Pratique de la césarienne au Cameroun : représentations et implications d’un mode d’accouchement en progression a l’hôpital gynéco- obstétrique et pédiatrique de Yaoundé(HGOPG)

Abstract

This research focuses on the theme: The Practice of Cesarean Sections in Public Hospitals in Cameroon: Representations and Challenges of a Growing Mode of Delivery at the Gyneco- Obstetric and Pediatric Hospital of Yaoundé (HGOPY). It is based on the observation of a significant increase in cesarean deliveries, far exceeding the thresholds recommended by the WHO (10 to 15%). At HGOPY, this trend is explained in part by the hospital’s role as a referral center for severe cases, with a significance level set at 0.05. Between 2007 and 2017, the caesarean section rate increased significantly by 8.6%, rising from 21.0% (445/2167) to 29.6% (812/2739) of deliveries. Among these, approximately 68% were emergency caesareans, maternal requests, or resulted from the systematic application of medical protocols aimed at reducing maternal and neonatal risks. This trend is explained by the hospital’s role as a referral center for severe cases, emergency cesareans, maternal requests, and the systematic application of medical protocols to reduce maternal and neonatal risks. The main research question explores the factors behind this increase, while secondary questions examine the social representations of cesarean sections, the elements influencing these perceptions, and the challenges associated with this practice in Yaoundé’s public hospitals. To address these issues, a qualitative approach was adopted, grounded in three theoretical frameworks: the theory of social representations, structuralist constructivism, and symbolic interactionism. Data were collected through semi- structured interviews, direct and participatory observations, and documentary research involving parturients, their relatives, healthcare professionals, and institutional stakeholders. The findings reveal several dimensions. Regarding explanatory factors, the increase in cesareans results from the excessive medicalization of childbirth, inadequate pregnancy management in some health centers, and the centralization of severe cases at HGOPY. Concerning social representations, cesarean sections are often perceived as a risky or even fatal procedure in the collective imagination, although some testimonies highlight their life-saving nature. These perceptions are influenced by personal experiences and the information available to patients and their families. Finally, regarding challenges, they are multidimensional. Cesarean sections have physical repercussions (persistent after-effects), psychological impacts (anxiety, feelings of loss of control), financial burdens (high costs), and social consequences (impact on family planning and dynamics). These findings demonstrate that while cesarean sections are indispensable in many cases, they are surrounded by contrasting representations and raise complex challenges that influence the trajectories of patients and families.