The lived experiences of postnatal mothers receiving birth companionship care in Katavi region,Tanzania: A phenomenological study

Abstract

Objective:

This study aimed to explore the lived experience of postnatal mothers receiving birth companionship care in the Katavi region.

Methods:

A qualitative descriptive phenomenological approach was used to explore the experiences of eleven postnatal women who received birth companionship care during intrapartum. The study was conducted between May and June 2023, and postnatal women were conveniently sampled, with all participants providing their consent to participate. Data were collected through in-depth, semistructured interviews. The data were analyzed using thematic analysis, which involved the following steps: familiarizing oneself with the data, conducting preliminary coding, organizing themes, creating an initial coding template, refining the template, and applying it to the entire dataset.

Results:

Six themes and twenty subthemes emerged in the current study. The main themes were (1) Choosing birth companions (BCs), (2) Mixed feelings about BCs, (3) Services offered by BCs, (4) Presence of BC during the intrapartum period, (5) Supportive infrastructure for birth companionship, (6) Challenges encountered with the presence of BCs.

Conclusion:

The study found that women who had a BC during intrapartum experienced mixed feelings. Some participants acknowledged the significant role that BCs played throughout the process. In contrast, others expressed concerns about knowledge and privacy violations and opted not to have a BC present during childbirth. However, they consented to their presence during the first stage of labor. The women employed various methods to select their BCs, who assumed a range of responsibilities in providing care, both formally and informally. It is essential to enhance community awareness of the importance of BCs during labor and childbirth, as well as to provide them with training during the antenatal period to understand their roles better.

Plain Language Summaries

The government of Tanzania has incorporated the birth companionship approach into its respectful maternity care (RMC) policy. However, the implementation process and impact of this approach have not been evaluated. Therefore, a current study is needed.

This study aimed to explore the lived experiences of postnatal mothers receiving birth companionship care in the Katavi region, Tanzania. Regarding study findings, the BC approach appears to be accepted and beneficial for postnatal women, making them feel safe and protected. They also reported receiving various services from BCs, including emotional support, physical assistance, practical support, information support, and advocacy for treatment.

The implementation of BC is ongoing, and is perceived with mixed feelings by pregnant women (positive and negative emotions). The implementation coverage should be expanded to all healthcare facilities in Tanzania, and the reported issues, such as infrastructure and training of BCs, should be addressed.

Background

Childbirth is a stressful experience, making laboring mothers often experience high levels of anxiety and fear. ¹ Uncontrolled anxiety and fear result in undesirable birth outcomes. ² Intrapartum Labor Support is a recent method aimed at improving maternal and perinatal outcomes during the intrapartum period, encompassing the entire labor process from the onset of true labor through the first, second, third, and fourth stages of labor. It is provided through social support, which is essential for a positive pregnancy outcome. ³

To realize the Integrated Labour Support model, the World Health Organization acknowledges that having a companion of choice during childbirth is a crucial element of high-quality care. ⁴ Birth companionship encompasses the support provided to women in labor by family members, partners, friends, doulas, or medical professionals. ⁵ This companionship includes a variety of supportive measures, such as providing physical comfort through touch and massage, offering emotional support through continuous presence, reassurance, and praise, sharing information about the progression of labor, advising on coping strategies, and addressing nutritional needs. ⁶ A birth companion (BC) can be any person of the woman’s choice who can provide support to the woman in labour and childbirth. ⁷ Research has demonstrated the positive impact of BCs on birth outcomes, including shorter labor duration, reduced labor anxiety, increased satisfaction with the birthing experience, decreased pain levels, and a lower reliance on pain relief medications.^8,9 Additionally, BCs have been shown to have many advantages on birth outcomes, such as increased likelihood of spontaneous vaginal childbirth, reduced caesarean and instrumental birth, reduced use of analgesia and regional analgesia, reduced birth asphyxia, and negative feelings about childbirth experience.^10–13 On the other side, research reported that women who lack BCs expressed anxiety during labor and childbirth; they feared the labor and childbirth process in the unfamiliar hospital surroundings, experienced pain from contractions, and worried about their safety and their baby’s health. ¹

