CHAPTER ONE
INTRODUCTION
Background to the Study
Childbirth is an experience full of change, enrichment, and challenge for couples and the family unit (Bloom, 2014). Childbirth takes not just one’s mind and body through a stream of change; it also takes the family through psychological adjustments (Eden, 2014). It is a time when couples as family confront their fears and expectations about becoming parents. In other words, parenthood may have physical and psychological changes in both mother and father depending on the circumstances of pregnancy, labour and mode of delivery.
Vaginal delivery is the birth of off-springs in humans through the vagina (Abedian, 2010). It is the natural method of birth for humans. The different types of vaginal delivery may include Normal/spontaneous vaginal delivery, assisted vaginal delivery, and induced vaginal delivery (Hakeem, 2014). Virtually all types of vaginal delivery produces some changes in a mother’s brain. Since the brain controls or regulates the functioning of the human body, it may be logical to assume a resultant change in functioning of the mother’s body (Glynn, 2014). The actual details in the process of vaginal delivery may determine the degree of impact of childbirth on health and well being (Rice, 2012). This could be evidenced by the fact that the average hospital stay after a normal vaginal delivery is 36-48hours or with an episiotomy [surgical cut to widen the vaginal canal] is 48-60hours (Abedian, 2010).
Caesarean delivery is the birth of off-springs through a surgical procedure in which one or more incisions are made through a mother’s abdomen and uterus to deliver one or more babies (Wiklund, Edman, & Andolf, 2007). It is performed when a vaginal delivery would put the baby’s or mother’s life or health at risk (Abedian, 2010). Some are also performed upon request without a medical reason to do so (Wiklund, Edman, & Andolf, 2007). Caesarean deliveries have been classified in various ways by different perspectives. It is most common to classify Caesarean deliveries by the urgency of performing them. Conventionally, caesarean sections are classified as being either an elective or emergency delivery (Adewara, Omokanye, Balogun, Salaudeen, Saidu, & Jimoh, 2012).
A planned or elective caesarean delivery is an elective surgery, meaning that it is scheduled in advance rather than performed because of an emergency. This confers the ability to perform the delivery at a time when hospital resources are optimal, such as at daytime rather than what might otherwise turn out to be at night. Critics also argue that because physicians and institutions may benefit by reducing night time and weekend work, an inappropriate incentive exists to suggest elective surgery (Gbenga, 2015). Therefore, elective caesarean sections may be performed on the basis of an obstetrical indication, or maternal request.
Rice (2012) argues that planned caeserean delivery may be putting greater strain on the health and well being of mothers than normal vaginal delivery. He noted that the average hospital stay after caeserean delivery is 60-120 hours. This statement eventually questions an affirmation made by Chong and Kwek (2010) that elective caeserean delivery is relatively safe for both mother and fetus. No matter the mode of delivery however, childbirth has some physical and psychological impact on the mother.
Following vaginal or caesarian delivery, mothers may often endure physical pain, haemorrhoids, constipation, urinary incontinence, prolonged haemorrhage, postpartum depression and difficulty regaining pre-pregnancy shape (Nassauer, 2013). Hence, childbirth could be considered a potent stressor (Hakeem, 2014). Therefore the process of birth may mean extra pressure on the functioning of a mother’s general system or her health and well being, which in turn could affect her quality of life.
Quality of life has been defined as a subjective feeling of comfort, happiness and satisfaction with activities of daily living as expressed in her physical and physiological functioning (Global Development Research Center, 2015).
As individuals within families with a newborn find themselves making social, environmental, occupational, physical and psychological adjustments in order to accommodate the care of a newborn; mothers are also expected to adjust from gravid to post-gravid health states in spite of the mode of delivery (Bjelica & Kapor-Stanulović, 2014). How fast this psycho-physiological adjustment of a mother is achieved may set limits to her ability to care for her newborn, as well as her quality of life at every stage in her postpartum period (James, 2008).
Within the African context, women are custodians of the home. In other words, mothers may engage in routine domestic work aside caring for the newborn. With little social support in families where women keep jobs outside home, mothers would have even more work time with the arrival of a new baby. Excessive work may put some strain on a mother’s ability to recover from the physiological demands of childbirth (Centers for Disease Control and Prevention , 2015). In other words, a mother’s perceived feeling of comfort and satisfaction with ability to cope with activities of daily living may be impacted upon. This individualistic perceived meaning to the multidimensional experience of one’s physical health, adjustment to socio-environmental demands, and coping with activities of daily living is generally dubbed “Health Related Quality of Life” (Global Development Research Center, 2015).
