Perception and Attitude of Women Attending Antenatal Clinic at Central Hospital Towards Cesarean Section
CHAPTER ONE
Objective of the Study
The purpose of the study was to find out the attitude of mothers attending antenatal clinics at the Central hospital in Edo State towards C- delivery. Specifically, the study aimed to find out the attitude of the women:
- towards accepting C- delivery;
- towards those who undergo C- delivery;
- towards the medical staff who execute C- delivery;
- to C- delivery according to age;
- to C- delivery according to parity;
- to C- delivery based on educational attainment; and
- to C- delivery on the basis of previous mode of delivery
CHAPTER TWO
REVIEW OF RELATED LITERATURE
Literatures abound on the attitude of women to C-delivery in both developed and developing countries including Nigeria. The literatures for this study were therefore gathered from both local and foreign sources. It was organized and presented under the following sub headings.
- Conceptual Framework;
- Concept of Attitude, Cesarean Delivery, Mothers, Antenatal Clinic and Central hospital.
- Demographic Factors Associated with Attitude of Women Towards Cesarean Delivery such as, age, previous mode of delivery, parity and literacy level;
- Theoretical Framework;
- Theory of Cognitive Dissonance (TCD);
- Theory of Reasoned Action (TRA);
- Empirical Studies on Attitude of Women Towards Cesarean delivery;
- Summary of Reviewed
CONCEPTUAL FRAMEWORK
Concepts of attitude, Cesarean delivery, antenatal clinic, mother and general hospital
Attitude has been comprehended differently by different researchers and has been defined conceptually and operationally. Eagly and Chaiken, (1995) identified two most distinct ways to define attitude, this include: attitude as a set of readiness and attitude as effect and evaluation. He described attitude as set of readiness as a mental and neural state of readiness, organised through experience, exerting a directive dynamic influence upon a response to all objects and the situation with which it is related. They also described attitude as effects and evaluation as a tendency or predisposition to evaluate an object or symbol of that object in a certain way. Attitude as effect and evaluation, consist of the following attributes; goodness and badness or desirable and undesirable quality to an object. Fazio (1986) affirmed that it was conceived that all the definition of attitude had the component of readiness or disposition to act. He therefore described attitude as mental and neural states of readiness organized through experience exerting a directive dynamic influence upon a response to all objects and situations with which it is related. Miller (2005) emphasized the tripartite (three component) classification of attitude. They defined attitude as the tendencies to evaluate an entity with some degree of favor or disfavor ordinarily expressed in cognitive, affective, and behavioral responses and formed on the bases of cognitive, affective and behavioural processes.
Eagly and Chaiken (1995) posited that attitude occupy the central position in the process of transforming work requirement into efforts and thus have a profound influence on one’s behavior. They maintained that attitude affects behavior by serving the four functions of an individual as listed below: instrumental function, ego defensive function, value orientation function and knowledge function. They explained that in instrumental function attitude serve as a means to reach a desired goal or to avoid an undesired one. Instrumental attitudes are aroused by the activation of need or cues that are associated with the attitude objects and arouse favorable or unfavorable feelings. For example, most traditional people in India do not think the soft-drinks as very good for health. Their propensity to cause acidity reinforces the attitude. He stated that the ego defensive function of attitude acknowledges the importance of psychological thought. Attitudes may be required and maintained to protect the person from facing threats in external world or from becoming aware of his own unacceptable impulses. In other words attitude help people to retain their dignity and self-image. The value orientation function takes into account the attitudes, which are held because they express a person’s values or enhance his self-identity. These attitudes arise by conditions that threaten the self-identity. For example, most Indians are not very comfortable to purchase contraceptives openly. By their advertisements, the marketers are trying to project the consumers that there is nothing bad if they purchase them and get the advantages of safety and birth control. The knowledge function of attitude is based on a person’s need to maintain a stable, organised and meaningful structure of the world. Attitudes that provide a standard against which a person evaluates aspects of his world serve as the knowledge function also. As explained above, these functions of the attitude influence an individual’s interpretation of the information.
