REPUBLIC OF CAMEROON REPUBLIQUE DU CAMEROUN

Peace-Work-Fatherland Paix- Travail-Patrie

…………………………. ………………………………

MINISTRY MINISTERE DU
L’ENSEIGNEMENT
OF HIGHER EDUCATION SUPERIEURE

ALPHA HIGHER INSTITUTEOF BIOMEDICAL AND

TECHNOLOGICAL SCIENCES DOUALA
MOTTO: QUALITY TRAINING FOR BETTER SERVICE AND DEVELOPMENT

FACULTY OF HEALTH SCIENCES

DEPARTMENT OF NURSING

KNOWLEDGE, ATTITUDE AND PERCEPTION OF PREGNANT WOMEN TOWARDS

CAESAREEN SECTION IN LAQUINTINIE HOSPITAL DOUALA

A research proposal submitted in partial fulfilment of the requirement of the award

of the Higher National Diploma in Nursing.

WRITTEN AND SUBMITTED BY:

MBENG CONRAD WAM

20HNDNU218

ACADEMIC SUPERVISOR:

Mme KINYUY EVETTE

Academic year 2022 - 2023

 KNOWLEDGE, ATTITUDE AND PERCEPTION OF PREGNANT WOMEN TOWARD
CESAREAN SECTION IN DEIDO DISTRIC HOSPITAL DOUALA

CERTIFICATION

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DEDICATION

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ACKNOWLEDGEMENT.

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TABLE OF CONTENTS
Certification ................................................................................................i

Dedication ...................................................................................................ii

Acknowledge ..............................................................................................iii

Table of contents .........................................................................................iv

List of figures ...............................................................................................v

List of tables..................................................................................................vi

Abstract........................................................................................................vii

CHAPTER ONE

INTROUDUCTION
1.1 Back ground of study................................................................................
1.2 Statement of problem................................................................................
1.3 Research question......................................................................................13
1.4 Research Hypothesis..................................................................................13
1.5 Research Objectives..................................................................................13
1.6 Justification of study..................................................................................13
1.7 Scope of study............................................................................................13
1.8 Significant of study....................................................................................14
1.9 Contextual definition of term....................................................................14

CHAPTER TWO

2.1 History.......................................................................................................15

2.2 Knowledge of pregnant women about C/s.................................................15

2.3 Attitude and perception of pregnant women about C/s..............................16

2.4 Classification of C/s...................................................................................16

2.5 Type of C/s incision...................................................................................17

2.6 Causes........................................................................................................18

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2.7 Risk factors................................................................................................19

2.8 Pre, intra and post Op care for C/s.............................................................19

2.8.1 Pre operative care....................................................................................19

2.8.2 Post operative care...................................................................................20

2.9 Management after C/s.................................................................................21

2.10 Advantages of C/s......................................................................................22

2.11 Disadvantages of C/s..................................................................................22

CHAPTER THREE
METHODOLOGY................................................................................................24

3.1 Study area and site...........................................................................................24

3.2 Study design....................................................................................................24

3.3 Study population..............................................................................................24

3.3.1 Inclusive criteria............................................................................................24

3.3.2 Exclusive criteria...........................................................................................24

3.4 Sample size.......................................................................................................25

3.5 Sample method.................................................................................................25

3.6 Data collected instrument..................................................................................25

3.7 Data management and statistical plan...............................................................25

3.8 Data analysis......................................................................................................25

3.9 Ethical consideration.........................................................................................25

CHAPTER FOUR
INTRODUCTION...............................................................................................

4.1 Definition of demography..............................................................................

4.2 Definition of statistic.....................................................................................

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CHAPTER FIVE
Discussion, conclusion and recommendation......................................................

5.1 Discussion………………………………………………………………........

5.2 Conclusion…………………………………………………………………...

5.3 Recommandations…………………………………………………………...

Reference………………………………………………………………………..

