KNOWLEDGE AND PERCEPTION OF PREGNANT WOMEN TOWARDS CAESAREAN SECTION AT ANTENATAL CLINIC OF STATE SPECIALIST HOSPITAL MAIDUGURI BORNO STATE

1.1 Introduction

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.

As a prelude to other parts of this study, this chapter will discuss the background upon which this study was initiated, the statement of problems that led to this study, the Aim and Objectives of the study. Others are Significance of the study, Scope of work, Research hypothesis and questions, Limitations of the Study and Definition of technical terms.

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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). 

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.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).

Therefore, in Nigeria where the research was carried out, the activities that was conducted is to know the Knowledge and Perception of Pregnant Women towards Caesarean Section at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State.

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1.3 Statement of Problems

Traditionally, Nigerian women are unwilling to have CS because of the general belief that abdominal delivery is reproductive failure on their part regardless of the feasibility of vaginal birth after CS and the decreasing mortality from Caesarean sections. Imperative to the average pregnant woman irrespective of her level of education and parity therefore is CS. Available reports on knowledge of CS amongst women are mainly from tertiary health facilities situated in cities and in the southern parts of the country while little is known about the perception and acceptance of pregnant women towards Caesarean section in Igbinedion University Teaching Hospital in Edo State.

Factors that played a major role in the increased maternal mortality rate included low socio economic status, lack of access to transport and communication problems, traditional belief, delay in utilization of available obstetric facilities, referrals of complicated cases and reduction in hospital staffing in rural areas (Bhutta, 2011). Hence cesarean section (CS) as a key component of Emergency Obstetric care (EMOc) remains one of the key aspects necessary to reduce the high mortality ratio (Ugwu & De Kok, 2015). Nevertheless a study have shown that acceptance of cesarean section among Nigerian women living in urban and semi-urban setting is low (Eifediyi Isabu, Akhimiona, Affusim, Ikheloa, & Njoku, 2015). Irrespective of an obvious clinical indication, most women pray not to undergo cesarean section (Adeoye et al, 2011).

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1.4 Aim and Objectives of Study

The aim of the study is to scrutinize the Knowledge and Perception of Pregnant Women towards Caesarean Section at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State. In achieving this aim, the following specific objectives were laid out as follows:

1. To assess the level of knowledge of the pregnant women about Caesarean section at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State
2. To determine the perception of the pregnant women towards Caesarean section at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State
3. To explore the perception and acceptance of pregnant women at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State
4. To ascertain what is known about caesarean section and the reasons for dislike by our women in Antenatal Clinic of State Specialist Hospital Maiduguri Borno State
5. To explore the perception and acceptance of pregnant women at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State

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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 level of knowledge of women of child bearing age about Caesarean section at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State?
• What is the perception of women of child bearing age about Caesarean section at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State?
• What is the perception and acceptance of pregnant women at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State?
• What is known about caesarean section and the reasons for dislike by our women?
• What is the perception and acceptance of pregnant women at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State towards caesarean section?

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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.

• H0: There is no significant difference between knowledge and socio-demographic data of the women of child bearing age about Caesarean section at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State towards caesarean section
• H1: There is a significant difference between knowledge and perception of women of child bearing age about Caesarean section at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State towards caesarean section

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1.7 Significance of Study

The findings from this study would be used in planning strategies towards improving the knowledge, perception and acceptance towards CS in the community in order to possibly reduce the delay in presentation to the health facility when CS is needed, improve utilization of this mode of delivery and limit the avoidable maternal and foetal complications.

This study will help in health seeking behaviors among women of child bearing age, which acts as a tool in detecting early, the problems associated with pregnancy and delivery and prompt treatments before it results in complications. It will help in reducing the complications resulting from maternal and child mortality rate in Nigeria especially in Lagos State.

It will help the nurses to carryout intensive mobilization for the communities on the benefits of Caesarean section to the mothers, family and community at large and the study will also increases both the nurses/midwives knowledge about caesarean section and create a positive perception towards caesarean section.

The study will prompt governmental and non-governmental organizations across the country to provide both public and private sectors practicing Caesarean section with adequate information on the factors influencing the perception towards Caesarean section and also pinpoint the areas where more work is to be done with respect to providing quality care and above all, gives room for further studies. The findings from this study can be used to design appropriate and effective enhancement programs aimed at improving knowledge and perception about caesarean section among pregnant women as well as healthcare providers so as to meet up the demands of pregnant mothers seeking care during delivery.

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1.8 Scope of Study

The study focuses on the Knowledge and Perception of Pregnant Women towards Caesarean Section at Antenatal Clinic of State Specialist Hospital Maiduguri Borno State

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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. Research material: availability of research material is a major setback to the scope of the study.
3. Frequent power failure: This made the researcher append more money on fuel to ensure sustainable power.
4. 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).

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1.10 Definition of Terms

Perception: 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.

Acceptance: In human psychology is a person's assent to the reality of a situation, recognizing a process or condition (often a negative or uncomfortable situation) without attempting to change it or protest it.

Caesarean Section: 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.