.
Corresponding contributor:
Dr. Olorunfemi O. Owa
Department of Obstetrics and Gynaecology,
Federal Medical Centre, Owo
Ondo State.
owaolorunfemi@yahoo.com
08037637532
INTRODUCTION
Labour is a physiological process with intense
physical and emotional challenges,1-5 the presence of a birth
companion is clearly linked to positive birth outcome 6,7,8,9,10
Social support in labour has been found to
significantly reduce the need for some interventions.11,12 Women
have preference for intrapartum support, mostly, their spouse but some their
mother, sister, mother in law or friends.10,13 Poor birth experience may contribute
significantly to perinatal mental health.11,14 Companionship in labour is a non-pharmacologic method of pain relief in
labour.15 In February 2018, the WHO published a consolidated set of
recommendations on intrapartum care for a positive childbirth experience (labour care guide).14,15,16 Respectful maternity care and knowing the
level of awareness and desirability for companionship in labour
among antenatal attendees at this facility would guide in policy making as
regards proper implementation of companionship in labour
as recommended by WHO.14,15,17, 18 This
study was aimed to determine the awareness and desirability of pregnant women
attending antenatal clinic for companionship in labour.
METHODOLOGY
Study
Settings
This study was carried out at the obstetrics unit of a tertiary
Centre, in Owo, Ondo state. It was an institutional based descriptive
cross-sectional study of antenatal clinic attendees in Owo.
Participants were selected by systematic random sampling and data collected
through interviewer-administered questionnaire, assessing their awareness and
desirability for companionship in labour. The
study population consisted of women who had Antenatal Care (ANC) services in
the hospital from January to
March, 2024. Inclusion criteria was pregnant women accessing antenatal care
services at FMC, Owo, irrespective of their
gestational age, who consented to participate in this study. Any patient with
contraindication to vaginal delivery or with any mental challenge was excluded.
Sample
Size Determination
The sample size for the study was determined
by Fischer’s formula using the prevalence rate of 75% found in a study in
Nigeria by Morhason-Bello et al.13
n = p (1-p) z2/d2
where n
= sample size, z = Za for
5% a, d = desired error
margin and p = prevalence.
Using prevalence of 75% and 95% confidence
interval, d = 0.05, Z = 1.96, p = 0.75
Therefore, n = 0.75(1-0.75) x 1.962/0.052
n =288.
The population size (N) is less than 10,000
(3300).
Therefore, the desired sample size (nf) will be calculated as; nf =
n/1+n/N
= 288 / 1 + 288/3300 = 288/1 + 0.087 =
288/1.087
= 265.
Non-response rate of 10% of sample size (27)
was added.
Thus, the minimum sample size used was 292
respondents.
Method of Data Collection
Data collection was through an interviewer
administered questionnaire. The research assistants were trained on how to
administer the questionnaires, how to tackle the questions that could arise
during the interview and how to ensure the research ethics were strictly
adhered to. The questionnaire consisted of the first part which had the
socio-demographic characteristics of the participants while the second and
third parts assessed the awareness and desirability of parturients
on/for companionship in labour respectively.
Data Analysis
The data collected was analysed
using IBM-SPSS (Statistical Package for Social Sciences) version 24.0 software.
The data was presented in tables, bar charts, pie charts and histogram.
Chi-square was used for categorical variables. The level of significance was
set at ≤ 0.05.
Ethical Consideration
An institutional ethical approval for this
study was obtained from the Ethics Review Committee of Federal Medical Centre, Owo. Participation in the study was voluntary and a written
informed consent was obtained from each participant at recruitment into the
study. All information and data obtained from the study were treated with
confidentiality and used solely for the purpose of the study.
