UNIVERSITY OF GONDAR

COLEGE OF MEDICINE AND HEALTH SCIENCES

SHOOL OF MIDWIFERY
DEPARTMENT OF CLINICAL MIDWIFERY

Labor companion utilization and associated factors among

postnatal women at Debremarkos town public health
facilities ,northwest Ethiopia,2021ABOR COMPANION
UTILIZATION AND ASSOCIATED FACTORS AMONG
POSTNATAL MOTHERS AT DEBRE MARKOS TOWN PUBLIC
HEALTH INSTITUTIONS, NORTHWEST ETHIOPIA, 2021

Principal investigator:- Hussien Muhamed Assfaw(BSc)RINCIPAL

INVESTIGATOR: - HUSSIEN MOHAMMED ASSFAW (BSC)

AdvisorsDVISORS:-

1. MrsRS. Mulunesh Abuay(MPH/RH, Assistant Professor))ULUNESH

ABUAHAY (MPH/RH, ASSISTANT PROFESSOR)

2. MrR. Melaku Hunie (MPH/RH)ELAKU HUNIE (MPH/RH)

A thesis submitted to the school of midwifery ,College of medicine and

health sciences ,University of Gondar for Partial fulfillment of the
requirements for the degree of masters in clinical midwifery THESIS
SUBMITTED TO SCHOOL OF MIDWIFERY, COLLEGE OF MEDICINE
AND HEALTH SCIENCES, UNIVERSITY OF GONDAR FOR PARTIAL
FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF
MASTER IN CLINICAL MIDWIFERY

JUNE, 2021

GONDAR, ETHIOPIA

2
 ACKNOWLEDGMENTS
First, I would like to acknowledge Mrs. Mulunesh Abuahay (MPH/RH, Assistant
professor) and Mr. Melaku Hunie (MPH/RH) for their cooperation and support to do this
thesis.

Secondly, I would like to give thanks University of Gondar College of medicine and
health sciences school of midwifery, department of clinical midwifery for giving chance
to do this thesis which undertaken in my area of interest in this specific place and for
support of money.

I would like express my deepest gratitude to the respondents, data collectors,

supervisors for their involvement to do this thesis.

Special thanks go to my friends, colleagues and to those who all contributed to do this
work for their posetivepositive critique and support through the development of the
thesis.

I
 ABBREVIATIONS/ACRONYMS

AOD Adjusted Oodds Rratio

CI Cconfidence Iinterval

COR Ccrude Oodd Rratio

EDHS Eethiopian Ddemographic Hhealth Ssurvey

EMWA Ethiopian Mmediwifery Aassociation

LMIC Llow and Mmiddile Iincome Ccountries

RMC Rrespectful Mmaternity Ccare

SBA SSkill Bbirth Aattendant

SDG Ssustainabel Ddevelopment Ggoal

UoG Uuniversity Oof Ggondar

WHO Wworld Hhealth Oorganization

II
 TABLE OF CONTENT

CONTENTS PAGE
ACKNOWLEDGMENTS....................................................................................................I

ABBREVIATIONS/ACRONYMS.......................................................................................II

TABLE OF CONTENT.................................................................................................... III

LIST OF TABLES............................................................................................................ V

LIST OF FIGURES......................................................................................................... VI

ABSTRACT....................................................................................................................VII

1. INTRODUCTION..........................................................................................................1

1.1. Statement of the problem......................................................................................1

1.2 Literature reviews................................................................................................. 3

1.3.Justification of the study.......................................................................................11

2. OBJECTIVE............................................................................................................... 12

2.1 General objective..................................................................................................12

2.2 Specific objectives................................................................................................12

3. METHODS................................................................................................................. 13

3.1. Study design and period......................................................................................13

3.3. Populations..........................................................................................................13

3.3.1. Source population.........................................................................................13

3.3.2. Study population........................................................................................... 13

3.4. Eligibility criteria...................................................................................................13

3.5. Sample size determinations.................................................................................14

3.6. Sampling procedure............................................................................................ 14

3.7. Variables of the study..........................................................................................16

III
 3.8. Operational definition...........................................................................................16

3.9.Data collection tools and procedure.....................................................................17

3.10. Data quality controls..........................................................................................17

3.11. Data processing and analysis............................................................................18

3.12. Ethical consideration.............................................................................................19

4. RESULT..................................................................................................................... 20

4.1. Socio-demographic characteristics of study participant.......................................20

4.2. Maternal obstetric characteristics........................................................................22

4.3. Maternal health service related variables...........................................................23

4.5. Mothers, Providers, facility and companion related variables..............................25

5. DISCUSSION.............................................................................................................30

6. REFERENCE............................................................................................................. 36

7. ANNEXES..................................................................................................................40

IV
 LIST OF TABLES

Table 1 Sociodemographic characteristics of respondents at Debre Markos town, North

West Ethiopia from February to March 2021..................................................................20
Table 2 Maternal obstetric characteristics of study participant at Debre Markos town,
North West Ethiopia from February to March 2021........................................................22
Table 3 Maternal health service related variables of study participant at Debre Markos
town, North West Ethiopia from February to March 2021..............................................23

V
 LIST OF FIGURES

Figure 1: conceptual frame work about labor companionship utilization and associated
Factors which developed from review of literatures (36, 43, 44, 48-52).........................10
Figure 2 Schematic presentation of the sampling procedure on utilization of
companionship during labor and associated factors among postnatal mothers who gave
birth at health institution of Debre-Markos town, North West Ethiopia, 2021.................15
Figure 3 Women future preferred companion at Debre Markos town, North West
Ethiopia.......................................................................................................................... 25

VI
 ABSTRACT
Background: - pregnancy is a matter of life and death besides in addition to having
baby. Labor companionship is a human interactive process which provides social
support during childbirth process and it is one component of respectful maternity care
that used to quality assurance to achieve sustainable goal of maternal and neonatal
mortality reduction. There is limited evidence on birth companion utilization and its
associated factors.

Objective: - The aim of this study wasis to assess utilization of labor companion and
associated factors in Debre Markos town public health institutions.

Methods: - An institution based A Cross sectional study design was conducted among
from 559 postpartum women at Debre-Markos town health institutions, East-Gojam
northwest Ethiopia from February/date/month/year to March /date/ 2021.A with
pretested interviewer administered questioner was useds. Participants were selected
by systematic random sampling technique. Data were entered and analyzed with Epi-
data version 4.60 and SPSS version 25.0 respectively. Bivariable regression was done
and variables with p-value </= 0.20 were analyzed with multivariable logistic regression.
Lastly variables with p-value </= 0.05 were considered significantly associated with
labor companion utilization. Model fitness was checked with Hosmer- Lemeshow and all
Multi-collinearity of variables with variance inflation factors up to 10 were tolerated.
Results were presented and disseminated with paragraphs, tables and figures.

Results:- A total of among 559 respondents 548 participants were involved in the study
were participate with 98.03% response rate. From all participants 14.6%( ) of them
were utilize labor companion. Factors significantly associated with outcome of interest
were Wwomen desire???Adjusted Odds Ratio(AOR)=---95% CI ------, parity(AOR=--
95% CI---, pregnancy complication(AOR=--95% CI---, sex of skill birth attendent mostly
follow(AOR=95% CI--- )and womens’ percived busy skill birth
attendentattendant(AOR=--95% CI---).were significantly associated with utilization of
labor companion

VII
Conclusion:- Uutilization of labor companion was found to be low in the study
area.Great attention needs to be given on women’s desire , parity, women with
pregnancy complication, sex of skill birth attendant who follows her and women
perceived busy skill birth attendant. is significantly low to achieve the goal of maternal
and neonatal mortality reduction. Maternal obstarics factors and providers related
factors were significantly associated with the prevalence of the service. It needs an
effert of concerning bodies so ministry of health, health facilities, health profesionals,
political leaderes and researchers should be give emphasis in this area.

VIII
IX
 1. INTRODUCTION

1.1. Statement of the problem

For most women being pregnant is not just a matter of having a baby, it is a matter of
life and death(1).Across time and cultures, women have been supported during labor by
other women who are experienced in providing continuous emotional and physical
support. However this component of maternal care was largely missed when childbirth
takes place in health facilities because of intrapartum care focus on utilization of
technological aspect of care like CTG for feto-maternal monitoring rather than
supportive aspect maternal care during the end of 20th century (2).

Labor companionship is a human interactive process which provides tangible

continuous social support or assistance (emotional, cognitive and physical support)
during childbirth process to help women cope with stress of labor with an empathic
person. Companion is any person chosen by a woman for providing continuous support
like advice, information and comfort during labor and child birth (2-4).

Evidences suggested that labor and childbirth with companionship have both long term
and short term obstetrical and postpartum benefits like reduction of anxiety(5, 6),
postpartum depression(6), emergency cesarean section rate(3, 6, 7), episiotomy, fetal
distress, instrumental delivery, need of antipain(3, 6),pain perception(5),length of
labour(3, 6-8), need of oxytocin for augmentation(6) and meconium-stained amniotic
fluid(9) and increase; spontaneous vaginal birth, positive feelings about childbirth
experience(6),exclusive breastfeeding practices(3, 6),rate of breast feeding initiation(6),
maternal satisfaction(9, 10) ,five-minute APGAR score(3, 8, 11), mother baby
bonding(6),skin to skin contact, labour easy and enjoyable, sufficient milk for baby(12).

Additionally, evidences also revealed that utilization of birth companion reduced the risk
of disrespected and abused care by 10 times (13), mean of childbirth fear by 0.866 (14)
compared to non-utilized one. Furthermore laboring women self-efficacy increased by
0.903 due to the presence of one preferred birth companion support in addition to

1
routine childbirth care given by SBAs (14). Generally as conclusion absence of a labour
companion is one predominant factors for negative birth experience(15).

Practice of labor companionship also necessary for family members and health care
providers. Continuous support of woman with her husband increase the satisfaction of
the husband and bonding of baby with the father(16).

In-spite of scholars clearly state about the benefits and women’s willingness , desire or
a profound need of companionship during labor (17), many health-care facilities in
developing countries still do not promote practice of companionship during labour and
delivery (18-20). Because of this many women in LMICS choose home and TBA than
health facility and SBA respectively to give childbirth (21, 22) and more than half of
women in Ethiopia still deliver at home(23).

As a result maternal and neonatal mortality is still a tragedic event in the globe
especially in developing countries. Maternal mortality ratio significantly different
between developed and developing worlds (11/100000 and 462 per 100000 live birth)
(24).This discrepancy is due to lack of quality of care and low utilization of
institutionalized, client centered and continuous preferred companion supported care
especially in less developing countries including Ethiopia(25-27).

To overcome these problems different countries like South Africa implement doula
care(28) and different scholars, WHO, FIGO, Ethiopian midwife association and the like
strongly recommend to practice labor companionship as a norm rather than the
exception(3, 4, 29-31).The Federal Ministry of Health of Ethiopia has also
endorsed/accepted these principles and adopted it; and streamlined/included in the
package in keeping with the launching of the Respectful Maternity Care(RMC).

Even though principle of birth companion utilization endorsed, adopted and included in
Ethiopian ministry of health of RMC package, there is no sufficient data about the extent
of implementation of labor companionship in our country health institutions as much as
I search with different searching engine. Therefore this study is aimed to assess the
prevalence of labor companion utilization and associated factors among postnatal
mothers in public health institution of Debre-Markos town.

2
1.2 Literature reviews

Enabling women’s pregnancy and childbirth as a part of sexual and reproductive health
rights is a part of International human rights law and fundamental commitments of each
Country including our country Ethiopia(32). As a result every pregnant woman and
newborns have the right to gate quality person centered care(33). Allowing
companionship in labor is one of hearty intervention to achieve quality care provision
which increase maternal satisfaction(34, 35).Every health institutions must have a
written policy that encourage practice of at least one birth companion throughout labor
and delivery to fulfill criteria of mother-baby friendly birthing centers(30).

