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Peer-reviewedCC BY-NC 4.0BMJ Open Quality

From policy to practice: establishing birth companion presence in labour rooms via quality improvement methods

  • Mukta Agarwal1
  • Simran Simran1
  • Divendu Bhushan2
  • Pallavi Lohani3
  • Sujit Kumar Sinha4
  • Hemali H Sinha1
  • Chandramani Singh5,6
6 affiliations
  1. 1Obstetrics and Gynecology, All India Institute of Medical Sciences Patna, Patna, Bihar, India
  2. 2Emergency Medicine, All India Institute of Medical Sciences Patna, Patna, Bihar, India
  3. 3Community Medicine, Madhubani Medical College & Hospital, Madhubani, Bihar, India
  4. 4Hospital Administration, All India Institute of Medical Sciences Patna, Patna, Bihar, India
  5. 5Community and Family Medicine, All India Institute of Medical Sciences Patna, Patna, Bihar, India
  6. 6Dr Ram Manohar Lohia Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract

Background: The WHO and the Government of India recommend allowing a chosen birth companion during labour and delivery. However, implementation across public facilities remains poor. This study aimed to introduce and sustain the presence of birth companions for at least 50% of labouring women within 5 months at a tertiary-care hospital in eastern India using quality-improvement (QI) methods.

Methods: The Model for Improvement (MFI) with sequential Plan–Do–Study–Act (PDSA) cycles was applied from May to September 2022. Barriers were analysed through a fishbone diagram. Interventions included staff sensitisation, protocol development and workflow redesign. Staff attitude and respectful maternity care perception were assessed using short Likert-scale feedback forms after each cycle.

Results: At baseline, no women were accompanied by a birth companion. After five PDSA cycles, 75% of labouring women had one. Staff-perception scores for respectful care improved by 38%, and resistance to the practice declined. No breach of privacy or infection-control incidents were reported.

Conclusions: Iterative QI cycles successfully introduced the birth-companion concept in a busy public-sector hospital. Context-specific administrative and behavioural interventions enhanced acceptance among staff and patients, improving respectful-maternity-care delivery. Sustained policy support and periodic staff motivation will be essential for scale-up.

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Cite

BibTeXRIS
BibTeX
@article{agarwal2026from,
  title = {{From policy to practice: establishing birth companion presence in labour rooms via quality improvement methods}},
  author = {Mukta Agarwal and Simran Simran and Divendu Bhushan and Pallavi Lohani and Sujit Kumar Sinha and Hemali H Sinha and Chandramani Singh},
  journal = {BMJ Open Quality},
  year = {2026},
  month = oct,
  doi = {10.1136/bmjoq-2025-003638},
  url = {https://doi.org/10.1136/bmjoq-2025-003638},
  note = {CC BY-NC 4.0},
}
RIS
TY  - JOUR
TI  - From policy to practice: establishing birth companion presence in labour rooms via quality improvement methods
AU  - Mukta Agarwal
AU  - Simran Simran
AU  - Divendu Bhushan
AU  - Pallavi Lohani
AU  - Sujit Kumar Sinha
AU  - Hemali H Sinha
AU  - Chandramani Singh
PY  - 2026
DA  - 2026/10/23
JO  - BMJ Open Quality
DO  - 10.1136/bmjoq-2025-003638
UR  - https://doi.org/10.1136/bmjoq-2025-003638
AB  - Background: The WHO and the Government of India recommend allowing a chosen birth companion during labour and delivery. However, implementation across public facilities remains poor. This study aimed to introduce and sustain the presence of birth companions for at least 50% of labouring women within 5 months at a tertiary-care hospital in eastern India using quality-improvement (QI) methods.  Methods: The Model for Improvement (MFI) with sequential Plan–Do–Study–Act (PDSA) cycles was applied from May to September 2022. Barriers were analysed through a fishbone diagram. Interventions included staff sensitisation, protocol development and workflow redesign. Staff attitude and respectful maternity care perception were assessed using short Likert-scale feedback forms after each cycle.  Results: At baseline, no women were accompanied by a birth companion. After five PDSA cycles, 75% of labouring women had one. Staff-perception scores for respectful care improved by 38%, and resistance to the practice declined. No breach of privacy or infection-control incidents were reported.  Conclusions: Iterative QI cycles successfully introduced the birth-companion concept in a busy public-sector hospital. Context-specific administrative and behavioural interventions enhanced acceptance among staff and patients, improving respectful-maternity-care delivery. Sustained policy support and periodic staff motivation will be essential for scale-up.
SN  - 2399-6641
ER  -