Doula Research Articles

Respectful Maternity Care Interventions in Promoting Quality at Level 5 Health Facilities in Bungoma County, Kenya

High maternal and newborn mortality is a pressing problem in developing settings. Poor treatment during childbirth contributes directly and indirectly to this problem at 82%. Many women experience disrespectful and abusive treatment during childbirth worldwide which violates their rights. In Kenya 20% of women report to have experienced some form of disrespect and abuse. Bungoma County is among the 15 counties with the worst maternal and newborn health statistics. Maternal mortality rate is 382 per 100,000 live births and newborn deaths 32 per 1,000 live births. Skilled birth attendance is 41.4%. This study was motivated by the poor maternal and newborn indicators, rising incidences of D&A, limited interventional and formal research on respectful maternity care. The study aimed at evaluating maternity care interventions for promoting quality of maternal and newborn care at level 5 health facilities in Bungoma County. Quasi-experimental pre-and-post-comparison study design was used. It involved 71 midwives, 351 mothers and 18 key informants. Sensitization was done using respectful maternity care learning resource package. Analysis was done using statistical package for social sciences (SPSS v. 25.0). Descriptive statistics were presented in graphs, tables, frequencies and percentages. On Inferential statistics, Chi square (X2) was used with 95% confidence interval (CI) to determine associations. P values ≤ 0.05 were considered significant. On statistical testing, Pearson Chi-Square was used to measure relationship between women’s experience of care and their socio-demographic characteristics, Wilcoxon Signed Ranks test to measure association between the women’s experience of care and midwives’ performance and McNemar test to measure the statistical difference before and after the intervention. Qualitative data was analyzed thematically. The baseline prevalence of D&A was 42.2% and 25% post intervention, younger age and lower education aggravated D&A. Autonomy, privacy and confidentiality, absence of birth companionship were major aspects of D&A. Health workforce shortage, inadequate supervision, space and beds, poor provider-patient relationship were factors leading to D&A. Sociodemographic characteristics and experience of D&A- age (X2-26.07, P-0.00), marital status (X2-20.851, P-0.002. Association between self-reported and observation report- privacy and confidentiality (Z- -7.728, P-0.00), communication (Z- -2.132, P-0.033), dignity and respect (Z- -7.599, P-0.00). Correlation Pre-Post intervention- dignity and respect (P-0.002), privacy and confidentiality (P-0.00), communication (P-0.00), autonomy (P- 0.063). Conclusion, incorporate RMC in routine care, deploy more staff, avail equipment and supplies, and enhance support supervision. The study information intends to assist stakeholders in prioritizing policy actions for improving quality of maternal and newborn health outcomes and indicator

'Never waste a crisis': a commentary on the COVID-19 pandemic as a driver for innovation in maternity care.

The coronavirus (COVID-19) pandemic has resulted in rapid changes in many areas of health care worldwide.1 Some organisational and governance controls on innovation have been relaxed, to enable rapid adaptation to changing circumstances. The speed of innovation raises a range of ethical, governance and organisational issues. It is important to assess what changes have been instituted, which ones should be maintained, and how to encourage effective innovations in future.

A Quasi-Experimental Study to Compare the Effect of Respectful Maternity Care Using Intrapartum Birth Companion of Her Choice on Maternal and Newborn Outcome in Tertiary Care Centre.

Traditionally during labour woman is supported by another woman. However, in hospitals, continuous support during labour has often become the exception rather than the routine. Worldwide, there is a growing concern about the disrespect and abuse of women seeking maternity care. This prompted us to decide to change the obstetric care practices by providing a birth companion of her choice to women during labour and compare their maternal and newborn outcomes with the data from the same institute before intervention. This was a quasi-experimental study conducted in the Department of OBGY, GMCH, Aurangabad for 20months and compared with the previous data from the same institute before implementation of the birth companion policy. The impact of this intervention was evaluated by caesarean section rate, episiotomy rates and admission to neonatal intensive care units, and data was analysed by an appropriate statistical test. The rate of caesarean Section (20%) and episiotomy (8.57%) was significantly lower in the intervention group than in the control group. The rate of NICU admission and time required for initiation of breastfeeding was significantly lower in the intervention than in the control group. Around 86.6% of women from the intervention group were fully satisfied with the role of birth companion and 13.4% were partially satisfied. Our study demonstrated that the use of an intrapartum birth companion of her choice helped us improve maternal and newborn outcomes without any harm. We recommend generalizing the policy of use of the trained birth companion of her choice in the private as well as the public sector.