Park (2009) perceived attitude as more or less permanent ways of behaving acquired by social interactions. He also noted that our success or failure in life depends upon our attitudes. According to (Sender Adersh & Pankaj, 2009), each society and indeed individuals has cultural values, ideologies, and interests relating to health and health services which determines their attitudes towards health services. Sender Adersh and Pankaj, (2009), noted that there are some beliefs values and ideologies that are inimical to survival and therefore indicates need for health promoting changes in cultural pattern depending on the tolerability of the changes. When attitude is linked to cesarean delivery, it is called attitude to cesarean delivery. Attitude to cesarean delivery in the context of the present study refers to the way the pregnant mothers think or feel about C-delivery which is expressed through their acceptance or non-acceptance of the procedure (C-delivery) which may in turn lead to their death or survival. While the study conducted by Sunday-Adeoye and Kalu (2011) aims at the determination of the perceptions of women in the southeastern Nigeria on C-delivery and their views about other women who have had C-delivery in the past this study aims at finding out the attitude of pregnant mothers in Edo state Central hospital towards accepting C-delivery, mothers that undergo C-delivery and health workers that execute C-delivery. The attitude of the women towards C-delivery according to previous mode of delivery, age, literacy level and parity will also be explored.
Since the dawn of time, labour and birth through the vaginal passage have been an inevitable consequence of pregnancy, a journey through to life, there was no alternative to vaginal birth, except death (Pieter and Dongen, 2009). They further stated that in this new millennium, women do have an alternative, one that has been provided by the wonders of modern technology – women today have choice, something, that women in ages past did not have. That is the C-delivery.
CHAPTER THREE
METHODS
This chapter is concerned with the research design, area of the study, population for the study, the sample and sampling technique, the instrument for data collection, validity and reliability of the instrument, method of data collection and data analysis.
Research Design
The cross-sectional survey research design was used for the study. According to Levin (2006), cross sectional survey design when simply put, provides a snapshot of a situation in a population, and the characteristics associated with it at a specific point in time. This study also involved the collection, analysis and interpretation of data which Osuala (1987) described that is better done by cross-sectional survey research design. This design was successfully used by Jeremiah, Enyidah and Fiebai (2011) to assess the attitude of antenatal patients at a tertiary health institution in Southern Nigeria towards cesarean section. The design was considered appropriate for the study because the information were collected directly from the respondents.
Area of the Study
The location of this study was Edo State.
Population for the Study
The population for the study consisted of all the mothers registered for antenatal clinics at all the Central hospital in Edo State. This was estimated at 3258 mothers (Government of Edo State Hospitals Management Board, 2010). The general hospital was chosen because it is widely spread in the State, as such, accessible to all the pregnant women in the State.
Sample and Sampling Techniques
The sample for the study consisted of 326 mothers representing 10 per cent of the mothers attending antenatal clinics in all the Central hospital in the State. This was in line with Nwana’s (1981) in Ejifugha (1998) rule of thumb which states that when the population of study is few hundreds, the sample study should be 40 per cent. If they are many hundred, 20 per cent of the population should be the sample size. When they are few thousands, 10 per cent of the population will do and if several thousands, 5 per cent of the population will be considered representative. A two stage sampling procedure was employed to draw the sample for the study. In the first stage, the simple random sampling technique of balloting without replacement was used to select ten Central hospital from the twenty Central hospital in the State which is believed to be a representative of the population. The second stage involved the use of systematic random sampling technique to draw 33 respondents from six hospital and 32 respondents from the remaining four hospitals using the mothers that are available on the day of visit. On the completion of these sampling procedures, three hundred and twenty six (326) mothers were selected and utilized for the study.
CHAPTER FOUR
RESULTS AND DISCUSSION
This chapter presents and discusses the findings of the study on attitude of mothers attending antenatal clinics at the Central hospital in Edo State towards cesarean delivery. Three hundred and twenty six copies of the questionnaire were distributed, and three hundred and twenty five were returned representing 99.7 per cent return rate. All the returned copies were filled correctly and therefore used for the study.
Research question one.
What is the attitude of the women towards accepting caesarean delivery?
