“A STUDY TO ASSESS THE FACTOR LEADING TO INCREASE RATE OF

CESAREAN SECTION AMONG PREGNANT WOMEN AT SELECTED HOSPITAL IN

HARIDWAR UTTARAKHAND”

Miss Shaheen1, Pratibha2, Sonam Rana2, Aayushi Yadav2, Anamika2

Mansi balodi2, Tanu Verma2, Sujeet Chauhan2, kajal singh2
1
Assistent Professor, Shri swami Bhumanand College of nursing, uttarakhand, 2 Basic B.Sc
Nursing 4th year students, Shri swami Bhumanand College of nursing, uttarakhand.

Research Guide-Miss Shaheen (Assistant Professor)

Corresponding author E-Mail: shaheen111malik@gmail.com

kumaripratibha945.kp@gmail.com.

ABSTRACT

A descriptive study was conducted to assess the factor leading to increase rate of cesarean
section among the pregnant women at selected Hospital in Haridwar Uttarakhand. Anon
experimental research design was used to assess the knowledge regarding factor leading to
increase rate of cesarean section among pregnant women. The sample size was 109 pregnant
women or reproductive women at selected hospital in Haridwar. Purposive sampling technique
was used for selection of samples. The data was collected using self structured questionnaire.
The result depict that the factors associated with increase number of cesarean section among
pregnant women in terms of mean ± SD score was 5.9±4.9. The Result of the study also indicate
that there is no any influence of factor leading to increase rate of cesarean section among
pregnant women with their level of knowledge.

Key word - knowledge, pregnant women, cesarean section.