RESULTS
A total of 292 women participated in this study with mean age of 31.8 ± 4.65 years. Majority
were married 97.3%. Concerning awareness of companionship in labour, 57.2% were aware, 42.1% were not aware while 2 of
them did not respond. Only 18% of those who were aware of companionship in labour experienced
Table 1:
Sociodemographic Characteristics of Respondents
|
|
Variables
|
Freq
(N)
|
(%)
|
Statistical test
(p-value)
|
|
|
Age Group
|
|
|
|
|
|
< 20 years
|
4
|
1.4
|
1.10a (0.778)
|
|
|
21 - 30 years
|
134
|
45.9
|
|
|
31 - 40 years
|
148
|
50.7
|
|
|
|
> 40 years
|
6
|
2.1
|
|
|
|
Age in years – Mean ± SD
|
31.8 ± 4.65
|
|
0.30b (0.765)
|
|
|
Marital status
|
|
|
|
|
|
Single
|
6
|
2
|
0.36a (0.547)
|
|
|
Married
|
284
|
97.3
|
|
|
|
Widowed
|
2
|
0.7
|
|
|
|
Religion
|
|
|
|
|
|
Islam
|
166
|
56.8
|
0.33a (0.553)
|
|
|
Christianity
|
124
|
42.5
|
|
|
|
Traditionalist
|
2
|
0.7
|
|
|
|
Level of Education
|
|
|
|
|
|
No formal education
|
6
|
2.1
|
0.73c (0.867)
|
|
|
Primary education
|
9
|
3.1
|
|
|
|
Secondary education
|
64
|
21.9
|
|
|
|
Tertiary education
|
213
|
72.9
|
|
|
|
Occupation
|
|
|
|
|
|
Self-employed
|
149
|
51
|
1.41c (0.704)
|
|
|
Professionals
|
62
|
21.2
|
|
|
|
Skilled workers
|
50
|
17.1
|
|
|
|
Unskilled workers
|
5
|
1.7
|
|
|
|
Unemployed
|
26
|
8.9
|
|
|
|
Ethnicity
|
|
|
|
|
|
Yoruba
|
224
|
76.7
|
0.80c (0.669)
|
|
|
Hausa/Fulani
|
28
|
9.6
|
|
|
|
Others
|
24
|
8.2
|
|
|
|
Igbo
|
16
|
5.5
|
|
|
|
Booking status
|
|
|
|
|
|
Booked
|
262
|
89.7
|
1.24c (0.403)
|
|
|
Unbooked
|
30
|
10.3
|
|
aFisher’s
exact; bStudent’s t -test; cChi-square test
companionship in their previous labour and
delivery. The booked patients were 88.2% of the studied population.
The association of the variables with desirability
for companionship in labour was tested with chi
square, parity (p-value = 0.008), religion (p-value 0.003), occupation (p-value
0.002), ethnicity (p-value 0.004) and level of education (p-value 0.0018) of
the participants were statistically significant. Age and marital status of the
respondents had no significant relationship with their desire for companionship
in labour. Regarding
preferred companions in labour among respondents; One
hundred and eighty-eight (188) of those who desired companionship in labour, accounted for 64.4% of the respondents preferred
their partner/husband as a companion in labour.
Thirty-Three (11.3%) of them preferred their mother, 19 (6.5%) of them
preferred their mother-in-law while 12 (4.1%) of them preferred their
sibling/sister as a companion in labour.
Table 2. Awareness Of Companionship in Labour Among the Respondents
|
|
Freq
|
%
|
Chi-square
(p-value)
|
|
Awareness of companionship
in labour
Companionship in previous childbirth
|
Yes
|
167
|
57.2
|
|
|
No
|
123
|
42.1
|
|
|
I
don’t know
|
2
|
0.7
|
78.248 (0.00004) *
|
|
|
|
|
|
|
Yes
|
30
|
18.00
|
|
|
No
|
137
|
82.0
|
|
DISCUSSION
There is dearth of
studies on companionship in labour in our setting
despite being recommended by the World Health Organization as one of the
components of respectful maternity care. Therefore, this study was set out to determine the awareness of
companionship and desirability of pregnant women attending antenatal clinic in
FMC, Owo for companionship during labour.
Exploring the desire of pregnant women for birth companionship for their future
labour and delivery is very important in order to
make the health facility ready to accommodate those companions and even, it is
important to create a positive impression on health care providers about those
companions.18,19
Table 4. Desirability For Companionship In Labour Among Respondents
|
Variables
|
Freq
|
Percent (%)
|
Chi-square
(p-value)
|
|
Desirability for companionship in labour
Yes
|
259
|
88.70
|
|
|
No
|
30
|
10.27
|
11.52 (0.001) *
|
|
No response
|
3
|
1.03
|
|
|
|
|
|
|
|
Desire for delivery at hospital with provision for companionship
Yes
|
268
|
91.8
|
|
|
No
|
24
|
8.2
|
|
|
|
|
|
|
|
Desire for companionship in labour at
additional cost
Yes
|
186
|
63.70
|
|
|
No
|
103
|
35.27
|
|
|
No response
|
3
|
1.03
|
|
Although
the benefits and subsequently the promotion of support during labour and delivery has been noted in the past, most
developing nations such as Nigeria, still practice it below expectation.13
This deprives women of cost-effective care in the course of their childbirth.
2,20 This might be because of cultural background and poor architectural
design of labour rooms in this environment which
discourages companionship during labour and delivery.
