1.

Study Questionnaire
Questionnaire for the study on “Psychological effects of caesarean section on mothers at postnatal

wards in Hawassa Referral Hospital”

Instructions: Thank you for your willingness to respond to the following questions and participate in the

study. The session will take 20 – 30 minutes. You will be interviewed by the research assistants who

will fill the questionnaire for you. Your responses will be recorded just the way you put them. You are

encouraged to be as accurate in your responses as possible. All gathered information will be kept

confidential and will only be used for the purposes of this study.

Thank you.

SECTION I: PSYCHOLOGICAL EFFECTS OF CAESARIAN SECTION

For psychological effects of caesarean, please respond to the following questions most appropriately.

1.1 Have you ever experienced any psychological effects after caesarean section?

Yes [ ] No [ ]

1.2 If yes, which of the following effects have you experienced after caesarean section?

a) Anxiety [ ]

b) Depression [ ]

c) Disappointment with mode of delivery [ ]

d) Failure to have normal birth [ ]

e) Fair of social stigma [ ]

f)Fear for next pregnancy [ ]

g) Feeling of cowardice [ ]

h) Feeling of not suffering enough for her baby [ ]

i) Hate for hospital of delivery [ ]

j) Post operation depression [ ]

k) Post-operative stress effect [ ]

l) Post-operative trauma effects [ ]

1.3 Are there any other psychological effects experienced after caesarean section?

Yes [ ] No

[ ] If yes

please specify

………………………………………………………………………………………………………

………………………………………………………………………………………………………

SECTION II: DEMOGRAPHIC DATA

For demographic data, please respond to the following questions most appropriately

2.1 What is your age (in completed years)? ..............................................

2.2 What is your highest level of education (completed level)?

a) Primary level [ ] b) Secondary level [ ] c) College/university level [ ] d) No formal education [ ]

2.3 What is your marital status?

a) Single [ ] b) Married [ ] c) separated [ ]d) Widowed [ ] e) Divorced [ ]

2.4 How many live children do you have? (Indicate numbers) ……………………….

2.5 How many children have you ever delivered in total? (Indicate numbers) ……………

2.6 Where do you stay? ...........................................................

SECTION III: SOCIO- CULTURAL FACTORS

For socio- cultural data, please respond to the following questions as most appropriate

3.1 What is your religion?

 a) Muslims [ ] 2) Christian [ ] 3) Protestant [ ] d) Traditional [ ] e) Others specify)
……………………………..

3.2 Where is your kebele? (district)…………………… …………..

3.3 What is the view of your people towards caesarean section?

a) Good [ ] b) bad [ ] c) I don’t know [ ]

If bad, why? (Specify)………………………………

3.4 Do you have cultural beliefs, taboos and practices that are negative towards caesarean section?

a] Cultural beliefs Yes [ ] b) No [ ] c) I don’t know [ ]

If yes, in which way? (Specify) ……………………..

a) Taboos Yes [ ] b) No [ ] c) I don’t know [ ]

If yes, in which way? (Specify) ……………………..

b) Cultural practices Yes [ ] b) No [ ] c) I don’t know [ ]

c) If yes, in which way? (Specify) ……………………..

3.5 Do you have traditional practices that are not in keeping with caesarean section?

a) Yes [ ] b) No [ ] c) I don’t know [ ]

If yes, which ones? (Specify) ……………………..

3.5 Do you belong to any social or peer group?

[ ] social group Yes ----- No------ If yes, which one? (Specify)……………

[ ] peer group Yes------ No------If yes, which one? (Specify)……………

3.6 If yes to 2.6 how the social has or peer group influenced your attitude towards caesarean section?

SECTIONIV: ECONOMIC FACTORS

For economic data, please respond to the following questions as most appropriate

4.1. What is your occupation?

a) Self-employed [ ] b) In formal employment [ ] c) Not-employed [ ]

d) Student [ ] e) others (specify)……………

4.2 How much is your average monthly earnings in Birr? (State) ……………….
4.3 What type of transport do you use to come to hospital?

(a) Public [ ] (b) Private [ ] (c) Foot [ ]

SECTION V: HEALTH FACTORS

For health data, please respond to the following questions as most appropriate

5.1How far is the hospital from your home? (In approximate No of km)…………………

5.2 How do you, in your opinion, rate the quality of your hospital?

a) Good [ ] b) bad [ ] c) I don’t know [ ] d) others (specify)…………………..