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

BackgroundSouth 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.ObjectivesTo 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.MethodAn 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.ResultsSeventy-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.ConclusionIt 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.

Social media and experiences of maternity care during the Covid-19 pandemic

BackgroundSocial media offer expecting and new mothers a space to discuss birth-related fears, hopes and experiences. This is particularly the case during the Covid-19 pandemic, which has altered delivery of maternity care. Measures to reduce transmission risk in birth facilities and changes in birth plans are likely to have had an impact on new mothers' experiences of birth and birth care. From a feminist epidemiology perspective, seeking to incorporate more the views of the “researched”, we explored themes discussed by (expecting) mothers on social media, hoping that those real-life concerns would find echo in the design of future research instruments for data collection.MethodsUsing content analysis, we identified key themes in 200+ comments posted on a social media public page as a reaction to the dissemination of a research survey on maternity care during the Covid-19 pandemic in Germany.ResultsIn the comments, the most mentioned topics were own mask wearing, having a companion of choice during birth, visiting hours, and the possibility to welcome visitors (e.g. siblings of the newborn, other relatives and friends). Those topics also generated the most reactions, revealing compassion from other women and mixed feeling about health measures (from acceptance to anger). Concerns about quality or appropriateness of care were almost absent from the data.ConclusionsSocial media content analysis shows clearly that women giving birth during the pandemic are most concerned with a specific set of disrupting and potentially upsetting measures. These spontaneous testimonies differ content-wise from what research surveys tend to ask women about (e.g. care standards). Those discrepancies are to some extent inevitable, but integrating more bottom-up generated topics from social media into research instruments could help move forward toward better care.Key messages On social media, women were most concerned with own mask wearing, presence of a birth companion and visits from the newborn’s siblings.Social media analysis brings valuable insights into what matters the most to women who give birth during the pandemic and could inform future research developments.

Weight of Evidence: Participatory Methods and Bayesian Updating to Contextualize Evidence Synthesis in Stakeholders' Knowledge.

Mixed methods research is well-suited to grapple with questions of what counts as valid knowledge across different contexts and perspectives. This article introduces Weight of Evidence as a transformative procedure for stakeholders to interpret, expand on and prioritize evidence from evidence syntheses, with a focus on engaging populations historically excluded from planning and decision making. This article presents the procedure’s five steps using pilot data on perinatal care of immigrant women in Canada, engaging family physicians and birth companions. Fuzzy cognitive mapping offers an accessible and systematic way to generate priors to update published literature with stakeholder priorities. Weight of Evidence is a transparent procedure to broaden what counts as expertise, contributing to a more comprehensive, context-specific, and actionable understanding.

Observations and reports of incidents of how birthing persons are treated during childbirth in two public facilities in Argentina.

This study sought to estimate the frequency and types of mistreatment during childbirth and explore health professionals' opinions on barriers/facilitators to providing respectful childbirth care. This prospective mixed-methods investigation consisted of direct observations of childbirth (n=250), at-home surveys with birthing individuals (n=45), and qualitative in-depth health staff interviews (n=6), conducted between January and July 2019, in two public facilities in Argentina. Frequencies of clinical practices and mistreatment and 5% confidence intervals were calculated. A logistic regression analysis was also conducted to examine associations between mistreatment and covariates of interest, with P<0.05 considered statistically significant. Overall, 61/250 (24.4%, confidence interval 19.6%-30.6%) observations recorded instances of mistreatment; 20/45surveyed participants (44.4%) reported at least one episode of mistreatment. The most frequent perpetrators were physicians (35.6%), birth companions (24.4%), midwives (22.2%), and nurses (13.3%). Participants with lower educational attainment and those racialized as non-white had higher odds of being mistreated. Health providers reported that respectful childbirth is currently widely implemented due to authorities' and communities' awareness on respectful birth´s rights. Almost a quarter of birthing people were observed to suffer mistreatment - primarily verbal abuse - and 44.4% of surveyed individuals reported mistreatment. Future research is needed to determine how to ensure the provision of respectful childbirth care for all. A quarter of participants experienced mistreatment; mostly those with lower educational attainment and/or racialized as non-white. Further research on implementation of respectful childbirth is warranted.

