PRESBYTERIAN UNIVERSITY COLLEGE, GHANA

ASANTE AKYEM CAMPUS, AGOGO

FACULTY OF HEALTH AND MEDICAL SCIENCES

DEPARTMENT OF NURSING

KNOWLEDGE, PERCEPTION AND ATTITUDE OF

PREGNANT WOMEN TOWARDS CAESAREAN

SECTION IN AGOGO PRESBYTERIAN HOSPITAL

DONKOR, COLLINS RUTHERFORD

JUNE, 2021

PRESBYTERIAN UNIVERSITY COLLEGE, GHANA

ASANTE AKYEM CAMPUS

 FACULTY OF HEALTH AN MEDICAL SCIENCES

DEPARTMENT OF NURSING

KNOWLEDGE, PERCEPTION AND ATTITUDE OF

PREGNANT WOMEN TOWARDS CAESAREAN SECTION IN
AGOGO PRESBYTERIAN HOSPITAL

A DISSERTATION SUBMITTED TO THE DEPARTMENT OF

NURSING OF THE PRESBYTERIAN UNIVERSITY COLLEGE,
GHANA FACULTY OF HEALTH AND MEDICAL SCIENCE IN
PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE
AWARD OF BSC IN NURSING
BY

DONKOR, COLLINS RUTHERFORD

AS 2619/ 17

JUNE, 2021

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 DECLARATION

Candidates Declaration

I hereby declare that, except for the references to other people’s work which have been cited, this

project work is the result of my own original research and that no part of it has been presented

for another degree in this university or elsewhere.

Candidate’s Signature: ………………… Date: ………………………………

Name: Donkor, Collins Rutherford

Supervisor’s Declaration

I hereby declare that the preparation and presentation of this research project work were

supervised in accordance with the guidelines on supervision of project work laid down by the

Presbyterian University College, Ghana.

Signature: ……………………………….. Date: ………………………………….

Name: Mr. Anthony Donyi

Head of Department’s Declaration

I hereby declare that the preparation and presentation of the project work were supervised in
accordance with the guidelines on supervision of project work laid down by the Presbyterian
University College, Ghana.

Head of Department’s Signature:………………….... Date: ………………………..

Name: Mr. Frank O. Bediako

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 ABSTRACT

Drug administration error that are made unintentionally by nurses continue to be a major concern

in hospitals, medical centers and other health care facilities not only in Ghana but worldwide.

The study assessed knowledge, perception and attitude of pregnant women towards caesarean

section in Agogo Presbyterian Hospital. The study used a descriptive cross-sectional study of

142 respondents who were selected using simple random sampling techniques. SPSS (version

24) was used to analyzed the data. Results showed all respondents (100%) indicated that they

had heard of CS before. On what CS is, most respondents (88.7%) explained that it is an incision

into the abdomen to deliver a baby. Furthermore, Majority of respondents (63.4%) indicated that

it is possible for a woman achieve vaginal delivery after a CS. Also, respondents (100%) stated

that CS helps in delivery when vaginal delivery is difficult. Concerning the perception of

pregnant towards CS, it was revealed that most respondents (95.8%) agreed that CS is caused by

family witches. Also, most respondents (90.8%) agreed that CS is for weaker women. On the

attitude of pregnant women towards CS. It was revealed that all respondents (100%) indicated

that they were not willing to undergo CS if necessary. Also, respondents (100%) indicated that

they were not willing to undergo a repeat CS. Again, respondents (100%) indicated that they

would not advice a friend on CS. It was recommended that health care professionals should

provide adequate education should be provided for pregnant women so as to help eliminate

misconceptions associated with CS.

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 DEDICATION

To my parents for their support and encouragement and also to my loved ones.

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 ACKNOWLEDGEMENT

My sincere thanks go to the almighty God for His protection and guidance through this course

and several difficult situations. Praise and Glory be to Him. I wish to express my profound

gratitude to my lectures, for without their guidance, support and patience this degree would never

been accomplished. I am also indebted to all the lecturers at the Department of Nursing,

Presbyterian University College, especially my supervisor Mr. Anthony Donyi for the advice,

supervision and inspirational support in the form of constructive criticism throughout the writing

of this research and I am highly appreciative. I owe him the deepest appreciation.

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 TABLE OF CONTENTS

DECLARATION............................................................................................................................i
ABSTRACT...................................................................................................................................ii
DEDICATION..............................................................................................................................iii
ACKNOWLEDGEMENT...........................................................................................................iv
TABLE OF CONTENTS..............................................................................................................v
LIST OF TABLES.......................................................................................................................vii

CHAPTER ONE............................................................................................................................1
INTRODUCTION.........................................................................................................................1
1.1. Background of the Study.......................................................................................................1
1.2. Statement of the Problem......................................................................................................3
1.3. Purpose of the Study.............................................................................................................5
1.4. Significance of the Study......................................................................................................5
1.5 Research Objectives...............................................................................................................6
1.6 Research Questions................................................................................................................6
1.7 Scope of the Study.................................................................................................................6
1.8 Methodology..........................................................................................................................6
1.9 Limitations and Delimitations of the Study...........................................................................7

CHAPTER TWO...........................................................................................................................8
LITERATURE REVIEW.............................................................................................................8
2.1 Overview of Cesarean Section...............................................................................................8
2.1.1 Revolution of Caesarian Birth.........................................................................................9
2.1.2 Caesarean Pros..............................................................................................................10
2.1.3 Caesarean Cons.............................................................................................................11
2.2 Knowledge of pregnant women on caesarean section.........................................................12
2.3 Attitude of attitude of pregnant women towards cesarean section......................................14
2.4 Perception of pregnant women towards cesarean section....................................................16

CHAPTER THREE.....................................................................................................................18

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METHODOLOGY......................................................................................................................18
3.1 Research Design...................................................................................................................18
3.2 Research Setting...................................................................................................................19
3.3 Study Population..................................................................................................................19
3.4 Sample Size and Sampling Method.....................................................................................20
3.4.1 Sample Size.......................................................................................................................20
3.4.2 Sampling Technique.........................................................................................................20
3.5 Tool for Data Collection and Method for Data Collection..................................................21
3.5.1 Tool for Data Collection...................................................................................................21
3.5.2 Method of Data Collection................................................................................................22
3.6 Method of Data Analyses.....................................................................................................22
3.7 Validity and Reliability........................................................................................................22
3.7.2 Reliability..........................................................................................................................23
3.8 Ethical Considerations.........................................................................................................23
3.9 Limitations and Delimitations of Study...............................................................................23
3.9.1 Limitations of Study..........................................................................................................23
3.9.2 Delimitations of Study......................................................................................................24

CHAPTER FOUR.......................................................................................................................25
RESULTS AND DISCUSSIONS................................................................................................25
4.1. Demographic Data..............................................................................................................25
4.2 Knowledge on Cesarean Section (CS).................................................................................27
4.3 Perception of pregnant women towards CS.........................................................................29
4.4 Attitude of pregnant women towards cesarean section........................................................31

CHAPTER FIVE.........................................................................................................................34
SUMMARY, CONCLUSION AND RECOMMENDATIONS...............................................34
5.1 Summary..............................................................................................................................34
5.2 Conclusions..........................................................................................................................36
5.3 Recommendations................................................................................................................36

REFERENCES............................................................................................................................37

