a moribund patient. This operation subsequently developed into a surgical procedure to resolve maternal or fetal complications not amendable by vaginal delivery (Roe and Chelmow, 2011).

The first modern caesarean section was performed by German Gynecologist Ferdinard Adolf in 1881. The procedure was usually performed when a vaginal delivery would put the baby’s or mother’s life at risk, although in recent times, it has been performed upon request for child births that could otherwise have been natural.

The second was that of Mauryan Sam rat (emperor of India], His mother, wife of Chandragupta Murya, accidentally consumed poison and died when she was close to deliver him. Chanakya, the Chandrayupta’s teacher and advisor, made up his mind that the baby should survive. He cut open the belly of the Queen and took out the baby, this saving the baby’s life (Geiger 1908).

The caesarean delivery has evolved from a vain attempt performed to save the fetus to one in which physician and patient both participate in decision making process, striving to achieve the benefit for the patient and their unborn child. There is no doubt that caesarean has contributed immensely to improve obstetric care throughout the world (Roe and Chelmow, 2011).

2.5 FACTORS INFLUENCING DECISION MAKING ON CAESAREAN SECTION

According to Orji et al 2003,Aziken et al 2011,Elmowafi 2004,Onah,Ezeh 2000 etc. Several factors may hinder caesarean delivery being undergone by women. Some of which include

Perceived failure of women hood, stigmatization

Complication that may be associated with the procedure.

The cost of the procedure

Cultural belief

Poor or inadequate knowledge on the procedure

Attitude of health care providers etc.

2.6 CONCEPTUAL FRAMEWORK: HEALTH BELIEF MODEL.

The health belief model (HBM) is a tool that scientist use to try and predicate health behaviors. Originally developed in the 1950’a by Becker and colleagues, it is based on the theory, that a person willingness to change their health behavior is primarily due to the following components.

Perceived threat which is whether the danger imposed by not undertaking a certain health action recommended is great.

Perceived susceptibility which is an individual’s assessment of their risk of getting the condition people will not change their health behavior unless they believe that they are at risk.

Perceived severity which is an individual’s assessment of the seriousness of the condition, and its potential consequences. The probability that a person will change his /her health behaviors to avoid consequence to be.

Perceived barriers which is an individual’s assessment of the influence that facilitate or discourage adoption of the promoted behavior.

Perceived benefits are individual’s assessment of the positive consequence of adopting the behavior. It’s difficult to convince people to change a behavior if there isn’t something in it for them.

Demographic variables such as age, gender ethnicity and occupation.

Cues to action are external influences promoting the descried behavior, it is something that helps move someone from wanting to make a health change to actually making the change include information provided or sought, reminders by powerful others, persuasive communications and personal dependences.

Perceived efficacy which is an individual’s self-assessment of ability to successfully adopt the desired behaviors.

2.7 EMPERICAL STUDY

According to Osis, Padua, Duarte et al (2001), study conducted on the opinions of women who had delivered only by caesarean section was compared with those of women who had had at least one vaginal delivery (90.4%). The result showed significantly more women who had experience at least one vaginal delivery considered this to be the best way of giving birth. Compared to be women who have undergo caesarean section (75%). The study stated that vaginal delivery is better because it cases less pain and suffering for the women. Furthermore, significantly more women who had experienced a vaginal delivery reported that it has no disadvantage. However, more women who had only caesarean section preferred not having contractions/pains as an advantage of this method.

In the study conducted by Awonyinka, Ayinde and Omigbodun (2006) on acceptability of caesarean delivery. Among 201 patients surveyed, a high level of acceptability of caesarean section was found (72%). However, 96.5% of those who accept would give consent after seeking the opinion of other people especially their husband. It was also found that previous major surgery and caesarean section were found to favour its acceptability while age, tribe, marital status and the women or their husband’s educational status did not have any influence. With proper health education, especially during antenatal care, many women find caesarean section acceptable.

According to study conducted by Enabudoso, Ezeanochie, Olagbiyi (2011), on perception and attitude of women with previous caesarean section towards repeat delivery, one hundred and thirty-nine respondents participated in the study. 76% had previous caesarean delivery while 24.5% will decline a repeat caesarean section. Major reasons for refusal were post-operative pain, cultural aversion, fear of death and cost of caesarean delivery. The rate of acceptance was significantly higher among those with more than one prior caesarean section while the rate of refusal was significantly higher amongst those who experience perinatal death in the last caesarean delivery and 12% experienced psychological problem from their relatives even spouse.

