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Published: March 7, 2024

Birth companions and their continuous support to pregnant mothers

Throughout pregnancy, delivery, and postpartum, every woman deserves dignified and respectful care, with compassionate providers who tend to her emotional and physical wellbeing. “Pregnancy is a very vulnerable time,” says Carren Siele, Nursing Officer In-Charge at Lwala Community Hospital. “Women need caregivers who offer them the information they need, encourage them to make their own choices, and advocate on their behalf.”

Dorothy Auma Omoro, a patient attendant at Lwala Community Hospital, was part of the team conducting informational sessions for expecting mothers during an open maternity day. She noticed a friend, Mary Gorety Ouko, was attending. At eight months pregnant with her first child, Mary was apprehensive about her upcoming delivery. Dorothy had recently been trained as a birth companion, and in that new role, she knew she was a trusted shoulder for pregnant mothers like Mary to lean on.

A week later, Mary arrived at the hospital to deliver. Without hesitation, she called on Dorothy to be her birth companion. Dorothy was present through the entire labor–she took walks with Mary, answered questions, and held her hand in moments of fear. “Everything she needed, I provided,” says Dorothy. “At one point, I asked her, ‘can you dance?’ And we did. We laughed that even her baby was dancing because she liked the song. If Mary’s back hurt, I would massage. Every moment, I noticed what was needed, and I used my birth companion training to offer the best support I could give.”

The baby was born 7 hours later, but Dorothy’s support didn’t stop there. She stayed with Mary, providing nutritional advice, breastfeeding tips, and insights to identify post-delivery danger signs. From pregnancy to birth to recovery, Dorothy listened to Mary, advocated for her, and cared for her emotional and physical wellbeing.

Training our first cadre of birth companions

Providing respectful maternal health care is key to building women’s trust in the health system. Lwala builds this trust through community health workers (CHWs), who visit pregnant and postnatal women, track their health, support birth planning, and encourage them to visit a health facility for antenatal care, skilled delivery, and postnatal care. Once women arrive at the facility, Lwala ensures they are met with high-quality services. If women feel supported and well taken care of, they are more likely to return, which drives better maternal and child health outcomes. Our birth companions program was envisioned as an extension of this model–a way to ensure that pregnant women receive respectful, dignified care.

In 2021, Lwala established a partnership with the International ChildBirth Initiative (ICI), which provides guidance on implementing evidence-based maternity care worldwide. ICI has done extensive research on the importance of respectful care–while labor is physiological, a baby’s journey to a healthy delivery rests on the consistent care and emotional investment made in the mother all throughout pregnancy, delivery, and the postpartum period. “Doing so reduces the likelihood of labor complications, need for referral, postpartum depression, and it protects the mothers birth memory,” says Carren.

In August 2023, we trained 24 health care professionals as birth companions–including CHWs, midwives, and patient attendants–from Lwala Community Hospital and nearby Minyena Health Center. Eight of those trained had previously been traditional birth attendants (TBAs), demonstrating the ability of these traditional care takers to be champions of facility-based delivery.

The week-long training equipped these individuals to provide expecting mothers with continuous emotional support, physical comfort, non-clinical advice, and guidance in labor and postpartum periods. “In training, we were taught that to help mothers post-delivery–with breastfeeding or any other problems–we had to make them feel free and comfortable with us,” says Monica Adhiambo Otieno, a CHW supported by Lwala. “I remember a mother came to deliver without anyone to support her, so we became her support.”

Advancing continuous support during labor, delivery, and postpartum

Training birth companions is one component of our broader goal to reduce maternal deaths. In Kenya, maternity mortality remains high, and many underserved communities bear the greatest burden of loss–just 15 of Kenya’s 47 counties contribute to 98% of maternal deaths. Yet research shows that continuous support during labor has clinically meaningful benefits for women–they need fewer pain medications, have more vaginal births, and require fewer cesarean sections or births assisted by vacuum or forceps, which can cause complications. Birth companions can also improve newborn health, as they are able to identify danger signs sooner. Newborns whose mothers have birth companions have better Apgar scores, which measures a baby’s overall health, and they bond better with their moms. The World Health Organization even recommends that women be supported continuously throughout labor.

But more than physical outcomes, birth companions contribute to the mother feeling more satisfied in their birthing journey. Lwala incorporated these insights into action at Lwala Community Hospital and Minyenya Health Center. Our trained birth companions recall pride in being able to counsel mothers and then observe positive outcomes on the health of their baby postdelivery.

“A woman is an asset in a community. You need to invest in taking care of her through the entire labor process because if she is taken care of, she can take better care of their child and their community.”
- Carren Siele, Nursing Officer In Charge, Lwala Community Hospital

Diligent monitoring and program evaluation reveal the early impact of birth companions. Lwala conducted an exit survey at the end of 2023 to gauge the experiences of women during antenatal care and delivery. The majority of the women supported by birth companions reported a sense of comfort, safety, and respect. 95% of women felt that the staff cared about what mattered to the mother and her family. 100% of women felt included by staff in the process of making decisions about themselves and newborn care. And lastly, nearly 100% of respondents felt the labor process went exactly as they hoped.

In 2024, we will continue to support trained birth companions at Lwala Community Hospital and Minyenya Health Center. We also hope to use what we learn and the data we collect to inform the wider health system–we believe mothers across Migori County could benefit from the continuous support birth companions provide.

It takes having someone there for you

When Mary relied on Dorothy, she expressed great hope and strength in knowing her baby would be okay come delivery. “Dorothy’s advice was special,” Mary points out. Because Dororthy built a strong sense of trust with Mary, she was free to express all worries and find a sense of calm in her labor and delivery. “My delivery was so short, and I think it was because of Dorothy and all the steps we took before delivery. Sometimes there was pain, but I was able to manage because she was always there. I would want other mothers to have the same support.”

Lwala is constantly exploring new ways to make health care better–and through the continuous support of birth companions, we know that we are giving every pregnant woman the respectful, dignified care she deserves.

 

 

Agency, health, and wholeness of life.

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