Utilization of companionship during delivery and associated factors among women who gave birth at Arba Minch town public health facilities, southern Ethiopia.

BACKGROUND: Companionship during delivery is an important feature of compassionate and respectful maternity care. It has a positive impact on delivery and birth outcomes. In low resource countries like Ethiopia lack of companionship discourages women from accessing facility-based delivery care. Therefore, this study aimed to assess the utilization of companionship during delivery and associated factors.
METHODS: Health facility-based cross-sectional study design was done from October to November 2019. Interviewer administered questionnaires were used to collect the data from 418 study participants. The data were entered with Epi data version 4.4 and exported to Statistical Package for Social Sciences (SPSS) version 25.0 for analysis. Binary logistic regression was done. Statistical significance was declared at P- values < 0.05 with a 95% confidence level.
RESULTS: The finding of the study showed that only 13.8% of mothers utilize companionship during delivery. Variables such as having a desire to have companionship during delivery in the health facilities (AOR = 5.17, CI 95% 2.63, 10.16), having complication during the labor and delivery (AOR = 3.48, CI 95%, 1.81, 6.70), and being primipara (AOR = 2.05, CI 95% 1.09, 3.87) were the independent factors associated with companionship utilization.
CONCLUSIONS: The finding of the study showed that the utilization of companionship during delivery was low. Permitting women to have a companion of choice during labor and childbirth can be a cost-effective intervention to improve the quality of maternity care, facing complications during delivery, having a desire to have companionship during delivery and primiparous women were more likely to utilize companionship. To improve this low utilization of companionship institutions and care providers should provide information about companionship during antenatal care attendance. Besides, there is a need for clear guidelines to govern the practice of companions.

Background

Worldwide, around 140 million births occur every year and the majority of these are vaginal births and most of these occur without complications for women and their babies [1]. However, in situations where complications arise during labor, the risk of serious morbidity and death increases for both the woman and baby. Over a third of maternal deaths and a substantial proportion of pregnancy-related life-threatening conditions are attributed to complications that arise during labor, childbirth, or the immediate postpartum period [2, 3]. And the majority of stillbirths and neonatal deaths result from complications during labor and childbirth [4]. The burden of maternal and perinatal deaths is suspiciously higher in low resource countries compared to developed countries, Therefore, improving the quality of care around the time of birth, especially in low-income countries, has been identified as the most vital strategy for reducing maternal and newborn death [5, 6].

Labour companionship refers to support provided to a woman during labor and childbirth. It may be provided by a partner, family member, friend, doula, or healthcare professional [7]. There is a global interest in improving the quality of maternal and newborn care [8]. Labor companionship is a key component of providing respectful maternity care and has been recommended most recently as part of WHO recommendations on intrapartum care for positive childbirth experience and included as one of the standards for improving the quality of maternal and newborn care in health facilities [9-11].

World health organization (WHO) recommends that facilitating and ensuring clear and respectful communication between health-care providers and the woman in labor, and providing continuous emotional support is advocated for all women. However, in the actual clinical setting, it not well-practiced [12, 13]. Permitting and supporting the presence of a woman’s companion of choice during labor and childbirth is vital to reduce mistreatment or abuse in a health facility [13]. Studies have shown that women who receive continuous support during labor are more likely to deliver spontaneously and Therefore require fewer cesarean sections or operational deliveries; have a shorter length of labor; are less likely to require intrapartum analgesia; are more satisfied with their childbirth experience, and are less likely to have a baby with a low five-minute Apgar score [14]. In addition to benefiting women in labor, companions may also help reduce staff workload and improve processes. Companions may allow health staff to attend to urgent issues, remind staff when it is time to re-examine women or when there is a sudden change, arrange transportation if complications arise, and reinforce messages and instructions to women [15].

One of the rights specified in the Respectful Maternity Care Charter (RMC) is “respect for her choices and preferences, including companionship during maternity care. but it is a neglected area [16, 17].

A previous study showed that the low practice of labor companions was associated with the absence of guidelines, lack of infrastructure to protect privacy, overcrowding of ward and poor knowledge and negative attitudes of health-care providers [18, 19].

Now a day, companionship being increasingly recognized as an integral component of respectful maternity care and a potentially important factor in facility delivery rates, a paucity of evidence exists on the factors that predict it [19, 20].

In Ethiopia, companionship during delivery is not well studied. Therefore, this study is aimed to assess the utilization of companionship during childbirth and associated factors among women who give birth at Arba Minch town public health facilities, South Ethiopia.