Health-Related Quality of Life (HRQoL) involves those aspects of Quality of Life or functioning, which is influenced or limited by health status; and is based on measurable physical, psychological and social dimensions (Baracaccia, et. al, 2013). This may further suggest that Health-Related Quality of Life (HRQoL) means how one’s health status influences one’s ability to cope effectively with activities of daily living. Therefore Health-Related Quality of Life (HRQoL) reflects perceived wellbeing within the physical, psychological and social domains of life. Hence, the link between maternal health status and type of delivery experienced by mothers may be vital to understanding the nature of this property of “Quality” in the life of a mother (Centers for Disease Control and Prevention, 2011).
Health-Related Quality of Life (HRQoL) is rather dynamic just as health and wellness (Baracaccia et. al, 2013). In other words, perceived comfort, happiness and satisfaction with life could change as one experiences change within oneself and his immediate environment. It may then be logical to assume that, Health-Related Quality of Life (HRQoL) in postpartum women change as they proceed from delivery through postpartum period to recommencement of pre-gravid work routines or chores (International Society for Quality of Life Research, 2015).
The World Health Organization thus recognizes Health-Related Quality of Life (HRQoL) as an important indicator along with traditional measures to capture the burden of health conditions (Yakasai & Abubakar, 2014). It is measured to quantify the degree to which a health condition or intervention impacts an individual’s life in a valid and reproducible way (Global Development Research Center, 2015). The gold standard is for individuals to self report their Health-Related Quality of Life (HRQoL). The measure can then be used to determine changes in Health-Related Quality of Life over time such as in clinical trials and observational studies etc, and compare the Health-Related Quality of Life of patients/clients with different conditions (International Society for Quality of Life Research, 2015). Health-Related Quality of Life (HRQoL) is therefore an imperative maternal and child health tool for estimating the positive and negative consequences of mediconursing interactions on health, wellness and functioning from the patient’s/client’s perspective. Thus, the consequences of vaginal or caesarean delivery on maternal health and wellness overtime could be empirically estimated and compared using the HRQoL measure.
According to Yakasai and Abubakar (2014), caesarean delivery is increasingly being used in place of vaginal delivery worldwide due to maternal requests or physician’s suggestions. Although elective caesarean delivery have been pronounced safe for both mother and fetus (Chong & Kwek, 2010), does caesarean delivery have any merit over vaginal delivery with regard to rapid return to optimal Health-Related Quality of Life (HRQoL)? As Gbenga (2015) noted, this question is yet to be fully answered using evidence based methods.
The postpartum period is the recovery period after childbirth (Declercq & Cunningham, 2008). Within this period, several changes take place within the body of a mother geared towards return from a stress/strain bourne situation to a dynamic health state which she had before pregnancy (Romano, Cacciatore, Giordano, & Rosa, 2010). Typically, the postpartum period begins immediately after birth and extends for about six weeks (Torkan, Parsay, Lamiyian, Kazemnejad, & Montazeri, 2009). However, it is expected that beyound six weeks most of the common health problems of the postpartum period such as pueperal blues, bleeding, bowel and bladder dysfunction would have resolved (Bjelica & Kapor-Stanulović, 2014). In otherwords, at twelve weeks mothers are assumed to have regained their health-related quality of life to a reasonable extent irrespective of the mode of delivery. How correct this assumption is, still remains a subject for further study.
Singh, Kaur, and Singh (2015), and Prick, Bijlenga, Jansen, Boers, Scherjon, and Koopmans (2014) argue that there could be a link between return to optimal Health-Related Quality of Life (HRQoL) and parity status, as well as maternal age. In other words, mother’s age and parity status may have an influence on Health-Related Quality of Life (HRQoL) just as mode of delivery may have an influence on Health-Related Quality of Life (HRQoL).
Against this backdrop, this study examines whether HRQoL differed among newly delivered mothers. This study determines how the HRQoL of mothers differ along eight indicators (Physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional wellbeing, social functioning, pain and general health) in relation to the mode of delivery experienced.
