CHAPTER I

INTRODUCTION

A cesarean section is a surgical procedure for the removal of the

fetus by cutting into the abdominal wall and then the uterus. If it is

thought that either the mother or the baby may not survive after a

vaginal delivery, or if both of their lives are in danger, then a C-section

is vital (Tezcan P, 2008). The World Health Organization has suggested

that C-sections should occur in between 5% and 15% of all births

(World Health Organization, 2015). However, the cesarean rate in

Turkey is much higher than this. The percentage of cesarean births,

which was 21% in 2002, increased to 51% in 2014 and then to 53% in

2015 and 2016 according to data from the Turkish Ministry of Health,

2008. In recent years, women have had a high number of C-sections

both for medical reasons and as a result of demands for a cesarean

delivery in the absence of any medical reason (ODU Journal of

Medicine, 2016). Pregnant women decide to give birth by C-section

because of their uncertainty about being in labor, worry about the pain

and suffering they will experience, fear that their labor will be

unsuccessful, concern about giving birth without any trusted health

personnel present, and as a result of the influence of their social

environment (O’Donovan C and O’Donovan J., 2018). In fact, as a

surgical intervention, a C-section is not necessarily easy or pleasant

because of the pain that it causes, the lack of control during delivery,

the length of the healing process, and the delay that may be

experienced in establishing the mother–infant relationship. Women

who have cesarean deliveries experience anxiety about the risks of the

operation and have fears about the long period of recovery and pain

after a C-section compared with a vaginal delivery (Velho MB, Santos

AK, Brüggemann OM, and Camargo BV, 2012). Amanak and Karaçam

(2018) found in their study with 235 women who gave birth by C-

section that women experience problems related to pain in the

workplace and difficulties in moving, passing wind, feeding, and

producing stools during the postpartum period. Their study determined

that women had problems related to feeding their babies, cleaning

themselves, and dressing and caring for their stomachs. It was

determined that even when the C-sections had been planned, the

women were not happy about the after pains and fear that they had

experienced (Dönmez S, 2018). In addition, the positive or negative

experiences women have during childbirth influence the method of

delivery they select for their next labor (Bilgin N.,2018). An unplanned

and emergency C-section, the type of anesthesia used in a cesarean

section, and their perceptions and experience of labor all affect the

satisfaction women derive from giving birth. A positive experience of

labor helps women to feel more in control, therefore improving their

relationship with their babies and the quality of care they are able to

provide. Thus, it is important to understand the experiences of women

in the early postpartum period and to determine their feelings,

thoughts, and experiences about giving birth. Women’s perceptions of

their C-section, how they understand it, how they respond to it, what

feelings they experience most after childbirth, the difficulties they

encounter, and how they deal with these difficulties all affect the

postpartum care of the mother and baby. Being aware of these will

enable health professionals who provide primary care to feel more in

control and help them to decide on and offer the best care. Thus, the

aim of the present study was to investigate the experiences of women

in the early postpartum period and to determine their feelings,

thoughts, and experiences about giving birth via C-section.

PURPOSE OF THE STUDY

Having a positive or negative experience of labor affects the

method of delivery women select for their next pregnancy. Having a

positive experience also helps women feel in control, thus improving

the relationship between them and their babies and the quality of care

they are able to provide. Therefore, the aim of this study is to

understand women's experiences of having a C-section and to

determine their feelings and thoughts on this subject in the early

postpartum period.
RESEARCH QUESTIONS

Specifically, this study seeks to answer the following questions:

1. What are the reasons of mothers for cesarean delivery?

2. What were the problems experienced by mother related to their

CS delivery?

3. What are the lesson learned by the mothers that they want to

share to would be mother?

THEORETICAL LENS

Mothers ’s
knowledge about
cesarean birth

Thoughts after a
cesarean birth had Mothers’
been decided on Experiences

Mother experience
after their C-
sections (post-
cesarean delusions).

The theoretical lens above demonstrates the mothers’

experience who underwent cesarean delivery in the various category of

experiences. The framework describes that three (3) category of

experiences can have an impact on mothers’ experience in cesarean

delivery.

SCOPE AND DELIMITATION

This study will be focusing on the mothers’ experiences of

mothers who underwent cesarean delivery which will be conducted

within the City of Digos. Identified mothers who had underwent CS will

be the participants of the study.

The study will be limited on the 15 questions about the socio-

demographic characteristics of the mother’s and 10 semi-structured

interviews, including questions about the women’s knowledge about

cesarean birth, their thoughts after a cesarean birth had been decided

on, and their experience after their C-sections (post-cesarean

delusions).

DEFINITIONS OF TERMS
Caesarian Section – is the surgical delivery of an infant via an

incision in the mother’s belly and uterus while the mother is under

anesthesia.

Experience - is knowledge or skill in a particular job or activity, which

you have gained because you have done that job or activity for a long

time.

