Most pregnant women receiving antenatal care at a Nigerian hospital said they would prefer to have someone with them during childbirth to provide social support, a practice not allowed in many Nigerian facilities.1 Although 86% said their husband would be their preferred companion, 67% indicated that they would be happy to have their mother or another relative with them. Professional women, those belonging to minority ethnic groups, and those without children were more likely than other women to want someone to accompany them in the labor room.
As in many Sub-Saharan African countries, the availability and quality of maternal health care is often inadequate in Nigeria. Only one-third of Nigerian women have skilled birth attendants when they deliver, in part because obstacles such as poverty, health workers' negative attitudes toward patients, and policies prohibiting relatives from being in the labor room discourage women from delivering at public hospitals. As a result, many women rely on traditional birth attendants, who allow them to obtain social, emotional and other forms of support from family members or friends.
To assess pregnant women's attitudes about these types of support and identify related factors, the investigators surveyed a random sample of pregnant women aged 18–44 who were visiting an antenatal hospital clinic in Ibadan in August–November 2006. All women who were approached agreed to participate. In addition to providing information on social and demographic characteristics, the women answered questions about whether they wished to have support during delivery, their preferred sources of support and the types of support they desired.
The 224 respondents were, on average, 31 years old, and most worked outside the home as professionals (e.g., accountants or engineers; 28%), teachers (17%) traders (15%) or artisans (11%); relatively few were housewives (9%) or students (9%). The majority (75%) had a postsecondary education. Three-quarters were Christian, and the remainder were Muslim. Nearly four in 10 were pregnant for the first time, and almost half had never given birth. One-fourth had had at least one abortion or miscarriage.
Overall, 75% of the women said they wished to have support during delivery. The proportion was higher among women with postsecondary education than among those with less education (79% vs. 66%), and higher among Christians than among Muslims (79% vs. 63%). The desire for support was greater among professionals than nonprofessionals (89% vs. 70%) and among members of minority ethnic groups than among Yoruba women (88% vs. 73%). Eighty-five percent of women who had never been pregnant, and 84% of those who had never given birth, preferred to have a companion, compared with 67–68% of those who had been pregnant before or had given birth.
Among women who wanted someone to accompany them during labor, the vast majority (86%) preferred their husband; seven percent chose their mother, while the remainder preferred a sibling, friend or someone else. However, 67% said they would be happy to have a relative with them during labor. About seven in 10 women were willing to pay extra to have a professional source of support, such as a doula. When asked about the kind of support they would desire most from their labor room companion, 80% of women cited emotional support (e.g., providing words of encouragement and comfort), 18% chose spiritual support (e.g., assuring them that God would protect them), 9% wanted someone who could run errands (e.g., fetching caregivers) and 7% desired physical support (e.g., massaging the patient's back).
In addition to receiving support during delivery, women said they wanted to be better prepared for giving birth. Three-quarters expressed interest in receiving information about labor, and more than half wanted the chance to visit the labor ward prior to delivery.
A multivariate analysis revealed that women who were professionals were more likely than others to want a companion during delivery (odds ratio, 3.1). The odds of wanting support were also elevated among women having their first child (3.6) and those who were members of a minority ethnic group (2.9). The only factor that was associated with favoring one's husband to other sources of support was education: The odds of preferring one's spouse were three times as high among women who had a postsecondary education as among women who had less education (3.0).
Given that hospital staff in Nigeria are often overworked and ill-equipped to provide the support that patients desire, the researchers encourage public hospitals to give women the option of having a companion during labor and to provide educational materials prior to delivery. They note that having a companion of the same cultural background and prior knowledge of the labor process have been associated with reduced anxiety and labor pain. Husbands may have been women's preferred choice for a companion in part because most respondents were well-educated and thus more likely than other Nigerian women to be in monogamous marriages. The investigators recommend that men be included in future research, as "the question of whether Nigerian husbands are ready to be their spouse's doula/companion in labour remains unresolved."
1. Morhason-Bello IO et al., Attitude and preferences of Nigerian antenatal women to social support during labour, Journal of Biosocial Science, 2008, 40(4):553– 62.