Statement of Problem

Childbirth is an experience full of change, enrichment, and challenge for couples and the family unit (Bloom, 2014). Childbirth takes not just one’s mind and body through a stream of change; it also takes the family through psychological adjustments (Eden, 2014). It is a time when couples as family confront their fears and expectations about becoming parents. In other words, parenthood may have physical and psychological changes in both mother and father depending on the circumstances of pregnancy, labour and mode of delivery.
Vaginal delivery is the birth of off-springs in humans through the vagina (Abedian, 2010). It is the natural method of birth for humans. The different types of vaginal delivery may include Normal/spontaneous vaginal delivery, assisted vaginal delivery, and induced vaginal delivery (Hakeem, 2014). Virtually all types of vaginal delivery produces some changes in a mother’s brain. Since the brain controls or regulates the functioning of the human body, it may be logical to assume a resultant change in functioning of the mother’s body (Glynn, 2014). The actual details in the process of vaginal delivery may determine the degree of impact of childbirth on health and well being (Rice, 2012). This could be evidenced by the fact that the average hospital stay after a normal vaginal delivery is 36-48hours or with an episiotomy [surgical cut to widen the vaginal canal] is 48-60hours (Abedian, 2010).
Caesarean delivery is the birth of off-springs through a surgical procedure in which one or more incisions are made through a mother’s abdomen and uterus to deliver one or more babies (Wiklund, Edman, & Andolf, 2007). It is performed when a vaginal delivery would put the baby’s or mother’s life or health at risk (Abedian, 2010). Some are also performed upon request without a medical reason to do so (Wiklund, Edman, & Andolf, 2007). Caesarean deliveries have been classified in various ways by different perspectives. It is most common to classify Caesarean deliveries by the urgency of performing them. Conventionally, caesarean sections are classified as being either an elective or emergency delivery (Adewara, Omokanye, Balogun, Salaudeen, Saidu, & Jimoh, 2012).
A planned or elective caesarean delivery is an elective surgery, meaning that it is scheduled in advance rather than performed because of an emergency. This confers the ability to perform the delivery at a time when hospital resources are optimal, such as at daytime rather than what might otherwise turn out to be at night. Critics also argue that because physicians and institutions may benefit by reducing night time and weekend work, an inappropriate incentive exists to suggest elective surgery (Gbenga, 2015). Therefore, elective caesarean sections may be performed on the basis of an obstetrical indication, or maternal request.
Rice (2012) argues that planned caeserean delivery may be putting greater strain on the health and well being of mothers than normal vaginal delivery. He noted that the average hospital stay after caeserean delivery is 60-120 hours. This statement eventually questions an affirmation made by Chong and Kwek (2010) that elective caeserean delivery is relatively safe for both mother and fetus. No matter the mode of delivery however, childbirth has some physical and psychological impact on the mother.
Following vaginal or caesarian delivery, mothers may often endure physical pain, haemorrhoids, constipation, urinary incontinence, prolonged haemorrhage, postpartum depression and difficulty regaining pre-pregnancy shape (Nassauer, 2013). Hence, childbirth could be considered a potent stressor (Hakeem, 2014). Therefore the process of birth may mean extra pressure on the functioning of a mother’s general system or her health and well being, which in turn could affect her quality of life.
Quality of life has been defined as a subjective feeling of comfort, happiness and satisfaction with activities of daily living as expressed in her physical and physiological functioning (Global Development Research Center, 2015).
As individuals within families with a newborn find themselves making social, environmental, occupational, physical and psychological adjustments in order to accommodate the care of a newborn; mothers are also expected to adjust from gravid to post-gravid health states in spite of the mode of delivery (Bjelica & Kapor-Stanulović, 2014). How fast this psycho-physiological adjustment of a mother is achieved may set limits to her ability to care for her newborn, as well as her quality of life at every stage in her postpartum period (James, 2008).
Within the African context, women are custodians of the home. In other words, mothers may engage in routine domestic work aside caring for the newborn. With little social support in families where women keep jobs outside home, mothers would have even more work time with the arrival of a new baby. Excessive work may put some strain on a mother’s ability to recover from the physiological demands of childbirth (Centers for Disease Control and Prevention , 2015). In other words, a mother’s perceived feeling of comfort and satisfaction with ability to cope with activities of daily living may be impacted upon. This individualistic perceived meaning to the multidimensional experience of one’s physical health, adjustment to socio-environmental demands, and coping with activities of daily living is generally dubbed “Health Related Quality of Life” (Global Development Research Center, 2015).
