Client and provider factors associated with companionship during labor and birth in Kigoma Region, Tanzania

The role and effect of companions during childbirth in Oman

BACKGROUND

There is increasing evidence that a companionship is an important tool for improving the quality of care provided to pregnant women during the labour and delivery process. The literature review shows very limited studies assessing the role of companions during childbirth from the companion's point of view. Many published papers studied the role and satisfaction of pregnant women but not their companions. Therefore, this study aimed to assess the role and effect of companions during childbirth in Oman.

METHODS

This cross-sectional observational study was conducted at Sultan Qaboos University Hospital, Oman, between June 2022 and April 2023. Companions were interviewed face-to-face at a time convenient to them. A telephone interview was conducted with those who left the hospital early. The questionnaire comprised sociodemographic data and other sections, including the nature of the help provided by the supportive companion, their effects on the women who gave birth, and the timing of their presence during companionship.

RESULTS

A total of 214 companions were included in this study with the mean age of 42.54 years. The most common relationship to the pregnant women was mothers (35.7%), followed by husbands (30.5%). The majority of companions provided support during admission (62.6%), in the immediate post-partum ward (56.5%) and during delivery (54.2%), while a minority helped from admission to discharge (22.4%). The most common type of support provided was encouraging words (89.7%) followed by transferring things (43.9%), massage (37.4%) and touch (33.6%). The majority of companions (96.7%) reported that their support helped very much, and the pregnant women felt better and calmer.

CONCLUSIONS

Labouring women felt better and calmer because of the presence of companions. Companions preferred to be present in the postpartum and during labour and delivery. The majority of companions support their labouring women by encouraging wards. Companions love and encourage others to support their labouring women during their critical times.

From global recommendations to (in)action: A scoping review of the coverage of companion of choice for women during labour and birth

Women greatly value and benefit from the presence of someone they trust to support them throughout labour and childbirth ('labour companion of choice'). Labour companionship improves maternal and perinatal outcomes, including enhancing physiological labour and birth experiences. Despite clear benefits, implementation is slow. We conducted a scoping review to assess coverage and models of labour companionship, including quantitative studies reporting coverage of labour companionship in any level health facility globally. We searched MEDLINE, CINAHL, and Global Health from 1 January 2010-14 December 2021. We extracted data on study design, labour companionship coverage, timing and type of companions allowed, and recoded data into categories for comparison across studies. We included data from a maternal health sentinel network of hospitals in Latin America, using descriptive statistics to assess coverage among 120,581 women giving birth in these sites from April 2018-April 2022. In the scoping review, we included 77 studies from 27 countries. There was wide variation in the coverage of labour companionship: almost one-third of studies reported coverage less than 40%, and one-third of studies reported coverage between 40-80%. Husbands or partners were the most frequent companion (37.7%, 29/77), followed by family member or friend (gender not specified) (32.5%, 25/77), family member or friend (female-only) (13.0%, 10/77). Across nine sentinel hospitals in five Latin American countries, there was variation in coverage, with no companion at any time ranging from 14.9%-93.8%. Despite the well-known benefits and factors affecting implementation of labour companionship, more work is needed to improve equitable coverage. Concerted efforts are needed to engage with communities, health workers, health managers, and policy-makers to establish policies, address implementation barriers, and integrate data on coverage into perinatal records and quality processes to ensure that all women have access. Harmonized reporting of labour companionship would greatly enhance understanding at global level.

Birth attendants' attitudes and practice of companionship during facility-based childbirth and associated factors in the West Shoa Zone, central Ethiopia: A mixed method design

Objectives

The World Health Organization strongly recommends companion of choice for all women during health facility delivery. However, in the developing countries, it is low and not well studied in Ethiopia. Thus, the study aimed to assess the birth attendants' attitude and practice of companionship during health facility-based childbirth and associated factors in the West Shoa Zone, Ethiopia.