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APPENDIX...................................................................................................................................41
Questionnaire ............................................................................................................................41

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 LIST OF TABLES

Table 1 Demographic Data

Table 2 Knowledge on CS

Table 3 Perception of pregnant women towards CS

Table 4 Attitude of pregnant women towards cesarean section

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 CHAPTER ONE

INTRODUCTION

1.1. Background of the Study

According to Van Dongen (2012) Caesarean Section (CS) is a surgical procedure in which one

or more incisions are made through a mother’s abdomen (laparotomy) and uterus (hysterotomy)

to deliver one or more babies, or to remove a dead fetus. It is one of the most important

operations performed in obstetrics and gynaecology. Its life saving value to both mother and

fetus has increased over the decades although specific indications for its use have changed. Its

purpose of preserving the life of a mother with obstructed labour and delivering a viable infant

from a dying mother have gradually expanded to include the rescue of the fetus from subtle

dangers. If there are no complications, a vaginal birth is safer than a CS. Advantages of having a

CS especially when it has been planned over the vaginal births includes: no contraction,

minimized risk of prolapse, no vaginal injury and reduced bleeding while its disadvantages

include: increased cost, uterine rupture and increased probability of complications (Van Dongen,

2012).

The rate of CS in developed countries are increasing as there has been a higher rate of

acceptability over time while developing countries are struggling with the issue of non-

acceptance of C/S even in the face of inherent danger/risk. This negative perception has led to

underutilization of the procedure (Chigbu and Iloabachie, 2010). Due to the current safety of the

procedure for both the mother and baby, the rates of CS in developed nations like in North

America and Europe has been increasing with the United States of America recording an average

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of 26.1%. China has been cited as having the highest rates of caesarean section in the world at

46% as of 2008 (Chigbu and Iloabachie, 2010).

In Nigeria, Geidam et al. (2015) recorded 11.6% as the rate of caesarean section in the

University College Hospital Ibadan between 2000-2005; Swende recorded 10.4% rate at the

federal medical centre Markudi between 2004-2006 while Chigbu and Iloabachie obtained

25.3% at the University teaching hospital, Enugu state, Nigeria between 2001 and 2005

(Swende, 2013).

According to the Centers for Disease Control [CDC], (2015) Australia recorded a surge from

21% to 31.9% between 1998 and 2007. While the overall rate of caesarean birth is lower in the

UK, accounting for almost 25% of all births from 2007 to 2008, it has however increased by

approximately 50% from 1995-1996.6 Birth rates via CS vary considerably across Europe,

ranging from an average of 15% in Norway and the Netherlands, 17% in Sweden and Finland

and increasing to 37.8% in Italy (Centers for Disease Control, 2015).

It is difficult to pinpoint an exact cause for the rising rates of Caesarean sections. Medical,

Institutional, legal, psychological and sociodemographic factors play a contributing role. India is

also not excluded from this trend. At the all-India level, the rate has increased from 2.9 per cent

of the childbirth in 1992-93 to 7.1 in 1998-99 and further to 10.2 per cent in 2005-06 (Swende,

2013).

Various factors such as: prolonged labour, foetal distress, cord prolapse, uterine rupture,

placental problems like placenta praevia, placenta accreta, abnormal presentation like breech or

transverse positions, failed instrumental delivery, macrosomia, contracted pelvis etc can

precipitate caesarean section. Other precipitating factors include lack of obstetric skill in

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performing breech births, multiple births, and improper use of technology (Electric Fetal

Monitoring (EFM) (Van Ham, et al., 2014).

Evidence shows that patients who are knowledgeable about their conditions are able to actively

participate in shared decision-making (Chigbu and Iloabachie, 2010). Due to their ignorance

about childbirth, they just submissively do what their provider tells them to. Therefore, they

cannot effectively talk about birth interventions with their providers, and agreeing for caesarean

delivery for medical and even for non-medical reason without knowing true risk and benefits of

the procedure. Since many providers prefer doing cesarean sections, the ignorance of pregnant

women is probably what is raising the cesarean section rate (Chigbu and Iloabachie, 2010).

The perceptions surrounding CS may have a significant role in the decision making process

which influenced by multiple complex factors like the reason for which the caesarean was

performed, her cultural values, her beliefs and anticipations of the birth, possible traumatic

events in her life, available social support, and her personal sense of control, are only a few (Van

Dongen, 2012).

The finding that women with only one child were more likely to undergo a caesarean section

may reflect women’s perceptions regarding the efficacy of the procedure as a means to ensure

newborn survival and to avert the risks of birth complications or stillbirth. A cohort study

showed that women are increasingly inclined to opt for delivery by caesarean for non-medical

reasons such as fear of labour pain, concerns about date or time of birth that are traditionally

believed to be auspicious and the belief that delivery by caesarean ensures protection of the

baby’s brain (Qazi, et al., 2013). The study seeks to identify the perception of pregnant women

towards cesarean section in Agogo Presbyterian hospital.

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1.2. Statement of the Problem

Caesarean section is an alternative for women whom vaginal delivery is not feasible. It involves

the delivery of a baby through an incision made on the uterus after the age of viability. Its

indications may be maternal or foetal. It is a relatively safe surgical procedure though may be

associated with complications (Jaiyesimi and Ojo, 2014).

In developed countries the incidence of caesarean section is on the increase unlike developing

nations. Women in less developed countries often think that caesarean section signifies

reproductive failure. It is usually bad news for them when told that they will be delivered

through caesarean section. For those that will eventually give their consent, it is done with

hesitation. This little time between counselling and giving consent for caesarean section may be

important in clinical practice for conditions such as foetal distress and antepartum haemorrhage

that require emergency caesarean section. With a positive perception of caesarean section, it is

expected that the decision-delivery interval will be reduced (Adeoye-Sunday and Kalu, 2015).

Previous studies have shown the knowledge and perception of caesarean section in various

settings. The results showed that women are not favourably disposed to caesarean section but

will accept it if the life of the mother and/or foetus are in danger (Owonikoko, et al., 2014).

Caesarean section has greatly contributed to improved obstetric care throughout the world. Even

though there is an increased rate of Caesarean section in both developed and developing

countries, there is a widely held belief that African women have an aversion for it and is

perceived as a “curse” of an unfaithful woman. It is therefore accepted reluctantly even in the

face of obvious clinical indications. Previous studies conducted among Ghanaian women

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indicated that majority of women prefer vaginal delivery to caesarean section and there are some

who will not accept the surgery even if indicated (Danso, et al., 2016).

According to Danso et al. (2016) although caesarean section is a consensus idea in developed

countries; in developing countries social and cultural paradigm is for women to reject caesarean

section due to certain beliefs. It was observed that education and past vaginal experiences can

also be a reason why women would most likely turn down caesarean section. for various reasons

which includes: maternal fear of death during surgery based on death of close relatives, past

unpleasant experiences in previous caesarean sections and unpleasant stories that they had heard

from other women, desire to experience vaginal delivery, perception that section was an

indication of reproductive failure, economic factor, inadequate counselling in the course of

antenatal care, complaints of uncaring or casual attitude of the doctors when giving the

information, religious belief in prophecies given that one would have a normal delivery (Danso,

et al., 2016). This study therefore seeks to assess the knowledge, perception and attitude of

pregnant women towards cesarean section in Agogo Presbyterian Hospital.