Utilization/practice of companionship during labor

Institutional based national survey finding which assessed by using hospitalized

interview, record review and telephone follow up interview among 23,940 postnatal
women in Brazil during 2011/12 asserted 42.1% of women utilize continuous
companionship during labor(36). Furthermore according to an evaluative retrospective
survey among 406 records of immediate post-partum mothers assisted for normal
childbirth at three maternity unit of Southern Brazil in 2014 finding only 16.7% of women
receive childbirth care with the presence of birth companion(37).

Community based crosectional study among 1367 mothers who had history of delivery
with in one year in 2018 at bangladish showed that 68% of women utilize companion of
choice during labor and child birth which was significantly higher at home birth(38).

Large scale crossectional observational study among 63077 in 2018 at 6 hospitals in

nepal revealed that 19% of study participants were utilize labor companion during their
hospital admission for labor and delivery process(39).

Interview administered prospective cohort study among 402 postpartum women in

Riyadh revealed that only 14.2% mothers ever had a supportive companion during any
of their previous childbirths(40).

3
Cohort study among 420 surveyed postnatal women who deliver single newborn
vaginally at hospital in United Arab Emirates asserted that 59.3% of mothers utilize
companionship from non-professional attendants like mother, sister, friend, close family
relative and husband (41).

Quantitative exploratory descriptive study in South Africa among 62 postnatal women

who were selected with Convenience sampling that assess with validated questioner to
explore experience and opinion about companionship during labor asserted that only 15
(24.2%) of women had companions during labor and from the remain 47(75.8%) of
mothers 35 (74.5%) had no knowledge about companionship(28).Another base line
evaluation study finding from interview of 2090 women in 10 hospitals of South Africa
before studying randomize control trial to assess feasibility of birth companion revealed
that majority (84.5%) of women had not had child birth companion(42).

Descriptive facility based cross sectional study in Nigeria among 512 postpartum
mothers within 48 hours of term uncomplicated delivery asserted that even more than
half of participants desired to have companionship in labour only 13.1% study
participants utilize labour companion(43).

A cross sectional facility and community based study in Tanzania during 2016 among
935 postnatal women who have alive neonate and 732 reproductive age women
asserted that only 44.7% and 60.1% of mothers respectively utilize companionship
during labor (44, 45).

Qualitative and quantitative study in Kenya about birth companion utilization among 877
surveyed and 8 group discussions with 58 reproductive age women who delivered in the
9 weeks preceding the study revealed that 88% of women were accompanied by
someone from their social network to the health facility during their childbirth, with 29%
accompanied by a male partner. Sixty-seven percent were allowed continuous support
during labor, but only 29% were allowed continuous support during delivery. Eighteen
percent did not desire companionship during labor and 63% did not desire it during
delivery(46).

4
A study in Addis Ababa health facilities on health professionals to assess attitude,
knowledge and practice towards labor companionship among 378 health professionals
who work in labor ward asserted that 63.2% of health professionals did not allow a labor
companion to the delivery room because of crowdedness of ward, fear of infection
spread, institutional policy and privacy concern. Among 275 female SBAs 37% had
history of childbirth and 59.8% of them utilize labor companion during their own delivery,
From those who had a companion, more than two third (68.8%) had their husband as a
companion followed by 17(27.8%), 13(21.3%), and 11(18%) their mothers, friends, and
sisters respectively. Out of the 61 female participants who had labor companion in their
own delivery, the majority, 55(90.2%) stated that having a companion gave them
strength during labor(47).

Facility based cross sectional survey from December 2014 to February 2015 in Tigray,
Northern Ethiopia to assess quality of intrapartum care among 216 labouring mothers
andA their newborns showed that for only 39.8% of women allowed their preferred
birthing partners(48)

A recent institutional based cross sectional study in Arbaminch Ethiopia to assess

utilization of labor companion among 407 postnatal women showed that only 13.8% of
women utilize labor companionship(49).

1.2.2 Factors associated with companionship during labor and childbirth

Utilization of birth companionship affected by women’s perception and preference,

characteristics and attributes of companion (support person), type of supportive care,
health care institutions policy and guidelines(50).

1.2.2.1 Maternal related factors

Socio-demographic related factors of the mother

National survey in Brazil stated that educational status of the women significantly
associated with birth companion utilization. Women’s educational status below 11 years
increase a risk of non-utilization of companion by a factor 1.8 compared with
educational status above 11 years (36).

5
Mixed community based surve in Kenya about birth companion utilization with interview
and group discussion among 877 and 58 reproductive age women who delivered in the
9 weeks preceding the study respectively conclude that economic status of a woman
significantly associated with labor companionship. Being more economically good
nearly 2times more likely utilize labor companion than very less household wealth(46).

Mixed community based survey in Kenya about birth companion utilization with
interview and group discussion among 877 and 58 reproductive age women who
delivered in the 9 weeks preceding the study respectively conclude that women’s work
status significantly associated with experience of labor companionship. Employed
women utilize labor companionship 1.97 times higher than un employed woman(46).

Mixed community based survey in Kenya about birth companion utilization by interview
with 877and group discussion with58 women who delivered in the 9 weeks preceding
the study conclude that status of literacy significantly associated with labor
companionship utilization. A woman who write very well 2.89 times more likely utilize
labor companion than a woman who not write totally (46).

Mixed community based survey in Kenya about birth companion utilization by interview
with 877 and 58 women who delivered in the 9 weeks before the study conclude that
group of ethnicity significantly associated with labor companionship utilization. Being
Kuria reduce utilization of labor complain by 43% compared to Luo tribe (46).

Obstetric related factors

Study in Brazil concludes that type of delivery was significantly associated with
utilization of companionship. Women who give birth with vaginally 1.6 and 2.5 times risk
of complete and partial absence of companionship in hospital admission compared to
women who give birth with cesarean section (36).

According to mixed community based survey in Kenya 2016and Brazil national survey
2011/12 number of delivery significantly associated with being allowed and utilization of
companionship during labor and total hospital stay respectively (36, 46). Being
multipara increase a risk of total and partial absence of companionship by 60% and

6
20% respectively compared to nulliparous during hospital stay (36).Being Para 3 had
63% lower odds of allowed continuous support during labor compared to Para one(46).

A recent cross sectional study in Arbaminch Ethiopia conclude that being primipara was
more than two times increase the utilization of labor companion compared with
multipara(49).

Mixed community based survey in Kenya about birth companion utilization by interview
with 877 and 58 women who delivered in the 9 weeks before the study conclude that
history of delivery in health facility significantly associated with utilization of labor
companionship. Having prior history of institutional delivery increase experience of
continuous support by a factor of 2.19 compared to woman who had no history of facility
based delivery(46).

A 2019 Interviewer administered questionnaires based cross sectional study finding in

Arbaminch Ethiopia among 407 postnatal mothers asserted that women’s who have
pregnancy, labor and delivery complication increase utilization of labor companion by
nearly 3.5 times than the other counterparts(49).

Other maternal related factors

Qualitative and quantitative study finding in Kenya showed that Women who desired a
labor companion had about 40% higher odds of being allowed continuous labor support
than those who did not desire one (46).

Institutional based cross sectional study in Arbaminch town, Ethiopia during 2019
conclude that women who have desire to have labor companion more than five times
utilize labor companionship compared to women who have no desire(49).

Qualitative and quantitative study finding in Kenya showed that woman who
accompanied by sister/sister in-law had 1.85 higher odds of being allowed labor
companionship than woman who was not accompanied by sister/sister in-law(46).

7
Health care providers related factors

An explorative descriptive and contextual qualitative study in south Africa during 2013
among 33 midwifes with focus group interview showed that communication status of the
midwives is the challenges for implementation of continuous labor support(51).

Facility based cross sectional study in Tanzania conclude that more than half (53%) of
women’s companionship utilization affected by client related variables like health care
provider’s sex(45).

Study finding in Kenya during 2016 with both qualitative and quantitative approach
among 877 and 58 women who deliver 9 month before survey with interview and group
discussion revealed that women who attend her childbirth process with male and female
SBAs at the same time increase utilization of birth companion by a factor of 4.68
compared to woman who attended by male SBAs only (46).

Facility related factors

Health institutions policy, input (human resource and bedside chair) and architectural
outlay of maternity unit and space of ward was significantly associated with utilization of
Companionship during maternity service provision (36, 51-53).

Facility which is not having policy that allow companionship supported service provision
was 4.1and 2.3 times more likely not and partial utilization of companionship
respectively compared to facility which have policy that allow companionship(36).

Chance of companionship absence strongly associated with facilities which have chair
beside each bed for companion. Presence of chair by the side of every bed and some
bed enhance companionship implementation by a factor of 3.4 and 2.0 respectively
compared to facilities which were not have chair for companion(36).

Facility type is significantly associated with utilization of labor companionship according

to mixed based study in Kenya. Woman who give birth at public health center 1.98
times more likely utilize continuous labor support by their own chosen companion than
who deliver at government hospital (46).

8
According to client perspective study finding in Kenya 2016 women’s experience for
labor with companionship was significantly associated with facility over crowdedness.
When health facility over crowded most or all time, allowing of labor companion reduced
by 35% compared to not crowded or crowded only a few times (46).

9
 Maternal health service
related variables:
Number of ANC
Providers and Facility related factors: antenatal education about
Type of facility companionship
Sex of SBAs
Input like bedside chair
Crowdedness of facility
architectural outlay of the maternity units
(space and privacy)

Labor companionship utilization

Obstetric related variables: Sociodemographic variables:

Parity Educational status
Type of delivery women occupation
History of institutional birth average Monthly income
A person accompanied from Ethnicity
home Age

Figure 1: conceptual frame work about labor companionship utilization and

associated Factors which developed from review of literatures (36, 45, 46, 50-54).

10
1.3. Justification of the study
Knew a time focusing on quality of service is a concern of the world especially
developing countries like Ethiopia to achieve sustainable development goal by
2030.Therefor to improve quality service provisions enhance client center care like
utilization of companionship is hearty intervention. As a result this study is a government
concern.

Furthermore in diverse cultural heritage countries like Ethiopia studying factors related
to non-utilization of labor companion is helpful for SBAs to understand and focus about
laboring women desire and willingness before allowing clients social as companion
during labor.

Even though companionship plays a great role for reduction of maternal and neonatal
mortality and morbidity, evidences related to utilization of labor companion is limited and
the practice also uncommon during my exposure to practice as clinician in midwifery
profession in our public hospitals. Therefore this study is our interest to explore all
aspects of labor companionship in our setup and forward recommendations and
promotions for future practice especially in the study area.

Knowing and identifying practice gap in companionship during labor and its predictors in
Ethiopian which have high burden of maternal and neonatal mortality and low coverage
of institutional delivery will play a great role for all stakeholders who work for
improvement of positive childbirth process as a ground to develop and incorporate labor
companion utilization strategy in order to reach the goal of sustainable development and
Ethiopian ministry of health plan. Therefore, this study finding will provides important
insights that can be used to improve practice and policies on birth companionship by
advocating companionship for Ethiopian health institution to do as a norm because
women centered care is not just complementary to provision of clinical practices.

Furthermore this research will objectively identify silent challenges of companionship

utilization and will give some clue of solution to tackle it according to other countries
experience. Additionally this study finding also gives important information for future
researches who are interested in this specific area.

