INTRODUCTION:

Cesarean delivery (CD) is a surgical procedure for fetus delivery when vaginal delivery (VD) becomes contraindicated (Gunalp and Tuncer, 2004). The proportion of CD is increasing all over the world (Kiran and Jayawickramam, 2002; Walker et al., 2004).

According to the World Health Organization (WHO), the rate of CD should not usually exceed 15% (Terhaar, 2005; Hopkins and Amaral, 2005; Wang et al., 2006). The World Health Statistics (WHS), 2012, said 9% of all births in India were by Caesarian section. The latest figure has gone up by 5% since nearly one in 10 women in India, who gave birth between 2005 and 2010, had gone under the surgical knife. Apart from medical CD indications, the reasons for the increase in the rates of CD are stated as fear for VD and delivery room due to failure to provide expectant mothers with sufficient level of information on delivery as well as some other reasons such as old-age mothers, multiple pregnancy and the increase in the use of electronic fetal monitoring (EFM) (Gunalp and Tuncer, 2004; Kiran and Jayawickrama, 2002; Lin et al., 2004; National Institute of Health State of Science Conference, 2006; Walker et al., 2004). In addition, the belief that CD is safer for both the mother and the baby turns CD into the preferred childbirth method (Dodd et al., 2004, Gamble and Creedy, 2001; Fenwick et al., 2008). It is stated that doctors, on the other hand, choose CD since it is more profitable, delivery occurs within a shorter time, they do not want to take risks during potentially difficult deliveries, and are aware of the potential to be sued for incorrect medical applications (Hopkins, 2000). It is believed that, in addition to the extension of the CD indications, the factors such as the increase of optional and repeated CD are thought to increase the CD rate. Recent developments in surgical procedures, anesthesia, medication, medical equipment, and postoperative care have reduced the mortality and morbidity related to CD. However; risks such as infection, bleeding, transfusion need, thromboembolism, prolonged hospital stay, long recovery period and increased pain are still to be considered while opting for the CD (Allen et al., 2003). A challenge to health care personnel would be to provide better information for pregnant women during antenatal period regarding mode of delivery, their indications, advantages and adverse consequences. In a country like India where still only 65% of women are educated, this study will provide data, which can be used as a platform to raise knowledge among pregnant women about the different methods of delivery and thereby empower women to make informed choices and have positive attitude. Thus the investigators felt the need to determine the attitude of primigravida women towards mode of childbirth attending the antenatal clinics in selected hospitals, Mangalore.

MATERIALS AND METHODS:

Setting:

The study was conducted in AJIMS antenatal clinic, Kuntikana; Dr. Poornima’s private clinic, Light House Hill road; Dr. Aruna Kamath’s private clinic, Kadri; Mangalore.

Population:

Primigravida women in third trimester at selected antenatal clinics of Mangalore.

Sample size:

200 primigravida women

Sampling procedure:

Non probability purposive sampling technique

Research Design:

Descriptive survey approach.

Description of the Instrument:

· Demographic proforma

· Attitude scale

· Attitude scale had a total of 16 items. Out of which, 9 statements were favoring vaginal delivery and 7 statements were favoring caesarean section. Responses ranged from “strongly agree” (5), “agree” (4), “undecided” (3), “disagree” (2), to “strongly disagree” (1). The potential scores favoring vaginal delivery were arbitrarily divided as Favourable (31 – 45), Neutral (16 – 30), Unfavourable (1 – 15). And scores favouring Caesarean section were arbitrarily divided as Favourable (24 – 35), Neutral (12 – 23), Unfavourable (1 – 11).

Data Collection Method:

· Prior to the data collection permission was obtained from the concerned authority

· The subjects were selected based on the set criteria

· Informed consent was obtained from the samples

· The data was collected in AJIMS antenatal clinic, Kuntikana; Dr. Poornima’s private clinic, Light House Hill road; Dr. Aruna Kamath’s private clinic, Kadri; Mangalore. 200 primigravida women who were in their third trimester were selected and the attitude scale towards mode of child birth was administered. Respondents were assumed about the confidentiality of the answers and the scores obtained.

· Content validity of the tool was obtained. Pre-testing of the tool was done to check the clarity of items, ambiguity of the language and feasibility of the tool. The reliability of the tool was established using test-retest method. The reliability coefficient was found to be 0.74.

Table 1 show that most of the samples (56%) were in the age group of 24-29 years. All of them were married. Highest percentage (43%) of the women had pre university education. Majority (58%) of the women were house wives and (52.5%) of samples were belonging to nuclear family. Majority (45.5%) of samples had information regarding mode of delivery from family members. Majority (87%) of women conceived spontaneously.

RESULT OF THE STUDY:

Section I: Description of sample characteristics:

Table 1: Frequency and Percentage distribution of primigravida women according to demographic variable N=200.

