A Descriptive study to Identify the Factors Associated with Caesarean Section and Problems of the Mothers after Caesarean Section Admitted in Selected Hospitals, Bangalore.

 

Ms. Divya K.M

Lecturer, M.E.S College of Nursing, Ghanekhunt- Lote, Tal- Khed, Dist-Ratnagiri, Maharashtra (state),-415722

 

ABSTRACT:

Introduction: caesarean section is a major surgical procedure that increases the likelihood of many types of harm for mothers and babies in comparison with vaginal birth. The maternal morbidity rate was high in caesarean section when compared to a morbidity rate of vaginal deliveries. Objectives: The study objectives are to find out factors associated with caesarean section and to find out the association between the problems associated with caesarean section with selected demographic variables. Methodology: Non experimental-Descriptive design. The study was conducted at K.T.G General Hospital, Bangalore. To achieve the objectives of the study, a non-probability (purposive) sample of 60 mothers who undergone caesarean section were selected for the study. The data was collected and analyzed using descriptive and inferential statistics. Results: Results of the study reveals that the major factors associated with caesarean section are failure to descend and non- reassuring fetal status. The physical problems after caesarean section were hemorrhage, severe pain, sleeplessness and severe breast feeding difficulty. The psychological problems after caesarean were anxiety, anger, cold blue and frustration. There was significant association between the demographic variables and problems such as age group in years 13.46, DF =3, S*, type of family 3.93, S*, DF=1 and type of cesarean section 4.98, DF=1, S*.

 

 

NTRODUCTION:

Pregnancy is a challenging time for all women as they adjust to the changes they experience and prepare to assure a new role as mother of one child or of two or more children. Childbirth is a life-altering experience for women and their families. it is the most exciting period of expectation and fulfillment in a women’s life.¹ Every pregnant women hopes for a normal labor with no complications, but it does not always work out that way.

 

Caesarean section is a lifesaving operation when either mother or fetus faces certain problems before or during labor. The caesarean section has become an increasingly common method of delivery worldwide, also increasing in developing countries. It’s a major surgical procedure that increases the likelihood of many types of harm for mothers and babies in comparison with vaginal birth. Short term harm for mothers include increased risk of infection, surgical injury, thromboembolism, emergency hysterectomy, intense and long lasting pain. Babies born by caesarean section are more likely to have surgical injuries, breathing difficulties, difficulty in breast feeding, asthma in childhood and beyond.² The World Health Organization estimates the rate of Caesarean sections at between 10% and 15% of all births in developed countries. In 2004, the Caesarean rate was about 20% in the United Kingdom, while the Canadian rate was 22.5% in 2001-2002. In the United States the Caesarean rate has risen 46% since 1996, reaching a level of 30.2% in 2009.³  According to recent estimates by WHO and UNICEF, nearly 5, 85,000 women die each year worldwide from complications related to pregnancy and child birth. This trend has prompted the emergence of a controversial debate on the risks and benefits associated with caesarean delivery. Caesarean delivery was associated with a significantly increased risk of maternal death from complications of anesthesia, puerperal infection and venous thromboembolism.³ The incidence of caesarean section is steadily rising. In the last few decades, the caesarean rates have increased dramatically in the developed world. Amongst developing countries like Brazil and China also, the caesarean section rates have sky-rocketed. In India, data collected from 30 medical colleges/ teaching hospital revealed that caesarean section rates increased from 21.8% in 1988-89 to 25.4% in 1993-94. A population based cross-sectional study conducted in India; a caesarean section of 32.6% has been documented from Madras City in South India. In East Delhi, a total of 419 deliveries were reported, out of which, one hundred and forty four (34.4%) deliveries were caesarean and rest were vaginal deliveries.⁴ There are various factors and problems that contribute to the mothers with caesarean section. There may be some difference in the influence of problems occurring after caesarean section both physical and mental health status of the women. It is important to know about how they can prevent and manage some problems. So it was felt that there is a need for gaining knowledge in the factors and problems associated with caesarean section.

 

OBJECTIVES OF THE STUDY:

1.    To identify the factors associated with caesarean section.

2.    To identify the problems of mothers associated with caesarean section.

3.    To find out the association between the problems associated with cesarean section with demographic variables.

 

Hypothesis:

There will be a significant association between problems associated with cesarean section and demographic variables.

 

Assumption:

·      Mothers may have some problems due to cesarean section.

·      The problems associated with caesarian section will vary from individual to individual according to their demographic variables.

RESEARCH METHODOLOGY:

·      Research design: Non experimental – Descriptive design.

·      Setting: K T.G General Hospital, Bangalore.

·      Population: Mothers who Undergone Caesarean Section.

·      Sample Size: 60 Mothers

·      Sampling Technique: Purposive Sampling Technique.

 

Development and Description of the Tool:

The tool consists of three sections.

 

Section A:

It comprised of 09 items seeking information on demographic data such as age, education, occupation,  religion, type of family, income, residence, parity and type of cesarean section. 