11
 2. OBJECTIVE

2.1 General objective

To assess labor companion utilization and associated factors among postpartum
mothers at Debre-Markos town public health institutions, northwest Ethiopia, 2021

2.2 Specific objectives

To determine assess labor companion utilization among postpartum mothers at Debre-
Markos town public health institutions, northwest Ethiopia, 2021

To identify factors affecting labor companion utilization among postpartum mothers at

mothers at Debre-Markos town public health institutions, northwest Ethiopia, 2021

12
 3. METHODS

3.1. Study area ,design and period

Institution based cross sectional study design was conducted from February-1/20??? to
March 30, 2021.

3.2. Study area

This study was conducted at Debre-Markos town public health institutions, EastGojam
Ethiopia. Debre-Markos town is an administrative town of east Gojam zone, which is
located 276 kilometer from Bahr Dar (capital city of Amhara region) and 300 kilometer
from Addis-Ababa (capital city of Ethiopia). It has latitude and longitude of 10 o20/N 37o
43/ E and an elevation of 2,446 meters. According to population projection of Ethiopia
for all regions at woreda level from 2014-2017, the total population of the town is
estimated to be 92470. Among these 46,738 are females (55). Currently it has seven
kebeles (the smallest administrative unit in Ethiopia). This town has 1 referral hospital
and 3 public health centers. All public health facilities of the town are providing maternity
care service including intrapartum care.

3.3. Populations

3.3.1. Source population

All postpartum mothers who give birth at public health facilities of Debre-Markos town

3.3.2. Study population

All postpartum mothers who give birth at public health facilities of Debre-Markos town
during data collection period

3.4. Eligibility criteria

3.4.1. Inclusion criteria

All postpartum mothers who gave birth at public health facilities of the town during data
collection period

13
3.4.2. Exclusion criteria

Women, who were seriously ill or unable to interviewed due to physical or mental
problems during data collection period.

All mothers who gave birth with elective cesarean section during data collection period.

All postnatal mothers who was admitted to facility after second stage

3.5. Sample size determinations

The sample size of the study was 559 which was determined with the consideration of
proportion of companionship utilization 13.8% from previous study in Arbaminch,
Ethiopia (49), 95% confidence level, 3% margin of error, 10% non-response rate. Then:
n = (zα/2)2×p (1− p ¿/d 2 where: n = sample size, p (0.138) = proportion of women utilize
labor companion during labor, d (3%) = margin of error within 95% CI. Then n= 508 by
adding 10% non-response rate, n =559

3.6. Sampling procedure

This study was conducted at all public health institutions of Debre Markos town with
proportional sample size allocation based on their number delivery reports of each
health facilities two month prior to the study period. Calculated k-factors for each
selected facilities was 2 according to their past delivery registration book as sampling
frame (i.e. k=N/n; N as total study population in each health institutions, n as allocated
sample size of each health facilities). After checked eligibility criterion using record
review the study unit was selected by systematic random sampling technique with
consideration of delivery time as reference frame. Starting point of interview was
obtained with lottery method and interview was carried out in every other client interval
for each facility until fulfillment of allocated sample size. A selected client who was not
volunteer to participate in the study was considered as non-response. The overall
sampling technique performed in the town is shown in the form of the following figure.

14
 Total expected delivery at Debre Markos public health facilities in a month

Public health facilities in the town with

average monthly client flow(4)

Hospital (1) Health centers (3)

MHC WHC
DMRH:
HHC N=30 N=28
N = 1040
N=60

Proportional allocation for each health institutions

n=501 n=29 n=15 n=14

Systematic random sampling

Total sample size = 559

Figure 2 Schematic presentation of the sampling procedure on utilization of

companionship during labor and associated factors among postnatal mothers
who gave birth at health institution of Debre-Markos town, North West Ethiopia,
2021

15
3.7. Variables of the study
3.7.1.Dependent variable

Labor companion utilization

3.7.2. Independent variables

Client related factors

 Socio-demographic characters: Age, Religion, marital status, Monthly income,

residence, ethnicity of the mother and educational & employment status of the
mothers and her husband.
 Obstetric factors: Gravidity, Parity, bad obstetric history, pregnancy
complication, labor and delivery complication, mode of delivery
 Maternal health service related variable; ANC utilization, place previous of
delivery labor, previous history of companion use,advice/information provided by
health care provider about birth companion utilization selection, counseling about
birth preparedness and complication readiness (BP and CR) during ANC.
 Other client related factors:- desire to have labor companion, clients culture
about companion utilization, knowledge about the right of companion utilization,
women preference companion

Provider related factors :- Care providers sex, workload/busyness of SBAs

Health service related factor: crowdedness of the facility, cleanliness of facility,

bedside chair for companion and curtain/single room availability.

3.8. Operational definition

Companionship/Companion:- any person chosen by a woman to provide her with
continuous support during labour and childbirth from the woman’s family or social
network (spouse/partner, a female friend or relative, a community member (such as,
female community leader, health worker or traditional birth attendant) or a doula (4).

16
Labor companionship/companion:- someone who the patient wanted to be present
during labor for providing support like emotional, tangible, informational and advocacy
all moments of the labor process. It may be provided by a partner, family member or
social network (56).

Utilization of labor companion:- a women having a continuous preferred

companion/support person from their social networks who provides either emotional,
tangible, informational, advocacy or all during labor in the labor ward (4).

Continuous labor support: allowing of labor companion to stay with the mother in all
or most of the time during labor at labor ward (46).

Routine/ standard maternal care: is that one professional staff member needs to
support a number of pregnant women over a certain time period.

Supportive care:- a care during the intrapartum period can involve many factors, like:
emotional care, comfort measures, information and advocacy (2).

Doula: A woman who has been trained in labor support but not a part of health care
facility professional staff (4).

Complicated pregnancy: displays either the presence of risk factors for obstetric
complications or complications manifested during current pregnancy(57).

3.9. Data collection tools and procedure

Data were collected with a pre tested semi structured interviewer administered
questionnaire with trained data collectors. Problems faced during data collection were
solved at that specific time point of data collection. On top of that there were continuous
follow up and supervision by supervisor and the principal investigator throughout the
data collection period. The questioner was taken from the review of all available
relevant literatures and adapted to suit the study context. Questioners were grouped
and arranged according to particular objective that they should address.

17
3.10. Data quality controls
To assure the quality of data properly designed data collection tools was developed and
pretest was conducted with 5% (28) participants of this sample size at lumama primary
hospital before one week of actual data collection to check the validity and reliability of
questionnaire to the objective of the study. One day intensive training on data collection
tool, ethical conduct and quality of data collection was given for data collectors and
supervisors. The questionnaire was translated to Amharic to make it understandable by
the study participants and then was retranslated to English by another person to check
whether the transition is consistent. The data collectors was strictly followed by the
supervisors and reported to principal investigator in daily basis. The supervisors and
principal investigator supervised the correct implementation of the procedure as per
planned and check completeness and logical consistence during data collection.

3.11. Data processing and analysis

All completed questionnaire was checked for completeness and internal consistency by
principal investigator and the coordinators each day and code was given to the
completed questionnaire. Data were cleaned before and after entry. Across checking
data were coded and entered with epidata 4.6 and analysis with SPSS version 23 after
coding and recoding. Data cleaning were performed to check for accuracy,
consistencies, and values. Then any form of error were identified and corrected.
Descriptive statistics like text, frequency distribution, percentage, tables, and were used
to describe and summarize the study population in relation to relevant variables. Both
bivariable and multivariable logistic regression models were used to identify factors
associated with the outcome variable. All variables with p-value less than 0.25 with bi-
variable analysis were entered in to multivariable analysis that used to not to miss
associated factors. Then multiple logistic regression analysis was performed to
investigate independent predictors by controlling for possible confounders. Finally,
variables whose p value <0.05 in logistic regression were considered as the cutoff point
for statistically significance association. HosmerLemeshow test was used to check
goodness of fit of the models. Multicollinearity was diagnosed using variance inflation
factor (VIF) and all covariates having a value VIF up to 10 was tolerated.

18
 3.12. Ethical consideration
The study proposal was submitted to and approved by School of midwifery ethical
review committee under the delegation of UOG institutional review committee.
University of Gondar wrote Official letter to debre-markos town health department and
each selected health institutions. An istitutional permission was obtained from debre-
markos town health departement, debre markos referal hospital clinical director.
Protective equipment like face mask was given for data collectors and supervisors..
Participants were informed clearly about the purpose and benefit of the study and
written and signed informed consent was obtained from them with data collectors who
wear face mask and keep his/her distant. Those who signed written consent were only
participate in the study and leave who were not volunteers to participate and consider
as non response. The confidentiality of responses was maintained throughout the
research process by giving code for participant. Personal privacy and cultural norms
was respected. All consent form was translated into and administered in Amharic.

19
 4. RESULT

4.1. Socio-demographic characteristics of study participant

From the initially planned sample size of 559 individuals, data was collected from 548
participants with a response rate of 98.03%. The median age of respondents were 27
years (with IQR: 24-30years) and nearly three fourth (71.5%) of women were within the
age category of 25-34 years. Most (96.9%) respondents were Orthodox Christian by
religion and two-third (66.8%) of the study participants live in rural. One hundred sixty
four (29.9%) and 153(27.9%) study participants were housewives and no-formal
education by occupation and educational attainment respectively. More than half of
(56.4%) of respondent average monthly income was greater than or equal to 3000
Ethiopian birr. About 96.2%of the participants were married and nearly one-third of
(32.6%) their accomplished College and above by education. Occupations of nearly
one-third (31/3%) respondent’s husband were farmers.[Table1].

Table 1 Sociodemographic characteristics of respondents at Debre Markos town,

North West Ethiopia from February to March 2021

S.no Variables Categories frequency Percentage

1 Age(n=548) 15 to 24 156 28.5%
25 t0 34 289 52.7%
35 to 49 103 18.8%
2 Residence(n=548) Rural 366 66.8%
Urban 182 33.2%
3 Religion (n=548) Orthodox 531 96.9%
Muslim 16 2.9%
Protestant 1 0.2%
4 Ethnicity (n=548) Amhara 543 99.1%
Agew 4 0.7%
Oromo 1 0.2%
5 Educational status(n=548) No formal education 153 27.9%
Primary education 149 27.2%
Secondary education 102 18.6%

20
 Colledge and above 144 26.3%
6 Occupation(n=548) House wife 164 29.9%
Government employee 106 19.3%
Private worker 48 8.8%
Merchant 64 11.7%
Farmer 144 26.3%
Othersa 22 4%
7 Marital status(n=548) Married 497 90.7%

Unmarried 9 1.6%
Divorced 12 2.2%
Separated 30 5.5%
8 Average monthly Less than 3000 239 43.6
income(n=548) >= 3000 309 56.4
9 Husband No formal education 117 22.2%
education(n=527) Primary school 122 23.1%
Secondary school 116 22%
Colledge and above 172 32.6%
10 Husband Farmer 165 31.3%
occupation(n=527) Government employee 132 25%
Merchant 111 21.1%
Private worker 87 16.5%
Daily laborer 21 4%
b
Others 11 2.1%
Foot note: - a; other includes: student, NGO, jobless and daily laborer

b; other include: jobless, NGO, intermid

21
4.2. Maternal obstetric characteristics respondents

From the total study participants, 306 (55.8%) mothers were multipara. Ffrom three
hundred thirty three multigravida women87 (26.4%) and 65(19.2%) had at least one
history of abortion and bad obstetric history (BOH) respectively. Nearly one fifth of
(18.8%) of interviewed women had at least one pregnancy complication. From all
interviewed mothers majority (98.7%) had no history of chronic illness and 61.9% not
faced any labor-delivery complication. Three-fourth of (74.6%) study participants were
delivered with spontaneous vaginal delivery [Table 2].

