Abstract
Background
This paper explores women’s experience and perception of cesarean birth in Burkina Faso and its social and economic implications within the household.
Methods
Five focus groups comprising mothers or pregnant women were conducted among residents of Bogodogo Health District in Ouagadougou to assess the perceptions of cesarean section (CS) by women in the community. In addition, 35 individual semistructured interviews were held at the homes of women who had just undergone CS in the referral hospital, and were conducted by an anthropologist and a midwife.
Results
Home visits to women with CS identified common fears about the procedure, such as “once you have had a CS, you will always have to deliver by CS”. The central and recurring theme in the interviews was communication between patients and care providers, ie, women were often not informed of the imminence of CS in the delivery room. Information given by health care professionals was often either not explicit enough or not understood. The women received insufficient information about postoperative personal hygiene, diet, resumption of sexual activity, and contraception. Overall, analysis of the experiences of women who had undergone CS highlighted feelings of guilt in the aftermath of CS. Other concerns included the feeling of not being a “good mother” who can give birth normally, alongside concerns about needing a CS in future pregnancies, the high costs that this might incur for their households, general fatigue, and possible medical complications after surgery.
Conclusion
Poor quality of care and the economic burden of CS place women in a multifaceted situation of vulnerability within the family. CS has a medical, emotional, social, and economic impact on poor African women that cannot be ignored. Managers of maternal health programs need to understand women’s perceptions of CS so as to overcome existing barriers to this life-saving procedure.
Supplementary material
Interview guide
For women with cesarean section, Bogodogo District, Ouagadougou
Identification
Age
Number of children Profession
Education
Spouse’s occupation
Spouse’s level of education
Places of residence
Address/telephone number
Notion of a difficult pregnancy
How was this pregnancy?
Was it a difficult pregnancy?
Have you ever had a difficult pregnancy?
How were your other pregnancies?
What can make a pregnancy difficult?
Have you ever lost a child in childbirth? If so, when did this happen? Where? Can you tell us a little about how it happened?
Medical supervision of the last pregnancy
Did you attend antenatal consultations?
If so, how many?
Where? Explain the criteria of choice for the medical facility
Have you attended the discussion sessions (“causeries”) given by the midwife during pregnancy?
What did the midwives say during these sessions?
During the antenatal consultation, what did caregivers tell you personally?
About childbirth, what were you told?
What did you learn during antenatal consultation? During the discussion sessions?
Childbirth and the perception of it
Can you talk about your delivery?
Do you have any idea when the pain started?
Who did you discuss it with?
What did you say?
Where was the first place you went for assistance? Why? What were you told there? What care did you receive, if any?
How did you come to maternity ward?
Who decided to send you?
Who accompanied you to the maternity ward?
Who helped you to give birth?
Were you afraid to give birth at the maternity ward?
Cost and financial players of pregnancy and childbirth
For the antenatal consultation, how much did you pay?
Who paid?
How much did you pay for delivery? Do you know how much your relatives paid? What did you pay yourself?
Who paid for the delivery?
Did you save money for the childbirth? For the cesarean section ? If so, how?
Knowledge of the health facility
Did you know about the existence of the maternity ward?
Did you know that there was an operating theater in the district hospital? If so, how did you know this? Who told you? When?
Perceptions of health personnel
How was your relationship with health workers?
Did you know some of them?
What did you like? Why?
What did you dislike? Why?
For the next delivery, would you choose to give birth in the maternity ward?
Proposed solutions
How could we improve things in the maternity ward?
What should be improved?
Why should we improve the particular point you mention?
What do you suggest to improve conditions for labor at the hospital?
Acknowledgments
This work is based on data gathered as part of the “ Amélioration de la Qualité et de l’Accès aux Soins Obstétricaux d’Urgence” (AQUASOU) project funded by the French Ministry of Foreign Affairs (Projet FSP 2001-149). We would like to thank the Bogodogo District management team in Ouagadougou, the maternity and operating theater staff for their commitment to and involvement in the home visits, the women and their families for their trust, and the team at the Health and Family Directory of the Ministry of Health for its constant support.
Disclosure
The authors report no conflicts of interest in this work.