CHAPTER ONE
INTRODUCTION
Background of the study
Pregnancy and childbirth devoid of any complication are source of joy and happiness not only to the immediate family members and relatives but to the entire community at large. The number of children a woman has or intends to have has been a topical issues in Nigeria for some time now not only because of population consideration but because of its implications for maternal health (Izugbara and Ezeh, 2011).
Obstetric risk are that which threatens the health or life of the mother and /or foetus whether during pregnancy, labour or within six months following delivery (Isiani, 2014). Obstetric risk increases with increasing parity and particularly with grand multiparity. High parity especially the grand and great grand multiparity has gained considerable attention from obstetricians because of known and documented complications associated with repeated child birth (Odukogbe, Adewole, Ojengbede, Olayemi, Awole, Ahmed and Owoaji, 2011). It is associated with increased risk of maternal and perinatal mortality and morbidity.
According to Omole and Ashimi (2011), Pregnancy in multiparous women are viewed with great anxiety especially by obstetricians in developing countries working with inadequate and substandard facilities. These have posed serious challenges in the management and outcome of pregnancy associated with multiparous women ranging from foetal distress, poor progress of labour, increase maternal and morbidity rate among multiparous women.
In a study on reasons for Index grand multiparous pregnancy by Kuti (2011), the most frequent reasons given by women include desire for large family (25.9%), loss of previous children (24.1%), mistake (16.7%) and desire for male child (14.8%). With report like these, it become very imperative to ask whether women do actually understand the nature of the risk they are exposed to with high parity.
The findings of a study carried out by Umoh and Abah(2012) in the university of Uyo teaching Hospital on “The hazards of high parity” shows that obstetric risks increase with increasing parity and particularly with grand multiparity. Some of these risks/complications include gestational diabetes, hypertension, anaemia, ante partum haemorrhage, preterm labour, malpresentation etc. Knowledge of these risks by women is important in making fertility decisions. It was concluded that while women were aware that there are dangers associated with high parity, they generally have poor knowledge of these dangers. It is important to utilize the ante natal period and women’s contact with the health system to provide appropriate information on grand multiparity in order to help women make informed choices with regard to their fertility.
A study carried out by Adeleye and Okonkwo (2010) in the university of Benin Teaching Hospital on “ideal child gender preference in men’s worldview and their knowledge of related maternal mortality indices”. The finding shows that almost half of the men expressed gender preference and that this is strongly associated with ignorance of the highest parity safe for a woman. These findings point to a high likelihood for persistent grand multiparity predisposing to post partum haemorrhage and maternal death.
Raising awareness about the danger signs of pregnancy and childbirth is the first essential step in accepting appropriate and timely referral to obstetric care. However, in many settings, little is known about the knowledge level of mothers about obstetric danger signs (Hailu and Berhe, 2014). Thus the provision of information, education and communication targeting women, family and the general community on danger signs of pregnancy and childbirth and its associated factors are of great necessity. A study carried out by Hailu and Berhe (2014) in Ethiopia revealed that a significant proportion of mothers were not knowledgeable about the danger signs of pregnancy, labour and childbirth. This indicates that many mothers are more likely to delay in deciding to seek for obstetric health care..........
Statement of Problem
Knowledge they said is power, lack of reproductive health knowledge, unmet needs for contraception, desire for sons and large family size, poor obstetric performance and early marriages were believed to be the main cause of grand multiparity and multi-parity among women (Cuisine, 2009). Several studies have provided data concerning the risk of grand multiparity for both mother and foetus. However, grand multiparity does not necessarily lead to significant additional maternal, foetal or neonatal complications in high income countries where access to high quality health care is available.
According to Chinweuba (2014), increasing gravidity is often associated with increasing maternal age, lower socio economic and low educational status, poor ante natal care, higher body mass index(BMI) and higher rates of gestational diabetes, placenta previa and hypertensive disease of pregnancy and anaemia. There is also increasing risk of abnormal foetal presentation, precipitate delivery, uterine atony, uterine rupture, amniotic fliud embolism, obstetric haemorrhage, stress incontinence and urinary urgency symptoms and levator ani dysfunction.
Leveno (2009) stated that advanced maternal age and high parity has also been considered to be a risk factor for maternal complications like preterm labour, pre eclampsia, hypertension which may or may not be associated with gestational diabetes, ante partum haemorrhage and increased rate of caesarean section. Many of them experience pregnancy unwillingly because of negligence of using contraceptive method. Furthermore, high parity has been deemed a burden to the family and health systems in Nigeria due to socio economic reasons.
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