PERCEPTION AND ACCEPTANCE OF CAESAREAN SECTION AMONG EXPECTANT MOTHERS ATTENDING ANTENATAL CLINIC, RIVERS STATE UNIVERSITY TEACHING HOSPITAL (RSUTH), PORT HARCOURT

Abstract

This study explored the perception and acceptance of Caesarean Section (C-section) among expectant mothers attending the Antenatal Clinic of Rivers State University Teaching Hospital (RSUTH), Port Harcourt, Nigeria. Adopting a quantitative survey research design, data were collected using a structured questionnaire from a sample of 120 respondents. The questionnaire was designed to assess expectant mothers' perceptions and acceptance of C-sections, as well as the socio-economic factors influencing their decisions. SPSS27 was employed to present and analyze the collected data, with the application of t-tests to test the hypotheses formulated. The findings of the study revealed significant insights into expectant mothers' perceptions and acceptance of C-sections. The analysis indicated a strong correlation between perceptions and acceptance of C-sections, suggesting that expectant mothers' views on this procedure significantly impacted their willingness to undergo it. Additionally, socio-economic factors were found to play a crucial role in influencing the acceptance of C-sections among pregnant women. Financial constraints and access to quality healthcare facilities emerged as key determinants in decision-making processes regarding C-sections. In conclusion, the study underscored the importance of understanding expectant mothers' perceptions and acceptance of C-sections, particularly within the context of socio-economic factors. The findings highlighted the need for targeted interventions aimed at addressing misconceptions and barriers to C-section acceptance, as well as improving access to quality healthcare services. Based on these insights, several recommendations were proposed to enhance maternal healthcare services and support informed decision-making regarding childbirth options. Recommendations included the implementation of educational programs to dispel myths and misconceptions surrounding C-sections, particularly targeting vulnerable populations with limited access to healthcare resources. Additionally, efforts were suggested to improve the affordability and accessibility of maternal healthcare services, with a focus on reducing financial barriers and expanding healthcare infrastructure in underserved areas. Furthermore, healthcare providers were recommended to undergo training to improve communication skills and provide comprehensive information to expectant mothers about their birthing options, including the risks and benefits of C-sections. By addressing these recommendations, policymakers, healthcare professionals, and stakeholders could contribute to improving maternal healthcare outcomes and promoting maternal well-being.

CHAPTER ONE

INTRODUCTION

1.1 Background to the Study

Caesarean section (C/S), also known as C-section, is a surgical procedure to deliver a baby through incisions in the mother's abdomen and uterus. This procedure is often employed when vaginal delivery poses risks to the baby or the mother. Despite its lifesaving potential, the rate of C-sections has been increasing globally, a trend observed even in Nigeria. The World Health Organization (WHO) recommends an ideal rate of C-sections to be between 10% and 15% of births, but many countries, including Nigeria, have surpassed this rate. This situation brings to light significant concerns regarding the perception and acceptance of C-sections among expectant mothers, particularly those attending the Antenatal Clinic at Rivers State University Teaching Hospital (RSUTH) in Port Harcourt.

The rising trend of C-sections can be attributed to several factors, including medical, socio-economic, and cultural influences. For instance, advancements in medical technology and increased access to healthcare facilities have made C-sections more accessible and safer, contributing to their rising prevalence (Ji et al., 2023). Moreover, the procedure's perceived convenience and the ability to schedule deliveries have also played a role in its increased acceptance. However, these factors alone do not fully explain the rapid rise in C-section rates, especially in developing countries like Nigeria.

Cultural beliefs and societal norms significantly impact the perception and acceptance of C-sections among expectant mothers. In many communities, natural childbirth is highly valued, and a C-section might be viewed as a sign of weakness or failure (Jeremiah et al., 2021). Such cultural stigma can discourage women from opting for or accepting a C-section even when medically necessary. Additionally, misinformation and lack of awareness about the benefits and risks associated with C-sections can further exacerbate negative perceptions.

Socio-economic status also plays a crucial role in determining the acceptance of C-sections. Women from higher socio-economic backgrounds may have better access to healthcare facilities and are more likely to be informed about the safety and necessity of C-sections (Kwawukume, 2022). On the other hand, those from lower socio-economic strata might face financial barriers and have limited access to quality healthcare, making them less likely to opt for or accept a C-section. This disparity highlights the need for targeted education and support programs to ensure that all women, regardless of their socio-economic status, can make informed decisions about their delivery method.

