INTERNATIONAL JOURNAL OF SPECIAL EDUCATION Vol.37, No.

3, 2022

Assessment Knowledge of Pregnant Women Toward Cesarean Section in

Al-Hilla City
Dr.Wafaa Ahmed1, Maryam Abdul-Kareem2, Mohammed Talib Abed3
1
PhD Maternal and Neonate Nursing, College of Nursing, University of Babylon, Iraq
2
MSc Maternal and Neonate Nursing, College of Nursing, University of Babylon, Iraq
3
MSc Pediatric Nursing, College of Nursing, University of Babylon, Iraq.

Abstract

Background: When vaginal birth is not possible (emergency CS) or the doctors believe the
risk to the mother and baby would be greater with a vaginal delivery, a Caesarean section is
performed to safeguard the safety of the mother and child (planned CS). The aim of the
study : to identify the personal characteristics of participants, to assess knowledge of
pregnant toward cesarean section and to find out the association between personal
characteristics of study sample and their knowledge. Methodology. A descriptive analytic
design was used on a non-probability (convenient sample) of (80) pregnant women who
were seen at the Babylon teaching hospital in Al-Hilla city. For the period of 19th December
2019 to 22nd January 2020, a questionnaire was used to gather data. It is divided into two
sections: demographic, reproductive, and pregnancy knowledge. These items are assessed
on a three-level Likert scale (I know, I'm not sure, and I have no idea). Results: The
majority of them were between the ages of 25 and 29, had a college education, and were
housewives in rural areas. Information was obtained from relatives and friends. Conclusion:
All pregnant women are aware of all aspects of C/S.

Keywords: Assessment, Pregnant Women, Knowledge, Cesarean Section

Introduction

Although Caesarean section (Cs) has dramatically improved maternal health and mortality,
it is still a common surgical procedure worldwide. In this surgical procedure, fetuses are
delivered after the 28th week of pregnancy through an abdominal and uterine incision (1,2). A
C-section is a life-saving therapy for both the mother and the fetus, but unnecessary
indications and overuse of C-section may greatly harm the quality of life for both the mother
and the newborn, as well as put their family in financial difficulties (3). In developed and
developing countries alike, Caesarean sections are becoming more popular for a variety of
reasons Preventing mother and baby deaths during childbirth is a primary objective of C-
sections (4,5)

Increased frequency of caesarean sections can lead to complications such as previous

caesareans, multiple pregnancies, malpresentation, fetal distress, obstructed labor, uterine
rupture, and obstetric fistulas, as well as a host of other medical issues for mothers (6,7,8). It is
suggested in the 2015 WHO Statement on Cesarean Section Rates that higher rates of
cesarean section (CS) in the population are not associated with lower rates of mother and
infant mortality, but that every effort should be made to provide CS to women who require it
(9,10)

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During the period from 1990 to 2014, the global CS rate rose by 12.4 percent, with
Latin America and the Caribbean experiencing the largest absolute increase (19.4 percent)
and Africa experiencing the lowest (4.5 percent). Estimates for CS rates in 2014 ranged
from 7.3% in Africa to 40.5% in Latin America and the Caribbean, with a global rate of
18.6% (11)

CS rates have risen dramatically in China over the past few decades. There was a dramatic
increase in the percentage of people in mainland China who had CS from 3 percent in 1988
to 39 percent by 2008. (12).

For every 74,809 deliveries in Iran, 48 percent resulted in a C-section; in Iraq, the CS rate in
the public sector was 24.5% in 2009, rising to 25.8% in 2010, but the private sector rate was
substantially higher, reaching 75.8% and 79.5 percent in 2009 and 2010, respectively; in
Iran (13,14). It jumped by 45 percent in these women, while the number of emergency
caesareans increased by 22 percent (15). Fetal morbidity is still high in cesarean sections
compared to vaginal delivery, and complications are more prevalent in emergency cesarean
sections than in elective procedures. When it comes to birthing, a cesarean section is by far
the most prevalent approach. An increasing number of women opt for cesarean delivery,
making it the most prevalent obstetric surgery. However, there are certain risks, such as the
risk of the mother's bladder or intestines being damaged, as well as an increased risk of
respiratory difficulties in the baby. These should be explained to the patient as part of her
pre-surgery education (16,17) .

