Navigating a vulnerable transition: a qualitative study of the role of companions and providers in pregnancy and childbirth in Burkina Faso

OBJECTIVE: To explore women's expectations and experiences of care and support from pregnancy to childbirth in Burkina Faso, with a focus on the role and impact of companions and providers. DESIGN: An exploratory qualitative study based on in-depth interviews with purposively sampled participants and employing reflexive thematic analysis. SETTING: Two public hospitals in urban Burkina Faso having implemented the 'QUALIty DECision-making by women and providers for appropriate use of caesarean section' intervention. PARTICIPANTS: 24 purposively selected postpartum women with variation in terms of parity, mode of birth, labour companionship experiences, education level and occupation were interviewed before discharge from the hospital. RESULTS: The two themes generated from the analysis elucidate how women rely on providers and companions to navigate uncertainty and vulnerability experienced during pregnancy and childbirth. Women viewed providers as essential for managing the biomedical risks of childbirth and voiced their need for care at critical moments. They expected companions to enhance the non-clinical aspects of their experiences by providing spiritual support and alleviating feelings of loneliness. However, participants also expressed ambivalence about companions witnessing intimate aspects of their birth experience and valued the ability to choose a companion as means to preserve personal integrity. CONCLUSIONS: Both providers and labour companions play an essential role in enhancing women's experiences of pregnancy and childbirth in Burkina Faso. Additional research and programmatic efforts are needed to support women's equitable participation in patient-provider interactions and operationalise the notion of choice of a labour companion in a contextually appropriate manner.