Facilitators and barriers to cesarean section delivery in south western Uganda: A qualitative study

Background Cesarean section is an important emergency obstetric care service; however, it loses its relevance of reducing maternal and neonatal mortality rates when the rates are above the recommended 15% by WHO. Cesarean section rates are unacceptably high and reasons for this remain unclear. In an attempt to understand this, we aimed at assessing facilitators and barriers of cesarean section among mothers that experience and health workers that take part in the cesarean section delivery in South-western Uganda in order to improve on knowledge and health practices in line with cesarean section delivery and its services. Objective To determine the facilitators and barriers of cesarean section among mothers and health workers in South-western Uganda. Methods We had 36 participants; 18 in-depth interviews and 2 focus-group-discussions with mothers and 6 key-informant interviews with health workers. Analysis Data collected was transcribed verbatim, coded using NVivo 20.2 and analyzed considering the health belief model and content thematic approach. Results Facilitators were maternal preference after previous cesarean section, maternal perception of importance of cesarean section to her and baby, health workers advise, health workers perception of benefit of cesarean section to mother and baby, traditional birth attendants, community and religious perception of benefits of cesarean section, high knowledge about cesarean section by health workers, family perception about importance of cesarean section to mother and baby, friend’s recommendation of cesarean section, health workers’ good communication skills during consenting process, maternal awareness about their condition and how it prevents vaginal delivery. Barriers included; rude health workers, high expenditures like buying expensive drugs and transport to and from the facility especially for referred mothers, delay by health workers to perform cesarean section on referred mothers, presence of medical students in the theatre, community, traditional birth attendants and church’s negative perception, limited staff on maternity ward, stock-outs, maternal preference for vaginal delivery, low maternal education status, bad previous experience with cesarean section, uncomfortable procedures like catheterization and spinal anesthesia injections and perception of having limited number of children due to cesarean section. Conclusion With this information, we were able to understand why cesarean section was done/ preferred or not done/ not preferred, this provides a basis for implementation of working evidence based interventions for proper use of cesarean section like strengthening health education talks in the communities to increase knowledge about cesarean section among community members.