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PERCEPTION AND ACCEPTANCE OF CESAREAN SECTION AMONG PREGNANT WOMEN  A CASE STUDY OF IGBINEDION UNIVERSITY TEACHING HOSPITAL OKADA EDO STATE

Abstract

This study investigated the perception and acceptance of cesarean sections among pregnant women at Igbinedion University Teaching Hospital, Okada, Edo State. The research aimed to assess the level of knowledge pregnant women had about cesarean sections, explore the factors influencing their perception of the procedure, and examine how demographic characteristics such as age, education, and socioeconomic status impacted their acceptance of cesarean sections. A quantitative survey research design was adopted, with a structured questionnaire used to collect data from a sample of 133 respondents. Various statistical methods, including frequency tables, percentages, mean, standard deviation, and t-tests, were applied to analyze the data and test the hypotheses. The findings indicated that most respondents were aware of cesarean sections and understood their risks and benefits, although cultural beliefs and social influences significantly shaped their perceptions and acceptance of the procedure. Demographic factors, particularly age and educational level, were found to influence women’s willingness to accept cesarean sections. The t-test results confirmed that the hypotheses regarding the relationship between knowledge, perception, and acceptance of cesarean sections were statistically significant. The study concluded that while awareness of cesarean sections was relatively high, cultural beliefs and social norms played a central role in shaping attitudes toward the procedure. Based on the findings, the study recommended implementing educational interventions, improving communication between healthcare providers and patients, and developing strategies that address cultural barriers to improve the acceptance of cesarean sections in semi-urban settings. Further research in diverse geographical areas is suggested to provide a more comprehensive understanding of the issue.

 

CHAPTER ONE

INTRODUCTION

Cesarean section (C-section) is a surgical procedure used to deliver a baby through incisions made in the mother’s abdomen and uterus. Historically, it was primarily performed as an emergency measure to save the lives of both the mother and child in cases of complications during childbirth. Advances in surgical techniques and anesthesiology have made C-sections safer and more accessible, contributing to their growing prevalence worldwide. For instance, countries like Brazil have reported skyrocketing cesarean section rates, where societal and cultural norms increasingly favour the procedure (Finger, 2023).

In recent decades, the prevalence of cesarean deliveries has risen globally, driven by advancements in medical technology, increased access to healthcare services, and evolving societal perceptions of childbirth. The World Health Organization (WHO) has long debated the optimal rate for cesarean deliveries, noting that medically unnecessary procedures can strain healthcare resources and increase risks for mothers and babies (Ye et al., 2022). Despite these concerns, the increasing rates reflect both the role of elective surgeries and a higher awareness of maternal and neonatal health issues.

Nigeria mirrors global trends, with cesarean section rates rising steadily across urban and rural areas. In urban Nigeria, attitudes toward C-sections are influenced by socioeconomic status, education, and exposure to modern healthcare services. A study on pregnant women’s perceptions found that cultural and societal factors still significantly impact decision-making, often leading to delays in accepting medically indicated procedures (Aziken et al., 2023). These delays can contribute to higher maternal and neonatal morbidity and mortality rates.

Cultural stigma associated with cesarean sections remains a persistent issue in Nigeria. Many communities perceive C-sections as a deviation from natural childbirth, often associating it with failure or weakness on the part of the mother. Studies have highlighted that the belief systems in some Nigerian communities link a woman’s ability to deliver vaginally with her social worth, leading to widespread resistance to cesarean deliveries (Ezechi et al., 2024). Such misconceptions pose significant challenges to healthcare providers attempting to prioritize the safety of mothers and babies.

Religious beliefs also play a role in shaping attitudes toward cesarean sections. In some cases, pregnant women believe that undergoing a C-section implies a lack of faith in divine intervention for safe childbirth. This has been documented in rural and urban areas alike, where health professionals must navigate religious sensitivities while advocating for necessary medical interventions (Chigbu & Iloabachie, 2007). These beliefs underscore the need for culturally sensitive communication strategies to address the root causes of resistance.

Educational attainment has emerged as a critical factor influencing the acceptance of cesarean sections. Women with higher levels of education are more likely to understand the medical indications and potential benefits of the procedure, which positively impacts their decision-making. For example, a study in Canada found that education significantly influenced women’s choices regarding elective repeat cesarean sections (Gilbert et al., 2020). While such findings highlight the value of education, they also reveal disparities in healthcare access and awareness that need to be addressed.

At Igbinedion University Teaching Hospital (IUTH) in Okada, Edo State, the situation reflects broader societal trends. Healthcare providers frequently encounter patients who are sceptical of cesarean deliveries, often citing fears of surgical risks and long recovery times. These fears are compounded by anecdotal reports of negative outcomes, which circulate widely and discourage women from considering the procedure. Such resistance has implications for timely obstetric care, as delayed decisions can escalate complications during labour (Bhartia et al., 2020).

