The case for companionship during labor and birth
Strong support from women and their partners for companionship during labor and birth is being limited by inadequate hospital infrastructure, restrictive policies, work practices and mixed views from health providers, a new Burnet Institute study into pregnancy and childbirth services in Papua New Guinea (PNG) has revealed.
The study, led by Burnet Senior Research Fellow Dr. Alyce Wilson, identifies barriers and enablers to companionship during labor and birth, and recommends a framework to facilitate the practice in PNG health facilities.
"Global research shows the presence of a companion can improve the birthing experience and lead to improved health outcomes for the woman and infant, and what we observed in this study was a strong desire from women to have a companion present during labor and birth," Dr. Wilson said.
"It could be a partner, but it could also be a cousin, an auntie or a sister. We also found that the partners really want to be involved in the labor and childbirth process."
The study, however, revealed mixed views among health providers, and barriers to companionship including a lack of privacy in health facility labor wards, and a lack of formal policies regarding companionship.
"Health providers acknowledged the benefits companions provide in terms of encouragement, advocacy and physical support during labor," study co-author and Burnet Healthy Mothers, Healthy Babies project Team Leader Pele Melepia, said.
"On the other hand, they were often unsure how to include the companion in the care team, and sometimes felt this changed the dynamic in the birth suite with a potential effect on care."
The research team's response was to develop a structural framework to facilitate companionship during labor and birth at community, facility, and provincial level, including:
- Enabling policies and protocols
- Adequate resourcing and accountability
- Education and training for health providers
- Health provider support and preparation for companions
- The need for health facility infrastructure that allows privacy
- Recognition of customs and cultures around companions during labor and birth
- The need to engage women and their families in the process of having a facility-based birth
"Having a companion of choice present can help with outcomes in terms of labor and birth and can mean that women will be more likely to want to come to a facility to give birth," Dr. Wilson said.
"If that's shared in the community, it will encourage others to attend.
"We know in PNG many women won't give birth in a facility for geographical, financial, cultural or logistical reasons, so medical care needs to be as accessible as possible for those who can attend.
"You need to be in a facility, for example, to prevent and manage postpartum hemorrhage which is one of the major causes of maternal mortality in PNG—so while this study is about companionship, there are serious flow-on effects."
The World Health Organization (WHO) highlights labor companions as an important component of quality care and recommends that all women have the opportunity to be supported by a companion.
Dr. Wilson said she expects lessons from the study, conducted in PNG's East New Britain province, would apply not only throughout PNG, but across the Pacific where there are similar challenges and barriers to quality maternal and newborn care.
This research was published in the journal PLOS Global Public Health.
More information: Alyce N. Wilson et al, Partnership-defined quality approach to companionship during labour and birth in East New Britain, Papua New Guinea: A mixed-methods study, PLOS Global Public Health (2022). DOI: 10.1371/journal.pgph.0000102