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

BackgroundLabor 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.MethodsAn 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.ResultsA 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.ConclusionsLabor 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.

An innovative intervention to improve respectful maternity care in three Districts in Ethiopia

BackgroundMistreatment of women during facility-based childbirth is a major violation of human rights and often deters women from attending skilled birth. In Ethiopia, mistreatment occurs in up to 49.4% of mothers giving birth in health facilities. This study describes the development, implementation and results of interventions to improve respectful maternity care.As part of a national initiative to reduce maternal and perinatal mortality in Ethiopia, we developed respectful maternity care training module with three core components: testimonial videos developed from key themes identified by staff as experiences of mothers, skills-building sessions on communication and onsite coaching. Respectful maternity care training was conducted in February 2017 in three districts within three regions.MethodsFacility level solutions applied to enhance the experience of care were documented. Safe Childbirth Checklist data measuring privacy and birth companion offered during labor and childbirth were collected over 27 months from 17 health centers and three hospitals. Interrupted time series and regression analysis were conducted to assess significance of improvement using secondary routinely collected programmatic data.ResultsSignificant improvement in the percentage of births with two elements of respectful maternal care—privacy and birth companionship offered— was noted in one district (with short and long-term regression coefficient of 18 and 27% respectively), while in the other two districts, results were mixed. The short-term regression coefficient in one of the districts was 26% which was not sustained in the long-term while in the other district the long-term coefficient was 77%. Testimonial videos helped providers to see their care from their clients’ perspectives, while quality improvement training and coaching helped them reflect on potential root causes for this type of treatment and develop effective solutions. This includes organizing tour to the birthing ward and allowing cultural celebrations.ConclusionThis study demonstrated effective way of improving respectful maternity care. Use of a multipronged approach, where the respectful maternity care intervention was embedded in quality improvement approach helped in enhancing respectful maternity care in a comprehensive manner.

Lived experiences of the partners of COVID-19 positive childbearing women: A qualitative study

ProblemSeveral maternity units worldwide have rapidly put in place changes to maternity care pathways and restrictive preventive measures in the attempt to limit the spread of COVID-19, resulting in birth companions often not being allowed to be present at birth and throughout hospital admission. BackgroundThe WHO strongly recommends that the emotional, practical, advocacy and health benefits of having a chosen birth companion are respected and accommodated, including women with suspected, likely or confirmed COVID-19. AimTo explore the lived experiences of the partners of COVID-19 positive childbearing women who gave birth during the first pandemic wave (March and April 2020) in a Northern Italy maternity hospital. MethodsA qualitative study using an interpretive phenomenological approach was undertaken. Audio-recorded semi-structured interviews were conducted with 14 partners. Thematic data analysis was conducted using NVivo software. Ethical approval was obtained from the relevant Ethics Committee prior to commencing the study. FindingsThe findings include five main themes: (1) emotional impact of the pandemic; (2) partner and parent: a dual role; (3) not being present at birth: a ‘denied’ experience; (4) returning to ‘normality’; (5) feedback to ‘pandemic’ maternity services and policies. Discussion and conclusionKey elements of good practice to promote positive childbirth experiences in the context of a pandemic were identified: presence of a birth companion; COVID-19 screening tests for support persons; timely, proactive and comprehensive communication of information to support persons; staggered hospital visiting times; follow-up of socio-psychological wellbeing; antenatal and postnatal home visiting; family-centred policies and services.

Association of Birth Companionship by Former Traditional Birth Attendants on Birthing Experiences of Parturient Women in Kakamega County, Kenya

