ADEQUACY OF MATERNAL COUNSELLING FOR CAESAREAN SECTION IN TEACHING HOSPITALS IN ENUGU.
David Aqua Cyril Dim
INTRODUCTION: Patient’s autonomy is paramount in all clinical decisions; thus, to perform a caesarean section, informed consent is critical. To the best of our knowledge, there are limited documented efforts in the study area, exploring the maternal role in the perception of consent process and their understanding of the messages within the process. This study filled the gap by exploring the adequacy of caesarean sections’ consenting process in teaching hospitals in Enugu, Nigeria.
OBJECTIVES: To audit the process and adequacy of informed consent for elective and emergency caesarean section in two teaching hospitals in Enugu, South-east Nigeria.
•DESIGN: This was a descriptive cross sectional study.
•METHODS: Pretested questionnaires were administered to consenting mothers (n=386), recruited consecutively after caesarean sections at the postnatal wards of the two teaching hospitals in Enugu state. Maternal counselling adequacy was determined by asking about the basics of the consent process for caesarean section. Responses were categorized as: strongly agree, agree, not sure, disagree and strongly disagree. The first two categories were considered adequate for each element. The adequacy of the consenting process was determined by the respondents’ responses to the procedure name, indication for the procedure and the risk associated with the procedure. Data was analyzed using the SPSS software version 25 at 95% confidence level.
•RESULTS: Out of the 386 respondents, the proportion of women that received adequate counselling for caesarean section was 47.7%. The prevalence of adequate informed consent among women who had elective and emergency caesarean section was 67.9% and 39.9%, respectively, [OR= 3.2, CI 95% (2.40-4.28)], p < 0.001.
•Two hundred and ninety-four (76.2%) of the respondents were informed about anesthesia options, and 266 (69.0%) women were allowed to choose their anesthetic option. Only in 20.2% (78) of the respondents was there a full documentation of the consenting process, including the patient’s response after being given the relevant information. The majority of the consent form was administered by the House Officers, 208 (53.9%). The mean maternal satisfaction score for the consent process estimated using the visual analogue scale was 88.1± 26.87 mm.
•CONCLUSION: Overall, there was inadequate maternal counselling at the two Teaching Hospitals in Enugu State, Nigeria, which are the highest level of health care in the state. Adequate and consistent counselling for caesarean section can be achieved in the study area by using standardized consent forms and health care workers’ training in patient’s communication and counselling.
