An Uninformed Decision-Making Process for Cesarean Section: A Qualitative Exploratory Study among the Slum Residents of Dhaka City, Bangladesh
2. Materials and Methods
2.1. Study Design and Study Settings
2.2. Sampling Technique
2.3. Study Participants
2.4. Data Collection
2.5. Data Analysis
2.6. Ethical Considerations
3.1. Sociodemographic Characteristics of the Sample
3.2. Involvement of Mothers and Family Members in Decision-Making
During the time of childbirth, we were in [an urban healthcare center] for two days … Everyone was coming and going, but the childbirth was delayed in my case. Everyone was saying that my childbirth would be late … the doctors checked my condition many times … then my mother got angry at the hospital and phoned my husband, and my husband said, enough! We are waiting for a long time, no need to wait anymore … they did the ultra (ultrasonography), blood tests, and then did the Caesar … My husband did not talk to me when all these things were going on.
Suddenly my mother-in-law noticed that my wife was not looking good, so she said to visit the doctor for checkups. After the visit, the doctor said, no, the condition is bad; there will be complications if we do not do the operation today. I again went to another hospital, visited a private doctor… She also said, there will be a problem if my wife is not operated today.
I took my wife to the doctor. I did the checkup every month to see if there was any problem with my children … It was I who told about the Caesar. As there were two babies, that’s why I wanted to do the Caesar without taking the risk. I arranged everything for the Caesar … We went to [a tertiary level government hospital] according to the date … She (the pregnant woman) became sicker after going there. The doctors told us that the Caesar needed to be done right then. They didn’t have a doctor to perform Caesar that night. They said, doctors don’t stay here at night, here doctors stay all day but not at night. Later I hired an ambulance from there to take her to [another tertiary level government hospital] … we had our babies doing the Caesar at [another tertiary level government hospital] at 4 am.
I consulted with everyone, with my husband, parents, and sisters. They said, as you have to remove the tumor [in the uterus], you can save money by doing both in one operation, then do the Caesar … Suppose, if there was no tumor [in the uterus], then everyone would have advised for normal delivery, would have told to do the delivery at home. Because of that tumor, everyone around me, all of my relatives, told me to do the Caesar.
3.3. The Extent of Information Received Regarding C-Sections
3.3.1. During ANC
I took my daughter-in-law many times, did the ultra (ultrasonography) two times, and had the checkup every month, did everything that needed to be done … Every time we went for a checkup, they examined whether the baby was well, whether the mother was in good condition.
The doctor said that the elder child was delivered by Caesar, so the younger one will also be delivered by Caesar … The doctors told that, as the previous childbirth was in Caesar, this time might need the same, so be prepared.
I went there (an NGO healthcare facility) with the doctor’s prescription, and they gave me the tablets of iron, calcium, vitamins, and gastric (anti-ulcer drugs), and I used to take them … They asked me, was your daughter born in normal delivery or Caesar? I replied, Caesar. Then they said, you will do the Caesar two weeks earlier … I knew that after doing Caesar, I would have a problem doing heavy works. It would strain a bit in place of Caesar cut, heavy work could not be done, and could not have more than three children.
We didn’t ask the doctors about Caesar. On their own, they assured us by saying, why are you so afraid? There is nothing to fear.
3.3.2. During Emergency
My request to everyone is that, if possible, then do not go for Caesar. What I understand is that general people should not go for Caesar. The reason behind that is, we cannot keep someone to help with the household chores, we have to look after everything, including babies, and we have to maintain cooking too. But this is not possible for us because our economic condition is not good...In our case, we should not go for this.
3.4. Attitude towards the Informed Decision-Making Process
Of course, there is a need to know because no one knows how Caesar is done or the pain in administering the Caesar. Of course, we need to know … some have to do Caesar when they are in trouble.
There are BRAC center (an urban healthcare facility established by an NGO) and other centers. If we go there and want to know the information that we don’t know, they will surely inform us. That’s why we do not fear anything … For this reason, everything can be heard … they give us all the suggestions, so we don’t have to worry anymore.
I don’t think knowing about Caesar prior procedure is necessary … I don’t feel like knowing more. If Allah gives only one child to someone, then I would only pray that it lives well.
We are seeing this for 10–15 years. Nowadays, no family goes for normal delivery; everyone chooses Caesar. Over time either the baby or the mother faces problems in normal delivery; got older seeing these. And so, we did not delay anticipating that the baby and the mother would be fine after Caesar.
Caesar has become very much normal these days, no more pain. Both the baby and pregnant women could live well.
Strengths and Limitations
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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Sultana, J.; Sutradhar, I.; Rahman, M.J.; Khan, A.N.S.; Chowdhury, M.A.K.; Hasib, E.; Chhetri, C.; Mahmud, S.M.H.; Kashem, T.; Kumar, S.; et al. An Uninformed Decision-Making Process for Cesarean Section: A Qualitative Exploratory Study among the Slum Residents of Dhaka City, Bangladesh. Int. J. Environ. Res. Public Health 2022, 19, 1465. https://doi.org/10.3390/ijerph19031465
Sultana J, Sutradhar I, Rahman MJ, Khan ANS, Chowdhury MAK, Hasib E, Chhetri C, Mahmud SMH, Kashem T, Kumar S, et al. An Uninformed Decision-Making Process for Cesarean Section: A Qualitative Exploratory Study among the Slum Residents of Dhaka City, Bangladesh. International Journal of Environmental Research and Public Health. 2022; 19(3):1465. https://doi.org/10.3390/ijerph19031465Chicago/Turabian Style
Sultana, Jesmin, Ipsita Sutradhar, Musarrat Jabeen Rahman, Abdullah Nurus Salam Khan, Mohiuddin Ahsanul Kabir Chowdhury, Enam Hasib, Charu Chhetri, S. M. Hasan Mahmud, Tahsin Kashem, Sanjeev Kumar, and et al. 2022. "An Uninformed Decision-Making Process for Cesarean Section: A Qualitative Exploratory Study among the Slum Residents of Dhaka City, Bangladesh" International Journal of Environmental Research and Public Health 19, no. 3: 1465. https://doi.org/10.3390/ijerph19031465