chapter one

introduction

background to the study

Based on the opinion of Schantz et al. (2019), a caesarean delivery or commonly known as C-section is defined as a surgical process where the baby is delivered by making cuts in the abdominal wall and uterus of the pregnant woman. It is usually done in cases where a vaginal delivery would be dangerous for the health of either the baby or mother. If complications arise during childbirth, such as fetal malpresentation, multiple deliveries, chorioamnionitis, labor arrest, oligohydramnios, cord prolapse, cephalopelvic disproportion, and diseases including eclampsia and HELLP syndrome, CS delivery is relatively safe.. In addition, the most common causes of caesarean sections carried out spontaneously without any medical indication are vaginal birth apprehension and the need to avoid any complications related to childbirth, including prolapse of pelvic organs and perineal injuries (Schantz et al., 2019). The fear of vaginal birth, the need to avoid any complications that may arise during childbirth, like prolapse of pelvic organs and perineal injuries, maternal work status, physician recommendation, and family history of the procedure are the most common causes of caesarean sections done on demand without any medical indications (Anaman-Torgbor, et al., 2022).

The attitude and level of acceptance concerning the method of birth and the rate of Caesarean section were evaluated among the mothers in Banha districts by Alkalash et al. (2020). Among the study subjects, 35.0% held a negative attitude toward computerized science, and 46.3% had a good awareness about the indications, pros, and cons of both methods of childbirth. In addition, compared to vaginal delivery, a number of hazards associated with Caesarean section can increase the chances of mortality and morbidity for the mother and the baby, both immediate and long-term complications can occur. Surgery and anesthesia are associated with immediate complications (Abbood & Khudhair, 2019). The negative impacts of anaesthesia include apnoea, hypoxia, and drug overdose. In addition, some of the common consequences of surgery include wound infection, injury to organs, thrombosis, bleeding, UTI, pelvic infections, and respiratory infections. However, some of the chronic conditions that may arise due to surgery include adhesions, ectopic pregnancy, infertility, and malformation of the placenta, which includes placenta previa, placenta accreta, placenta increta, and placenta percreta (Grabarz et al., 2020).

Once again, Al-Harthi et al. (2020) explored the attitude, comprehension, and acceptability of south-eastern Nigeria females towards the acute and chronic outcomes of C-sections. In their analysis, 39.8% claimed that vaginal delivery is comparatively safe for the woman and her baby, 68.8% preferred vaginal delivery, while 77.6% thought that it is much more detrimental compared to vaginal delivery. Moreover, approximately 18% stated that constant pain is a prevalent complication of C-sections, and 47.9% stated that uterine adhesions are the most prevalent CS complication during chronic management.. Vaginal delivery is less prevalent in Nigeria compared to other countries, even though it is becoming increasingly popular globally as a method of reducing deaths and illnesses among mothers due to caesarean section. This could be linked to pregnant women's lack of knowledge and misconception about mothers and the benefits and risks associated with caesarean section. Moreover, there have been inadequate studies regarding the impact of caesarean section on women's health both in the short and long term. Therefore, the objective of this study is to assess the knowledge and attitude of pregnant women towards the consequences of caesarean delivery on women's health. Being the first source of health-related information, keeping updated and being seen as the basic foundation for further health promotion in their lives, community health workers play an important role in promoting community health through their efforts. Health workers aim at giving control to their patients regarding health matters, which lead to successful results. A health worker must focus especially on the issue of health promotion in expectant mothers’ cases.. It is essential to increase awareness among pregnant women on the adverse effects of cesarean delivery on their health. Given that there are numerous educational sessions conducted on the impacts of cesarean delivery on women’s health, early diagnosis and treatment of the disease become vital. Pregnant women must be supported by nurses in different community locations, such as family health centers (Stanhope & Lancaster, 2018). This is the reason why the current research is focusing on the knowledge and attitudes towards cesarean delivery among pregnant women in Awka south local government area

Statement Of Problem

In the past few years, there has been a marked rise in the rate of caesarian sections, prompting the need to identify what may be behind such a development. One factor that is vital in determining whether or not to opt for the procedure is the attitude and acceptance of pregnancy towards caesarian births. It is necessary to understand the impact of these factors on decision-making..

