Implementation of a labour companionship model in three public hospitals in Arab middle‐income countries

Kabakian‐Khasholian, Tamar; Bashour, Hyam; El-Nemer, Amina; Kharouf, M; El-Sheikh, Ohoud

doi:10.1111/apa.14540

Cited by 20 publications

(32 citation statements)

References 23 publications

(33 reference statements)

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“…A study in three Arab countries found that women who had better preparedness for birth had a higher likelihood of companionship during labor. 26 Consistent with other studies on the effect of companionship during labor on intrapartum care, companionship during labor facilitates spontaneous vaginal delivery and reduces the intensity of pain 27 and maternal satisfaction. 28 Given the global epidemic of unnecessary cesarean birth, increasing coverage of nonclinical interventions such as companionship during labor can reduce the risk of unnecessary cesarean births.…”

Section: Discussionsupporting

confidence: 85%

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Coverage, associated factors, and impact of companionship during labor: A large‐scale observational study in six hospitals in Nepal

Axelin

Litorp

et al. 2019

Birth

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Background Companionship at the time of birth is a nonclinical intervention that has been proven to improve the quality of intrapartum care. This study aims to evaluate the coverage, associated factors, and impact of companionship during labor at public hospitals in Nepal. Methods We conducted a cross‐sectional observational study in six public hospitals in Nepal. The study was conducted from July 2018 to August 2018. Data were collected on sociodemographic, maternal, obstetric, and neonatal characteristics from patient case notes and through predischarge interviews. Coverage of companionship during labor and its association with intrapartum care was analyzed. Bivariate and multivariate analyses were done to assess the association between companionship during labor and demographic, obstetric, and neonatal characteristics. Results A total of 63 077 women participated in the study with 19% of them having a companion during labor. Women aged 19‐24 years had 65% higher odds of having a companion during labor compared with women aged 35 years and older (aOR 1.65 [95% CI, 1.40‐1.94]). Women who were from an advantaged ethnic group (Chhetri/Brahmin) had fourfold higher odds of having a companion than women from a disadvantaged group (aOR 3.84; [95% CI, 3.24‐4.52]). Women who had companions during labor had fewer unnecessary cesarean births than those who had no companions (5.2% vs 6.8%, P < .001). Conclusions In Nepal, sociodemographic factors affect women's likelihood of having a companion during labor. As companionship during labor is associated with improved quality of care, health facilities should encourage women's access to birth companions.

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Section: Discussionsupporting

confidence: 85%

“…Our study showed that women who had prepared for delivery at a health institution had a higher likelihood of companionship during labor. A study in three Arab countries found that women who had better preparedness for birth had a higher likelihood of companionship during labor …”

Section: Discussionmentioning

confidence: 99%

Coverage, associated factors, and impact of companionship during labor: A large‐scale observational study in six hospitals in Nepal

Axelin

Litorp

et al. 2019

Birth

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“…This often involved identifying factors that might help or hinder implementation via stakeholder interviews or focus groups [126,127,171,178,182]. Many of these efforts informed policies, guidelines and/or implementation plans [116,124,125,172,182].…”

Section: Theories Models and Framework: Absentmentioning

confidence: 99%

Implementation science in maternity care: a scoping review

Piper

Coates

2021

Implementation Sci

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Background Despite wide recognition that clinical care should be informed by the best available evidence, this does not always occur. Despite a myriad of theories, models and frameworks to promote evidence-based population health, there is still a long way to go, particularly in maternity care. The aim of this study is to appraise the scientific study of methods to promote the systematic uptake of evidence-based interventions in maternity care. This is achieved by clarifying if and how implementation science theories, models, and frameworks are used. Methods To map relevant literature, a scoping review was conducted of articles published between January 2005 and December 2019, guided by Peters and colleagues’ (2015) approach. Specifically, the following academic databases were systematically searched to identify publications that presented findings on implementation science or the implementation process (rather than just the intervention effect): Business Source Complete; CINAHL Plus with Full Text; Health Business Elite; Health Source: Nursing/Academic Edition; Medline; PsycARTICLES; PsycINFO; and PubMed. Information about each study was extracted using a purposely designed data extraction form. Results Of the 1181 publications identified, 158 were included in this review. Most of these reported on factors that enabled implementation, including knowledge, training, service provider motivation, effective multilevel coordination, leadership and effective communication—yet there was limited expressed use of a theory, model or framework to guide implementation. Of the 158 publications, 144 solely reported on factors that helped and/or hindered implementation, while only 14 reported the use of a theory, model and/or framework. When a theory, model or framework was used, it typically guided data analysis or, to a lesser extent, the development of data collection tools—rather than for instance, the design of the study. Conclusion Given that models and frameworks can help to describe phenomenon, and theories can help to both describe and explain it, evidence-based maternity care might be promoted via the greater expressed use of these to ultimately inform implementation science. Specifically, advancing evidence-based maternity care, worldwide, will require the academic community to make greater explicit and judicious use of theories, models, and frameworks. Registration Registered with the Joanna Briggs Institute (registration number not provided).

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“…For example, an implementation research study conducted in Syria, Egypt and Lebanon used participatory approaches to develop and implement a tailored labour companionship model and reported improvements in acceptability of labour companions among health workers and women's satisfaction with care during childbirth. 9 There are important components of labour companionship implementation that need to be taken into consideration. Creating physical spaces in health facilities or structuring labour wards that support companionship may also be important, such as ensuring the availability and use of privacy measures (curtains/dividers) and a chair for the companion.…”

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confidence: 99%

Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey

et al. 2020

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BackgroundEvidence has shown the benefits of labour companions during childbirth. Few studies have documented the relationship between the absence of labour companions and mistreatment of women during childbirth in low-income and middle-income countries using a standardised tool.MethodsWe conducted a secondary analysis of the WHO multi-country study on how women are treated during childbirth, where a cross-sectional community survey was conducted with women up to 8 weeks after childbirth in Ghana, Guinea, Nigeria and Myanmar. Descriptive analysis and multivariable logistic regression were used to examine whether labour companionship was associated with various types of mistreatment.ResultsOf 2672 women, about half (50.4%) reported the presence of a labour companion. Approximately half (49.6%) of these women reported that the timing of support was during labour and after childbirth and most of the labour companions (47.0%) were their family members. Across Ghana, Guinea and Nigeria, women without a labour companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. However, there were country-level variations. In Guinea, the absence of labour companionship was associated with any physical abuse, verbal abuse, or stigma or discrimination (adjusted OR (AOR) 3.6, 1.9–6.9) and non-consented vaginal examinations (AOR 3.2, 1.6–6.4). In Ghana, it was associated with non-consented vaginal examinations (AOR 2.3, 1.7–3.1) and poor communication (AOR 2.0, 1.3–3.2). In Nigeria, it was associated with longer wait times (AOR 0.6, 0.3–0.9).ConclusionLabour companionship is associated with lower levels of some forms of mistreatment that women experience during childbirth, depending on the setting. Further work is needed to ascertain how best to implement context-specific labour companionship to ensure benefits while maintaining women’s choices and autonomy.

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Implementation of a labour companionship model in three public hospitals in Arab middle‐income countries

Cited by 20 publications

References 23 publications

Coverage, associated factors, and impact of companionship during labor: A large‐scale observational study in six hospitals in Nepal

Coverage, associated factors, and impact of companionship during labor: A large‐scale observational study in six hospitals in Nepal

Implementation science in maternity care: a scoping review

Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey

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