Table 2 Maternal obstetric characteristics of study participant at Debre Markos town,

North West Ethiopia from February to March 2021

Variables Categories Frequency Percent (%)

Gravidity(n=548) Premigravida 215 39.2%
Multigravida 333 60.8%
parity(n=548) Premipara 242 44.2%
Multipara 306 55.8%
BOH(n=333) Yes 64 19.2%
No 269 80.8%
History of abortion(n=333) Yes 88 26.4%
No 245 73.6%
pregnancy status(n=548) Planned 507 92.5%
Un-planned 41 7.5%
Wanted 534 97.4%
Un-wanted 14 2.6%
Supported 528 96.4%
Un-supported 20 3.6%
Pregnancy complication(n=548) Yes 103 18.8%
No 445 81.2%
History of chronic Yes 541 98.7%

22
 illness(n=548)
No 7 1.3%
Labor-delivery complication Yes 209 38.1%
(n=548)
No 339 61.9%
Current delivery type(n=548) SVD 409 74.6%
Cesarean delivery 111 20.3%
Instrumental 28 5.1%
delivery
Foot-note;

4.3. Maternal health service related variables

The majority (96%) of mothers had at least one ANC visit, 73.4% of them was informed
about at least asingle component of birth preparedness and complication readiness
during index pregnancy. Nearly one-fifth of (18.4%) study participants were informed
about birth companion selection during their ANC follow up time. Among 526
participants, who had ANC follow up 73.4% of them had four and above visit. For this
labor and delivery, one tenth (10.4%) of study participants were delivered at health
center [Table 3].

Table 3 Maternal health service related variables of study participant at Debre

Markos town, North West Ethiopia from February to March 2021

S.No Variables Categories Frequency Percent

(%)
1 At least one ANC(n=548) Yes 526 96%
No 22 4%
2 Number of ANC(n=526) Less than 4 140 26.6%
>= four 386 73.4
3 Counseled on BP and CR Yes 387 73.6%
during ANC(n=526) No 139 26.4%
4 Informed about birth companion Yes 97 18.4%
selection at ANC(n=526) No 429 81.6%

23
5 Current labor delivery Hospital 491 89.6%
place(n=548) Health center 57 10.4%
6 Previous delivery place(n=306) Health facility 244 79.7%
Home 58 19%
Elsec 4 1.3%
7 Is fear of loneliness at labor Yes
room risk for home delivery? No
(n=58)
8 Previous delivery facility Public hospital 153 62.7
type(n=244) Public health 87 35.7
center
Private health 0 0
facility
Health post 4 1.6
9 History of labor companionship Yes
No
Foot-note;c: past delivery place other than health facility and home which is at road.

4.4. Mother’s knowledge, desire and preference on labor companion related

variables

From all 548 study participants, more than two third of (69.9%) them knowledge status about
labor companion was below the mean (2.31) and the rest (30.1%) above the mean. About 450
(82.1%) study participants had a desire to utilize labor companion for their future laboring
process. Among women who had desire 37.23% were preferred their husband followed by
mothers/mother in-law (30.66%) see figure (1) below

24
Figure 3 Women future preferred companion at Debre Markos town, North West
Ethiopia

4.5. Providers, facility and companion related variables

From total 468 respondents who were not utilize labor companion during their labor process
were mention different reasons. From these reasons facility related, health care professional
related and companion related variables were mentioned. Among these variables 93.8% were by
non-allowing of SBAs table. See table below.

S.No Variable Category Frequency Percent (%)

1 Facility not Allow(n=468) Yes
No
2 No bed side chair for companion Yes 123 26.3%
(n=468) No 345 73.7%
3 Busy laboring class(n=468) Yes 224 47.9
No 244 52.1

25
4 No single room or curtain for Yes 225 48.1
labor(n=468)
No 243 51.9
5 SBA not allow(n=468) Yes 439 93.8
No 29 6.2
6 No preferred companion at a Yes 41 8.8
time(n=468)
No 427 91.2
7 I did not want/no desire(n=468) Yes 129 27.6
No 339 72.4

4.6 variable of labor companion utilization and its association

All most all (99.8%) of respondents were accompanied from home to health facility with at least
one supporting person from her social-network. More than two third of them were accompanied
by husband (78.4%) followed by mother/mother in-law (37.5%), sister/sister in-law (35.6%),
father/father in-law (17.2%) brother (16.1%) friends/neighbors (16.1%). About 80(14.6%) of
study participants were utilized labor companion. Of those women who had a companion,
98.8% of them were accompanied with their preferred companion. More than one third of
them were accompanied by their husband (39.4%) and mother/mother in-law (35.5%). Among
respondents (547) who had companion from their social networks 10(1.8%) of them were
allowed to had continuously supported during their labor process after admission to the labor
ward with their preferred companion. see figure below

26
Figure 3 prevalence of labor companion allowness with respect to the contiunity period at Debre-
Markos town public institutions North West Ethiopia, 2021

5. 5 Factors associated with labor companion utilization.

Bi-variable and multivariable binary logistic regression analysis was done to identify factors
associated with labor companion utilization. On bi-variable binary logistic regression mothers’
age, parity, pregnancy complication, current delivery type, busyness of staff, sex of SBAs mostly
followed, women’s future desire, knowledge of women and current labor and delivery place had
an association with utilization of labor companion. However, on multivariable logistic regression
analysis pregnancy complication, SBAs busyness, sex of SBAs mostly followed, parity and
desire were significantly associated with labor companion utilization.

Those women who had at least one pregnancy complication or pregnancy was high risk were 3.3
times more likely utilize labor companion compared to those women who did not face any type
of pregnancy complications (AOR = 3.287, 95%CI:1.818-5.943).

27
Being Premipara were 2.4 times more likely utilize labor companion compared to Multipara
women (AOR= 2,358, 95% CI: 1.354-4.108).The odds of utilizing labor companion among
women who were followed their most laboring time with female SBAs were reduced by 65.6%
(AOR= 0.344, 95%CI: 0.18-0.67) compared to those women followed by only male SBAs for
their most laboring time after admission to the health facility.

According to women’s perspective view being busyness of staffs were decreased the odds of
labor companion utilization with eight six percent compared to those staffs that were not busy
during their labor follow up time (AOR=0.138, 95%CI: 0.079-0.241).

Women who had a desire for labor companion utilization 3.5(AOR=3.480, 95%CI1.426-8.494)
times more likely utilize labor companion compared to counterpart. For more information see
table below

28
Table: Bi-variable and multivariable binary logistic regression analysis of factors associated with
labor companion utilization, in Debre-Markos town public health institutions, northwest
Ethiopia,2021 (n=548).
Variable Labor companion COR(95%CI) AOR (95%CI)
utilization
Yes No
Future desire (n=548)
Yes 73 349 3.556 (1.593-7.937) 3.480 (1.426-
8.494)**
No 7 119 1 1
Parity(n=548)
Premipara 51 191 2.550 (1.560- 2.358 (1.354-
4.170) 4.108)**
Multipara 29 277 1 1
Pregnancy
complication(n=548)
Yes 30 73 3.247 (1.936- 3.287 (1.818-
5.444) 5.943)***
No 50 395 1 1
SBA Busyness
(n=548)
Yes 34 390 0.148 (0.089- 0.138(0.079-0.241)***
0.245)
No 46 78 1 1
Sex of SBAs mostly
followed(n=548)
Both 26 83 1.241(0.674-2.284) 0.847(0.418-1.717)
Female 27 107 .385 (0.216- 0.344(0.180-
0.686) 0.657)***
Male 27 278 1 1

29
AOR= Adjusted odd ratio, COR = Crude odd ratio, CI = Confidence interval,
1; reference category, ***P ≤0.001, **P≤0.01, *P≤0.05

5. DISCUSSION
This study aimed to assess utilization of labor companion and associated factors among
women who gave birth at public health institutions of Debre-Markos town, Ethiopia. The
overall prevalence of labor companion utilization in this study is was 14.6% (95%CI 117-
17.5). This implies practice of labor companion which is one main component of RMC
failed to practice during institutional labor and delivery service of study area.
This study is in line with studies conducted at retrospective record review based in
south Brazil (16.7%), prospective cohort in Reyadis (14.2%)(58), base line evaluation
study in south Africa (14.5%), Nigeria (13.1%) and Arbaminch, south, Ethiopia (13.8%)
(49).

In contrast to these studies prevalence of labor companion utilization of this study

(14.6%) iswas lower than findings from Brazil (42.1%) (36), UAE (59.3%), Nepal (19%)
(54), South Africa (24.2%) (28), Tanzania (44.7%) (43), Kenya (67%) (44), Addis Ababa
Ethiopia (59.8%) (45) and Tigray Ethiopia (39.8%)(46). The general possible
explanation might be our study was done in the era of COVID-19 which mainly
transmitted with contact and the glob at all proclamations distance keeping policy and
wearing of protective equipment.

The inconsistency of our study from Brazil national survey might be due to the
difference between health system policies of the countries which we understand from
their demographic health survey. Companionship is key maternal health indicators in
Brazil and which incorporate in to Brazil national demographic health survey as key
maternal health indicators and implementation of labor companion for all women were
included in their national law, whereas in our EDHS this service is not included as
maternal health service indicator like ANC, PNC and institutional delivery coverage. In

30
addition to this the disagreement between the studies might be due to sociocultural
difference and methods mainly study setting, model of analysis, data collection tool and
sampling technique. In Brazil study all postnatal women were included from both private
and public health facilities including baby friendly hospitals and data were collected with
both interview and record review then analyzed with multinomial regression whereas in
this study sample was collected from only interview at public health institutions and
analyzed with binary logistic regression model.

The possible explanation for lowering of our study compared to a study conducted at
UAE (58) might be sampling technique, study design, setting, sociocultural difference
and study population difference. Their sampling technique was not random and
interviewed post-partum women up to up to 2 months of post vaginal delivery of
singleton uncomplicated or good birth outcome postpartum. However, in our study
population multiple delivery, women with complicated pregnancy, bad delivery outcome
and women with emergency cesarean section were included by random sampling
technique. Furthermore the inconsistency between them might be due to socio-
economic difference

The possible justification for the inconsistency between studies at Nepal and our study
might be sociodemographic characteristics’ of study population, inclusion criterion of
population, study setting and measurement tool of outcome variable (labor companion
utilization). In Nepal study finding was affected mainly with women sociodemographic
characteristics. Participants were from different ethnic groups, at hospital level only,
both high and low risk groups including women who deliver after 22 weeks of gestation
and measure utilization with single yes or no question (54) while from a total of 548 our
study participants (99.1%) were from Amhara ethnic group and minimum gestational
age was 28 weeks. The more remote from term the more complication as a result being
complicated labor enhance labor companion utilization (47). Our tool for outcome
measurement was not with single yes or no question rather it contains three variables.

Our study finding showed that prevalence of labor companion utilization iswas lower
than a study conducted at South Africa at 2014. The possibility for the difference might
be sampling method, eligibility criterion and sociodemographic difference. The

31
maximum age group of our study participants were 25 to 34 whereas in Nigeria
maximum participants age category was less than or equal to 25(28). Women’s age
decrease utilization of labor companion increase (54). They include in the study only
women who read and write, does not have loss and only who deliver SVD with
convenience sampling technique but our study participants educational status include
women with no formal education and the higher educational level the high chance of
labor companion utilization (36, 44).

A study result on prevalence of labor companion at Tanzania with both client and health
professional interview was higher than our study. The possible explanation might be the
difference in the study population. In our study maximum numbers of participants were
interviewed from hospital whereas they interview more than 50% of respondents from
health-center (43).

Our prevalence study finding iswas lower than a study conducted in Kenya (67%) the
possible justification might be the study populations, they include participants from
private facilities(59) whereas in our study only from public facilities which are not
enduring for profit.