Methods

A cross-sectional study design with a concurrent mixed method approach was employed from 17 August to 23 September 2021. A simple random sampling was used to collect data from 422 birth attendants using a pretested structured self-administered questionnaire. The data was entered into Epi-data 3.1 and exported to the Statistical Package for Social Sciences for analysis. Bivariate and multivariate logistic regressions were done. The qualitative data was analyzed manually using thematic analysis, and the result was triangulated with the quantitative data.

Results

About, 208 (51.2%) of birth attendants had favorable attitude, and only 79 (19.5%) of them reported that they practice companion presence during childbirth. Reported job satisfaction (adjusted odds ratio = 5.29, 95% confidence interval: 3.08, 9.1), presence of a screen (adjusted odds ratio (AOR) = 3.4, 95% confidence interval: 1.94, 5.99), and wideness of the delivery room (adjusted odds ratio = 4.74, 95% confidence interval: 2.48, 9.04) were factors associated with the attitude of birth attendants. The number of deliveries per month (adjusted odds ratio = 3.34, 95% confidence interval: 1.37, 8.13), having had training (adjusted odds ratio = 3.286, 95% confidence interval: 1.52, 7.08), and presence of a screen (adjusted odds ratio = 2.88, 95% confidence interval: 1.42, 5.85) were statistically associated with practice of companion presence during childbirth. The main themes that emerged as the key barriers to the practice of companion presence during childbirth include structural factors, societal norms and culture, lack of interest, birth attendant-related barriers, unsupportive administration protocol, and companions' awareness.

Conclusion

The magnitude of favorable attitudes and reported practice of birth attendants regarding companion presence during childbirth is low. Structural related factors were the main barriers. Training of birth attendants and structural interventions are needed to ensure that delivery rooms are designed in ways that facilitate the presence of companions during childbirth.

Desire for Birth Companionship Among Pregnant Women Attending Antenatal Care in Debremarkos City, Northwest Ethiopia: Magnitude and Associated Factors

Background

Birth companionship is one of the components of the respectful maternity continuum of care recommended by the World Health Organization (WHO). Women's desire for birth companionship needs to be given attention during the antenatal care period to make them ready during labor and delivery. There is a dearth of study about the status of women's desire for birth companionship and associated factors.

Objective

This study aimed to assess the prevalence of desire for birth companionship and associated factors among pregnant women in Debremarkos city, northwest Ethiopia.

Methods

Institution-based cross-sectional study was conducted from February 1, 2021 to March 30, 2021 in Debremarkos city, northwest Ethiopia. A total of 423 participants were accessed by systematic random sampling. A face-to-face interviewer-administered questionnaire was employed. The data were entered into Epi data version 4.6 and transformed to SPSS version 25. Binary logistic regression analysis was done, and variables with a p-value ≤ 0.2 on bivariable analysis were taken for multivariable analysis. Adjusted odds ratio with a 95% confidence interval was used to detect the association, and a p-value of <0.05 in the multivariable analysis was used to declare statistical significance.

Results

The prevalence of desire for birth companionship was 57.45% (52.6–62.2%). Women who were the primary decision-maker for maternal health care services [adjusted odds ratio (AOR) =3.0; 95% CI 1.7–5.6], women with planned pregnancy (AOR = 2.0; 95% CI 1.0–3.9), women who have no bad obstetric history (AOR = 2.3; 95% CI 1.2–4.4), and women whose 1st antenatal care visit starts within the second trimester (AOR = 2.6; 1.6–4.4) were statistically significant with desire on birth companionship.

Conclusions

Desire of pregnant women for birth companionship was high in this study. Improving women's decision-making power, emphasis on the type of pregnancy, obstetrical history, and early initiation of antenatal care visit were the suggested areas to increase the desire of women for birth companionship.

Midwives' perspectives on person-centred maternity care in public hospitals in South-east Nigeria: A mixed-method study

Background

Person-centred maternity care (PCMC) is acknowledged as essential for achieving improved quality of care during labour and childbirth. Yet, evidence of healthcare providers’ perspectives of person-centred maternity care is scarce in Nigeria. This study, therefore, examined the perceptions of midwives on person-centred maternity care (PCMC) in Enugu State, South-east Nigeria.