When it comes to complications during labor, the most common ones are hemorrhage
of the uterus, a wound infection of the uterine and urinary system, and abdominal organ
injury (18). Children born via C-section are more likely to suffer from childhood asthma,
juvenile diabetes, and childhood obesity as well as a higher risk of cancer in later life,
according to various studies. Complications for the baby can include respiratory distress,
delivery trauma, and hypoglycemia as a result of the CS procedure (19,20). To put it another
way: The United Kingdom had a 26.2% C-section rate in 2014. A significant percentage of
all births in the United States were C-sections last year, according to the Centers for Disease
Control and Prevention (CDC) (21). Woman-centered care enables women to make decisions
in conjunction with healthcare experts, based on their unique needs and preferences and the
best evidence of potential advantages and dangers (22) .

As the caesarean rate rises in developing nations, it is imperative that pregnant women and
their partners receive more knowledge about the various methods of childbirth and the
associated indications, benefits, and drawbacks. Mothers' education and psychological and
emotional preparation for a natural birth lowered the rate of cesarean section by 15%, for
example. (23,24)

Objectives of the study:

(1) To identify the personal characteristics of participants

(2) To assess the knowledge of pregnant toward cesarean section

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II. Methodology:

2.1 Design of the study: A descriptive analytic study.

2.2 Sample of the study: Non-probability (convenient sampling) of pregnant women

undergoing cesarean section .

2.3 Setting of the study: Babylon for maternity and children, Al-Emam Al-

Sadiq and Al-Hilla teaching hospitals in Al-Hilla city , data collected from the

period of 19th Dec.2019 to 22th Jan.2020.

2.4 Instruments: The questionnaire was created specifically for the purpose of the research.
The instruments were divided into two categories:

2.4.1Part 1 :Demographic and Reproductive information:

(8) items are included in this section, which deals with demographic and reproductive data
(age, educational level, occupation, residence, economic state, number of pregnancies,
previous cesarean section and source of information).

2.4.2 Part 2: pregnant women's understanding about cesarean sections (17) The mother has
a greater risk of infection in a cesarean section, the hospital stay costs are higher in cesarean
sections, the emotional relationship between mother and child is less in cesarean sections,
there are many indications for a cesarean section and pain is a common complication
following cesarean sections, cesarean sections are preferred by the pregnant because the
position of normal vaginal delivery is not desirable by the mother, anesthesia complication
problems are of concern. Neonatal respiratory issues that are less common with cesarean
section birth, uterus delivered by cesarean section does not require long-term bed rest for
women undergoing tubal ligation, blood can be transfused during or after cesarean section,
and the pregnant woman can give birth vaginally following cesarean section; cesarean
section affects the initiation and duration of breastfeeding). As a result, points are assigned
based on how each question is judged on a Likert scale of one, two, and three (3,2,1).
Respectively. Validity was carried out through (5) experts. Data were analyzed using the
Statistical Package for Social Sciences (SPSS) version (20). Through the application of

descriptive statistical data analysis include (Frequencies, Percentages, and Cum. Percent)

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Table (1): Distribution of Socio Demographic and Reproductive Information No .(80)

Items Groups Frequency Percent (%)

15-19 11 13.75
20-24 25 31.25
Age
25-29 29 36.25
30-34 9 11.25
35-39 4 5
40more 2 2.5
Total 80 100
Educational level Not read & Write 1 1.25
Read &write 16 20
Primary 8 10
secondary school 18 22.5

