Perception of childbirth companion presence and its determinants among maternity care providers in Southwest Ethiopia: Mixed-method study

Abstract

Background

Quality of care is a key focus of the global maternal and newborn health agenda, especially during labor and delivery. Allowing a companion during labor and childbirth is an effective intervention that promotes quality of care; however, the practice is still low in Ethiopia. This study aimed to assess perceptions of childbirth companions and their determinants among maternity care providers working in public health facilities in southwest Ethiopia.

Design

An explanatory-sequential mixed-method study was conducted.

Method

This study was conducted from March 2024 to May 2024 among 481 maternity care providers. Quantitative data were collected using self-administered, semi-structured questionnaires and entered using Epi Data, then exported to SPSS for analysis. Bivariate and multivariate logistic regressions were performed to determine factors associated with perceptions of childbirth companions. Qualitative data were collected through interviews using a semi-structured guide, recorded, transcribed, translated, coded, and analyzed using thematic framework analysis.

Result

Of the 481 participants, only 284 (59%) had positive perceptions toward childbirth companions. Above ten years of work experience (AOR = 2.11, 95% CI: 1.14–3.91), received training (AOR = 3.51, 95% CI: 2.25–5.48), recognizing the importance of companion (AOR = 3.77, 95% CI: 2.14–6.64), and having good awareness (AOR = 2.25, 95% CI: 1.43–3.53) were identified as factors affecting care providers’ perceptions. The qualitative data revealed themes of awareness, perception, and barriers related to companionship.

Conclusion

Nearly half of the respondents had positive perceptions of childbirth companions. Participants’ experiences, training status, views on the importance of companionship, and awareness of companionship were statistically significant to their perceptions. Overcrowding in labor rooms and confidentiality issues were identified as barriers. This study calls for interventions, including strengthening providers’ training and expanding labor ward resources to support companion presence.

Keywords

perception childbirth companion maternity care providers mixed method southwest Ethiopia

Introduction

Maternal morbidity and mortality continue to be significant public health concerns, despite a 40% decrease in the maternal mortality ratio from 328 to 197 per 100,000 live births between 2000 and 2023, largely due to improved healthcare access and interventions.¹ In 2023, approximately 260,000 women died from preventable pregnancy-related causes, which are still heavily concentrated in low- and lower-middle-income countries.^2,3 Sub-Saharan Africa is responsible for 70% of global mortality (182,000 deaths), far above the global average and the Sustainable Development Goal target of fewer than 70 by 2030, highlighting significant disparities compared to regions like Southeast Asia and Latin America.^1,3 Poor-quality health care services significantly contribute to maternal mortality by failing to prevent or manage common complications during pregnancy and childbirth. This issue is particularly acute in low- and middle-income countries, where health system shortcomings exacerbate risks.⁴ Improving the quality of care, particularly in areas such as emergency obstetric services and antenatal care, could reduce maternal deaths by 21-32% on average.⁴

Global maternal health efforts have evolved from primarily focusing on access to facility-based care to emphasizing quality of care, equity, and respectful, dignified experiences for women and families, driven by evidence that access alone does not reduce mortality.^5,6 High coverage of skilled birth attendants alone will not reduce mortality. Sustained reductions and elimination of preventable deaths require improved quality across the entire continuum of care.⁷ Quality of care is a key focus of the global maternal and newborn health agenda, especially during labor and delivery and the immediate postnatal period. The World Health Organization (WHO 2016), Standards for improving quality of maternal and newborn care in health facilities, outline eight key standards aligned with a quality-of-care framework, including clinical guidelines, infrastructure, and emotional support, with Standard 6 focusing on providing emotional support to every woman and newborn. This standard ensures compassionate care that addresses psychological needs during labor and delivery. Its importance lies in enhancing maternal satisfaction, reducing stress-related complications, and supporting better health outcomes in maternal and neonatal care.⁷

The WHO strongly recommends allowing women to have a childbirth companion of their choice during labor and delivery, highlighting its critical role in enhancing maternal and newborn health outcomes by providing continuous support and reducing stress during childbirth.⁸ A childbirth companion provides continuous emotional, physical, and informational support during childbirth. They can be family members, friends, community members, or healthcare professionals, but they do not replace medical staff.^5,9

The presence of a companion during childbirth is recognized as a crucial component of respectful maternity care, offering physical, emotional, and psychological support to women during labor.¹⁰ These measures align with global initiatives aimed at reducing disrespectful practices and promoting care that honors autonomy and dignity.¹¹ Women often encounter disrespectful or neglectful treatment in facility-based childbirth, including physical, verbal, and emotional abuse, along with neglect, which contributes to low satisfaction rates in public health institutions.^12,13 This also negatively influences maternal and newborn outcomes and compels some women to give birth at home due to unfamiliar surroundings, in contrast to the ‘safe and reassuring environment’ of home.^11,14

Companions can also assist healthcare providers by helping to identify labor complications early, such as signs of fetal distress, and facilitating effective communication between the woman and medical staff, ensuring timely interventions.^8,15 It also improves maternal and perinatal outcomes, including enhancing the physiological process of labor.⁵

Research has shown clinically meaningful benefits of this support, including a shorter duration of labor, increased rates of spontaneous vaginal birth, decreased cesarean section and intrapartum analgesia, less fear and distress, increased satisfaction with childbirth experiences, and improved health of the newborn.^16,17

Traditionally, companionship focused on emotional advocacy; however, their role now faces challenges in adapting to modern midwifery practices and facility-based childbirth efforts, which are aimed at reducing maternal mortality.¹⁸

The slow progress in the introduction of birth companions has been globally attributed to specific factors such as a lack of awareness among healthcare providers, concerns about privacy, and inadequate physical space in labor rooms. Slow progress in the introduction of birth companions has been globally attributed to several factors, including a lack of awareness among healthcare providers regarding the benefits associated with the practice, concerns among maternity healthcare providers (MCPs), health system factors, and a lack of physical space in the labor room, as well as the volume of work.^9,19–21 Other factors include hospital policy,²² embarrassment, fear of gossip and privacy concerns, the absence of guidelines, and poor knowledge and negative attitudes among healthcare providers.^23,24

Poor quality and disrespectful maternity care affect nearly half of women (49.4%) in our country, increasing emotional distress, reducing healthcare-seeking behavior, and raising the risks of preventable disabilities and deaths.^6,25 Due to this issue, 65.1% of women opt for home deliveries.²⁶ The presence of a birth companion during labor reduces three forms of disrespect and abuse: discrimination based on patient attributes, abandonment of care, and detention in facilities.^25,27