Despite the significance of BC in maternal and fetal outcomes, the global implementation of BCs remains at 40%. ¹⁴ The coverage of labor companion utilization in African countries is still as low as 14.6%. ¹⁵ Meanwhile, in some African countries such as South Africa, Ethiopia, and Kenya, the adoption of birth companions is still in its inception, as some women would only allow the companion during the first and beginning of the second stage of labor, but not during childbirth. ⁵ Several factors have hindered the implementation of BCs, including a lack of privacy infrastructure, interference with routine medical care, risk of theft, worsened distrust of health professionals, inadequate space, a busy labor ward, distrust of the benefits of BCs, and societal disagreement with the practice. ¹⁶ Furthermore, women who benefit from BC services often experience feelings of embarrassment when their health status and private areas are exposed. For instance, those who have chosen not to disclose their HIV status may feel uncomfortable when their newborns are given Nevirapine immediately after childbirth at the facilities in the presence of BCs. Additionally, women may worry about breaches of confidentiality, as some BCs might engage in gossip. ⁵

In Tanzania, many women experience fear of childbirth (15%), which is rooted in fear of labour pain, being alone, and losing control of their bodies during labor and childbirth. ¹⁷ Moreover, some women choose not to deliver in a health facility due to the suboptimal care provided. ¹⁸ The shortage of staff increases the workload, which directly reduces the provider’s ability to deliver quality care.^19,20 Whenever there is inappropriate care, it contributes to reduced facility delivery. ²¹ A companion’s presence provides laboring women with a more profound sense of control and reassurance. ¹⁸ The BCs model was introduced as a pilot program in Tanzania, specifically in the Kigoma and Katavi regions. Since its implementation, no research has been conducted to investigate women’s experiences with BCs. This study aims to explore the lived experiences of postnatal women regarding BCs during labor and childbirth in the Katavi region. The study has four specific objectives: (i) to examine how postnatal women select their birth companions during labor and childbirth in the Katavi region, (ii) to explore the experiences of postnatal women regarding having a birth companion and the support (services) provided during labor and childbirth.

Methods

Study design and setting

This study utilized a qualitative descriptive phenomenological approach, focused on the lived experiences of postnatal women who had received care from BCs during labor and childbirth. This study was conducted in the Katavi region of the Tanzanian mainland. The region is one of Tanzania’s 31 administrative regions. The Katavi region is part of the Southwest Highlands zone, bordered to the east by the Tabora region and to the south by the Rukwa region and the Songwe region. According to the Tanzanian Demographic and Health Survey, the region has 34.4% of women aged 15–19 years who have ever been pregnant, with a fertility rate of 10.3%, for the 3 years preceding the survey. About 66.5% of women have given birth at a health facility, and 42.9% of women are involved in agriculture. Regarding the level of education, 34.7% have an informal education, and 52.3% are employed. Regarding health insurance, 94% of women have no health insurance. Additionally, 30% of women have good knowledge of HIV prevention. ²² In Katavi, women have no power of decision-making related to their health and other things. ²³ The region was selected purposefully because it is one of the marked regions for piloting the implementation of birth companionship.

Study population and recruitment criteria

The study included all postnatal women who had vaginal childbirth within 24 h and were supported by BCs during the intrapartum period in the Katavi region hospitals. The participants who were present during data collection and provided consent to participate were included. However, postnatal mothers who underwent a caesarean section or were sick during data collection were excluded from the study.

Sampling procedures and sample size estimation

The Katavi region was purposefully selected due to its initial implementation of the Birth Companion Programme. A convenience sampling method was employed to choose postnatal women who were present at the time of data collection and agreed to participate in the study. The sample size of eleven postnatal women was determined by saturation when no new information emerged from the participants.

