The knowledge and attitudes of Palestinian women towards different childbirth delivery options

Bara'a Samara ,Anton Robert Sabella

doi:10.31083/j.ceog.2021.01.2155

Bara'a Samara , Anton Robert Sabella

Open Access

https://doi.org/10.31083/j.ceog.2021.01.2155

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Abstract

Purpose: To evaluate the knowledge and attitudes of Palestinian women toward cesarean and vaginal deliveries in public, private and charitable hospitals. Methods: A cross-sectional survey using face-to-face interviews with a sample of 372 pregnant women at 20 and above weeks of pregnancy selected randomly and in proportion to the monthly average antenatal visits to each hospital. Data analysis included descriptive statistics, analysis of variance tests and chi-square tests. Results: The majority of participants 250 (67%) were younger than 29 years old. Most participants 325 (87%) interviewed were aware that pain and muscle weakness are greater after cesarean delivery and as much as 341 (91%) of them knew that a cesarean section (CS) is required if a baby is in the breech position. The results also showed a significant association between women’s knowledge scores and educational level, occupation and income across all 3 types of hospital. Furthermore, most women indicated that they thought it was not a women’s right to request a cesarean and that the decision to deliver by cesarean should rest with the doctors. Conclusion: Approximately 1 in every 4 births was delivered by cesarean among primiparous women (26%). Despite the high cesarean section rates seen in Palestinian hospitals, women in Ramallah predominantly prefer vaginal delivery.

Highlights

One of the most frequently performed surgical operations in modern obstetrics is a Cesarean Section (CS) [1,2,3]; the procedure itself represents a contentious issue among health care administrators and the medical community across the world [2, 4]
While 72% (268/372) of them had a previous experience of childbirth, the results further indicated that 93 or 25% of them had delivered their babies by cesarean, with the highest cesarean section (CS) rate of 28.7% (58/202) found in the public hospital
325 or 87% of them knew that pain and muscle weakness are greater after a CS and 325 (58%) were aware of the possibility of uterine scar rupture in future pregnancies, only 82 (22%) knew that CS is linked to higher maternal mortality

Summary

Introduction

One of the most frequently performed surgical operations in modern obstetrics is a Cesarean Section (CS) [1,2,3]; the procedure itself represents a contentious issue among health care administrators and the medical community across the world [2, 4]. Cesarean delivery rates are reported to have increased to ‘epidemic proportions’ [5], exceeding the World Health Organization’s (WHO) recommended expected level of 10-15% of the population This phenomenon continues to be observed across the globe in most countries: for example, in Brazil and China CS rates are over 50% while in 2014, in Italy and the United States CS rates were respectively 32.8% and 38.1% [6]. In South American countries, a correlation was found between the rate of CS in private hospitals and GNP per capita: in Brazil in 1998 the rate of CS in private hospitals reached 70%, which was twice that recorded in public hospitals [6] Another example relates maternal knowledge and education as being contributory factors; a study targeting women obstetricians found that 31% of respondents had opted for an elective cesarean delivery [2], suggesting that expert knowledge of childbirth might favor choice of a cesarean delivery. A study conducted in Nagpur, India, concluded that maternal knowledge could help lower the rates of cesarean delivery [7]

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