Birth companions are practical and well-accepted by healthcare providers and birthing women in a pilot study in Tanzania.²⁸ Another cross-sectional study in several countries, including Tanzania,²⁹ Sri Lanka,²¹ Brazil,³⁰ and Kenya,³¹ has supported the presence of childbirth companions in their public facilities. However, in most low-resource settings like Ethiopia, companionship implementation is limited due to healthcare providers’ lack of knowledge about its benefits, privacy concerns, interference with medical procedures, and fear of complaints or litigation. Evidence from Ethiopia highlights low birth companionship rates, with only 13.8% utilization during delivery,³² despite policy recommendations, indicating a significant gap between policy and practice. Another study in Ethiopia revealed that about 51.2% of participants held favorable attitudes toward childbirth companions, while just 19.5% practiced it.³³ Key barriers include healthcare provider attitudes, ward overcrowding, and a lack of privacy infrastructure.^9,12,33 These barriers hinder the integration of birth companions into routine care and compromise the quality of maternity services. This may deter women from choosing facility-based deliveries, which are essential for reducing maternal and neonatal morbidity and mortality.⁹

As Ethiopia focuses on improving facility-based childbirth care, understanding maternity care providers’ perceptions of birth companions is critical. This understanding will help develop effective interventions that promote quality and respectful care for better perinatal outcomes. Therefore, this study aimed to assess maternity care providers’ perceptions of childbirth companions and their determinants in public health facilities in southwest Ethiopia.

Method and materials

Study setting, period, and population

This study was conducted among maternity care providers working in public health facilities in two selected zones in Southwest Ethiopia, namely Ilu Ababor and Buno Bedelle Zones, from March 2024 to May 2024. The two zones are located in the Oromia region in the southwestern part of Ethiopia. The study population consisted of sampled maternity care providers who were actively working in the selected public health facilities. The reporting of the quantitative component of the study conforms to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement for cross-sectional studies.³⁴

Study design

An explanatory sequential mixed-methods study was conducted. The quantitative data were collected and analyzed first, and then the qualitative data were collected and analyzed.

Eligibility criteria

Inclusion criteria

Maternity care providers who are active in their workplace were included in the quantitative study.

Exclusion criteria

Maternity care providers with less than six months of work experience and those on maternity, study, or annual leave during the study period were excluded.

Sample size determination and sampling procedure

The sample size was calculated using a single population proportion formula, assuming a previous study of healthcare workers’ perspectives on birth companionship, where 82.4%³⁵ of participants reported disapproval of childbirth companionship. A 95% confidence interval and a 5% margin of error were used in the calculation.

n = {(Z_{@ / 2})}^{2} * \frac{p * q}{d^{2}} = {(1.96)}^{2} . \frac{0.824 * 0.176}{{0.05}^{2}} = 222.8

We determined a final sample size of 490, considering a 10% non-response rate and a design effect of two.

For the qualitative study, interviews were planned with twenty key informants, including heads of facilities, maternity case team leaders, and senior maternity care providers, who were deliberately selected for their specialized expertise in maternal health phenomena; however, only eleven participants took part due to saturation of information. Saturation was assessed prospectively by interviewing eight key informants. Themes were organized thereafter, and no new information emerged during interviews with three subsequent key informants. No participants refused to participate.

The study utilized a multistage sampling technique. Two zones, Buno Bedelle and Illuababor, were included in the study. Twelve districts were selected using a simple random sampling technique: five districts from Buno Bedelle (Bedelle town, Bedelle Zuria, Gachi, Chora, and Dembi) and seven districts from Illuababor (Darimu, Becho, Yayo, Mettu Zuria, Bure, Alle, and Halu). All public health facilities in these districts were included. Finally, maternity care providers were selected via simple random sampling with proportional allocation across facility types (hospitals or health centers) in the selected districts. For the qualitative study, a critical purposive sampling technique was used to select key informants from the health facilities.

Data collection tools and procedures

A semi-structured, self-administered questionnaire written in English was used for the quantitative study. The questionnaire was adapted based on a review of related literature.^6,29,31,36 It included questions on socio-demographic characteristics, individual factors, institutional factors, and perceptions of childbirth companions. A total of twelve BSc-holding midwives and nurses were recruited for data collection; seven were data collectors, and five were supervisors.

Key informant interviews were conducted using pretested semi-structured interview guides, prepared in Amharic and Oromic languages (based on participants’ language preferences), and adapted from various literature sources, incorporating probing techniques as needed. The qualitative data collection adhered to the criteria for reporting qualitative research (COREQ) guidelines developed by Tong et al.³⁷ Key informant interviews were conducted by two male MSc professionals who had experience in qualitative data collection and were fluent speakers of Amharic and Oromic languages. The day and time of the interview sessions were arranged via phone calls to prospective participants. None of the data collectors had prior contact with any of the interviewees, and no incentives were given to the interviewees for their participation. The interviews were undertaken in private and quiet locations, such as the participants’ offices or stations. Moreover, quiet and free settings were ensured for the interviewees, and non-participants were restricted from the interview sessions to prevent possible interruptions. A mobile audio recorder captured the interviews while field notes were taken simultaneously. Each interview session lasted between 30 and 90 minutes.

Study variables

Dependent variable

Maternity care providers’ perception of childbirth companion.

Independent variables

Socio-demographic characteristics (age, sex, residence, religion, marital status, education level, and had child).

Individual factors (work experience, work and salary satisfaction, training, birth experience, and awareness of companionship).

Institutional factors (Types of health facility, delivery room status, guidelines, training access).

Operational definitions

Childbirth companion: any person selected by a childbearing woman who provides her with continuous physical, informational, and emotional support throughout labor and birth.^5,36

Participants’ perception of the presence of a companion during childbirth was measured using 11 items on companion presence, employing a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). The total score ranged from a minimum of 11 to a maximum of 55; higher scores indicated a stronger perception of the birth companion’s presence.²⁹ The mean score was then calculated and dichotomized into two groups.

Positive perception: Those who scored greater than or equal to 30 of the perception-related 11 questions.^29,33

Data quality control of the study

To establish the content validity of the questionnaire, experts were consulted, and their feedback was analyzed based on the clarity, relevance, and completeness of the questions. A two-day training was given for the data collectors and supervisors to familiarize them with the tools and procedures. A pre-test was conducted two weeks before the actual data collection period, covering 5% of the total sample size in one of the non-selected districts of the Illuababor zone (Burussa district). Following the pretest analysis, the questionnaire items were reordered, and content modifications were made to improve fluency and facilitate easier data entry. Reliability was assessed using established statistical methods, including the calculation of Cronbach’s alpha, which resulted in a value of 0.861. Daily supervision was implemented to verify data completeness and consistency throughout the study period.