Institute / College 37 46.25

Total 80 100.0
Employed 29 36.25
Occupation Housewife 51 63.75
Total 80 100.0
Urban 28 35
Residency Rural 52 65
Total 80 100.0
Enough 50 62.5
Economic level Some extent enough 25 31.25
Not enough 5 6.25
Total 80 100.0
Number of pregnancy 1-2 45 56.25
(Gravida) 3-4 26 32.5
5&More 9 11.25

Total 80 100.0
Previous cesarean Yes 27 33.75
section No 53 66.25
Total 80 100.0
Friends and family 42 52.5
Information Colleagues 3 3.75
TV and net 14 17.5
Doctors 14 17.5
Others 7 8.75
Total 80 100.0

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Results:

Table 1 reveals Age group (25-29) was found to make up 36.25% of the study sample,
according to the findings of this study. According to the findings of this study, 46.25 percent
of the participants were educated up to the college level. Housewives make up the largest
percentage of the sample, and they are reflected in the results (63.75 percent ). Rural
residents make up the largest percentage of the sample, according to the research (65 percent
). According to the findings of the research, the majority of the sample had sufficient
economic standing to be taken into consideration ( 62.5 percent ). Most of the sample falls
between the gravida range of one to two (56.25 percent ). When it comes to past caesarian
sections, the majority of women in the sample did not have any (66.25 percent ). Family and
friends make up the majority of the sample, and this is taken into consideration (52.5 percent
).

Table(2) Knowledge of Pregnant Women towards Cesarean Section No (80)

ITEMS Group Frequenc Percent (%)

y

I don’t know 23 28.75

1-Do you know the definition of I'm not sure 6 Not

7.5sure Not sure
cesarean section .
I know 51 63.75

Total 80 100.0

2-Mother is greater risk for infection I don’t know 15 18.75

I'm not sure 5 6.25

I know 60 75

Total 80 100.0

3-Hospital stay cost is more in cesarean I don’t know 7 8.75

section
I'm not sure 3 3.75

I know 70 87.5

Total 80 100.0

I don’t know 16 20

4-Emotional relationship between I'm not sure 12 15

mother and neonate is less and delay in
cesarean section. I know 52 65

Total 80 100.0

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5-There are many indication for I don’t know 13 16.25

cesarean section.
I'm not sure 8 10

I know 59 73.75

Total 80 100.0

6-Pain is common complication after I don’t know 7 8.75

cesarean section .
I'm not sure 3 3.75

I know 70 87.5

Total 80 100.0

I don’t 20 25
know
7-Cesarean section is prefer normal
vaginal delivery not desirable by the I'm not sure 16 20
pregnant.
I know 44 55

Total 80 100.0

8-Anesthesia complication problems are I don’t 17 21.25

more in cesarean section. know

I'm not sure 6 7.5

I know 57 71.25

Total 80 100.0

9-Inappropriate pelvis structure is one I don’t 25 31.25

of the indication of cesarean section. know

I'm not sure 17 21.25

I know 38 47.5

Total 80 100.0

I don’t 18 22.5
know
10-Neonate delivery by cesarean
section is less exposure to head injuries. I'm not sure 14 17.5

I know 48 60

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Total 80 100.0

11-Respiratory problems of the neonate I don’t 19 23.75

less in cesarean section. know

I'm not sure 20 25

I know 41 51.25

Total 80 100.0

12-Cesarean section prevent uterus I don’t 29 36.25

prolapse. know

I'm not sure 4 5

I know 47 58.75

Total 80 100.0

13-Deliverd women by cesarean section I don’t 6 7.5

need comfort in bed rest long period. know

I'm not sure 4 5

I know 70 87.5

Total 80 100.0

14-Cesarean section is suitable for tubal I don’t 14 17.5

ligation. know

I'm not sure 9 11.25

I know 57 71.25

Total 80 100.0

15-Blood may be transfused during or I don’t 14 17.5

after cesarean section. know

I'm not sure 12 15

I know 54 67.5

Total 80 100.0

I don’t 8 10
know
16-The pregnant can birth vaginally after
cesarean section I'm not sure 16 20