1.3. Purpose of the Study

The purpose of this study is to assess the knowledge, perception and attitude of pregnant women

towards cesarean section in Agogo Presbyterian Hospital.

1.4. Significance of the Study

The study will provide insights into how the perception and attitude of pregnant women

influence cesarean section. By understanding the perception and attitude of pregnant women

towards cesarean section, the ministry of health can develop future programs aimed at promoting

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cesarean section while eliminating negative perception and barriers to it. The study will also

serve as a reference material for future research work.

1.5 Research Objectives

1.5.1 Main Objectives

To assess the knowledge, perception and attitude of pregnant women towards cesarean section in

Agogo Presbyterian Hospital.

1.5.2 Specific Objectives

1. To assess the knowledge of pregnant women on cesarean section

2. To identify the perception of pregnant women towards cesarean section.

3. To find out the attitude of pregnant women towards cesarean section.

1.6 Research Questions

1. What is the knowledge of pregnant women on cesarean section?

2. What is the perception of pregnant women towards cesarean section?

3. What is the attitude of pregnant women towards cesarean section?

1.7 Scope of the Study

The present study will investigate the perception and attitude of pregnant women towards

cesarean section in Agogo Presbyterian hospital. Also, the study will be focused on the

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knowledge of pregnant women on cesarean section and the factors that influence pregnant

women concerning cesarean section.

1.8 Methodology

This study will be a descriptive cross-sectional study which will use structured questionnaires. A

sample size of 142 participants will be obtained using the convenient sampling technique and

self-administered questionnaires. Data will be analysed descriptively using Statistical Package

for Social Sciences (SPSS 20.0).

1.9 Limitations and Delimitations of the Study

1.9.1 Limitation of the Study

Since the research will be carried out at in Agogo Presbyterian hospital and the results of the

study cannot be generalized as an accurate reflection of the perception and attitude of pregnant

women on cesarean section in the whole of Ghana. The time limit in carrying out the study will

be a limitation to the study. Lastly, since the study will depend on the accurate and truthful

response from the study participants, the results cannot be guaranteed of any bias.

1.8.2. Delimitation of the Study

The study will be delimited in scope on knowledge, perception and attitude of pregnant women

towards cesarean section in Agogo Presbyterian Hospital. This will help the researcher to focus

on such scope.

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 CHAPTER TWO

LITERATURE REVIEW

2.0 Introduction
Literature reviewed was done with respect to the specific objectives of the study. Information

regarding the topic areas were searched from google scholar, PUC library database such as

Hinary, ect, open sources such as ResearchGate, academia, etc.

2.1 Overview of Cesarean Section

Birth is the method through which the animals reproduce themselves. Giving birth can be natural

or be through Cesarean Section (C-section). C-section refers to the procedure of delivering a

child by operating the abdomen of the delivering mother. As commonly known, the C-section

has been practiced for several decades now. From the ancient Roman history, Cesarean section

was named after the birth of Julius Caesar who was the first to be born through the C-section

(Levine, 2012).

During the Roman times, the C-section procedure was only practiced when saving the baby from

a dying or dead mother. The method was used as the last option if vaginal birth fails, or when

there is a breech presentation. However, the mother of Julius Caesar survived the procedure thus

showing the success of the C-section (Sewell, 2014). Similarly, the ancient Jewish literature

argued that the surgical delivery was possible without losing the mother thereby increasing the

8
survival rates. However, very few women would have survived from this delivery because of the

wound infection and bleeding. Due to this argument, the procedure was rarely practiced and was

only intended to save the baby rather than the mother (Sewell, 2014).

According to history, the first mother to survive the C-section was in the 1580s in Switzerland.

The surgery was done by Jacob Nufer, a pig gelder who operated his wife when her labor failed

to progress. His wife healed well and went on to have five more deliveries through vaginal birth.

All through this time, anesthesia was not yet discovered, so the mother was subjected to painful

cuttings on her abdomen. From seventeenth to the nineteenth century, cadavers and introduction

of anesthesia helped to ease medical techniques such as caesarean section procedure. In this

paper, I shall review the benefits, implications, arguments, and counterarguments behind C-

sections procedure as an alternative to giving birth (Levine, 2012).

2.1.1 Revolution of Caesarian Birth

Today, C-section procedure has become part of human culture in both western and non-western

culture (Ponte, 2007). Though the intention of this process was to do in an emergency, it has

been exploited by many medics. Taking America for instance, the rates of C-section have

increased overwhelmingly. According to medical reports, 30 percent of all deliveries done in the

country are done through C-section (Andrew, 2015). In fact, most women prefer surgical

delivery over the natural birth because of own arguments. On the other hand, medical

practitioners have been accused of conducting unnecessary C-section procedures (Andrew,

2015).

9
A study done by Journal of medicines found out that more than a third of cesareans are done too

early like before the 39 weeks of pregnancy thereby putting these babies at the risk of many

health problems (Ponte, 2007). For instance, the baby faces respiratory distress because her lungs

are not well developed to breathe independently. Therefore, early C-section has caused many

newborns to make frequent visit to intensive care unit to seek specialized care. According to

researchers, elective C-section are more safe to the baby’s health when done between 39 to 41

weeks of pregnancy. These researchers have done campaigns across countries to inform women

on the safest way of delivery (Andrew, 2015).

When caesarean birth is compared to vaginal birth, several risks should be understood by the

mother before rushing to unnecessary decisions. Every woman should learn the caesarean section

Pros and Cons to themselves and the baby.

2.1.2 Caesarean Pros

For the mother,

Many women choose C-section because there is no need to go through long hours of labor which

is painful to them. The contraction of the uterus and expansion of the genitals cause a lot of pain

to the mother. Under planned caesarean procedure, a mother can make plans for the birth, thus

giving more control over delivery predictability. Similarly, surgical delivery is opted by many

women because it does not have damages caused by natural birth on the pelvic floor. Mothers

who use C-section face less risk of sexual dysfunction, which occurs during the first three

months postpartum (Ayalon, 2015).

For the Baby,

10
In a situation of large babies or a twin case, C-section is the best option because it is easy for

doctors to access the children. The procedure has saved children from premature births,

accidents, breech presentation, and birth distress. Also, surgical birth has been used to mothers

with HIV and who show a high viral load (Andrew, 2015). In such a case, the procedure reduces

the risk of passing the infection to the baby. Other diseases such as high blood pressure are well

resolved by caesarean because natural birth requires labor that endanger the life of both the

mother and the child. The newborns delivered through the C-section faces a little threat of

oxygen deprivation and birth trauma (Levine, 2012).

2.1.3 Caesarean Cons

For the mother,

The fact that C-section is a surgery, then a mother needs a longer time than giving birth

naturally. Just like any other surgery, C-section wound requires extra care to reduce the risk of

infection. Similarly, a mother who undergoes caesarean has immediate contact neither her baby

nor breastfeeding. Due to this, psychologists claim that this might affect the bonding process

between the child and the mother. According to doctors, parents who have several C-sections are

unable to have a vaginal birth in future (Levine, 2012).

For the baby,

Due to the use of anesthesia, some babies delivered through caesarean have respiratory problems

such as asthma. There are also rare cases where C-section has led to stillbirth. According to

recent medical studies, children born through C-section have a high risk of becoming obese

though there is no explicit theory to prove this argument (Andrew, 2015). Though these type of

11
cases rarely exists, expectant mothers should still consider them before opting to have a C-

section.