Trustworthiness in the qualitative arm of the study was ensured through established criteria such as credibility, transferability, dependability, and confirmability, adapted from Lincoln and Guba’s framework and the pillars of trustworthiness in qualitative research.^38,39 Credibility was achieved via prolonged engagement with participants, member checking, and triangulation to accurately reflect their realities. Transferability was supported by providing thick descriptions of the context, participants, and processes, enabling readers to assess applicability to similar settings. Dependability involved detailed documentation of methods, an audit trail for transparency, and peer debriefing to ensure consistency if the study were replicated. Confirmability was ensured by documentingdirect quotations of participants.

To recruit participants, the researchers contacted facility managers. Facility and asked for permission to attend wards to discuss the study with staff; both written and verbal study information was provided to study participants. Informed consent was taken prior to the interviews taking place. Interviews were conducted face to face based on participant’s preference time.

Ethics approval and consent to participate

The Research and Ethics Review Committees of the College of Health Sciences at Mattu University reviewed and approved the research proposal bearing the reference number IRC/CHS/1597/2024. All participants provided written informed consent to participate in this study.

Data analysis

Quantitative data

The collected data were entered into Epi-Data version 3.1 and then exported to SPSS version 25 for analysis. The descriptive statistics were presented using percentages, textual narrations, and graphs. Multicollinearity among variables was assessed using the variance inflation factor (VIF), with a maximum VIF of 4.01. Logistic regression analysis was conducted. In the binary logistic regression, variables with a p-value < 0.25 were selected as candidates for multivariable analysis to identify potential confounders while minimizing type II errors. Subsequently, multivariable analysis was performed to determine statistically significant associations between explanatory variables and the outcome variable. Adjusted odds ratios (AOR) and p-values < 0.05 were used to indicate the strength and significance of associations. The backward elimination method was applied to refine the model by iteratively removing the least significant variables (p > 0.05), retaining only those with meaningful contributions. Model adequacy was confirmed using the Hosmer-Lemeshow goodness-of-fit test, which yielded a non-significant result (p = 0.19), indicating that the final model provided a good fit to the observed data without systematic bias.

Qualitative data

The data were transcribed verbatim in Amharic and Oromo, and then translated into English by two authors after a language expert was also recruited. Through iterative analysis involving multiple readings of the transcripts, the material was systematically coded across multiple layers. To ensure the data’s validity and reliability, the research team revised and double-checked all translations and transcriptions. The Framework approach, along with thematic analysis through deduction and using the principles of Braun and Clark,⁴⁰ was used during the analysis. Codes with similar meanings were grouped into subcategories and main categories. A total of 11 codes were generated from the key informant interviews. These codes were organized into six sub-themes and subsequently consolidated into three major themes following the framework thematic analysis. The three main themes were awareness, perception, and barriers to childbirth companionship. The analysis involved a series of interconnected stages, allowing the researcher to move back and forth across the data until a coherent narrative emerged.

The data were presented in a descriptive way after quantitative findings were presented. The results were presented sequentially: quantitative findings first, followed by qualitative findings, and finally, the results were integrated.

Results

Socio-demographic characteristics of participants

A total of 481 maternity care providers participated in this study, yielding a response rate of 98.2%. The participants’ ages ranged from 24 to 46 years, with a mean age of 31.44 years (SD ± 4.06). Female participants were 267 (55.5%), and approximately 411 (85.4%) of the participants were married. About 45.9% (221) of respondents had 5-10 years of experience. Approximately 73.8% (355) of respondents had a BSc degree as their highest level of education. 274 (57%) reported that they conduct about 11 to 20 deliveries per month. Around two-thirds of the respondents, 320 (66.5%), reported that they were satisfied with their job, and only 136 (28.3%) reported that they thought they were paid fairly. More than half of the respondents, 221 (45.9%), reported having training like RMC (Table 1).

Table 1.

Socio-demographic and individual characteristics of maternity care providers in Southwest Ethiopia, 2024.

Variable	Category	Frequency	Percentage
Age (years)	≤25	36	7.5
	26–29	162	33.7
	31-35	224	46.6
	>35	59	12.3
Sex	Male	214	44.5
Sex	Female	267	55.5
Religion	Orthodox	251	52.2
	Protestant	176	36.6
	Muslim	54	11.2
Marital status	Married	411	85.4
Marital status	Single	70	14.6
Having child	Yes	223	54.3
Having child	No	188	45.7
Level of education	Diploma	112	23.3
	first degree	355	73.8
	master’s degree and above	14	2.9
Years of experience	less than 5 years	154	32.0
	5-10 years	221	45.9
	more than 10 years	106	22.0
Time of last delivery conducted	Within the last 6 months	375	78.0
	Last 6-12 months	70	14.6
	Greater than 12 months	36	7.5
Deliveries attended per month	≤10	122	25.4
	11–20	274	57
	>20	85	17.7
Reported job satisfaction	Dissatisfied	161	33.5
Reported job satisfaction	Satisfied	320	66.5
Perceived as paid fairly for job duties.	Yes	136	28.3
Perceived as paid fairly for job duties.	No	345	71.7
Having had training	Yes	221	45.9
Having had training	No	260	54.1

In the qualitative study total of eleven (six female) key informants participated, with a mean age of 35 years. The duration of the interviews ranged from 30 to 90 minutes.

Characteristics of healthcare facilities

Of the respondents, 372 (77.3%) participated in health centers. More than half, 232 (48.2%), of respondents reported that there was a guideline like CRC or RMC in their health facility. Also, 255 (53%) respondents reported that their facility had provided an opportunity to train (Table 2).

Table 2.

Characteristics of healthcare facilities in southwest Ethiopia, 2024.

Variables	Category	Frequency	Percentage
Type of health facility	Hospital	109	22.7
Type of health facility	HC	372	77.3
Number of couches in the delivery room/ward	≤2	263	54.7
Number of couches in the delivery room/ward	≥3	218	45.3
Screen/curtain presence	Yes	207	43.0
Screen/curtain presence	No	274	57.0
:The width of the space in the delivery room	Yes	156	32.4
:The width of the space in the delivery room	No	325	67.6
Guideline presence (CRC, RMC)	Yes	232	48.2
Guideline presence (CRC, RMC)	No	249	51.8
Is companion presence in the facility necessary	Yes	116	24.1
Is companion presence in the facility necessary	No	365	75.9
Does your institution incorporate companion presence in the delivery time	Yes	72	15.0
	No	409	85.0
Does the facility allow you to train?	Yes	255	53.0
Does the facility allow you to train?	No	226	47.0

Awareness and perception of childbirth companions

More than half, 272 (56.5%), of the respondents had good awareness of companion presence during childbirth. Regarding the preferred companion during labor and childbirth, mothers were the most frequent choice, with 210 mentions (43.7%), followed by husbands, with 105 mentions (21.8%).

