title: Perceptions about labor companionship at public teaching hospitals in three Arab countries.
abstract: OBJECTIVE
  To explore the perspectives of women, female relatives, and healthcare providers on labor companionship.
  
  
  METHODS
  In a qualitative study, data were collected from women giving birth, female family members, and healthcare staff via semi-structured interviews in three large public teaching hospitals in Beirut (Lebanon), Damascus (Syria), and Mansoura (Egypt) between May and December 2012. Focus groups were conducted with midwives, nurses, and medical residents. Data were assessed by thematic analysis.
  
  
  RESULTS
  A total of 69 women, 57 female relatives, and 28 obstetricians were interviewed, and two focus groups discussions occurred. Women reported that being alone during labor raises feelings of fear and anxiety. They reported appreciating professional support, but found comfort in the psychological support offered by family members during labor. Midwives and nurses pointed to structural factors related to the organization of care and to the marginalization of their role as barriers to implementing best practices. Obstetricians referred to the absence of prenatal education classes, and social norms as factors impeding the organization of labor support initiatives.
  
  
  CONCLUSIONS
  Implementing labor companionship can improve women's childbirth experiences and outcomes. Organizational structural barriers and non-supportive providers' attitudes need to be addressed to influence hospital practices.
authors.affiliation: Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon. Electronic address: tk00@aub.edu.lb.
authors.forename: Tamar
authors.initials: T
authors.lastname: Kabakian-Khasholian
authors.affiliation: Department of Women's Health and Midwifery Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt.
authors.forename: Amina
authors.initials: A
authors.lastname: El-Nemer
authors.affiliation: Department of Family and Community Medicine, Faculty of Medicine, Damascus University, Damascus, Syria.
authors.forename: Hyam
authors.initials: H
authors.lastname: Bashour
mesh_terms: D001007:Anxiety / Q000209:etiology; D001291:Attitude of Health Personnel; D004534:Egypt; D005190:Family / Q000523:psychology; D005239:Fear; D005260:Female; D017144:Focus Groups; D007722:Health Knowledge, Attitudes, Practice; D006779:Hospitals, Public; D006784:Hospitals, Teaching; D006801:Humans; D007396:Internship and Residency; D007743:Labor, Obstetric / Q000523:psychology*; D007861:Lebanon; D008880:Midwifery / Q000458:organization & administration; D009035:Mothers / Q000523:psychology*; D009773:Obstetric Nursing / Q000458:organization & administration; D009774:Obstetrics; D010465:Perception; D011247:Pregnancy; D064186:Prenatal Education; D036301:Qualitative Research; D066262:Social Norms; D012944:Social Support; D013593:Syria
keywords: Arab countries; Health facility; Hospital; Labor companionship; Labor support