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I know 56 70

Total 80 100.0

I don’t 13 16.25
know
17-There is impact of cesarean section on
breast feeding initiation and duration I'm not sure 9 11.25

I know 58 72.5

Total 80 100.0

Table (2) reveals that the majority of the sample understands what a cesarean section is, and
these individuals are included in the analysis (63.75 percent ). The sample mother with the
highest chance of infection is accounted for (75 percent ). Cesarean sections account for the
majority of the sample hospital stay costs (87.5 percent ). A cesarean section delay and a
weaker emotional attachment between mother and baby account for the highest percentage
of the sample (65 percent ). The vast majority of respondents are aware that there are
numerous reasons to perform a cesarean section (73.75 percent ). Pain is a common
complication following cesarean surgery, and the biggest percentage of the sample is aware
of this (87.5 percent ). They favor cesarean sections because they don't want to be in a
situation where a normal vaginal delivery isn't desired by the expectant woman (55 percent
). Cesarean sections contribute for the highest percentage of sample anesthetic
complications ( 71.25 percent ). There is a higher than average number of women in this
sample who require a cesarean section due to an abnormal pelvic structure (47.5 percent ).
Because cesarean sections are less likely to result in head injuries, the highest percentage of
respondents are included in the sample ( 60 percent ). Cesarean section is associated with
the highest percentage of neonatal respiratory issues in the sample (51.25 percent ). There is
a significant rate of cesarean sections that prevent uterine prolapse in the sample (58.75
percent ). The majority of the women who gave birth via cesarean section were found to
require long-term comfort in bed rest (87.5 percent ). The majority of the women who
underwent cesarean sections are candidates for tubal ligation, and this group is included in
the analysis (71.25 percent ). Blood transfusions during or following cesarean delivery may
account for the majority of the sample's transfusions (67.5 percent ). It is the highest
percentage of women who are able to give birth vaginally following cesarean section that is
included in the total sample size (70 percent ). The greatest proportion of the population is
affected by the effects of cesarean section on the initiation and duration of breastfeeding,
and this group is taken into consideration (72.5 percent )

Table (3): Overall assessment knowledge of pregnant women about cesarean section

Classification of knowledge Frequency Percent MS Assess.

Poor 7 8.8 2.0493 Fair

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Fair 48 60.0
Good 25 31.3
Total 80 100.0
Overall cesarean section knowledge of participants was found to be fair, with a mean of
2.0493.

Table (4): The association between knowledge of pregnant women with their demographic
characteristic

variables Knowledge Sig.

Poor Fair Good
Rating
Age 15-19 0 6 5 p-value=0.000
20-24 0 12 13 Df=10
25-29 0 22 7 HS
30-34 5 4 0
35-39 2 2 0
40 and more 0 2 0
Education Not read and 0 0 1 p-value=0.028
write df=8
Read and write 4 11 1 S
Primary 1 6 1
Secondary 1 10 7
institute or 1 21 15
college
Occupation Worker 1 15 13 p-value=.097
Housewife 6 33 12 NS
Df=2
Residence Rural 4 14 10 p-value=.0.286
Urban 3 34 15 NS
Df=2
Economic status Enough 4 32 14 p-value=0.707
Some extent 2 13 10 df=4
enough NS
Not enough 1 3 1

Number of 1-2 5 26 14 p-value=0.292

pregnancy 3-4 0 17 9 df=4
more than5 2 5 2 NS
Previous CS Yes 3 14 10 p-value=0.563
No 4 34 15 df=2
NS

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This table shows that participants' demographic variables (age and educational level) were
statistically associated with their knowledge of CS at a p-value 0.05.

Discussion:

Pregnant women between the ages of 25 and 29 were included in this study, which implies
that the majority of the participants are within the optimal reproductive age range. In
Nigeria, (25) showed that 26.6 percent of all pregnant women in the southwest were between
the ages of 30 and 34. There are the greatest percentages of people who graduated from a
college or university in the sample. Knowledge is greatly influenced by education.