Perceptions of childbirth companions

More than half of the respondents, 284 (59%), had a positive perception of the presence of a childbirth companion during labor, as shown in Table 3.

Table 3.

Awareness and perception toward childbirth companions among Maternity care providers in Southwest Ethiopia, 2024.

Variables	Category	Frequency	Percentage
Awareness towards birth companion	Good aware	272	56.5
Awareness towards birth companion	Poor aware	209	43.5
Preferably to be a companion during childbirth	Husband	105	21.8
	Mother	210	43.7
	Sister	24	5.0
	Mother-in-law	73	15.2
	HCPs	69	14.3
Perception	Positive perception	284	59.0
Perception	Negative perception	197	41.0

Perceptions of MCPs on the barriers to companionship

Regarding perceived the barriers to companion presence during childbirth, over half of respondents identified overcrowding in the labor room 346 (71.90%), lack of privacy for women 326 (67.70%), privacy concerns for other laboring women 320 (66.50%), concerns that women’s health information would not be kept confidential 299 (62.20%), and concerns that women would not cooperate with hospital staff in the presence of a birth companion 246 (51.2%) (Figure 1).

Figure 1.

Perceived barriers to childbirth companionship among maternity care providers in Southwest Ethiopia, 2024.

MCPs’ perception of overcoming barriers

To overcome barriers to companion presence during childbirth, more than half of respondents perceived the following as important: creating physical partitions to ensure privacy (315, 65.5%), incentivizing health facility that allow companions (287, 59.7%), providing funding to health facility to upgrade labor rooms (267, 55.6%), formulating guidelines for instructing birth companions (256, 53.3%), and increasing awareness of companions (255, 53%) (Figure 2).

Figure 2.

Perceived overcoming the barriers of childbirth companionship among maternity care providers in Southwest Ethiopia, 2024.

Factors associated with perceptions

In the bivariable logistic regression analysis, variables with p-values of less than 0.25 were selected for multivariable analysis. These included having a child (P = 0.076), years of experience (P = 0.03), training (P = 0.000), the importance of companion presence in the facility (P = 0.000), and awareness of the childbirth companion (P = 0.000). In the multiple logistic regression analysis, years of experience, the importance of companion presence in the health facility, training, and awareness of birth companions were significantly associated with maternity care providers’ perception of childbirth companions at a p-value less than 0.05.

Participants who underwent RMC training were 3.5 (AOR = 3.51, 95% CI: 2.25, 5.48) times more likely to have positive perceptions of childbirth companions than those who did not undergo RMC training. Participants who reported the importance of childbirth companions in the facility were 3.8 (AOR = 3.77, 95% CI: 2.14-6.64) times more likely to have a positive perception of childbirth companions than their counterparts. The odds of MCPs having good awareness of a childbirth companion were 2.3 (AOR = 2.25, 95% CI: 1.43-3.53) times higher among those who had poor awareness of childbirth companions. Participants with more than 10 years of experience were 2.2 (AOR = 2.22, 95% CI: 1.14-3.91) times more likely to have a positive perception of childbirth companions than those with less than 5 years of experience (Table 4).

Table 4.

Factors associated with maternity care providers’ perception towards childbirth companions in Southwest Ethiopia, 2024.

Variable	Category	Perception of birth companion presence		COR (95% CI)	AOR (95% CI)	P-value
Variable	Category	Negative perception	Positive perception	COR (95% CI)	AOR (95% CI)	P-value
Having child	Yes	85	138	1.43(0.96, 2.12)	1.08 (0.68, 1.69)	0.742
Having child	No	88	100	1
Years of experience	<5 years	72	82	1
	5-10 years	95	126	1.16(0.77, 1.76)	1.05(0.63, 1.76)	0.828
	>10 years	30	76	2.22(1.31, 3.77)	2.11(1.14, 3.91)	0.017
Having training	Yes	55	166	3.63 (2.46, 5.36)	3.51 (2.25, 5.48)	0.0001
Having training	No	142	118	1
Vies on importance of companion presence in HF	Yes	20	96	4.52 (2.68, 7.63)	3.77 (2.14, 6.64)	0.0001
Vies on importance of companion presence in HF	No	177	188	1
Awareness of birth companion	Good awareness	82	190	2.84 (1.95, 4.13)	2.25(1.43,3.53)	0.0001
Awareness of birth companion	Poor awareness	115	94	1

Note. HF: Health facility, AOR: Adjusted Odds Ratio, COR: Crude Odds Ratio, CI: confidence Interval.

Qualitative findings

In the qualitative study total of eleven (six female) key informants participated, with a mean age of 35 years. The duration of the interviews ranged from 30 to 90 minutes (Table 5).

Table 5.

Socio-demographic characteristics of the key informant interviewee.

Variables	Category	Frequency	Percentage
Age	25-30	2	18.2
	31-35	3	27.3
	36-40	4	36.4
	>40	2	18.2
Sex	Male	5	45.5
Sex	Female	6	54.5
Job role	Head of facility	3	27.3
	Maternity case team leader	5	45.5
	Senior maternity care providers	3	27.3
Working facility	Health center	7	63.6
Working facility	Hospital	4	36.4
Preferred language	Oromic	4	36.4
Preferred language	Amharic	7	63.6

In the qualitative findings, the participants explained that a companion serves as a birth supporter. They also stated a companion is chosen based on the mother’s preference and can be any person (partner, family member, mother, sister, husband, neighbor, friend, etc.), particularly someone who aligns with the mother’s interests. . A 38 year-old female participant stated:

“In my opinion, a companion is someone who accompanies a laboring mother. As we know, women desire essential support and care throughout childbirth.”

Another 36-year-old female participant shared:

“Companionship has been valued since ancient times. When a mother gives birth at home, neighbors come together to encourage her and remain by her side until delivery.”

Similarly, a 37-year-old male participant stated:

“Whether it is a partner, family member, or friend, having someone present to hold her hand, massage her back, and offer words of encouragement can greatly reduce the mother’s anxiety and fear during labor”.

Perceived importance of childbirth companions

The key informants explained that a childbirth companion has two advantages: one for the mother and one for the healthcare provider. They explained that it is important for mothers to be encouraged, massaged, and talked to, to prevent loneliness, access materials, buy medication, and receive food and drink. It is also important for maternity care providers to decrease workload and support women; if midwives are busy, they will support women during movement.

A 42-year-old male participant stated the advantage for the mother as

“In my opinion, companions are the best protectors of maternal emotion. Laboring mothers often feel lonely and depressed when giving birth in health facilities. However, if a family member or companion is present, they will deliver without fear or loneliness and leave the facility feeling supported.”

A 36-year-old female participant added:

“I have a responsibility to stand by her side. Companions also play a critical role in supporting laboring mothers, especially when midwives are tired or busy with other tasks. During these moments, companions provide emotional support, encouragement, and massage and ensure the mother stays nourished with food and drink.”