INTRODUCTION

Cesarean section delivery or lower segment This is vital clinical procedure is performed
cesarean section is a surgical procedure to avoid obstetric complication and thereby
which is used to deliver a baby through averts the incidence of maternal and
incision in the abdomen and uterus 9. neonatal deaths1. According to several
Cesarean section delivery are known to be studies the first cesarean section
major life saving obstetric surgical documented occurred in 1020 AD, and since
intervention for mothers and babies from then the procedure has evolved
pregnancy and child birth related tremendously. Cesarean section is now the
complications so as these reduce the chances most common surgery performed in the
of IMR (infant mortality rate ) and MMR United States, with over 1 million women
(maternal mortality rate)1. delivered by cesarean section every year20.
The cesarean delivery rate rose from 5% in
1970 to 31.9% in 201620. Today cesarean
birth accounts for 15%-25% of all the
deliveries in developed countries with
maternal mortality of less than 1:10, 0000.
Though there are continuing efforts to
reduce the rate of cesarean sections, experts
do not anticipate a significant drop for at
least a decades or two20.
Whiles it confers the risk of both immediate
and long term complications for some
women, cesarean section delivery can be the
safest or even the only way to deliver a
healthy newborn20. Many people prefer
cesarean section because they think it will
be the safest procedure for the delivery of
the healthy baby and also safe for mother’s
life2.
According to new research from the world
health organization (WHO) there will be a
increase of cesarean section rate
continuously globally, now accounting for
more than 1 in 5 (21%) of all the child
births. This number is set to continue
increasing over the coming decades, with
nearly third (29%) of all births likely to take
place by cesarean section mode of delivery
by 203010.
While cesarean section can be life saving
surgery, it can put women and babies at
unnecessary risk of long and short term
health problems if performed when there is
no medical need21. Cesarean section are
absolutely critical to save lives in situations
when normal vaginal deliveries would
causes more risk to mother’s and baby’s
health,
So all health system must ensure timely
access for all women when needed, said Dr.
Ian Askew, director of WHO’s department
of sexual and reproductive health and
research and the UN joint programmed,
HRP10. But not all cesarean section carried
out at the moment is needed for medical
reasons. Unnecessary surgical procedure can
be harmful for both women and her baby10.
Cesarean section is done because the
cesarean section is safer for both mother and
her baby than vaginal delivery9. Doctors
might recommend for cesarean section mode
of delivery if women have some medical
conditions like her labor is not progressing,
baby is in distress, baby or babies are in
abnormal position, there is problem in
location of placenta, prolapsed umbilical
cord, health related problems, mechanical
obstruction, previously having a history of
cesarean section9.
Identification of factors associated with a
cesarean section is important to minimize
the unnecessary practice of such life saving
intervention and increasing its access to
those who needed it the most16. Factor
contributing to this increase rate of cesarean
section includes delayed child bearing,
policies promoting repeat cesarean section
refusal to offer vaginal birth after,
cesarean section wide use of continuous
electronic fetal monitoring, use of epidural
analgesics, fear of mal practice liability,
dystocia, professional practice style,
professional expectation for work life
balance, reimbursement system, financial
incentives, maternal request or lack of
regulation4. Studies done to explore the
prevalence and factor associated with
cesarean section in the current study area are
limited16.
Unnecessary cesarean section has adverse
impact upon maternal, neonatal and infant
morbidity and mortality. The more cesarean
section the higher the risks of other medical
condition like abnormal placental location
and uterus tearing. The high cost of cesarean
section may result in catastrophic health
expenditure for families and additional
pressure upon health systems, especially in
low and middle income countries18.
The reasons for such drastic increases rate of
cesarean section are multi factorial including
medical as well as non medical reasons. It
has been suggested that non medical factors
such as social, cultural, or unequal
accessibility to health services, as well as
clinical practice pattern styles, might have
been major contribution to wide variation in
cesarean section rate across different
countries19.
OBJECTIVES
 To assess the factor associated with the
increment of cesarean rate like mother’s
age, cesarean indicator, educational
level, socioeconomic status.
 To find out the association factor leading
to the increase in the number of cesarean
section among pregnant women with
their selected demographic variable.
HYPOTHESIS
All hypothesis were tested p<0.05 level of
significance.
H0- there is no statistical significance exists
in a set of given observation and is used to
assess the credibility of a hypothesis by
using sample data at p<0.05 level of
significance.
REVIEW OF LITRATURE
Avjit roy, pintu paul, pradip chouhan ,
margubur Rahaman and Nanigopal
Kapasia.2021 India, Geographical
varialibility and factors associated with
cesarean section delivery in India: a
comparative assessment of Bihar and
Tamilnadu. The result of the study shows
that about 19% of women had undergone C-
Section delivery. The study conclusion
reveals that the women who experience
pregnancy loss and have pregnancy
complication were more likely to under gone
cesarean section delivery. The study
conclusion reveals that the women who
experience pregnancy loss and have
pregnancy complication were more likely to
under gone cesarean section delivery.
Aisha Amjad, uzair Amjad , rubeena zakar,
et al 2012 Pakistan “Factor associated with
cesarean section deliveries among child
bearing women in Pakistan”. The result of
the study was shows that cesarean delivery
is associated with the women whose age is
more than 24years. Therefore the women in
Pakistan under gone cesarean section
delivery were about 13.6%. The conclusion
of the study reveals that the women should
be have adequate awareness about reduction
of pregnancy complication that helps n
reducing malpractice and detailed medical
justification by doctors for performing the
cesarean delivery.
Chitkasaem Suwanrath, sopen chunuan, et al
2020 South Thailand. A study to assess why
pregnant women prefer cesarean section
birth. The result of the study was that
women who have negative experience of
vaginal delivery, positive attitudes towards
cesarean section birth, and belief in
auspicious birth dates. The study conclusion
reveals that obstetrician should provide
effective counseling to women who have
preferred for cesarean delivery that could
reduce the rate of cesarean section delivery.
Sulochana dhakal, Edwin van teijlingen,