The coverage of labor companion utilization among health care professionals in Addis
Ababa Ethiopia who had history of labor and delivery were (59.8%) (60) which is higher
than our study. The discrepancy might be their profession and their companion was
friends who were health professionals. In other study to assess quality of delivery care
(39.8%) (48)of participants were accompanied by their companion which is higher than
our study. This difference might be due to way of data collection method and
measurement instrument of outcome interest.

Like, other studies done in Brazil(54), Kenya(59) and Arbaminch (61) Ethiopia, our
study conclude that number of delivery significantly associated with labor companion
utilization.

Regarding the factors ………are significantly associated with birth companion utilization

32
The odds of labor companion utilization for Premipara iswere 2.4 times (95%CI: 1.354-
4.108) higher than Multipara. This finding is consistent with a study done at Arbaminch
Ethiopia (2.05)(61). This finding also supported by a study done in Brazil, being
Multipara increase a risk of non utilization of companion with odds of 1.6 times. The
possible explanation might be women with no experience a child birth process needs
more social support, emotional support than women who had history of childbirth.
Premigravida women experience fears concerning helplessness, loss of control her
self’s in labor and had negative child birth expectation compared to Multipara(62). An
other possible justification might be multiparous women were less worry on pregnancy
and less prepared for labor and delivery compared to premiparous. Multiparous had
generally expected shorter time of labor and receive less support from people compared
to counter parts(63).

Our study asserted that complicated pregnancy complication iswas significantly

associated with companionship service utilization during labor. Being high risk
pregnancy increase the odds of labor companion utilization by more than 3.2 times
compared to those women who had no risk for this pregnancy. This finding is was
supported with a study done at Arbaminch which asserted that the odds of labor
companion utilization is 3.5 (AOR = 3.48, CI 95%, 1.81, 6.70) times higher for women
who had complication during labor and delivery compared to counterparts (61). The
possible explanation might be high risk pregnancy or complicated labor needs more
support from both health professionals and social networks in order to assist for
decision making and to improve the outcome.

Women desire for companionship significantly associated with labor companion

utilization. The odds of labor companion utilization among women who had future desire
for the service nearly 3.5 times than women who had no desire. This finding supported
with a study in Arbaminch(61). The possible explanation might be desire of the service
had strong correlation with culture, education and knowledge. Most Ethiopian women
were delivered at home with the presence of families.

Being female health care provider In this study unpredictably being female reduce
prevalence of labor companion utilization with compared to male which is difficult to

33
infer because of disagreement with stereotype of women being care and more emphatic
than man. Our finding also supported with another related study on RMC in Ethiopia.
The possible rationalization might be females deployed violence against patient in their
work as a means of creating social distance and maintaining fantasies identity and
power in their continues struggle to assert their professional and middle class
identity(64). In addition to this female health care providers had triple burdens
(reproductive, productive and community management) which might be end up with
moral distress and burn out which may lead to abusive behavior(65).

Limitation of the study

This study was done cross-sectional study design which precludes any conclusion of casual
effect association between outcome of interest and independent variables.

Our study also quantitative study which is not digs out more information even we use more
variables in the study.

Conclusions and recommendation

Conclusions
In this study, coverage of labor companion utilization was low .and indicates that
respectful maternity care to achieve sustainable development goal is questionable.
Pregnancy complication, parity, sex of health professional, busyness of SBAs and
women desire were affect women's likelihood of having a companion during labor. As
companionship during labor is associated with improved quality of care, health facilities,
health professionals, and other concerning bodies should encourage women's access to
birth companions.

Recommendations
For health facilities: - we recommend to health facilities to permit and encourage
women to have companion of their choice during labor by preparing curtain from locally

34
available materials to assure privacy. We also recommend to-give in-service
refreshment training especially for females to reduce burn out from multiple tasks.

For policy makers and administrators: - we recommend to policy makers and

administrators even maternal health service coverage show improvements, our goal of
maternal mortality reduction not achieved. Therefore policy makers should focus and
consider accommodating companion in promoting on quality care like respectful
maternity care including labor companion utilization by looking at system reform and
rigorous attention to evidence based use of interventions. In addition to reduce
busyness of staffs employ additional health care providers.

For researchers: - we recommend for researchers a qualitative research to dig out

more information and to add new knowledge especially a reason for superior allowing of
labor companion male over female providers.

For health care providers: - we recommend for both male and female SBAs to allow
companion of choice for all regardless of parity and pregnancy complication and do their
activities based on evidence based intervention by referring WHO and EMOH health
care plan.

35
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https://www.who.int/gho/publications/world_health_statistics/2019/en/ accessed on
1/23/2020. 2019.
27. World Health Organization. Standards for improving quality of maternal and
newborn care in health facilities. 2016.
28. Ntombana R, Sindiwe J, Ntombodidi T. Opinions of labouring women about
companionship in labour wards. African Journal of Midwifery and Women's Health.
2014;8(3):123-7.
29. EMWA. Best practice in respectful maternity care. Ethiopia midwife association.
2018.
30. FIGO. FIGO Guideline Mother—baby friendly birthing facilities. International
Journal of Gynecology and Obstetrics. 2015;128:95-9.
31. Montagu D, Sudhinaraset M, Diamond-Smith N, Campbell O, Gabrysch S,
Freedman L, et al. Where women go to deliver: understanding the changing landscape
of childbirth in Africa and Asia. Health policy and planning. 2017;32(8):1146-52.

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32. Office of the United Nations High Commissioner for Human Right (OHCHR).
Technical guidance on the application of a human right-based approach to the
implementation of policies and programmes to reduce preventable maternal morbidity
and mortality. (A/HRC/21/22. 2012.
33. Tuncalp Ó WW, MacLennan C, Oladapo OT, Gulmezoglu AM, Bahl R, et al. .
Quality of care for pregnant women and newborns - the WHO vision. Bjog.
2015;122(8):1045-9.
34. World Health Organization. WHO recommendations for augmentation of labour.
Geneva: . World Health Organization. 2014.
35. World Health Organization. WHO recommendations on health promotion
interventions for maternal and newborn health. Geneva. World Health Organization.
2015.
36. Diniz Carmen Simone Grilo, Eleonora dO, Madeira DRMS, Alves TJ, Bastos
DMA, A SC, et al. Implementation of the presence of companions during hospital
admission for childbirth: data from the Birth in Brazil national survey. Cad Saúde
Pública. 2014.
37. Fabio André Miranda de Oliveira, Giseli Campos Gaioski Leal, Lillian Daisy
Gonçalves Wolff, Gonçalves. LS. The use of Bologna Score to assess normal labor
care in maternities. Rev Gaúcha Enferm. 2015;36(spe):177-84.
38. Perkins J, Rahman AE, Mhajabin S, Siddique AB, Mazumder T, Haider MR, et al.
Humanised childbirth: the status of emotional support of women in rural Bangladesh.
Sexual and reproductive health matters. 2019;27(1):228-47.
39. Kc A, Axelin A, Litorp H, Tinkari BS, Sunny AK, Gurung R. Coverage, associated
factors, and impact of companionship during labor: A large‐scale observational study in
six hospitals in Nepal. Birth. 2020;47(1):80-8.
40. Hazem Mahmoud Al-Mandeel, Auroabah Saad Almufleh, Al-Jawhara Talal Al-
Damri, Dana Ahmed Al-Bassam, Eman Abdullah Hajr, Nora Ahmed Bedaiwi, et al.
Saudi women’s acceptance and attitudes towards companion support during labor:
Should we implement an antenatal awareness program? Ann Saudi Med.
2013;33(1):28-33.
41. · MMDEERLT, Ezimokhai M, attitudes Ws. Women's attitudes towards
psychosocial support in labour in United Arab Emirates. Arch Gynecol Obstet.
2004;269:181-7.
42. Heather Brown GJH, V Cheryl Nikodem, Helen Smith and Paul Garner.
Promoting childbirth companions in South Africa: a randomised pilot study. BMC
Medicine 2007;5:7.
43. Akin-adenekan OK. Attitude of Nigerian parturients to companionship in labour
and assessement of their childbirth experience. Faculty of Obstetrics and Gynaecology.
2006.
44. Bishanga DR, Massenga J, Mwanamsangu AH, Kim Y-M, George J, Kapologwe
NA, et al. Women’s experience of facility-based childbirth care and receipt of an early
postnatal check for herself and her newborn in northwestern Tanzania. International
journal of environmental research and public health. 2019;16(3):481.
45. Dynes MM, Binzen S, Twentyman E, Nguyen H, Lobis S, Mwakatundu N, et al.
Client and provider factors associated with companionship during labor and birth in
Kigoma region, Tanzania. Midwifery. 2019;69:92-101.

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46. Afulani P, Kusi C, Kirumbi L, Walker D. Companionship during facility-based
childbirth: results from a mixed-methods study with recently delivered women and
providers in Kenya. BMC pregnancy and childbirth. 2018;18(1):150.
47. Getachew Sewit NSaY. Knowledge, Attitude, and Practice of Health
Professionals Towards Labor Companion in Health Institutions in Addis Ababa.
International Journal of Women’s Health Care. 2018;3(2).
48. Fisseha G, Berhane Y, Worku A. Quality of intrapartum and newborn care in
Tigray, Northern Ethiopia. BMC pregnancy and childbirth. 2019;19(1):1-8.
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50. Lunda P, Minnie CS, Benadé P. Women’s experiences of continuous support
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51. Spencer NS, Du Preez A, Minnie CS. Challenges in implementing continuous
support during childbirth in selected public hospitals in the North West Province of
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among Sri Lankan practitioners. BMC Pregnancy and Childbirth 2017; 17:392.
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companionship at public teaching hospitals in three Arab countries. International Journal
of Gynecology & Obstetrics. 2015;129(3):223-6.
54. Diniz CSG, d'Orsi E, Domingues RMSM, Torres JA, Dias MAB, Schneck CA, et
al. Implementation of the presence of companions during hospital admission for
childbirth: data from the Birth in Brazil national survey. Cadernos de saude publica.
2014;30:S140-S53.
55. Statistics AC. Population Projection of ethiopia for all region at woreda level from
2014-2017. Addiss Ababa. 2013.
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WHO Reproductive Health Library; Geneva. 2018.
57. Berg M, Lundgren I, Lindmark G. Childbirth experience in women at high risk: is it
improved by use of a birth plan? The Journal of Perinatal Education. 2003;12(2):1-15.
58. Al-Mandeel HM, Almufleh AS, Al-Damri A-JT, Al-Bassam DA, Hajr EA, Bedaiwi
NA, et al. Saudi women’s acceptance and attitudes towards companion support during
labor: Should we implement an antenatal awareness program? Annals of Saudi
medicine. 2013;33(1):28-33.
59. Afulani P, Kusi C, Kirumbi L, Walker D. Companionship during facility-based
childbirth: results from a mixed-methods study with recently delivered women and
providers in Kenya. BMC pregnancy and childbirth. 2018;18(1):1-28.
60. Getachew S, Negash S, Yusuf L. Knowledge, Attitude, and Practice of Health
Professionals towards Labor Companion in Health Institutions in Addis Ababa. Int J
Women’s Health Care. 2018;3(2).
61. Beyene Getahun K, Ukke GG, Alemu BW. Utilization of companionship during
delivery and associated factors among women who gave birth at Arba Minch town
public health facilities, southern Ethiopia. PloS one. 2020;15(10):e0240239.

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62. Pirdil M, Pirdel L. A comparison of women’s expectations of labour and birth with
the experiences in primiparas and multiparas with normal vaginal delivery. Journal of
Kathmandu Medical College. 2015;4(1):16-25.
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systematic mapping of barriers in low and middle income countries from the provider
perspective. PloS one. 2016;11(5):e0153391.

