ATTITUDE OF MOTHERS ATTENDING ANTENATAL CLINICS AT GENERAL HOSPITALS IN ANAMBRA STATE TOWARDS CESAREAN DELIVERY

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ABSTRACT

The study was conducted to find out the attitude towards cesarean delivery among mothers attending antenatal care at the general hospitals in Anambra State. Seven specific objectives with seven corresponding research questions and four null-hypotheses were postulated to guide the study. The cross-sectional survey research design was used for the study. The population for the study was 3,256 mothers while the sample for the study consisted of 326 mothers. Random sampling technique of balloting without replacement and systematic random sampling technique were used to draw the sample for the study. A two-sectioned researcher designed questionnaire was the instrument used for data collection. The instrument was validated by five experts from the department of Health and Physical Education, University of Nigeria, Nsukka. Mean was used to analyze the data obtained while ANOVA was used in testing all the hypotheses at .05 level of significance. The results of the study showed that the overall attitude of mothers towards accepting cesarean delivery (2.20) and towards the medical staff that executes cesarean delivery (2.42) were negative while their attitude towards those who undergo cesarean delivery were positive (2.50). The independent variables (age, parity, educational attainment and previous mode of delivery) had no significant influence at .05 level of significance on attitude of mothers towards C-delivery. Following from the findings, discussion and conclusion of the study, four recommendations were made among which is that community health education about the benefits of cesarean delivery when indicated at primary care level is needed for the women’s and community’s understanding of the necessity of cesarean delivery. This will go a long way to reduce the number of women declining cesarean delivery and the morbidities and mortalities associated with such an action and improve the pregnancy outcome.

TABLE OF CONTENTS

Title Page
Table of Contents
List of Tables
List of Figures
Abstract

CHAPTER ONE: Introduction
Background to the Study
Statement of the Problem
Purpose of the Study
Research Questions
Hypotheses
Significance of the Study
Scope of the Study

CHAPTER TWO: Review of Related Literature
1.  Conceptual Framework;
•  Concept of attitude, cesarean delivery, mothers, antenatal clinics and general hospital
            •  Demographic factors associated with attitude of women towards Cesarean delivery
2.         Theoretical Framework;
            •  Theory of cognitive dissonance (TCD)
            •  Theory of reasoned action (TRA)
3.         Empirical Studies on Attitude of Women Towards Cesarean delivery
4.         Summary of Reviewed Literature

CHAPTER THREE: Methods
Research Design
Area of the study
Population for the Study
Sample and Sampling Techniques
Instrument for Data Collection
            •           Validity of the instrument
            •           Reliability of the instrument
Method of Data Collection
Method of Data Analysis

CHAPTER FOUR: Results and Discussion
Results
Summary of Major Findings
Discussions
•  Attitude of mothers towards cesarean delivery
•  Differences in the attitudes of mothers towards cesarean delivery

CHAPTER FIVE: Summary, Conclusions and Recommendations
Summary
Conclusions
Recommendations
Suggestions for Further Study
References
Appendices

CHAPTER ONE

Introduction

Background to the Study
The trend of acceptability and the rate of cesarean delivery have been on the increase in the developed countries in the last three decades due to the current safety of the procedure (Sunday-Adeoye and Kalu 2011), conversely, in the developing countries, the change in cesarean delivery rate has been less dramatic during the same period. While developed countries are dealing with the ethical and legal issues associated with caesarean delivery on maternal request, developing countries are still struggling with issues of refusal of caesarean delivery even in the face of obviously defined risks of maternal and perinatal morbidity and mortality. Kwawukume (2001) stated that in developed countries women often accept caesarean delivery because of their improved understanding of its role and safety, and the increasing importance of the right to self decision making regarding mode of delivery. By contrast, in developing countries women are reluctant to accept cesarean delivery, which may be as a result of many factors such as their traditional beliefs and socio-cultural norms as well as financial problems. Cesarean delivery is still being perceived as an abnormal means of delivery by some women in the developing countries. Sunday-Adedoye and Kalu (2011) affirmed that among women in the developing countries, cesarean delivery is still being perceived as a curse on an unfaithful women and the lot of weak women. They further noted that cesarean delivery was viewed with suspicion, aversion, misconception, fear, guilt, misery and anger.

