Introducing and establishing birth companionship in labour ward of a tertiary care centre in North India: a quality improvement journey through and beyond COVID-19 pandemic.

Abstract

Background: Allowing a birth companion is the basic right of a mother and is identified as an important component of respectful maternity care. The implementation of this intervention has been a challenge in heavy-load public health facilities in India.

Local problem: Despite the proven benefits of the presence of birth companions on maternal-fetal outcomes, there was no policy of allowing birth companions in our hospital.

Methods and interventions: We aimed to introduce and establish the practice of allowing birth companions for all eligible mothers admitted to the labour ward from 0% to 70% in 8 weeks duration. The study was conducted in the Department of Obstetrics and Gynecology, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, New Delhi. A quality improvement (QI) team was formed. After collecting the baseline data and observing the process flow, fishbone analysis was done to identify the main problems. Various change ideas were listed and tested in the form of plan-do-study-act (PDSA) cycles and ideas were either adapted or adopted. Simple interventions such as antenatal sensitisation and counselling of the mother and the family, WhatsApp groups, and monthly labour room induction classes for residents helped achieve the target. During COVID-19 pandemic, the practice of allowing birth companions was suspended temporarily but was rolled out again after the second wave of COVID-19 in COVID-19-negative and COVID-19 suspect labour wards.

Results: The median value of the percentage of mothers accompanied by birth companions marginally increased to 20% after the first PDSA cycle. Finally, after multiple PDSA cycles, we could achieve our goal in 8 weeks. During a pandemic, the project was suspended temporarily during the first two waves but was revived again and we succeeded in reaching the desired goal and sustaining the policy after fewer PDSA cycles compared with the first phase.

Conclusion: The application of QI methodology and teamwork is pivotal in implementing any novel idea for patient care without additional infrastructure, manpower or financial resources.