Health-Related Quality of Life (HRQoL) involves those aspects of Quality of Life or functioning, which is influenced or limited by health status; and is based on measurable physical, psychological and social dimensions (Baracaccia, et. al, 2013). This may further suggest that Health-Related Quality of Life (HRQoL) means how one’s health status influences one’s ability to cope effectively with activities of daily living. Therefore Health-Related Quality of Life (HRQoL) reflects perceived wellbeing within the physical, psychological and social domains of life. Hence, the link between maternal health status and type of delivery experienced by mothers may be vital to understanding the nature of this property of “Quality” in the life of a mother (Centers for Disease Control and Prevention, 2011).
Health-Related Quality of Life (HRQoL) is rather dynamic just as health and wellness (Baracaccia et. al, 2013). In other words, perceived comfort, happiness and satisfaction with life could change as one experiences change within oneself and his immediate environment. It may then be logical to assume that, Health-Related Quality of Life (HRQoL) in postpartum women change as they proceed from delivery through postpartum period to recommencement of pre-gravid work routines or chores (International Society for Quality of Life Research, 2015).
The World Health Organization thus recognizes Health-Related Quality of Life (HRQoL) as an important indicator along with traditional measures to capture the burden of health conditions (Yakasai & Abubakar, 2014). It is measured to quantify the degree to which a health condition or intervention impacts an individual’s life in a valid and reproducible way (Global Development Research Center, 2015). The gold standard is for individuals to self report their Health-Related Quality of Life (HRQoL). The measure can then be used to determine changes in Health-Related Quality of Life over time such as in clinical trials and observational studies etc, and compare the Health-Related Quality of Life of patients/clients with different conditions (International Society for Quality of Life Research, 2015). Health-Related Quality of Life (HRQoL) is therefore an imperative maternal and child health tool for estimating the positive and negative consequences of mediconursing interactions on health, wellness and functioning from the patient’s/client’s perspective. Thus, the consequences of vaginal or caesarean delivery on maternal health and wellness overtime could be empirically estimated and compared using the HRQoL measure.
According to Yakasai and Abubakar (2014), caesarean delivery is increasingly being used in place of vaginal delivery worldwide due to maternal requests or physician’s suggestions. Although elective caesarean delivery have been pronounced safe for both mother and fetus (Chong & Kwek, 2010), does caesarean delivery have any merit over vaginal delivery with regard to rapid return to optimal Health-Related Quality of Life (HRQoL)? As Gbenga (2015) noted, this question is yet to be fully answered using evidence based methods.
The postpartum period is the recovery period after childbirth (Declercq & Cunningham, 2008). Within this period, several changes take place within the body of a mother geared towards return from a stress/strain bourne situation to a dynamic health state which she had before pregnancy (Romano, Cacciatore, Giordano, & Rosa, 2010). Typically, the postpartum period begins immediately after birth and extends for about six weeks (Torkan, Parsay, Lamiyian, Kazemnejad, & Montazeri, 2009). However, it is expected that beyound six weeks most of the common health problems of the postpartum period such as pueperal blues, bleeding, bowel and bladder dysfunction would have resolved (Bjelica & Kapor-Stanulović, 2014). In otherwords, at twelve weeks mothers are assumed to have regained their health-related quality of life to a reasonable extent irrespective of the mode of delivery. How correct this assumption is, still remains a subject for further study.
Singh, Kaur, and Singh (2015), and Prick, Bijlenga, Jansen, Boers, Scherjon, and Koopmans (2014) argue that there could be a link between return to optimal Health-Related Quality of Life (HRQoL) and parity status, as well as maternal age. In other words, mother’s age and parity status may have an influence on Health-Related Quality of Life (HRQoL) just as mode of delivery may have an influence on Health-Related Quality of Life (HRQoL).
Against this backdrop, this study examines whether HRQoL differed among newly delivered mothers. This study determines how the HRQoL of mothers differ along eight indicators (Physical functioning, role limitations due to physical health, role limitations due to emotional problems, energy/fatigue, emotional wellbeing, social functioning, pain and general health) in relation to the mode of delivery experienced.

Statement of Problem