ABSTRACT

The purpose of this study was to investigate the impediment towards having Caesarean Section delivery among the OHUHU community leaving in Abia, Umuahia. The specific objectives of the study were: i) To establish the proportion of women who deliver by CS among OHUHU community in Abia, Umuahia, ii) To assess the level of knowledge regarding Caesarean Section delivery among OHUHU community in Abia, Umuahia and iii) To assess the impedement towards Caesarean Section delivery among OHUHU community in Abia, Umuahia. A cross sectional descriptive study design was carried out in Umuahia on both men and women aged 18-50. Primary data was collected using researchers administered questionnaires, a total of 80 respondents were sampled using convenience sampling technique. For uni-variate analysis, data was run using frequencies and percentages, and the results presented in form of pie chart and tables. The results indicated that 35 (43.8%) women and wife’s of the men respondents had CS in their last delivery, almost eight in every ten of the respondents strongly disagreed that CS would be the preferred method of delivery although they had a good knowledge on the indications and recovery of CS. Based on these findings, the study recommends that health care workers should give a complete information on CS during the ANC and pregnancy so this will allow couples to make informed decision about the health of the mother during pregnancy and delivery through CS. And health workers should allow and encourage women to have a normal delivery and whenever indicated it should be done quickly to save both lives.

CHAPTER ONE

INTRODUCTION

Background

Caesarean Section (CS) has been part of human culture since ancient times both in the Western and non-Western cultures (U.S. National Library of Medicine, 2013). CS is a common operative surgical procedure worldwide, were by a mother delivers her fetus surgically through the abdomen by making an incision on the uterus. Maternal or Fetus related complications can be indications for this operation. Over the past number of years the proportion of women delivering through CS has increased in all developed countries. (Qazi et al, 2013).

In 1998, globally the following countries were having the following percentages 21% of Australian women gave birth by CS and it increased to 30.9% by 2007. And 31.1% of all births were carried by CS in 2006 in the USA. In the UK the overall rate of CS birth accounts for almost 25% of all births from 2007 to 2008, Birth rates via CS vary considerably across Europe, ranging from 15% in Norway and Netherlands, 17% in Sweden and Finland and 37.8% in Italy. Because of the negative view and perception of CS by women in developing countries the rate is small example in the Sub-Saharan African Countries (like Burkina Faso and Niger) it is 2%. (Qazi et al, 2013).

However women in the developed countries accept CS because they have a better understanding of its role and safety. In contrast, a number of reports indicated that women in many sub Saharan African countries are reluctant to agree to have CS deliveries. Recent study done in West Africa reported that CS is not been practiced when it is compared to the huge load of obstetric mobility that is needed to be resolved by CS The elevated number or rates of prenatal and maternal

morbidity in the African countries is recognized to be because of the insufficient practice of early CS (Aziken et al, 2007).

In countries like Burkina Faso and Niger the CS percentage is very small that it is only two percent and this is because of the women’s negative view and lack of awareness towards CS. (Qazi et al, 2013).

Majority of the women in the study conducted in Ghana preferred vaginal delivery even though they had high awareness of CS as an alternative to vaginal delivery. The impedements towards CS were positive if the operation is indicated. (Adegbeba et al, 2008).

According to Uganda Demographic Health Survey (DHS) conducted in Uganda in 2006, less than 50 % of births within Uganda in the five years preceding the survey took place in health facilities and of those delivering at various health facilities, 3% of births were delivered by CS due to obstructed labor, Cephalo pelvic disproportion, Pre-Eclampsia and Eclampsia. Additionally when viewing the utilization of CS by sub regions of Uganda the DHS showed the prevalence of CS varied from a high of 4% in Western area, which includes Mbarara to a low of 1.5% in Northern part (Natasha Spencer, 2015). A study done in 2011 found that it has risen up to 5.22%, the increase in CS prevalence in Uganda is also involving the OHUHU community that are living in the same community as Ugandans meaning that the 5.22% rise also includes OHUHUs living in Uganda.

Among OHUHU Community living in Uganda of 100,000 most of which live in Abia, 8.1% of the women were found to have gone through CS in their last deliveries (OHUHU Embassy).