The current model of maternity care is institution-centred, rather than woman-centred. Women's experiences illuminate midwives' efforts to maintain power and control by situating birth as a medical event and to secure status by focusing on the technical elements of care, including controlling bodies and knowledge. A study conducted in Kenya, India and Ghana concluded that regardless of the setting, women are not getting adequate person-centred maternity care and that such care varied by socioeconomic status, type of provider and type of facility.Most women in Kakamega county labour alone. As a result, women in labour experience ‘emotional distress’, ‘stressful circumstances’, ‘lack of social support’ and may not open up to service providers contributing to unfavourable birth outcomes. To investigate the association between supportive companionship provided by traditional birth attendants and birthing experiences of parturient women during labour and childbirth in Kakamega County, Kenya. A quasi-experimental cross-sectional mixed method design was adopted involving 2367 parturient women in Kakamega county, Kenya. Former traditional birth attendants were trained and deployed as birth companions providing emotional support in the form of encouragement, advice, information, comfort measures and physical support to women during labour and childbirth in intervention health facilities. Measurements were taken at baseline and after implementation of the birth companion intervention from control and intervention health facilities using a questionnaire capturing data on client satisfaction, anxiety and self-esteem. Data was summarized using frequency distributions and cross tabulations and presented in the form of tables and graphs. Associations were determined using Pearson’s correlation and independent sample t-test. The study found traditional birth attendant as birth companions significantly improved birthing experiences of parturient women. Supported women as they had higher levels of satisfaction, lower anxiety and higher self-esteem than those who were not supported.

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...

Effect of Intranatal Gentle Birthing Care on Labor Outcome

Background: Birth companionship, and continuous support during labor and delivery, can improve women's childbirth experience and birth outcomes. Aims and Objective: To assess the effect of Intra-natal Gentle Birthing Care (IGBC) on Labor Outcome. Material and Methods : The post-test only control group design and a evaluate approach was used on 30 parturient mothers who were admitted in the Krishna Hospital &amp; Medical Research Centre, Karad. The Intra-Natal Gentle Birthing Care was administered in separate unit and post test for labor outcomes of parturient mothers was assessed. The informed consent was obtained from mothers. All calculations were carried out using SPSS V20. Results: Out of 30 (100%) mothers only 2(6.6%) mothers were administered injection Oxytocin and 2(6.6%) mothers' injection Drotin / Epidosin. Rest all 26(86.66%) mothers were not administered any type of analgesia and anesthesia. There was statistically significant difference found between Mean ± SD coping(with labor pain) score of the mothers who completed labor process within 6hrs, 8hrs, 10hrs and 12hrs (P&lt;0.0001). Majority parturient mothers, 27(90%) completed 1st stage within 10 hours. Intra natal gentle birthing care was having significant effect on decent of fetal head and dilatation of cervix (P&lt;0.0001). The Bonferroni multiple comparison test, 1st stage Vs 2nd and 4th stage, 2nd stage Vs 3rd and 4th stage, 3rd stage Vs 4th stage among all comparison showed significant difference(P&lt;0.001) except 1st stage Vs 3rd stage (P&gt;0.05). Conclusion: The mean coping score of parturient mothers was more and there was significant difference in mean score of duration of labor stages, cervical dilatation and decent of fetal head after administration of “Intra-natal gentle birthing care” thus the Intra-natal gentle birthing care was effective.

Relationship between pregnant women and their partners during COVID-19 and the role of accompanying persons during childbirth

Objective: Although the World Health Organization (WHO) recommends the presence of a support person, several hospitals in Latvia have restricted the presence of supporting persons due to COVID-19. This study was conducted to understand the importance of partnership and the role of the accompanying person in childbirth in the context of COVID-19 in Latvia.Methods: A mixed method study with sequential explanatory design was conducted from 26 July to 30 October 2020. The quantitative study consisted of a behavioral cross-sectional online survey with convenience sampling. The survey items, methods, and implementation were performed as part of the I-SHARE study carried out in 33 countries, with standardized survey instruments that were focused on sexual and reproductive health issues. In Latvia it was supported by the National Research Program to lessen the effects of COVID-19. Our study analyses only one part of all data. To answer the research question besides quantitative data the qualitative study that consisted of 7 semi-structured in-depth interviews and 11 focus group discussions was integrated.Results: 1,173 people of Latvia have participated in the I-SHARE online survey. The answers of 662 women of reproductive age and 70 pregnant women have been analyzed. Pregnant women had less tension with their partners and received higher partner emotional support before the COVID-19 pandemic than other women of reproductive age, and pregnant women were less frustrated during COVID-19 than non-pregnant women of reproductive age (p &lt; .05). More than half (61.4%) of the pregnant women felt anxiety and depression due to COVID-19 restrictions. The qualitative part of the study revealed that having a partner during childbirth was an important aspect when choosing a facility to give birth in, as the lack of an accompanying person caused anxiety and additional stress.Conclusions: COVID-19 has increased anxiety and depression among pregnant women. Birth companions should not be considered third parties, and establishing a delivery unit visitor policy is necessary to balance the benefits and risks in an evidence-based and compassionate manner.