In the study conducted by Mungrue, Nixon, David et al (2013) on women’s knowledge, perception and preference regarding caesarean section. Three hundred and sixty eight women participated. The majority of women (46.2%) were found to have very little information from which to make informed decisions about selecting caesarean section as the preferred choice of delivery. Their preference was significantly associated with the perception of safety, complications and pains. Notwithstanding, persons who received information from health care professionals were likely to have a high or adequate level of information about caesarean section.

2.8 APPLICATION OF MODEL

The models involves the knowledge and perception regarding caesarean section and its importance as well as the severity of the consequences of refusing caesarean section to women who may have complication and caesarean section is indicated. This is influenced and modified by the individual demographic variables such as age, religion, level of education, occupation etc. and cues to action such as adequate knowledge of caesarean section from health facilities, mass media, friends and family. there is likelihood that women will take necessary action to prevent complication.

Also if their perceived benefits outweighs the side effect, then there is also likelihood that they will take necessary action to assess the health need to prevent complication. In other words, the women are likely to accept caesarean section when they perceive it as beneficial to them.

CHAPTER THREE

METHODOLOGY

3.0 INTRODUCTION

This chapter discusses the research design, the setting, target population, sample and sampling techniques, research instrument, testing of instrument for validity, reliability, ethical consideration, data collection procedures and method of data analysis.

3.1 RESEARCH DESIGN

A descriptive survey was used to assess perception and attitude of pregnant women attending antenatal clinic toward caesarean section in Civil Service Hospital, Ilorin

3.2 RESEARCH SETTING

This study was conducted in Civil Service Hospital, Ilorin (CSH). CSH is located in Ilofa Road, GRA in Ilorin west local government area of Kwara State. It is a State Institution well equipped with personnel and equipment. It’s made up of 12 units; Post natal antenatal, gynecology ward, combined medical ward, combined surgical ward, outpatient department, pediatrics clinic, dental clinic eye clinic, orthopedic ward, emergency ward, antenatal clinic, labor ward and psychiatric outpatient department.

The antenatal clinic has the highest number of maternal visit running into hundred. Antenatal clinic days are on Mondays, Tuesdays and Thursdays and it starts from 8am and end by 2pm. Most pregnant women from Ilorin and visit this hospital for antenatal.

3.3 TARGET POPULATION

The target population of study consist of all women attending the antenatal clinics in the Civil Service Hospital, Ilorin.

3.4 SAMPLING TECHNIQUE

Simple random sampling technique was used to select a sample size of respondents 210 pregnant women.

The total population of the pregnant women attending antenatal clinic is 500. The sample size was determined using fisher’s formula

3.5 SAMPLE SIZE

The sample size was calculated using fisher’s formula. Population of women attending antenatal in Civil Service Hospital for a month is 500.

The inclusion criteria include all pregnant women attending antenatal

The exclusion criteria include the pregnant women not attending antenatal, nurses, doctors, cleaners.

Using Fisher’s formula, the sample size was calculated as stated below:

n = Z2 (P (1-P)

d2

Where Z = test statistic (1.96%) at 95% confidence interval

P = 72%, true proportion of prevalence in the population (Awonyinka et al, 2006)

d= 0.05 (5% error margin)

q= (1-P) (1-0.72 = 0.28)

N=total population

n = (1.962) x (0.72) x (1- 0.72)

(0.052)

n = 3.8416 x 0.2016

0.0025

n = 309.8

n

But S= ________

1+ (n)/N

309.8


1+ (309.8)/500

Sample size = 191

Attrition rate: 10 × 191

100

= 19.1

No of questionnaires: 191+19.1

= 210

Therefore, 210 questionnaires will be administered to pregnant women attending antenatal clinic at Civil Service Hospital, Ilorin, Kwara state.

