Predilection for Birth Companionship among Antenatal Women of North India: Experience of a Tertiary Care Center

Abstract

Background: 

In the accomplishment of respectful maternal care, the birth companion of choice is a well-known cost-effective, beneficial intervention with evidence of improved labor and delivery outcomes. However, there is paucity regarding the status of women’s desire for birth companionship. The following study was directed to assess the prevalence of predilection for birth companionship and factors influencing it among antenatal women in Karnal city of North India.

Methodology: 

This was a cross-sectional study conducted in a tertiary care center over 3 months in Karnal city of North India. A total of 423 antenatal women were accessed by systematic random sampling using a face-to-face interviewer-administered questionnaire. The data were entered into Epi data version 4.6 and transformed to SPSS version 25. Binary logistic regression analysis was performed, and variables with a P ≤ 0.2 on bivariable analysis were taken for multivariable analysis. Adjusted odds ratio (AOR) with a 95% confidence interval (CI) was used to detect the association, and a P < 0.05 in the multivariable analysis was used to declare statistical significance.

Results: 

The prevalence of desire for birth companionship was 59.1%. Women with planned pregnancy (AOR = 2.9; [95% CI 1.67–5.04]), first or second gravida (AOR = 3.375 [1.670–6.818]) and between 18 and 25 years of age (AOR = 6.087 [2.28–16.22]) had a significant desire for birth companionship.

Conclusions: 

The desire for birth companionship among pregnant women was high in this study. Improving women’s decision-making power, emphasis on planned pregnancy and antenatal education classes were the areas of improvement to increase the desire of women for a labor companion.

INTRODUCTION

Maternal respect and preservation of dignity remain the locus of improvement in global maternal health today. To improve women’s experiences by providing respectful care and emotional support, WHO and even the Government of India now strongly advocate the option of birth companionship for every pregnant female.^[1,2]

A birth companion can be any person of a woman’s choice, preferably someone who has gone through the process of labor and childbirth (female family member/partner/community health worker/friend) who would provide one-to-one continuous support during labor and delivery. They aid to provide support as well as warmth to cope with labor pains, serve as a representative to communicate parturient’s choices and preferences as well as to inform the former of her progress of labor, serve as a witness and curtail the workload of nursing staff, provide back massage, maintain hydration during labor, help her in decision-making and may strengthen the marital relationship (in case of male partner).^[3]

Cochrane reviews corroborate the relevance of a birth companion, like shorter duration of labor, higher incidence of spontaneous vaginal birth, and better 5-min Apgar scores for newborns.^[3,4] Despite the affirmed benefits, the implementation of labor companionship remains suboptimal. In India, especially in the government health facilities, the poor compliance of this companionship has various aspects to it, like space constraints in labor wards which pose maintaining privacy and integrating labor companions into part of the care team a real challenge, lack of confidence in them in the event of a complication, health-care providers distrust in companions.^[5–7] There is a need to apprehend their desire of having a companion to sail through this momentous journey of their lifetime antenatally. There is no study from India focused on women’s desire for birth companionship and factors associated with it to date. The rationale of this study may further help to re-evaluate the rules and regulations in general labor room policies to accommodate these beneficial companions and to provide a conducive environment.

METHODOLOGY

Study setting and study duration

This was a cross-sectional study conducted in a tertiary care institute in Karnal city in Northern India from March 1, 2022 to May 31, 2022. On an average, 1700 antenatal women attend antenatal care clinics per month here.

Inclusion criteria

All the pregnant women who attended the antenatal clinic during the study period were included in the study, and written informed consent for participation was obtained. Institutional ethical committee clearance was obtained vide letter no. KCGMC/IEC/2021/42.

Exclusion criteria

Those antenatal women who refused to participate in the study were excluded from this study.

Sample size calculation and sampling

The sample size was calculated using the single population proportion formula by considering the prevalence of desire for labor companionship to be 50%. Taking a nonresponse rate of 10%, and a margin of error of 5% with a 95% confidence interval (CI), the sample size has been calculated as follows:

(where; n = estimated sample size, z α/2 = 1.96, the value given from the table is 95% CI, P = estimated proportion of desire for labor companionship).

After adding a nonresponse rate of 10%, the final estimated sample size for this study was 423. We used a systematic random sampling technique for selecting the participant from the study population, K = N/n where N = 1700, n = 423, and K = 4. Every fourth antenatal woman was selected as a study participant.

Data collection

A structured interviewer-administered questionnaire adapted and modified from different literature was used as a data collection tool.^[8,9] The questionnaire was translated into the local language (Hindi) and pretested for appropriateness and clarity on 21 antenatal women. The data were collected through a face-to-face interview. Sociodemographic details, obstetrical history, the standard of health-care services, and the desire for a birth companion were taken into account. The antenatal women were asked about their predilection for a birth companion when they would be in labor, and the answer was recorded as a “yes” or “no.”

Data analysis

The collected data were translated back into English and entered using Epi data version 4.6 and exported into the SPSS version (IBM SPSS Statistics 20) for the analysis. Data were coded, and descriptive statistics were calculated. A binary logistic regression model was used to determine the association between independent variables and outcome variables (desire for labor companionship). All variables with a P ≤ 0.2 from the bi-variable analysis were used for multivariable analysis. An adjusted odds ratio with a 95% CI was used to declare the statistical significance of the variable. A variable with a P < 0.05 in the multivariable analysis was considered statistically significant.

