CHAPTER ONE

INTRODUCTION

1.1       BACKGROUND OF STUDY

In most poor nations, including Nigeria, the primary cause of death among pregnant women is maternal mortality (Eni-Olorunda and Otito, 1 ). According to Mboho and Moller (2013), an estimated one-third of all maternal fatalities worldwide occur in just two countries: India and Nigeria. According to UNFPA (3], India was responsible for around 20% of worldwide maternal fatalities (56,000) in 2010, while Nigeria was responsible for 14%. (40,000). In contrast, the great majority of sub-Saharan African women endure disease, deformity, and death during pregnancy and birth (Hogan, [4]; and Gynaecol, [5]). Similarly, the majority of African women are often seen to be at a significant risk of illness, injury, and death during pregnancy and the preceding months [6]. In recent years, women in Nigeria have raised concern over childbirth options, particularly vaginal birth difficulties. Normal labor and delivery is every woman's greatest wish. Several decades ago, vaginal birth was the most accessible and desired choice for most women. Some of the women gave birth at home with the assistance of traditional birth attendants, but the labor was often complicated by blockage, and the women died prior to the use of effective interventions. Today, however, many infants are safely delivered through caesarean section. This success tale has its detractors. In developing women, caesarean section is still seen as a "curse" of an unfaithful woman [7]. In section, the authors suggest that caesarean sections are more prevalent in weak women. Moreover, caesarean section is accompanied with distrust, aversion, misunderstanding, anxiety, shame, suffering, and wrath among the women of South Western Nigeria [7]. Even when there are obvious medical grounds, caesarean section is only grudgingly recognized in the majority of sub-Saharan African nations, such as Nigeria [7]. Despite the fact that the causes of maternal mortality are often obstetric in nature, underlying cultural factors and attitudes limit access to and use of health services, hence contributing to preventable maternal deaths [1]. Multiple studies have shown that local beliefs and practices have an effect on overall health and fertility. Some of these ideas have been recognized as leading to delays in obtaining expert assistance when difficulties emerge during labour [8]. It is important to emphasize that the problem of vaginal birth is not exclusive to poor nations alone, but also exists in certain industrialized nations. Despite post-dates for elective caesarean section, women continue to prefer vaginal birth after a caesarean section [9]. The author also emphasized that women badly want to go into labour before their scheduled appointments since not delivering birth vaginally was considered a sign of "failure." Furthermore, many women see vaginal birth as a rite of passage [9]. Obstetrics is a controversial topic in contemporary America [10]. Typically, childbirth and the acts surrounding it, whether medical or otherwise, elicit strong emotions, with discussions often framed in terms of nature against technology. Consequently, caesarean section is a particularly contentious matter [10]. Nevertheless, caesarean section rates are on the rise in a number of western nations, including the United States and the United Kingdom [11]. In 1985, in response to the growing gap in the frequency of caesarean deliveries across countries, the World Health Organization (WHO) set out to define a 15 percent caesarean birth rate as appropriate. The 15 percent suggested by the WHO would best reduce childbirth-related injuries and fatalities. Moreover, many women and children would forgo surgical procedures that are unneeded and possibly hazardous [12]. In 2009, the WHO amended this specific suggestion, noting that "the optimal rate is uncertain, although both very low and extremely high rates of caesarean sections may be harmful." In other words, the surgery should only be performed when absolutely required. Academic Research International's editorial board came to the conclusion that a balance must be struck; that is, women should be let to have vaginal births with little assistance. Nevertheless, the families' obstetricians will be prepared for any unanticipated emergency.

1.2       STATEMENT OF PROBLEM

A Caesarean section (CS) is the delivery of a fetus, placenta, and membranes via an abdominal and uterine incision following viability (which is 28 weeks of gestation in developing countries). The caesarean section is still the most frequent surgical procedure done on women across the globe, and its prevalence is rising. CS may be prescribed for maternal, fetal, or both indications. The incidence of CS has increased during the previous two decades. Due to the procedure's safety, several CSs have been performed for different medical and non-medical justifications. In Nigeria, the national rate of CS is 1.8%. In many regions of the nation, the rates for tertiary health institutions are substantially greater. Lower rates were recorded from northern Nigeria, including 10.1% in Kano, 10.6% in Sokoto, 11.8% in Maiduguri, and 20.3% in Birnin-Kebbi, while higher rates were reported from southern Nigeria, including 25% in Sagamu, 27.6% in Enugu, and 34.5 % in Abraka. Mortality and morbidity due to pregnancy and childbirth have been shown to be high in poor countries, particularly in sub-Saharan Africa.

Traditionally, Nigerian women are hesitant to undergo CS because to the prevailing notion that abdominal delivery is a sign of reproductive failure, despite the possibility of vaginal birth following CS and the declining mortality rate associated with CS. Therefore, the typical pregnant woman, regardless of her level of education or parity, is CS. The majority of available information on women's understanding of caesarean section come from tertiary health institutions in cities and the south of the nation, whereas little is known about women's view and acceptance of caesarean section in the Iyamho community of Edo state.

A prompt caesarean section may prevent many significant complications, including prolonged obstructed labour, uterine rupture, and obstetric fistulae. The role of caesarean section in emergency obstetric care and the avoidance of fetal and maternal morbidity and mortality is self-evident. This necessitates a periodic evaluation of the operation, particularly with regard to identifying the variables working against the adoption of this life-saving therapy. This research was done to evaluate the acceptability and perception of caesarean section among female personnel at the teaching hospital of the University of Calabar.

1.3       RESEARCH OBJECTIVES

The main objective of this study is to assess the acceptance and perception of caesarean section among female staff in university of Calabar teaching hospital. The specific objectives are as follows;

1.      To determine the perception of female staff towards caesarean section in university of Calabar teaching hospital.

2.      To ascertain the knowledge of caesarean section among female staff in university of Calabar teaching hospital.

3.      To explore the acceptance of caesarean section among female staff in university of Calabar teaching hospital.

1.4       RESEARCH QUESTION

1.      What is the perception of female staff towards caesarean section in university of Calabar teaching hospital?

2.      What is the knowledge of caesarean section among female staff in university of Calabar teaching hospital?

3.      What is the level of acceptance of caesarean section among female staff in university of Calabar teaching hospital?

1.5       SIGNIFICANCE OF STUDY

The findings from this study would be used in planning strategies towards improving the knowledge, perception and attitude 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 foetal complications.

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