5.3 Are there enough health service providers in your hospital to take care of you?

a) Yes [ ] b) No [ ] c) I don’t know [ ]

5.4What quality of health service providers are in your hospital?

a) Good [ ] b) bad [ ] c) I don’t know [ ] d) others (specify)…………………..

a) Was there everything available that you needed in your hospital for your caesarean delivery?

Yes [ ] b) No [ ] c) I don’t know [ ]

5.5 Was there a maternity theatre in your hospital for caesarean delivery care?

a) Yes [ ]b) No [ ] c) I don’t know [ ]

5.6 Was there enough equipment in your hospital for caesarean delivery?

a) Yes [ ] b) No [ ] c) I don’t know [ ]

5.7 Was there a laboratory in your hospital for caesarean delivery care?

a) Yes [ ] b) No [ ] c) I don’t know [ ]

5.8 Were you given counseling or health education in your care? Yes [ ] No [ ]
SECTION VI: KNOWLEDGE
 For knowledge data, please respond to the following questions as most appropriate

6.1 During birth preparedness were you informed about caesarean section delivery?

Yes [ ] b) No [ ] c) I don’t know [ ]

If yes, what advise were you given? (Specify)…………………………………..

If yes, who gave you the information? (Indicate more than 1 if applicable)

a) Doctors [ ] b) Nurses [ ] c) Midwives [ ] d) relatives [ ] (specify the relative)…………………

e) Friends [ ] f) Traditional medicine man [ ] g) Traditional birth attendant [ ]

h) Other [ ] (specify)………………

6.1 Are you aware of the availability of free maternity services at the time when labour started?

Yes [ ] b) No [ ]

If yes, who gave you the information? (Specify)…………………………..

6.2 Which was your preferred place of birth before you came?

State why? ...................................................

6.3 How much do you know about the following with respect to caesarean delivery?

a) risks or dangers involved

Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

b) possible complications
Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

c) benefits of caesarean delivery

Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

 d) normal expected outcome of caesarean delivery Nothing [ ],

little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

6.4 What do you know about caesarean delivery care needs?

Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

6.5 What do you know about delivering through caesarean section?

Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

6.6 What do you know about the psychological effects of caesarean section?

Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

6.7 What do you know about complications of caesarean section?

Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

6.8 What do you know about the type of Caesarean section?

Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

6.9 Which was your preferred way of delivery before giving birth?
a) Normal delivery [ ] b) Caesarian section [ ] c) I don’t know [ ] others (specify)…………

6.10 What do you know about the gestational age at caesarean section? Nothing [ ], little [ ] enough [ ]
much [ ] very much [ ] If you have knowledge, what do you know (specify)………………………….

6.12. What do you know about the indication for caesarean section (Specify)………

Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify………………………………

6.13. What do you know about the gestational age at caesarean section?

Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

6.14 What do you know about the indication for caesarean section (Specify)………

Nothing [ ], little [ ] enough [ ] much [ ] very much [ ]

If you have knowledge, what do you know (specify)………………………….

SECTION VII: ATTITUDE

Indicate the level of agreement concerning caesarean section delivery

Statement

Strongly Agree Disagree Strongly Not

agree disagree sure
Nurses can’t advise me on preferred mode
of delivery
A mother should have her own right to
request for the type of delivery

Vaginal birth is natural and the most

acceptable type of delivery.
Woman will regain her health status sooner
after vaginal delivery than
caesarean delivery
Children born by caesarean section are
healthier than those born through vaginal
delivery
I can’t decide on type of delivery alone
without my relatives
I fear caesarean section and don’t trust it
The health workers should decide on the
best type of delivery and advice
accordingly
I have very little faith in doctor, nurses
and midwives, concerning caesarean
section.
 There are a lot of uncertainties about c/s
that nurses, doctors and midwives don’t
know

Section VIII: Practice

For practice data, please respond to the following questions as most appropriate

8.1 If you delivered in the past, where was your place(s) of delivery? (Indicate more than 1 if applicable)

a) Home b) hospital c) on the way d) others state).................................

8.2 Did you attend all scheduled Antenatal visits?

a) Yes [ ] b) No [ ]

If no, why did you not? ...............................................................