Socioeconomic factors also contribute to the perceptions of cesarean sections in Nigeria. Wealthier women who can afford private healthcare are more likely to opt for or accept the procedure than their less affluent counterparts. This disparity reflects broader inequities in access to healthcare resources, where lower-income women often lack the financial means or knowledge to make informed decisions (Naa Gandau et al., 2019). Bridging this gap requires targeted efforts to ensure equitable access to antenatal education and counselling services.

In addition to these factors, the role of previous childbirth experiences cannot be underestimated. Women who have undergone traumatic vaginal deliveries or emergency cesarean sections often approach subsequent pregnancies with a heightened sense of caution. For example, studies have shown that women’s attitudes toward repeat cesarean sections are significantly shaped by their prior experiences, influencing their willingness to accept the procedure (Maduka & Enaruna, 2021). Understanding these experiences can help healthcare providers offer personalized support to expectant mothers.

The increasing prevalence of cesarean deliveries worldwide has also sparked discussions about healthcare systems and their role in promoting or discouraging the procedure. Some studies suggest that cesarean section rates are influenced by hospital policies and provider preferences rather than strictly by medical necessity. For instance, research in India demonstrated how quality improvement initiatives reduced unnecessary cesarean sections by emphasizing evidence-based practices and patient-centered care (Bhartia et al., 2020). Similar interventions could benefit Nigerian healthcare institutions like IUTH.

Efforts to reduce maternal and neonatal mortality have highlighted the importance of timely decision-making in obstetric care. However, resistance to cesarean sections remains a significant barrier, particularly in settings where cultural beliefs and misinformation prevail. A study in Ghana emphasized the need for public health campaigns to educate women on the safety and benefits of cesarean deliveries, noting that such interventions could reduce perinatal and neonatal mortality rates (Naa Gandau et al., 2019). Applying similar strategies in Edo State could improve outcomes at IUTH.

Understanding the perception and acceptance of cesarean sections is crucial for improving maternal health outcomes in Nigeria. Healthcare providers must navigate a complex landscape of cultural, religious, and economic factors that influence women’s decisions. For instance, a study in Lagos revealed that misconceptions about cesarean sections often lead to delays in care, emphasizing the need for better patient education and trust-building initiatives (Ezechi et al., 2022). Addressing these challenges requires a multi-faceted approach that prioritizes both clinical expertise and cultural competence.

As cesarean section rates continue to rise globally, balancing the benefits of the procedure with its potential risks is essential. Healthcare systems must ensure that cesarean deliveries are performed only when medically indicated while addressing the underlying factors contributing to unnecessary procedures. In Thailand, qualitative research highlighted how women’s preferences for cesarean births were shaped by societal and personal factors, demonstrating the importance of patient-centered care (Suwanrath et al., 2021). Such findings are relevant for understanding the dynamics at IUTH and similar settings.

At Igbinedion University Teaching Hospital, healthcare providers face the dual challenge of providing evidence-based care while addressing the fears and misconceptions of their patients. Addressing these challenges requires a collaborative effort between healthcare professionals, policymakers, and community leaders to promote accurate information and build trust in medical interventions. Studies from Enugu, Southeast Nigeria, have shown that involving families and community influencers in health education campaigns can significantly improve the acceptance of cesarean sections (Ezeome et al., 2018).

1.2 Statement of the Problem

Cesarean section (C-section) is a critical surgical intervention that can prevent maternal and neonatal mortality in cases of childbirth complications. However, its acceptance among pregnant women remains a significant challenge in many parts of Nigeria, including Edo State. Existing studies, such as those conducted in Lagos and Southeast Nigeria, have highlighted the cultural and societal barriers to C-section acceptance, yet these studies often generalize findings without exploring the unique sociocultural dynamics of specific communities like Okada (Ezechi et al., 2022; Ezeome et al., 2018). This creates a gap in understanding how localized beliefs and practices shape attitudes toward C-sections in this region.

While education is recognized as a key factor in improving the acceptance of C-sections, there is limited research into the availability and effectiveness of antenatal education programs in tertiary hospitals like the Igbinedion University Teaching Hospital (IUTH). Many women, especially those from lower socioeconomic backgrounds, lack access to culturally sensitive information on the safety and benefits of C-sections, perpetuating misconceptions and fears (Gilbert et al., 2020). This highlights a need for targeted studies on the quality and impact of antenatal education within such healthcare settings.

Healthcare provider-patient communication is another area with insufficient research focus. Studies have shown that the trust and rapport between healthcare providers and patients significantly influence women’s willingness to accept a C-section when recommended (Suwanrath et al., 2021). However, little attention has been given to how healthcare providers at facilities like IUTH can improve communication to address pregnant women’s fears, clarify misconceptions, and build confidence in the procedure. This gap leaves many women without adequate support to make informed decisions about their childbirth options.