Data collection methods and tools

In-depth interviews were conducted using a semistructured format, featuring four open-ended questions complemented by probing questions to capture data while allowing participants to express their experiences with BCs fully. The in-depth interviews were conducted using an interview guide and an audio recorder. The interview guide developed by the researchers included six open-ended questions. Before data collection commenced, the interview guide was tested for feasibility and clarity with four postnatal women from the study area. The data were collected through face-to-face interviews, as the in-person interview is the gold standard for obtaining rich phenomenological data, allowing the interviewer to build rapport and observe participants’ visual expressions quickly. ²⁴ The interviews were carried out by two researchers (females), both registered nurses, with experience in conducting qualitative research. The first interviewer was a principal investigator who was in charge of leading the interview. She was supposed to initiate the discussion, introduce the purpose of the interview session, establish rapport, ask the main questions from the interview guide, probe, take notes, and ask for consent to record the conversation. The second interviewer was assigned to identify any skipped question(s) from the interview guide and any emerging concepts that weren’t probed adequately. She also needed to ensure the audio recorder was functioning and noted the nonverbal expression. At the end of the interview session, when the principal investigator had completed asking all questions, the second interviewer was given a chance to ask any questions that had been forgotten or skipped. To engage the second interviewer at the end of the interview session, mitigated the confusion that the participants could encounter. Data collection took place in the postnatal ward, specifically in one of the selected rooms for privacy and confidentiality. Before the commencement of the study, there was no relationship between the participants and the researchers. The interview for one informant lasted between 45 and 75 min.

Reflexivity of the researcher

To ensure trustworthiness, the researchers employed bracketing, self-reflection, note-taking, and awareness of personal experiences, skills, and attitudes that could potentially influence the findings. To validate the information shared by each participant, transcripts were returned to them for review, allowing them to confirm whether the captured data accurately reflected their perspectives, as member checking was not feasible.

Data analysis

Verbatim transcription was carried out, and transcripts were translated from Swahili native to English by a linguist fluent in both languages. Data analysis was conducted using thematic analysis, from coding to theme development, independently by the principal investigator (CL) and a research assistant (WM) who were involved in the interview sessions. The data analysis adhered to six steps, as proposed by Braun and Clarke: data familiarization, generating codes, searching for themes, reviewing themes, defining and naming the themes, and writing up. ²⁵ Initially, the data were reviewed, with researchers independently gaining a thorough understanding of the collected information through transcription, taking initial notes, and reading and rereading the transcripts. In the second coding phase, researchers highlighted specific texts, including words, phrases, or short statements, to represent the content. Next, the patterns of generated codes were identified; thus, codes having similar meanings were grouped to form subthemes. Defining and naming themes involves creating a succinct and easily understandable name for each theme by merging subthemes with uniform patterns. Thereafter, they completed the codebooks and wrote up the results. Since the analysis was performed independently by two researchers, they had to agree on each generated code, subtheme, and theme. The final version of the agreed codebook was used for this study (Table 1).

Table 1.

Participants’ demographic.

Participants reg.#	Age	Marital status	Education level	Parity	Home childbirth	Reasons for home childbirth	Type BC	Relationship with the women
001	40	Married	Primary	10	0	N/A	From home	Sister-in-law
002	25	Married	Primary	4	1	Delayed decision to go to the hospital	From home	Grandma
003	25	Married	Primary	2	0	N/A	From home	Mother-in-law
004	22	Married	Primary	2	0	N/A	From the community	TBA
005	16	Married	Primary	1	0	N/A	From the community	TBA
006	35	Married	Primary	6	0	N/A	From home	Aunt
007	25	Married	Secondary	2	0	N/A	From home	Mother
008	26	Unmarried	Secondary	2	0	N/A	From home	Mother
009	36	Married	Informal	7	1	TBA was delayed in escorting her to the hospital	From community	TBA
010	27	Married	Informal	4	1	Long distance	From the community	TBA
011	32	Married	Primary	1	0	N/A	From the community	TBA

BC: Birth companions; TBA: Traditional birth attendant.

Results

Study characteristics

A total of 11 postnatal women participated in the study. The majority (90%, n = 10) were married. More than half (63.6%, n = 7) attained primary education. The majority (72.7%, n = 8) of postnatal women were aged 16–32 years. Regarding parity, the study showed that the majority (81.8%, n = 9) were multipara. More than half (54.5%, n = 6) obtained BC from their homes, indicating they were their family members (Table 1).

Subthemes and themes

Themes and subthemes were generated via thematic analysis. A total of 6 themes and 20 subthemes emerged during data analysis and discussion. Six themes were (i) choosing birth BCs, (ii) mixed feelings about BCs, (iii) services offered by BCs, (iv) presence of BC during the intrapartum period, (v) supportive infrastructure for birth companionship, (vi) challenges encountered with the presence of BCs (Table 2).

Table 2.

Generated codes, subthemes, and themes about the four specific objectives.