3.5 INSTRUMENT FOR DATA COLLECTION

A self-structured and carefully designed questionnaire will be used to obtain data on perception and attitude of pregnant women towards caesarean section in Civil Service Hospital, Ilorin. The questionnaire consist of four sections Section A deals with the socio-demographic history of women, section B is concerned with assessment of pregnant women’s perception on caesarean section, section C deals with pregnant women’s attitude towards caesarean section while section D deals with factors influencing decision making on caesarean section in Civil Service Hospital, Ilorin, using Yes or No and likert scale.

3.6 VALIDITY OF INSTRUMENT

To ensure face and content validity, the project supervisor scrutinized the questionnaire (which entails a thorough confirmation of items of the instrument in terms of clarity of words, sentence structure, language difficulty and relevance to the study).

3.7 RELIABILITY OF INSTRUMENT

Reliability of the instrument used by the researcher was ensured by, a test-retest of method.

3.8 METHOD OF DATA COLLECTION

The researcher was directly involved in the collection of data from respondents using questionnaires specifically designed to elicit fact on perception and attitude of women toward caesarean section. Respondents consent was obtained after some explanations about the nature and purpose of the study. These respondents were met in the hospital between 8.00am on Mondays, Tuesday and Thursday to 2:00pm. The illiterate women were assisted by interpreting the questionnaire to their understanding.

3.9 METHOD OF DATA ANALYSIS

Data was analyzed using the Statistical Package for Social Sciences (SPSS) windows version 21.0. Both descriptive and inferential statistics were used to analyze the data collected and express data in the form of frequency and percentages, chi-square to establish the associations between variables level of significance set at 5% (0.05).

3.10 ETHICAL CONSIDERATION

The researcher obtained a letter of introduction from the Department of Nursing Science to the Head of the Nursing Unit at Civil Service Hospital for permission to conduct the research. Respondents were informed about the nature of the study and their voluntary consent was secured. All documents obtained were kept private and confidential. Respondents were not identified by name in the questionnaire, they were given adequate information about the study and freedom of withdrawal at any point was stated to them.

CHAPTER FOUR

4.1 DATA ANALYSIS AND RESULTS

The results obtained from the statistical analysis of data are presented in this chapter. The demographic characteristics of the respondents was described using percentage, while mean rating was used to answer research question. The hypotheses formulated for this study were tested using the independent t-test statistics and tested at 0.05 level of significance using Statistical Package for Social-Sciences (SPSS 21.0).

Demographic Description of the Respondents

The data presented in Tables 1 was based on the demographic characteristics of the respondents’ frequency counts and percentage. The table was based on respondents’ religion, marital status, ethnicity, level of education, and occupation.

Table 1: Distribution of the Respondents by Age, Marital Status, religion, ethnicity, level of education, and occupation.

Variables

Frequency

Percentage (%)

Marital Status

Single

Married

Divorced

widowed

Total

30

167

9

4

210

14.3

79.5

4.3

1.9

100.0

Age

(15-19)

(20-24)

(25-29)

(30- 34)

(35-39)

(40-44)

Total

10

65

74

40

16

5

210

4.8

30.9

35.3

19.0

7.6

2.4

100.0

Occupation

Teacher

Trader

Civil Servant

Student

Total

44

103

53

10

210

21.0

49.0

25.2

4.8

100.0

Ethnicity

Yoruba

Igbo

Hausa

Others

Total

160

31

14

5

210

76.2

14.8

6.7

2.4

100.0

Religion

Christianity

Islam

Others

Total

73

133

4

210

34.8

63.3

1.9

100.0

Figure 1

Figure 3

Figure 4

Figure 5

Table 1 revealed that out of the 210 respondents that participated in the study, 30 representing (14.3%) of the respondents were single by marital status, 167 representing (79.5%) of the respondents were married by marital status, while 9 representing (4.3%) of the respondents were divorced, while 4 representing (1.9%) of the respondent were widowed by marital status respectively. This implies that majority of the respondents in this study were married by marital status.

Table 1 revealed that out of the 210 respondents that participated in the study, 44 representing (21.0%) of the respondents were teachers, 103 representing (49.0%) of the respondents were trader, 53 representing (25.2%) of the respondents were civil servants, while 10 representing (4.8%) of the respondents were students. This implies that majority of the respondents in this study had trader.

