ORIGINAL ARTICLE


https://doi.org/10.5005/jp-journals-10084-12169
Pondicherry Journal of Nursing
Volume 13 | Issue 4 | Year 2020

Knowledge and Attitude on Mode of Childbirth among Primigravid Women Attending Antenatal Outpatient Department at Mahatma Gandhi Medical College and Research Institute, Puducherry


V Poongodi1, Kandasamy Renuka2

1Department of Obstetrics and Gynecology Nursing, Kasturba Gandhi Nursing College, Puducherry, India
2Department of Medical Surgical Nursing, Kasturba Gandhi Nursing College, Puducherry, India

Corresponding Author: Poongodi V, Department of Obstetrics and Gynecology Nursing, Kasturba Gandhi Nursing College, Puducherry, India, Phone: +91 9585340354, e-mail: poongodiv@kgnc.ac.in

How to cite this article Poongodi V, Renuka K. Knowledge and Attitude on Mode of Childbirth among Primigravid Women Attending Antenatal Outpatient Department at Mahatma Gandhi Medical College and Research Institute, Puducherry. Pon J Nurs 2020;13(4):78–81.

Source of support: Nil

Conflict of interest: None

ABSTRACT

Background: Delivery mechanism is a spontaneous process and requires no intervention. Advance in medical technology in maternity care have drastically reduced maternal and infant mortality. Childbirth is not only of great importance to the mother and her partner, but also to the entire family. It is a profound event which is physiological, psychosocial and metaphysical. This is the whole family’s joy and hope that pushes the mother to face all of the pain associated with this.

Aims and objectives: To assess the knowledge and attitude regarding mode of childbirth among primigravid women.

Materials and methods: Descriptive research approach and design was adopted for this study. Sixty primigravid women were selected by purposive sampling technique based on the inclusion and exclusion criteria. The demographic variables were collected using structured questionnaire, structured knowledge questionnaire used to assess the knowledge regarding mode of childbirth and five point rating scale was used to assess the attitude regarding mode of childbirth. The data were analyzed by means of descriptive and inferential statistics like frequency, percentage, mean, standard deviation, Spearman’s Rank Correlation and Chi-square test.

Results: Among 60 primigravid women 40 (66.7%) had moderately adequate knowledge and 20 (33.3%) had adequate knowledge regarding mode of childbirth. Regarding the attitude 53 (88.3%) had positive and 7 (11.7%) had neutral attitude towards normal vaginal delivery and 8 (13.3%) had positive and 52 (86.7%) had neutral attitude towards cesarean section. By using Spearman’s Rank Correlation Coefficient there was no correlation between mode of childbirth (normal vaginal delivery vs cesarean section) among primigravid women. By using Chi-square, findings showed that there was no significant association between the level of knowledge and attitude regarding mode of childbirth among primigravid women at p < 0.05 level.

Conclusion: This study concludes that the preference of mode of childbirth is very important among healthy primigravid women. Our research suggests that women are not responsible for the increase in cesarean section rates. Women have to accept the medically-indicated reasons for mode of delivery.

Keywords: Attitude, Knowledge, Mode of childbirth, Primigravid women.

INTRODUCTION

Childbirth style finishes a pregnancy by any one procedure, such as unassisted vaginal birth, assisted vaginal birth from ventouse or forceps, unplanned and planned cesarean section (CS).18 With more than 80% of women in favor of vaginal delivery (VD), Potter et al. surveyed pregnant women attending public and private institutions and found that preferences in both sectors were close.911 For most participants, VD was considered a normal, healthy, and natural delivery method, except in the case of a medical indication for CS, which was seen as a medical decision.12,13 Cesarean section rates have steadily risen over the last few decades, without a medical reason, in most middle- and high-income countries.14 The maternal order for a CS is one of the widely cited non-medical variables leading to this pattern.1317 As critical as physical and material preparation, mental preparation must be provided enough time and space for expectant mothers to have a free and frank discussion about all aspects of their pregnancy and delivery.1820

More recently, among pregnant women visiting public and private hospitals, multiple factors of motivation related to women’s mode of delivery preferences have been added.21,22 The majority of participants, considered VD as a normal, safe, and natural mode of delivery, except for a medical indication for CS.23,24 The experience of childbirth has always represented a very important event in women’s lives, a rare and unique moment marked by the woman’s transformation into her new status of being a mother. Vaginal delivery is the natural form of birth, but CS delivery is recommended to avoid either maternal or fetal morbidity or mortality, although about 10% of regular deliveries may be complicated.25,26