Medical professionals' attitudes and practices also influence the rate of C-sections. In some cases, healthcare providers may prefer C-sections over vaginal deliveries due to the predictability and control the procedure offers (Johanson & Lucking, 2021). Additionally, concerns about potential legal implications of complications arising from vaginal births might prompt some doctors to recommend C-sections more readily. This trend underscores the importance of continuous medical education and adherence to guidelines to ensure that C-sections are performed only when medically indicated.

The impact of C-sections on maternal and neonatal outcomes cannot be overlooked. While C-sections can prevent severe complications associated with difficult vaginal deliveries, they also carry inherent risks such as infections, increased blood loss, and longer recovery times (Dumont et al., 2021). Therefore, it is crucial to balance the benefits and risks when considering a C-section. Educating expectant mothers about these aspects can help them make informed decisions and alleviate undue fears associated with the procedure.

Efforts to address the high rates of C-sections must also consider the healthcare infrastructure and policy frameworks in place. In many developing countries, including Nigeria, the healthcare system may lack the necessary resources and trained personnel to handle the increasing number of C-sections safely (Lydon-Rochelle et al., 2020). Strengthening healthcare infrastructure, training more healthcare providers, and ensuring the availability of essential medical supplies are vital steps in managing the rising rates of C-sections effectively.

Furthermore, public health campaigns and community outreach programs can play a significant role in reshaping perceptions about C-sections. By providing accurate information and addressing common misconceptions, these initiatives can help build a more positive outlook towards C-sections among expectant mothers (Lee et al., 2020). Engaging community leaders and influencers in these efforts can also enhance their reach and effectiveness.

1.2 Statement of Problem

The rising rates of Caesarean sections (C-sections) globally and particularly in Nigeria present significant concerns and reveal critical gaps in understanding and addressing maternal health. One major problem is the discrepancy between recommended and actual C-section rates. The World Health Organization (WHO) recommends that C-section rates should ideally range from 10% to 15% of all births; however, many regions in Nigeria significantly exceed this range (Jeremiah et al., 2021). This gap suggests an overutilization of the procedure, which may not always be medically necessary, and points to potential issues in clinical decision-making and healthcare practices.

Cultural and socio-economic factors heavily influence the perception and acceptance of C-sections among expectant mothers. In many Nigerian communities, cultural stigmas surrounding C-sections can deter women from opting for this procedure, even when it is medically necessary (Jeremiah et al., 2021). These cultural perceptions need to be thoroughly understood and addressed to ensure that women are making informed decisions about their health and that of their babies. Additionally, there is a lack of comprehensive education and awareness programs that accurately inform women about the risks and benefits of C-sections (Ji et al., 2023).

Another significant gap is the disparity in access to quality healthcare services based on socio-economic status. Women from lower socio-economic backgrounds often have limited access to healthcare resources, which can negatively affect their ability to make informed decisions about delivery methods (Kwawukume, 2022). This disparity underscores the need for equitable healthcare provision and targeted interventions to support vulnerable populations.

Moreover, the attitudes and practices of medical professionals significantly impact C-section rates. Some healthcare providers may favor C-sections over vaginal deliveries due to perceived convenience or fear of legal repercussions from vaginal birth complications (Johanson & Lucking, 2021). This inclination suggests a need for better adherence to clinical guidelines and ongoing professional education to ensure that C-sections are performed based on medical necessity rather than convenience or fear of litigation.

Addressing these gaps requires a multifaceted approach that includes improving healthcare infrastructure, enhancing education and awareness programs, and ensuring equitable access to healthcare services. By filling these gaps, we can better align C-section practices with medical guidelines and improve maternal and neonatal health outcomes.

1.3 Objectives of the Study

The following specific objectives were examined:

1. To determine the perception of expectant mothers about C/S in the Antenatal Clinic of RSUTH.

2. To ascertain the level of acceptance of caesarean section among expectant mothers attending the Antenatal Clinic of RSUTH.

3. To examine the socio-economic factors influencing the acceptance of caesarean section among pregnant women attending the Antenatal Clinic of RSUTH.

