CHAPTER ONE

INTRODUCTION

1.1.   BACKGROUND OF STUDY

Pregnancy is the term used to described the period in which a fetus develops inside a woman’s womb or uterus. Pregnancy usually lasts about forty weeks or just over nine (9) months, as measure from the last menstrual period to delivery (Office on women’s health, 2010). Health care providers refer to three segments of pregnancy, called trimester. These include: first trimester which begins from week one to twelve week, that is from one to three months, Second trimester from Week 13 to week 28. Third trimester from Week 29 to week 40 (Hansen et al. 2016). A Caesarean section is an operative technique by which a fetus is delivered through the abdomen. Indications can either be maternal or fetal or a double previous scar. Caesarean section is considered by medical Professionals to be relatively safe, though it does in fact pose a higher risk for complication than vagina delivery (Hall et al. 2015). Furthermore a Caesarean section denotes the use of surgery to deliver one or more babies from a Mother’s womb (Hinkle et Al 2016). Several caesarean section are sometimes done for justifiable medical and non-medical indication.

According to a European study,   the rate of Caesarean in Eastern Europe was 25.0% , Northern 25.3%, Southern 30.1%, Western 24.2%. It was hypothesized that the rate of Caesarean section will increase to 31.8%  in North America by 2020  (Declercg et al. 2013).Other studies revealed that, up to 80% of the participants declared that they would prefer a vaginal birth, if they could opt for route of delivery. Preference for CS was higher among younger women; almost 35% of those < 25 years preferred a CS compared to less than 16% of those > 35 years. Similarly, the proportion of women with lower education who preferred CS was significantly higher than those with higher education (20.5% versus 13.4%). Women with a previous delivery were more likely to prefer vaginal delivery than those without any deliveries (82.3% versus 77.3%). Within the group of over 500 women with previous births, those without a previous CS were even more likely to prefer a vaginal delivery than women who had undergone at least one previous CS (94.2% versus 60.0%, respectively). Over 80% of the participants strongly agreed or agreed with the statement that they preferred a vaginal birth because they did not want to miss the first hours of life with the baby and because the hospital stay was shorter in this type of delivery (Tarloni et al. 2013).  However, in some developed countries, women often accept Caesarean section because of their improved understanding of its role and safety (Johanson et al 2001). 

In many sub Saharan African Countries, several reports indicates that women are often reluctant to accept Caesarean section delivery. This reluctance comes as a result of the negative perceptions women in developing countries have concerning cesarean section (Behaque et al 2002). Caesarean section, is still being perceived as an abnormal means of delivery by some women in developing countries, hence caesarean Section rate in sub-Saharan African Country like Burkina Faso and Niger is low. The cesarean section rate in Burkina Faso has, however, increased from 1.2% in 2005 to 2% in 2017(minitere de la sante de Burkina Faso, 2017; Sunday et al. 2011).  Furthermore, among women in the developing countries, Caesarean section is still being perceived as a curse on an unfruitful women and a lot of weak women. In a study among Yoruba women of south Western Nigeria, caesarean section was viewed with suspicious, aversion, misconception, fear, guilt, misery and anger (Sunday et al 2011) .Africa Studies have shown widespread rejection of Indicated caesarean section by women which is viewed by them as a reproductive failure (Fasuba et al 2004).

Despite the higher risk of uterine rupture in women with previous Caesarean section scars, some studies have shown a high default rate among these women with some Presenting to hospital only following complication during vagina birth at home, thus contributing to increase maternal and fetal morbidity and mortality(Ekanem et al 2001). This is the reason why this study seeks to assess pregnant women’s knowledge, perceptions and challenges pre cesearean section.  

1.2   STATEMENT OF THE PROBLEM.

Caesarean section is now a common surgical operation around the world with many being aware of the existence of his medical Procedure (Williams et al 2016). The recent rates of delivery by caesarean section continue to rise worldwide, with reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America (Betran et al 2014).

Delivery by caesarean section can minimize maternal and perinatal mortality and morbidity when there are maternal or fetal complications (Gibbons et al 2010). Nigerian has been rated the third country, with the highest mortality rate after India and Sierra Leone with over 40,000 deaths of pregnant women (WHO 2013). In Cameroon, the World Health Organisation (WHO) recommends caesarean section rates of 10-15% (Njim et al 2020).

This is based on evidence from several reports suggesting that at 10-15%. Not much information has been reported within our scope of search, whether published or unpublished to assess pregnant women knowledge, perception and challenges at the Limbe Regional Hospital.

1.3 RESEARCH OBJECTIVES.

1.3.1 General Objectives

To assess the perception and challenges encountered by pregnant women pre-caesarean section in the Regional Hospital Limbe.

1.3.2 Specific Objectives

1. To assess the knowledge of pregnant women attending ANC at LRH on cesarean section
2. To determine the perception of pregnant women pre-caesarean section at the Regional Hospital Limbe.
3. To evaluate the challenges of pregnant women pre-caesarean section at the Regional Hospital Limbe.

1.4 RESEARCH QUESTIONS

1. What is the knowledge of pregnant women attending ANC at LRH on caesarean section?
2. What are the perceptions of pregnant women attending ANC at LRH about Caesarean Section?
3. What are the challenges encountered by pregnant women pre-Caesarean Section?