pramod R. Regmil 2021 South Asian
countries. Factors contributing to increase
cesarean section rates in south Asian
countries: a systemic review. A total of
1543 studies, of which 524 duplicates were
removed using Endnotes. Of 1019 studies,
925 studies were excluded after initial
screening and a further 23 were removed
after assessing the full text, leaving 71
which were assessed for quality. The result
of the study was that cesarean delivery of
the women is associated with the medical
and non medical conditions. The conclusion
of the study include greater precision in
diagnosis of fetal distress keeping primary
CS to a minimum and educating the family
and women about the risk and benefits of the
CS and avoiding CS for non medical reason.
Roshni R. Patel, Tim j petres, Deirdre J
Murphy, 2004 England. Prental risk factor
for caesarean section analysis of the
ALSPAC cohort. The result of this study
was that 1153 had Caesarean section (685
emergencies, 468 elective. The conclusion
of this study was careful exploration of risk
factor may allow us to identify reasons for
CS.
Honglei Ji, Hong Jiang, Limin Yang Xu
Qian, Shenglan Tang 2015 Shanghai.
Factors contributing to the rapid rise of
caesarean section: a prospective study of
primiparous Chinese women in Shanghai.
The result of this study was that 13.2%
preferred CS in the second trimester and
34.9% of women undergoing CS who didn’t
have indications listed in the clinical
guidelines nor based on maternal request.
The conclusion of the study was reveals that
concerted action targeting services providers
as well as users needs to be taken in the
near future, in order to effectively control
the rapid rise of CS.
Batieha AM, Al-Daradkah SA, et al 2017.
Cesarean Section: Incidence, Causes,
Associated Factors and Outcomes: A
National Prospective Study from Jordan.
The result of this study was the overall rate
of CS was 29.1% (13.2% as emergency CS
and 15.9% as planned CS or EMR CS. The
conclusion of this study was that the CS was
more currently based on the physician’s
judgments it may be extremely useful to
develop and strictly implement national
guideline for CS.
Dr. Nazia Mussarat, Dr. Saima Qurashi,
Prof. Dr. Mahnaz Roohi 2013 Faisalabad.
LOWER SEGMENT CESAREAN
SECTION (LSCS); Indications and
Complications at Teaching Hospital. The
result of the study was that Out of 100
patients, 58(58%) had emergency and
42(42%) had elective caesarean section. The
conclusion of the study was the most
effective means to control previous CS is the
prevention of the first CS which could be
achieved by adopting the policy of trial of
vaginal delivery after previous CS.
Eghbal Zandkarimi, Abbas Moghimbeigi, The tools of the study was self structured
Hossein Mahjub. 2020 Hamadan, Iran. questionnaire to assess the knowledge of the
Assessing the Factors Affecting Cesarean pregnant women to assess the factor leading
Section Selection in Iranian Women. The to increase rate of Cesarean Section among
result of this study, was out of the 17284 Pregnant women. The self structured
Iranian women with a mean age of 34.86 ± questionnaire is used to assess the level of
9.98 years, 11588 (67%) of VD and 5696 knowledge of the women regarding the
(33%) used CD. The conclusion of this causes of increase cesarean section rate
study was that the findings highlighted the among women. Other section consists of
importance of supplemental insurance and socio demographic variables. In this way
socioeconomic status in choosing a CD by there were two tools used
women.
 Socio demographic variables
RESEARCH METHODOLOGY  Closed ended question
Research approach: DATA COLLECTION
The study attempt to find the knowledge of The written permission obtained from the
the pregnant or reproductive women about authority. Prior informed consent was
the factor leading to increase rate of obtained from the participant before the for
cesarean section among pregnant women. the purpose of data collection. Data was
The investigator has employed the collected from 109 pregnant women or
quantitative and non experimental research reproductive women from selected hospital
approach. This may do by asking questions. of haridwar, who are available at the time of
The investigator employed non- study. Purposive sampling technique was
experimental research approaches in this used for the selection of sample for the
study to assess the factor leading to increase purpose of data collection. The data was
rate of Cesarean Section among Pregnant collected through the self structured
women17. questionnaire.
Research design: Table No. 1 Frequency And Percentage
The investigator has applied the non Distribution Of Demographic Variables.
experimental research design. The design N=109
used in this study was descriptive research
design where the aim of this research is to S. Demographi Frequency Percenta
N c Variable Distributio ge
be generate new facts is largely non
o. n
experimental. It is especially suited to such
studies since description implies natural 1 Age In year
observation of the characteristics of research 19-29 70 64.22%
subject without deliberate manipulation of
30-43 39 35.77%
the variables or control over the research
setting17. 2 Education
The study has analyzed the factor leading to Primary 42 38.53%
increase rate of Cesarean Section among education
Pregnant women.
Secondary 67 61%
Instruments: education
 3 Income primary education 42 (38.53%) and 67
8,000- 65 59.63% (61%) were secondary education. Majority
55,000 of reproductive women 65 (59.63%) were
56,000- 44 40.36% have family income between 8,000 to
2.5lakh
55,000 and 44 (40.36%) were have 56,000
4 Gravida
to 2.5 lakh.
Primi 51 46.78%
gravida Majority of the reproductive women 58
Multi 58 53.21%
(53.21%) are multigravida mothers and 51
gravida
5 Antenatal (46.78%) were primigravida. Majority of the
visits reproductive women were 62 (56.88%) were
1-7 47 43.11% have 8-15 antenatal visits and 47 (43.11%)
8-15 62 56.88% were have 1-7 antenatal visits. Majority of
6 Hospital the reproductive women 75 (68.80%) have
Private 75 68.80% preferred private institutional delivery where
hospital as 34 (31.19%) have preferred government
Government 34 31.19%
hospital for the delivery.
hospital
7 Mode of Majority of the reproductive women 67
delivery
(61.46%) had preferred for normal vaginal
preferred
Normal 67 61.46% delivery mode whereas 42 (38.53%) were
vaginal preferred for the cesarean section mode of
delivery delivery. Majority of the women 90
Cesarean 42 38.53% (82.56%) said they had medical indication
section related to the cesarean mode of delivery and
8 Cesarean 19 (17.43%) women said they had
section complication related to delivery so that their
mode of
delivery doctor suggested cesarean section mode of
indication delivery.
Yes 90 82.56%
No 19 17.43%
Table no. 2: Distribution of the sample
The data shown in table no.1 depict the according to their knowledge score
percentage and frequency of characteristics
which shows that majority 70(64.22%) of Poor Average Excellent
the reproductive women were in the age
group of 19-29 years and 39 (35.77%) Knowledge
score 1-5 6-10 11-15
participants were in the age of 30-43 years.