Materials and methods

This study was conducted in seven public hospitals in Enugu metropolis, Enugu State, South-east Nigeria. A mixed-methods design, involving a cross-sectional survey and focus group discussions (FGDs) was used. All midwives (n = 201) working in the maternity sections of the selected hospitals were sampled. Data were collected from February to May 2019 using a self-administered, validated PCMC questionnaire. A sub-set of midwives (n = 56), purposively selected using maximum variation sampling, participated in the FGDs (n = 7). Quantitative data were entered, cleaned, and analysed with SPSS version 20 using descriptive and bivariate statistics and multivariate regression. Statistical significance was set at alpha 0.05 level. Qualitative data were analysed thematically.

Results

The mean age of midwives was 41.8 years ±9.6 years. About 53% of midwives have worked for ≥10 years, while 60% are junior midwives. Overall, the prevalence of low, medium, and high PCMC among midwives were 26%, 49% and 25%. The mean PCMC score was 54.06 (10.99). High perception of PCMC subscales ranged from 6.5% (dignity and respect) to 19% (supportive care). Midwives’ perceived PCMC was not significantly related to any socio-demographic characteristics. Respectful care, empathetic caregiving, prompt initiation of care, paying attention to women, psychosocial support, trust, and altruism enhanced PCMC. In contrast, verbal and physical abuses were common but normalised. Midwives’ weakest components of autonomy and communication were low involvement of women in decision about their care and choice of birthing position. Supportive care was constrained by restrictive policy on birth companion, poor working conditions, and cost of childbirth care.

Conclusion

PCMC is inadequate in public hospitals as seen from midwives’ perspectives. Demographic characteristics of midwives do not seem to play a significant role in midwives’ delivery of PCMC. The study identified areas where midwives must build competencies to deliver PCMC.

Labor Companionship in Labor and Delivery at Debremarkos Town Public Health Facilities: Magnitude and Associated Factors

Background

Labor companionship is a human interactive process that provides social support during the childbirth process. Despite it being one component of respectful maternity care (RMC) that is used for quality assurance to achieve the sustainable goal of maternal and neonatal mortality reduction, there is limited evidence about the current status of birth companionship. The study was aimed to assess labor companion and its associated factors at Debremarkos town public health facilities.

Methods

An institution-based cross-sectional study design was conducted. The study was conducted at Debremarkos town from February 1/2021 to March 30/2021. From the 559 sample size, 548 women participated in the study. A systematic random sampling technique was used. A pre-tested interviewer-administered questioner was used, data were entered and analyzed with Epi-data version 4.60 and SPSS version 25.0. Bivariable regression was done and variables with p-value </= 0.20 were analyzed with multivariable logistic regression. Variables with p-value </= 0.05 were considered significantly associated with labor companionship. Hosmer–Lemeshow goodness of fit was checked and all multi-collinearity of variables with variance inflation factors (VIF) up to 10 was tolerated.

Results

A total of 548 participants were involved in the study with a 98.03% response rate. The magnitude of labor companionship was found to be 14.6% (11.7–17.5). Women who had complicated pregnancy (adjusted odds ratio [AOR]=5.53; 95% CI: 3.09–9.92), women's desire for a labor companion (AOR=3.63; 95% CI: 1.51–8.69), being primipara (AOR=3.49; 95% CI: 1.93–6.35), labor followed by female skilled birth attendant (AOR=0.37;95% CI: 0.17–0.82), and women’s perceived busyness of skilled birth attendant (AOR=0.13;95% CI: 0.07–0.23) were significantly associated with labor companionship.

Conclusions

Labor companionship was found to be low. Giving emphasis on the desire, primipara, complicated pregnancy, sex of skilled birth attendant and women perceived busy skilled birth attendant were suggested for the improvement of labor companionship.