Methods

Study setting and design

A health facility-based cross-sectional study design was carried out in Arbaminch town public health facilities from October to November 2019. Arbaminch town is the administrative city of the Gamo zone, southern Ethiopia, which is 454km south of Addis Ababa (the capital city of Ethiopia) and about 280 Km from Hawassa (the capital of SNNP). The town is subdivided into 4-sub city and 11 kebeles (the smallest administrative structure in Ethiopia). The town has a total area of 5556 hectares and a total population of 112,724 among those (50.2%) of them were females. The number of health institutions in Arba Minch town is 1 governmental general hospital, 2 health centers, 33 private clinics, 12 drug store, and 2 community pharmacy.

Populations

Source population

All women who gave birth at Arba Minch town public health facilities.

Study population

All women who gave birth in Arba Minch town public health facilities during the study period.

Inclusion and exclusion criteria

Inclusion criteria

All women who were laboring and gave birth at Arba Minch town public health facilities.

Exclusion criteria

Those women who are seriously ill and unable to communicate during the data collection period were excluded from the study.

Sample size determination

The sample size was calculated using a single population proportion formula by considering the following assumptions: 95% confidence level, the margin of error (0.05), p = 44.7% [21]. The required sample size after adding a 10% non-response rate was 418.

Sampling techniques & procedure

There is one public hospital (Arbaminch general hospital) and two public health centers (Sikela and Shecha health centers) in Arbaminch town and all were included in the study. The allocation of the sample to health facilities was made proportionally based on the number of women who give birth at each facility in the two months preceding the data collection period.

Individual study subject at each health facility was selected by systematic random sampling during the data collection period until the required sample size at each health facility was obtained.

The sampling interval k = 2 was calculated by dividing the source population to the total sample size and this interval was used in all health facilities to select study subjects.

Therefore, the first women from each health institution were selected by lottery method. Then every other woman from each health institution was interviewed.

Operational definitions

Labor companionship

Support provided to laboring women at all moments of the labor process. It may be provided by a partner, family member, or social network [22].

Utilization of companionship

Having a support person of laboring women to provide support and stay with her during labor in the health facilities.

Data collection tool and quality control

Before actual data collection occurred two-day training was provided for data collectors and the supervisor about techniques of data collection and briefed on each question included in the data collection tool. The pretest was done on 5% [21] of mothers receiving care in a health center that was not included in the study before the actual study period. After pre-testing the questionnaire, Cronbach’s Alpha was calculated by using SPSS window version 25.0 to test internal consistency (reliability) of the item, and Cronbach’s Alpha greater than 0.7 was considered as reliable. Data were collected by trained midwives and nurses. During data collection, regular supervision was done by the supervisors.

Data analysis and interpretation

The collected data were checked manually for completion and any incomplete or misfiled questions, cleaned and stored for consistency, entered into EpiData version 4.4. (EpiData Association, Odense, Denmark), and then exported to SPSS version 25.0 (IBM Corp., Armonk, NY, USA) for analysis. Descriptive statistics were calculated and presented using tables and figures. Multivariable logistic regression analysis was performed to adjust for possible confounding variables. Variables that were significant in the bivariate logistic regression were entered into the multiple regression analysis. The p< 0.05 or 95% confidence intervals (CIs) not including 1.0 were considered to indicate statistical significance.

Ethical approval and consent to participant

Ethical clearance was obtained from the institutional Research Ethics review board of the college of medicine and health science, Arba Minch University. Permission was obtained from the managers of each health facility. After the purpose and objective of the study have been informed, informed verbal consent was obtained from each study participant. Moreover, the confidentiality of information was guaranteed by using code numbers rather than personal identifiers and by keeping the data locked. Data were collected before discharge to home after she was stable and comfortable.

Results

Socio-demographic characteristics of respondents

Four-hundred seven women participated in the study with a 97.3% response rate. The mean age of the study participants was 26 years (SD± 4.86 years) and 181 (44.5%) women were between the age group of 25–34 years. 281 (69%) of respondents were urban residents and 386 (94.8%) of the study participants were married. Among the total respondents, 146 (35.9%) of women had a primary education level and One hundred ninety-seven (48.4%) were Orthodox Christians. Half of the respondents were from Gamo ethnic group (51.4%) followed by Gofa ethnic group 68 (16.7%) (Table 1).

Table 1

Socio-demographic characteristics of the study participants, Arba Minch town, south Ethiopia, 2019, (n = 407).

Variables	Frequency	Percentage
Age
<25	171	42
25–34	181	44.5
≥35	55	13.5
Residency
Rural	126	31
Urban	281	69
Marital status
Married	386	94.8
Single	11	2.7
Divorced	8	2
Widowed	2	0.5
Occupation
Housewife	212	52.1
Government employee	69	17.0
NGO/private	99	24.3
Others	27	6.6

Key = *traditional, Jehovah witness, **Konso, Derashe, Gurage, Amaro, ^ Students, Daily labor.