In addition to that, Africa is facing the biggest challenge when it comes to maternal deaths, whereby 98 percent of maternal deaths are recorded in sub-Saharan Africa (World Health Organization, 2017). One out of every 22 women in sub-Saharan Africa dies during delivery, compared to one out of every 210 women in Northern Africa, one out of every 62 in Oceania, one out of every 120 in Asia, and one out of every 290 in Latin America and the Caribbean (World Health Organization 2017). Based on the findings obtained from the aforementioned study conducted in 2022, the World Health Organization & UNICEF produced a report in 2021. The other important characteristic about Nigeria apart from its huge population size is that Nigeria contributes greatly to the maternal mortality ratio of sub-Saharan Africa due to its relatively high maternal mortality ratio. Nigeria has a higher maternal mortality ratio (1,100) than the average for the region, with 59,000 estimated maternal deaths. Almost 10% of all maternal deaths in the world happen in Nigeria, which is due to complications in pregnancy and childbirth. This is happening in a country that constitutes only 2% of the world's total population (Federal Ministry of Health, 2015). The most important reasons for the high maternal mortality rate in Nigeria include poor knowledge, attitude, and acceptability towards caesarian sections. It is for this reason that this study focuses on the knowledge, attitude, and acceptability of caesarian sections among pregnant women in Awka South Local Government Area.

 Purpose Of The Study

Objectives

The main objective of the study is to evaluate the knowledge, attitude, and acceptability of cesarean section among pregnant women in Awka South Local Government Area. Some of the other specific objectives of this study are;

1. To examine the level of knowledge among pregnant women regarding cesarean section in Awka South Local Government Area.

2. To evaluate the attitude of pregnant women regarding cesarean section in Awka South Local Government Area.

3. To find out the level of acceptability of cesarean section among pregnant women in Awka South Local Government Area.

SCOPE OF THE STUDY

The Study Is Restricted to knowledge, attitude and acceptability of cesarean section among pregnant women in Awka south local government area of Anambra state

Significance Of The Study

One of the many surgeries that are frequently performed around the globe is the CS, which stands for the Caesarean Section. The prevalence of CS is a threat to public health in developing countries, including Nigeria (Alaa-El-Din Wali, Taher, & Abd-ElFatah, 2020). There is fear that there might be an abuse or misuse of the surgery because of the rapid increase in the number of Caesarean sections being performed globally (Abdel-Tawab, et al., 2018). According to the World Health Organization (World Health Organization 2021), the cesarean section is a crucial intervention during pregnancies. But when the practice of Caesarean section is done wrongly, the dangers can overshadow the benefits. Also, Caesarean section delivery rates higher than 10-15% among nations show unnecessary exposure of the mother to dangers. But Nigeria ranks highest globally in terms of Caesarean delivery, which forms 75-80% of total deliveries while the rest of the world stands at 25-30%. The issues, dangers, and costs of increased C-section delivery among mothers and pregnancies make it a serious public health issue (Karim et al, 2020). Common complications that could arise on the mother while and after undergoing the C-section process include infection, excessive blood loss, clotting of blood in the legs and the lungs, nausea, vomiting, and an excruciating headache after the process; there are other cases where injury of another organ like the bladder occurs. Moreover, complications can arise in the neonate during childbirth like breathing problems and immature lungs. Another demerit that is considered is high costs of both operations and hospitalization. Other demerits of cesarean delivery include cultural preference of cesarean deliveries over vaginal births due to lack of proper awareness among communities regarding the advantages of vaginal deliveries, fear of pain, myths about the function of the bladder and sex post delivery, and misconceptions that cesareans are more secure for both the baby and the pregnant woman (Rabie, 2020).. Therefore, doing this research can be valuable to the current literature on this issue. Moreover, the findings from this research can be used to design strategies for informing pregnant women about the pros, cons, and complications of CS so that they can improve their understanding and perception of this technique, which can reduce the negative impact on the well-being of women and society. Also, it can affect the implementation of educational policies to focus on this matter and train nursing students and maternity nurses on how to teach pregnant women about the pros and cons of CS and its consequences through health education programs in outpatient settings.. In addition, the present study will make contributions in relation to the effect of caesarean sections on women's health through the results that will be found in this research. Simultaneously, the study can be used as an information source for other studies in the future. Therefore, the objective of this study is to evaluate knowledge and beliefs about the effect of cesarean delivery on women’s health.

 Research Questions

1) What is the knowledge level of pregnant women on Cesarean Section in Awka South Local Government Area?

2) What is the attitude level of pregnant women on Cesarean Section in Awka South Local Government Area?

3) What is the acceptance level of Cesarean Section among pregnant women in Awka South Local Government Area?