Experiences and perceptions of birth companions supporting women in labour at a District Hospital in Limpopo, South Africa

Background: South Africa has included birth companions in its national guidelines for maternity care and the revised Maternity Case Record, in and effort to improve the quality and experience of care. However, reservations amongst healthcare providers remain about the acceptability of birth companions in the labour ward.Objectives: To document the experiences and perceptions of birth companions who supported women in labour in a rural hospital in Limpopo Province where a Respectful Maternity Care (RMC) project was piloted.Method: An institution-based cross-sectional study design was employed. Purposive sampling was employed where all birth companions who supported a woman during labour and birth were included in the study. The experiences and perceptions of birth companions were captured using a birth companion feedback book during the period of 1st April to 30th August 2019. Thematic analysis was used to analyse the data.Results: Seventy-one (71) of the 73 birth companions only had positive responses about the birthing experience and how both the birth companion and woman in labour were treated. Two birth companions were dissatisfied with the treatment provided by the midwife that supported the birth.Conclusion: It is important for healthcare providers to understand the far reaching emotional and psychological impact of their attitudes and behaviour on, not only women in labour but also on others who witness their (healthcare providers) behaviour. Mechanisms to obtain feedback from birth companions should be integrated into strategies to improve the quality and experience of care for women during childbirth.

Perception of Post-Partum Women Towards Birth Companions at a Tertiary Hospital and its Catchment Health Centers in Addis Ababa, Ethiopia

Background: Birth companion refers to a person who provides support to laboring women during child birth. Various studies have shown the benefits of birth companions. The objective of this study was to assess the attitude of mothers towards the involvement of birth companions during child birth at St Paul’s Hospital Millennium Medical College (SPHMMC) and its selected catchment health centers. Methodology: The study used a cross-sectional study to determine the perception of postpartum mothers on the involvement of birth companions during child birth. Result: The study included a total of 393 postpartum women. The finding from the study showed majority of the post-partum women (98.7%) were not allowed to have companions during labor. Among postpartum women 27.3 % has negative attitude towards involvement of birth companions. The commonest reasons mentioned by postpartum women for having negative attitude to this practice included need for privacy, religious values and fear of overburdening family members with stress. Conclusion: The findings from this study showed that majority of women were denied the option of having a birth companion. The study has also shown the desire to have birth companion isn’t universal among laboring women in our setup. There is a need to understand the socio-cultural values of the community before embarking on widespread implementation of involvement of birth companions.

Establishing the practice of birth companion in labour ward of a tertiary care centre in India—a quality improvement initiative

BackgroundBirth companion is a key component for providing respectful maternity care and has been recommended by WHO and Government of India. It is a low-cost beneficial intervention that is vital in improving quality of care during labour and delivery.Local problemDespite the available evidence on benefits of birth companion, there was no policy on allowing birth companion at our hospital in the past.Methods and interventionsWe aimed to establish the practice of allowing birth companions in all eligible women in labour ward from existing 0% to 50% in 6 weeks’ duration. This study was conducted in the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, New Delhi. A quality improvement (QI) team was formed, and after obtaining the baseline data, problems were analysed using fish bone chart. A new policy of allowing birth companion was made and efforts made to sensitise and train the doctors and nurses posted in labour ward. Changed ideas were executed in multiple plan-do-study-act (PDSA) cycles. Simple interventions such as dress code for birth companions, curtains for ensuring privacy, display of posters and frequent reminders on WhatsApp groups were planned .ResultsThe median value of women accompanied by birth companion marginally increased to 25% after the first PDSA cycle. Implementation of further changed ideas led to increase in median, which reached 66.6%. Thereafter, there was a decline, but by the end of 6 months, it was possible to attain the goal and sustain it.ConclusionsSimple steps of QI methodology can be used to address the prevalent problems in our healthcare. Implementation of any new practice comes with major challenges, but we could achieve our goal because of a motivated team working together on multiple changed ideas applied sequentially in PDSA cycles.

Opinion of Health Care Providers on Birth Companions in Obstetrics Department of a Tertiary Care Hospital in North India

Background Despite impressive improvements in institutional births and a fall in maternal mortality, satisfaction of women with birthing experience in public health institutions is low (68%). Birth Companion is an important part of the Labour room Quality Improvement (LaQshya) programme introduced by the Government of India in 2017. Despite mandates, implementation of the concept has been unsatisfactory (9%), even though the importance of Birth Companion has increased due to enhanced risk posed by COVID-19. Little is known about awareness among health care providers on Birth Companions, perceived barriers or their suggestions. Methods We canvassed a 15-question instrument using ordinal scales on 151 health care providers comprising consultants, post graduates, residents, and nurses (response rate 69%) in the department of Obstetrics & Gynecology, Lok Nayak Hospital, Delhi, India to gauge their awareness and opinions about Birth Companions. Results Most health care providers across all categories were aware of the concept (93%), World Health Organization recommendation (83%) and Government instructions for its hospitals (68%) that every woman should be accompanied by a Birth Companion of her choice during labour. Birth Companions of choice suggested by them were the mother (70%), husband (69%). sister (46%) or nurse (43%). Most health care providers agreed that a Birth Companion should wear clean clothes (95%), be free from any communicable disease (91%), stay with the pregnant woman throughout the process of labour (74%) and should have herself gone though labour (42%). Almost all providers (95%) agreed that the presence of a Birth Companion during labour will be beneficial, as they would provide emotional support (99%), boost the confidence of the woman (98%), provide comfort measures like massage (95%), early initiation of breastfeeding (93%), reduce post-partum depression (91%), humanize labour (83%), reduce need for analgesia (70%) and increase spontaneous vaginal births (69%). Yet support for its introduction in their hospital was low (59%). Staff nurses had reservations (62%) with only 40% of those who believed Birth Companion to be beneficial approving of its introduction in their hospital. Over-crowding in labour room and privacy concerns for other women were identified as key barriers. Conclusion Even though most health care providers were aware of and convinced of multiple benefits of Birth Companion during labour, lack of adequate infrastructure in the labour room prevented them from supporting its introduction. Government should provide adequate funding to upgrade labour rooms in a way that provides privacy to the delivering women and frame guidelines and train Birth Companions to perform their role appropriately. Keywords: Birth Companion, Delivery, Respectful Maternity Care, Privacy, Health Care Providers, COVID-19

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.

