Abstract:
Background: Research suggests that birth companionship, and in particular, continuous
support during labor and delivery, can improve women's childbirth experience and birth
outcomes. Yet, little is known about the extent to which birth companionship is
practiced, as well as women and providers' perceptions of it in low-resource settings.
This study aimed to assess the prevalence and determinants of birth companionship, and
women and providers' perceptions of it in health facilities in a rural County in Western
Kenya.
Methods: We used quantitative and qualitative data from 3 sources: surveys with 877
women, 8 focus group discussions with 58 women, and in-depth interviews with 49
maternity providers in the County. Eligible women were 15 to 49 years old and delivered
in the 9 weeks preceding the study.
Results: About 88% of women were accompanied by someone from their social network
to the health facility during their childbirth, with 29% accompanied by a male partner.
Sixty-seven percent were allowed continuous support during labor, but only 29% were
allowed continuous support during delivery. Eighteen percent did not desire
companionship during labor and 63% did not desire it during delivery. Literate, wealthy,
and employed women, as well as women who delivered in health centers and did not
experience birth complications, were more likely to be allowed continuous support
during labor. Most women desired a companion during labor to attend to their needs.
Reasons for not desiring companions included embarrassment and fear of gossip and
abuse. Most providers recommended birth companionship, but stated that it is often not
possible due to privacy concerns and other reasons mainly related to distrust of
companions. Providers perceive companions' roles more in terms of assisting them with
non-clinical tasks than providing emotional support to women.
Conclusion: Although many women desire birth companionship, their desires differ
across the labor and delivery continuum, with most desiring companionship during labor
but not at the time of delivery. Most, however, don't get continuous support during labor
and delivery. Interventions with women, companions, and providers, as well as structural
and health system interventions, are needed to promote continuous support during labor
and delivery.