Categorized codes	Subthemes	Themes
Family-related Blood-related Neighbourhood Living together	Selecting BC based on a relationship	Choosing a birth companion
Trustiness	Selecting BC based on trustworthiness
Selected according to knowledge	Selecting BC based on the experience.
Self-selection Partner involvement Parent involvement	Selection of BCs by different people
Comfortability on care I feel pure, safe, and peaceful. I felt good, really.	Positive feelings toward BCs	Mixed feelings about birth companions,
Honestly, I didn’t like it.	Negative feelings toward BC
Comforting with kind words Reassurance Hold hand Be strong	Emotional support	Services offered by BC
Collect clothes and give them to the nurses fetch and bring those items	Instrumental support
Helps in providing food Helps in providing tea	Nutritional support
Assisting in doing physical exercises	Physical support
The BC called the nurse inform the health provider	Give information
Washed the clothes I gave birth in Help with laundry Change clothes.	Laundry/washing clothes
Services provided by my BC were good All the services were good were the exercises Those exercises she brought me here safely was to go to health facilities clean environment All the things I wanted, she did for me everything went well because she did everything I asked Help mother was to go health facilities	Most important things
She was with me until I gave birth When I was pushing, my mother was there we are in the labor room the whole time	BC is present in all stages of labor.	Presence of BC during the intrapartum period.
She was just told to step out for a while She was just outside She came back shortly after giving birth	BC stays away during childbirth
Currently, the services are better The past was not good Now, everything is well-organized You stay close to her	Comparing current and past maternal services	Supportive infrastructure for birth companionship
The labor room was spacious and clean. crowded; everyone is squeezed together The size is good, very good Good, I haven’t seen any flaws, it’s clean The room can accommodate many people Oh, there is enough space in the rooms	Space of the labor room
They make a lot of noise	Making noise	Challenges encountered with the presence of BCs.
put more leaves in the tea	Use of traditional medicine
They spread rumors about you	Loss of privacy and confidentiality

BC: Birth companions.

Theme (1): Choosing BCs

Selecting BC was based on relationship, trustworthiness, and the experiences

Sub-theme 1: Selecting BCs based on the relationship

Most participants selected their BCs based on family relationships, blood relatives, neighbors, and living together. For example, the postnatal woman discussed below showed that her choice of BC was influenced by family ties or kinship, as she indicated:

Because she is my mother-in-law, and we live together at home. When I felt labour pains, I woke her up to come with me. We live together at home, so when I felt the pain, I woke her up, and we left together. I wouldn’t choose a neighbor over a family member. It’s better to bring someone from home. . .PW3

In terms of blood relations, some postnatal women demonstrated that they chose BC because she is a relative, someone who shares the same bloodline as her father. As this participant reported:

I chose her as my aunt. . . my relative she is from the same family as my father and me, yes. I chose her as my relative, someone who comes from the same family as my father and I, I trusted her, that’s why. I didn’t like to choose someone else, other than my relative, considering the privacy involved . . .PW6

Additionally, several participants indicated that they chose BC because it was their neighbor. One participant specifically remarked that

I chose her because we understand each other very well. We are very close. It was our decision, my husband and I, because she is nearby. We chose her to accompany us to the health centre . . .PW10

Sub-theme 2: Selected BC based on trust

Several participants demonstrated that trust was among the factors that influenced their decision about who should be selected for the BC position.

I chose my mother because she is the person I trust the most. I don’t trust anyone else more than her . . .. PS8.

Sub-theme 3: Selecting BC based on the experiences

The study further found that BCs were selected based on experiences, as the participant said:

This person is a traditional birth attendant. I know that they know everything, even how to measure if the pregnancy is going well or not. That’s why I chose a traditional birth attendance. . . PW 4

Sub-theme 4: Selection of BC by different people

The findings of the study revealed that some BC were selected by other people. Under this sub-theme, three categories that influence the selection process emerged, which comprise self-selection, partner involvement, and parent involvement.

In terms of self-selection, the findings indicate that postnatal women would choose the BC of their preference without undue influence.

I chose her myself after being informed about certain changes. I have told her in advance that I will give birth in a certain month, so when that month arrives, she knows that I will give birth this month. That’s why when I feel the pain, I call her, and she comes to accompany me . . .PW8

The study’s findings revealed that the parents of postnatal women chose some BC.

