ASSESSMENT OF CAESAREAN SECTION ANXIETY AMONG PREGNANT WOMEN ATTENDING ANTENATAL CLINIC IN AMINU KANO TEACHING HOSPITAL, KANO STATE.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

One of the most prevalent psychological disorders during pregnancy is anxiety. It includes a wide variety of emotions, from slight concern and anxiety, to profound and overwhelming fear, which can impact the mother's health, the baby's health and birth outcomes. Caesarean section (CS) anxiety is a type of childbirth anxiety that is characterized by feelings of fear and apprehension about the prospect or actual experience of cesarean section. This type of anxiety has become important as a public health problem, especially in tertiary hospitals in low and middle income countries (LMICs) where caesarean sections have been increasing rapidly (Seng et al., 2019; Khadem et al., 2021).

The worldwide caesarean section rate has also risen significantly in the last 20 years, from around 7% in 1990 to more than 21% in 2021, and is expected to reach 29% in certain areas by 2030 (Betran et al., 2021). The caesarean section rate has also increased in Nigeria, with rates reported at tertiary hospitals between 18 and 35%, due to the rise of childbirth with obstetric indications such as obstructed labour, fetal distress, previous uterine scars and others (Adesina et al., 2020). Aminu Kano Teaching Hospital (AKTH), a major tertiary hospital in the northern part of Nigeria conducts a considerable number of elective and emergency cesarean sections (CS) every year and is a good setting to study anxiety associated with CS.

The worry about caesarean section can appear in different types, for instance, dread of medical issues, dread of anaesthetic, dread of agony, concern for the wellbeing of the unborn child, dread of death and issues with breastfeeding and wound healing after the surgery (Nilsson et al., 2018). Unmanaged CS anxiety has been linked to potentially negative maternal outcomes, such as postpartum depression, post-traumatic stress disorder (PTSD), poor maternal-infant bonding, and poorer quality of life (Størksen et al., 2022; Ding et al., 2020). High anxiety levels also have been linked with longer labor, requests for emergency caesarean section, and lower satisfaction with care among mothers.

The context of antenatal clinics in Kano State, northwest Nigeria, a region where Muslims are the dominant religion and the socio-cultural environment is conservative, poses specific factors for CS anxiety among pregnant women. Women's cultural views surrounding womanhood and modesty, pain endurance, and the spirit of childbearing might influence perceptions of and reactions to caesarean section (Ibrahim et al., 2020). Furthermore, low health literacy, negative birth experiences, lack of antenatal counselling, and weak communication between healthcare providers and patients have been found to be key factors associated with high levels of CS anxiety in this context (Musa et al., 2021).

Although CS anxiety has been identified as an important clinical and public health phenomenon, there is a dearth of systematic investigation of CS anxiety per se among pregnant women at AKTH and Kano State, in general. Most of the existing studies on childbirth anxiety in Nigeria have been in general terms about the fear of childbirth or have been conducted in the tertiary hospitals in the Southern part of the country, thereby posing a gap in the evidence from the northwestern geopolitical zone of Nigeria. It is therefore essential to have a facility-specific assessment to provide context-specific data to guide clinical practice and antenatal care protocols.

The midwives are an integral part of the management of CS anxiety among people attending the antenatal clinic. The midwives can help reduce anxiety and enhance maternal outcomes by educating patients, providing emotional support, communicating with patients in a therapeutic way, and referring patients to psychological services. The burden of CS anxiety at AKTH will give the midwives and other health care workers evidence to inform the development of evidence-based anxiety management strategies for the specific needs of pregnant women of Kano State.

1.2 Statement of the Problem

Over the past few years, the rate of cesarean sections at Aminu Kano Teaching Hospital (AKTH) has been on the up and upward trend, and reports have emerged of an increase in anxiety among pregnant women referred for cesarean section or expecting such delivery at AKTH. Fear and apprehension over caesarean section have been noted among women who attend the antenatal clinic at AKTH, but are not routinely screened and systematically addressed in the current antenatal care system.

Untreated CS anxiety has significant repercussions. Higher levels of anxiety have been linked to unfavorable birth outcomes, poor mental health of mothers, and lack of compliance with antepartum care visits (Khadem et al., 2021; Ding et al., 2020). This can be done by empirically assessing the prevalence and factors associated with CS anxiety in a resource-limited, high-burden environment like AKTH, where rates of obstetric complications are high, and psychological support services are limited, in order to develop targeted, effective interventions for use within a routine antenatal care pathway.