Table 1 revealed that out of the 210 respondents that participated in the study, 160 representing (76.2%) of the respondents were Yoruba by tribe, 31 representing (14.8%) of the respondents were Igbo, 14 representing (6.7%) of the respondents were Hausa, while 5 representing (2.4%) of the respondents were other ethnicity. This implies that majority of the respondents in this study were Yoruba’s.

Table 1 revealed that out of the 210 respondents that participated in the study, 73 representing (34.8%) of the respondents were Christians, 133 representing (63.3%) of the respondents were Muslims, while 4 representing (1.9%) of the respondents were other religion. This implies that majority of the respondents in this study were Christians.

Table 1 revealed that out of the 210 respondents that participated in the study, 10 representing (4.8%) of the respondents were between the age of (15-19)years,65 representing (30.9%) of the respondents were between the age (20-24) years, 74 representing (35.3%) of the respondents were between the age of(25-29) years,40 representing (19%) of the respondents were between the age of (30-34)years, 16 representing (7.6%) of the respondents were between the age of ( 35-39) years while 5 representing (2.4%) of the respondents were between the age of (40-44) years. This implies that majority of the respondents in this study were between the ages of (20-24) years.

Table 1 revealed that out of the 210 respondents that participated in the study, 4 representing (1.9%) of the respondents had no primary education, 43 representing (20.5%) of the respondents had secondary school education, 13 representing (6.2%) of the respondents had NCE certificate, 31 representing (14.8%) of the respondents had OND certificate, 87 representing (41.4%) of the respondents had degree certificate, 28 representing (13.3%) of the respondents had MSc/MA certificate, while 4 representing (1.9%) of the respondents had PhD certificate. This implies that majority of the respondents in this study had degree certificate.

Answering of Research Questions

Research Question 1: Do women have positive or negative perception toward caesarean section?

Table 2: Percentage Analysis of Pregnant Women’s Perception of Pregnant Women

S/N

Pregnant women’s Perception of Pregnant Women

Responses

Frequency

Percentage

13

Caesarean section (C/S) is an abnormal means of deliver

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

39

21

52

26

72

18.6

10.0

24.8

12.4

34.3

14

Caesarean section is the surgical delivery of a baby

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

47

24

61

61

27

22.4

11.4

29.0

24.3

12.9

15

Caesarean section causes death

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

40

15

48

44

63

19.0

7.1

22.9

21.0

30.0

16

Most pregnant women opt for Caesarean section out of fear of safe delivery

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

53

23

55

56

23

25.2

11.0

26.2

26.7

11.0

17

Pregnant women undergo Caesarean section because of low pain tolerance

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

58

22

60

47

23

27.6

10.6

28.6

22.4

11.0

18

Caesarean section guarantees safety of the baby

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

35

47

51

42

35

16.7

22.4

24.3

20.0

16.7

Results in Table 2 showed that 72 (34.3%) strongly agreed to Caesarean section (C/S) is an abnormal means of deliver, 26 (12.4%) agreed, 52 (24.8%) strongly disagree, 21 (10.0%) disagree, while 39 (18.6%) were undecided. 61 (29.0%) strongly disagree on Caesarean section is the surgical delivery of a baby. Also, 63 (30.0%) strongly agree that most pregnant women opt for Caesarean section out of fear of safe delivery. 56 (26.7%) agreed that pregnant women undergo Caesarean section because of low pain tolerance. 60 (28.6%) strongly disagree that pregnant women undergo Caesarean section because of low pain tolerance. 35 (16.7%) were undecided that caesarean section guarantees safety of the baby, 47 (22.4%) disagree, 51 (24.3%) strongly disagree, 42 (20.0%) agreed, while 35 (16.7%) strongly agree.

Research Question 2: What is the attitude of pregnant women towards caesarean section in General Hospital Ilorin?