7. ANNEXES
7.1. Information Sheet and Consent Form: English Version

Information sheet

Hello, how are you? My name is _______________. This is an interview to be done with
you for a study that is being conducted at UoG, College of medicine and health
Sciences School of midwifery, Department of clinical Midwifery.

The purpose of the study is to assess labor companion utilization and associated factors
among women who gave birth in Debre Markos public health institutions, East Gojam,
Ethiopia.

I would like to ask you some questions that are related to your sociodemographic,
obstetric history and labor companion utilization. I believe that the results of this finding
will help policy makers, planners and health professionals for improving quality of
delivery service provision and also contribute to provide adequate quality peripartum
care by involving social support during institutional labor and delivery service provisions.

Your contribution has a great input for the study and I would greatly appreciate your
participation. There is no possible risk associated with participating in this study. Your
name will not be written in the questionnaire and please be assured that all the

40
information you give will be kept strictly confidential. Your participation is completely
voluntary.

Therefore, you will not be obliged to answer any question that you do not want to and
you may end this interview at any time you want to. There are also no obligations for not
participating in the interview. The interview will take about at most 15 minutes.

If you have questions regarding this study or would like to be informed of the results
after its completion, please do not hesitate to contact Mr. Hussien Mohammed
(0923744869).

Consent Form

I have read the information sheet concerning this study (or have understood the verbal
explanation) and I understand what will be required of me and what will happen to me if
I take part in it. I also understand that any time I may withdraw from this study without
giving a reason and without me or my families’ routine service utilization and provision
being affected for my refusal.

Participant’s signature ___________________ Date___________________

Interviewer signature certifying that informed consent has been given verbally.

Interview‘s name ______________

Interview’s signature ______________ Date ______________

May I continue the interview?

1. Yes ____________Continue the interview

2. No ______________Stop the interview and thank the respondent

Result: (to confirm for completeness)

41
A. Questionnaire completed _____________

B. Questionnaire partially completed _____________

C. Participant refused _____________

D. Others (please Specify) _____________

Checked by Supervisor:

Supervisor’s Name _____________

Supervisor’s Signature _____________ Date _____________

Questionnaire English version

Part I:- Socio-demographic profile of the women

Name of institution --------------------- Questioner code --------------------- Remark
S.No Question/variables Coding category/response
100 How old are you? _______( age inyears)
101 Where do you live? 1. Rural 2. Urban
102 What is your religion 1. Orthodox2. Muslim 03
3. Protestant 4. Other specify--
103 What is your ethnicity 1. Amhara 2. Oromo
3. Agew 4. Other specify-----
104 What is your highest level of 1. No formal education
2. Primary school
education?
3. Secondaryschool
4. College& above
105 What is your occupation? 1. Housewife
2. Farmer.
3. Non-governmental employee
4. Self-employed
5. Government employed
6. Daily laborer
7. Others specify__
106 What is your current marital 1. Married
2. Un-married/single
status?
3. Widowed
4. Divorced
5. Separated

42
107 What is yourhusband’s
highest level of education?
108 What is your partner’s
occupation?
109 How muchyour average
family monthlyincome
1. No formal education
2. Primary school
3. Secondaryschool
4. College& above
1. Farmer
2. Government employed
3. Non-governmental employee
4. Self-employed
5. Daily laborer 7. Others specify__
------Ethiopian birr

Part II:-past and current obstetrics related factors of the women

200 How many times have you had pregnant? ------- in Any type
numbers
201 How many times have you delivered a baby after 28 -------in alive or
weeks of gestation? numbers dead
202 Have you had poor obstetric history before index 1. Yes If no go
2. No to Q 205
baby?
203 If yes in Q no 204 which problem? 1.
Abortion
2.
Intra-uterine fetal death
More than one answers possible
3.
Still birth
4.
Early neonatal death
5.
Others specify--------
204 Was this pregnancy planned? 1. Yes
2. No
205 Was this pregnancy wanted? 1. Yes
2. No
206 Was this pregnancy supported? 1.Yes
2. No
207 Have you ever faced any of maternal morbidity 1. Yes If no skip
during index pregnancy period? 2. No to Q 209
208 If yes which common 1. Antepartum hemorrhage
2. Pregnancy induced hypertension
morbidity?More than one
3. Gestational diabetes mellitus
answer possible 4. Premature rupture of membrane or
chorioamnionitis
5. Others specify-------
209 Did you have any complication 1. Yes
during labor of your index baby? 2. No

43
210 If yes types of complication of labor? 1. non reassuring fetal heart
rate pattern
(only you told from SBAs)
2. contracted pelvis
3. Uterine rupture
4. Preterm labor
5. prolonged labor
6. cord prolapse/presentation
7. Others specify…..…
211 Mode of delivery for your index baby? 1 Spontaneous vaginal delivery
2. Cesarean delivery
3.Operative vaginal
delivery(forceps, vacuum&
destructive)
4.Episiotomy assisted delivery
PartIII: - Maternal health service-related factors during index pregnancy, labor
and delivery and post-partum period.
300 Did you attend antenatal clinic for this pregnancy? 1.Yes If no go
2. No to Q 306
301 If yes at what time have you start first antenatal care visit? ------ in weeks
302 Where was your ANC started? 1. Health post
2. Health center
3. Hospital
4. Private clinic
5. Others specify-----
303 How many times did you receive antenatal care? ____ in numbers

304 Did you get advice about birth preparedness plan during 1. Yes
your antenatal care follow up? 2. No
305 If yes for Q number 305 what 1.Decision on delivery place
were advices you get? More than 2. Save money
one answer is possible 3. Skill attendant at birth
4. How to access emergency transport
5. Emergency blood donors
6. Family support during birth
7. Collecting items needed for birth
306 Did the provider ever mentioned about your choose your 1. Yes
companion in labor at the time of your antenatal care visit? 2. No
307 Where did you gave birth your last baby? 1. health facility If no home
2. Home go to Q
3. Other specify------ 309
308 If you delivered at home why? 1.my pregnancy is normal
2. fear of being abused and disrespected
3. To be attended by TBA’S
4. it is usual practice/culture

44
 5. Fear of being lonely in labor
6. No transport
7. Shorter labor duration
8. Other specify-------------
309 From Q 307 if answer is health 1. Health post
2. Health center
facility from which?
3. Public hospital
4.Private Health institution
310 Did you have labor companion during your history of 1. Yes
health facility birth other than your index baby? 2. No
311 When was your most time of laboring 1. Night 2. Morning
after admission to the labor ward? 3. Day in the working hours
Part IV:- variable of labor companion utilization
400 Did anyone accompany you from home to this health 1. Yes If no skip
facility? 2. No to Q: 404
401 If yes for Q 401 Who accompanied you? 1) Husband
2) TBA
3) Mother/ Mother in Law
4) Friend/Neighbor
5) Sister/Sister in law
6) Others (specify)______
402 Were you allowed to have someone from 1.No, never If a&/b
your social networks/family members to 2. Yes, few times skip to
stay with you during labor? 3. Yes, most of the time Q: 406
4. Yes, all the time
403 Yes, most of the time and above , who was 1.Husbund
? 2.Mother /mother in law
3.Sister/siter in law
4.TBA
5.friend or neighbour
6.others,specify-----------
404 Did you want this person to stay with you 1. Yes
during labor? Or was that support person 2. No
your preferred choice?
404 If yes for all the time and most of the time or either of 1. Yes
them, was that support person your preferred choice? 2. No
405 If your answer for Q yes for 404 all 1. There for me
the time and most of the time or 2. Talking to me
3. Holding my hands
either of them Which intervention 4. Mopping my sweat
carried out by 5. Keeping my informed of the
progress
yourcompanion/support person 6. Encouraging fluid intake
during this labor? More than one 7. Meetingelimination needs

45
 possible answer 8. Encouraging deep breathing
& relaxation
9. Massaging my back and
extremities
10. Communicating me with
family members
11. Praying for me
12. Calling SBAs when I need
13. Others specify--------
406 If no or yes few times or both for Q 1.Absence of preferred companion 40
2. institution not allow
404 did you know the reason of not 5
3. providers not allow
allowingcontinuous support during 4. Privacyissue
5. cultural issue
labor?
6. religious issue
7. ward was crowded
8. I don’t need
9. absence of chair for companion
10. others specify_______
Part V:- women’s knowledge, desire&preference toward labor companion
A)women’s knowledge toward labor companion utilization
500 Have you ever heared about support or companion in labor? 1. Yes
2. No
501 If yes what is labor 1. support person during labor other than SBA’s/staff
2. Support person during labor who was staff
companion is?
3. support person during ANC other than staff
4. support person during ANC from staff
5. support person during ANC other than staff
6. support person during ANC from staff
7. other
502 Did you know everyone has a right to utilize labor companion? 1. Yes
2. No
503 If yes where do you 1. Mass media
2) From health care provider (ANC follow up)
get this information?
3) Social media/read about it
4) Heard from people/friends
5) experienced it before
6) Others specify……..
504 What do you say about having support 1. Good practice
person during labor? 2. not good
505 Is utilization of labor companion beneficial 1. Yes 2. No
for positive birth out come?
506 If yes what are the benefits? 1. Reduce labor pain and need of antipain

46
 2. Enhance spontaneous vaginal birth
3. decrease anxiety and fear
4. reduced loneliness
5. Reduced chance of abuse and
disrespect by SBA’s
6. make women happy
7. others specify-------------
B) women’s desire toward labor companion utilization
039 Would you like someone of your choice to stay with you for future 1. Yes
labor? 2. No
040 If yes What are your expect from labor 1. Tangible support
2. Emotional support
companion? (you can choose more than one)
3. Informational support
4. Advocacy
041 Why not you have no desire? 1. Cultural issue
2. companion issue
3. religious issue
4. personal issue
5. institutional issue
6. others specify_______
042 Allowing you to choose labor companion would make eager 1. Yes
to deliver at health institution? 2. No
C) women’s preference companion during labor
043 Who will be your preferred type of 1)Husband
2) TBA
companion for future labor? (choose only
3) Mother/ Mother in Law
one) 4) Friend/Neighbor
5)Sister/Sister in law
6)Others (specify)______
044 What dictate your choice? 1) feel more comfortable with
2)his/her experience or knowledge about labor
(you can choose more
3) religious concern
than one reason) 4) cultural acceptability
5) others specify-------------
Part VI :- women’s perspective to providers and facility related factors
600 Do you think this facility is comfortable to be accompanied by 1.Yes
your choose of companion during labor? 2. No
601 If no what is the reason? 1.crowdness of room
2. absence of screen
3. absence of bed side chair
4. room is not well cleaned

47
 5. others specify---------
602 Do you think that SBA’s in this facility busy? 1. Yes
2. No
603 Was your SBA’s who mostly followed you allowed to have 1.Yes
2. No
labor companion?
604 What sex of your SBAs who give most of your labor care? 1.Male
2. Female
3. Both

Thank you a lot for your participation

7.3. Information Sheet and Consent Form: Amharic Version (ስለ

ጥናቱማስታወቂናበጥናቱለሚሳተፉፍቃደኝነትመጠየቂያቅጽ)

