Birth companionship: Making childbirth safer

What you need to know:

  • The goal is to improve women’s experience giving birth at health facilities, in the hopes that more women will decide to deliver in a facility, where they can benefit from skilled attendance and emergency care in case of a complication.

Neema arrived at Ilagala Health Centre in Uvinza District, Kigoma Region, in December 2017 ready to deliver her ninth child. Neema had already delivered two of her babies at the health facility, but this time was different: Neema had been encouraged to select a “mama msindikizaji,” or official birth companion, from home to stay with her during the delivery.

Though the term may not be common in Tanzania, a birth companion serves a familiar role: when women give birth at home, it is usually with the help and support of their female relatives and often a traditional birth attendant. In a pilot programme underway in nine facilities in Kigoma, birthing women can benefit from a companion’s emotional, physical, and practical support before, during, and after childbirth in the health facility.

The goal is to improve women’s experience giving birth at health facilities, in the hopes that more women will decide to deliver in a facility, where they can benefit from skilled attendance and emergency care in case of a complication.

“When you deliver at health facility there are professional people to take care of you,” Neema said.

“At home they are not professional, they just guess. Everyone is commanding you to do something in a guessing manner and in case of a problem no one knows what to do, so your life is at risk.” With her birth companion, “Mary,” at her side, Neema could take advantage of the professionals while still having someone familiar and trusted to stay with her during the delivery. The pilot in Kigoma, launched by the Regional Health Management Team in partnership with Thamini Uhai, is supported by the Blue Lantern Foundation, Bloomberg Philanthropies, and the Foundation H&B Agerup.

While Tanzania has made considerable progress in reducing maternal and infant mortality, the rates are still too high, and skilled health care at birth is essential to reducing those rates. The 2015-16 Tanzania Demographic and Health Survey showed that only 63 per cent of births in Tanzania—and 46 per cent in Kigoma—took place in health facilities. It is thought that one factor contributing to low utilization of facilities for childbirth may be that, in the government facilities that are the primary source of care in Kigoma, women are not allowed to bring a person of their choice with them into the labor/delivery room. These women have to navigate the health system alone at a very vulnerable moment of their lives. Assistance from a companion can help them to have better experience in the labour ward, and the companions can help make the providers’ jobs easier by giving the delivering woman non-medical assistance. This is one reason the introduction of birth companionship is more and more considered important for improving women’s satisfaction with facility-based childbirth and increasing the rate of facility delivery.

As in the case of Neema, the birth companion may be someone from the woman’s family or social network. Additionally, in the pilot facilities in Kigoma, women trained as birth companions are stationed at the health facility for women who want a companion but did not bring someone from home. What is most important is that a pregnant woman who wants a companion is supported to choose the woman who will serve as her birth companion.

As birth companion, Mary was with Neema at every step of her pregnancy. When

Neema started attending the antenatal clinic, Mary was given an identity card so that the health centre staff would recognize that she was authorized to be with Neema throughout labour and delivery. Once Neema went into labour, Mary helped Neema walk to the restroom, gave her water and food when she felt weak and helped her feel more comfortable. When it was time for delivery, Mary worked with the nurse on call, and stayed by Neema’s side during delivery, helping to reassure and comfort her.

Finally, Mary accompanied Neema back home with her new-born daughter. By providing continuous emotional support to the woman, encouraging and reassuring the woman, dispelling fears, and providing company during labour and delivery, a birth companion can help to reduce a labouring woman’s stress. Some evidence indicates that reducing stress may have physiologic effects that can lead to shorter labour, fewer complications, and therefore fewer medical interventions. Properly trained birth companions might also be able to help identify danger signs of potential complications early, and signal providers when problems arise. Earlier identification and management of complications would contribute to improved health outcomes for the woman and the baby.

The WHO has issued a number of recommendations for companionship and continuous emotional support at birth, both as a health promotion intervention and in its guidelines for supporting labour. Emotional support is also included in the WHO “Standards for Improving Quality of Maternal and Newborn Care in Health Facilities.”