Majority of reproductive women 58 39 12

participated in the study were having
 mean percentage is 24.58%, therefore the
Level Of Knowledge result of the study based on, ages factor of
the women 64.22% women have age
Poor Average between 19-29 years old and 35.77%
Excellent
women have age between 30-43, 38.53%
11%
women only have primary education where
as 61% women have secondary or higher
36% 53% education. indication of cesarean section
among women which means 82.56% women
have cesarean section indication where as
Figure no. 1 inferred that 53% pregnant
only 17.43% women said that they does not
women had poor knowledge, 36% pregnant
have any indication of cesarean delivery.
women had average knowledge and only
46.78% women were primigravida where as
11% pregnant women had excellent
53.21% women were multigravida. There is
knowledge regarding the cesarean section
no significant association between the
mode of delivery.
demographic variables with the factor
Table no. 3: Knowledge score of the study leading to increase rate of cesarean section.
participants regarding increase rate of
CONCLUSION
cesarean section.
The study concluded that majority of
82.56% reproductive women have indication
Kno Mean Media Ran Mean related to cesarean section medical condition
wled ± SD n ge Percen
ge scor like placenta previa, meconium aspiration,
tage
score e twin pregnancy, hypertension and non
5.9 5 1-15 24.58% medical indication like prolonged labor, mal
±4.9 practice during the time of first delivery,
anxiety related to labor pain where as
Table no. 3 reveals that overall mean score
61.46% women have first preference toward
± SD for increase cesarean section rate was
normal vaginal delivery. The doctors play an
5.9 ±4.9, median knowledge score was 5 and
important role in using the decision of
minimum knowledge score was 1 and
cesarean section mode of delivery; the
maximum knowledge score was 15 and
women should be have adequate awareness
mean percentage of the knowledge score is
about reduction of pregnancy complications
24.58%.
that helps in reducing malpractice and
RESULT detailed justification by doctors for
performing the cesarean delivery.
The factors associated with increase number
of cesarean section among pregnant women RECOMMENDATION
in terms of mean ± SD score was 5.9±4.9
and median is 5, standard deviation is 4.9
A similar study can be conducted
undertaken on a large scale for making more
valid generalization.
 The study was conducted in college,
expectant parents, student nurses and
obstetrics.
 The study can be replicated by other
research design such as pre experimental
design.
 A similar study can be done to provide
education program to enhance the
knowledge of the pregnant women.
 A similar study can be done on the
knowledge, attitude of the pregnant
women and doctors.
 A comparative study can be done to
compare the knowledge of the pregnant
women regarding cesarean section in
public and private hospital.
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