A 34-year-old male participant explained the advantage of companion presence for the provider as

“If a companion is not present in the labor ward, MCPs find it difficult to perform their duties. Companions play a significant role, such as assisting with tasks like retrieving pharmacy and laboratory results…”

In contrast to the advantages for the mother and the care providers, they also explained that companion presence is a disadvantage. The mentioned disadvantages related to companion presence include compromising others’ privacy, being unsuitable during the second stage of labor, criticizing midwives, and creating conflict with midwives.

A 32 year-old female participant spoke about the disadvantage as

“… the presence of a companion is good; it gives comfort and satisfaction to the mother, but it compromises the comfort and confidence of the provider. For instance, the companion may criticize us in the things they don’t know about…”

In the qualitative study, KII participants reported that a childbirth companion program has been implemented in some facilities, while others mentioned it has not been regularly implemented in their facilities. A 31-year-old female participant said, “…it is recommended during childbirth, allowing families to give touching therapy, cheering, holding, massaging the back, etc. As I know, this is practical in our facility…”

Contrary to the previous reports, a participant reported that a childbirth companion program is not implemented in their facility. It was mentioned as follows:

30-year-old female participant said: “…It’s hard to say that companionship is implemented because we are not allowing companionship for all mothers. Sometimes we are going to let them in; sometimes we are going to force them out…”

Another 28-year-old female participant added: “…I think it is not about implementation because family is always available outside of the room rather than being allowed to enter the labor and delivery room…”

The participants’ perceptions of barriers to implementing childbirth companion programs were explored, revealing privacy issues, confidentiality issues, room overcrowding, number of beds per room, and large numbers of families as obstacles to implementation. For example, a 38-year-old female from the hospital stated: “…Even if having a companion is important, it’s hard to decide which family member to choose because all of them want to enter the single labor room we have. So we are forced to prohibit them all…”

Another participant added: (37-year-old male): “There are four beds in one labor room of our hospital. To allow a companion to sit in the room, there is not enough space, and also no privacy cover between each bed ... Privacy and confidentiality are a great issue in implementing a childbirth companion program.”

A 31 year-old female participant from the qualitative part also stated that the inadequacy of the room is a barrier to implementing a childbirth companion, and as an option, she suggested constructing a room per patient. “…Constructing a lot of rooms and putting only one bed in a single room will be the alternative solution to applying a childbirth companion for keeping the privacy of the laboring mother…”

Integration of both results

More than half of MCPs (59%) held positive perceptions, which were further supported qualitatively by companions’ roles as birth supporters providing encouragement, massage, access to materials, and workload relief for providers. Both methods identified key barriers, including labor room overcrowding caused by family entry and bed shortages, as well as concerns about privacy and confidentiality. To address these issues, over half of respondents favored physical partitions, increased funding, and awareness campaigns (Table 6).

Table 6.

Joint display table showing the integration of quantitative and qualitative finding.

Domain	Quantitative findings	Qualitative findings	Integration
Perception	59% had positive perception	Most participants had positive perception	Convergent
Awareness	56.5% had good awareness (AOR= 2.25)	Good midwife knowledge promotes companions’ roles effectively, increasing women’s appreciation for support, shortening labor duration, and boosting vaginal births.	Convergent
Work experience	More than 10 years’ work experience had positive perception than less experience (AOR= 2.11)	Through experience, maternity care providers tend to develop better emotional regulation, empathy, and social-skill refinement, which can make them more patient, understanding, and supportive companions.	Convergent
Training	46% trained (AOR= 3.51)	Lack of training affect perception to childbirth companion	Convergent
View on importance of companionship	24.1% viewed as importance (AOR= 3.77)	Participants reported that childbirth companion important as emotional support, physical support, advocacy and decision making. Some reported as not important.	Both convergent and divergent
Privacy and confidentiality	67.7% & 62.2% reported violate privacy and confidentiality respectively	Most of participants reported privacy and confidentiality as barriers to apply companionship	Convergent
Health institution structure	Not fully measured quantitatively	Study participants explained structure of institution was as barriers to child birth companion due to overcrowded, not adequate for more attendants	Expansion

Note. AOR = Adjusted Odds Ratio.

Discussion

Women who are supported by a companion during labor and childbirth have more positive pregnancy outcomes.⁴¹ This study aimed to assess maternity care providers’ perception of companion presence during childbirth and its determinants in public health facilities of southwest Ethiopia. More than half of the participants had a positive perception of companion presence during childbirth. Factors associated with providers’ perceptions included work experience, having compassionate and respectful care or respectful maternity care training, the perceived importance of companion presence in the facility, and awareness of birth companions were identified. In the qualitative arm, it was reported that companionship is not implemented in most facilities, and privacy and confidentiality issues, conflicts with care providers, lack of adequate rooms, beds, and screens in labor rooms were explained as barriers to implementing companion presence during childbirth (Table 7).

Table 7.

Themes and example quotes.

Main themes	Sub-themes	Quotes
Awareness to childbirth companion	Who are companions	“In my opinion, a companion is someone who accompanies a laboring mother. As we know, women desire essential support and care throughout childbirth” (36-years, female)
	Who are companions	“Whether it is a partner, family member, or friend, having someone present to hold her hand, massage her back, and offer words of encouragement can greatly reduce the mother’s anxiety and fear during labor”. (37-years, male)
	Roles of companions	“Companionship has been valued since ancient times. When a mother gives birth at home, neighbors come together to encourage her and remain by her side until delivery.” (41 years, male)
	Recommendations on companions	“There is a recommendation in order to allow childbirth companion, …” (42 years male, 36 years male, 28 years, female)
	Recommendations on companions	“… Ministry of health tell us to allow companion for laboring mothers…” (34 years, male)
Perceived importance of a childbirth companion	Emotional support benefits	“In my opinion, companions are the best protectors of maternal emotion” (37-years, male)
		“Laboring mothers often feel lonely and depressed when giving birth in health facilities. However, if a family member or companion is present, they will deliver without fear or loneliness and leave the facility feeling supported…” (42 years, male)
		“…it gives comfort and satisfaction to the mother, but…(32 years, female)
	Physical support benefits	“If a companion is not present in the labor ward, MCPs find it difficult to perform their duties. Companions play a significant role, such as assisting with tasks like retrieving pharmacy and laboratory results…” (34 years, male)
	Advocacy and decision making	“If a companion is present with the mother during childbirth, they can serve as an effective decision-maker and witness to any complications that occur.” (41 years, male)
	Advocacy and decision making	“If a childbirth companion is available …, healthcare providers will be less likely to face confusion when deciding on a cesarean section for complicated cases and …” (36-years, female)
	Not important	“…it gives comfort and satisfaction to the mother, but it compromises the comfort and confidence of the provider. For instance, the companion may criticize us in the things they don’t know about…” (32 years, female)
Perceived implementation of a childbirth companion	On implementation	“…it is recommended during childbirth, allowing families to give touching therapy, cheering, holding, massaging the back, etc. As I know, this is practical in our facility…” (31 years, female)
	Not on implementation	“…It’s hard to say that companionship is implemented because we are not allowing companionship for all mothers. Sometimes we are going to let them in; sometimes we are going to force them out…” (30-years, female)
	Not on implementation	“…I think it is not about implementation because family is always available outside of the room rather than being allowed to enter the labor and delivery room…” (28-years, female)
Perceived barriers to implementing a childbirth companion	Barriers to implementation	“…Even if having a companion is important, it’s hard to decide which family member to choose because all of them want to enter the single labor room we have. So, we are forced to prohibit them all…” (38-years, female)
	Barriers to implementation	“There are four beds in one labor room of our hospital. To allow a companion to sit in the room, there is not enough space and also no privacy cover between each bed ... Privacy and confidentiality are a great issue in a childbirth companion program” (37 years, male)
	Overcoming barriers	“…Constructing a lot of rooms and putting only one bed in a single room will be the alternative solution to applying a childbirth companion for keeping the privacy of the laboring mother…” (31 years, female)

