Perception and Attitude of First-Time Mothers Towards Caesarean Section in Secondary Health Care Facility (A Mixed-Method Study).

Abstract

Background: Despite the global rise in caesarean section (CS), Nigeria has a CS rate of 2.8%, which is far below the World Health Organisation recommendation of 10%-15%. Primigravida and/or first-time mothers constitute a cohort of women who are prone to obstetric emergencies such as cephalo-pelvic disproportion and obstructed labour.

Objectives: To evaluate the first-time mothers' knowledge, perceptions, and attitudes towards CS.

Materials and methods: This was a mixed-methods study conducted among first-time mothers (primigravids >28weeks and first-time CS-delivered) at Adeoyo Maternity Teaching Hospital, Ibadan, using questionnaires that assessed knowledge and attitude for the quantitative aspect and in-depth interviews for the qualitative aspect using a structured topic guide. Responses from the quantitative aspect were analysed using STATA 15, and each participant's level of knowledge was scored and categorised as: Good knowledge >70%, fair knowledge 50%-70% and poor knowledge <50%. Content analysis was done for the qualitative aspect, and emerging themes on perception and interpretation in CS were summarised and presented as results for interpretation.

Results: About 275 mothers (178 pregnant and 97 CS-delivered) were sampled. Only a few (13.45%) of the participants had good knowledge with an equivocal attitude towards CS. The majority (84%) believed that CS helped in saving lives. Also, there was a statistically significant difference between their knowledge and their educational level, occupation, religion, ethnicity, and family income (P < 0.05). The multinomial regression showed that gainfully employed Christian women significantly had more fair and good knowledge than Muslims (RR = 2.01, 95% CI = 1.13-3.57, P = 0.017) (RR = 2.71, 95% CI = 1.23-5.95, P = 0.013).

Conclusion: Only a small number of the participants had good knowledge, and their perceptions about CS varied. The attitudes of participants towards CS appeared mixed, as nearly equal proportions of participants had positive and negative attitudes. Hence, there is a need to increase advocacy, antenatal education, and counselling during antenatal clinic visits. Also, first-time mothers need to be put on insurance to reduce the burden of costs.