Mother - is a woman who gives birth or who has the responsibility of

physical and emotional care for specific children.

Interview -  is essentially a structured conversation where one

participant asks questions, and the other provides answers.

Survey - as a research method used for collecting data from a pre-

defined group of respondents to gain information and insights on

various topics of interest.

Childbirth - is the ending of pregnancy where one or

more babies leaves the uterus by passing through the vagina or

by Caesarean section.

Vaginal delivery - is the giving birth of babies in humans

in mammals through the vagina.
 CHAPTER II

REVIEW OF RELATED LITERATURE AND STUDIES

The following are literatures that are used as building block that

strengthen and will be caused basis for the study:

Foreign Literature

The present body of research has mostly studied specific

aspects, either physical or psychological, of a cesarean birth. Only a

few studies have explored the overall cesarean birth experience, from

the time of the decision through the postpartum recovery and

including both the physical and emotional aspects of the birth (Blüml,

2012) and no studies have specifically examined first-time mothers’

overall experiences related to a planned cesarean birth. In a

quantitative study, Blüml (2012) assessed 48 women, both primiparas

and multiparas, who had a planned cesarean birth. The results

indicated that only half the women felt adequately informed about the

cesarean procedure and majority (83.3%) of the women felt anxious

during the surgery (Blüml, 2012).

Fries (2010) conducted a phenomenological study of the overall

experience of seven African American women, both primiparas and

multiparas, who had an unplanned cesarean birth. Fries (2010) defined

an unplanned cesarean as any cesarean in which the woman learned

of the surgery less than 2 hours before the surgery. Analysis of the

interviews resulted in five themes which conveyed an overall

experience of sadness and disappointment (Fries, 2010). A

metasynthesis investigated the experience of women having a

cesarean birth by examining the 10 qualitative studies that had been

conducted. Analysis of the data resulted in six overarching themes:

that conveyed notions of fear, failure, difficulty bonding, lack of

control, and mistrust. Ten themes depicting a negative experience also

emerged from a descriptive qualitative survey of 2960 English women

conducted by Redshaw and Hockley (2010).

A review of the literature revealed the majority of studies

examined women’s experiences that have included both primiparas

and multiparas who had vaginal birth as well as planned and

unplanned cesarean births all within the same study, thus making it

difficult to determine if the results are applicable specifically to

primiparas undergoing planned cesarean births. The mixture of parity

and birth method within single studies may have contributed to the

many negative experiences reported. No studies have specifically

examined the experience of first time mothers who had a planned

cesarean birth.
 The Cesarean section (CS) has been increasing worldwide. CS is

the most common abdominal surgery procedure, performed around

the world, explaining its high prevalence worldwide. The World Health

Organization (WHO) suggests a cesarean rate between 5% and 15%;

a rate above 15% implies an unnecessary 5% may be related to the

population´s lack of access to medical technology Villar (2006). Some

factors that contribute to the increased use of CS are: the

improvement of surgical and anesthetic techniques, reduction of the

postoperative complications and the perception of greater safety

during the procedure. CS rate has become more prevalent over the

years, without to mothers and children born by CS. There are several

adverse effects that may affect the mother, which include maternal

death, the greater number of hospital remissions and increases the

risk in future pregnancies for placenta previa. Respiratory distress

syndrome is the only adverse outcome well documented in babies born

by CS Althabe (2006). In addition, there are chronic diseases that

occur more frequently in children born by CS and for the mother is

more convenient to set up the surgery date than to wait for an

unpredictable onset of labor. However, in a normal pregnancy, CS has

eight-fold higher mortality than vaginal delivery, in addition to 8-12

times higher morbidity. Has been an alarming increase of the

worldwide CS rate in the last decade, CS prevalence had an estimate,

until 2010, of 17.6%. The World Health Organization (WHO) yielded an

estimate of CS prevalence by continent; 36% in America, 23% in

Europe, 9% in Asia and 4% in Africa Declercq (2007). Nevertheless,

there is not a world research on cesarean prevalence and the factors

that contribute to this health problem. The woman´s motivation for

the choice of CS includes: fear of vaginal delivery, preservation of

coital function, relief from the pain of labor, and to obtain a tubal

ligation Sakala C. (2008).

Local Literature

According to the Philstar, Cebu, Philippines – To ensure safer

pregnancy for expecting women, the Philippine Health Insurance

Corporation (PhilHealth) made prenatal care a key component in its

benefit package for normal child birth.

Prenatal care is important not just for pregnant women but also

for their unborn babies. Maternal difficulties such as diabetes and high

blood pressure which are harmful both to the mother and the child

may be detected earlier through prenatal visits with a skilled or trained

health care provider. Constant check-up and monitoring during these

visits ensure a healthier pregnancy and delivery for both the mother

and child.
 Members may avail themselves of P1,500 as prenatal care

benefit covering drugs and medicines, laboratory tests and ancillary

procedures. Reimbursement for prenatal expenses is generally paid to

the member. But corresponding official receipts for the procedures

and/or drugs and medicines availed of must be submitted in support of

the claim.