Worldwide, the rate of CS delivery is growing. In some nations, it is a part of their culture. The World Health Organization (WHO) proposed that CSs should be terminated for no more than 10–15% of pregnancies. The rate of CS can be influenced by certain individual and cultural factors. It has been well established that CS delivery mortality and morbidity are greater than normal VD.27,28 One of WHO’s tactics for improving maternal well-being is to shield mothers from needless medical technology. The International Confederation of Midwives declared that it is illegal to deliver CS deliveries without any medical indication.29,30 While the health professional authorities have considered reducing the rate of elective CS delivery, in some countries this rate is rising. Because of the importance of the values and beliefs in directing behavior, understanding elements of behavior are necessary to promote any health promotion program.31,32 The current investigation aims to establish the mode of childbirth among primigravid women attending antenatal outpatient department at Mahatma Gandhi Medical College and Research Institute, Puducherry.

AIMS AND OBJECTIVES

HYPOTHESES

  1. H1—There is a significant difference in the level of knowledge regarding the mode of childbirth among primigravid women.
  2. H2—There is a significant difference in the level of attitude regarding the mode of childbirth among primigravid women.
  3. H3—There is a significant correlation between knowledge and attitude regarding the mode of childbirth among primigravid women.
  4. H4—There is a significant association between the level of knowledge and attitude regarding the mode of childbirth among primigravid women with selected demographic variables.

MATERIALS AND METHODS

For this study, descriptive research strategy and design were adopted. Sixty primigravid women were chosen based on inclusion and exclusion criteria using a purposeful sampling technique. The inclusion criteria include the primigravid women between 35 and 40 weeks of gestation with a single fetus and those who were able to take part in the research. The research was carried out after approval by the Institutional Human Ethical Committee (IHEC). The researcher received formal approval from the study participants and informed consent. For all samples, the aims of the analysis were clarified. Using a standardized questionnaire, demographic variables were collected. A structured knowledge questionnaire was used to assess the knowledge regarding the mode of childbirth and a five-point rating scale was used to assess the attitude regarding the mode of childbirth. Descriptive and inferential statistics, such as, frequency, percentage, mean, standard deviation, Spearman’s rank correlation, and Chi-square test, were used to analyze the results.

RESULTS

Most of the samples 37 (61.66%) belong to the age group of 26–30 years and 42 (70%) belong to Hindu, 39 (65%) belong to high school education, majority of samples 46 (76.66%) belong to the sedentary worker, 41 (68.33%) samples’ family income is more than Rs. 10,001 to Rs. 15,000. Fifty-two (86.66%) were taking a mixed diet, 46 (76.66%) were had spontaneous conception, 38 (63.33%) belong to residential is an urban area, 35 (58.33%) were received information from health personnel, and 51 (85%) were in 38 weeks of gestation.

Table 1 reveals the level of knowledge regarding the mode of childbirth. Among 60 primigravid women, 40 (66.7%) had moderately adequate knowledge and 20 (33.3%) had adequate knowledge regarding the mode of childbirth. Hence, the stated hypotheses (H1) were accepted.

Tables 2 and 3 show the level of attitude toward the mode of childbirth (VD), regarding the attitude 53 (88.3%) had positive and 7 (11.7%) had a neutral attitude toward normal VD and 8 (13.3%) had positive and 52 (86.7%) had a neutral attitude toward CS. Hence, the stated hypotheses (H2) were accepted.

By using Spearman’s rank correlation coefficient, there was no correlation between knowledge and attitude regarding the mode of childbirth. Hence, the stated hypotheses (H3) were rejected. Results showed that there was no important correlation between the level of knowledge and attitude regarding the mode of childbirth among primigravid women at p < 0.05 level by the use of Chi-square. Hence, the listed hypotheses (H4) were rejected.

IMPLICATIONS

The investigator extracted from the study the following implications that are of primary interest in the fields of nursing practice, nursing education, nursing administration, and nursing science.