8.3 Which delivery method did you have?

a) Normal delivery [ ] b) Caesarean section [ ] c) I don’t know [ ] others (specify)…………

8.4 How satisfied were you with the delivery method you had?

Not satisfied [ ] little satisfied [ ] satisfied [ ] very satisfied [ ] extremely satisfied [ ]

8.5 Did you understand why you delivered with the method of delivery you had?

a) Yes [ ] b) No [ ]

If yes, what was the reason? .................................................................

Normal labor [ ] b) Fetal distress [ ] c) Obstructed labor [ ] e) others [ ] (specify)……

8.6 How much past experience have you had with nurses, doctors and midwives in their practice?

a) None [ ] b) very little [ ] c) little [ ] (d) enough [ ] (e) much [ ] (f) very much [ ]

8.7 Have you ever been hospitalized in the past?

a) Yes[ ] b) no [ ]

If yes, what was its effect on your experience?

Not satisfied [ ] little satisfied [ ] satisfied [ ] very satisfied [ ] extremely satisfied [ ]
b) Now that you have had a caesarean delivery, if you had a caesarean delivery again what would you

do? Nothing [ ] b) only slightly disturbing [ ] c) bad [ ] (d) very bad [ ] (e) extremely bad [ ]

(f) others (specify)………

9. Others

8.1 According to you which other measures may be undertaken so as to prevent/manage

the psychological effects of caesarian section?

……………………………………………………

………………………………………………………………………………………………………

………………………………………………………………………………………………………

…………………………………………………………………………………
 4: Key Informant Interviews guide
Dear participant,

You are hereby invited to participate in a Key Informant Interview for a study on psychological effects
of caesarean section on mothers at postnatal ward in Hawassa Referral Hospital

You have been chosen purposively due to the expected level of information and knowledge you have on

the study topic. The details of the research are as per the information sheet for participants.

Requirements for informed consent are as specified in the informed consent form which you will be

expected to fill for proof of consent to participate. Be honest, free and active in your participation in

responding to the questions given for due response. Participation will be guided by use of Key Informant

Interviews Guide shown below. There will be an observer, moderator and note taker for your Key

Informant Interview information. Recordings will also be made by use of tape recorders to store

information as presented. All information gathered will be held under strict confidentiality and will be

used only for purposes of the research.

1. What is the psychological effect of caesarean section on mothers attended to at Hawassa Referral
Hospital?

2. What are the factors that influence psychological effects of caesarean section on mothers
attended to at Hawassa Referral Hospital?

3. What is the relationship of mothers’ knowledge to the psychological effects of caesarean section on
mothers attended to at Hawassa Referral Hospital?

4. What is the relationship of mothers’ attitude to the psychological effects of caesarean section on mothers
attended to at Hawassa Referral Hospital?

5. How does mothers past experience and practice relate to the psychological effects of caesarean section on
mothers attended to at Hawassa Referral Hospital?

Thank you very much for your participation.

 5: Focused Group Discussion Guide

Dear participant,

You are invited to participate in a focused group discussion for a study on ‘psychological effects of
caesarean sections on mothers’ sections at postnatal ward in Hawassa Referral Hospital’

You will be one of the members of a focused discussion group made up of 8 to 12 participants. The
details of the research are as per the information sheet for participant. Requirements for informed
consent are as specified in the informed consent form which you will be expected to fill for proof of
consent to participate. Be honest, free and active in your participation in responding to the questions
given for due response. Participation will be guided by use of Focused Group Discussion Guide shown
below. There will be an observer, moderator and note taker for your focused group discussion.
Recordings will also be made by use of tape recorders to store information as presented. All information
gathered will be held under strict confidentiality and will be used only for purposes of the research.
What are the characteristics that determine psychological effects of caesarean sections on mothers
delivered by caesarean sections in obstetric ward at Hawassa Referral Hospital?

1. What are the socio-cultural factors that influence psychological effects of caesarean sections on mothers
delivered by caesarean sections in obstetric ward at Hawassa Referral Hospital?

2. What are the factors that influence psychological effects of caesarean sections on mothers delivered by
caesarean sections in postnatal ward at Hawassa Referral Hospital?

3. What are the hospital related factors that influence psychological effects of caesarean sections on
mothers delivered by caesarean sections in postnatal ward at Hawassa Referral Hospital?

4. What are the knowledge, attitude and practice issues that determine psychological effects of caesarean
sections on mothers attended to at Hawassa Referral Hospital?

Thank you very much for your participation.