Effect of Midwife-Provided Orientation of Birth Companions on Maternal Anxiety and Coping during Labor: A Stepped Wedge Cluster Randomized Control Trial in Eastern Uganda
Open accessAbstract
The study aimed to assess the effect of midwife-provided orientation of birth companions on maternal anxiety and coping during labor. A stepped wedge cluster randomized trial design was conducted among 475 participants (control n = 240), intervention n = 235) from four clusters. Midwives in the intervention period provided an orientation session for the birth companions on supportive labor techniques. Coping was assessed throughout labor and anxiety scores were measured after birth. Independent t-test and Chi-Square tests were used to assess the differences by study period. Anxiety scores were reduced among women in the intervention period (p = 0.001). The proportion of women able to cope during early active labor was higher during the intervention period (p = 0.031). Women in the intervention period had 80% higher odds of coping (p = 0.032) compared to those in the control period. Notable differences in anxiety and coping with labor were observed among first-time mothers, younger women, and when siblings provided support. Midwife-provided orientation of birth companions on labor support lowers maternal anxiety and improves coping during labor. Findings could inform the planning and development of policies for the implementation of the presence of birth companions in similar low-resource settings.
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One of the primary reasons for choosing the stepped-wedge design was the ethical imperative to ensure that all study participants eventually received the intervention, especially when the intervention was expected to be beneficial.
“One of the primary reasons for choosing the SWD was the ethical imperative to ensure that all study participants eventually received the intervention, especially when the intervention was expected to be beneficial (44, 46, 47, 52, 55, 57, 69, 96, 97, 106, 110).”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [47]
Materials and Methods (page not specified) says the design was preferred for ethical reasons so that a beneficial intervention would not be withheld from some clusters. It also says different individuals participated in the control and intervention periods. All facilities eventually received the intervention, but the paper does not say that all study participants did. (LLM, conf=0.88)
Experimental — accuracy not yet measuredWanyenze et al. (2023) calculated a sample size of 290 participants per period based on the primary outcome of spontaneous vaginal delivery, with a baseline rate of 87%.
“The sample size was calculated based on the primary outcome (incidence of having a spontaneous vaginal delivery). The baseline rate for spontaneous delivery was 87%. A sample size of 290 participants per period was calculated.”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [47]
Wanyenze et al. (2023) defined the facility as the cluster, including one district hospital, one regional referral hospital, and two Health Centre IVs.
“Facility was labeled as a cluster. The clusters included one district hospital (Bududa), one regional referral hospital in Mbale district, and two Health Centre IVs”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [47]
Wanyenze et al. (2023) used a simple random technique to generate the sequence of the four hospitals, with the principal investigator generating the random sequence.
“Randomization was performed using a simple random technique. The principal investigator generated a random sequence of the four hospitals using a random sequence generator.”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [47]
Wanyenze et al. (2023) used four steps in the stepped wedge design.
“4”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [47]
Wanyenze et al. (2023) chose a stepped wedge design because of anticipated difficulty in simultaneously introducing the intervention and for ethical reasons to not withhold a beneficial intervention from some clusters.
“The stepped wedge design was chosen because of the anticipated difficulty in simultaneously introducing the intervention to the different clusters and for ethical purposes to not withhold a beneficial intervention from some clusters.”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [47]
Ethical considerations were a major rationale for selecting SWD in many studies.
“Ethical considerations were a major rationale for selecting SWD in many studies (44, 46, 47, 52, 55, 57, 69, 96, 97, 106, 110) onsistent with prior work emphasising the design's capacity to support equity in intervention rollout (6).”
From Applications and implementation considerations for stepped-wedge designs in sub-Saharan Africa: a systematic review (2026) · cites this paper as [47]
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Cited by
Sorted by citations
Wanyenze, E. W., Nalwadda, G. K., Tumwesigye, N. M., & Byamugisha, J. K. (2023) · BMC Pregnancy and Childbirth · doi:10.1186/s12884-023-05978-8 · Cited by 7 · see citing works
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- Authors
- Wanyenze, E. W., Nalwadda, G. K., Byamugisha, J. K., Muwanguzi, P. A., & Tumwesigye, N. M.
- Affiliations
- Mbarara University of Science and Technology (UG)
- Makerere University (UG)
- Corresponding author
- Wanyenze, Eva Wodeya
- Venue
- International Journal of Environmental Research and Public Health
- Publisher
- MDPI AG
- Published
- 2023-01-14
- Volume
- 20
- Issue
- 2
- Pages
- 1549
- ISSN
- 1660-4601 (ISSN-L)
- PMC
- PMC9866548
- OpenAlex
- W4316664732
- Cited by
- 10
- References
- 48
- Citations by year
- 2026: 5 · 2025: 3 · 2023: 2
- FWCI
- 3.13
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- International Journal of Environmental Research and Public Health (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (publishedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Swedish International Development Agency (SIDA) (377)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Maternal Mental Health During Pregnancy and Postpartum
- Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Global Maternal and Child Health
- Keywords
- birth companions, maternal anxiety, childbirth support, primiparous women, resource-limited settings, Eastern Uganda
- MeSH terms
- Adaptation, Psychological, Anxiety, Female, Humans, Midwifery, Pregnancy, Uganda, Friends
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