ለመረጃ ሰብሳቢ፡- እባክዎ የፊትና ያፍንጫ ጭንብልወን በትክክል ይልበሱናእርቀትዎን በመጠበቅ የጥናቱን ተሳታፊ

የፊትና ያፍንጫ ጭንብልወን በትክክል እንድለብሱ ያድርጉና ሰላምታ ሰጥተው ራስዎን ካስተዋወቁ በኋላ ከዚህ በታችየ

ተገለፀውን መረጃ ተገንዝበው ለጥናቱ ለመሳተፍ ፍቃዳቸውን መሰጠት ይችሉ ዘንድ አንብቡላቸው እና ፈቃደኛ ከሆኑ

ቲክ/የራትምልክት ፈቃደኛ ካልሆኑ የኤክስም ልክት ያድርጉ፡፡

እኔ…………በዚህ ጥናት እንደ መረጃ ሰብሳቢ ሁኜ የምሰራ ስሆን ይህ ጥናት ከጎንደር ዩኒቨርሲቲ

ሚድዋይፈሪ ት/ቤት ጋር በመተባበር በአቶ ሁሴን ሙሀመድ አስፋው በክሊኒካል ሚድዋይፈሪ የማስትሬት

ዲግሪ በከፊል ለማጠናቀቅ ለሚደረግ የምርምር ጥናት ቃለመጠይቅ ሲሆን ለዚህ ጥናት እርስዎ የተመረጡ

በመሆንዎ በዚህ ጥናት እንዲሳተፉ በትህትና እንጠይቃለን፡፡የዚህ ጥናት ዋና አላማ “በምጥ ወቅት ከጤና

ተቋም ሰራተኛ ውጭ ከማህበራዊ አውታርዎ እገዛ የማግኘት ተግባራዊነት እና ተግዳሮቶችን ማጥናት ሲሆን

ከ 10-15 ደቂቃ የሚፈጁ በተለያዩ ክፍሎች የተከፈሉ ጥያቄዎችን እጠይቀወታለሁ፡፡በዚህ ጥናት በመሳተፍዎ

የሚያገኙት ምንም አይነት ጥቅምም ጉዳትም የለም፡፡ነገር ግን የዚህ ጥናት ዉጤት ለፖሊሲ

አስፈጻሚዎች፣ዕቅድ አዉጭዎችና ለጤና ባለሙያዎች ጥሩና ጥራት ያለው የእናቶች አገልግሎት ለመስጠት

ይረዳል ብለን እናምናለን፡፡ስለዚህም በዚህ ቃለመጠይቅ ቢሳተፉ ምስጋናዬ የላቀነዉ፡፡ከዚህ ጥናት የሚገኘው

መረጃ ሁሉ በማህደር የሚቀመጥ ሲሆን ማህደሩም በስም ሳይሆን በተለየ ኮድ ሲቀመጥ ኮዱን ከዋናው

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 ተመራማሪ ውጭ ለማንም ስለማይገለጽ ሚስጥራዊነቱ የተጠበቀነው፡፡ለዚህ ጥናት ለመሳተፍ የእርሶ ፈቃድ

በጣም አስፈላጊ ቢሆንም በጥናቱ ሙሉ በሙሉ ወይም በከፊል ያለመሳተፍ መብትዎ የተጠበቀነው፡፡ስለ ጥናቱ

ማንኛዉንም ጥያቄ/አስተያየት በሚከተለዉ አድራሻ ማነጋገር ይችላሉ፡፡

ሁሴን ሙሀመድ አስፋው

ስልክቁጥር፡0923744869

ኢሜል፡baluka2007.12.14@gmail.com

ከላይ በመግቢያው ላይ የተጠቀሰውን መረጃ ተነቦልኝ ተረድቻለሁ፡፡በዚህ መሰረት ከእኔ የሚጠበቅብኝን

ድርሻ በሚገባ አውቄያለሁ፡፡

ፈቃደኛ ናቸው-----------------------------ቃለ መጠይቁ ይቀጥላል፡፡

አይ ፈቃደኛ አይደሉም ---------------------------------------ቃለ መጠይቁን በማቆም አመስግነው ይለያዩ፡፡

የጠያቂው ስም----------------------------------------- ፊርማ--------------- ቀን -------------

ሀ. ሙሉ ለሙሉ የተሞላ-------------------ለ. በከፊል የተሞላ----------------------------

ሐ. ሙሉ ለሙሉ ፍቃደኛ ያልሆኑ---------------------------መ. ሌላ ካለ ይጠቀስ---------------------

መጠይቁን መሙላቱን ለማረጋገጥ:- የተቆጣጣሪው ስም---------------------ፊርማ------------ቀን ---------------

ክፍልአንድ፡- የማህበረሰባዊናስነ-ህዝብጥናትመረጃ
የተጠየቀበትጤናተቋምስም______________ የጥያቄውመለያቁጥር________
ተ.ቁ ጥያቄዎች አማራጭመልሶች ዝለል
100 እድሜዎስንትነው? -------------ዓመት
101 የትነዉየሚኖሩት? 1. ገጠር 2. ከተማ
102 ሃይማኖትዎምንድንነው? 1) ኦርቶዶክስ 2) ሙሰሊም
3) ፕሮቴስታንት 4) ሌሎች (ይገለጹ) ------
103 ብሔርዎምንድንነው? 1. አማራ 2. ኦሮሞ
3. አገው 4. ሌሎች(ይገለጹ)____
104 የርስዎየት/ትሁኔታ? 1. አልተማረኩም 2. የመጀመሪያደረጃ
3.የሁለተኛደረጃ 4. ኮሌጅእናከዚያበላይ
105 ስራወትምንድንነዉ? 1) የቤትእመቤት 2) የመንግስትሰራተኛ
3) የግልስራ 4)ነጋደ

49
 5) ገበሬ 6) መንግስታዊያልሆነድርጅትሰራተኛ
7) ሌላካለይገለጹ-------------
106 ባሁኑወቅትየረስዎየጋብቻሁኔ 1. ያገባች(አብረውየሚኖሩ) 2.ያላገባች ያላገባች፣ የፈታች ወይም
ታ 3. የፈታች 4. የሞተባት የሞተባት ከሆነች ወደ 109
5. ያገባች (ተለያይተውየሚኖሩ)
107 የባለቤትዎየት/ትደረጃ? 1)አልተማረም 2)የመጀመሪያደረጃ
3)የሁለተኛደረጃ 4)ኮሌጅእናከዚያበላይ
108 የባለቤትዎስራምንድንነው? 1)ገበሬ 2)የመንግስትሰራተኛ
3)ነጋደ 4)የግልስራ
5)የቀንሰራተኛ 6)መንግስታዊያልሆነድርጅትሰራተኛ
7)ሌላካለይገለጽ------------
109 የቤተሰበዎአማካኝየወርገቢስንትነው? ------------------- ኢትዮጵያንብር
ክፍልሁለት፡- ከቀደሞውእናከአሁኑከእርግዝናእናምጥጋርየተያያዙጥያቄዎች
200 ስንተኛእርግዝናዎነው?ማንኛዉንምአይነትእርግዝና ------------በቁጥር የመጀመሪያካሉወደ 204
201 ስንተኛ ወሊድዎ ነው? (ከ 7 ወርበኋላበሒዎት/ሞቶ የተወለድ) ------------በቁጥር
202 ከዚህበፊትመጥፎየእርግዝውጤትነበረወት? 1)አዎ 2)አልነበረም ካልነበረወደ 204
203 አዎካሉየትኛው?ከአንድበላይመምረጥይችላሉ 1)ውርጃ 2)ከ 7
ወርበኋላበማህፀንውስጥመጥፋት 3)ሞቶመወለድ
4)ከተወለደበኋላበ 1
ወርውስጥመሞት 5)ሌላካለይገለጽ--------

204 ይህእርግዝናሽየታቀደነበር? 1)አዎ 2) አልነበረም

205 ይህእርግዝናሽየተፈለገነበር? 1)አዎ 2) አልነበረም
206 ይህእርግዝናሽየተደገፈነበር? 1)አዎ 2) አልነበረም
207 በዚህእርግዝናየተለየችግርነበር? 1) አዎ 2) አልነበረም ካልነበረወደ 2010 ዝለይ
208 አዎካሉምንድንነበር? 1)ከ 7 ወርበፊትደምመፍሰስ 2) ከ 7 ወርበኋላደምመፍሰስ 3)
ከአንድበላይመመለስይቻላል ከእርግዝናጋርየተያያዘየደምግፊት 4)ከእርግዝናጋርየተያያዘስኳር 5)የእንሽርት
ውሀከምጥቀድሞመፍሰስ 6)ምጥሳይመጣቀኑንማለፍ 7)ሌሎችይገለጹ-------

209 ስርየሰደደበሽታነበረበዎት? (በህክምናየተረጋገጠ) 1) አዎ 2) አልነበረም ካልነበረወደ 211

210 አዎካሉምንድንነው/ነበር? 1)የስኳርበሽታ 2)የደምግፊት
(ከአንድበላይመምረጥይቻላል) 3)የልብህመም 4)የአስም በሽታ
5)የሚጥልበሽታ 6)ሌሎችይጠቀሱ----

211 በዚህምጥ/ወሊድወቅትያጋጠመሽችግርነበር? 1) አዎ 2) አልነበረም ካልነበረወደ 213 ዝለይ

212 አዎካሉምንድንነበር?በባለሙያ የተነገረዎትን 1)የፅንስመታፈን 2)የማህፀንመጥበብ
ብቻ (ከአንድበላይመመለስይቻላል) 3)የማህፀንመተርተር 4)ቀኑሳይደርስምጥመጀመር 5)የምጥጊዜ
መርዘም 6)የእትብትከልጁ መቅደም 7)ሌሎችይገለፁ----

213 ያሁኑየወሊድአይነትበምንነበር? 1)በብልቴ 3)በመሳሪያታግዠበብልቴ

2)በኦፕሬሽን 4)በብልትኦፕሬሽን/እስቲችታግዠ
ክፍል፡- 3 ከእናቶችጤናአገልግሎትጋርየተያያዙጥያቄዎች

50
300 በዚህእርግዝናየቅድመወሊድክትትልአድርገውነበር? 1)አዎ 2) አልነበረም ካልነበረወደ 307
301 አዎካሉበስንትሳምንተዎጀመሩ? --------------------------(በሳምንት)
302 የትጀመሩ? 1)ጤና-ጣቢያ 2)ሆስፒታል 3)የግል-
ክሊኒክ 4)ጤናኬላ
303 ስንትጊዜየቅድመወሊድክትትልአደረጉ? --------------በቁጥር
304 በቅድመወሊድክትትልጊዜስለወሊድዝግጅትምክርአገኙ? 1)አዎ 2)አላገኘሁም
305 አዎካሉምንምክርአገኙ? 1) የመውለጃቦታስለመወሰን
ከአንድበላይመመለስይቻላል፡፡ 2) ገንዘብስለማዘጋጀት/መቆጠብ
3) በጤናባለሙያስለመውለድ
4) የድንገተኛትራንስፖርትእንደትእንደማገኝ
5) በወሊድጊዜስለቤተሰብድጋፍአስፈላጊነት
6) ለወሊድአስፈላጉነገሮችንስለማዘጋጀት
7) ሌላካለይጠቀስ--------

306 በቅድመወሊድክትትልጊዜበምጥወቅትአብሮሽየሚሆንሰውመምረጥእ 1 አዎ
ንደምትችይገለጻተደርጎልሽያውቃል? 2) አያውቅም
307 የመጨረሻልጅዎንየትወለዱ? 1)ጤና-  ጤናተቋምካሉወደ 309
ተቋም 2)ቤት 3)ሌላካለይገለፅ  ሌላካሉወደ 310
---------
308 በቤትውስጥከወለድሽለምን? 1) እርግዝናዬየጤናችግርስለሌለው
(ተገቢከሆነከ 1 2)ባህላዊአዋላጆችንስለምመርጥ
በላይመልስንመስጠትትችያለሽ) 3)በጤናአገልግሎትሰጪእንዳልንገላታናክብሬንእንዳላጣ
4) የተለመደስለሆነ/ባህልስለሆነ
5) በምጥወቅትብቻዬንመሆንስለምፈራ
6)የትራንስፖርትችግርስላለ
7)ያማጥሁትለአጭርጊዜበመሆኑ
8)ሌሎች (ይግለጹ)--------------------
309 ጤናተቋምከወልዱየት? 1)ሆስፒታል 2)ጤናጣቢያ 3)ከግል-ጤና-ተቋም 4)ጤናኬላ

