Introduction: Pregnant women in Malawi receive inadequate emotional support during labour in hospital settings related to critical shortage of midwives and restrictive policies on supportive companionship.
Objective: To assess whether the provision of emotional support by a female companion during labour and delivery in a hospital setting reduces adverse perinatal and maternal birth outcomes such as infant?s apgar score, mode of delivery, postpartum infection and maternal pain experience.
Methods: This was a randomized controlled non-blinded clinical trial conducted in two mission hospitals and one government health centre. 671 pregnant women classified as „low risk pregnancy consented to the study and were randomly allocated into intervention (n=372) and control (n=299) arms. The intervention arm was supported by a female companion in addition to the standard midwifery care offered by midwives and doctors while the control arm received the standard care alone. A questionnaire and exit interviews were was used to collect quantitative and qualitative data respectively Quantitative data were analyzed using Epi info package while qualitative data were categorized according to emerging themes, coded and analyzed quantitatively.
Results: The incidence of low apgar score at one minute of birth was significantly lower for infants in the intervention (11%) than those in the control (32%) arm (Chi-square=32.238, p=<0.001). Although not statistically significant, mothers in the intervention arm were 6% more likely to experience less pain unlike women in the control arm. The proportion of women who felt less severe pain during the current childbirth was significantly higher in the intervention (71%) than in the control (52%) arm, Chi-square=12.503, p=<0.001) The prevalence of postpartum infection was statistically not different in infants and women in the intervention and control arms.
Conclusion: Supportive companionship during labour and delivery decreases the incidence of low Apgar score among infants born to supported mothers. Supportive companionship also reduces maternal pain experience and does not increase risk of postnatal infection to infants and their mothers. Therefore, promoting companionship during labour in our hospitals could reduce perinatal deaths related to birth asphyxia.