Knowledge and Attitude Regarding Elective Caesarean Section and NormalVaginal Delivery among Pregnant Women Attending OPD in a SelectedHospital at Bangalore with a View to Develop an Information Booklet

Introduction

Pregnancy ends with childbirth which means birth of baby or babies. It can occur through various modes such as vaginal or abdominal delivery. Childbirth is a normal physiological change that occurs in pregnant women. ^1,2 It is the ending of pregnancy where baby or babies exit from the uterus by passing through the vagina or by caesarean section. About 10% of all the deliveries are considered as high risk; some may require caesarean section.³

It is the commonest obstetric operative procedure globally. The incidence of caesarean section is constantly increasing giving women frequently an obstetric status of previous caesarean section.^3,4 Even normal vaginal delivery carries some risks. The strain on the pelvic muscles may lead to urinary or bowel incontinence later in life and the delayed labour can harm babies. All modes of child birth are risky but a knowledgeable decision joined with adequate monitoring during the delivery usually results in a good outcome for the mother and baby.⁵ It is shocking that 98 percent of maternal deaths occur in developing countries due to pregnancy or child birth causes.⁶ Prevention of maternal deaths remains one of the most important goals of the National Family Welfare Programme.⁵ Therefore proper health teaching makes the pregnant women more aware of their choices of child birth.

Statement of the problem

A study to assess the knowledge and attitude regarding elective caesarean section and normal vaginal delivery among pregnant women attending OPD in a selected hospital at Bangalore with a view to develop an information booklet.

Objectives of the study

• To assess the knowledge of pregnant women regarding elective caesarean section and normal vaginal delivery

• To assess the attitude of pregnant women regarding elective caesarean section and normal vaginal delivery

• To find the correlation between knowledge and attitude regarding elective caesarean section and normal vaginal delivery

• To determine the association between the knowledge and attitude regarding elective caesarean section and normal vaginal delivery and selected sample characteristics

• To prepare, validate and provide pregnant women an information booklet on benefits and risks of elective caesarean section and normal vaginal delivery

Hypotheses

H₁ : There is a significant correlation between the knowledge and attitude score of pregnant women on elective caesarean section and normal vaginal delivery.

H₂ : There is a significant association between the knowledge score of pregnant women on elective caesarean section and normal vaginal delivery and selected sample characteristics.

H₃ : There is a significant association between the attitude score of pregnant women on elective caesarean section and normal vaginal delivery and selected sample characteristics.

Materials and Methods

The study used a survey approach and a descriptive design. The study was conducted at St. Philomena’s Hospital, Bangalore which is a 400 bedded hospital, having an average of 100-120 pregnant women coming to outpatient department every day. The sample comprised of 100 pregnant women attending outpatient department of St. Philomena’s Hospital, Bangalore who were selected through convenient sampling.

Inclusion criteria: Pregnant women

• at ≥ 12 weeks of gestation

• who can understand Kannada or English

Exclusion criteria: Pregnant women

• not willing to participate in the study

• not available during data collection

• at high risk with obstetric, medical and surgical complications

Research tool

Tools were developed and pre tested by the researcher, validated by the experts in the field of Obstetrics and Obstetrics & Gynecological nursing. Based on the blue print and expert’s suggestions, the structured knowledge questionnaire and attitude rating scale (5 point) was developed by the researcher. The developed information booklet on benefits and risks of elective caesarean section and normal vaginal delivery was pre-tested by distributing it to 10 pregnant women attending the OPD at St. Philomena’s Hospital, Bangalore. Majority (93%) found it to be easy, clear to understand and accepted that the information provided was meaningful, simple and comprehensive through an Opinionnaire. Hence the information booklet was retained without any change after the pre-test.

Reliability of the tool was found using split half method. The correlation co-efficient was found using raw score method. The reliability score for the knowledge questionnaire was γII= 0.8808> 0.70 and the reliability score for the attitude scale was γII = 0.9682 > 0.70 which showed that the tool was reliable.

Data collection procedure

The formal permission from the concerned authority of St. Philomena’s Hospital, Bangalore and approval from the Institutional ethical review board (IERB) to conduct the study were obtained. The data collection for the main study was done from 5th July 2011 to 14th August 2011 at St. Philomena’s Hospital, Bangalore. The total sample for the main study was 100 pregnant women attending OPD at St. Philomena’s Hospital, Bangalore who were selected by convenient sampling technique. After self-introduction, the purpose of the study was explained and the pregnant woman’s willingness to participate in the study was ascertained. Pregnant women were assured of anonymity and confidentiality of the information provided by them. Written informed consent was obtained. Each day 4 to 5 pregnant women were interviewed. The researcher took 40-45 minutes to complete one structured interview schedule.