Table 1: Level of knowledge regarding mode of childbirth
Level of knowledgeFrequency (n)Percentage
Adequate (8–10)0000
Moderately adequate (5–7)4066.7
Inadequate (0–4)2033.3
Table 2: Level of attitude toward the mode of childbirth (vaginal delivery)
Level of attitude (vaginal delivery)Frequency (n)Percentage
Positive 23–305388.3
Neutral 15–22  711.7
Negative 6–140000
Table 3: Level of attitude toward the mode of childbirth (cesarean section)
Level of attitude (cesarean section)Frequency (n)Percentage
Positive 23–30  813.3
Neutral 15–225286.7
Negative 6–140000

LIMITATION

RECOMMENDATIONS

CONCLUSION

This study concludes that the preference for a mode of childbirth is very important among healthy primigravid women. Our study indicates that women are not responsible for the rise in CS rates. Women have to accept the medically indicated reasons for the mode of delivery. Finally, education has been given regarding the progress of childbirth (normal VD and CS) and postnatal care.

REFERENCES

1. Mungrue K, Nixon C, David Y, Dookwah D, Durga S, Greene K, et al. Trinidadian women’s knowledge, perceptions, and preferences regarding cesarean section: how do they make choices? Int J Womens Health 2010;2:387–391. DOI: 10.2147/IJWH.S12857.

2. Kushtagi P, Guruvare S. Documenting indications for cesarean deliveries. J Postgrad Med 2008;54(1):52–53. DOI: 10.4103/0022-3859.39195.

3. Angeja AC, Washington AE, Vargas JE, Gomez R, Rojas I, Caughey AB. Chilean women’s preferences regarding mode of delivery: which do they prefer and why? BJOG 2006;113(11):1253–1258. DOI: 10.1111/j.1471-0528.2006.01069.x.

4. Belizán JM, Althabe F, Cafferata ML. Health consequences of the increasing caesarean section rates. Epidemiology 2007;18(4):485–486. DOI: 10.1097/EDE.0b013e318068646a.

5. Soltani H, Sandall J. Organisation of maternity care and choices of mode of birth: a worldwide view. Midwifery 2012;28(2):146–149. DOI: 10.1016/j.midw.2012.01.009.

6. Althabe F, Belizán JM. Caesarean section: the paradox. Lancet 2006;368(9546):1472–1473. DOI: 10.1016/S0140-6736(06)69616-5.

7. Nouri TS. Relationship of knowledge and attitude with reasons for cesarean selection among pregnant women of Rasht health centers that were applicant for cesarean. J Guilan Univ Med Sci 2006;15:75–84.

8. Devendra K, Arulkumaran S. Should doctors perform an elective caesarean section on request? Ann Acad Med Singapore 2003;32:577–581.

9. Pezeshki Z, Pezeshk S. Educating quaternary prevention (P4) in Iran for decreasing the harms and costs of unnecessary services in clinical medicine and public health. Payesh 2013;12:329–332.

10. Rozenberg P. Evaluation of cesarean rate: a necessary progress in modern obstetrics. J Gynecol Obstet Biol Reprod (Paris) 2004;33(4):279–289. DOI: 10.1016/S0368-2315(04)96456-3.

11. Tita ATN, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al. Timing of elective repeat cesarean delivery at term and neonatal outcomes. N Engl J Med 2009;360(2):111–120. DOI: 10.1056/NEJMoa0803267.

12. Jurdi R, Khawaja M. Caesarean section rates in the Arab region: a cross-national study. Health Policy Plan 2004;19(2):101–110. DOI: 10.1093/heapol/czh012.

13. Badakhsh MH, Seifoddin M, Khodakarami N, Gholami R, Moghimi S. Rise in cesarean section rate over a 30-year period in a public hospital in Tehran, Iran. Arch Iran Med 2012;15:4–7.

14. Bagheri A, Masoudi Alavi N, Abbaszadeh F. Iranian obstetricians’ views about the factors that influence pregnant women’s choice of delivery method: a qualitative study. Women Birth 2013;26(1):e45–e49. DOI: 10.1016/j.wombi.2012.09.004.

15. Hajian S, Shariati M, Najmabadi KM, Yunesian M, Ajami ME. Psychological predictors of intention to deliver vaginally through the extended parallel process model: a mixed-method approach in pregnant Iranian women. Oman Med J 2013;28(6):395–403. DOI: 10.5001/omj.2013.115.