In terms of labor at home, 63.75 percent of Iranian housewives (26) were found to be
housewives, which is in line with the findings of this current study (which found that 21
percent were housewives). It is clear that the study participants' residences were in rural
areas, which were reported in the results (65 percent ). The findings of this study are
consistent with those of a previous study (27), which found that the majority of pregnant
women live in rural areas.

The study participants' economic level was found to be adequate, and they were accounted
for in the findings (62. 5 percent ). In tertiary care center City, (61.0 percent) of pregnant
women's income was sufficient, a conclusion supported by (28). Most women who
participated in the study had one or two pregnancies, and these were accounted for in the
findings (56.25 percent ). As previously reported by (29) in Abidjan city, the majority
(64.96%) of the study sample was pregnant with one or more children.

An even higher percentage (66.25 percent) of women who took part in this study had
not previously undergone a caesarian section, which is in line with a recent study that
indicated that 24.3% of pregnant women had not undergone a caesarian section. .

More than half of the sample (52.5 percent) got their knowledge from family and friends,
which is in accordance with a study from North America (31) that revealed that (63 percent)
of the sample got their information from family and friends.

The (80) participants showed that they and they are accounted for (63.75 percent) of the
sample's knowledge about cesarean section, which is in line with the findings of the (32)
study, which reported that 60.4 percent of the sample had a high degree of knowledge about
cesarean section.

According to the results of this study, 75% of people are aware that the statement
"mothers are at greater risk of infection" is true. (33) Decreased fibrogenesis, macrophage
response, and angiogenesis in North America (39.10 percent) may cause wound breakdown
and infection by delaying wound closure and healing.

Most of the answers to questions about cesarean section costs were (I know) in relation to
the remark that cesarean sections cost more. The findings of this investigation (34) in
Bangladesh concur with ours.

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According to the findings of this study, 52 of the respondents (or 65 percent) reported
having information about (the lack of an emotional bond between mother and newborn and
the length of time it takes to perform a cesarean section). Only (69 percent) of women in
tertiary care centers agreed with (35) that vaginal delivery is favored by the majority because
it fosters a closer bond between mother and child.

59 (73.75 percent) of the respondents stated that they were aware of the statement that there
are many reasons for a cesarean section. The results of a (36) study conducted in Nigeria with
well-educated people back up this assertion. regarding cesarean section indications.

Pain is a prevalent problem following cesarean section, according to 73.75% of

those surveyed. Some of the reasons provided by pregnant women for not desiring a CS
were dread of postoperative pain.

In light of the fact that the position of normal vaginal delivery is not ideal by pregnant
women, a cesarean section is preferred (55 percent ). According to (37), in Brazil, 86% of
women who took this post claimed that it had no benefit for the advancement of labor, but
that they had been forced to do it because of the professional imposition. .

According to the findings, 57 out of 71.25% of women who underwent cesarean

sections experienced anesthetic complications. The most common anesthetic side effects,
according to a 38-year-old study conducted in southern Nigeria, were headache and delayed
recovery, with the former accounting for 64,9 percent of all cases (29.7 percent ) .

It was shown that when we assessed the item (wrong pelvic anatomy is a sign of cesarean
section) that we accounted for (38) (47.5 percent). This is in line with the Baghdadi notion (39)
that young women's pelvises are too tiny for vaginal delivery at the time of marriage.

Concerning the statement (knowing that neonate delivered by cesarean section is less
exposed to head trauma) the finding mentions that 48 (60 percent) are aware of this
information.. 57.1 percent of women in south western Nigeria believe that caesarean
sections and the level of intelligence of the baby are not linked; however, if an instrumental
delivery is performed when the vaginal delivery is not properly managed, it can cause brain
damage in the baby, which can affect the level of the child's intelligence in the future.

According to the results of this study, (respiratory difficulties of the neonate less in
cesarean) 51.25% of the answers were relevant to the topic. Although this is supported by
(41)
, a review comparing cesarean section without medical indication with vaginal delivery
has found that this increases the incidence of respiratory problems in newborns.

