Determinants of Caesarean Section as a mode of delivery at the Mater Hospital, Nairobi

Abstract

Caesarean Section (C/S) rate continues to rise in many countries with good access to medical services, yet this increase is not associated with improvement in peri-natal mortality or morbidity. The United States of America (USA), Mexico, Brazil, and Italy have the highest rate of C/S (over 35 %). In Kenya the rate of hospital-based C/S was below 6.3% while the population-based C/S was 0.95%. However, at The Mater Hospital rates of C/S deliveries have shown a steady increase in the last three years despite the availability of almost all the necessary facilities required for monitoring a mother in labor, hence the current study to investigate the determinants of C/S as a mode of delivery at The Mater Hospital, Nairobi. The general objective of the study was to investigate the determinants of Caesarean Section as a mode of delivery. The study adopted a facility based cross-sectional study design. The study population included all women aged 18-49 years who had delivered through C/S, doctors and midwives involved in maternal and child health care at The Mater Hospital as well as mothers who had undergone C/S mode of delivery and were seeking Child Welfare Clinic (CWC) services formed the sampling frame for the study. The study used an interview schedule, a self-administered questionnaire and a Key Informant Interview Guide (KII) to collect both qualitative and quantitative data. The desired sample size for the study was 114 (79 mothers, 23 midwives and 12 doctors) respondents. The different groups of the respondents were stratified after which simple random sampling method was used to identify the respondents. Data was analyzed using Statistical Package for Social Sciences version 20. Chi square was used to determine the relationship between variables, with a p ≥ 0.05 being significant (95% CI). From the study, the identified determinants of C/S included university level of education (p=0.042, x2=1.3), being single parent (p=0.038, x2=.400), having a formal employment (p=0.034, x2=5.8) and a salary scale range of 40,000 to 60,000 (p=0.037, x 2=2.56). Other determinants included mal-presentation (p=0.006, x2=27.681), fetal distress, (0.0001, x2=6.34), previous C/S scar (p=0.001, x2=30.024), and Cephalo-Pelvic Disproportion (p=0.0001, x2=2.56). Hypertension (0.0001, x2=9.34), failed induction (p=0001, x2=35.690), prolonged labor (p=0.0001, x2=8.39), previous bad outcome (p=0.0001, x2=7.632) and gestational diabetes (p=0.0001, x2=5.98). The study findings, demonstrated that there was a significant relationship between the mothers’ socio demographic characteristics and the preference of caesarian section as a mode of delivery. Therefore, the null hypothesis was rejected. The hospital needs to initiate a programme to mitigate against the C/S deliveries that can be prevented. Pregnant mothers need to be well informed about what they can do to minimize C/S deliveries. The healthcare providers and the hospital management team also need to educate and encourage mother for trial of labour after previous C/S