Questionnaire……………………………………………………………………

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LIST OF ABBREVIATION
CDMR Cesarean Section on Maternal Request

ACOG America College of Obstetricians and Gynecologists

NICE National Institute for Health and Care Excellence

C/s Caesarean Section

MEOWS Modified Early Warming Chart

ANC Antenatal Care

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LIST OF FIGURES

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LIST OF TABLES

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ABSTRACT
Over the years, Caesarean section has become increasingly safe and remains one of the most
one performed surgeries in obstetric practice worldwide. Even though there is an increased
rate of Caesarean section in both developed and developing countries some studies have
suggested that African women have an aversion for it.The general objective of this study is to
assess the knowledge, attitude and perception of pregnant women towards Caesarean
section.A cross sectional study non experimental design was conducted in Deido District
Hospital Douala. A structured questionnaire was used to assess the knowledge, attitude and
perception of 50 pregnant women towards Caesarean section.This study was carried out in
Deido District Hospital Douala, which is located in 3p77+xp3 ,Littoral Region, Douala
Cameroon. According to result carried out of 50
respondents……………………………………………………………………………………
………….

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CHAPTER ONE

INTRODUCTION

1.1. BACKGROUND OF STUDY

Caesarean section (CS) is one of the most commonly performed surgical procedures in
obstetrics and is certainly one of the oldest surgeries. Probably the term caesarean will be
derived from the decree in Roman law, which it mandatory for the operation to be performed
on women dying during child birth, a term called lex Caesarea. This surgery has been
reported throughout medical history and has steadily progressed from being fatal resulting in
morality for the mother or the child to being rendered safe for both mother and foetus during
the 20th century. 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 indicated that majority
of women prefer vaginal delivery to caesarean section and there are some who will not accept
the surgery even if indicated. There is evidence to show that pregnant women who are
knowledgeable about their condition are able to participate in shared decision making.
Education on caesarean section is expected to be given, it is expected that pregnant women in
Cameroon should be more knowledgeable on caesarean section than found in previous
studies. The researcher therefore set out to assess the knowledge, attitude, and perception of
pregnant women in Cameroon on caesarean section.

1.2 STATEMENT OF PROBLEM

Cameroon has recorded instance of maternal mortality due to some factors related to child
bearing. Unfortunately, despite the well documented record of safety, the strong aversion
of women in sub-Saharan Africa (tot eh) procedure especially in the presence of life
threatening indication is a great concern .The researcher during a number of clinical
experience noticed that most pregnant women who were proposed c/s refused and as a
result had complication and ended death . Many research have been carried out on this

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topic but no changes. Hence the researcher wants to assess the knowledge, attitude and
perception of pregnant women at the antenatal clinic to know if it is accepted or not.

1.3 RESEARCH QUESTIONS

- What is the perception and attitude of pregnant women in Deido District Hospital
towards C/s.
- Are women in the Deido District Hospital properly educated about C/s.
1.4 RESEARCH HYPOTHESIS
Null Hypothesis (HO): Most women have negative perspective toward caesarean
section.
Alternate Hypothesis (H1): Most women have positive perspective toward
caesarean section.
1.5 RESEARCH OBJECTIVES

` 1.5.1 General Objectives

- To assess the knowledge, attitude and perception of pregnant women toward

caesarean section.

1.5.2 Specific Objectives

- To assess the pregnant women knowledge on C/S

- To assess the pregnant women perception towards c/s in DEIDO
1.6 JUSTIFICATION OF THE STUDY
The research aim toward this study is assess pregnant women knowledge, attitude and
perception toward caesarean section and suggest solution on how to handle this
perception if negative or educate them more if positive.
1.7 SCOPE OF STUDY

This study covered a period of 6 months that will be from the 20th January to June 2023.

1.8 SIGNIFICANCE OF STUDY

- To the community: To help the women understand the need of c-section
especially when vaginal delivery seems threatening to their life and that of the
foetus.

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- To the institution: To inspire more research on the topic by other students.

- To the profession: To bring awareness of this personal perception of pregnant
women to health team so more care and education will be applied to help them.
- To the researcher: To have HND certificate and better understanding of the topic
so as to apply a solution to this problem in health team.
1.9 CONTEXTUAL DEFINITION OF TERMS
 Caesarean section: Also known as C-section or CS is defined as the use of
surgery to deliver babies.(WHO).
 Perception: To notice something in a particular way or hold a view about
something.(English Oxford Advanced Dictionary,2018).
 Knowledge: To have information about something because you have experience
or because you have learned about it or be told. (English Oxford Advanced
Dictionary, 2018).
 Attitude: The way one behave towards somebody or something that show how
you think or feel. (English Oxford Advanced Dictionary, 2018).