The WHO strongly recommends the presence of companions throughout labor with the aim of better labor outcomes.⁴² In this study, only 59% of maternity care providers had a positive perception of childbirth companions. This represents a critical gap in Ethiopia’s efforts to promote respectful maternity care (RMC), as both WHO and national guidelines endorse companions to enhance emotional support and birth outcomes. Ethiopia’s Ministry of Health includes companionship in its compassionate care guidelines within the Health Sector Transformation Plan. However, inconsistent enforcement has resulted in ongoing disrespectful care. This violates human rights and reduces skilled birth attendance rates. These issues underscore the need for clear national directives that mandate companion-friendly designs in new facilities and monitor respect-in-childbirth (RMC) indicators. Such measures align with WHO standards and aim to increase utilization from current low levels. Without stronger policy enforcement, efforts to reduce maternal mortality in rural, low-resource areas will likely falter.^43,44

This study indicates a moderate level of acceptance, slightly higher than the 51.2% reported in the 2023 mixed-methods study from West Shoa Zone public health facilities in Ethiopia³³ and Sri Lanka.²¹ The discrepancy may be attributed to factors such as provider workload, or facility-specific policies, as increased staffing demands are often associated with more restrictive practices, even in comparable Ethiopian settings.

In this study, the proportion was lower than that reported in a study conducted in Addis Ababa, which found that 63.2% of health professionals had a positive attitude.⁴⁵ The possible reason may be a difference in infrastructure and health care service delivery in our study settings, which can erode job satisfaction and motivation compared to the city level. It is also lower than the study conducted in India²⁹ and Gaza City.⁴⁵ Possible reasons for this discrepancy may include differences in the type and level of facilities, as our study involved in all institutions, from primary health care facilities to tertiary hospitals where workload, staffing patterns, and infrastructural constraints may limit the perceived feasibility of childbirth companions, while the Indian study was conducted in a single tertiary hospital with relatively better resources and more structured protocols. In contrast, national policies, implementation strategies, and managerial emphasis on birth companionship may differ between countries, influencing providers’ perception and the extent to which childbirth companions are institutionalized in routine care. Cultural norms regarding privacy, gender roles, and family involvement during labor also shape providers’ views. While some see companions as supportive; others view them as causing crowding, interference, or confidentiality breaches of confidentiality.

Based on our study, maternity care providers with more than ten years of experience had twice as positive a perception as those with less than five years’ experience. This may be because experienced providers have likely encountered a wider range of patient cases and a challenge, which helps them develop positive and realistic attitudes. Their longer tenure often leads to advanced training and stronger relationships, enhancing their commitment to quality care and improving their work environment.

Training healthcare providers is an identified strategy to enhance the acceptance of childbirth companions.⁴¹ In this study, training was identified as a factor associated with the perception of childbirth companion. This may be because experienced providers have likely encountered a wider range of patient cases and a challenge, which helps them develop positive and realistic attitudes. This finding aligns with evidence that training improves the capabilities of maternity care providers.⁴⁶

Moreover, in this study, awareness of childbirth companion presence was a significant factor for the maternity care providers’ perception of childbirth companions. Specifically, maternity care providers who had good awareness of companion presence during childbirth had a twofold higher probability of having a positive perception of companion presence during childbirth. This finding is consistent with those from a study in India,²⁹ where health professionals having adequate knowledge are significantly associated with a positive perception of childbirth companions.

In this study, maternity care providers who reported the importance of companion presence in the facility showed better odds (nearly fourfold) of positive perception of childbirth companions. To the best of our knowledge, there has been no previous study childbirth companion. However, a study conducted in India showed higher proportions of positive perception among participants who believed companion presence during childbirth was highly beneficial.²⁹

Regarding the benefits of a childbirth companion, this study indicated that 95.4% of maternity care providers perceived childbirth companions as beneficial. This finding is consistent with those from a study in Addis Ababa,³⁵ India,²⁹ and Kenya.³¹ In our study, 70% of respondents perceived that the presence of childbirth companions would increase women’s satisfaction. This finding was supported by the qualitative findings, indicating that even if it affects the care provider’s comfort and confidence, childbirth companion benefits the mother by providing comfort and satisfaction.

In the qualitative parts of this study, nearly all maternity care providers had positive perception to childbirth companions. They explained companions have benefit regarding providing emotional and physical support, pain management, preventing loneliness, providing necessary materials, buying medication, giving food and drink to the woman, and decreasing the workload of maternity care providers in the labor room, but implementing it in the facility. Privacy issues, confidentiality issues, room status, and family members were identified as barriers to implementing companionship during childbirth in both quantitative and qualitative studies.

In quantitative part of finding more than half of respondents identified significant barriers to allowing companion presence during childbirth, including overcrowding in labor rooms, lack of privacy, and confidentiality concern. This was supported by qualitative findings; participants identified several key barriers to implementing companion presence during childbirth, including privacy and confidentiality concerns, overcrowded labor rooms, and insufficient space due to multiple beds per room. Studies in different settings also report similar institutional and structural barriers. In India, healthcare providers highlighted overcrowding in labor rooms and privacy concerns for other women as primary obstacles, alongside fears of infection and interference with clinical decisions.²⁹ This also aligns with our previous Ethiopian research, which identified structural issues such as narrow delivery rooms without partitions, birth attendants’ negative attitudes, and unsupportive facility protocols as main hindrances, often prioritizing other women’s privacy (37.1% of refusals).³³

Strengths and limitations of the study

This study can serve as a foundational reference for future researchers in similar fields of study. It employed a mixed-methods approach to identify and investigate the factors influencing providers’ perceptions regarding the presence of companions during labor and childbirth. However, since the study exclusively involved maternity care providers from public facilities, the findings may not represent the views of those who work in private healthcare settings. It is difficult to draw causal inferences from a cross-sectional design, and the reliance on self-reported data may introduce social desirability and recall biases. Additionally, the qualitative component relied solely on Key Informant Interviews (KIIs), which provides in-depth insights but limit the breadth of perspectives captured.