Ethical consideration

The study was approved by the Institutional ethical review board committee of St. Philomena’s Hospital, Bangalore. After explaining the purpose of the study and assuring the confidentiality, the written informed consent was obtained from the pregnant women. There were no ethical issues encountered during the study period.

Results

Section I : Description of sample characteristics

Section II: Overall knowledge scores of pregnant women on elective caesarean section and normal vaginal delivery

Figure 1 depicts the knowledge scores of pregnant women. Among 100 pregnant women included, most of them (68%) had adequate knowledge with scores above 75%, while 32% had moderate knowledge with scores ranging between 51-75%.

Section III: Overall attitude scores of pregnant women on elective caesarean section and normal vaginal delivery

Figure 2 depicts the attitude scores of pregnant women. Among the 100 pregnant women included, more than half (51%) had favourable attitude with scores above 75%, while 49% pregnant women had moderately favourable attitude with scores ranging between 51-75%.

Section IV: Correlation between knowledge and attitude of pregnant women regarding elective caesarean section and normal vaginal delivery

Table 2 depicts the statistical relationship between the knowledge and attitude and it was found to be significant (0.532). The study revealed that as the knowledge increased, the attitude score increased resulting in positive attitude towards the modes of delivery.

Section V: Association between sample characteristics and knowledge attitude level of pregnant women on elective caesarean section and normal vaginal delivery

A significant association was observed between knowledge regarding elective caesarean section and normal vaginal delivery and sample characteristics such as occupation = 7.61 (p-0.021), number of children = 5.54 (p-0.019), type of family = 5.16 (p-0.023), family income/month = 8.83 (p-0.012) and number of previous normal vaginal delivery = 5.15 (p-0.023). Hence the research hypothesis was accepted for these variables. 

A significant association was found between attitude regarding elective caesarean section and normal vaginal delivery and sample characteristics such as number of living children = 5.04 (p-0.025), type of family = 4.80 (p-0.028), family income/month = 7.67 (p-0.022), parity = 5.04 (p-0.025) and number of previous caesarean section = 4.39 (p-0.036). Hence the research hypothesis was accepted for these variables.

Discussion

The study findings revealed that most of the pregnant women (68%) had adequate knowledge regarding elective caesarean section and normal vaginal delivery and none of them had inadequate knowledge and a little more than half (51%) of them had favorable attitude, less than half (49%) of them had moderately favorable attitude and none of them had unfavorable attitude. The statistical relationship between the knowledge and attitude was found to be significant r = (0.532) which revealed that as the knowledge increased, the attitude scores increased resulting in positive attitude towards the modes of delivery. The study also revealed that working pregnant women, increase in number of children, pregnant women living in joint family and women who earned more than Rs 20000 per month, and without previous normal vaginal delivery had adequate knowledge. It has been found that pregnant women with one child, living in joint family, having given birth once, and undergone one caesarean section had favorable attitude towards elective caesarean section and normal vaginal delivery. Surprisingly pregnant women with monthly income less than Rs 10000 had favorable attitude than those who earned more.

Other findings: An outstanding difference was seen with regard to the source of information on modes of delivery. Among the pregnant women included, 58% of them received information from their family and relatives whereas only 8% had received information from health personnel. Hence the study revealed that there is a prime necessity to disseminate the information on modes of delivery to the pregnant women by the health personnel.

Conclusion

The study concluded that higher the knowledge, positive was the attitude regarding elective caesarean section and normal vaginal delivery. Hence it is an eye opener for all the health care personnel, especially the midwives who have the responsibility to educate the pregnant women about their informed choices of various modes of delivery, thereby promoting maternal, fetal and neonatal health.

Nursing Implications

Nursing Practice: Proper education during the antenatal period, especially during their visits to the OPD can lead to better maternal and neonatal outcome.

Nursing Education: It should emphasize on training the nursing students in women centered maternity care approach, and individualized education since each individual is unique.

Nursing Administration: Administrators in the field of nursing are required to take responsibility to equip the nurses to provide sufficient information, provide suitable teaching aid and aid nurses create awareness about the benefits and risks of elective caesarean section and normal vaginal delivery.

Nursing Research: The findings of the study serve as a basis for the professional and the student nurses to conduct further studies on knowledge and attitude regarding elective caesarean section and normal vaginal delivery.

Community: The study findings reveals the need for the community health nurse to create awareness about the different modes of delivery, its benefits and risks to have less complications and better maternal and neonatal outcome.

Recommendations

• Follow up study can be conducted to evaluate the effectiveness of health information booklet on knowledge and attitude of pregnant women regarding elective caesarean section and normal vaginal delivery

• The same study can be replicated by including attitudes of husbands of pregnant women

• A comparative study to assess the knowledge and attitude of multigravidas and primigravidas regarding elective caesarean section and normal vaginal delivery

• An exploratory study can be done on specific demographic factors which influence the knowledge and attitude regarding elective caesarean section and normal vaginal delivery

Conflicts of Interest

None