The Caesarean Birth

Medical institutions have taken years to provide better healthcare services and delivery. From

their appreciated work, new techniques and treatments have been introduced to healthcare

centers. However, the changes in nutrition and weather have been cited as the biggest challenge

to human health. The growth in science and technology has made various complications to be

easily handled. For instance, obstetricians have been able to reduce the rate of birth

complications (Ayalon, 2015).

From the above Pros and cons of caesarean, it clear that the procedure is not a perfect way to

deliver a baby. However, nurses and doctors give different advice to different expectant mothers

because not all pregnancies are the same. Under the medical studies, C-section is entitled to

expectant mothers who have no option of natural birth. However, the simplification of caesarean

has attracted many women who fear labor pains.

According to me, it is necessary for an expectant mother to consider both the pros and cons of

caesarean before making it the final decision. Similarly, medics need to advise mothers who rush

for C-sections because of its simplicity. In most cases, health practitioners are the cause of the

increase rate of cesareans in the world because they advise mothers to have unnecessary

surgeries. Mothers should get back to their conscious and understand the dangers behind

caesarean. According to human science, the body of a pregnant woman undergoes internal and

external changes to prepare itself for the vaginal delivery. Therefore, natural birth is easy and

healthy to both the baby and the mother. Most mothers assume this knowledge and instead rush

12
for unnecessary C-sections. The human body has an agent or a hormone that is responsible for

stopping and clotting blood. This hormone is also used in vaginal birth to control bleeding thus

reducing the chances of prolonged medication like in surgical birth (Sewell, 2014).

2.2 Knowledge of pregnant women on caesarean section

A study by Aminidav & Weller (2015) showed that pregnant women knowledge about caesarean

section was poor. The findings suggest that pregnant women showed a poor understanding of

caesarean section (Gordon et al., 2014), and synonymous terms, and that awareness of caesarean

section varies considerably between different pregnant women. On this note, educated pregnant

women showed more accurate as well as a greater breadth of knowledge about caesarean section

than less educated pregnant women (Aminidav & Weller, 2015).

Ohene and Akoto (2008) indicated that lack of knowledge about caesarean section can

discourage pregnant women from accepting caesarean section. Pregnant women have poor

knowledge and attitude about caesarean section especially those from cultures characterized by

conservative birth attitudes (Lallemand et al., 2016). Two recent surveys found that educated

pregnant women were significantly more likely than non-educated pregnant women to be

knowledgeable about caesarean section. Poor knowledge can translate into misconceptions

about caesarean section and about accepting it (Lallemand et al., 2016).

Satchidanand et al. (2014) posit that pregnant women had poor knowledge about caesarean

section as they were likely to have negative attitudes towards caesarean section. The finding

corroborates with a study by Cruddock and Maccomack (2015) that pregnant women knew less

about caesarean section only to be told be a nurse.

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According to a study by Adageba et al. (2014) there is general awareness about CS in Nigeria;

however, the 99% acceptance rate noted in this study is higher than 91% in the same report from

Ghana. It is also higher than the 85% from Ibadan in southwest Nigeria, 81% from Abakaliki in

southeast and much higher than the 68% reported from Port Harcourt in southsouth. Eighty-two

percent of the respondents surveyed would accept to have a repeat CS compared to the 65%

noted in the study from Port Harcourt however the reasons highlighted by these women for not

accepting a repeat CS were similar. Fifty-two percent of the respondents in this study would not

accept a repeat CS due to fear of pain compared to the 19% noted in Port Harcourt while 49% of

the respondents in this study would not accept repeat CS due to concern about dying which is

higher than the 36% observed in the study from Port Harcourt.

Bako et al. (2013) in their study indicated that although this study revealed that 93.8% of the

respondents were aware of CS, 40.9% had adequate knowledge of it while 2.7% knew that the

woman undergoing CS was required to give consent for the surgery. This may be explained by

the fact that most of the respondents surveyed were not educated and were unemployed hence

they solely depended on their husbands for guidance and financial support. This would imply

that in the event that an emergency CS is required, obtaining consent for the procedure would

constitute a form of delay at the health facility as the patient may wait for her husband to come

and give consent.

This buttresses the findings of Ashimi et al. (2014) in a cross sectional study among women who

presented with obstetric emergencies at a tertiary hospital in northeast Nigeria to determining the

informed consent practices and implication. They found out that consent was significantly

delayed when given by husbands, in-laws and relatives and this contributed significantly to

increased maternal and foetal morbidity and mortality among the group with delayed consent.

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2.3 Attitude of attitude of pregnant women towards cesarean section

Attitudes are likes and dislikes- affinities for or aversions to objects, persons, groups, situations,

or any other identifiable aspects of the environment, including abstract ideas and social policies

(Atkinson et al., 2015). Attitude comprise of three components; affective, behavioural and

cognitive (Mishra, 2014). Affective is shown by positive or negative emotional expression

towards people, events or object. Behavoural is the tendency to behave in a particular way

towards people, events, actions. and, cognitive refers to our beliefs formed about the object or

person. (Mishra, 2014).

Research at Michigan state university explored the effect of caesarean section. The authors were

of the view that negative perceptions and attitudes toward caesarean section persist. These

invisible barriers serve to limit interventions towards caesarean section and fuel the reciprocity

of negative attitudes. Research suggests that social proximity to caesarean section is a major

factor affecting how these attitudes manifest themselves. (Schoen et al., 2014).

Tervo et al. (2014) investigated the pregnant women attitudes toward caesarean section. A cross

sectional survey of 338 pregnant women of South Dakota was carried out. All respondents’

attitudes were less positive. No attitudinal differences by age, those with background in

caesarean section had more positive attitude. The author concluded that pregnant women were at

greater risk of holding negative attitudes and recommend specific educational experiences to

promote more positive attitudes (Tervo et al., 2014).

A cross sectional studies of 128 pregnant and non-pregnant women in the Netherlands were

recruited to join this research. Both pregnant and non-pregnant women scored negative in

attitude toward caesarean section (Tervo et al., 2014).

15
A study completed by Kim et al. (2015) comparing the attitudes of pregnant women toward

caesarean section revealed that most pregnant women have negative attitudes toward caesarean

section and preferred not to do it.

Torbjorn (2015) also reported the existence of negative attitude in Sweden among pregnant

women. Respondents with knowledge also display stigmatizing attitudes.

Rao et al. (2014) also studied 108 pregnant women attitudes toward caesarean sections.

Participants had highly stigmatized attitudes towards caesarean section from a forensic hospital.

An overwhelming majority of women in this study preferred vaginal delivery (91.5%) and

potential demand for CS was mere (8.5%). Most preferred vaginal delivery as it is natural way to

deliver (64.7%) and safer way to deliver (29.2%) (Hubert, 2014).

A study in Nigeria, Ibadan in southwest showed that Eighty-two percent of the respondents

surveyed would accept to have a repeat CS compared to the 65% noted in the study from Port

Harcourt however the reasons highlighted by these women for not accepting a repeat CS were

similar. Fifty-two percent of the respondents in this study would not accept a repeat CS due to

fear of pain compared to the 19% noted in Port Harcourt while 49% of the respondents in this

study would not accept repeat CS due to concern about dying which is higher than the 36%

observed in the study from Port Harcourt (Adageba et al., 2014).

