Submission ID 130963
| Issue/Objective | Background: The World Health Organization recommends a companion of choice during labour and birth, yet implementation remains limited in low‑resource settings. Evidence is limited on whether companion presence, and especially which type of companion, is associated with intrapartum and postpartum care practices and outcomes in routine hospital care. Objective: To characterise changes in birth companionship coverage and by companion type after implementing a quality improvement programme, and to examine whether companion presence, overall and by companion type, is associated with evidence‑aligned intrapartum and early postpartum practices. Relevance: This research demonstrates how the MIDWIZE programme implements context-driven solutions to build resilient, equity-focused health systems. By normalising birth companions, particularly partners, the study identifies a feasible lever to shift clinical power dynamics and ensure marginalised voices are centred within respectful, physiological intrapartum care in routine hospital settings. |
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| Methodology/Approach | Methods: We conducted a facility‑based pre‑post observational study embedded within the MIDWIZE quality improvement programme in two public hospitals in Ethiopia. Data were collected through structured labour observations and post-birth interviews from 1,065 mother-infant dyads. We compared intrapartum and early postpartum practices by companion presence using χ² tests and estimated adjusted odds ratios (aORs) using sequential multivariable logistic regression models that adjusted for women's socio‑demographic characteristics, care context, and intervention period (pre vs post). |
| Results | Results: Among 1,065 women, 802 (75.8%) had a companion present. Companion coverage increased from 59.4% pre‑intervention to 89.2% post‑intervention, while the share of accompanied births with a partner increased from 32.6% to 66.2%. In fully adjusted models, any companion (vs none) was associated with higher odds of spontaneous pushing (aOR 2.68, 95% CI 1.55-4.65) and hands-on perineal support (aOR 2.36, 95% CI 1.23-4.55). Compared with no companion, all companion types were independently associated with more spontaneous pushing; partners were additionally associated with hands‑on perineal support and delayed cord clamping, and female relatives with immediate skin‑to‑skin contact. |
| Discussion/Conclusion | Conclusion: In routine Ethiopian hospital care, enabling companionship appears to be a feasible lever for shifting second‑stage care toward more physiologic, respectful practice. Scaling implementation strategies that normalise companions as part of the care team may strengthen adherence to core intrapartum standards. |
| Presenters and Affiliations | Tenagnework Dilnessa Mulualem Karolinska Institute/Stockholm Helena Lindgren Karolinska Institute Johanna Blomgren Karolinska Institute Kerstin Erlandsson Dalarna University Solomon Hailemeskel Dalarna University Michael B. Wells Karolinska Institute |