RESULTS

Among the study participants, the mean age was 26.32 (±4.26 years). Table 1 shows various sociodemographic characteristics of the study participants. Table 2 enlists various factors related to the utilization of maternal health-care services by study participants. A vast majority (87.7%) of them had the support of a health-care provider and chose a hospital setup (58.2%) to avail of antenatal health-care services. With rising literacy rates over the past few decades, it was observed that nearly half the study participants were independent decision-makers for attending maternal health-care services and for their family planning.

Table 1: Sociodemographic characteristics of women in Karnal city, North India

Table 2: Maternal health-care services related factors

Table 3 shows a compilation of the obstetrical history of the study participants. It was evident that women are now laying more emphasis toward planning their pregnancy. The prevalence of desire for birth companionship was 59.1% in this study.

Table 3: Obstetrical history of antenatal women attending antenatal care clinic in Karnal city, North India

From bi-variable analysis, eight variables (maternal age, education level of mothers, parity of women, planned pregnancy status, exposure to media, availability of ambulance service, decision-maker status for availing maternal health-care services, and family planning services) were significantly associated with outcome variable predilection for birth companionship. From multivariable analysis, three variables (less maternal age, planned status of current pregnancy, and lower parity of woman) continued significantly with the outcome variable [Table 4].

Table 4: Factors associated with women’s desire for birth companionship

The predilection for birth companionship was six times higher in young antenatal women (age 18–24 years) compared to women above 25 years of age. Participants with their first or second pregnancy were three times more likely desirable for companionship compared to those with a still higher order of birth. Women with planned current pregnancies were thrice more likely desirable for birth companionship as compared to women where current pregnancy was not planned. The study found no influence of previous experience with a traditional birth attendant or the type of residence (rural or urban). The desire was higher in women with no formal education than literate women.

DISCUSSION

The prevalence of predilection for birth companionship among pregnant women of Karnal city was 59.1%, which was a little higher than the estimated prevalence for the sample size calculation of 50%. This finding was comparable (57.45%) to that of a similar study conducted in Ethiopia by Assfaw etal.^[10] The possible explanation for the high prevalence in our study may be attributed to the fact that the majority of the pregnant women who were desirous of a birth companion were young (in the age group 18–25 years) and with either no formal or just primary education which accounts for a lot of fears and apprehension surrounding childbirth, especially when it is their first or second pregnancy. Moreover, such women need the nearest confidant to communicate their needs during labor. This is also supported by evidence from a study conducted by Bangal etal.^[11] The finding of our study is also higher than studies conducted worldwide.^[8,12,13] Moreover, may be due to differences in the study setting (including peripheral health centers) and also to the fact that the data for future predilection might be slightly higher.

Women who were the independent decision-maker for their family planning were eight times more desirable for birth companionship than deciding jointly with others. This finding is supported by evidence obtained from various studies.^[9,10,14,15] With the autonomy of decision-making, women have full access to maternal health services and are often informed about the advantages of labor companionship.

Women with a planned pregnancy were three times more desirable for birth companionship than those with an unplanned pregnancy. With a planned pregnancy, women tend to care for themselves and their unborn babies right from the time of conception till delivery and often express their need for a supportive person throughout this time and even during the initial years of child upbringing.^[10,16,17]

Women who were expecting their first or second child were three times more desirable for labor companionship compared to those with their third, fourth, or fifth child. This is attributed to the anxiety surrounding the new would-be mothers as to how they would cope with long duration of pain, the treatment that would be given, communication with the healthy caregiver, the anticipation of labor–birth events, and how they would manage their other child. Women who were pregnant at an early age (18–24 years) were six times more desirable for a birth companion owing to inexperience at a young age and apprehension about childbirth. These findings are supported by evidence from other research.^[11,18]

The desire for a birth companion was significantly less (P < 0.001), where women had complications in the current pregnancy, had a bad obstetrical history, or had their first antenatal visit beyond the second trimester. Similar findings have been reported by other studies also.^[10,11] We found that the women were often scared to disclose their pregnancies (in accordance with their traditional disbeliefs) when they had any complications in their pregnancies.

Gaps observed

The rate of institutional delivery, which is gaining momentum throughout the country, has led to the isolation of laboring women away from their loved ones. Despite affirmed benefits, the implementation of birth companionship remains suboptimal. Space constraints in government setup often pose it difficult to accommodate the birth companions. The majority of Indian women attending antenatal care at health facilities is not exposed to any antenatal education classes or get any Information, Education, and Communication material on birth companionship and thus do not identify or register a birth companion.

Possible solutions

By apprehending the desire of antenatal women for a labor companion, the facilities can be prepared to handle and accommodate them. The health-care service providers also need sensitization toward them so that they can be effectively incorporated as a part of the care team and rather be a help in areas that are deficient in hospital staff. These are critical advocacy tools and strategies to normalize birth companionship within our health system. It is high time to re-formulate the hospital policies and sensitize the health-care service providers toward these confidants.

There is an urgent need to prioritize the gaps between proclamations and practice surrounding birth companionship with the high desire of antenatal women. The policymakers must target the hurdles in achieving this goal. One of the limitations of our study was the data for future prediction tends to be higher; this might lead to higher value of predilection.

CONCLUSIONS

It was evident by this study that there is a high desire for a birth companion among pregnant women, and a thorough probe is essential to keep health facilities and health-care workers ready for accommodation and training of those companions as well as to create a positive impression on health-care providers about those companions.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.