 

Section B:

It consists of 15 items check list for identifying the factors associated with cesarean section. They include Failure to Descend, Non-reassuring Fetal Status, Failed Induction, Failure to Progress, Cephalopelvic Disproportion, Failure to Dilate, Malpresentation, Pregnancy-Induced Hypertension, Infection, Elective caesarean , Prolapsed Cord, Multiple Gestation, Separated Placenta, Macrosomia, Prolonged Rupture of Membranes, presence of Meconium on PV examination,

 

Section C:

It consists of 15 self-administered questionnaires on problems associated with cesarean section. The number of questions under various headings is given below:

Physical problems.                                          10 items.

Psychological problems                                 05 items

Total                                                                  15 item

 

Data Analysis:

Descriptive Statistics: frequency, percentage, mean and standard deviation.

 

Inferential Statistics:

Chi-Square test

 

Organization and Presentation of data analysis:

The substantive summary of the analysis are presented under the following headings:

 

Section 1:

Description of selected socio demographic variables of mothers.

 

Section 2:

Assessment of the factors associated with caesarean.

 

 

Section 3:

Identify the problems of mothers associated with caesarean.

 

Section 4:

Association between the problems associated with cesarean section with demographic variables.

 

SECTION I: Description of socio demographic variables

Classification of Respondents by Personal Characteristics  N=60

Characteristics	Category	Respondents
		Number	%
Age group (years)	20-24 years	29	48.33
	25-29 years	14	23.33
	30-34 years	09	15
	35- 40 years	08	13.33
Education	No formal education	15	25
	Primary	21	35
	Secondary	24	40
Occupation	House wife	41	68.33
	Self employed	12	20
	Private	07	11.66
Religion	Hindu	45	75
	Muslim	15	25
Family Income/month	<Rs.5,000	27	45
	Rs.5,001-10,000	33	55
Type of family	Nuclear	18	30
	Joint	42	70
Residence	Rural	23	38.33
	Urban	37	61.67
Parity	Primi	26	43.33
	Multi para	34	56.66
Type of cesarean section	Elective	38	63.33
	Emergency	22	36.66

 

Section 2: Assessment of the factors associated with caesarean.

Sr. no.	Factors	Frequency	%
1	Failure to Descend	19	31.66
2	Non-reassuring Fetal Status	8	13.33
3	Failure to Progress and failed induction.	5	8.33
4	Cephalopelvic Disproportion	6	10
5	Failure to Dilate	2	3.33
6	Malpresentation	3	5
7	Pregnancy Induced Hypertension	2	3.33
8	Infection	1	1.66
9	Prolapsed Cord	2	3.33
10	Repeat C-section	3	5
11	Separated Placenta	1	1.66
12	Multiple Gestation	2	3.33
13	Primary Elective	2	3.33
14	Macrosomia	1	1.66
15	Prolonged Rupture of Membranes	3	5

 

Section 3: Identify the problems of mothers associated with caesarean.

Percentage distribution of the cesarean women according to physical problems.

Sl. No.	Problems	Absent		Present
		No	%	No.	%
1	Haemorrhage	12	20	48	80
2	Bowel obstruction	28	46.66	22	36.66
3	Pain	4	6.66	56	93.33
4	Infection	44	73.33	16	26.66
5	Breast feeding difficulties	16	26.66	44	73.33
6	Extreme tiredness	8	13.33	52	86.66
7	Sleeplessness	19	31.66	41	68.33
8	Wound separation	56	93.33	4	6.66
9	Urinary tract infection	33	55	27	45
	Psychological problems		0		0
10	Irritability	23	38.33	37	61.66
11	Frustration	12	20	48	80
12	Anxiety	18	30	42	70
13	Cold blue	21	35	49	81.66
14	Confusion	34	56.66	26	43.33
15	Anger	15	25	45	75

 

Section 4: Association between the problems associated with cesarean section with demographic variables.

Characteristics	Category	Respondents	Present		absent		Chi square
		N	F (42)	%	F (18)	%
Age group (years)	20-24 years	29	23	79.31	6	20.68	13.46, df=3, S*
	25-29 years	14	9	64.28	5	35.71
	30-34 years	9	5	55.55	4	44.44
	35- 40 years	8	5	62.5	3	37.5
Education	Illiterate	15	11	73.33	4	26.66	0.22, df=2, NS.
	Primary	21	15	71.42	6	28.57
	Secondary	24	16	66.66	8	33.33
Occupation	Age House wife	41	30	73.17	11	26.82	0.81, df=2, NS.
	Self employed	12	8	66.66	4	33.33
	Private	7	4	57.14	3	42.85
Religion	Hindu	45	32	71.11	13	28.88	0.10, df=1, NS
	Muslim	15	10	66.66	5	33.33
Family Income/month	<Rs.5,000	27	20	74.07	7	25.92	0.38, df=1, NS
	Rs.5,001-10,000	33	22	66.66	11	33.33
Type of family	Nuclear	18	14	77.77	4	22.22	3.93, S*, Df=1
	Joint	42	28	66.66	14	33.33
Residence	Rural	23	15	65.21	8	34.78	0.72, NS,
	Urban	37	27	72.97	10	27.02
Parity	Primi	26	19	73.06	7	26.92	0.20, NS
	Multi para	34	23	67.68	11	32.35
Type  of cesarean section	Elective	38	28	73.68	10	26.31	4.98, Df=1, S*
	Emergency	22	14	63.63	8	36.36

RESULTS:

·      The majority 29(48.33%) women were in the age group 20-24, 14(23.33%) were between 25-29age group, 09(15.0%) in between 30-34 age group and 08(13.33%) were in the age group of 35- 40 years.