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CHAPTER TWO

LITERATURE REVIEW

2.1 HISTORY

The history of caesarean section (c- section) dates back as far Ancient Roman times.
PLING the Elder suggested that Caesarean section will be named after an ancestor Julius
Caesar who will be born by C-section. During this era, the C- section procedure will be used
to save a baby from the womb of a mother who has died while giving birth. The mother of
Julius Caesar himself lived through childbirth, therefore eliminating the possibility that the
ruler will be himself born by C-section. Ancient Jewish literature from Maimonides suggests
that the surgical delivery of baby will be possible without killing the mother, but the surgery
will be rarely performed. Survival rates would have been low after the procedure due to the
risk of bleeding and infection. Historically, the surgery has always been performed to save
baby rather than the mother. The first recorded case of a mother surviving the surgery will be
in the 1580s in Siegersausen, Switzerland where Jacob Nufer who will be a pig gilder is said
to have performed the operation on his wife when her labour will be not progressing. The
mother survived the operation and went on to have five more successful deliveries naturally.
In ancient times, it will be performed only when the woman will be dead or dying as an
attempt to rescue the foetus. With few exceptions, this will be the pattern until the era of
anaesthesia in the nineteenth century. Developments in surgical technique from the later
nineteenth century and through the twentieth century have refined the procedure, with
resulting low morbidity and mortality. As a consequence, the objectives of the caesarean
section have evolved from rescuing the foetus or for cultural or religious reasons towards
concern for the safety of mother and child as well as considering the mother’s preferences.

Caesarean section , also known as C-section or caesarean delivery ,is the use of surgery
to deliver babies. A caesarean section is often necessary when a vaginal delivery would put
the baby and mother at risk.

2.2 KNOWLEGDE OF PREGNANT WOMEN ABOUT C-SECTION

Knowledge of C/s rates had increased worldwide thus making its awareness and
existence accepted and practiced. However several researchers have questioned whether

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maternal request for C/s delivery might explain the increasing C/s rate or whether these rates
may be influenced by midwives or obstetricians. Most pregnant women demand for their C/s
(maternal request) to avoid the unpredictable danger of child birth. In Sweden, women who
request for C/s are more likely to have poor health condition, additionally these women often
planned to have one child and were more likely to report of anxiety due to the lack of support
during the delivery process, anxiety about the loss of control and concern regarding the well
being of their fetus.Women giving birth by C-section on maternal request are more likely to
have psychiatric problem. Thus showing that larger rates of women are aware of C/s and
there is a great maternal request on the procedure.

2.3 ATTITUDE AND PERCEPTION OF PREGNANT WOMEN ABOUBT C/s

Based on the maternal request of most women for C/s it shows that there is a positive
attitude towards the procedure as they see it as an easily means to avoid unpredictable danger
of child birth and the anxiety to be left alone during child bearing, some women do not want
to involve in vaginal delivery so as not to experience the pain of contraction and changes that
comes with child birth. However some women has a negative attitude toward C/s as they see
it as a failure as a woman or losing their lives in the process. There is a widely held belief that
African women have an aversion for it and perceive as a curse of an unfaithful woman. Thus
making it difficult of these women to accept C/s even indicated so losing their lives. This
study is to assess their attitude and perception towards C/s and also help in better educating
them of the disadvantages and advantage of the procedure.

2.4 CLASSIFICATION OF CAESAREAN SECTION

Caesarean section has been classified in various ways by different perspectives. One way to
discuss all classification system is to group them by their focus either on the urgency of the
procedure, characteristic of the mother, or as a group based on other, less commonly
discussed factors. It is most common to classify caesarean section by the urgency of
performing them.

 By urgency
Caesarean section is classified as being either an elective surgery or an
emergency operation. It used to help communicate between the obstetric,
midwifery and anaesthetic team for discussion of the most appropriate method of

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anaesthesia. The decision whether to perform general anaesthesia or regional

anaesthesia ( spinal or epidural anaesthesia) is important and is based on many
indications, including how urgent the delivery needs to be as well as the medical
and obstetric history of the woman.
A planned caesarean ( or elective/ scheduled caesarean), arranged ahead of time,
is most commonly arranged for medical indications which have developed before
or during the pregnancy and ideally after 39 weeks of gestation.
 By characteristics of the mother
Caesarean delivery on maternal request
C/s on delivery on maternal request (CDMR) is a medically unnecessary C/s,
where the conduct of a child birth through a C/s is requested by the pregnant
patient even though there is not a medication to have the surgery. Systematic
review has found no strong evidence about the impact of C /s for nonmedical
reason. Recommendations encourage counselling to identify the reason for the
request, addressing anxieties and information and encouraging vaginal birth.
Elective C/s at 38 weeks in some studies showed an increased health complication
in the new born. Therefore ACOG and NICE recommend that elective C/s should
not be schedule before 39 weeks of gestation unless there is a medical reason, and
planned C/s may be scheduled earlier if there is a medical reason.
 After previous Caesarean
Mothers who have previously had a caesarean section are most likely to have a
C/s for future pregnancies than mothers who have never has a C/s .

