Health Promotion and Community Health Department, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon.
Department of Maternal, Newborn, Child and Adolescent Health, World Health Organization, Geneva, Switzerland.
BMC Pregnancy Childbirth. 2017 Aug 31;17(1):265. doi: 10.1186/s12884-017-1447-9.
Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different settings around the world. We conducted a review to determine factors that affect implementation of this intervention considering the perspectives and experiences of different stakeholders and other institutional, systemic barriers and facilitators.
Forty one published studies were included in this review. Thirty one publications were identified from a 2013 Cochrane review on the effectiveness of companion of choice at birth. We also reviewed 10 qualitative studies conducted alongside the trials or other interventions on labour and birth companionship identified through electronic searches. The SURE (Supporting the Use of Research Evidence) framework was used to guide the thematic analysis of implementation factors.
Women and their families expressed appreciation for the continuous presence of a person to provide support during childbirth. Health care providers were concerned about the role of the companion and possible interference with activities in the labour ward. Allocation of resources, organization of care, facility-related constraints and cultural inclinations were identified as implementation barriers.
Prior to introducing companion of choice at birth, understanding providers' attitudes and sensitizing them to the evidence is necessary. The commitment of the management of health care facilities is also required to change policies, including allocation of appropriate physical space that respects women's privacy. Implementation research to develop models for different contexts which could be scaled up would be useful, including documentation of factors that affected implementation and how they were addressed. Future research should also focus on documenting the costs related to implementation, and on measuring the impact of companion of choice at birth on care-seeking behavior for subsequent births.
世界卫生组织最近的两项建议确认了在分娩时选择陪伴者的好处；然而，机构实践和政策并不总是支持在世界各地不同环境下实施这一建议。我们进行了一项审查，以确定影响该干预措施实施的因素，考虑到不同利益相关者的观点和经验以及其他机构、系统障碍和促进因素。
本综述纳入了 41 项已发表的研究。31 项出版物是从 2013 年关于分娩时选择陪伴者的有效性的 Cochrane 综述中确定的。我们还审查了 10 项定性研究，这些研究是在针对分娩陪伴的试验或其他干预措施进行的，通过电子搜索确定。使用 SURE（支持使用研究证据）框架来指导实施因素的主题分析。
妇女及其家属对在分娩期间有一个人持续提供支持表示赞赏。卫生保健提供者对陪伴者的角色和可能对产房活动的干扰表示关注。资源分配、护理组织、与设施相关的限制和文化倾向被确定为实施障碍。
在引入选择陪伴者之前，有必要了解提供者的态度，并使他们了解证据。卫生保健设施管理层的承诺也需要改变政策，包括分配适当的尊重妇女隐私的物理空间。开展实施研究以开发适用于不同情况的模式并将其推广是有用的，包括记录影响实施的因素以及如何解决这些因素。未来的研究还应侧重于记录与实施相关的成本，并衡量选择陪伴者对随后分娩的寻求护理行为的影响。
