Birth Companionship During Labour: A Study of Acceptance Facilitators, Barriers/Challenges among Midwives in Sekondi/ Takoradi, Ghana.

Abstract

The World Health Organization (WHO) recommends birth companionship (BC) as a strategy to enhance maternal birth experiences, citing numerous benefits, chiefs among them being the emotional support it offers to women during labour. Despite this endorsement, the implementation of birth companionship remains inconsistent across healthcare settings. This study explored midwives’ acceptance, facilitators, and barriers to the potential implementation of the birth companionship strategy in Sekondi and Takoradi. The research employed a qualitative descriptive design, underpinned by Ajzen’s (1985) Theory of Planned Behaviour. Sixteen (16) midwives from four health facilities in Sekondi-Takoradi were purposively selected. Data were collected using a semi-structured interview guide, audio recorded, transcribed, and analysed manually using Braun and Clarke’s (2022) thematic analysis procedure. Three (3) main themes and thirteen(13) subthemes emerged:1) Midwives’ Attitudes Towards the Birth Companionship Strategy, 2) Social Expectations Regarding Birth Companionship, 3) Behavioural Control Factors Influencing Midwives' Support for Birth Companionship. Although midwives demonstrated knowledge of the benefits of birth companionship, this was insufficient to secure their support for its future implementation. Many expressed concerns about the challenges birth companions may pose to the care process. These included potential conflict and confrontation with clients, as well as perceived threats to professional autonomy. Additionally, midwives cited the design of labour wards, particularly dormitory-style layouts, as a significant barrier to maintaining privacy and confidentiality during labour. Some companions were perceived as disruptive, interfering with care, taking photographs, or documenting events for social media. The study concludes that for successful implementation, clear guidelines and context-related protocols on birth companionship should be developed. Furthermore, the strategy should be integrated into midwifery education curricula to foster a shared understanding and acceptance among midwives.