Promoting childbirth companions in South Africa: a randomised pilot study.
BACKGROUND
Most women delivering in South African State Maternity Hospitals do not have a childbirth companion; in addition, the quality of care could be better, and at times women are treated inhumanely. We piloted a multi-faceted intervention to encourage uptake of childbirth companions in state hospitals, and hypothesised that lay carers would improve the behaviour of health professionals.


METHODS
We conducted a pilot randomised controlled trial of an intervention to promote childbirth companions in hospital deliveries. We promoted evidence-based information for maternity staff at 10 hospitals through access to the World Health Organization Reproductive Health Library (RHL), computer hardware and training to all ten hospitals. We surveyed 200 women at each site, measuring companionship, and indicators of good obstetric practice and humanity of care. Five hospitals were then randomly allocated to receive an educational intervention to promote childbirth companions, and we surveyed all hospitals again at eight months through a repeat survey of postnatal women. Changes in median values between intervention and control hospitals were examined.


RESULTS
At baseline, the majority of hospitals did not allow a companion, or access to food or fluids. A third of women were given an episiotomy. Some women were shouted at (17.7%, N = 2085), and a few reported being slapped or struck (4.3%, N = 2080). Despite an initial positive response from staff to the childbirth companion intervention, we detected no difference between intervention and control hospitals in relation to whether a companion was allowed by nursing staff, good obstetric practice or humanity of care.


CONCLUSIONS
The quality and humanity of care in these state hospitals needs to improve. Introducing childbirth companions was more difficult than we anticipated, particularly in under-resourced health care systems with frequent staff changes. We were unable to determine whether the presence of a lay carer impacted on the humanity of care provided by health professionals.


BACKGROUND
Current Controlled Trials ISRCTN33728802.
Brown
Heather
H
Worthing Hospital, Lyndhurst Road, Worthing, W Sussex, UK. heather.brown@wash.nhs.uk
Hofmeyr
G Justus
GJ
Nikodem
V Cheryl
VC
Smith
Helen
H
Garner
Paul
P
D000328:Adult; D004733:Enema / Q000706:statistics & numerical data; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D005508:Food Deprivation; D033062:Friends; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006293:Health Promotion; D006771:Hospitals, Maternity / Q000458:organization & administration*; D006779:Hospitals, Public / Q000458:organization & administration*; D006801:Humans; D009774:Obstetrics / Q000193:education / Q000592:standards; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration*; D016134:Organizational Policy; D017060:Patient Satisfaction; D010865:Pilot Projects; D011187:Posture; D017410:Practice Guidelines as Topic; D011247:Pregnancy; D011369:Professional-Patient Relations; D011785:Quality Assurance, Health Care; D013019:South Africa; D013664:Teaching Materials; D014754:Violence; D014838:Volunteers / Q000706:statistics & numerical data; D014868:Water Deprivation; D014944:World Health Organization