Date of Award

12-2025

Degree Type

Thesis

Degree Name

Master of Science in Advanced Practice Midwifery (MSc-APM)

First Advisor

Dr Abednego Ongeso

Second Advisor

Dr Roselyter Riang’a

Third Advisor

Prof Eunice Ndirangu

Department

School of Nursing and Midwifery, East Africa

Abstract

Background: A caesarean section (C/S) is a lifesaving procedure to reduce maternal and newborn morbidity and mortality. It is associated with more risks compared to a vaginal birth. The rates of C/S have been on an upward trend globally and are expected to continue to rise further. C/S predisposes neonates to poor outcomes, some of which could be life-threatening compared to vaginal birth. Similarly, C/S mothers are at greater risk for serious complications.

Objective: The primary objective of this study was to investigate the factors influencing the decision to undergo a caesarean section among couples and healthcare workers at The Nairobi Hospital. The specific objectives were to describe the factors that influence the choice of C/S among couples and healthcare workers.

Methodology: This facility-based qualitative research study employed a descriptive research design. Data collection was conducted in October 2024 at the maternity unit of Nairobi Hospital, a private tertiary hospital located in Nairobi County, Kenya. The study recruited 13 postnatal women who underwent caesarean section (C/S) at the hospital and their spouses, 2 midwives, and 1 obstetrician involved in the decision-making process for the mode of birth. Criterion purposive sampling was used to select the study participants. A semi-structured interview guide was used to collect data from women and their spouses, while a key informant interview guide was used to collect data from midwives and the obstetrician. The interviews were audio recorded, transcribed, and analysed thematically using the NVivo software version 12. Ethical approval was sought from relevant bodies at the Aga Khan University and the Nairobi Hospital Research Committee.

Results: Five major themes and several subthemes emerged from the collected data, informing the choice for CS. The themes included previous birth experiences, influence of healthcare providers, personal preference, lack of knowledge, and social factors. Some of the subthemes included non-progressive labour, loss of a previous baby, previous C/S, medical conditions, fear of childbirth and peer influence.

Conclusion and Recommendations: Factors informing the choice for C/S were diverse, ranging from personal preferences, healthcare provider influence and social factors. There is a need to educate couples on the realities of vaginal and C/S births, as well as the risk factors for each mode of birth. In addition, hospitals should be audited regularly to ensure adherence to set guidelines for conducting C/S.

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1

Last Page

131

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