MATERNAL SATISFACTION WITH INTRAPARTUM CARE IN HEALTHCARE FACILITIES IN KERICHO COUNTY, KENYA

Purpose: The main objective was to determine maternal satisfaction with intrapartum care in healthcare facilities in the Kericho County and specifically to determine the association between mothers’ experience of intrapartum care and satisfaction with quality of nursing, analyze the influence of psychosocial aspects on satisfaction with intrapartum care and evaluate the relationship between hospital factors and maternal satisfaction on intrapartum care among women delivering in healthcare facilities in Kericho County&#x0D; Materials and Methods: This was a cross sectional analytical research design and data was collected using mixed method approach. The study targeted women who delivered in the facilities used for study and 441 mothers were sampled. Data was analyzed using (SPSS) version 24. Descriptive statistics was used to describe the findings on socio-demographic characteristics and inferential statistics employed Chi square and logistic regression to determine maternal satisfaction with intrapartum care. Odds ratio was used to test the strength of association, and a p-value of ≤ 0.05 considered as statistically significant.&#x0D; Findings: Several factors influence mothers’ satisfaction with intrapartum care. Employment (OR: 3.0; 95% CI: 1.2 – 7.4; p = 0.02) delivery through instrument/Caesarian section were 2.6 more likely to have been satisfied with the care unlike those who delivered through SVD (OR: 2.6; 95% CI: 1.1 – 6.0; p = 0.03). On the other hand, mothers who got encouragement and reassurance by midwives and doctors (OR: 0.2; 95% CI: 0.1 – 0.8; p = 0.02) were more likely to be satisfied with care. Mothers who were shown their babies immediately after delivery to identify sex of the baby (OR: 3.2; 95% CI: 1.5 – 7.0; p = 0.002) were 3 times more satisfied than their counterparts. Mothers who were asked for their opinion about unplanned procedure before it was performed (OR: 3.7; 95% CI: 1.1 – 12.6; p = 0.02) were four times more likely to be satisfied. In conclusion, determinants of intrapartum care satisfaction in public hospitals in the study area are: level of education, employment status and type of delivery, showing the baby to the mother immediately after delivery to identify sex, midwives and doctors asking clients their opinion about unplanned procedure before it is performed. Provision of linen and beds, provision of hot drinks and hot shower after delivery and provision of a locker are all associated with satisfaction.&#x0D; Unique Contribution to Theory, Practice and Policy: Therefore, the hospitals should allow mothers to stay with their birth companions and health care providers should be taught on importance of good relation and good communication skills.

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

BackgroundHaving 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.MethodsThe 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.ResultsMore 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).ConclusionBirth 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.

Widening inequalities should galvanise action across systems

Naomi Delap, Director of Birth Companions, reflects on the inequalities highlighted by the latest reports from MBRRACE-UK

COMPARISON OF INTRAPARTUM MANAGEMENT BETWEEN INTERNATIONAL STANDARDS WITH THE MALAYSIAN GUIDELINES

Evidence-based recommendations on intrapartum care are important to ensure the safety of mothers and neonates. The objective of this study was to compare two established guidelines for intrapartum care to provide clinicians with more comprehensive recommendations on intrapartum management. We carried out a descriptive analysis of guidelines from the Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines published by the World Health Organization, and the Perinatal Care Manual published by the Ministry of Health Malaysia, on intrapartum care to determine differences, if any, with regards to management. Latent, active and the second phase of labour are defined differently in both guidelines. Both guidelines showed high similarity in the steps of clinical management for all phases of labour but differed in foetal monitoring methods, indications for episiotomy, mood and behavior assessment, universal precautions, pain management, and placental disposal. Both guidelines had similar managements for most of the problems encountered during the intrapartum period except for preterm labour and multiple births which have substantial differences. Malaysian guidelines highlight additional systems such as the red alert system, and referral and retrieval system, which would enhance the quality of intrapartum management. The IMPAC guidelines emphasize supportive care, birth companionship, maternal care and monitoring up to one hour after placental delivery; and home birth management; these are inadequately explained or lacking in Malaysian guidelines. From the comparison, it was seen that substantial variation exists in intrapartum management between both guidelines that indicates the need for better evidences to synthesize a more comprehensive set of guidelines for the improvement in intrapartum care.

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.