Presence of birth companion-a deterrent to disrespectful behaviours towards women during delivery: an exploratory mixed-method study in 18 public hospitals of India

Birthing women require support, particularly emotional support, during the process of labour and delivery. Traditionally, across cultures, this support was made available by the continuous presence of a companion during labour, childbirth and the immediate post-partum period. However, this practice is not universal, especially in health facilities in low- and middle-income countries. This cross-sectional study was conducted in 18 tertiary health care facilities of India using a mixed-method approach. The quantitative data were collected to document the number of birthing women, birth companions and healthcare providers in the labour rooms, and the typology of disrespect and abuse (D&A) faced by women. This was followed by in-depth interviews with 55 providers to understand their perspective on the various dimensions of D&A and the challenges they face to provide respectful care. This article explores the status of birth companionship in India and its plausible associations with D&A faced by birthing women in public facilities. Our study reveals that birth companionship is still not a common practice in Indian public hospitals. Birth companions were present during less than half of the observational period, also less than half of the birthing women were accompanied by a birth companion. Lack of hospital policy, space constraints, overcrowding and privacy concerns for other patients were cited as reasons for not allowing birth companions in the labour rooms, whose supportive roles, both for women and providers, were otherwise widely acknowledged during the qualitative interviews. Also, the presence of birth companions was found to be critically negatively associated with occurrences of D&A of birthing women. We contend that owing to the high pressure on the public hospitals in India, birth companions can be a low-cost intervention model for promoting respectful maternity care. However, adequate infrastructure is a critical aspect to be taken care of.

Male partner participation in maternity care and social support for childbearing women: a discussion paper

Male partners/fathers are key support persons for many childbearing women and their involvement in pregnancy, childbirth and the postpartum/postnatal period has beneficial effects on a wide range of outcomes related to maternal and child health and family wellbeing. Social support is implicated in the relevant causal pathway, but has received largely tangential attention in the public health literature. This discussion paper aims to reframe men's participation in maternity care as an opportunity to enhance their readiness and ability to provide social support to women, contributing to the debate on the definition and rationale for male partner involvement, and paving the way for further empirical work. I begin by presenting a theory of change illustrating the causal pathway leading from male partner participation, through the key intermediate step of social support, to improved health and wellbeing for women and children. I proceed by arguing that many people desire male partner participation in maternity care; however, in practice, this is often limited owing to cultural, social and institutional barriers. I use examples from the intervention literature to demonstrate how participation in care can boost men's motivation to support women and enhance their ability to do so by increasing their knowledge and skills. Finally, I draw up general implications for further male partner involvement programmes, suggesting that in order to achieve meaningful and sustainable gains, attention to design is crucial in order to avoid reinforcing patriarchal gender norms. Programmes should be implemented alongside other efforts to improve quality and promote woman-centred care. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Birth companionship in a government health system: a pilot study in Kigoma, Tanzania

BACKGROUND

Having a companion of choice throughout childbirth is an important component of good quality and respectful maternity care for women and has become standard in many countries. However, there are only a few examples of birth companionship being implemented in government health systems in low-income countries. To learn if birth companionship was feasible, acceptable and led to improved quality of care in these settings, we implemented a pilot project using 9 intervention and 6 comparison sites (all government health facilities) in a rural region of Tanzania.

METHODS

The pilot was developed and implemented in Kigoma, Tanzania between July 2016 and December 2018. Women delivering at intervention sites were given the choice of having a birth companion with them during childbirth. We evaluated the pilot with: (a) project data; (b) focus group discussions; (c) structured and semi-structured interviews; and (d) service statistics.

RESULTS

More than 80% of women delivering at intervention sites had a birth companion who provided support during childbirth, including comforting women and staying by their side. Most women interviewed at intervention sites were very satisfied with having a companion during childbirth (96-99%). Most women at the intervention sites also reported that the presence of a companion improved their labor, delivery and postpartum experience (82-97%). Health providers also found companions very helpful because they assisted with their workload, alerted the provider about changes in the woman's status, and provided emotional support to the woman. When comparing intervention and comparison sites, providers at intervention sites were significantly more likely to: respond to women who called for help (p = 0.003), interact in a friendly way (p < 0.001), greet women respectfully (p < 0.001), and try to make them more comfortable (p = 0.003). Higher proportions of women who gave birth at intervention sites reported being "very satisfied" with the care they received (p < 0.001), and that the staff were "very kind" (p < 0.001) and "very encouraging" (p < 0.001).

