Improving Experience of Labour and Delivery Care Through Birth Companionship: Findings from A Qualitative Study on A Pilot Birth Companionship Project in Kigoma, Tanzania

Introduction: The World Health Organization underlines the significance of care experience in the standards for improving the quality of maternal and newborn care in health facilities. (WHO, 2016). Quality standard six states, "Every woman is provided with the emotional support that is sensitive to their needs." The quality statement emphasizes, all women to be offered the option to experience labor and childbirth with the companion of their choice. Again, birth companions form a key component of respectful maternity care (White Ribbon Alliance, 2011). One possible way to prevent mistreatment during childbirth is by having companions assume roles such as witness or safeguard for the woman they are supporting (Kruk et al., 2018).

Methods: Thamini Uhai partnering with the local government authorities and Columbia University's Averting Maternal Death and Disability (AMDD), implemented a NIMR-registered pilot birth companionship project nine public health facilities in Kigoma from July 2017 to December 2019. AMDD supported qualitative implementation research using purposive sampling. 19 Focus group discussions and 55 In-depth interviews were conducted at nine intervention facilities (8 health centers and one hospital. Findings: After introducing birth companions, many women reported better treatment during labor and delivery and improved childbirth experience. Women and providers both perceived increased respectful care. Precisely, the following elements: (1) privacy and confidentiality due to construction of partitions in the labor ward; (2) receiving timely care as birth companions alerted providers when a woman needed attention; (3) being spoken to kindly, either thanks to an overall shift in facility culture or because providers feared that birth companions would report any rude behavior; and (4) enhanced accountability as birth companions could act as a witness on a woman's behalf.

Conclusion: Respectful and compassionate cares are inevitable in improving the quality of care. Implementation of birth companionship has shown positive influence in improving both provider and client perceived respectful maternity care and better labor and childbirth experience.