This study
found the level of awareness of companionship in labour
among antenatal clinic attendees in FMC, Owo to be
relatively high (57.2%). However, only 18% of those who had awareness of it had
some forms of companionship in their previous childbirth. The result is similar
to what was reported in a study from Ethiopia which showed only 13.8% of
mothers utilized companionship during labour and
delivery.[21] The result from the index study as regards utilization
of companionship during labour is low when compared
with a study done in Saudi Arabia which found that 59% of women in labour had support during labour11 and the one
conducted in Denmark where 95% of women in labour had
companions.10 This could be due to socio-cultural differences and
better planned health care facilities to accommodate companions during labour unlike in our environment where women labour mostly in open labour
rooms without required privacy.
This study
also found high desire for companionship in labour
among the respondents (88.7%). This is similar to what was reported in a study
from Abakaliki where 92% of the respondents desired
for companionship in labour.22 Similarly, another study done at the
University College Hospital, Ibadan, Nigeria reported that 75% of the
respondents desired companionship in labour.13 This showed that
Nigerian women desire companionship in labour,
however, its utilization is low and efforts must be made to prevent depriving
them of this important supportive care as recommended by the WHO.
In this
study, most women preferred their husband/partner as labour
companion (64.4%). The finding is similar to what was obtained from a study
conducted in Abakaliki which reported that 67.25% of
the respondents preferred their husband as companion in labour.22 However,
the finding in this study is in contrast with what a study from Russia reported
in which 68% of the women declined to have male partners present during labour.7
This difference may be individual, socio-cultural or societal perception of the
role of male partners.[16] It could also be due to difference in
family structures, relationships and ties.
This study
also found that majority of the respondents (92%) expressed desire to deliver
their babies in a hospital with provision for companionship in labour. Most of these women would prefer to experience it
even at an additional cost. This is in agreement with what was obtained from a
study conducted in Abakaliki.22
This study
also revealed majority of the respondents (72.9%) had tertiary (post-secondary)
level of education. Most of these women opted for companionship in labour. Although it is not unexpected that those more
educated women opted for companionship in labour.
Enhanced efforts should also be made to propagate the role and value of
companionship to those who are less well educated. This is in agreement with
other study which demonstrated that educational level of women was an important
determinant.13
Ethnicity,
parity and occupation of the respondents were also found to be statistically
significant in this study similar to what was reported in other study.13
However, age and marital status of the respondents were not statistically
significant in the desire for companionship in labour
in this index study. This is in agreement with a study from Hong Kong.[23]
In contrast, the finding in this study contradicts what was obtained from a
study from Abakaliki where the age and parity were
found to be statistically significant.22
CONCLUSION
Companionship in labour
is evidently the intense aspiration of parturients in
our societies. Their desire to be in the company of their loved ones during one
of the most stressful moments of their lives should be made a reality. The
findings of this study showed that most of the respondents are aware of
companionship in labour and majority of them desired
it but its utilization is low. To improve this low utilization of companionship
in labour, institutions and care givers should make
provisions for it, provide information about it during antenatal care
attendance as well as need for clear guidelines to govern its practice.
Companionship of choice in labour is a cost-effective
intervention to improve the quality of maternal care with positive birth
experience.
Limitations of the Study
This study has some
limitations. It is obviously one of the few of its kind on the subject matter
and an eye opener at our facility to the wish of our women. This does not
represent the opinion of the entire society. Most of the respondents who had
companions in their previous delivery (ies) did so in
facilities outside our facility (place of study). Therefore, a community-based
study would be preferable.
REFERENCES
1.
Bennett T,
Proudfit C, Roman AS. Normal and abnormal
labour and delivery. In: Alan HD, Nathan L, Roman A, Laufer N. (eds). Current Diagnosis and
Treatment; Obstetrics and Gynecology. 12th Ed. New York; McGraw Hill. 2019;
156-163.
2.
Sapkota S,
Kobayashi T, Kakehashi M, Baral
G, Yoshida I. In the Nepalese Context, Can a Husband
Attendance during Childbirth Help His Wife Feel More in Control of Labour? BMC Pregnancy
and Childbirth. 2012
3.
Vehviläinen-Julkunen K and Emelonye AU. Spousal Participation in Labour
and Delivery in Nigeria. Ann Med Health
Sci Res. 2014; 4: 511-515.
4.
Diniz SG, Dominingues
R, Torres J, Dias M, Schneck C, Lansky S, et al.
Implementation of Presence of Companions during Hospital Admission for
Childbirth: Data from the Birth I Brazil National Survey. Cadernos de Saúde Pública,
Rio de Janeiro. 2014; 30: 140-153.
5.
Kungwimba E, Malata A, Maluwa A, Chirwa E.