2.5 TYPES OF C/s INCISION

In a C/s delivery, an incision (cut) is made in the skin and into the uterus at the
lower part of the mother’s abdomen. The incision in the skin may be vertical
(longitudinal) or transverse (horizontal), and the incision in the uterus may be
vertical or transverse.
A transverse incision extends across the pubic hairline, whereas, the vertical
incision extends from the navel to the pubic hairline. A transverse uterine incision
and is used most often, because it heals well and there is less bleeding. It also
increases the possibility of vaginal birth in future pregnancy.

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2.6 CAUSES

C/s can be caused by different factors which includes;

 Foetal or maternal distress: This occurs when the foetus has not been receiving
enough oxygen.
 Prolapsed umbilical cord: This is when the umbilical cord slips through the cervix
before the baby is born thus causes lessen blood flow to the baby, putting the baby’s
health at risk.
 Placenta abruption: This is when the placenta detaches from the inner wall of the
womb before delivery.
 Uterine rupture: This is a spontaneous tear of the uterus that may result in the foetus
being expelled into the peritoneal cavity.
 Prolonged labour: This is the inability of a woman to proceed with child birth upon
going into labour. Prolonged labour typically lasts over 20 hours for the first time
mother, and over 14 hours for women that have already had children.
 Previous C/s delivery: This is when the mother has undergone a C/s delivery before.
 Chronic health conditions: Mothers with certain chronic health condition that will
be risk for delivery such as heart diseases, high blood pressure, gestational diabetic,
HIV undergo C/s to reduce the risk of complication which will be dangerous to the
mother and foetus as well.
 Cephalopelvic disproportion (CPD): This when the mother pelvic passage is small
for the foetus to be delivered through.
 Birth defect: This is reducing delivery complication with foetus having certain health
condition such as hydrocephalus, congenital heart disease to reduce further
complication.
 Maternal request: This is when the mother decides to on her own to ask for a C/s

2.7 RISK FACTORS

Like other type of major surgery, C-sections also carry some risks.

Risk to the baby includes:

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 Breathing problems: Babies born by scheduled C-section are more likely to develop
transient tachypnea ( a breathing problem marked by abnormally fast breathing during
the first few days after birth)
 Surgical injury: Although rare, accidental nicks to the baby’s skin occur during
surgery.

Risk to the mother includes;

 Infection: After a C-section, the might be at risk of developing an infection of the

lining of the uterus (endometritis).
 Postpartum haemorrhage: It may cause heavy bleeding during or after delivery.
 Reaction of anaesthesia: Adverse reaction to any type of anaesthesia is possible.
 Increased risks during future pregnancies: After a C/s , there is a higher risk of
potentially serious complication in subsequent pregnancy than it would be after
vaginal delivery. The more C-section done, the higher the risks of placenta previa
and a condition in which the placenta become abnormally attached to the wall of the
uterus ( placenta accreta). And there is a risk of uterus tearing open along the scar
line from the previous C/s (uterine rupture).
 Blood clots: A C/s might increase the risk of developing blood clots inside a deep
vein, especially in the legs or pelvic organs ( deep vein thrombosis ).
 Surgical injury: Although rare, surgical injuries to the bladder or bowel can occur
during a C-section, it might be an increased risk of an incision infection.

2.8 PRE, INTRA AND POST OPERATIVE CARE FOR C-SETION

2.8.1 PRE-OPERATIVE

a) Subjective data; it involves the following.

- Patient’s history.
- Present complains.
- Past medical history.
- Past surgical history.
- Find out about medication history.
- Find out if the patient has any pertinent, emotional, or psycho social problems.

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b) Objective data

It deals with the physical examination findings obtained by the nurse on the patient.
Access the body parts and organs to bring out any potential risk, complication during surgery.

- Check the patient level of understanding.

