Asian Research Journal of Gynaecology and Obstetrics

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

Solomon Nyeche

Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.

Justina Omoikhefe Alegbeleye *

Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.

Dagogo Semenitari Abam

Department of Obstetrics and Gynaecology, University of Port Harcourt Teaching Hospital, Rivers State, Nigeria.

*Author to whom correspondence should be addressed.

---

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.

Keywords: Caesarean delivery, maternal request, knowledge, perception

---

---

---

References

Cronje HS, Cilliers JBF, du Toit MA, Pretorius MS. (editors) “Clinical Obstetrics. A South African Perspective” 3rd ed. South Africa: Van Schaik. 2012; 3:345.

Ye J, Betrán AP, Guerrero Vela M, Souza JP, Zhang J. Searching for the optimal rate of medically necessary cesarean delivery. Birth 2014;41(3):237-244.

Betrán AP, Ye J, Moller A-B, Zhang J, Gülmezoglu AM, Torloni MR. The increasing trend in caesarean section rates: global, regional, and national estimates: 1990-2014. Plos One. 2016; 11(2):e0148343.

Bhutta ZA, Chopra M, Axelson H, Berman P, Boerma T, Bryce J, et al. Countdown to 2015-decade report (2000–10): Taking stock of maternal, newborn, and child survival. The Lancet 2010;375(9730):2032-2044.

Anderson, T. Caesarean section for non-medical reasons at term. Pract Midwife 2006; DOI: 10.1002/14651858.CD004660.pub2

The Royal Australian and New Zealand College of Obstetricians and Gynaecologists: Caesarean Delivery on Maternal Request (CDMR). New College Statement: C-Obs 39. 2017;1-11.

Christilaw JE. Cesarean section by choice: constructing a reproductive rights framework for the debate. Int J Gynaecol Obstet. 2006;94(3):262-268.

Dweik D, Sluijs AM. What is underneath the cesarean request? Acta Obstet Gynecol Scand. 2015;94:1153-1155.

Camara R, Burla M, Ferrari J, Lima L, Junior JA, Braga A, et al. Cesarean section by maternal request. Rev Col Bras Cir. 2016;43(4):301-310.

Agency for Healthcare Research and Quality. Cesarean Delivery on Maternal Request; 2006.

Robson SJ, Tan WS, Adeyemi A, Dear KB. Estimating the rate of cesarean section by maternal request: Anonymous survey of obstetricians in Australia. Birth. 2009;36(3):208-212.

Soltanifar S, Russell R. The National Institute for Health and Clinical Excellence (NICE) guidelines for caesarean section, 2011 update: implications for the anaesthetist. Int J Obstet Anesth. 2012; 21(3):264-272.

Cesarean Delivery on Maternal Request. ACOG Committee Opinion No. 761. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2019;133: e73-e77.

Paterson-Brown S, Fisk NM. Caesarean section: Every woman's right to choose? Curr Opin Obstet Gynecol. 1997;9(6):351-355.

Ozumba BC, Anya SE. Maternal deaths associated with caesarean section in Enugu, Nigeria. Int. J Gynaecol Obstet. 2002; 76:307-309.

Ezeome IV, Ezugworie JO, Udealor PC. Beliefs, perceptions, and views of pregnant women about cesarean section and reproductive decision-making in a specialist health facility in Enugu, Southeast Nigeria. Niger J Clin Pract. 2018; 21:423-428.

Sunday Adeoye I, Kalu CA. Pregnant Nigerian women’s view of cesarean section. Niger J Clin Pract. 2011; 14:276 279.

Aziken M, Omo Aghoja L, Okonofua F. Perceptions, and attitudes of pregnant women towards caesarean section in urban Nigeria. Acta Obstet Gynecol Scand 2007; 86:42 47.

Adageba RA, Danso KA, Adasu Donkor A, Ankobea Kokroe F. Awareness, and perception of and attitudes towards caesarean delivery among antenatal. Ghana Med J. 2008; 42:137 140.

Deyo NS. Cultural Traditions and Reproductive Health of Somali Refugees and Immigrants. Master’s Thesis, University of San Francisco; 2012.

Acharya DR, Bell JS, Simkhada P, Van Teijingen ER, Regni PR. Women’s autonomy in house hold decision making: A demographic study of Nepal. Reprod Health. 2010;7:15.

Robson S, Carey A, Mishra R, Dear K. Elective caesarean delivery at maternal request: A preliminary study of motivations influencing women’s decision-making. Aust N Z J Obstet Gynaecol. 2008;48(4):415-420.

Okonkwo NS, Ojengbede OA, Morshan-Bello IO, Adedokun BO. Maternal demand for caesarean section: perception and willingness to request by Nigerian antenatal clients. Int J Women’s Health. 2012; 4:141-148.

Chigbu CO, Ezenyeaku CC. Women’s opinions and experiences with induction of labour and caesarean delivery on request in Southeastern Nigeria. Int J Gynaecol Obstet. 2008;103(2):158-161.

Akintayo AA, Ade-Ojo IP, Olagbuji BN, Akin-Akintayo OO, Ogundare OR, Olofinbiyi BA. Cesarean section on maternal request: The viewpoint of expectant women. Arch Gynecol Obstet. 2014; 289:781-785.

Mancuso A, De Vivo A, Fanara G, Settineri S, Triolo O, Giacobbe A. Women’s preference on mode of delivery in southern Italy. Acta Obstet Gynecol Scand. 2006;85(6):694-699.

Awoyinka BS, Ayinde OA, Omigbodun AO. Acceptability of caesarean delivery to antenatal patients in a tertiary health facility in South-West Nigeria. J Obstet Gynaecol. 2006; 26:208-210.

Bukar M, Ibrahim SM, Kawuwa MB, Dabu BA, Moruppa JY, Ehailaye B, Bakari MA. Caesarean section on maternal request in north-eastern Nigeria: Women’s knowledge, perception, and attitude. Int J Med Biomed Res. 2014;3(1):11-16.

Olayemi O, Morhason-Bello IO, Adedokun BO, Ojengbede OA. The role of ethnicity on pain perception in labor among parturients at the University College Hospital Ibadan. J Obstet Gynecol Res. 2009;35(2):277-281.

Omotayo RS, Logo A, Bade-Adefioye A, Adewale O, Sanni EA. Maternally requested caesarean delivery: Popularity amongst pregnant women at a Southwest Nigerian teaching hospital. Int J Sci Res Arch. 2021;3(1):19 - 30.