Presence of birth companion—a deterrent to disrespectful behaviours towards women during delivery: an exploratory mixed-method study in 18 public hospitals of India

Abstract

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.

Two are better than one? The impact of lay birth companions on childbirth experiences and PTSD

“…This may be especially important in pandemic times, where the presence of lay companions has been limited, though their presence may be needed more than ever when there is shortage of staff (Kathuria et al 2020). This is a simple cost-effective way of providing beneficial support in all birth settings, promoting respectful maternity care (Singh et al 2021) and, by that, preventing future psychopathology sequela.…”

“We Beat them to Help them Push”: Exploring Midwives’ Perspectives on Obstetric Violence in Ghana

“…Birth companions also reduce women's chances of being mistreated. Singh et al's [41] quantitative study in India revealed that women with birth companions were less likely to experience obstetric violence. From these bases, it is apparent that there is a need for concrete measures to facilitate accompanied delivery in Ghana.…”

Implementing the Practice of Birth Companion in Labor During the COVID-19 Pandemic: A Quality Improvement Endeavor in India

“…They found that despite awareness of the importance and advantages of birth companions, it was the absence of defined hospital policies, lack of space, lack of privacy, and crowding in labor rooms that were reported as reasons birth companions were not allowed. They also reported that the presence of birth companions was negatively associated with incidences of disrespect and abuse of women [ 6 ]. Childbirth is a very personal event in a woman’s life, and the experiences (positive or negative) stay with her for a very long time.…”

“…The WHO recommends that all women should have access to a birth companion of their choice [ 2 ]. Birth companions are commonly allowed in private maternity facilities in the country; however, very few government setups in India allow birth companions [ 6 ].…”