Medical and Administrative Barriers to the Implementation and Sustenance of a Labor Companionship Program: A Cross-sectional Study in a Teaching Hospital in Sri Lanka
Prasad Dilruwan, Malik Goonewardene, Rameez Furukan
Administrative barriers, Implementation, Labor companion, Labor companionship program, Medical barriers, Positive childbirth experience, Quality of care during labor, Sustenance
Citation Information :
Dilruwan P, Goonewardene M, Furukan R. Medical and Administrative Barriers to the Implementation and Sustenance of a Labor Companionship Program: A Cross-sectional Study in a Teaching Hospital in Sri Lanka. J South Asian Feder Obs Gynae 2022; 14 (2):152-156.
Aim: The aim of the study was to describe how medical and administrative barriers in implementing a labor companionship program were overcome and to identify similar barriers adversely affecting the sustenance of the program.
Materials and methods: Medical and administrative barriers encountered when implementing a labor companionship program at the Academic Unit (AU) of Teaching Hospital, Mahamodara, Galle (THMG), in 2012 and how these barriers were overcome are described. From March to April 2016, a cross-sectional study was carried out using an interviewer-facilitated self-administered questionnaire, on specialist obstetricians and gynecologists, house officers, staff nurses, and midwives of AU of THMG, to identify possible reasons for the failure to sustain the labor companionship program. Data regarding demographic characteristics, knowledge and attitudes regarding women having a labor companion (LC), and counseling pregnant women to have an LC were collected.
Results: Four out of five specialists, all 13 house officers, 23 out of 30 staff nurses, and 12 out of 16 midwives participated in the study. All the specialists and nurses, 85% of house officers, and 58% of midwives were aware that the presence of an LC was beneficial for women in labor. However, only 24% of doctors and 17% of staff nurses and midwives had counseled pregnant women routinely regarding an LC and only 53% of doctors and 20% of nurses and midwives had counseled more than 10 pregnant women regarding LC, during the week immediately preceding the data collection.
Conclusion: Medical and administrative barriers are encountered when establishing a labor companionship program, but they can be overcome. Midwives must be educated regarding the beneficial effects of an LC. Doctors and nurses must be motivated to increase counseling of women and their partners regarding the beneficial effects of an LC in order to sustain a labor companionship program.
Hodnett ED, Gates S, Hofmeyer GJ, et al. Continuous support for women during childbirth. Cochrane Database Syst Rev 2013;7:CD003766. DOI: 10.1002/14651858.CD003766.pub5.
WHO recommendations on health promotion interventions for maternal and newborn health. Geneva: World Health Organization; 2015. Available from: http://www.who.int/maternal_child_adolescent/documents/health-promotioninterventions/en/.
WHO recommendations: intrapartum care for a positive childbirth experience: Geneva: World Health Organization; 2018, License: CC BY-NC-SA 3.OIGO.
Tuncalp Ö, Were WM, MacLennan C, et al. Quality of care for pregnant women and newborns—the WHO vision. BJOG 2015;122(8): 1045–1049. DOI: 10.1111/1471-0528.13451.
Hofmeyr GJ, Bernitz S, Bonet M, et al. WHO next generation partograph: revolutionary steps towards individualised labour care. BJOG 2021;128(10):1658–1662. DOI: 10.1111/1471-0528.16694.
Bharti J, Kumari A, Zangmo R, et al. Establishing the practice of birth companion in labour ward of a tertiary care centre in India-a quality improvement initiative. BMJ Open Qual 2021;10(Suppl. 1):e001409. DOI: 10.1136/bmjoq-2021-001409.
De Mucio B, Binfa L, Ortiz J, et al. Status of national policy on companion of choice at birth in Latin America and the Caribbean: gaps and challenges. Rev Panam Salud Publica 2020;44:e19. DOI: 10.26633/RPSP.2020.19.
Munkhondya BMJ, Munkhondya TE, Chirwa E, et al. Efficacy of companion-integrated childbirth preparation for childbirth fear, self-efficacy, and maternal support in primigravid women in Malawi. BMC Pregnancy Childbirth 2020;20(1):48. DOI: 10.1186/s12884-019-2717-5.
Falade-Fatila O, Adebayo AM. Male partners’ involvement in pregnancy related care among married men in Ibadan, Nigeria. Reprod Health 2020;17(1):14. DOI: 10.1186/s12978-020-0850-2.
McCauley M, Stewart C, Kebede B. A survey of healthcare providers’ knowledge and attitudes regarding pain relief in labor for women in Ethiopia. BMC Pregnancy Childbirth 2017;17(1):56. DOI: 10.1186/s12884-017-1237-4.
Agha S, Fitzgerald L, Fareed A, et al. Quality of labor and birth care in Sindh Province, Pakistan: findings from direct observations at health facilities. PLoS One 2019;14(10):e0223701. DOI: 10.1371/journal.pone.0223701.
Perkins J, Rahman AE, Mhajabin S, et al. Humanised childbirth: the status of emotional support of women in rural Bangladesh. Sex Reprod Health Matters 2019;27(1):1610277. DOI: 10.1080/26410397.2019.1610277.
Chaote P, Mwakatundu N, Dominico S, et al. Birth companionship in a government health system: a pilot study in Kigoma, Tanzania. BMC Pregnancy Childbirth 2021;21(1):304. DOI: 10.1186/s12884-021-03746-0.
National strategic plan on maternal and newborn health (2012-2016). Sri Lanka: Family Health Bureau; Ministry of Health; 2011. p. 62–65.
Senanayake HM, Somawardana UABP, Samarasinghe M. Effect of a female labour companion and of educating her regarding support during labour on perinatal and labour outcomes. Sri Lanka J Obstet Gynecol 2013;35(4):112–115. DOI: 10.4038/sljog.v35i4.6584.
Senanayake H, Wijesinghe RD, Nayar KR. Is the policy of allowing a female labor companion feasible in developing countries? Results from a cross sectional study among Sri Lankan practitioners. BMC Pregnancy Childbirth 2017;17(1):392. DOI: 10.1186/s12884-017- 1578-z.
Kabakian-Khasholian T, Portela A. Companion of choice at birth: factors affecting implementation. BMC Pregnancy Childbirth 2017;17(1):265. DOI: 10.1186/s12884-017-1447-9.