·      Regarding the education, 15(25%) were in no formal education, 21(35%) had primary, 24(40%) had secondary education.

·      Regarding the occupation, majority of the mothers 41(68.33%) were house wives, 12 (20%) were self-employed and 7(11.66%) works on private field.

·      According to religion, majority of the mothers 45 (75%) were Hindus and 15 (25%) were Muslim.

·      Regarding the family income, 27 (45.0%) had an income between <Rs 5000 per month, 33 (55.0%) had Rs. 5001-10,000 per month.

·      In relation to type of family 18(30%) of the mothers belonged to nuclear family and 42(70%) belonged to joint family.

·      Regarding the residence, 37(61.67%) were from urban, 23 (38.33%) from rural.

·      Majority of the mothers, 26 (43.3%) primipara and 34(56.66%) were multi para.

·      In relation to the type of the cesarean section, 38(63.33%) elective and 22(36.66%) emergency cesarean section.

 

The factors associated with the cesarean section were failure to descent 19(31.66%), non-reassuring fetal status was 08(13.33%), failure to progress and failed induction 05(8.33%), cephalopelvic disproportion 6(10%), failure to dilate 2(3.33%), mal presentation3(5%), pregnancy induced hypertension 2(3.33%) infection1(1.66%), prolapsed cord 2(3.33%), Repeat caesarean section 3(5%), separated placenta 1(1.66%), multiple gestation 2(3.33%), primary elective 2(3.33%), macrosomia 1(1.66%) and prolonged rupture of membrane 3(5%). The physical and psychological problems of mothers after cesarean section were, the hemorrhage was present in 48(80%) and absent in 12(20%), bowel obstruction was present in 22(36.66%) and absent in 28(46.66%), the severe pain was present in 56(93.33%) and absent in 4(6.66%). The infection was present in 16(26.66%) and absent in 44(73.33%), breast feeding difficulties 44(73.33%) were had difficulty and 16(26.66%) did not had. Regarding the extreme tiredness, 52 (86.66%) were tired and 08(13.33%) were did not tired. Regarding sleeplessness, 19(31.66%) were not had sleeplessness and 41(68.33%) sleeplessness. Wound infection was present in 4(6.66%) and absent in 56(93.33%). Urinary tract infection, 33(55%) had UTI and 27(45%) did not had UTI. On relation to the psychological problems, 37(61.66%) had irritability, 23(38.33%) did not had irritability, the frustration was present in 48(80%) and absent in 12(20%). Anxiety was present in 42(70%) and absent in 18(30%). Cold blue was present in 49(81.66%) and absent in 21(35%). And the anger was present in 45(75%) and absent in 15(25%). There was significant association between the demographic variables and problems such as age group in years 13.46, df=3, S*, type of family 3.93, S*, Df=1 and type of cesarean section 4.98, Df=1, S*.

 

RECOMMENDATIONS:

Keeping in view the findings of the present study, the following recommendations were made:-

1    The study can be repeated on a large sample size having a control group.

2    Cohort study can be conducted with the large samples.

3    A comparative study can be conducted to find out the most common associated factors.

4    A comparative study can be conducted to assess the different problems and prevalence of psychological problems among cesarean section mothers and vaginal delivery mothers.

 

REFERENCES:

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13.   Ryding et al. “Group counseling for after emergency caesarean section”. Canadian Medical Association Journal. Sweden 1993;148 (8):p-1315-1320.

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15.   F. Althabe, C. Sosa, J. M. Belizán, L. Gibbons, F. Jacquerioz, and E. Bergel, “Cesarean section rates and maternal and neonatal mortality in low-, medium-, and high-income countries: an ecological study,” Birth, vol. 33, no. 4, pp. 270–277, 2006.

16.   Klossner N J and Hatfield N. “Introductory Maternity and pediatric Nursing”.1^sr edition. Philadephia: Lippincott Publishers; 2006.p-261-262

17.   Ladewing P W et al.”Essentials of maternal New Born Nursing”. 3^rd edition. Colorado: Cummings Publishing Company; 1994. p-527-529

18.   Wong D L et al “Maternal Child Nursing Care”.3^rd edition .USA: Mosby Publications; 2006.P-571-575.

19.   Berghlot T et al. “Intraoperative surgical complications during caesarean section”. An obstetric and gynecology SC and. Denmark: 2003 march;82(3):p-251-256.

20.   P. M. Tebeu, A. L. Major, F. Ludicke, M. T. Obama, L. Kouam, and A. S. Doh, “Outcome of delivery at extreme ages of reproductive life,” Revue Medicale de Liege, vol. 59, no. 7-8, pp. 455–459, 2004.

 

 

 

Received on 15.10.2016          Modified on 21.12.2016

Accepted on 13.01.2017          © A&V Publications all right reserved