Well, I’m new here, so my mother brought her. They have a relationship with my mother. My mother said we should choose her because she. . . she helps well. She provides good care. She has experience in delivering babies . . .PW5

Theme (2): Mixed feelings about BCs

Two sub-themes emerged from this theme, which are the positive and negative feelings of postnatal women about the presence of BCs.

Sub-theme 1: Positive feelings toward BCs

Several participants in this study reported that having BCs promotes comfort in care, feeling at ease, safe, peaceful, and protected. For example, the postnatal women said that

I felt good, I found comfort in her presence, yes. . .I felt at ease, as if she were my aunt, someone who came from the same family as my father and me. She wouldn’t reveal any secrets. . . Yes. . . PW6

I felt good because she was helping me. If I felt like vomiting, she would take a basin and give it to me. And when the pain intensified, she would go to the nurse, and the nurse would come and check on me. That’s how it went until the end . . . PW8

Additionally, other participants were noted as saying they felt peaceful. Peaceful in this context implies that these postnatal women were very comfortable with the service offered by BCs and with the presence of BCs. In the same manner, their trust and self-confidence grew; hence, they confessed that the presence of BCs increased their peace of mind, as noted below:

I felt comforted; she was holding my hand while the doctor was busy with other things, and she was there, comforting me with kind words. PW11

I felt at ease like she was my aunt, someone who came from the same family as my father and me. She wouldn’t reveal any secrets. . . Yes . . . PW6

I felt very peaceful and secure having a companion. I would have been afraid if I were alone, but having a companion made me feel very peaceful; truly, I felt good. I comforted her also, there was a good service . . . PW7

Another notable category that emerged from the sub-theme was “feeling good.” For example, participants said they felt excellent, which is an indication of a higher level of satisfaction with the presence of BC. The participants were recorded saying that

Having this companion made me feel excellent because even during the pain, she was comforting me and relieving the pressure. When the pain became unbearable, she was there to console me. Being alone, you tend to have many thoughts and end up being unable to give birth. But she was comforting me, talking to me, and we had good conversations. PW1

“She would tell me, “Sister, you’ll give birth, God will help you. “That’s what she kept telling me. Sometimes she would say, “That’s right, my sister, you’ll be fine. “Yeah, I felt at ease” . . .PW 11

Sub-theme 2: Negative feelings toward BC

Fewer respondents said that they were not comfortable having BC throughout the childbirth period. The respondents stated that it would have been wise to have BC before and after childbirth.

Well, what annoyed me, I would say it was not her fault, but due to the pain. She would insist on the instructions of the midwife and tell me to lie in a certain way, and when I had to push the baby, she would repeat the instructions of a midwife and tell me to spread my legs. The pain was severe. So, I thought she was causing me pain and asked her to leave and let my aunt come in. However, the pain increased, but what she was directing me to do was not wrong; it was right, except that I was in severe pain. . . PW8

Also said that

The presence of a support person is important, but they should be educated about their role. Some of them don’t know what to do and end up being unhelpful. Education should be provided. . .. PW8

Honestly, I didn’t like it because, for all my pregnancies, my mother was present. When she was absent, I called my aunt, and among these five pregnancies, this is the one where I chose my aunt. . .PW6

I didn’t like to choose someone else. . . other than my relative. . . considering the privacy involved . . .PW5

Theme (3): Services offered by BCs

The sub-themes that emerged included emotional support, instrumental support, laundry/ washing clothes, nutritional support, physical support, and providing information from birth companions.

Sub-theme 1: Emotional support

Participants reported that birth companions provide emotional support by offering praise and reassurance. In this instance, a participant noted that

She was there, comforting me with kind words; she would tell me, “Sister, you’ll give birth, and God will help you, That’s what she kept telling me. Sometimes she would say, “That’s right, my sister, you’ll be fine” . . .PW11

She would hold me, and she. . . she. . . I mean, she comforted me by saying I would recover and have a healthy baby . . .PW6

Sub-theme 2: Physical support

Birth Companions offer physical support to women during labour and childbirth, including massage and assistance with walking or changing positions. They also help with getting into bed.