Though the problem is enormous, there is no study conducted at a facility level to find out the level of CS anxiety experienced by pregnant women in AKTH, Kano State. This is an important gap in the literature and is the reason for conducting the present study.

1.3 Objectives of the Study

General Objective

The general objective is to assess the level of caesarean section anxiety among pregnant women attending the antenatal clinic in Aminu Kano Teaching Hospital, Kano State.

Specific Objectives

1. Determine the prevalence of caesarean section anxiety among pregnant women attending antenatal clinic at AKTH.
2. Identify the specific dimensions of caesarean section anxiety experienced by the participants.
3. Determine the socio-demographic and obstetric factors associated with caesarean section anxiety.
4. Identify the coping strategies employed by the pregnant women to manage CS anxiety.

1.4 Research Questions

1. What is the prevalence of caesarean section anxiety among pregnant women attending antenatal clinic at AKTH, Kano?
2. What are the specific dimensions of caesarean section anxiety experienced by the study participants?
3. What socio-demographic and obstetric factors are associated with caesarean section anxiety among the study participants?
4. What coping strategies do pregnant women use to manage caesarean section anxiety?

1.5 Research Hypotheses

H0: There is no significant association between socio-demographic factors and the level of caesarean section anxiety among pregnant women at AKTH.

H1: There is a significant association between socio-demographic factors and the level of caesarean section anxiety among pregnant women at AKTH.

1.6 Significance of the Study

This study will generate the first facility-specific empirical data on the prevalence and determinants of CS anxiety among pregnant women at AKTH, Kano. For midwives and other obstetric care providers at AKTH, the findings will inform the development of routine anxiety screening protocols during antenatal visits, enabling early identification and management of at-risk women. The study will also highlight socio-cultural and obstetric risk factors that should be incorporated into individualized birth plans and antenatal counselling sessions.

For hospital administrators and policy makers, the study will provide a compelling evidence base for the integration of psychological support services, including antenatal anxiety counselling and midwifery-led psychoeducation programs, into the antenatal care framework at AKTH and similar facilities in northern Nigeria. The findings will also contribute to the growing literature on maternal mental health in LMICs and serve as a reference for researchers in the field of obstetric anxiety.

1.7 Scope of the Study

This study focuses on pregnant women attending the antenatal clinic at Aminu Kano Teaching Hospital, Kano State, specifically those who have been informed of or are anticipating a caesarean section. The study will be conducted during routine antenatal clinic visits over a defined data collection period in 2024–2025. It does not extend to women at other facilities in Kano or to women who have already undergone caesarean sections.

1.8 Limitations of the Study

Limitations include the cross-sectional nature of the design, which precludes causal inference. Self-report tools may introduce response bias, particularly in a cultural context where mental health discussions may be stigmatized. Language barriers may also affect data quality, although questionnaires will be translated into Hausa and back-translated for equivalence. Findings may not be generalizable beyond AKTH, Kano State.

1.9 Definition of Terms

Caesarean Section (CS): A surgical procedure in which one or more incisions are made through the mother's abdomen and uterus to deliver a baby, performed when vaginal delivery would put the baby or mother at risk.

Anxiety: A state of apprehension, unease, or worry about a perceived threat or uncertain outcome; in this study, refers specifically to worry and fear related to undergoing a caesarean section.

Caesarean Section Anxiety: The specific fear, apprehension, or emotional distress experienced by a pregnant woman in relation to the possibility or certainty of delivering her baby by caesarean section.

Pregnant Women: Women in any trimester of pregnancy who are attending the antenatal clinic at AKTH, Kano.

Antenatal Clinic (ANC): A scheduled healthcare visit for pregnant women during which physical, psychological, and social aspects of their health and pregnancy are assessed and managed.

Aminu Kano Teaching Hospital (AKTH): A tertiary health institution in Kano, Nigeria, serving as a major referral centre for maternal and child health services in Kano State and the Northwestern geopolitical zone.

Childbirth Fear: A broad term encompassing fear or anxiety specifically associated with the process of giving birth, including surgical delivery.

Elective Caesarean Section: A planned caesarean delivery scheduled before the onset of labour, typically for non-emergency medical indications.

Emergency Caesarean Section: An unplanned caesarean delivery performed urgently due to acute complications threatening the life of the mother or infant.

References

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