In addition to informational gaps, the psychosocial factors influencing C-section acceptance remain underexplored. Research indicates that fear of societal judgment and personal feelings of shame often deter women from considering C-sections, even when medically necessary (Chigbu & Iloabachie, 2007). However, these emotional and psychological barriers are often overlooked in studies focusing primarily on medical or logistical aspects. Addressing these gaps requires a more comprehensive approach that integrates psychosocial support into maternal healthcare practices.

This study aims to fill these gaps by investigating the perceptions, educational challenges, communication dynamics, and psychosocial factors affecting the acceptance of C-sections among pregnant women at IUTH. By addressing these critical areas, the research seeks to inform tailored interventions that improve maternal and neonatal outcomes in the region (Aziken et al., 2023).

1.3 Objectives of the Study

The primary aim of this study is to investigate the perception and acceptance of cesarean sections among pregnant women at Igbinedion University Teaching Hospital, Okada, Edo State. The specific objectives are:

1. To assess the level of knowledge pregnant women have about cesarean sections.
2. To examine the factors influencing pregnant women’s perception of cesarean sections.
3. To determine the relationship between pregnant women’s acceptance of cesarean sections and their demographic characteristics, such as age, educational level, and socioeconomic status.

1.4 Research Questions

1. What is the level of knowledge pregnant women at Igbinedion University Teaching Hospital have about cesarean sections?
2. What factors influence the perception of cesarean sections among pregnant women at the hospital?
3. How do demographic characteristics such as age, education, and socioeconomic status affect pregnant women’s acceptance of cesarean sections?

1.5 Research Hypotheses

1. There is no significant relationship between pregnant women’s knowledge about cesarean sections and their acceptance of the procedure.
2. Sociocultural factors do not significantly influence pregnant women’s perception of cesarean sections.
3. Demographic characteristics such as age, education, and socioeconomic status have no significant effect on the acceptance of cesarean sections among pregnant women.

1.6 Significance of the Study

The study offers critical insights into how pregnant women perceive and respond to the option of cesarean sections. Understanding these perceptions is essential for healthcare providers who face the challenge of addressing cultural, emotional, and informational barriers during antenatal care. By uncovering the specific concerns and attitudes of pregnant women, the findings will help healthcare professionals develop more effective communication strategies that are tailored to their patients’ needs. Improved patient education and rapport-building can foster trust, reduce misconceptions, and promote acceptance of medically necessary cesarean sections, ultimately leading to better maternal and neonatal outcomes.

For policymakers, this study provides evidence-based findings that can guide the formulation and implementation of strategies to improve maternal healthcare. It emphasizes the need for public health interventions that address the barriers to timely acceptance of cesarean sections, including cultural stigma and lack of access to accurate information. Policymakers can use these findings to design targeted educational campaigns, strengthen antenatal care services, and improve healthcare infrastructure. By addressing these systemic issues, policymakers can help reduce maternal and neonatal mortality rates while promoting safer childbirth practices.

This research contributes significantly to the existing body of knowledge on maternal health, particularly in Nigeria. Its focus on a semi-urban context, like Okada in Edo State, highlights the unique sociocultural and systemic factors influencing healthcare decisions in such settings. The study addresses gaps in the literature by exploring under-researched aspects, such as the impact of psychosocial barriers and healthcare provider-patient communication on cesarean section acceptance. The findings will not only enrich academic discourse but also serve as a basis for future studies aimed at improving maternal health outcomes in similar contexts.

1.7 Scope of the Study

This study focuses on pregnant women receiving antenatal care or obstetric services at Igbinedion University Teaching Hospital, Okada, Edo State. It explores their perceptions and acceptance of cesarean sections, considering factors such as knowledge, sociocultural influences, and demographic characteristics. The study is limited to data collected from patients within the hospital, providing a case-specific understanding of the topic.

1.8 Operational Definition of Terms

1. Cesarean Section (C-Section): A surgical procedure used to deliver a baby through incisions made in the abdomen and uterus.
2. Perception: The way cesarean sections are viewed or interpreted by pregnant women, influenced by their knowledge, beliefs, and experiences.
3. Acceptance: The willingness of pregnant women to agree to undergo a cesarean section when recommended by healthcare providers.
4. Pregnant Women: Women carrying a developing fetus within their uterus, specifically those attending antenatal care at Igbinedion University Teaching Hospital.
5. Sociocultural Factors: Social and cultural beliefs, practices, and norms that influence health behaviors and decision-making.
6. Knowledge: The level of awareness and understanding pregnant women have about cesarean sections, including their indications, benefits, and risks.
7. Demographic Characteristics: Attributes of pregnant women such as age, educational level, marital status, and socioeconomic status that may influence their healthcare decisions.
8. Maternal and Neonatal Outcomes: The health status of the mother and newborn following childbirth, influenced by the mode of delivery and timing of medical interventions.