Implementation of RMC at Tertiary Care Centre in South India

Title: Implementation of RMC at Tertiary Care Centre in South IndiaAbstract:Background: Disrespect and abuse experienced during childbirth has been reported by women to various sections of health care workers. The objective was to abolish Disrespect and Abuse and to bring about a policy change in labour room practices and to implement Respectful Maternity Care (RMC) in a high-volume tertiary care teaching hospital in South India.Methods: A Workshop and Continuous Medical Education Programme involving RMC experts were conducted in Phase I with defined objectives. These targeted health care workers were nurses, resident doctors, consultants, medical nursing students involved in giving care during pregnancy and labour. In Phase II the Govt. of India Policy on Birth Companion was presented in a meeting discussing on the National guidelines of “LaQshya”. Consent forms for birth companions were introduced and a dedicated public health nurse was trained to train the birth companions regarding their role in maternal support. The change of policy was officially intimated to the hospital administration. A qualitative assessment was done whether the Residents and Nurses practiced RMC as demonstrated in the Workshop. The operationalization of the birth companion policy was followed on daily observations, enquiries and onsite surprise visits over one year period.Results: The practice of RMC was followed only by few health care workers and certain cadre of women who laboured, received RMC and disrespect and abuse still prevailed. The bottle necks identified were low socioeconomic status of women, the in-charge consultants not insisting on presence of birth companions, the residents and nurses not promoting birth companion policy.Conclusions: : Implementation of Respectful Maternity Care needs change of attitudes of personnel who render care during child birth and it can only be successful unless it forms an integral part of Medical and Nursing curriculum.

HUBUNGAN PENDAMPING SUAMI DENGAN KALA DUA LAMA PADA IBU BERSALIN

Old labor is one of the fourth leading causes of maternal mortality in Indonesia. The incidence of old childbirth in 2007 and 2012 is still the same, namely 5%.This study aims to study the relationship between birth companion and the incidence of prolonged second stage of labor among women in labor. This study used a survey analytical research design with a cross sectional approach. The study sample were 124 women in labor in Sakura Ward of Central Bengkulu Regional Hospital in 2019, who were taken by total sampling. Data to be analysed in this study were secondary data, that were collected using a checklist and data collection form as the study instruments. The results showed that of the 124 mothers who gave birth, 28.2% experienced prolonged second stage of labor and 71.8% did not experience it, 46.8% were not accompanied by their husbands and 53.2 were accompanied by their husbands. There was a significant relationship between the presence of a birth companion and the incidence of prolonged second stage of labor among women in labor. Women in labor who were not accompanied by their husbands were at risk of experiencing prolonged second stage of labor by 3.529 times compared to them who were accompanied by their husbands. It was concluded that there was a significant relationship between husbands companion and the incidence prolonged second stage of labor among women in labor. It is expected that this study can improve health services and appropriate screening to the incidence of prolonged second stage of labor among women in labor. Furthermore, husbands are expected to be present as the birth companion.

Perception of Post-partum Women Towards Birth Companions at a Tertiary Hospital and Its Catchment Health Centers in Addis Ababa, Ethiopia

Background: Birth companion refers to a person who provides support to laboring women during child birth. Various studies have shown the benefits of birth companions. The objective of this study was to assess the attitude of mothers towards the involvement of birth companions during child birth at St Paul’s Hospital Millennium Medical College (SPHMMC) and its selected catchment health centers. Methodology: The study used a cross-sectional study to determine the perception of postpartum mothers on the involvement of birth companions during child birth. Result: The study included a total of 393 postpartum women. The finding from the study showed majority of the post-partum women (98.7%) were not allowed to have companions during labor. Among postpartum women 27.3 % has negative attitude towards involvement of birth companions. The commonest reasons mentioned by post-partum women for having negative attitude to this practice included need for privacy, religious values and fear of overburdening family members with stress. Conclusion: The findings from this study showed that majority of women were denied the option of having a birth companion. The study has also shown the desire to have birth companion isn’t universal among laboring women in our setup. There is a need to understand the socio-cultural values of the community before embarking on widespread implementation of involvement of birth companions.

BIRTH COMPANION AND RESPECTFUL MATERNAL CARE – AN EXPERIENCE AT TERTIARY CARE CENTRE

Background: The promotion of facility based delivery has been at the forefront of the international efforts to reduce maternal mortality, promoting respectful maternal care being recognized as critical element to improve the quality of maternal care. Aim-To explore the contribution of a birth companion during labor and child birth to promote respectful maternal care. Method: This is a descriptive study with qualitative approach involving the experience of 489 women who delivered during November 2019 to February 2020. Results: Mean age was 25.58 years, 48.67% participants were primigravida, in 52.35% cohort birth companion was given by mother-in-law followed by mother( 25.56%). Most common reason for companion was to build their condence (50.5%) followed by better emotional support (46.83%).All participants felt sense of newborn security due to companion. Conclusion: Birth companion generates positive feelings for women and contributes to humanization of delivery thus bringing a respectful and zero defect maternal care.