Her presence there. . . as soon as she entered, she started assisting me in doing exercises, helping me exercise. . . as the pain increased when it reached its peak. . . she called the nurses. I mean, her services were going well; I had no complaints about the companion. . . . PW1

Sub-theme 3: Nutritional support

Regarding nutritional support, participants indicated that BC would provide them with a variety of services, including nutritional support.

Well, all the things I wanted, she did for me. If I wished to get tea or a basin, she would get them for me. And when it came to food, she would bring it to me PW8

Sub-theme 4: informational support

Most postnatal women stated that their BC would act as an intermediary between them and healthcare providers to ensure that the correct information was disseminated in a timely manner.

When we arrived, she went to look for the nurse, the nurse came and took care of me . . .PW 5

Sub-theme 5: instrumental support

Postnatal women reported that birth companions played a vital role in assisting healthcare providers by collecting clothes, giving them to the nurses, and fetching and bringing other items, such as purchased medications:

My mother was there too, and she was the one providing all the clothes and necessary items . . .PW8.

After giving birth, the doctor asked her to get some clothes, and she had taken them from the bag. They would provide them with any necessary items asked, like purchased drug . . .PW11.

Sub-theme 6: Laundry support

Participants reported that their companions helped them by washing their clothes after childbirth.

As they reported below:

The traditional birth attendant shed the clothes I gave birth in . . .PW10

After giving birth, the nurse was busy with the baby and doing the check-up, while the companion took care of my cleanliness, brought clean clothes for me to wear. That is how she assisted me . . .PW1

Theme (4): Presence of BC during the intrapartum period

Some have reported their birth companion being available full-time. In contrast, others have reported their birth companion being available at specific times, with BC present during all stages of labor, and others staying away during intrapartum.

Sub-theme 1: BC is present at all stages of labor

Well, from the beginning of the pain, until I gave birth, she didn’t leave the room. . . PW1

When I was pushing, my mother was there, and when I was giving birth, my mother and the nurse were there. The nurse would clean me, and my mother would take care of things like medicines or diapers. She would cover the baby . . . PW8

Sub-theme 2: BC stays away during childbirth

Some BC stay away during the intrapartum period, as reported by several participants.

Oh, when she brought me to the labour room, she handed me over to the nurse and left. She was just outside, a little away from the room. . . .PW 9

Theme (5): Supportive infrastructure for birth companionship

Three subthemes were generated regarding the challenges experienced as a result of having BC: making noise, loss of privacy and confidentiality, and use of traditional medicine.

Sub-theme 1: Making noise

Although the majority of participants noted that the work environment appears satisfactory, all participants reported issues with noise:

When you have just given birth and need to rest, you can’t rest properly because people are making noise. It’s helpful when they finish their assistance and leave. . . they make a lot of noise – PW1.

Sub-theme 2: Loss of privacy and confidentiality

The issue of privacy and confidentiality emerged as a concern during birth companionship, as reported by participants during the discussion:

There are other people who could accompany you and would spread rumours about you, saying this person is like this, that person is like that. . .PW6

Sub-theme 3: Beliefs in traditional medicine

Some postpartum women reported that their birth companions added more leaves to the tea and gave it to them to induce contractions, facilitate a quicker birth, and prevent them from staying in the labor room for an extended period:

She just brewed the tea without adding sugar. She boiled it and added leaves, but no sugar was added. She didn’t tell me; he just said that he put leaves in it so that I could drink it and the pain would intensify quickly for me to give birth early. PW3

Theme (6): Challenges encountered with the presence of BCs

Sub-theme 1: Comparing current and past maternal services

The quality of care improvement in childbirth services in healthcare facilities was investigated by comparing current and past maternal services.

Currently, the services are better compared to the past because. . . even when the nurse was busy, she would call BC to assist with my case, and she would come and help you more easily. . . yes . . .PW6

Because now, in the labour ward, everything is well-organised. Even if you have your relative there, there’s no problem because nowadays, each person has their room, which adds comfort and reduces distraction . . .PW11.