Demographic variables

Frequency (f)

Percentage (%)

1. Age (in years)

a. 18-23

b. 24-29

c. 30-34

d. >35

112

30.5

0.5

2. Education

a. No formal education

b. Primary education

c. Pre university

d. Graduate

e. Post graduate

23.5

20.5

3. Occupation

a. House wife

b. Daily Wager

c. Private Employee

d. Government Employee

e. Employee in health organization

116

16.5

1.5

4. Income (in Rs)

a. < 5000

b. 5000-10000

c. >10,000

43.5

45.5

5. Type of family

a. Nuclear

b. Joint

c. Extended

105

52.5

5.5

6. Source of information

a. Family members

b. Colleagues

c. Related publications

d. Television

e. Health centers

f. Private Physician

g. No information

45.5

17.5

14.5

0.5

7. Mode of conception

a. Spontaneous

b. ART

174

Section II: Attitude level of primigravida women towards mode of child birth

Figure 1: Pie graph showing percentage distribution of primigravida women’s attitude towards caesarean section

Figure 1 illustrates that majority (50.5%) of the primigravida women were found to have neutral attitude, (41.5%) of them had favorable attitude and only (8%) of the women had unfavorable attitude towards caesarean section.

Figure 2: Doughnut diagram showing percentage distribution of primigravida women’s attitude towards vaginal delivery

Figure 2 illustrates that majority (71.5%) of the primigravida women were found to have favorable attitude, (20%) of them had neutral attitude and only (8.5%) of the women had unfavorable attitude towards vaginal delivery.

Section III: Association of level of attitude towards mode of child birth with selected demographic variables

In order to determine the significance of association of the level of attitude with selected demographic variables, Chi square test was computed for the available data.

Table 2: Chi square value showing the association of attitude with selected demographic variables N = 200

Sl. No	Demographic variable	χ2	df	P value	Inference
1	Age	8.032	6	0.236	Not significant
2	Education	13.767	10	0.184	Not significant
3	Occupation	13.258	8	0.103	Not significant
4	Income	2.429	4	0.657	Not significant
5	Type of family	2.349	4	0.672	Not significant
6	Source of information	28.362	12	0.005	Significant*
7	Mode of conception	3.348	2	0.187	Not significant

P<0.05, * significant

Table 2 shows that there was a significant association of attitude with source of information (χ2 = 28.36) at p <0.05.

DISCUSSION:

The present study showed that majority (50.5%) of women had neutral attitude regarding caesarean section, (41.5%) had favorable attitude and (8%) had unfavorable attitude towards caesarean section. Majority (71.5%) of women had favorable attitude regarding vaginal delivery, (20%) had neutral attitude and (8.5%) had unfavorable attitude towards vaginal delivery. A similar study was conducted to assess women’s knowledge and attitude towards mode of delivery and frequency of cesarean section on mother’s request in six public and private hospitals in Tehran, Iran. The findings showed that a higher percentage (>50%) of mothers in the intermediate and good knowledge score groups had a positive attitude towards NVD compared to the poor knowledge group.

LIMITATIONS:

· The study was limited to primigravida women who were in their third trimester

· Only 200 samples were included because of time constraints

· The study was carried out only in antenatal clinics

REFERENCES:

1. Ghotbi F, Akbari Sene A, Azargashb E, Shiva F, Mohtadi M, Zadehmodares S, Farzaneh F, Yasai FA. Women's knowledge and attitude towards mode of delivery. J Obstet Gynaecol Res. 2014 May; 40(5):1257-66. doi: 10.1111/jog.12335. Epub 2014 Apr 2.

2. Lee SI, Khang YH, Lee MS. Women's attitudes toward mode of delivery in South Korea--a society with high cesarean section rates. Birth. 2004 Jun; 31(2):108-16.

3. Asli Karakus, Nevin Hotun Sahin. The attitudes of women toward mode delivery after childbirth. International Journal of Nursing and Midwifery Vol. 3(5), pp. 60-65, May 2011. Available online http://www.academicjournals.org/ijnm

4. Christina Gunnervik, Ann Josefsson, Adam Sydsjö and Gunilla Sydsjö, Attitudes towards mode of birth among Swedish midwives, 2010, MIDWIFERY, (26), 1, 38-44. Available from: http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-54392

5. Rudolf KA, Kwabena AD. Awareness and Perceptions of and Attitudes towards Caesarean Delivery among Antenatal. Ghana medical journal 01/2009; 42(4):137-40. Available from: https://www.researchgate.net/publication/24436805Awareness and Perceptions of and Attitudes towards Caesarean Delivery among Antenatal.

Received on 17.12.2015 Modified on 08.02.2016

Asian J. Nur. Edu. and Research.2017; 7(1): 17-20.

DOI: 10.5958/2349-2996.2017.00005.2