16
2.4 Perception of pregnant women towards cesarean section

Perceptions of caesarean section are neither fixed nor similar but varied significantly across

culture and nations. While several successes have been achieved in the developed countries there

have however been some drawbacks recorded in developing countries as having a caesarean

section in the developing country still exposes the individual to neglect, stigma and

discrimination (Ndeezi, 2014).

Lam et al. (2014) identified misperceptions about caesarean section and lack of caesarean section

-specific knowledge as important interrelated factors hindering access to quality health care.

A study by Magallona and Datangel (2014) posit a strong case that perception usually emerges

because of a lack of experiences and limited knowledge on caesarean section related issues.

A recent large scale survey in the UK concluded that pregnant woemn’ understanding of

caesarean section is still limited (Mencap, 2013). This is of concern as lack of awareness about

caesarean section has been linked to negative perception more prevalent in some cultures, such

as caesarean section is due to immorality or unchaste life (Hatton et al., 2016; Hughes, 1983) or

punishment for past sins (Hubert, 2014).

Based on a large scale survey, Gilmore et al. (2016) concluded that pregnant women in Africa

showed some significant misconceptions about caesarean section, despite showing reasonably

knowledge about caesarean section. Twenty-six per cent of their respondents believed caesarean

section to be caused by immoral lifestyle and witchcrafts.

17
 CHAPTER THREE

METHODOLOGY

3.0 Introduction

This chapter includes a discussion of the methods that were used for this study. More

specifically, the chapter includes a discussion of the study site and the design of this research.

The remainder of this chapter includes the discussion of the scale development procedures,

sampling strategies, data collection techniques and statistical analysis procedures that was used

to analyze the data.

3.1 Research Design

The design of the study was a descriptive cross-sectional study and that assessed the knowledge,

perception and attitude of pregnant women towards caesarean section in Agogo Presbyterian

Hospital. A descriptive research was used to obtain information concerning the current status of

the phenomena to describe "what exists" with respect to variables or conditions in a situation.

This research design has a lot of advantages such as it is relatively quick and easy to conduct, no

problems with drop outs and data on all variables are only collected once. This type of study has

been chosen because it is suitable for short term investigations and often involves data collection

at a specific point in time. Cross-sectional study is relatively easy and inexpensive to carry out

18
and also useful for investigating individuals or groups with the same or similar characteristics.

The study does not give much accurate result since the study involves only a representative

sample of the entire population under study.

3.2 Research Setting

The study was conducted at the Agogo Presbyterian Hospital in the Asante Akyem municipality.

It is a CHAG hospital which also operates under the Presbyterian Health Services and is

popularly known for its specialty in Ophthalmological care. The hospital is accredited for the

training of both House officers and Physician Assistant interns in all specialties as well as a

training centre for Surgery and Pediatric Residents. It is also a Public Health Research centre for

the Kwame Nkrumah University of Science and Technology as well as a Malaria Vaccine

Research Center. The hospital also serves as a training center for the Agogo Presbyterian Nurses

and Midwifery Training school (APNMTC) as well as the Faculty of Health and Medical

Sciences of the Presbyterian University College, Ghana. Asante Akyem Agogo is located in the

Ashanti region. Its share boundaries with Juansa which is closer to Konongo on the south, then

shares boundaries with Kwahu to the east, Kumawu to the west and Afram plains to the north.

The hospital offers varies services ranging from outpatient services, maternal and child health,

laboratory and other imaging studies, specialist care emergency services among others. Agogo

Presbyterian Hospital has a total number of about two hundred and fifty (250) beds.

19
3.3 Study Population

The study population covered pregnant women attending antenatal at the Agogo Presbyterian

hospital. The hospital has about 220 pregnant women attending antenatal a day at the Agogo

Presbyterian hospital.

Inclusion criteria: only pregnant women who attended ANC at Agogo Presbyterian Hospital

and had attended ANC for at least two or more.

Exclusion criteria: excluded pregnant women visiting for the first time at the Agogo ANC.

3.4 Sample Size and Sampling Method.

3.4.1 Sample Size

Using a total of 220 pregnant women, a sample size 142 was determined using the Yamane

formula (1967) with an error 5% and with a 95% Confidence coefficient.

Using the Yamane formula (1967)

n= N
1+N e2

Where n= the sample size

N= the size of population
e=the error of 5percentage points
n= 220
1+220(0.0052)
= 220
1+220(0.0025) =141.93
=142 respondents

20
3.4.2 Sampling Technique

A sampling technique is the name or other identification of the specific process by which the

entities of the sample have been selected. The simple random technique was use in selecting

respondents for the study. A simple random sample is a subset of a statistical population in

which each member of the subset has an equal probability of being chosen (Polit and Beck,

2014). A simple random sample is meant to be an unbiased representation of a group and this is

an advantage in using simple random technique. Also, ease of use represents the biggest

advantage of simple random sampling. Unlike more complicated sampling methods such as

stratified random sampling and probability sampling, no need exists to divide the population into

subpopulations or take any other additional steps before selecting members of the population at

random. Polit and Beck (2014) defined eligibility criteria as the criteria that specify the

characteristics that people in the population must possess, to be considered for inclusion in a

study.

3.5 Tool for Data Collection and Method for Data Collection

3.5.1 Tool for Data Collection

The survey involved self-administration of an anonymous written questionnaire. Respondents

were asked to indicate using a 3-point Likert scale (strongly disagree to strongly agree) and

dichotomous answers (yes and no) to respond questions on the knowledge of pregnant women on

cesarean section, perception of pregnant women towards cesarean section and the attitude of

pregnant women towards cesarean section. The questionnaires were distributed and collected in

21
unmarked envelopes by the researcher, with the support of research assistant. Those who did not

wish to participate were encouraged to return the questionnaire unanswered. The items in the

questionnaire was categorized into 4 sections: socio- demographic data, knowledge, perception

and attitude of pregnant women towards cesarean section. The entire questionnaire included

items on: demographic section, on knowledge, perception and attitude of pregnant women

towards cesarean section. Under socio-demographic section, data was collected on variables such

as age, marital status, and educational level.

3.5.2 Method of Data Collection

As indicated, data was collected at the Agogo Presbyterian Hospital among pregnant women at

the hospital. Data collection was done by administration of questionnaire which were open and

closed ended questionnaires. That is data was collected on the background of respondents,

knowledge of pregnant women on cesarean section, perception of pregnant women towards

cesarean section and the attitude of pregnant women towards cesarean section. The

questionnaires were administered by the researcher with help of research assistant.

3.6 Method of Data Analyses

Statistical Package for Social Sciences (SPSS) version 20.0 was used for data entry and analysis.

Statistical frequency distribution table and percentages were calculated according to variables

which related to the objectives and research questions of the study.

3.7 Validity and Reliability

3.7.1 Validity

22
Validity refers to the degree to which the instrument used measures what it is supposed to

measure. In general, VALIDITY is an indication of how sound the research is. More specifically,

validity applies to both the design and the methods of the research. Validity in data collection

means that research findings truly represent the phenomenon the researcher is claiming to

measure. Valid claims are solid claims. The study findings represented the actual phenomenon of

the study.

3.7.2 Reliability

Reliability on the other hand is the degree of consistency with which the instrument measures the

attributes under study. To assess this, a pretesting of the instrument was conducted using ten (10)

respondents at the Agogo Presbyterian Hospital before the main study was conducted. Based on

the responses that were gathered, some questions were re-framed of errors that were encountered

before the actual study was carried out.