16. Ghotbi F, Akbari Sene A, Azargashb E, Shiva F, Mohtadi M, Zadehmodares S, et al. 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, 2012. J Obstet Gynaecol Res 2014;40(5):1257–1266. DOI: 10.1111/jog.12335.

17. Jacquemyn Y, Ahankour F, Martens G. Flemish obstetricians’ personal preference regarding mode of delivery and attitude towards caesarean section on demand. Eur J Obstet Gynecol Reprod Biol 2003;111(2):164–166. DOI: 10.1016/S0301-2115(03)00214-8.

18. Bryanton J, Gagnon AJ, Johnston C, Hatem M. Predictors of women’s perceptions of the childbirth experience. J Obstet Gynecol Neonatal Nurs 2008;37(1):24–34. DOI: 10.1111/j.1552-6909.2007.00203.x.

19. Lowe NK. Maternal confidence for labor: Development of the childbirth self-efficacy inventory. Res Nurs Health 1993;16(2):141–149. DOI: 10.1002/nur.4770160209.

20. Penna L, Arulkumaran S. Cesarean section for non-medical reasons. Int J Gynaecol Obstet 2003;82(3):399–409. DOI: 10.1016/S0020-7292(03)00217-0.

21. Blomquist JL, Quiroz LH, Macmillan D, McCullough A, Handa VL. Mothers’ satisfaction with planned vaginal and planned cesarean birth. Am J Perinatol 2011;28(5):383–388. DOI: 10.1055/s-0031-1274508.

22. Ip WY, Tang CS, Goggins WB. An educational intervention to improve women’s ability to cope with childbirth. J Clin Nurs 2009;18(15):2125–2135. DOI: 10.1111/j.1365-2702.2008.02720.x.

23. Zamani F, Shahry P, Kalhori M. Factors influencing cesarean section: a theory based study. Daneshvar 2011;19:1–10.

24. Fenwick J, Staff L, Gamble J, Creedy DK, Bayes S. Why do women request caesarean section in a normal, healthy first pregnancy? Midwifery 2010;26(4):394–400. DOI: 10.1016/j.midw.2008.10.011.

25. Callister LC. Making meaning: women’s birth narratives. J Obstet Gynecol Neonatal Nurs 2004;33(4):508–518. DOI: 10.1177/0884217504266898.

26. Yilmaz SD, Bal MD, Beji NK, Uludag S. Women’s preferences of method of delivery and influencing factors. Iran Red Crescent Med J 2013;15(8):683–689. DOI: 10.5812/ircmj.11532.

27. Lavender T, Walkinshaw SA, Walton I. A prospective study of women’s views of factors contributing to a positive birth experience. Midwifery 1999;15(1):40–46. DOI: 10.1016/S0266-6138(99)90036-0.

28. Mazzoni A, Althabe F, Liu N, Bonotti A, Gibbons L, Sánchez A, et al. Women’s preference for caesarean section: a systematic review and meta-analysis of observational studies. BJOG 2011;118(4):391–399. DOI: 10.1111/j.1471-0528.2010.02793.x.

29. Turner CE, Young JM, Solomon MJ, Ludlow J, Benness C, Phipps H. Vaginal delivery compared with elective caesarean section: the views of pregnant women and clinicians. BJOG 2008;115(12):1494–1502. DOI: 10.1111/j.1471-0528.2008.01892.x.

30. Liu NH, Mazzoni A, Zamberlin N, Colomar M, Chang OH, Arnaud L, et al. Preferences for mode of delivery in nulliparous Argentinean women: a qualitative study. Reprod Health 2013;10(1):12. DOI: 10.1186/1742-4755-10-2.

31. Wiklund I, Edman G, Andolf E. Cesarean section on maternal request: reasons for the request, self-estimated health, expectations, experience of birth and signs of depression among first-time mothers. Acta Obstet Gynecol Scand 2007;86(4):451–456. DOI: 10.1080/00016340701217913.

32. Ryding EL, Lukasse M, Kristjansdottir H, et al. Pregnant women’s preference for cesarean section and subsequent mode of birth - a six-country cohort study. J Psychosom Obstet Gynecol 2016;37(3):75–83. DOI: 10.1080/0167482X.2016.1181055.

________________________
© The Author(s). 2020 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and non-commercial reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.