Cesarean section prevents uterine prolapse is a statement that most of the answers were (I
know) to. CS was viewed as a painless and safe delivery method by a majority of
participants (51.0 percent) who had favorable opinions about the CS and prioritized it,
according to research conducted by )42( other researchers in Iran's northern provinces.

With regards to the statement (delivered women by cesarean section need comfort in bed
rest long period) In the findings, 70 people were mentioned as having knowledge of the
subject (87.5 percent ). (43) go to school in Addis Ababa, Ethiopia. Because of the higher rate

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of problems, prolonged bed rest, and bleeding dangers associated with cesarean section, they
viewed it as abnormal.

According to the findings, 57 (71.25 percent) of pregnant women were aware of the
fact that cesarean section is suited for tubal ligation, which is in line with the findings of (44).

The findings of this study show that (blood may be transfused during or after cesarean
section) 67.5 percent of those who answered this question correctly were knowledgeable
about it. Blood transfusions are more likely after a cesarean section because of the
possibility of life-threatening hemorrhage.

In support of the claim (that women who have had cesarean sections know they can give
birth vaginally again), research shows that 56 (70 percent ). (45) A Saudi Arabian study
indicated that the majority of pregnant women (82,5%) were aware that a vaginal delivery
was an option following a cesarean section.

I know that cesarean section has an impact on breastfeeding initiation and duration in most
cases, but when we assessed the information fairly, the answer was (I know) in most cases.
A cesarean section usually results in a mother-baby withdrawal because of the surgery's
limitations, so the mother's ability to meet the baby's needs in the first few hours or days of
life is limited, and breastfeeding may be delayed, which may affect the desire of the mother
to nurse.

Pregnant women's knowledge of cesarean birth in the following state was assessed as fair
(60.0%), good (31.3%), and poor (8.8%). This result is consistent with the findings of a
study conducted by (47), which examined the perception, knowledge, and attitude of pregnant
women in north Trinidad regarding cesarean birth; their findings indicated that the highest
percentage of pregnant women had fair knowledge. According to (48), a study on expectant
women's awareness of the birth mood, the highest percentage of the study sample's
knowledge was "fair" at this point in the delivery process (46.6 percent ).

Pregnant women's knowledge and attitudes about cesarean sections are strongly linked to
their demographic parameters, with a P. value of 0.00 for the age of the research participant.
Pregnant women's knowledge of the risks of cesarean section and their educational
attainment were shown to be significantly associated at a p-value of 0.02, which is in
agreement with the findings of (50), which looked at pregnant women's knowledge of the
benefits of cesarean section. Pregnant women's occupational status was shown to have no
significant association with knowledge, contrary to the findings of research )51(, which found
a substantial association between knowledge and occupational position. Pregnant women's
knowledge of venous thromboembolism is not associated with their residency, economic
status, or the number of pregnancies they have. These findings are consistent with those of a
previous study (52) that assessed the level of patient knowledge about venous
thromboembolism before they underwent CS. Finally, when it comes to the previous
cesarean section delivery, the results show that pregnant women's knowledge does not have
an impact on this parameter, which is in contrast to the findings of a study examining the

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factors that influence the method of delivery and attitude of pregnant women admitted to the
civil hospitals of the Social Security Organization.

Conclusions:

(25 – 29) year old’s make up the largest share of the study participants' age group. the
majority had a college degree, they had a good financial standing, and they were well-versed
in all aspects of c/s. .

Recommendations:.

1.All women of childbearing age, as well as those who are pregnant, should be educated
about C-sections in order to better understand the procedure.

2.To make an educated decision on delivery methods, their indications, benefits, and risks,
primary health care providers have an important role to play in providing prenatal education
and recognizing the early manifestation of unfavorable postnatal outcomes.

3.More research is needed to examine the link between moms' awareness and bad pregnancy
outcomes.

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