“We need local evidence”: Facilitating the introduction of labor support in public hospitals in Lebanon

Background: Lay labor companionship decreases rates of cesarean and operative vaginal deliveries, labor analgesia, and improves neonatal outcomes and psychological wellbeing. Despite this evidence, this practice is yet to be allowed in public hospitals of many Arab countries. This study is the first component of a phased intervention that will be conducted in three Arab middle-income countries. It aims at identifying the structural and personal barriers from health care providers' perspectives and the needs of women giving birth in order to develop an effective approach for the introduction of lay labor support in public hospitals. Methods: The study was conducted in one large public hospital in Beirut, Lebanon. Semi-structured interviews were conducted with 24 women from the prenatal clinic, 15 female family members, and 6 obstetricians. Two focus groups were conducted with midwives. Data was processed through thematic analysis. Results: Being alone during labor raises feelings of fear and anxiety among women. Women appreciate professional support however find comfort in the psychological support offered by their family members during labor. The midwives point to structural factors related to the organization of care and to marginalization of their role as barriers to implementation of best-practices. Obstetricians refer to women's educational level, the absence of prenatal education classes and to other social norms as factors impeding the organization of lay labor support initiatives at the hospital. Conclusion: The findings will feed into the development of a model of lay labor support that will facilitate the uptake of this practice in public facilities.