3.8 Ethical Considerations

Since the respondents are human beings with rights, their rights were observed as such. Adequate

information was given regarding the research and the respondents were made aware that they can

either choose to participate or decline to take part in the study and that no punishments or

rewards offered. Respondents were made to understand that they could voluntarily leave the

study at any time without incurring any penalty or pre-judicial treatment. Respondents were not

coerced to participate in the study. Approval was sought from the Hospital Authority. Data

23
collected was kept confidential and anonymity ensured. Coding systems were developed so that

sources of various data were identified only by the researcher.

3.9 Limitations and Delimitations of Study

3.9.1 Limitations of Study

Since the research was carried out at in Agogo Presbyterian hospital and the results of the study

cannot be generalized as an accurate reflection of the perception and attitude of pregnant women

on cesarean section in the whole of Ghana. The time limit in carrying out the study was a

limitation to the study. Lastly, since the study depended on the accurate and truthful response

from the study participants, the results cannot be guaranteed of any bias.

3.9.2 Delimitations of Study

The study was delimited in scope on knowledge, perception and attitude of pregnant women

towards cesarean section in Agogo Presbyterian Hospital. This helped the researcher to focus on

such scope.

24
 CHAPTER FOUR

RESULTS AND DISCUSSIONS

4.1. Demographic Data

The demographic data involves the background of respondents; it involves age, marital status,

occupation and educational level of respondents.

Table 1 Demographic Data

Variables Frequency Percentage (%)
Age
Below 19 years 16 11.3
20-25 32 22.5
26-31 40 28.2
32-37 23 16.2
38-43 15 10.6
44 and above 16 11.3
Total 142 100.0
Educational level
None 29 20.4
Middle/JHS 57 40.1
Secondary 28 19.7
Tertiary 28 19.7
Total 142 100.0
Monthly income

25
 200-300 29 20.4
400-500 29 20.4
Above 500 84 59.2
Total 142 100.0
Ethnic group
Akan 58 40.8
Ewe 37 26.1
Ga 31 21.8
Northerners 16 11.3
Total 142 100.0
Religious affiliation
Christianity 111 78.2
Traditional 8 5.6
Islam 23 16.2
Total 142 100.0
Marital status
Married 84 59.2
Separated/divorced 8 5.6
Single 33 23.2
Co-habiting 17 12.0
Total 142 100.0
Number of children
1-3 79 55.6
4-6 47 33.1
More than 7 16 11.3
Total 142 100.0
Source: field survey, (2021)

Table 1 showed information on respondents’ demographic background, it was revealed that out

of 142 respondents, 11.3% were below 19 years, 22.5% were between 20-25 years, 28.2% were

were between 26-31 years. 16.2% were between 32-37 years, 10.6% were between 38-43 years

and another 11.3% were 44 years and above. Also, 20.7% had middle/JHS education, 20.4% had

no education, 19.7% had secondary education and another 19.7% of respondents had tertiary

education. Majority of respondents (70.6%) were married, 17.3% were separated,

divorced/widowed and 12.2% were single. On occupation, 87.3% were traders, 6.6% were

26
farmers whilst 6.1% were government workers. On religion, majority of respondents (58.9%)

were Christians, 35% were Islamic, whereas 6.1% were traditionalist. Majority of respondents

(58.4%) were Akans, 35.5% were Ewes, and 6.1% were Ga-Adangbes.

On respondents’ income level, 59.2% of respondents’ income level was above 500 Ghana Cedis,

20.4% of respondents’ income level was between 200-300 Ghana Cedis and another 20.4% of

respondents’ income level was between 400-500 Ghana Cedis.

4.2 Knowledge on Cesarean Section (CS)

Table 2 Knowledge on CS

Variables Frequency Percentage (%)

Have you heard about CS
Yes 142 100.0
Total 142 100.0
If yes where did you hear about cesarean
section/source of information
From school 49 34.5
Health personnel/hospital 64 45.1
Friends 29 20.4
Total 142 100.0
In your opinion what is cesarean section
Operation on mother during birth 8 5.6
An incision into the abdomen to deliver a baby 126 88.7
Not sure 8 5.6
Total 142 100.0
Do you know why CS is done
Yes 142 100.0
Total 142 100.0
If yes, why
To help deliver the baby when vaginal delivery
78 54.9
is difficult
To prevent the mother from dying 64 45.1
Total 142 100.0

27
 What are indications for Caesarean section
Prolonged labour due to big baby 117 82.4
Small pelvis for the size of baby 25 17.6
Total 142 100.0
Is it possible for a woman achieve vaginal
delivery after a CS
No 52 36.6
Yes 90 63.4
Total 142 100.0
CS helps in delivery when vaginal delivery is
difficult
Yes 142 100.0
Total 142 100.0
Giving a fixed cost for both vaginal delivery
and CS which one would you prefer most
vaginal delivery 142 100.0
Total 142 100.0
Source: field survey, (2021)

Table 2 depicted information on respondents’ knowledge on Cesarean Section (CS). It was

revealed that all respondents (100%) indicated that they had heard of CS before. On sources of

information on CS, respondents indicated that they heard about CS from the school (34.5%),

health personnel/hospital (45.1%), and friends (20.4%

=. On what CS is, most respondents (88.7%) explained that it is an incision into the abdomen to

deliver a baby. This is in line with a study by Bako et al. (2013) as the study indicated that

although this study revealed that 93.8% of the respondents were aware of CS, 40.9% had

adequate knowledge of it while 2.7% knew that the woman undergoing CS was required to give

consent for the surgery. On the contrary, Satchidanand et al. (2014) posit that pregnant women

had poor knowledge about caesarean section as they were likely to have negative attitudes

towards caesarean section. The finding corroborates with a study by Cruddock and Maccomack

(2015) that pregnant women knew less about caesarean section only to be told be a nurse.

28
All respondents (100%) indicated that yes, they know why CS is done. On why CS is done,

respondents stated to help deliver the baby when vaginal delivery is difficult (54.9%) and to

prevent the mother from dying (45.1%).

Furthermore, Majority of respondents (63.4%) indicated that it is possible for a woman achieve

vaginal delivery after a CS. Also, respondents (100%) stated that CS helps in delivery when

vaginal delivery is difficult. Lastly, all respondents (100%) indicated that giving a fixed cost for

both vaginal delivery and CS the one they would prefer most is vaginal delivery.

4.3 Perception of pregnant women towards CS

Table 3 Perception of pregnant women towards CS

Variables Frequency Percentage (%)
Cesarean section is caused by family witches
Agree 136 95.8
Disagree 6 4.2
Total 142 100.0
Cesarean section is caused by punishment by
God for sins commented
Disagree 105 73.9
Neutral 6 4.2
Agree 31 21.8
Total 142 100.0
Cesarean section is for weaker women
Agree 129 90.8
Neutral 7 4.9
Disagree 6 4.2
Total 142 100.0
Cesarean section shows that a pregnant
woman is not capable to deliver
Disagree 129 90.8
Neutral 6 4.2
Agree 7 4.9
Total 142 100.0
Caesarean section is dangerous to a

29
 woman’s health
Agree 136 95.8
Disagree 6 4.2
Total 142 100.0
CS is associated with pain during and after
surgery
Agree 142 100.0
Total 142 100.0
CS associated with fear of dying
Agree 128 90.1
Neutral 8 5.6
Disagree 6 4.2
Total 142 100.0
CS is associated with being mocked
Disagreed 142 100.0
Total 142 100.0
Source: field survey, (2021)

In table 3, on the perception of pregnant women towards cesarean section, most respondents

(95.8%) agreed that CS is caused by family witches. Also, most respondents (90.8%) agreed that

CS is for weaker women. As high as 95.8% of respondents agreed that CS is dangerous to a

woman’s health. All respondents (100%) agreed that CS is associated with pain during and after

delivery. Most respondents (90.1%) agreed that CS is associated with fear of dying.

