Caesarean Delivery on Maternal Request: Knowledge and Perception of Pregnant Women from Southern Nigeria

Abstract

Background: Caesarean section (CS) rates are rising globally. There are numerous reasons for this increasing CS rate, one of which is the increased requests by women for caesarean section in the absence of medical or obstetric indications. Women in developed countries now believe that elective caesarean section is safer than vaginal delivery. Aim and Objectives: To determine the knowledge and perception of pregnant women towards caesarean delivery, as well as to ascertain the reasons for caesarean delivery on maternal request (CDMR). Methodology: This was a descriptive, cross-sectional study carried out among 400 pregnant women who attended the antenatal clinics of the University of Port Harcourt Teaching Hospital (UPTH), Rivers State University Teaching Hospital (RSUTH), and Primary Health Centre, Rumukrushi from January 1, 2022, to March 31, 2022. Pre-tested semi-structured questionnaires were used to obtain socio-demographic and obstetric variables, knowledge, and perception of CDMR, and the willingness to request CS without the obstetrician’s recommendation. Data was analyzed with SPSS version 25. Results are presented in frequency tables and figures. Results: The response rate was 95.3%. Majority 232 (58%) of the women were aged 20-35 years and most 183 (45.8%) have had one previous delivery. A large proportion 343 (85.8%) of the women had tertiary education. The knowledge for CDMR was 26%. About 35% of the respondents have had a caesarean delivery in the past. Most 315 (78.8%) of them believed that caesarean delivery is not safer than vaginal delivery, with severe post-operative pain accounting for 75.8% of their reasons. Cephalopelvic disproportion was the commonest 72 (51.4%) indication for caesarean delivery amongst the respondents, 0.8% claimed they were not informed of the indication for their caesarean delivery, while 121 (43.8%) have had both methods of delivery in the past. Only 41(10.3%) would request a caesarean delivery in the index pregnancy, 299 (74%) declined approval for caesarean section on maternal request, with socio-cultural beliefs and fear of damage to the pelvic floor as their main reasons. Conclusion: The knowledge and acceptability of CDMR is rather low. Women's reproductive indices, including maternal and perinatal morbidity and mortality, have been shown to be influenced by socio-cultural beliefs. As a result, advocacy and policies aimed at empowering women and addressing male partner involvement in decision-making should be put in place.