Discussion
birth companions, anxiety
In this study, we assessed the efficacy of midwife-led role orientation of birth companions of on maternal satisfaction and labor outcomes. Results from our study showed that the mean maternal satisfaction rate was significantly higher in the intervention period compared to the control period. And, there were no statistically significant differences between mode of delivery, length of labor, Apgar score, and need to augment labor.The World Health Organization framework for improving quality of care for pregnant women during childbirth highlights experience of care as important as clinical care provision in achieving desired person-centred outcomes [High maternal satisfaction levels from sub-group analysis were noted among the women who were; at the regional referral hospital, younger, first-time mothers, and unmarried. Better results reported at the referral hospital could be attributed to the seniority of the midwives. Additionally, this was in a fairly urban setting and the effectiveness of the intervention was probably associated with income, and educational level of birth companions [Support during childbirth is an important aspect of maternal satisfaction with care. Findings from a study conducted in Uganda showed that women desired the presence of someone most especially when health workers were not available. They needed reassurance, encouragement, and motivation for them to ably navigate through the birthing process [Non-significant findings on birth outcomes are similar to findings from a study where the rates of cesarean section delivery were almost identical in the intervention and control groups. Moreover no significant differences were noted in maternal and neonatal outcomes [A possible explanation for the contrast of findings in our study could be attributed to short duration of the intervention. The birth companions in our study had one session of orientation for 20 min on admission; this was probably not enough to make a difference. The current study found that orientation had a greater effect on the psychological outcomes (anxiety, coping and maternal satisfaction) [Whereas the midwife providing an orientation for birth companions had no significant effect on the biological process of labor, it had an immediate positive effect on how women experienced care given. We also recognize that midwives providing a detailed orientation for birth companions may perhaps be a challenge with large numbers of women in labor at a given time. Also, the short time of interaction may limit building good relations with the midwife lessening the effect of the intervention. Midwives could consider group sessions, illustration chats and videos in the admission areas of busy maternity units. Evaluation of the acceptability and perceptions of birth companions and midwives regarding orienting birth companions is essential for implementation. Furthermore, we excluded women with special needs like mental illness, deaf or mute. Future studies could explore birth companionship for such women because they might need even more support during childbirth.