4. Discussion
post-traumatic stress disorder, birth companions, anxiety, Birth companions
EVENTS
In this study, we assessed the effect of midwife-provided orientation for birth companions on maternal anxiety and coping with labor. Results from our study showed that maternal anxiety score was reduced and the proportion of women coping was higher in the intervention period. Similar findings are also reported in other related studies where the presence of trained husbands during delivery decreased maternal anxiety [The current study further found that the intervention was more effective among first-time mothers. A study conducted in Malawi to determine the efficacy of a companion-integrated package for primigravid women showed that birth companions enhanced childbirth self-efficacy [Coping during childbirth is a significant predictor of the development of post-traumatic stress disorder symptoms after birth [It is also imperative to note that the current study found non-significant findings on coping during the later stages of labor. A related study found that the anxiety levels of women were high during the last stage of labor, irrespective of the intervention [Following WHO implementation, labor companionship has been implemented in Uganda to a certain extent. Birth companions, however, are not oriented nor the midwives trained on how to integrate the birth companion in the woman’s care. This study highlights the effectiveness of midwife-provided orientation on maternal anxiety and coping during labor. Findings could inform the feasibility of implementing the presence of birth companions. We would like to acknowledge that having 20 min for orientation of each birth companion in low-resource settings may perhaps be a challenge. This intervention can be modified by considering these options: group orientation sessions, conducting sessions during the antenatal period, and video recordings of supportive techniques playing on TV screens in the admission and waiting areas in busy facilities.To our knowledge, this is the first study to assess the effect of continuous labor support on the events of labor and outcomes in Uganda. The selected study design enabled all the facilities to receive the intervention. The facilities were their controls, thereby buffering the effects of heterogeneity. Nonetheless, caution should be taken in generalizing the findings, given the following limitations: randomization was performed to determine the order of introduction of the intervention to clusters and not by individual participants. The ratings of the anxiety were recalled retrospectively and could have been affected by the arrival of the baby. Additionally, coping in labor was midwife assessed, which could have led to potential bias. The numbers within the subgroup analysis were small and this may perhaps have generated a spurious correlation. However, it is beneficial to note that subgroup analysis of treatment effects in subgroups of participants may provide useful information for the specific care of women and for future research.