On the other hand, most respondents (73.9%) disagreed that CS is caused by punishment by God

for sins committed. Most respondents (90.8%) disagreed that CS shows that a pregnant woman is

not capable to deliver. All respondents (100%) disagreed that CS is associated with being

mocked.

The above findings therefore showed respondents had some misconceptions about CS as most

respondents (95.8%) perceived CS to be caused by family witches. Also, most respondents

(90.8%) perceived that CS is for weaker women. As high as 95.8% of respondents perceived that

CS is dangerous to a woman’s health. All respondents (100%) perceived that CS is associated

30
with pain during and after delivery. Most respondents (90.1%) perceived that CS is associated

with fear of dying. These are supported in a study based on a large scale survey, Gilmore et al.

(2016) concluded that pregnant women in Africa showed some significant misconceptions about

caesarean section, despite showing reasonably knowledge about caesarean section. Twenty-six

per cent of their respondents believed caesarean section to be caused by immoral lifestyle and

witchcrafts. Lam et al. (2014) identified misperceptions about caesarean section and lack of

caesarean section -specific knowledge as important interrelated factors hindering access to

quality health care. A study by Magallona and Datangel (2014) posit a strong case that

perception usually emerges because of a lack of experiences and limited knowledge on caesarean

section related issues. A recent large scale survey in the UK concluded that pregnant women’

understanding of caesarean section is still limited (Mencap, 2013). This is of concern as lack of

awareness about caesarean section has been linked to negative perception more prevalent in

some cultures, such as caesarean section is due to immorality or unchaste life (Hatton et al.,

2016; Hughes, 1983) or punishment for past sins (Hubert, 2014).

4.4 Attitude of pregnant women towards cesarean section

Table 4 Attitude of pregnant women towards cesarean section

Variables Frequency Percentage (%)

Are you willing to undergo cesarean section if
necessary
No 142 100.0
Total 142 100.0
Are you willing to undergo a repeat CS
No 142 100.0
Total 142 100.0
Would you advice a friend on cesarean section
No 142 100.0

31
 Total 142 100.0
Do you deem cesarean section important and
good practice
No 142 100.0
Total 142 100.0
Are you afraid to undergo cesarean section
Yes 142 100.0
Total 142 100.0
If yes why
I will become weak after CS 6 4.2
I can die 136 95.8
Total 142 100.0
Source: field survey, (2021)

Table 4 depicted information the attitude of pregnant women towards CS. It was revealed that all

respondents (100%) indicated that they were not willing to undergo CS if necessary. Also,

respondents (100%) indicated that they were not willing to undergo a repeat CS. Again,

respondents (100%) indicated that they would not advice a friend on CS. Furthermore,

respondents (100%) did not deem CS important and good practices. All respondents (100%)

indicated that they were afraid to undergo CS.

Reasons respondents were afraid to undergo CS were because they fear they could die (95.8%)

and they would become weak after CS (4.2%). These results showed that respondents showed

negative attitude towards CS as they were not willing to undergo CS because they were afraid

they could die or become weak. Similarly, a cross sectional studies of 128 pregnant and non-

pregnant women in the Netherlands were recruited to join this research. Both pregnant and non-

pregnant women scored negative in attitude toward caesarean section (Tervo et al., 2014). A

study completed by Kim et al. (2015) comparing the attitudes of pregnant women toward

caesarean section revealed that most pregnant women have negative attitudes toward caesarean

section and preferred not to do it. Besides, Torbjorn (2015) also reported the existence of

32
negative attitude in Sweden among pregnant women. Respondents with knowledge also display

stigmatizing attitudes.

Contrary, Tervo et al. (2014) investigated the pregnant women attitudes toward caesarean

section. A cross sectional survey of 338 pregnant women of South Dakota was carried out. All

respondents’ attitudes were less positive. No attitudinal differences by age, those with

background in caesarean section had more positive attitude. The author concluded that pregnant

women were at greater risk of holding negative attitudes and recommend specific educational

experiences to promote more positive attitudes (Tervo et al., 2014).

33
 CHAPTER FIVE

SUMMARY, CONCLUSION AND RECOMMENDATIONS

5.1 Summary

The current study assessed perception and attitude of pregnant women towards cesarean section

in Agogo. The study used a descriptive cross-sectional study of 142 respondents for the study.

SPSS (version 24) was used to analyzed the data.

On respondents’ demographic background, it was revealed that out of the 142 respondents,

11.3% were below 19 years, 22.5% were between 20-25 years, 28.2% were between 26-31 years,

16.2% were between 32-37 years, 10.6% were between 38-43 years and another 11.3% were 44

years and above. On respondents’ income level, 59.2% of respondents’ income level was above

500 Ghana Cedis, 20.4% of respondents’ income level was between 200-300 Ghana Cedis and

another 20.4% of respondents’ income level was between 400-500 Ghana Ceids.

With regards to the knowledge of respondents on CS. It was revealed that all respondents (100%)

indicated that they had heard of CS before. On sources of information on CS, respondents

indicated that they heard about CS from the school (34.5%), health personnel/hospital (45.1%),

34
and friends (20.4%). On what CS is, most respondents (88.7%) explained that it is an incision

into the abdomen to deliver a baby. All respondents (100%) indicated that yes, they know why

CS is done. On why CS is done, respondents stated to help deliver the baby when vaginal

delivery is difficult (54.9%) and to prevent the mother from dying (45.1%). Furthermore,

Majority of respondents (63.4%) indicated that it is possible for a woman achieve vaginal

delivery after a CS. Also, respondents (100%) stated that CS helps in delivery when vaginal

delivery is difficult. Lastly, all respondents (100%) indicated that giving a fixed cost for both

vaginal delivery and CS the one they would prefer most is vaginal delivery.

Concerning the perception of pregnant towards CS, it was revealed that most respondents

(95.8%) agreed that CS is caused by family witches. Also, most respondents (90.8%) agreed that

CS is for weaker women. As high as 95.8% of respondents agreed that CS is dangerous to a

woman’s health. All respondents (100%) agreed that CS is associated with pain during and after

delivery. Most respondents (90.1%) agreed that CS is associated with fear of dying. The above

findings therefore showed respondents had some misconceptions about CS as most respondents

(95.8%) perceived CS to be caused by family witches. Also, most respondents (90.8%) perceived

that CS is for weaker women. As high as 95.8% of respondents perceived that CS is dangerous to

a woman’s health. All respondents (100%) perceived that CS is associated with pain during and

after delivery. Most respondents (90.1%) perceived that CS is associated with fear of dying.