- Access the level of mobility, muscular strength and motion levels.
- Access the GIT to make sure the bowel function is normal.

c) pre-op exercises

Exercises are also very necessary in the pre-op period as the patient learns how to do them
post-op. Exercises such as deep breathing, voluntary coughing are helpful as they relax the
patient and help in clearing the air way.

d) Patient work-up

It involves a series of laboratory test to access the patient’s fitness for the surgery. It also
prepare the patient for any eventuality such as blood transfusion if need arises.

e) Personal care

For elective cases, the patient should take a bath before getting into the theatre; all
artificial objects should be removed. Painted and coloured nail should be removed and clean
and hairs should be secured under a cap.

2.8.2 POST OPERATIVE CARE

 Assess maternal vital signs every 15 minutes the first 1 hour, every 30 minutes the
second hour , and hourly until she is transferred to the postpartum unit or per facility
protocol
 Evaluate fundal position and firmness along with vital signs
 Evaluate amount and type of lochia along side vital signs
 Assess condition of the incision line or dressing.
 Monitor urinary output, presence of bowel sounds.
 Assess level of presence of anaesthesia or pain.
 Auscultate lung sound, maternal oxygen saturation.

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 Assess maternal-infant bonding.

2.9 MANAGEMENT AFTER C/s

1) Observation on return to the ward:

- Maintain half hourly observations of respiration rate, impulses, blood
pressure; wounds, lochia, and pain for a minimum of 2 hours. The observation
should be recorded on the Modified Early Warming Chart (MEOWS chart).
- If the observations are not stable, more frequent observations at 15 mintues
intervals are required and a medical review of the patient.
2) Bladder care:
The urinary catheter should remain in place for at least 12 hours following the
operation. It is acceptable to allow the catheter in for 12- 24 hour post operatively.
After the removal of the catheter they should be observation for the return of normal
urinary function. Record the time and volume of urine passed with the first void
following removal of the catheter. Ensure that advice is given to the woman to inform
the Nurse in charge if there is any difficulty passing urine.
3) Nutrition:
It is recommended (NICE 2004) that women who feel well and have no
complications can resume eating and drinking when they feel hungry or thirsty. It may
be advisable to commence sips of water or juice and build up to hot drinks and then
commence normal diet. Once the woman is tolerating fluids her IV can be
discontinued and the cannula left in place for 24 hours post-delivery.
4) Ambulation and prevention of thrombus-embolic disorder
The woman should be encouraged to resume simple leg movement as legs the
woman can begin to mobilise. Early ambulation reduces the risk of thrombus-embolic
condition.
5) Care of the wound/ perineum
On admission to the ward post caesarean section, the wound dressing should be
observed for signs of oozing. The dressing should be removed 24 hours post
operatively using aseptic techniques. The dressing may be removed shower if the
woman requires (NICE 2011). If re-dressing of the wound becomes necessary, this

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should be undertaken using an aseptic or non-touch technique. The wound should be

observed for signs of infections e.g. redness, discharges and increased pain.

2.10 ADAVANTAGES OF C-SECTION ON WOMEN

 A surgical birth can be scheduled in advance, making it more convenient and

predictable than a vaginal birth than vaginal delivery and going through a long labor.
 It is considered safe and in some situation life saving when vaginal delivery is life
threatening.
 There is no tearing and stretching of the perineum.
 Some studies have found that women who have delivered vaginally are most likely to
have problem with bowel and urinary incontinence than women who have had C/s.
 It reduces complications indicated to the mothers due reducing the risk that with
jeopardy the life of the women and the fetus.

2.11 DISADVANTAGES OF C-SECTION ON WOMEN

 A prolong stay in the hospital , at least two to four days on average, compared to
vaginal delivery.
 A C/s increases a woman’s risk for more physical complaints following delivery such
as; pains or infection at the site of the incision and longer-lasting soreness.
 It involves an increased risk of blood loss and a greater risk of infections. The bowel
or bladder can be injured during the surgery or blood clot may form.
 Women who had a C-section are less likely to begin early breast feeding than those
who had a normal vaginal delivery.
 The recovery period after delivering is also longer because a woman may have more
pains and discomfort in her abdomen as the skin and nerves surrounding her surgical
scar need time to heal, often at least two months.
 There is a higher risk of death during C/s than vaginal delivery, due mostly to blood
clots, infections and complication from anaesthesia.
 Once a woman undergoes a C/s she is most like to go through it in all her deliveries,
this is due to a greater risk of placental abnormalities and uterine rupture. Which is
when the uterus tears along the scar line from a previous C/s, the risk for placental
problems continues to increase with every C/s a woman undergoes.