CONCLUSION

Birth companionship was feasible and well accepted by health providers, government officials and most importantly, women who delivered at intervention facilities. The introduction of birth companionship improved women's experience of birth and the maternity ward environment overall.

Utilization of companionship during delivery and associated factors among women who gave birth at Arba Minch town public health facilities, southern Ethiopia

Background

Companionship during delivery is an important feature of compassionate and respectful maternity care. It has a positive impact on delivery and birth outcomes. In low resource countries like Ethiopia lack of companionship discourages women from accessing facility-based delivery care. Therefore, this study aimed to assess the utilization of companionship during delivery and associated factors.

Methods

Health facility-based cross-sectional study design was done from October to November 2019. Interviewer administered questionnaires were used to collect the data from 418 study participants. The data were entered with Epi data version 4.4 and exported to Statistical Package for Social Sciences (SPSS) version 25.0 for analysis. Binary logistic regression was done. Statistical significance was declared at P- values < 0.05 with a 95% confidence level.

Results

The finding of the study showed that only 13.8% of mothers utilize companionship during delivery. Variables such as having a desire to have companionship during delivery in the health facilities (AOR = 5.17, CI 95% 2.63, 10.16), having complication during the labor and delivery (AOR = 3.48, CI 95%, 1.81, 6.70), and being primipara (AOR = 2.05, CI 95% 1.09, 3.87) were the independent factors associated with companionship utilization.

Conclusions

The finding of the study showed that the utilization of companionship during delivery was low. Permitting women to have a companion of choice during labor and childbirth can be a cost-effective intervention to improve the quality of maternity care, facing complications during delivery, having a desire to have companionship during delivery and primiparous women were more likely to utilize companionship. To improve this low utilization of companionship institutions and care providers should provide information about companionship during antenatal care attendance. Besides, there is a need for clear guidelines to govern the practice of companions.

A family-oriented antenatal education program to improve birth preparedness and maternal-infant birth outcomes: A cross sectional evaluation study

Background

In Tanzania, the information on Birth Preparedness and Complication Readiness is insufficiently provided to pregnant women and their families. The aim of this study was to evaluate the maternal and infant outcomes of a family-oriented antenatal group education program that promotes Birth Preparedness and Complication Readiness in rural Tanzania.

Methods

Pregnant women and families were enrolled in a program about nutrition and exercise, danger signs, and birth preparedness. The cross sectional survey was conducted one year later to evaluate if the participants of the program (intervention group) were different from those who did not participate (control group) with respect to birth-preparedness and maternal and infant outcomes.

Results

A total of 194 participants (intervention group, 50; control group, 144) were analyzed. For Birth Preparedness and Complication Readiness, the intervention group participants knew a health facility in case of emergency (OR: 3.11, 95% CI: 1.39–6.97); arranged accompaniment to go to a health facility for birth (OR: 2.56, 95% CI: 1.17–5.60); decided the birthplace with or by the pregnant women (OR: 3.11, 95% CI: 1.44–6.70); and attended antenatal clinic more than four times (OR: 2.39, 95% CI: 1.20–4.78). For birth outcomes, the intervention group had less bleeding or seizure during labour and birth (OR: 0.28, 95%CI: 0.13–0.58); fewer Caesarean sections (OR: 0.16, 95% CI: 0.07–0.36); and less neonatal complications (OR: 0.28, 95% CI: 0.13–0.60).

Conclusions

The four variables were significantly better in the intervention group, i.e., identifying a health facility for emergencies, family accompaniment for facility birth, antenatal visits, and involvement of women in decision-making, which may be key factors for improving birth outcome variables. Having identified these key factors, male involvement and healthy pregnant lives should be emphasized in antenatal education to reduce pregnancy and childbirth complications.

Trial registration

No.2013–273-NA-2013-101.

Registered 12 August 2013.