CHAPTER ONE

1.1. Background

Pregnancy as a physiologic state is expected to lead to a process of delivery within thirty six weeks (36) of gestation in a normal delivery but due to the different reasons such as variation in human body, sizes, races, external factors e.t.c, it can be a very unpleasant experience as women may have difficulties in being delivered of the pregnancy they have carried over many weeks. Caesarean section (c-section or ‘caesarean’) is a surgical procedure in which a baby is born through an incision (cut) made in the mother’s abdominal wall and the wall of the uterus (womb). Your baby will need to be born by caesarean section if there are problems that prevent the baby being born by a normal vaginal birth. It was reported sporadically throughout medical history and was only rendered safe for both mother and foetus during the 20thCentury (Dickson et al 1999) .The trend of acceptability and the rate of C/S has been on the increase in the developed countries in the past two decades. In the United State of America, it has revolved off a 32.8% in 2010 and 2011 (Hamilton et al 2010). Several cesarean sections are sometimes done for justifiable medical and non-medical indications sequent the rate of C/S in Europe and North America have been increasing (Declercq E, et al 2007).Conversely, in the developing countries, the change in C/S rate has been dramatic during the same period. This results from negative perception of C/S among women in the developing countries. C/S is still being perceived as an abnormal means of delivery by some women in developing countries, hence C/S rate in Sub-Saharan African Country like Burkina Faso and Niger is as low as 2% (Adeoje et al 2011).Among women in the developing countries, C/S is still being perceived as a curse on an unfruitful women and the lot of weak women. In a study among Yoruba women of south western Nigeria, C/S was viewed with suspicious, aversion, misconception, fear, guilt misery and anger. (Sunday-Adeoje et al, 2011).In most sub-Saharan African countries like Cameroon, it has been suggested that women reluctantly accept C/S even in the face of obvious clinical indications. Also, negative view and perception of C/S by women in the developing country has led to gross under rated of the procedure compared to the large burden of obstetric morbid requiring resolution by C/S (Aziken M, et al 2010).Despite the causes of maternal mortality often obstetric in origin, underlying cultural factors and beliefs also affect access to and use of health facilities and thus contribute to avoidable maternal deaths (Mboho et al 2013). Several studies have indicated how local beliefs and practices impact general health and childbearing. Some of these beliefs have been identified as contributing to the delays in accessing appropriate skilled help when complications arise in labour (Okafor 2000).It is necessary to note that the issue of vaginal birth is not only peculiar to developing countries but also in some developed countries. Women still choose vaginal birth after having caesarean section even in the case of postdates slated for elective caesarean section (Clift-Mathews 2010). The author further highlighted the fact that women desperately wished to go into labour before their appointment dates because not giving birth vaginally was a sign of ‘failure’. In addition; vaginal birth is something a number of women look upon as a rite of passage (Clift-Mathews 2010) Obstetrics in modern America is a contentious subject in general (Ecker 2013). Usually childbirth and the actions surrounding it whether medical or otherwise normally evoke strong emotions where discussion is often framed ideologically as a matter of nature versus technology. Hence the issue of caesarean section in particular is much contested issue (Ecker 2013). Even so, caesarean section rates are on the increase as evident in a number of western countries such as the United States of America and United Kingdom (McAra-Couper, et al 2010).In 1985, following the increasing disparity rate among nations in the number of caesarean births, the World Health Organisation (WHO) set out to determine an optimal rate of 15 percent as ideal. The postulated 15 percent by WHO would optimally prevent childbirth injuries and deaths. In addition, many women and babies would avoid unnecessary and potentially harmful surgery (Harvard magazine 2013). However, WHO has since modified this particular recommendation in 2009, stating that ‘the optimum rate is unknown but asserts that both very low and very high rates of caesarean sections can be dangerous In other words, the procedure should be done only when it is absolutely necessary. The editorial team of Academic Research International of Harvard Magazine concluded that there is need for a balance to be reached, that is, women should be allowed to have normal vaginal deliveries with as little intervention as possible. However, at the same time, the families, obstetricians will be ready to address any unexpected emergencies. Although Caesarean section (CS) is the commonest major surgery performed in Obstetrics and it has contributed to improved obstetric care throughout the world; there are still concerns about the attitude of women especially women of PMI hospital down beach Limbe towards CS.

1.2. Problem statement

Unfortunately, despite the well documented record of safety, the strong aversion of women in Sub-Saharan Africa to CS especially in the presence of life threatening indications is a great concern (Awoyinka BS, 2006). CS is effective in saving maternal and neonatal lives when required but still some women have limited knowledge about CS. Recent studies in Cameroon at the Yaounde Central Hospital and Yaounde General Hospital revealed a CS rate of 19.74% and 16.95% maternal complications [          Tebeu PM, et al 2008]. A study in the Far North Region of Cameroon revealed that one of three caesarean deliveries ended in fetal death [Tebeu PM, et al 2008]. Furthermore Forsah, in Buea had a 14.4% Adverse Neonatal Outcome (ANO) following indication for CS, recently a study in the southwest region showed a CS rate of 13.3% which is very low in this century (Tanyi TJ, et al 2016). This gendered socio-cultural, knowledge of CS, fear of death also limit women’s capacity to make health-related decisions, including their capacity to accept C-section thus increasing their risk of potentially life threatening pregnancy complications. There are also many questions regarding the effects of personal, religious, and traditional health beliefs on one’s preference for a mode of delivery.  During my internship at the PMI down beach hospital Limbe, I realized that most women will refuse CS even when the indications for CS  are there, thus this attitude of the women towards CS prompted me to carry out this research to know their perceptions on CS.

1.3. Rational of the 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 fetal complications

1.4  Research questions

1. What is the perception of women in PMI hospital down beach Limbe toward Caesarean section?
2. What is the attitude of pregnant women in PMI hospital downbeach Limbe towards caesarean section?
3. What are the factors influencing the acceptance of Caesarean section

1.5 General Objective

To ascertain what is known about CS and the attitude towards CS amongst pregnant women attending Antenatal care in PMI down beach limbe.

1.5.1 specific Objectives

1. To assess the perception of women of PMI Hospital down beach Limbe
2. To determine the attitude of women of PMI Hospital down beach Limbe towards CS
3. To identify the factors influencing the acceptance of CS