Sub-theme 2: Physical capacity of labor rooms within healthcare facilities

This study identified one sub-theme that emerged throughout the dataset, which is the space of the labour room. As participants stated below:

Honestly, the rooms are good because they have beds, equipment, and no cramped space. The room is spacious and very adequate, there is no squeezing at all . . . PW1

Discussion

Sustainable development goal target aiming to reduce the global maternal mortality rate to fewer than 70 deaths per 100,000 live births by 2030 ²⁶ through enhancing the quality of care, promoting respectful maternity care (RMC), and increasing the number of facility births while also ensuring the presence of birth companions during labor and childbirth.^26–28 The birth companion of choice is a component of RMC. Having a birth companion during intrapartum care has been reported to have positive pregnancy outcomes.^27,29,30 The BCs can provide RMC, which offers emotional support, reassurance, and advocacy, ultimately contributing to a more positive and dignified birthing experience for mothers and improved health outcomes.^27,29–32

This study explored the experiences of postnatal women in Katavi, Tanzania, who had a birth companion during labor and childbirth. Among the study participants, the majority were married, had completed a primary education level, and were accompanied by a family member as BC. This finding is similar to studies by Wanyenze et al, Tamar Kabakian-Khasholian, Hoga, and Alwahaibi.^33–36

The main findings of this study include six themes: choosing BCs, mixed feelings about BCs, services offered by BCs, the presence of BCs during the intrapartum period, supportive infrastructure for birth companionship, and challenges encountered with the presence of BCs.

Choosing BCs

The findings revealed that BCs were selected based on trustworthiness. Since the companion can easily see the woman’s private parts, know the diseases the woman has, and witness how strong the woman can endure labor pain, these are sensitive issues that require a companion who can be trusted to keep the information confidential. The study is in line with the previous mixed-method study, which reported that postnatal women fear the presence of birth companions as they can discuss private matters with others outside the facility. ⁵ Another earlier study conducted in Addis Ababa, Ethiopia, revealed that postpartum women select their BCs, with whom they feel comfortable and may communicate anything they want. ³⁷ Even though most postnatal mothers prefer to be accompanied by someone from their families, others opt to be accompanied by a traditional birth attendant (TBA). The new roles for TBAs have been established, involving escorting women to health facilities for childbirth and providing necessary support, including emotional, physical, nutritional, and hygienic care. The expanded role of TBAs has led to an increase in facility-based deliveries, which has made women and their families happier. Historically, TBAs had conducted childbirth at their homes, though they didn’t have official training, which limited their ability to identify early pregnancy complications. ³⁸ However, women tend to favor TBAs because of their influence in the community.

Mixed feelings about BCs

Having BCs during labor and childbirth elicits a range of emotions in postnatal women, with both positive and negative aspects influencing their experiences. For many women, the presence of a BCs during childbirth enhances their overall experience by providing emotional and physical support. Several participants expressed that having companions contributed to increased comfort, alleviated anxiety and stress, making the birthing environment feel less intimidating, especially for first-time mothers who may perceive the hospital setting as unfamiliar or overwhelming. Additionally, postnatal women reported having a sense of satisfaction and achievement, emotional security, and a reduction in feelings of loneliness and fear. The findings align with those of other scholars.^{27,33,34,39–41} The probable reason for the postnatal women having positive feelings regarding BCs could be because many health facilities in the country are understaffed and overwhelmed; as a result, women in labor and childbirth could be limited in getting close monitoring and support for emotional and physical care.^27,30,34,42 Additionally, more reasons for selecting the family member as BCs could stem from the trust that a close relative can maintain confidentiality of all issues related to the process of labor and childbirth. Since the majority of participants were married, the BC could be selected from either the husband’s or the woman’s side. Furthermore, the cultural norms of specific communities may influence this choice, as some traditions prioritize family support during childbirth, fostering a sense of security and emotional well-being for the mother.

Despite the positive feelings of postnatal women, some expressed doubts about having BCs present throughout the entire intrapartum period. Their concerns were that the presence of BCs during the actual childbirth process was unnecessary or even uncomfortable; some felt that BCs may be acceptable during labor pain and after childbirth. Postnatal women are worried about privacy, confidentiality, cultural considerations, and personal preferences. Some might have conditions that they do not prefer to share or disclose with family members, such as HIV infection. The presence of BCs during childbirth could expose their conditions, potentially leading to gossip, stigma, and discrimination. These findings aligned with studies conducted elsewhere, such as a study conducted in Kenya, ⁵ India, ⁴³ and Ethiopia. ⁴⁴ Individual preferences vary and should be respected. The healthcare providers should consider these mixed feelings and offer flexible options that allow women to choose the level of support they feel most comfortable with. Ensuring that birth companions are adequately prepared and informed about their role can also enhance their effectiveness in providing meaningful support.