Prenatal care in lying-in clinics has been an integral part

PhilHealth’s maternity care package. But it was only with the recent

expansion of its normal delivery package that expenses for prenatal

care in hospitals also became reimbursable. This is PhilHealth’s way of

encouraging pregnant women to really undergo prenatal care in

support of the Department of Health’s safe motherhood campaign.

According to Mec Arevalo (2019), Maternal mortality is defined as

death of a woman during pregnancy or within 42 days of giving birth

due to complications arising from, or aggravated by, pregnancy).

Perinatal mortality, on the other hand, is death of a fetus after 20

weeks of gestation, during the birth, or 7-28 days after delivery. Both

continue to be health issues that need to be prioritized in the country.

Maternal deaths are often due to haemorrhage, sepsis,

obstructed labour, hypertensive disorders in pregnancy, and

complications arising from unsafe abortions. Lack of trained birth

attendants or access to proper facilities also contributes to the loss of

lives.

Factors contributing to our high maternal mortality rate are

either cultural or economic. Women, especially from urban poor areas

and far-flung provinces, usually lack decision-making power over their

own bodies. Their choices are limited by an equally inadequate

education, and Catholic upbringing that prohibits other family planning

methods other than abstinence and natural family planning.

Poverty often results in poor nutrition and overall health in the

mother, aside from cultivating early marriages and teen pregnancies.

According to a UNICEF report in 2009, only 60% of all births in the

Philippines are supervised by a qualified birth attendant such as a

physician or midwife.

All of these end up compromising perinatal health as

malnourished women, and women who have borne many children

already, are more likely to give birth pre-term. Based on 2009 National

Statistics Office, infant mortality rate in the Philippines is at an

alarming rate of 20.56 babies for every 1,000 live births.

 CHAPTER III

RESEARCH METHODOLOGY

This chapter states the methods and tools that the researchers

choose that will deem significant and appropriate to justify the study

Research Locale

This study will be conducted within the Barangay Zone 1, Digos

City. The area has health center that cater needs of all health care

services in the community such as immunization, population health

monitoring, and also prenatal services. They also have active

community nurse, midwife and barangay health worker (BHW) wherein

the information are gathered by the researchers about the mother who

underwent caesarian.

Research Design

The research will be conducted using a phenomenological

approach, which is a qualitative research method. In the

phenomenological approach, the researcher is interested in how the

participants perceive the events they are experiencing and how

participants attribute a meaning to them through their own

descriptions.
Respondents and Subject of the Study

The population of the study will be consisted of women

underwent C-sections at the obstetrics and gynecology section of

Digos City Provincial Hospital between January and February 2020.

The study sample will be the 27 Bisaya - speaking women who

underwent C-sections between the dates specified and who are agreed

to participate in the study.

Sampling Technique

There is no specific sample number in qualitative studies, and

the present study will employ the purposive sampling method in which

researcher relies on the own judgment when choosing members of

population to participate in the study.

Research Instrument

Data will be collected using a form with 15 questions about the

socio-demographic characteristics of the women and 10 semi-

structured interviews, including questions about the women’s

knowledge about cesarean birth, their thoughts after a cesarean birth

had been decided on, and their experience after their C-sections (post-

cesarean delusions).
Subject/Respondents of the Study

The respondents of the study will be the mother who underwent

caesarian section aging 30 years old below and are residents of

Barangay Zone 1, Digos City.

Data Gathering Procedure

The researcher will conduct an individual in-depth interviews in

the women’s rooms in the first 48 h after delivery. During the

interviews, the researcher ensured that the women are not suffering

from any severe pain and had finished breastfeeding their newborns.

As the babies are sleeping after breastfeeding, the mothers are

comfortable, and this will ensure that they will be able to answer as

they wish.

During the interview, the participants will be observed by the

interviewer, and their behaviors and moods will be noted along with

their statements. The interviews will be lasted for 20–25 min and will

be recorded with the participants’ consent.

Data Analysis

All audio recordings will be transferred to the computer by the

researcher on the same day. The participants’ statements will be

 transcribed and read individually by the researchers, and content

analysis will be used to determine what the statements meant and

how categories could be formed from them.

The analysis of the data to be generated five categories (no

computer-assisted qualitative data analysis software will be used). To

test the validity of the study, the data to be obtained from the

interviews will be examined by two faculty members who experienced

in qualitative research, and the consistency of the researchers will be

checked.

Ethical Considerations

Participants will be informed in writing and orally about the aim of the

study, its confidential nature, its voluntary basis, and their right to end

the interviews whenever they wished. Informed consent will be

obtained from the women who will participate in the study. The study

was approved by the research committee for ethics in Science. The

case histories have been altered in order to protect confidentiality.

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