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CHAPTER THREE

METHODOLOGY

3.1 STUDY AREA AND SITE

The research will be carried out at Deido District Hospital (3P77+XP3) found in Douala,
Littoral Region, Cameroon. The Deido District Hospita is located in the littoral region of
Cameroon and is situated in the heart of Deido quarter precisely at’’ Carrefour Ecole
Public’’. It is boarded in the North by ‘’ Commessariat Du 9eme Arrondissement’’, to the
South by ‘’Maison d’Habitation’’, to the West by ‘’Hotel de Bouquet’’. It covers a surface
area of 4600m2

3.2 STUDY DESIGN

A cross sectional non -experimental study designed will be used because it is a sensitive
study. Questionnaires were in open and closed ended methods which will be administered to
participants through interviewed, questionnaires will be printed both in English and French.

3.3 STUDY POPULATION

The study population will be pregnant women of child bearing age who attended the antenatal
in Deido District Hospital from January to June 2023. This involved all religion depending on
the individual who will be willing to participate in the study.

3.3.1 INCLUSIVE CRITERIA

Inclusive criteria will be pregnant women of child bearing age in the hospital who will come
for antennal clinics.

3.3.2 EXCLUSIVE CRITERIA

Exclusive criteria will be pregnant women who will be present but will not be willing to
participate in the study.

3.4 SAMPLE SIZE

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The total sample sizes will be 50 participants who will be conveniently selected to take part
in the study.

3.5 SAMPLE METHOD

The research will be a non -probability method and the techniques use will be convenience
sampling which will be done out of free will during ANC.

3.6 DATA COLLECTION INSTRUMENT

Data will be collected with the use of well structured questions opened and closed ended
questions. Copies were made both in English and French Languages.

3.7 DATA MANAGEMENT AND STATISTICAL PLAN

The information on the filled questionnaires will be checked for completeness, a code book
will be developed, after coding, a raw data will be cleaned and entered into excel spreadsheet
on a computer.

3.8 DATA ANALYSIS

Data collected with PSS version 21 and will be presented on table, figure and charts using
percentage and frequencies.

3.9 ETHICAL CONSIDERATION

An authorization from the Regional Delegate of Higher Education Littoral Region

will be obtained upon submission of a research proposal and another granted by the
Director of Deido Distric hospital after a hand written application approval . Each
question had a consent form attached to it explaining the right for free will
participation and confidential treatment of information . This will be done by the
researcher after an introduction of the participants.

REFERENCE
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 Awoyinka B.S, 2006.Copyright c 1999 Awoyinka , B.S., Ayinde,

O.A.,Omigbodum, O.A (2006). Acceptability of Caesarean delivery to antenatal
patients in a tertiary health facility in South west Africa. J ObstetGynaecol. 26 (3);
208-10.
 Awoyinka , B.S., Ayinde, O.A., & Omigbodum, O.A (2006). Acceptability of
Caesarean delivery to antenatal patients in a tertiary health facility in South west
Africa. J ObstetGynaecol. 26 (3); 208-10
 Biswill be, A; su, LL; Mattar,c ( April 2013). “ Caesarean section for preterm
birth and, breech presentation and twin pregnancies”. Best Practice & Research.
Clinical Obstetric & Gynaecology. 27(2): 209-19.
 Chaser, MJ. (1956). Caesarea section, sterilization and hysterectomy. In: Munro
Kerr’s Operatives obstetrics, Ballierre Tindall and Cox, London, 1956; p.539.
 Dr Ananya mandal, MD reviewed by Sally Robertson, B.Sc.
 “ Caesarean section / Guidance and guidelines / NICE”. www.nice.org.uk.
Retrieved 5 January 2019.
 Glavind, Julie: Uldbjerg, Niels ( April 2015). “ Elective caesarean delivery at 38
and 39 weeks” Current opinion in Obstetrics and Gynecolgy.27 (2): 121-127.
 Ilesanmi, A.O., Odukogbe, A ., & Olaleye , D.O (1997). Vaginal delivery after
one previous Caesarean section in Nigerian women . J Obstet Gynecol.
 James kojo Prah, Andreas Kudom, Obed Uwumbornyi Lasim, Emmanuel Kwill
bei Abu,university of cape coast hospital, Cape Coast, Ghana

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