Partnership-defined quality approach to companionship during labour and birth in East New Britain, Papua New Guinea: A mixed-methods study

Alyce N Wilson; Pele Melepia; Rose Suruka; Priscah Hezeri; Dukduk Kabiu; Delly Babona; Pinip Wapi; Meghan A Bohren; Joshua P Vogel; Angela Kelly-Hanku; Alison Morgan; James G Beeson; Christopher Morgan; Naomi Spotswood; Michelle J L Scoullar; Lisa M Vallely; Caroline S E Homer

doi:10.1371/journal.pgph.0000102

Partnership-defined quality approach to companionship during labour and birth in East New Britain, Papua New Guinea: A mixed-methods study

PLOS Glob Public Health. 2022 Feb 28;2(2):e0000102. doi: 10.1371/journal.pgph.0000102. eCollection 2022.

Authors

Alyce N Wilson^{1

2}, Pele Melepia^{1

3}, Rose Suruka^{1

3}, Priscah Hezeri^{1

3}, Dukduk Kabiu^{1

3}, Delly Babona⁴, Pinip Wapi⁵, Meghan A Bohren⁶, Joshua P Vogel^{1

2}, Angela Kelly-Hanku^{7

8}, Alison Morgan^{2

9}, James G Beeson^{1

10}, Christopher Morgan^{1

2

11}, Naomi Spotswood^{1

10

12}, Michelle J L Scoullar^{1

10}, Lisa M Vallely^{7

8}, Caroline S E Homer¹

Affiliations

¹ Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Australia.
² Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
³ Healthy Mothers, Healthy Babies, Burnet Institute, Kokopo, Papua New Guinea.
⁴ St Mary's Hospital, Kokopo, Papua New Guinea.
⁵ Nonga General Hospital, Rabaul, Papua New Guinea.
⁶ Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
⁷ Papua New Guinea Institute for Medical Research, Goroka, Papua New Guinea.
⁸ Kirby Institute, University of New South Wales, New South Wales, Australia.
⁹ Global Financing Facility, World Bank, Washington, DC, United States of America.
¹⁰ Department of Medicine, University of Melbourne, Melbourne, Australia.
¹¹ Jhpiego, The Johns Hopkins University affiliate, Baltimore, Maryland, United States of America.
¹² Department of Paediatrics, Royal Hobart Hospital, Tasmania, Australia.

Abstract

Companionship during labour and birth is a critical component of quality maternal and newborn care, resulting in improved care experiences and better birth outcomes. Little is known about the preferences and experiences of companionship in Papua New Guinea (PNG), and how it can be implemented in a culturally appropriate way. The aim of this study was to describe perspectives and experiences of women, their partners and health providers regarding labour and birth companionship, identify enablers and barriers and develop a framework for implementing this intervention in PNG health facilities. A mixed methods study was conducted with five facilities in East New Britain, PNG. Data included 5 facility audits, 30 labour observations and 29 in-depth interviews with women who had recently given birth, partners and maternity care providers. A conceptual framework was developed drawing on existing quality care implementation frameworks. Women and partners wanted companions to be present, whilst health providers had mixed views. Participants described benefits of companionship including encouragement and physical support for women, better communication and advocacy, improved labour outcomes and assistance with workforce issues. Adequate privacy and space constraints were highlighted as key barriers to address. Of the women observed, only 30% of women had a companion present during labour, and 10% had a companion at birth. A conceptual framework was used to highlight the interconnected inputs required at community, facility and provincial health system levels to improve the quality of care. Key elements to address included attitudes towards companionship, the need for education and training and restrictive hospital policies. Supporting women to have their companion of choice present during labour and birth is critical to improving women's experiences of care and improving the quality of maternal and newborn care. In order to provide companionship during labour and birth in PNG, a complex, intersecting, multi-faceted approach is required.

Copyright: © 2022 Wilson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Grants and funding

Funding was provided by the Burnet Institute through philanthropic support from numerous private and business donors in Australia and PNG. Major funding was provided by June Canavan Foundation Australia; Gras Foundation, Australia; Bank South Pacific PNG Community Grant; Steamships PNG Community Grant; Alistair Lucas Prize for Medical Research; National Health and Medical Research Council (NHMRC) of Australia (Fellowships to CSE and JGB, Postgraduate Research Scholarship to AW); Naylor Steward Ancillary Fund, and the Chrysalis Foundation. The funders had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. Burnet Institute is supported by an Operational Infrastructure Grant from the State Government of Victoria, Australia, and the NHMRC Independent Research Institutes Infrastructure Support Scheme.