Data in Table 1 indicated generally, that the women had a cluster mean score of 2.20 which was below the criterion mean ( X = 2.50). This implies that the women had a negative attitude towards accepting cesarean delivery. specifically, the Table further reveals that the women had mean scores above the criterion mean of 2.50 in the individual such items “Cesarean delivery is a necessary option to save the lives of the mother and baby when pregnancy poses a great threat to their lives and should be accepted whenever it is indicated” ( X = 2.67); “Cesarean delivery is unacceptable to me because it is expensive” ( X = 3.15); and “Cesarean delivery should not be accepted by anyone because God’s promise to His children is safe natural/vaginal delivery”( X = 2.60). This implies that the women had positive attitude towards the items. However, the women had mean scores less than the criterion mean of 2.50 in such items as “Cesarean delivery is acceptable to me provided that the decision concerning mode of delivery is taken without considering the views and advice of significant others (parents, husbands, religious leaders, in-laws and friends)” ( X = 1.44) and “Cesarean delivery is acceptable to me because it makes me not to experience the pains of natural child birth” ( X = 1.14), these imply that the women had negative attitude towards the items in question. The standard deviation which ranges from 0.424 to 1.082 shows that there was much variation in the attitude of the women towards accepting C-delivery.
CHAPTER FIVE
Summary, Conclusions and Recommendations
Summary
The study was conducted to find out the attitude of mothers attending antenatal clinics at the Central hospital in Edo State towards C-delivery. In order to accomplish this purpose, seven specific objectives with seven corresponding research questions were formulated to guide the study.
Four null-hypotheses were postulated for verification. Four demographic variables, namely age, parity, educational attainment and previous mode of delivery were investigated. Literature pertinent to the study was reviewed under the following headings, conceptual framework, theoretical framework, empirical studies on attitude of women towards C-delivery and summary of literature review.
A cross-sectional survey research design was utilized for the study. The population for the study was 3256 pregnant mothers. A two-stage sampling procedure was utilized to draw the sample. At each of the two stages employed, an appropriate sampling technique was adopted. This process produced a sample of 326 mothers.
Conclusions
Based on the findings and discussions of the study, the following conclusions were attained.
- The findings affirm previous suspicion that a significant number of mothers have unfavourable attitude towards cesarean
- Age did not influence the mother’s attitude towards cesarean delivery.
- Mother’s parity status had little or no effect on their attitude towards cesarean
- Mother’s level of education did not influence their attitude to cesarean
- Mother’s previous mode of delivery also had little or no effect on their attitude to cesarean
Recommendations
Based on the findings, discussions and conclusions, the following recommendations were made.
- More scientific research should be conducted on the demographic factors that influence the attitude of women towards cesarean
- A challenge to health care personnel would be to provide better information for pregnant women during antenatal period about cesarean deliveries, their indications, advantages and adverse consequences.
- Community health education about the benefits of cesarean delivery when indicated at primary care level is needed for the women’s and community’s understanding of the necessity of cesarean delivery. This will go a long way to reduce the number of women declining cesarean delivery and the morbidities and mortalities associated with such an action and improve the pregnancy
- Health planners need to recognize that the objective of the Safe Motherhood Initiative to reduce maternal mortality cannot be realized if the mothers are ignorant of the necessity of cesarean delivery as a life saving procedure.
Suggestions for further studies
Further studies should be carried out on:
- Attitude towards cesarean delivery among mothers attending antenatal care at the private hospitals in Edo
- Demographic factors associated with the attitude towards cesarean delivery among child bearing mothers in Edo
- Attitude towards cesarean delivery among male adult members in Edo
- Knowledge of and attitude towards cesarean delivery among female adolescents in Edo State
References
- Adeleye, J. A (1977). Primary elective Caesarean section in Ibadan, Nigeria, Acta Tropica, 28:45-48.
- Agumuo, Z, (2010). Perception of Cesarean section, comments and views from Nigeria; a systematic review. Birth.;37(3):219-226.
- Ajzen, I. & Fishbein, M. (1980). Understanding attitudes and predicting social behavior. Englewood Cliffs, NJ: Prentice-Hall.
- Allport, G.W. (1985). Introduction to social psychology. New York: McGraw Hill.
- Awoyinka, B. S; Ayinde .O. A & Omigbodun, A. O. (2006). Acceptability of caesarean delivery to antenatal patients in a tertiary health facility in South-West Nigeria. Obstetric Gynecology. 26:208-10.
- Aziken, M.; Omo-Aghoja L. & Okonofua, F. (2007). Perceptions and attitudes of pregnant women towards caesarean section in urban Nigeria. Acta Obstetricia et Gynecologica Scandinavica, 86:42-47.