Conclusion and recommendations

WHO recommended that women receive respectful and companionship care from care providers so that maternity care providers are encouraged to ensure continuous support women in childbirth, including companionship. This study showed that nearly half of maternity care providers had a positive perception of childbirth companions. Maternity care providers’ work experience, previous training, views on the importance of companionship, and overall awareness were identified as significant factors. Overcrowding of labor rooms, confidentiality, and privacy issues were explored by maternity care providers as barriers to the implementation of childbirth companionship. To promote the practice of birth companions during childbirth, enhancing awareness through focused training for maternity care providers that emphasizes the importance of birth companions for maternal well-being and birth outcomes. Creating a supportive environment by upgrading labor rooms with privacy-enhancing setups and providing clear and specific policies that encourage the presence of birth companions is also important.

Supplemental material

Supplemental material - Perception of childbirth companion presence and its determinants among maternity care providers in Southwest Ethiopia: Mixed-method study

Supplemental material for Perception of childbirth companion presence and its determinants among maternity care providers in Southwest Ethiopia: Mixed-method study by Getu Amsalu Erqu, Wubishet Gezmu, Bikila Jiregna, Yeshiwas Ayale Ferede, and Agerie Mengistie Zeleke in Women’s Health.

Supplemental material

Supplemental material - Perception of childbirth companion presence and its determinants among maternity care providers in Southwest Ethiopia: Mixed-method study

Footnotes

Acknowledgments

We express heartfelt gratitude to Mattu University College of Health Sciences for approving the ethical review process, support grant and giving opportunity to do this study. Our heartfelt appreciation also extends to the study participants, supervisors, data collectors, and language translators.

ORCID iDs

Getu Amsalu Erqu

Wubishet Gezimu

Bikila Jiregna

Yeshiwas Ayale Ferede

Agerie Mengistie Zeleke

Ethical considerations

The research proposal was reviewed and approved by the Research and Ethics Review Committees of the College of Health Sciences at Mattu University, bearing the reference number IRC/CHS/1597/2024.

Consent to participate

All participants gave their written informed consent to participate in this study.

Consent for publication

In this study, no person’s privacy, photographs, or videos are used.

Author contributions

Getu Amsalu Erqu: Conceptualization; Data curation; Formal analysis; Funding acquisition; Investigation; Methodology; Project administration; Resources; Software; Supervision; Validation; Visualization; Writing original draft; Writing - review & editing.

Wubishet Gezimu, Bikila Jiregna, and Yeshiwas Ayale Ferede: Conceptualization;Data curation; Formal analysis; Funding acquisition; Investigation;Methodology; Project administration; Software; Validation; Visualization; Writing original draft; Writing - review & editing.

Agerie Mengistie Zeleke: Conceptualization; Formal analysis; Investigation; Methodology, Supervision; Validation; Visualization; Writing - review & editing.

Funding

The authors received financial support for the research. There is no financial support receieved authorship, and/or publication of this article.

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Data Availability Statement

The authors will provide access to the raw data underlying the findings of this article upon request, without unnecessary restrictions.*

Generative AI statement

The authors declare that no Generative AI was used in the creation of this manuscript.

Supplemental material

Supplemental material for this article is available online.

References

WHO . Trends in maternal mortality 2000 to 2023: estimates by WHO, UNICEF, UNFPA. World Bank Group and UNDESA/Population Division, 2025.

FMOH . STANDARD OPERATING PROCEDURES FOR MEDICAL REFERRAL OF PERSONS OF CONCERN IN UNHCR REPRESENTATION IN ETHIOPIA (Updated March 2015) Table of Contents, 2015.

Keenan

Alhattab

Alam

. Aid cuts threaten fragile progress in ending maternal deaths, UN agencies warn. Neonatol Today 2025; 20(4): 14–15.

Baten

Biswas

Kendal

, et al. Utilization of maternal healthcare services in low- and middle-income countries: a systematic review and meta-analysis. Syst Rev 2025; 14(1): 88. https://doi.org/10.1186/s13643-025-02832-0

Bohren

Hazfiarini

Corona

, et al. From global recommendations to (in)action: A scoping review of the coverage of companion of choice for women during labour and birth. PLOS Glob Public Heal 2023; 3(2): e0001476.

Gizachew

Getinet

Bekele

. Perception and Experience of Post-Partum Women Towards Birth Companions: Facility-Based Study in a Tertiary Hospital and Its Catchment Health Centers in Addis Ababa, Ethiopia. Ethiop J Reprod Heal 2022; 14(4): 51–58.

WHO . Standards for improving quality of maternal and newborn care in health facilities, 2016.

WHO . Companion of choice during labour and childbirth for improved quality of care: evidence to-action brief, 2020.

Getahun

Ukke

Alemu

. Utilization of companionship during delivery and associated factors among women who gave birth at Arba Minch town public health facilities, southern Ethiopia. PLoS One [Internet] 2020; 15(10 October): 1–11, Available from. https://doi.org/10.1371/journal.pone.0240239

10.

AlKhunaizi

Al-Otaibi

Alharbi

, et al. Exploring Healthcare Providers’ and Women’s Perspectives of Labor Companionship during Childbirth: An Interpretative Phenomenological Analysis Study. Healthc 2024; 12(9): 1244. https://doi.org/10.3390/healthcare12090869

11.

WHO . WHO Recommendations on Intrapartum Care for a Positive Childbirth Experience, 2018.

12.

Nawab

Erum

Amir

, et al. Disrespect and abuse during facility-based childbirth and its sociodemographic determinants - A barrier to healthcare utilization in rural population. J Fam Med Prim care 2019; 8(1): 239–245. https://doi.org/10.4103/jfmpc.jfmpc_247_18

13.

Bohren

Vogel

Hunter

, et al. The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLoS Med 2015; 12(6): 1–32. https://doi.org/10.1371/journal.pmed.1001847

14.

Lavender

Downe

Renfrew

, et al. Rapid analytic review: Labour and birth companionship in a pandemic: Companionship of choice for asymptomatic childbearing women in hospital throughout labour and birth. Royal College of Midwives 2020; 5, Available from: https://www.rcm.org.uk/media/3951/birth-companionship-in-a-pandemic-master-27-04-2020-002.pdf.