1.4 Research Questions

The following research questions were asked:

1. What are the perceptions of expectant mothers regarding C-sections?

2. How accepting are expectant mothers of C-sections as a delivery method?

3. What socio-economic factors influence the acceptance of C-sections among pregnant women?

1.5 Research Hypotheses

The following hypotheses were tested:

1. Expectant mothers' perceptions of C-sections do not significantly impact their acceptance of the procedure.

2. Socio-economic factors do not play a significant role in influencing the acceptance of C-sections among pregnant women.

3. There is no correlation between the level of education and acceptance of C-sections among expectant mothers.

1.6 Significance of the Study

The significance of studying the perception and acceptance of Caesarean section (C-section) among expectant mothers at the Antenatal Clinic of Rivers State University Teaching Hospital (RSUTH) in Port Harcourt is multi-faceted, addressing critical issues in maternal health, healthcare delivery, and public health policy. This research holds substantial importance for several reasons:

Firstly, understanding the perception and acceptance of C-sections among expectant mothers provides valuable insights into maternal health behaviors and decision-making processes. This knowledge is crucial for healthcare providers as it can guide them in offering better patient-centered care. By comprehending the factors that influence women's attitudes towards C-sections, healthcare professionals can tailor their communication and education strategies to address misconceptions, alleviate fears, and ensure that mothers are well-informed about their delivery options. This, in turn, can lead to more positive maternal and neonatal health outcomes, as mothers who are well-informed are more likely to make decisions that are best for their health and that of their babies.

Secondly, the study has significant implications for public health policy and healthcare planning. The rising rates of C-sections in Nigeria, often exceeding the World Health Organization's recommended levels, indicate a potential overutilization of the procedure. By identifying the socio-economic and cultural factors that contribute to this trend, policymakers can develop targeted interventions to promote appropriate use of C-sections. This might include implementing guidelines that encourage vaginal deliveries when safe, improving access to maternal health education, and addressing systemic issues that lead to unnecessary C-sections. Effective policy interventions can help optimize healthcare resources, reduce healthcare costs, and improve overall health outcomes for mothers and infants.

Furthermore, the research addresses critical issues of healthcare equity and access. In many parts of Nigeria, there are significant disparities in access to quality healthcare based on socio-economic status. By examining how these disparities influence the acceptance of C-sections, the study can highlight the need for more equitable healthcare services. This might involve increasing access to antenatal care for underserved populations, ensuring that all expectant mothers receive comprehensive education about delivery options, and addressing financial barriers to accessing C-section services when needed. Such measures are essential for ensuring that all women, regardless of their socio-economic background, can make informed decisions about their childbirth options.

Additionally, this study contributes to the broader field of maternal health research by providing context-specific data from a Nigerian tertiary hospital setting. Maternal health issues can vary significantly between different regions and healthcare systems. Thus, localized research is essential for developing effective, culturally relevant health interventions. The findings from this study can inform similar research in other parts of Nigeria and Sub-Saharan Africa, promoting a more nuanced understanding of C-section perceptions and practices across diverse settings.

Lastly, the study has the potential to empower women by enhancing their knowledge and agency in making childbirth decisions. Empowered women who understand the risks and benefits of different delivery methods are more likely to advocate for themselves and seek the care that aligns with their preferences and needs. This empowerment is a critical component of improving maternal health outcomes and ensuring that women have positive childbirth experiences.

1.7 Scope of the Study

This study focuses on expectant mothers attending the Antenatal Clinic of RSUTH, Port Harcourt, to explore their perception and acceptance of C-sections. The research will consider socio-economic factors such as education, income, and access to healthcare services.

1.8 Operational Definition of Terms

Caesarean Section (C/S): A surgical procedure to deliver a baby through incisions in the mother's abdomen and uterus.

Perception: The way in which individuals interpret and make sense of information regarding C-sections.

Acceptance: Willingness and readiness of expectant mothers to undergo a C-section if recommended by healthcare professionals.

Socio-economic factors: Variables related to an individual's social and economic status, including education, income, and employment.

Expectant Mothers: Pregnant women who are awaiting the birth of their child.

Antenatal Clinic: A healthcare facility where pregnant women receive medical care and advice before childbirth.

Rivers State University Teaching Hospital (RSUTH): A tertiary healthcare institution located in Port Harcourt, Nigeria, providing specialized medical services.

Port Harcourt: The capital city of Rivers State, Nigeria, serving as a major economic and cultural hub in the region.