Table 3: Percentage Analysis of attitude of pregnant women towards caesarean section in General Hospital Ilorin

S/N

Pregnant women’s attitude towards Caesarean section

Responses

Frequency

Percentage

19

Caesarean section is associated with complications

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

29

21

46

45

69

13.8

10.0

21.9

21.4

32.9

20

Caesarean section prevents uterus and bladder prolapse

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

54

38

45

46

27

25.7

18.1

21.4

21.9

12.9

21

Babies born by Caesarean section are healthier than those delivered by vaginal delivery

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

64

23

68

34

21

30.5

11.0

32.4

16.2

10.0

22

The mother regains her health status sooner after Caesarean section

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

61

44

36

34

35

29.0

21.0

17.1

16.2

16.7

23

Pain is less in Caesarean section

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

68

35

47

33

27

32.4

16.7

22.4

15.7

12.9

24

Risk for infection is greater in Caesarean section

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

25

24

48

44

69

11.9

11.4

22.9

21.0

32.9

25

Risk of bleeding is reduced in Caesarean section

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

38

21

74

50

27

18.1

10.0

35.2

23.8

12.9

Results in Table 3 showed that 69 (32.9%) strongly agreed to Caesarean section is associated with complications, 45 (21.4%) agreed, 46 (21.9%) strongly disagree, 21 (10.0%) disagree, while 29 (13.8%) were undecided. 54 (25.7) were undecided on Caesarean section prevents uterus and bladder prolapse. Also, 68 (32.4%) strongly disagree that Babies born by Caesarean section are healthier than those delivered by vaginal delivery. 61 (29.0%) undecided on the mother regains her health status sooner after Caesarean section. 68 (32.4%) were undecided on statement that pain is less in Caesarean section. 69 (32.9%) strongly agree on risk for infection is greater in Caesarean section. 38 (18.1%) were undecided on statement on risk of bleeding is reduced in Caesarean section, 21 (10.0%) disagree, 74 (35.2%) strongly disagree, 50 (23.8%) agreed, while 27 (12.9%) strongly agree.

Research Question 3: What are the factors influencing consent uptake of caesarean section?

Table 4: Percentage Analysis of factors influencing consent uptake of caesarean section

S/N

factors influencing consent uptake of caesarean section

Responses

Frequency

Percentage

26

Low income influence consent for caesarean section

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

48

38

43

47

34

22.9

18.1

20.5

22.4

16.2

27

Fear of complication also influences consent for caesarean section

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

56

19

55

46

34

26.7

9.0

26.2

21.9

16.2

28

Level of literacy influences the decision to do caesarean section

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

59

30

40

46

35

28.1

14.3

19.0

21.9

16.7

29

Previous caesarean section can be an indication to undergo another

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

55

23

52

46

34

26.2

11.0

24.8

21.9

16.2

30

High parity also influences decision to undergo caesarean section

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

50

24

71

36

29

23.8

11.4

33.8

17.1

13.8

31

Cultural beliefs also influences decision to undergo caesarean section

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

43

36

53

40

38

20.5

17.1

25.2

19.0

18.1

32

Religious beliefs also influences decision to undergo caesarean section

Undecided

Disagree

Strongly disagree

Agree

Strongly agree

31

43

69

51

16

14.8

20.5

32.9

24.3

7.6

Results in Table 3 showed that 48 (22.9%) were undecided on factors influencing consent uptake of caesarean section, 38 (18.1%) disagreed, 43 (18.1%) strongly disagree, 47 (22.4%) agree, while 34 (16.2%) were strongly agree. 56 (26.7) were undecided on fear of complication also influences consent for caesarean section. Also, 59 (28.1%) were undecided on statement of Level of literacy influences the decision to do caesarean section. 55 (26.2%) undecided on the Previous caesarean section can be an indication to undergo another. 50 (23.8%) were undecided on statement that High parity also influences decision to undergo caesarean section. 53 (25.2%) Cultural beliefs also influences decision to undergo caesarean section strongly disagree. 31 (14.8%) were undecided on statement on Religious beliefs also influences decision to undergo caesarean section, 43 (20.5%) disagree, 69 (32.9%) strongly disagree, 51 (24.3%) agreed, while 16 (7.6%) strongly agree.

Having answered research question, the researcher proceeded to test the null hypothesis generated for the study.

4.2 TESTING HYPOTHESES

HO1: There is no significant relationship between educational status of pregnant women and their attitude towards caesarean section.