On the attitude of pregnant women towards CS. It was revealed that all respondents (100%)

indicated that they were not willing to undergo CS if necessary. Also, respondents (100%)

indicated that they were not willing to undergo a repeat CS. Again, respondents (100%) indicated

that they would not advice a friend on CS. Furthermore, respondents (100%) did not deem CS

important and good practices. All respondents (100%) indicated that they were afraid to undergo

35
CS. Reasons respondents were afraid to undergo CS were because they fear they could die

(95.8%) and they would become weak after CS (4.2%). These results showed that respondents

showed negative attitude towards CS as they were not willing to undergo CS because they were

afraid, they could die or become weak.

5.2 Conclusions

In concluding, pregnant women had a fair knowledge on CS. Their sources of information on CS

included the school, health personnel/hospital and friends. most respondents explained CS as an

incision into the abdomen to deliver a baby and CS helps in delivery when vaginal delivery is

difficult.

There are some misconceptions about CS as most respondents perceived CS to be caused by

family witches. Also, most respondents perceived that CS is for weaker women, dangerous to a

woman’s health, associated with pain during and after delivery and CS is associated with fear of

dying.

There was negative attitude towards CS as respondents were not willing to undergo CS because

they were afraid they could die or become weak.

5.3 Recommendations

Based on the findings of the research, the researcher recommends the following:

36
Adequate education should be provided for pregnant women so as to help eliminate

misconceptions associated with CS.

Adequate knowledge on CS will lead to good attitude towards CS and therefore with support

from the government, media and the district assemble should embark on such education on CS

for pregnant women and the community as a whole.

Education on CS should be extended to the local FMs and radio stations as these are powerful

media for health education.

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APPENDIX

PRESBYTERIAN UNIVERSITY COLLEGE, GHANA

FACULTY OF HEALTH AND MEDICAL SCIENCES

DEPARTMENT OF NURSING
INFORMED CONSENT
TOPIC: KNOWLEDGE, PERCEPTION AND ATTITUDE OF PREGNANT WOMEN

TOWARDS CAESAREAN SECTION IN AGOGO PRESBYTERIAN HOSPITAL

Dear Respondent,

I am Donkor, Collins Rutherfor an undergraduate student of Presbyterian University College of

Ghana. As part of the requirements for the award of the Bachelor of Nursing, I am conducting a

research on the above topic. I sincerely welcome you to participate in this study by completing

the attached questionnaire. The completion of the questionnaire could last from 20 minutes to 45

minutes. Although there are no known risks associated with the research protocols, participation

in this study is entirely voluntary. The data and information to be obtained from you will be

confidential. Therefore, you are not required to write your name on the questionnaire.

41
Please indicate you if you agree to participate

Yes
No

Signature ………………………….

PRESBYTERIAN UNIVERSITY COLLEGE, GHANA

FACULTY OF HEALTH AND MEDICAL SCIENCES

DEPARTMENT OF NURSING
QUESTIONNAIRE

TOPIC: KNOWLEDGE, PERCEPTION AND ATTITUDE OF PREGNANT WOMEN

TOWARDS CAESAREAN SECTION IN AGOGO PRESBYTERIAN HOSPITAL

Having consented to participate in this study, I entreat you to answer the following questions.

Kindly answer to the best of your knowledge and remember you can always opt out.

SECTION A: SOCIO-DEMOGRAPHIC DATA

INSTRUCTION: For this section, please tick ( √ )the appropriate bracket.

1. What is your age range?

a. Below 19 years [ ]
b. 20- 25 years [ ]
c. 26-31 years [ ]
d. 32-37 years [ ]
e. 38-43 years [ ]
f. 44 years and above [ ]

42
2. What is your ethnic group?
a. Akan [ ]
b. Ewe [ ]
c. Ga [ ]
d. Guan [ ]
e. Mole-Dagbani [ ]
f. Other (please specify) …………………………………….

3. What is your religious affiliation?

a. Christianity [ ]
b. Traditional [ ]
c. Islam [ ]
d. Other (please specify) …………………………………….

4. What is your marital status?

a. single [ ]
b. Separated/divorced [ ]
c. Married [ ]
d. Co-habiting [ ]
e. Widowed [ ]

5. What is your educational level?

a. None [ ]
b. Primary [ ]
c. Secondary [ ]
d. Middle/JHS [ ]
e. Diploma/certificate [ ]
f. First degree [ ]
g. Masters [ ]
h. Doctorate [ ]
i. Other (please specify) ……………………………………

6. What is your monthly income?

a. Below 100 Ghana cedis [ ]
b. 100 -200 Ghana cedis [ ]
c. 200-300 Ghana cedis [ ]
d. 400-500 Ghana cedis [ ]
e. Above 500 Ghana cedis [ ]

7. Number of children?

a. ………………………………………………

43
SECTION B: KNOWLEDGE TOWARDS CESAREAN SECTION

Instructions: For this section, please tick in the appropriate answer.

8. Have you heard about cesarean section?

a. Yes [ ]

b. No [ ]

9. If yes where did you hear about cesarean section?

a. School [ ]

b. Media [ ]

c. Friends [ ]

d. Health personnel/hospital [ ]

e. Others, please state …………..

10. In your opinion what is cesarean section?

…..……………………………………………………

………………………………………………………..

11. Do you know why cesarean section is done?

a. Yes [ ]

b. No [ ]

12. If yes, why?

……………………………………………

……………………………………………

……………………………………………

……………………………………………

44
 13. What are indications for Caesarean section?

a. Prolonged labour due to big baby [ ]

b. Eclampsia (disorder in pregnancy characterized by the onset of high blood) [ ]

c. Bleeding per vaginam before delivery [ ]

d. Small pelvis for the size of baby [ ]

e. Others, please state …………..

14. Is it possible for a woman achieve vaginal delivery after a CS?

a. Yes [ ]

b. No [ ]

15. CS helps in delivery when vaginal delivery is difficult?

a. Yes [ ]

b. No [ ]

16. Giving a fixed cost for both vaginal delivery and CS which one would you prefer most?

a. vaginal delivery [ ]

b. CS [ ]

SECTION C: PERCEPTION OF PREGNANT WOMEN TOWARDS CESAREAN

SECTION

Please tick [√] the extent to which you agree or disagree with the following statements

45
 Perception of pregnant women towards cesarean section Agree Neutral Disagree

17. Cesarean section is caused by family witches

18. Cesarean section is caused by punishment by God for sins
commented
19. Cesarean section is for weaker women

20. Cesarean section shows that a pregnant woman is not

capable to deliver.
21. Caesarean section is dangerous to a woman’s health

22. CS is associated with pain during and after surgery

23. CS associated with fear of dying

24. CS is associated with being mocked

SECTION D ATTITUDE OF PREGNANT WOMEN TOWARDS CESAREAN SECTION.

Instructions: For this section, please tick the appropriate answer.

25. Are you willing to undergo cesarean section if necessary?

a. Yes [ ]

b. No [ ]

26. Are you willing to undergo a repeat CS?

c. Yes [ ]

d. No [ ]

27. Would you advice a friend on cesarean section ?

a. Yes [ ]

46
 b. No [ ]

28. Do you deem cesarean section important and good practice?

a. Yes [ ]

b. No [ ]

29. Are you afraid to undergo cesarean section?

a. Yes [ ]

b. No [ ]

30. If yes, why?

a. ……………………………

b. ……………………………

c. ……………………………

d. ……………………………

31. If no why?

a. ……………………………

b. ……………………………

c. ……………………………

d. ……………………………

Thank you

47
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