15.

Maknojia

Malik

. Why can’t I have a choice of companion during labor? Barriers to implementation of companion presence. J Asian Midwives 2021; 8(2): 39–45.

16.

Kabakian-Khasholian

BAEN

Bashour

. Perceptions about labor companionship at public teaching hospitals in three Arab countries. Int J Gynecol Obstet 2015; 129(3): 223–226.

17.

WHO . World Health Organization recommendations for augmentation of labour, 2014.

18.

WHO . Why having a companion during labour and childbirth may be better for you. World Health Organization, 2019.

19.

Berhane

Gebrehiwot

Weldemariam

, et al. Quality of basic emergency obstetric and newborn care (BEmONC) services from patients’ perspective in Adigrat town, Eastern zone of Tigray, Ethiopia. 2017: A cross sectional study. BMC Pregnancy Childbirth 2019; 19(1): 1–9. https://doi.org/10.1186/s12884-019-2307-6

20.

Asratie

Assfaw

Abuhay

. Labor companionship in labor and delivery at debremarkos town public health facilities: Magnitude and associated factors. Int J Womens Health 2021; 13: 815–827. https://doi.org/10.2147/IJWH.S327753

21.

Senanayake

Wijesinghe

Nayar

. 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): 1–6. https://doi.org/10.1186/s12884-017-1578-z

22.

Maimbolwa

Sikazwe

Yamba

, et al. Views on involving a social support person during labor in Zambian maternities. J Midwifery Women’s Heal 2001; 46(4): 226–234. https://doi.org/10.1016/s1526-9523(01)00134-9

23.

Kabakian-Khasholian

Portela

. Companion of choice at birth: Factors affecting implementation. BMC Pregnancy Childbirth 2017; 17(1): 1–13. https://doi.org/10.1186/s12884-017-1447-9

24.

WHO . Mother− baby friendly birthing facilities of Gynecology, International Federation of Midwives, International Confederation Alliance, White Ribbon Association, International Pediatric Organization, World Health. Int J Gynecol Obstet 2015; 128(2): 95–99.

25.

Kassa

Husen

. Disrespectful and abusive behavior during childbirth and maternity care in Ethiopia: A systematic review and meta-analysis. BMC Res Notes [Internet] 2019; 12(1): 2–7, Available from. https://doi.org/10.1186/s13104-019-4118-2

26.

Dugasa

. Determinants of Delivery Care Utilization in Ilu Aba Boor Zone, South West Ethiopia. Endocrinol Metab Syndr 2021; 10: 749.

27.

Yismaw

Teklu

Panduragman

. Respectful maternity care during facility-based child birth and associated factors in public health facilities of Ilu AbaBor zone, Southwest Ethiopia. Reprod Health [Internet] 2022; 19(1): 1–7, Available from. https://doi.org/10.1186/s12978-022-01368-z

28.

Chaote

Mwakatundu

Dominico

, et al. Birth companionship in a government health system: a pilot study in Kigoma, Tanzania. BMC Pregnancy Childbirth 2021; 21(1): 1–17. https://doi.org/10.1186/s12884-021-03746-0

29.

Sarwal

Tyagi

, et al. Healthcare providers perceptions regarding the presence of Birth Companion during childbirth at a tertiary care hospital in India. BMC Pregnancy Childbirth 2023;23(1):1–11. [Internet] Available from. https://doi.org/10.1186/s12884-022-05327-1

30.

Leite

Pereira

APE

Leal

Mdo C

, et al. Disrespect and abuse towards women during childbirth and postpartum depression: findings from Birth in Brazil Study. J Affect Disord 2020; 273: 391–401. https://doi.org/10.1016/j.jad.2020.04.052

31.

Afulani

Kusi

Kirumbi

, et al. Companionship during facility-based childbirth: results from a mixed-methods study with recently delivered women and providers in Kenya. Journal of Affective Disorders 2018; 273: 1–28.

32.

Gizachew

. Birth Companions, Health workers perspective: Mixed Method Study in St. Paul’s Hospital and Millennium Medical College and its Catchment Centers. BMC Pregnancy and Childbirth 2021; 18: 1–15.

33.

Doba

Bulto

Tefera

, et al. Birth attendants’ attitudes and practice of companionship during facility-based childbirth and associated factors in the West Shoa Zone, central Ethiopia: A mixed method design. SAGE Open Med 2023; 11: 20503121231168284. https://doi.org/10.1177/20503121231168284

34.

Vandenbroucke

Elm

Altman

, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. PLoS Med 2007; 4(10): e297. https://doi.org/10.1371/journal.pmed.0040297

35.

Gizachew

Getinet

Bekele

. Perspective of Health Workers on Birth Companions Involvement in Maternal Care. PLOS Medicine 2024; 3(2): 297.

36.

Summerton

Mtileni

Moshabela

. Experiences and perceptions of birth companions supporting women in labour at a District Hospital in Limpopo, South Africa. Curationis 2021; 44(1): 1–7. https://doi.org/10.4102/curationis.v44i1.2186

37.

Science C . Debark university, 2015, pp. 1–63.

38.

Lincoln

Guba

. Naturalistic Inquiry. Sage Publ, 1985.

39.

Ahmed

. The Pillars of Trustworthiness in Qualitative Research. Sage Publications, 2024.

40.

Braun

Clarke

. Using thematic analysis in psychology, Sage Publications, 2006.

41.

Braun

Clarke

. Companion of choice during labour and childbirth for improved quality of care. Sage Publications, 2020, p. 1–7.

42.

WHO . World Health Organization recommendations on health promotion interventions for maternal and newborn health, 2015.

43.

Sheferaw

Bazant

Gibson

, et al. Respectful maternity care in Ethiopian public health facilities. Reprod Health 2017; 14(1): 60. https://doi.org/10.1186/s12978-017-0323-4

44.

Asefa

Bekele

. Status of respectful and non-abusive care during facility-based childbirth in a hospital and health centers in Addis Ababa, Ethiopia. Reprod Health 2015; 12: 33. https://doi.org/10.1186/s12978-015-0024-9

45.

Getachew

Negash

Yusuf

. Knowledge, Attitude, and Practice of Health Professionals Towards Labor Companion. Health Institutions in Addis Ababa 2018; 3(2): 1–9.

46.

Hulsbergen

Abera

Adefris

, et al. Evaluation of the Emergency Obstetric and Newborn Care training in Gondar, Ethiopia; a mixed methods study. PLOS Glob Public Heal 2023; 3: 1–11. https://doi.org/10.1371/journal.pgph.0000889

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.25 MB

0.36 MB

0.00 MB