Table 4: Summary Table of Chi-square Analysis relationship between educational status of pregnant women and their attitude towards caesarean section

attitude

Total

df

Cal. X2-value

Cal. Sig.(2-sided)

Decision

positive

negative

Education

primary

Count

4

0

4

Expected Count

2.6

1.4

4.0

secondary

Count

31

12

43

Expected Count

28.1

14.9

43.0

6

14.02

.03

HO1

Rejected

NCE

Count

9

4

13

Expected Count

8.5

4.5

13.0

OND

Count

26

5

31

Expected Count

20.2

10.8

31.0

Degree

Count

49

38

87

Expected Count

56.8

30.2

87.0

MSC/MA

Count

17

11

28

Expected Count

18.3

9.7

28.0

PhD

Count

1

3

4

Expected Count

2.6

1.4

4.0

Total

Count

137

73

210

Expected Count

137.0

73.0

210.0

ρ>0.05

Results in Table 4 showed that the calculated Cal. X2-value is 14.02 with calculated significance of .03 significant at 0.05 alpha level. Since the calculated significance (.03) is lower than the critical alpha level of significance (0.05), this implies that the null hypothesis was therefore rejected, and stated as research hypothesis that there was a significant relationship between educational status of pregnant women and their attitude towards caesarean section.

HO2: There is no significant relationship between socio-economic status of the respondents and their attitude towards caesarean section.

Table 5: Summary Table of Chi-square Analysis of relationship between socio-economic status of the respondents and their attitude towards caesarean section

attitude

Total

df

Cal. X2-value

Cal. Sig.(2-sided)

Decision

positive

negative

Monthly

less than 50,000

Count

69

36

105

Expected Count

68.5

36.5

105.0

3

.13

.99

HO2

Not Rejected

50,000 - 100,000

Count

48

25

73

Expected Count

47.6

25.4

73.0

100,000 - 150,000

Count

15

9

24

Expected Count

15.7

8.3

24.0

Others

Count

5

3

8

Expected Count

5.2

2.8

8.0

Total

Count

137

73

210

Expected Count

137.0

73.0

210.0

ρ>0.05

Results in Table 5 showed that the calculated Cal. X2-value is .13 with calculated significance of .99 significant at 0.05 alpha level. Since the calculated significance (.99) is greater than the critical alpha level of significance (0.05), this implies that the null hypothesis was therefore not rejected, and stated as research hypothesis that there was no significant relationship between socio-economic status of the respondents and their attitude towards caesarean section.

Summary of the Findings

Based on the data collected, analyzed and interpreted, the following findings were obtained:

There was a significant relationship between educational status of pregnant women and their attitude towards caesarean section.

There was no significant relationship between socio-economic status of the respondents and their attitude towards caesarean section.

CHAPTER FIVE

DISCUSSION OF FINDINGS

5.1 INTRODUCTION

This chapter presents the discussion of findings and conclusion based on the data analysed and results presented in chapter four. In view of the findings of this study, recommendations and suggestions for further studies were made.

5.2 Discussion of findings

5.2.1: Socio-demographic profile of respondents

The findings from this study showed that 74 (35.3%) of the respondents were between 20-24years. 133 (63.32%) of the respondents practiced Islam. Most of the respondents 167 (79.5%) were married. Most of the respondents 160(76.2%) belonged to Yoruba ethnic groups and 103 (49%) of them were traders.

5.2.2 Perception of pregnant women attending antenatal clinic towards caeserean section in Civil Service Hospital.

Finding from this study reveals that both positive and negative perceptions were held concerning caesarean section which has serious implications to behavior towards this life saving surgical intervention.

Result shows that more than half of the respondents perceived caesarean section to be a cause of death during childbirth (51%) while another 46.7% reported that the procedure is an abnormal means of delivery. This finding is in line with studies done by Dr Soha Sobhy of Queen Mary University of London (2019) which reported that about half of the women believes that caesarean section causes death. The implication of such perception is the fact that these women will be afraid of going in for caesarean section because of dying. This finding is contrary to studies in Brazil and the United Kingdom where anaesthesia and expert care is done and as such, women tend to prefer caesarean delivery than vaginal birth as reflected by the high caesarean section rate in this locality unlike in countries like Nigeria. A finding by Enabudoso, Ezeanochie and Olagbiji (2011), asserts that fear of death significantly affects the perception of women towards caesarean section.