In developed countries court-ordered caesarean deliveries are performed on mentally competent women on their refusal to the procedure. It was carried out when a woman refused the operation in circumstances where it was considered to be essential for the safety of herself, her baby or both, and following a court application made by doctors or hospital administrators (Chigbu & Iloabuchi, 2007). Unfortunately, no such order exists in most developing countries particularly in Nigeria where there is prevalence of this refusal of cesarean delivery.


Studies have established that maternal aversion to caesarean delivery is prevalent in developing countries especially in Sub-Saharan Africa. According to Behaque (2000) in Nigeria, as in most Sub-Saharan African countries, it has been suggested that women accept cesarean delivery reluctantly even in the face of obvious clinical indications. Thus, Awoyinka, Ayinde and Omigbodun (2006) noted that despite the well-documented record of safety of cesarean delivery, there are strong aversion of women in sub-Saharan Africa to the procedure (cesarean delivery), even in the presence of life-threatening indications. Okonta, Okali, Otoide and Twomey (2002) affirmed that refusal of life cesarean delivery is not uncommon among women in urban settings in Sub- Saharan Africa particularly in a country like Nigeria which is a leading contributor to both local and regional burden of maternal mortality.

Though the actual population of women who rejected caesarean delivery in real-life clinical practice has not been established in the previous studies in an African setting, many studies have reported that there is a mass rejection of cesarean delivery in Africa and other developing countries. For example a study conducted by Saoje, Nayse, Kasturwar and Relwani (2011) reaveled among other findings that 91.5 percent of the women in their study show preference to vaginal delivery against cesarean delivery when asked for their preferred mode of delivery. Orji, Ogunniyi and Onwudiegwu; (2003) affirmed that there is a general aversion to cesarean delivery in developing countries such as Nigeria, giving rise to difficulties in persuading patients to undergo surgery even in the context of obstetric emergencies. They further stated that reasons for these are grounded in social misconception, religious views, fear of surgical complications and cost.

While the contribution of caesarean delivery to maternal mortality has been reported in literature, the safety of elective cesarean delivery has not been well reported. Most of the literature on the maternal and neonatal outcomes following cesarean delivery addresses the emergency cesarean delivery, and this may not be comparable to elective cesarean delivery. Cesarean delivery is classified as elective if the decision to perform the operation was made before onset of labour, even when labour started before the operation. All others were considered as emergency. Finger (2003) posited that in those women who are having a scheduled procedure, the decision has already been made that the alternate of medical therapy, that is, a vaginal delivery, is least optimal. For other patients admitted to labour and delivery, the anticipation is for a vaginal delivery. Every patient admitted in this circumstance is admitted with the thought of a successful vaginal delivery. However, if the patient’s situation should change, a cesarean delivery is performed because it is believed that outcome may be better for the fetus, the mother, or both. The relative safety of elective cesarean delivery has seen a rise in the number of women being delivered in this way in developed countries. Gonen, Tamir and Degani, (2002) noted that most maternity units in the UK deliver between 10 and 20 per cent of babies by caesarean delivery.

Women in the developed countries like America, United Kingdom, Brazil, Northern Ireland and Canada, show favourable attitude towards cesarean delivery and some consider it the best option for themselves, while women in Sub Saharan Africa distaste it. WHO (2006) reported that in most African countries women may refuse surgery because of fear of suffering and other cultural perceptions of womanhood. Olusanya and Solanke (2009) affirmed that non-vaginal delivery is generally viewed in Nigeria as a sign of maternal laziness, reproductive failure or a curse from perceived enemies or deity in this population. It was therefore not uncommon even where cesarean delivery was indicated by past pregnancy history for women to attempt vaginal delivery until there was a glaring failure with obvious threat to the life of the mother or unborn child. Aziken, Omo-Aghoja, and Okonofua (2007) noted that qualitative studies have established that some women will not even accept cesarean delivery under any circumstances for reasons such as the fear of pain or death, financial cost, embarrassment by friends, religious beliefs and husband's disapproval. The delays associated with these and other factors may have contributed to the high proportion of emergency cesarean delivery, maternal and fetal disability as well as maternal and fetal mortality.....

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