Services offered by BCs

The participants reported various services provided to them by their birth companions. The services that were mentioned consisted of emotional support, physical support, informational support, nutritional support, and laundry support. BC provides emotional support to help the laboring mother cope with the labor process and feel loved and supported. This finding aligns with earlier findings, which established that BCs offer several services in different forms. The services offered by BC go beyond providing emotional support, laundry assistance, and information to increasing women’s confidence and hope.^11,45 In Tanzania’s context, since some women have unintended pregnancies, and some of their partners have denied being responsible for pregnancies, all these trigger women’s emotions during labor, making the presence of companions the best way to overcome emotions.

Presence of BC during the intrapartum period: Some participants stated that their BC were present throughout the childbirth process, which was positively perceived. On the other hand, some postnatal women claimed that their BC was only present after the childbirth period, which indicated some level of dissatisfaction. BC, who was asked to vacate the labor rooms and did so as instructed by healthcare providers, may have lacked knowledge about their right to stay in the labor room at all times. Similarly, Nilver & Berg, 2023 ³⁹ It has been reported that BC plays a crucial role in supporting women throughout the labor process; therefore, they are required to remain in the labor room at all times.

Supportive infrastructure for birth companionship

Challenges encountered with the presence of BCs: Study participants reported that noise, loss of privacy, and confidentiality are challenges experienced by women when they have birth companions. Noises are considered a burden, disturbing the relaxation of laboring women. A previous study reported that noise at the hospital facility affects patients’ sleep quality, speech processing, and various physiological functions. ⁴⁶ The habit of BC making noise at the healthcare facility can be due to a lack of awareness and understanding of how much it negatively affects maternal outcomes. ³⁴ Regarding privacy and confidentiality, the leaking of client information affects women’s reputations, makes them lose confidence in the community, and can be the source of humiliation and stigmatization.^47,48

Limitations of the study

The study is limited by its small sample size and is confined to a single region, which is geographically restricted to people of a particular culture, tradition, belief, and lifestyle. These findings may not be representative of other diverse cultural populations from different regions. Some of the women’s experiences could not be directly attributed to companionship; rather, physiological mood fluctuations that occur in the first few days postpartum might have influenced the women’s responses. Moreover, although the approach of a face-to-face interview is recommended in qualitative studies, based on the nature of the study, it might have influenced study participants to respond nicely to the researchers. Meanwhile, social distancing could have been beneficial for participants to discuss sensitive topics. ²⁴

Conclusion and recommendation

Having a birth companion during intrapartum significantly influences women’s experiences, evoking both positive and negative feelings. Many women gain from emotional and physical support, increased comfort, less anxiety, and a stronger sense of security. However, factors such as privacy, confidentiality, cultural beliefs, and personal preferences can influence how postnatal women perceive companionship during childbirth. Since BCs are chosen based on experience, TBAs should be empowered by the government through training on the importance of facility delivery and offered incentives for every woman they escort. This strategy will likely boost the number of deliveries attended by skilled birth attendants and decrease home births, ultimately reducing maternal and neonatal morbidity and mortality.

Supplemental Material

sj-docx-1-smo-10.1177_20503121251387967 – Supplemental material for The lived experiences of postnatal mothers receiving birth companionship care in Katavi region, Tanzania: A phenomenological study

Supplemental material, sj-docx-1-smo-10.1177_20503121251387967 for The lived experiences of postnatal mothers receiving birth companionship care in Katavi region, Tanzania: A phenomenological study by Caroline Linja, Angelina A. Joho and Joanes Faustine Mboineki in SAGE Open Medicine

Supplemental Material

sj-docx-2-smo-10.1177_20503121251387967 – Supplemental material for The lived experiences of postnatal mothers receiving birth companionship care in Katavi region, Tanzania: A phenomenological study

Supplemental material, sj-docx-2-smo-10.1177_20503121251387967 for The lived experiences of postnatal mothers receiving birth companionship care in Katavi region, Tanzania: A phenomenological study by Caroline Linja, Angelina A. Joho and Joanes Faustine Mboineki in SAGE Open Medicine