5.2.3 Attitude of pregnant women attending antenatal clinic towards caeserean section in Civil Service Hospital.

Result shows that more than half of the respondents agrees that caesarean section is associated with complications (54.3%) while another 53.9% reported that he risk for infection is higher in caesarean section. According to a study carried out in Kermanshah University of Medical Sciences (KUMS), Iran(2016), numerous complications may arise for mothers and babies due to CS, including the general surgical complications (e.g. fever, infections, bleeding, scarring, long time bed restrain complications of anesthesia), and many specific complications such as urinary tract involvement, hysterectomy, child-mother relationship issues etc. The mortality rate for elective CS has been reported to be about 6 in 100,000 cases.

5.2.4 Factors Influencing Uptake of Caesarean section

Several factors have been reported to immensely influence women’s decision towards uptake of caesarean section (Azinke et al, 2008). Findings from this study shows that a combination of factors affect perception and attitude of pregnant women towards caesarean section.

Among these factors, level of literacy is one of the determinants of pregnant women’s perception and attitude towards caesarean section as reported by (38.6%) of respondents and it was also a contributory factor to their perception of the procedure. Among this study population, cultural beliefs was also noted to play an important role with (37.1%) of respondents. Furthermore, low income was noted to influence perception (38.6%) while high parity was observed to have the least effect in influencing decision to uptake caesarean section. Findings that corresponds to studies by Eze (1998) and Elmowafi (2004), showed that cultural beliefs, inadequate knowledge, cost and health workers behavior, influences uptake of caesarean section.

5.2.5 Hypothesis testing

Hypothesis 1 testing showed significant association between educational status of pregnant women and their attitude towards caesarean section. Since the calculated significance (.03) is lower than the critical alpha level of significance (0.05), this implies that the null hypothesis was therefore rejected, and stated as research hypothesis that there was a significant relationship between educational status of pregnant women and their attitude towards caesarean section.

Hypothesis 2 testing showed that the calculated significance (.99) is greater than the critical alpha level of significance (0.05), this implies that the null hypothesis was therefore not rejected, and stated as research hypothesis that there was no significant relationship between socio-economic status of the respondents and their attitude towards caesarean section.

5.3 Implication to nursing practice

Understanding the various factors that influence uptake of health care services is critical to proper nursing care and management of patients, especially pregnant women who are a high risk group in developing countries like Nigeria. In view of this, nurses (both students and midwives) are expected to understand the various community and other factors that influence perception and attitude of caesarean section with a view of educating mothers prior to delivery, when clear indications of caesarean section is observed. Such education will prevent primary delays in decision making and expedite compliance with an eventual early intervention of conducting a caesarean section and therefore, saving maternal and fetal life. Hence on the road to attaining Millennium development goals 4 and 5 that addresses the issues of reducing maternal and infant death by 2015.

5.3 CONCLUSION

Adequate knowledge and positive perception of medical interventions like caesarean section are the cornerstone to optimal patients cooperation and outcome during child birth.

Thus, this study has investigated women’s knowledge and perception of caesarean section and noted that women possess an adequate but sub-optimal level of knowledge on caesarean section while majority of the women showed positive perception of this surgical intervention.

Factors such as lack of health education, attitude of health workers and cost of the procedure together with cultural beliefs were reported to influence women’s knowledge and uptake of caesarean section.

Recommendations including promoting maternal knowledge on caesarean section and encourage a positive attitude among health workers was made.

Conclusion

It was concluded that there was a significant association between educational status of pregnant women and their attitude towards caesarean section. Another finding revealed that there was no significant association between socio-economic status of the respondents and their attitude towards caesarean section.

Recommendations

These recommendations are based on the summary of findings and conclusion reached thereafter.

Women’s preferred mode of delivery was influenced by their educational status and the perceived consequences of undergoing the procedure. It was therefore, recommended that education should target women with low education and primigravida as well as men since they are the major decision makers in most families in developing countries.

Suggestions for Further Studies

Including more schools would have allowed a larger sample size and better generalization of results. Also, future research could work on: Perceptions and attitude of pregnant women towards caesarean section in urban Nigeria. A retrospective study of intraoperative and postoperative maternal consequences of caesarean section during a 10-year period.

Name is Olaboopo mubarakat opeyemi, a clinical instructor at fountain universigy, oke osun, osogbo,osun state

olabsopisco@gmail.com

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