CHAPTER ONE
INTRODUCTION
1.1  BACKGROUND OF STUDY

Maternal mortality represents the leading cause of death among the pregnant women in most developing countries including Nigeria (Mekonnen and Mekonnen, 2003; WHO, 2007). Furthermore, it is estimated that one third of all maternal deaths globally occur in just two countries, namely India and Nigeria (Mboho et al 2013). According to UNFPA (2012), in 2010, India was accountable for about 20% of global maternal deaths (56,000) and Nigeria, 14% (40,000). Meanwhile, disease, deformity and death are terms usually employed to describe the experiences of a vast majority of sub-Saharan African women during pregnancy and birthing (Harrison, 2001; Brookman-Amissah and Moyo, 2004; WHO, 2004a). Similarly, the majority of African women are often viewed as being at high risk of infections, injury and death during pregnancy and the periods surrounding it (Izugbara and Ukwayi, 2007). In recent time women in Nigeria have expressed worries about choices of childbirth especially the issues surrounding vaginal birth. The joy of every woman is to deliver her baby normally. Some decades ago the most available or preferred option for most women was vaginal birth. Some of the women had their babies at home with traditional birth attendants but quite often with difficult labour resulting from obstruction and the women died before any meaningful interventions. Today, however, many babies have been delivered successfully through caesarean section. This success story in not without criticism. Among women in the developing countries, caesarean section is still being perceived as a ‘curse’ of an unfaithful woman (Adeoye and Kalu 2011). The authors further assert that caesarean section is seen among weak women. In addition, caesarean section is surrounded with suspicion, aversion, misconception, fear, guilt, misery and anger among the women of South Western Nigeria (Adeoye and Kalu 2011). Furthermore, in most sub-Saharan African countries including Nigeria, caesarean section is being accepted reluctantly even in the face of obvious clinical indication (Adeoye and Kalu 2011). Despite the causes of maternal mortality often obstetric in origin, underlying cultural factors and beliefs also affect access to and use of health facilities and thus contribute to avoidable maternal deaths (Mboho et al 2013). Several studies have indicated how local beliefs and practices impact general health and childbearing. Some of these beliefs have been identified as contributing to the delays in accessing appropriate skilled help when complications arise in labour (Okafor 2000) It is necessary to note that the issue of vaginal birth is not only peculiar to developing countries but also in some developed countries. Women still choose vaginal birth after having caesarean section even in the case of post dates slated for elective caesarean section (Clift-Mathews 2010). The author further highlighted the fact that women desperately wished to go into labour before their appointment dates because not giving birth vaginally was a sign of ‘failure’. In addition; vaginal birth is something a number of women look upon as a rite of passage (Clift-Mathews 2010) Obstetrics in modern America is a contentious subject in general (Ecker 2013). Usually childbirth and action surrounding it whether medical or otherwise normally evoke strong emotions where discussion is often framed ideologically as a matter of nature versus technology. Hence the issue of caesarean section in particular is much contested issue (Ecker 2013). Even so, caesarean section rates are on the increase as evident in a number of western countries such as the United States of America and United Kingdom (McAra-Couper, Jones and Smythe 2010). In 1985, following the increasing disparity rate among nations in the number of caesarean births, the World Health Organisation (WHO) set out to determine an optimal rate of 15 percent as ideal. The postulated 15 percent by WHO would optimally prevent childbirth injuries and deaths. In addition, many women and babies would avoid unnecessary and potentially harmful surgery (Harvard magazine 2013). However, WHO has since modified this particular recommendation in 2009, stating that ‘the optimum rate is unknown but asserts that both very low and very high rates of caesarean sections can be dangerous’. In other words, the procedure should be done only when it is absolutely necessary. The editorial team of Academic Research International of Harvard Magazine concluded that there is need for a balance to be reached, that is, women should be allowed to have normal vaginal deliveries with as little intervention as possible. However, at the same time, the families, obstetricians will be ready to address any unexpected emergencies.