310 በባለፈውምጥበጤናተቋሙውስጥከተቋሙሰራተኛውጭየምትፈልጊ 1)አዎ

ውአጋዥአብሮሽነበር? 2)አልነበረም
311 በዚህምጥበዚህጤናተቋምከተኛሽበኋላያማጥሽበትጊዜከመቸእስከመቸነው? ከ------እስከ------በሰዓት
ክፍልአራት፡- በምጥጊዜሊኖርዎትስለሚችልረዳት/ድጋፍሰጪያለውንተግባራዊነትጥያቄዎች
400 ከቤትሽወደጤናተቋምአብሮሽየመጣድጋፍሰጭሰውነበር? 1)አዎ 2)አልነበረም ካልነበረወደ 500

401 አዎካልሽማንነበር? 1)ባለቤቴ 2)የባህልአዋላጅ

(ከአንድበላይመምረጥይቻላል) 3)እህቴ/አይቴ 4)እናቴ/አማቴ
5)ጓደኛዬ/ጎረቢቴ 6)ሌሎች ( ይግለጹ)_____
402 የመጣውቤተሰብበምጥወቅትከእርስዎጋርእን 1)አልነበረም 2)አዎአልፎአልፎ አልነበረም/አልፎአልፎ
ድቆይተፈቅዶልዎትነበር? 3)አዎአብዘሀኛውንጊዜ 4)አዎሁልጊዜ ካሉወደ 406
403 መልስሽአዎአብዘሀኛውንጊዜ/ 1)ባለቤቴ 2)የባህልአዋላጅ
አዎሁልጊዜከሆነማንነበርከጎንሽበመሆንየረዳ 3)እህቴ/አይቴ 4)እናቴ/አማቴ

51
 ሽ? 5)ጓደኛዬ/ጎረቢቴ 6)ሌሎች ( ይግለጹ)____

404 ይህከጎንሽበመሆንየረዳሽሰው/ግለሰብእንድረዳሽየምትፈልጊውምርጫሽነበር? 1)አዎ 2)አልነበረም

405 አብሮሽየቆየውረዳትሽምንአደረገ 1)ምንምአላደረገልኝ

ልሽ? 2)ለእኔብሎመቆየቱንአሳየኝ 3)እጀንያዘልኝ 4)ላቤንጠረገልኝ 5)ፈሳሽእንድጠ
ቀምአበረታታኝ 6)ጀረባየንአሸልኝ
7)ለሰገራናሽንትመቀበያአመቻቸልኝ 8)ከሌላውቤተሰቤጋርአነጋገረኝ
9)ጤናባለሙየውንሰፈልገውጠራልኝ 10)ፀለየልኝ
11)በደንብእንድተነፍስእናእንድፈታታአበረታታኝ 12)እምንእንደደረስኩከጤና
ባለሙያውበመጠየቅነገረኝ 13)ሌላካለይገለፅ------

406 አብዘሀኛውንጊዜእናከዚያበላይየረ 1) ዕኔስላልፈለኩ

ዳሽእናከጎንሽየቆየሰውከሌለለምን 2) ጤናተቋሙስለማይፈቅድ
?
3) የጤናባለሙያውባለመፍቀዱ
4) ረዳቴየሚቀመጥበትወንበርሰለሌለ
5) ሀይማኖቴስለማይፈቅድ
6) ባህሌስለማይፈቅድ
7) የምጥክፍሉስለተጨናነቀ
8) የምጥክፍሉመጋረጃ/የግልክፍልስለሌለው
9) የምመርጠውረዳቴስለሌለ
10) ሌሎች ( ይግለጹ)-----------

ክፍልአምስት፡-በምጥወቅትአብሯትስለሚሆንና ስለሚረዳትሰውያላትንእውቀት፣ፍላጎትናምርጫበተመለከተ
ሀ) በምጥወቅትአብሯትስለሚሆንናእናስሚረዳትሰውያላትንእውቀትበተመለከተ
500 በጤናተቋምውስጥበምጥጊዜበቤተሰብአባላትስለሚደረግእገዛሰምተሽታ 1) አዎ አላውቅምከሆ
ውቂያለሽ (እውቀትአለሽ)? 2) አላውቅም ነወደ 502
501 አዎከሆነምንማለትነው? 1) በምጥጊዜበተቋሙሰራተኞችየሚደረግእገዛ
2) በእርግዝናጊዜበተቋሙሰራተኞችየሚደረግእገዛ
3) በምጥጊዜከተቋሙሰራተኞችውጭየሚደረግእገዛ
4) በእርግዝናጊዜከተቋሙሰራተኞችውጭየሚደረግእገዛ
5) ከወሊድበኋላከተቋሙሰራተኞችውጭየሚደረግእገዛ
6) ከወሊድበኋላበተቋሙሰራተኞችየሚደረግእገዛ
7) ሌላካለ------
502 በምጥላይያለችሴትበጤናተቋምውስጥልጇንእስክትገላገልድረስአብሯትእንዲቆይናእንዲደግ 1)አዎ ካላወቁወ
ፋትየምትፈልገውንሰውየመምረጥመብትእንዳላትታውቂያለሽ? 2)አላውቅም ደ 504
503 አዎከሆነእንዴትልታውቂቻልሽ/ 1)ከሰዎች/
ከየትመረጃውንአገነኙት? ከጓደኛሰምቼ 3)ከዚህበፊትተሞክሮስላለኝ 2)አንብቤ 4)ከማህበራዊ/
ሌሎችሚድያዎችሰምቸ
5)ከጤናአገልግሎትሰጪዎችሰምቸ/በክትትልወቅትተንግሮኝ
6)ሌሎች ( ይግለጹ)------------

52
504 በምጥወቅትየሚረዳሽአንድቤተሰብአብሮስለመሆኑየምትይውነገርምን 1) በጣምጥሩአሰራርነው
ድንነው? 2) ጥሩአሰራርአይደለም
505 በምጥወቅትበፈለጉትረዳት/ቤተሰብድጋፍማግኘት/ 1) አዎአውቃለሁ አላውቅምካሉ
የሚረዳሽሰውአብሮሽቢኖርያለውንጥቅምታውቂለሽ? 2) አላውቅም ወደ 507

506 አዎከሆነጥቅሙ 1)የምጥህመምንመቀነስ 2) )የእናትንደስታመጨመር 3)በቀዶጥገናየመውለድአስፈላጊነትመቀነ

ምንድንነው? ስ 4)ጭንቀትእናፍርሀትንመቀነስ 5) በማህፀን/
(ከአንድ በብልትየመውለድእድልንመጨመር 6)የምጥጊዜእንዲቀንስያደርጋ 7)የጨቅላውንበህይወትየመ
በላይመምረጥት ቆየትእድልየተሻለያደርጋል 8)ብቸኝነትእንዳይሰማማድረግ 9)በጤናባለሙያየሚመጣንእንግልት
ችያለሽ) እናክብርማሳጣትንመቀነስ
10)በጤናተቋምየመውለድፍላጎትለመጨመር 11)ሌላካለይጠቀስ-------------

ለ) በምጥወቅትአብሯትስለሚሆንናእናስለሚረዳትሰውያላትንፍላጎትበተመለከተ
507 ለወደፊቱበምጥጊዜየሚረዳሽሰውአብሮሽእንዲሆንፍላጎቱአለሽ? 1)አዎ 2)የለኝም ከሌላትወደ 510
508 አዎከሆነበምጥጊዜአብሮሽየሚሆንሰውእንዲደርግልሽየምትፈልጊዉ/ 1) አዎ የለምካሉወደ 511
የምጠብቂውነገርአለ? 2) የለም
509 አለካሉበምጥወቅትምንእ 1)ስነልቦናዊድጋፍ (ማበረታታት፣መፀለይ)
ንዲያደርግልዎትይጠብቃ 2)ተግባራዊድጋፍ(ጀረባማሸት፣እጅመያዝ/መደገፍ፣አስፈላጊነገሮችንማቅረብ)
ሉ? 3)መረጃዊድጋፍ(ስለምጡ ደረጃ፣ስለሌላው ቤተሰብ ሁኔታ) መረጅ መስጠት
(ከአንድበላይመልስመምረ 4)ጥበቃዊድጋፍ(እንዳልወድቅ፣ባለሙያው እንዳያንገላታኝናክብሬን እንዳይነካኝ)
ጥይቻላል) 5)ሌላካለይጠቀስ----------------

510 ፍላጎትየለኝምካሉለምን? 1)አብሮኝላለሰውተጋላጭላለመሆን 2)ብቻዬንመሆንስለምፈልግ

(ከአንድበላይመምረጥይ 3)ባህሌስለማይፈቅድ 4)ሀይማኖቴስለሚከለክለኝ
ችላሉ) 5)የቤተሰቤንጭንቀትላለማየት/እንዳይጨነቁ 6)ሌላምክኒያት-------------
ሐ)ድጋፍሠጭንሰውምርጫበተመለከተ
511 በምጥጊዜአብሮዎትየሚሆንአንድሰ 1)ባለቤቴን 2)እናቴን/ ሴትአማቴን 3)እህቴን/አይቴን
ውምረጡቢባሉማንንይመርጣሉ 4)የባህልአዋላጅ 5)ጓደኛየን/ጎረቤቴን 6)ማንንምአልመርጥ 7)ሌላካለይጠቀ
(ከአንድበላይመምረጥአይቻልም) ስ-------------------

512 ለምርጫዎምክናየቱምንድንነው? 1)ምቾትስለሚሰጠኝ

(ከአንድበላይመምረጥይችላሉ) 2)በሀይማኖትምክናየት 3)ልምድእናእውቀትስላለው 4)በባህልስለሚፈቀድ
5)ሌላካለይገለፅ---------------

ክፍልስድስት፡- ከጤናተቋማትእናከባለሙያዎችጋርየተያያዙመረጃዎች
600 በዚህተቋምበምጥወቅትአብሮሽለሚሆንሰውሁኔታወቹምቹይመስሉሻል? 1)አዎ 2)አይደለም አዎካሉወደ
602
601 አይደለምካሉለምን? 1) የምጥክፍሉስለሚጠብ/ስለተጨናነቀ
(ከአንድበላይመምረጥይችላሉ) 2) የግልየምጥክፍል/መጋረጃስለሌለው
3) ለድጋፍሰጭውመቀመጫቦታስለሌለ
4) የምጥክፍሉንፅህናስለማይመች

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 5) ሌላካለይጠቀስ----------------------------

602 በዚህተቋምውስጥየሚሰሩባለሙያዎችስራይበዛባቸዋልብለውያስባሉ ? 1)አስባለሁ 2)አላስብም

603 በዚህጤናተቋምበቂጤናባለሙያአለብለሽታስቢያለሽ? 1)አስባለሁ 2)አላስብም

604 አብዘሀኛውንየምጥጊዜየተከታተለወትጤናባለሙያፆታምንድንነው? 1)ወንድ 2)ሴት 3)ሁለቱም

Declaration
I, the undersigned, senior MSc clinical midwifery declare that this thesis is my original
work in partial fulfillment of the requirements for the degree of master of science in
clinical midwifery.

Name Hussien Mohammed Assfaw

Signature ___________________

Place of submission: school of midwifery, college of medicine and health science, UoG

Date of submission ______________________-

This thesis work has been submitted for examination with my/our approval as university
advisor(s) for thesis defense with my school of midwifery advisor(s).

Advisor(s)

Name Signature
1. _____________________ _____________________
2. _____________________ _____________________

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