CHAPTER ONE

INTRODUCTION

1.1 Background of Study

Pregnancy is the term used to describe the period in which a foetus develops inside a woman’s womb or uterus. Pregnancy usually lasts about forty weeks or just over nine (9) months, as measure for the last menstrual period to delivery. Perception is man’s primary form of cognitive contact with the world around him. As all conceptual knowledge is based upon or derived from this primary form of awareness, the study of perception has always had a unique significance for philosophy and science. Health care providers refer to three segments of pregnancy, called trimester. The events in which trimesters are: first trimester begins from week one to twelve week (1-12week) 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 foetus is delivered through abdomen and uterine incision and the indication can either be maternal or foetal. It can also be defined as a surgical opening of the abdomen used for the delivery of a baby.

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). Caesarean section is very suitable for the doctors, their team, the hospital and also for the mother to choose the delivery date as compared to suddenly unwanted labour pain (Jamil k et al). The term “Caesarean’ was derived from a decree in Roman Law, which made it mandatory for children to be cut out of women who had died during childbirth. In fact the term used at the time was “Lex Caesarare” (kwawukume et al, 2002).In addition; a Caesarean section denotes the use of surgery to deliver one or more babies from a Mother’s womb (Hinkle et al, 2016). Contrary to Caesarean section, Spontaneous vaginal delivery (SVD) is the most commonly accepted and widely used method for child delivery worldwide. It is the process through which Childbirth naturally occurs through the birth Canal (Bruner et al, 2016).

Several caesarean sections are sometimes done for justifiable medical and non-medical indication. Subsequently the rate of Caesarean in Eastern Europe 25.0%, Northern 25.3%, Southern 30.1%, Western 24.2% and North America 31.8% in 2020 have been increasing (Declercg et al, 2013).In developed Countries, women often accept Caesarean section because of their improved understanding of its role and safety (Johanson et al, 2001).  Contrary to, many Sub Saharan African countries, where several reports indicates that women are often reluctant to accept Caesarean section delivery (Behaque et al, 2002). Conversely, in the developing countries, the Change caesarean section rate has been dramatic during the same Period .This result from negative perception of caesarean section among women in the developing countries. However in Africa where the median caesarean section rate is estimated to be 8.8% the risk of neonatal death is reported to be lower in settings having higher elective caesarean section rates (Azad et al, 2015).The procedure of caesarean section is divided into elective and emergency caesarean section. The elective procedure means planned surgery and the emergency section is done when there is a sudden threat to the life of the mother or the foetus (Jamil K et al).Many studies showed that there are many private and socioeconomic causes. Some are anxiety, lack of care and perceived inconsistency these all are the reason for increasing the rate of caesarean section on mothers’ request. On the other hand, the women who already faced caesarean section in their previous obstetric history highly recommend the method of caesarean section. The increasing rate of CS is due to more preventive attempt against labour pain.

The national average of caesarean section rates in Ghana is estimated at 12.8% but it ranges from 11.2-14. 6% (Boerma et al, 2018), even then, there are wide disparities in access and uptake of caesarean section in urban and rural areas which may be partly related to perception about caesarean section. 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 foetal complications (Gibbons et al, 2010).Nigeria 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 organization (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% caesarean section are associated with a significant reduction of maternal and perinatal morbidity and mortality (Betran et al, 2015).

1.2 Problem Statement

 Worldwide rise in caesarean delivery (CD) rates during the last three decades has been a cause of alarm (J             Obstet Gynecol 2006). The rates such as delivery have increased dramatically in recent years, from 12% in 1990 to 24% in 2008 with no improvement in outcome for neonates (Lopes T et al,2010). The increasing rates of CD have been debated globally for over two decades, especially during the 1980s, when a peak was reached in industrialized countries. This lead to guidelines from the relevant United Nations (UN) agencies for CD rates in country, it stated that; CD rates should be between 5% and 15% and further research on the issue was warranted.

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 caesarean section rate in Burkina Faso  increase 1.5 times, from 1.2% in 2005 to 2% in 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) .African Studies have shown widespread rejection of indicated caesarean section by women which is viewed by them as a reproductive failure (Fasuba et al, 2004).

Not much information has been reported on this study in Cameroon; therefore, the investigator wants to assess the Knowledge, Perception and attitude of pregnant women at the antenatal clinic in the Buea Regional hospital

1.3 Rationale.

From the problem statement above caesarean section in on a rise worldwide based on what I encountered during my internship precisely in the Regional Hospital Buea where a higher percentage of the women chose caesarean section delivery to normal vaginal delivery. For this reason It is therefore of great importance to find out the cause of this increase in caesarean section percentage in recent times. Thereby increasing and promoting normal vaginal delivery reducing caesarean section rate, expenditure and future complications related to this method of delivery.

1.4 Research Questions.

1. What level of knowledge do pregnant women in the Regional Hospital in Buea have on Caesarean section.
2. What is the perception of pregnant women about Caesarean Section?
3. What is the attitude of women towards Caesarean Section?

1.5 Research Objective

1.5.1 General objective

This study has as general objective to assess the Knowledge perception and attitudes of pregnant women toward caesarean section.

1.5.2 Specific objective

1. To assess the knowledge of pregnant women towards caesarean section in the Buea Regional Hospital.
2. To assess the perception of pregnant women towards caesarean section.
3. To determine the attitude of women towards caesarean section in the Buea Regional Hospital.

1.6 Operational Definition of Key Terms (Oxford Nursing Dictionary)

• Anaesthesia: loss of feelings or sensation in a part or all of the body, especially when induced by drugs.

• Attitude: The way one behave towards some body or something that shows how you think or feel.
• Caesarean section: It is an operative technique by which a foetus is delivered through an abdominal and uterine incision and the indications can either be maternal of foetal.
• Dystocia: (Difficult birth): It may be caused by abnormalities in the foetus such as excessive size or mal-presentation, or -by abnormalities in the mother such as abnormally small pelvic or failure of the uterine muscles to contract.
• Knowledge: to have information about something because you have experience or because you have learned it or be told.
• Macrosomia: Large babies weighing more than 4kg at birth, especially in diabetic mothers.
• Mortality: The number of death in a particular situation or period of time.
• Perception: To notice something in a particular way or hold a view about something.
• Placenta Previa: This is a Condition in which the placenta of a foetus lies where the presenting Part of the foetus is supposed to come out (the cervical os).
• Morbidity: The state of being ill or disease or the occurrence of a disease in a given population at a particular period of time.

 Foetal Hydrops: A condition in which large amounts of fluid build-up in a baby’s tissues and organs causing extensive swelling (oedema).