Experience of Women with the Support They Received from Their Birth Companions
during Labour and Delivery in Malawi. I Health. 2013; 5: 45-52.
6.
Alexander A, Mustafa A, Emil SA, Amekah
E, Engmann C, Adanu R et al. Social Support during Delivery in
Rural Central Ghana: A Mixed Study of Women’s Preference for and against
Inclusion of a Lay Companion in the Delivery Room. J Biosci. 2013; 46: 669-685.
7.
Bakhta Y, Lee RH. A Survey of Russian Women
Regarding the Presence of a Companion during Labour. Int J Obstet Gynaecol. 2010; 109: 201-203.
8.
Oboro VO, Oyeniran
AO, Akinola SE, Isawumi AI. Attitudes of Nigerian
Women toward the Presence of Their Husband or Partner as a Support Person
during Labour. Int
J Obstet Gyaecol. 2011;
112: 56-58.
9.
Kabakian-Khasholian EA, Bashour H. Perceptions about Labour
Companionship at Public Teaching Hospitals in Three Arab Countries. Int J Obstet Gynaecol. 2015; 129: 223-226.
10. Bruggemann OM, Parpinelli MA, Osis JD, Neto AS.
Support to Woman by a Companion of Her Choice during Childbirth: A Randomized
Controlled Trial. Reprod Health. 2007; 4(5), 98-108.
11. Al-Mandeel HM, Almufleh AS, Al-Damri AT, Hajr EA, Bedaiwi NA, et al. Saudi Women’s Acceptance and
Attitudes towards Companion Support during Labour:
Should We Implement an Antenatal Awareness Program? Ann Saudi Med. 2013; 33: 28-33.
12. Hodnett ED, Gates S,
Hofmeyr GF, Sakala C, Weston J. Continuous Support
for Women during Childbirth. Cochrane Database of Systematic Reviews, 2011.
13. Morhason-Bello IO, Olayemi O, Ojengbede OA, Adedokun BO, Kuyemi OO, Orji B.
Attitude and Preferences of Nigerian Antenatal Women to Social Support during Labour. J Biosci. 2008; 40: 553-562.
14. WHO Recommendations: Intrapartum Care for a
Positive Childbirth Experience. Geneva: World Health Organisation;
2018. Accessed 1st Feb, 2022.
15. Oladapo O.T, Tuncalp O, Bonet M, Lawrie TA, Portela A, Downe S et
al. WHO model of intrapartum care for a positive childbirth experience:
transforming care of women and babies for improved health and wellbeing. BJOG. 2018; 125(8): 918-922.
16. Adeniran AS, Aboyeji
AP, Fawole AA, Balogun OR, Adesina KT, Adeniran PI.
Male Partner’s Role during Pregnancy, Labour and
Delivery: Expectations of Pregnant women in Nigeria. Int J Health Sci, Qassim University. 2015; 9(3): 305-313.
17. Lindner S, McGrath J. Family centred care and continuous labour
support. NAINR(Internet). 2012(cited 2015 March 21); 12(2): 70-2.
18. Morhason-Bello IO, Adedokun BO, Ojengbede
OA, Olayemi O, Oladokun A, Fabanwo AO. Assessment of the effect of psychosocial
support during childbirth in Ibadan, South-west, Nigeria: A randomized
controlled trial. Aust New Zeal J Obstet Gynaecol. 2009; 49(2):
145-50.
19. Assfaw HM, Abuhay M and Asratie
MH. Desire for Birth Companionship Among Pregnant Women Attending Antenatal
Care in Debremarkos City, Northwest Ethiopia:
Magnitude and Associated Factors. Front Glob Womens
Health. 2022; 3: 823020. doi:10.3389/fgwh.2022.823020.
20. The Royal College of Midwives. Evidence Based
Guidelines for Midwifery-Led Care in Labour. Supporting
Women in Labour. 2012.
21. Beyene GK, Ukke GG, Alemu BW. Utilization of
companionship during delivery and associated factors among women who gave birth
at Arba Minch town public health facilities, Southern
Ethiopia. PLOS. 2020; 1: 15 (10): e0240239
22. Asogwa SU, Nwafor JI, Obi CN, Ibo CC, Ugoji D-PC, Ebere IC, et al.
A Study on the Attitude and Preference of Antenatal Clinic Attendees to
Companionship during Labour and Delivery in Alex
Ekwueme Federal University Teaching Hospital, Abakaliki.
Adv Reprod Sci. 2019; 7: 71-81.
23. Chiu WK, Chung WH, Chan LW, To WK.
Companionship during Labour: Attitude and Expectation
of Hong Kong Chinese. HKJGOM. 2015; 15:
124-130.