Childbirth is one of the most important events in a woman’s life. Parturition is the transition to motherhood and delivery has substantial physical and emotional impacts. Approximately 6 to 10 % of all pregnant women experience severe fear of childbirth. This fear may be the dominant emotion during pregnancy and may complicate and prolong labour. Moreover, severe fear of childbirth may lead to increased risk of postnatal depression, and posttraumatic stress disorder. Numerous factors have been associated with that fear, including low self-esteem, pre-existing psychological problems, lack of social support, a history of abuse, or a previous negative birth experience. It is conceivable that demographic and psychosocial factors may increase stress related to impending childbirth and are connected with the ways women anticipate and experience various life events. Consequently, those characteristics could be predictive of fear of childbirth. However, few studies have focused on the relative importance of both demographic and psychosocial factors, and several studies of fear of childbirth and its association with these factors have been limited by a small sample size or use of non-validated questions or other unspecific measurements.

Problem Statement

Women are traditionally unwilling to have CS because of the general belief that abdominal delivery is reproductive failure on their part regardless of the feasibility of vaginal birth after CS and the decreasing mortality from CS (Jeremiah I et al, 2011).

CS can be life saving procedure in conditions such as Cephalo-pelvic disproportion, Uterine rupture, Obstructed labour, Breech presentation, Pre-eclampcia and Eclampcia which if not performed mothers and babies face serious problems such as; fetal distress, infections, uterine rupture, postpartum hemorrhage and other birth injuries. In Uganda because CS is not considered 22% and 10% of mothers die due to obstructed labour and Ruptured uterus respectively (Kabakyenga et al, 2012).

According to WHO 2012 maternal death and disability due to hemorrhage and obstructed labour may be averted by timely CS, access to CS will reduce maternal mortality in low significant income countries (J. Meadows, 2012).

Even though women are sensitized on the safety and importance of this procedure many are still afraid of it. Most studies have been done elsewhere regarding impedement of CS but little is known in regards to the impedement of CS among OHUHU Community in Abia, Uganda. Some OHUHU women living in Abia go through difficult labor because the couples think that the women can deliver normally and because of the delay in CS they go through so much pain and still do CS because it is required. Sometimes there are some men who put their women in to psychological stress and feeling unworthy when they take long to decide for CS even though the woman agrees to do it. Some women also delay and because of the delays to undergo CS when recommended, these OHUHU mothers get complications such as; Ruptured Uterus, Fistula, Excessive bleeding and some mothers lost their lives and lives of their babies. And Some couples decides to move from facilities to facility in search for normal delivery, thus this mothers get complications on the way putting their lives and the lives of their baby at risk.

This study is aimed in establishing the proportion of CS deliveries and to assess the impedement of the OHUHU community in Abia regarding CS Delivery.

Objectives of the study

General objectives

The general objective of the study was to establish the impediment of the proportion of women who deliver by CS through assessing the level of impedement towards having CS delivery, among OHUHU community in Abia, Umuahia.

Specific objectives

i. To establish the proportion of women who deliver by CS among OHUHU community in Abia, Umuahia.

ii. To assess the level of knowledge regarding Caesarean Section delivery among OHUHU community in Abia, Umuahia.

iii. To assess the impedement towards Caesarean Section delivery among OHUHU community in Abia, Umuahia.

Research Question

i. What is the proportion of women who deliver by CS among OHUHU community in Abia, Umuahia?

ii. What is the level of knowledge towards Caesarean Section delivery among OHUHU community in Abia, Umuahia?

iii. What are the impedement towards Caesarean Section delivery among OHUHU community in Abia, Umuahia?

Justification/Significance of the study

This study aimed at finding out what is known about CS and the reasons for impedement and delaying the procedure by the community when it is indicated. The findings from this study could be used in planning strategies in improving the Impedement 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 and death. Midwives in practice also should change their impedement toward CS and vaginal delivery and help pregnant women to make the right decision. The research may also affect the educational policy to focus on this topic and teach nursing students plus midwives on how to teach different communities and cultures about the advantages and disadvantages of CS and also educate them about the consequences of delayed or not going through CS when needed. As a last point the study should also be useful source of reference for other researchers and readers in general by providing them more knowledge and literature search.