Obstetrics characteristics of the respondents

Two hundred thirty (56.5%) of the study participants were multiparous and 54 (29.3%) had labor companionship during previous institution delivery. Almost all 363 (89.2%) women had antenatal follow up during current pregnancy and only 45 (12.4%) of women had got information from health care providers about labor companionship during antenatal care attendance.

The majority of 346(85%) of respondents perceived that allowing laboring women to have a companion during childbirth. Of the total respondent, 387(95.1%) of them had planned pregnancy (Table 2).

Table 2

Obstetrics characteristics of women who give birth in Arbaminch town public health facilities southern Ethiopia, 2019.

Variables	Frequency	Percentage
Parity
Primipara	177	43.5
Multipara	230	56.5
Have companion during the last delivery (n = 230)
Yes	54	29.3
No	130	70.7
Place of last delivery (n = 230)
Home	48	20.9
Health institutions	182	79.1
Did you attend ANC in your current pregnancy (n = 407)
Yes	363	89.2
No	44	10.8
Did the provider inform you about companion (n = 363)
Yes	45	12.4
No	318	87.6
Status of Pregnancy
Planned	387	95.1
Unplanned	20	4.9

Benefits of companionship during delivery

Majority of respondent 77.2% mention that having companionship during delivery can reduce loneliness followed by reducing labor pain management (Fig 1).

Fig 1

Benefits of companionship during labor and childbirth mentioned by respondents in Arbaminch town public health facilities, south Ethiopia, 2019.

Utilization of companionship during delivery

Of the total respondents, 56 (13.8%) of laboring mothers utilize companionship during delivery, and 351(86.2%) do not utilize companionship. The main reason mentioned for not to utilize companionship during delivery was provider denial 47.9% followed by an institution not allowed 21.1% (Fig 2).

Fig 2

The distributions of a reason not to utilize companionship during delivery in Arbaminch town public health facilities, south Ethiopia 2019.

Factors associated with having a companion during delivery

To determine the association between utilization of companionship during delivery in the health facilities with different factors, the following dependent variables were checked against outcome variables. On bivariate analysis, women’s occupation, family monthly income, complication during labor and delivery, parity of woman, Comfortability of facilities to be accompanied and knowledge had significantly associated with the utilization of companion during delivery in the health facilities.

After controlling the effects of confounder on multivariable analysis, having a desire to be accompanied, and complication during labor and delivery and parity have a statistically significant association with utilization of companionship during delivery. Respondents who had a desire to be accompanied during labor and delivery were 5 times more likely to be accompanied by their companion than others (AOR = 5.17 (2.63, 10.16). Those respondents who have had complications in the current pregnancy and labor were 3,48 times more likely to utilize their companionship than others (AOR = 3.48 (181, 6.70). Besides, those respondents who gave birth for the first time (primipara) were 2.05 times more likely to have been accompanied by their companion than multiparous women (AOR = 2.05, 1.09, 3.87) (Table 3).

Table 3

Bivariate and multivariable analysis of factors associated with utilization of companion during delivery, Arbaminch Ethiopia, Feb 2019 (n = 407).

Variables	Having companion during delivery		Odds Ratio with 95% CI
	Yes	No	COR	AOR
Women occupation
Unemployed	25	187	1	1
Employed	31	164	0.70(0.40,, 1.24)	1.48(0.77, 2.78)
Monthly family income
≥3000 ETB	29	211	0.71(0.40, 1.25)	0.52(0.27, 1.02)
<3000 ETB	27	140	1
Desire to have a companion during delivery
Yes	42	135	4.80(2.52, 9.12)	5.17(2.63, 10.16)*
No	14	216	1
Complications during pregnancy & labor
Yes	24	63	3.42(1.89, 6.21)	3.48(181,6.70)**
No	32	288	1	1
Parity
Primipara	35	142	2.45(1.37, 4.38)	2.05(1.09, 3.87)*
Multiparous	21	209	1	1
the facility was comfortable to be accompanied
Yes	15	70	1.46(0.76, 2.80)	1.50(0.73, 3.08)
No	41	281	1	1
Knowledge
Good	6	46	0.79(0.32, 1.96)	0.84(0.31, 2.26)
Poor	50	305	1	1

* = p-value <0.05,

** = p-value≤ 0.01, CI = Confidence Interval, COR = Crude Odds Ratio, AOR = Adjusted Odds Ratio.

Discussions

In this study, the overall utilization of companionship during delivery was found to be 13.8%. The finding of this study is lower than the study done in Brazil 38.1%, and Kenya 67%, [23, 24]. The discrepancy might be due to the cultural difference in labor companion and policy that enforce health care providers to allow labor companion. Similarly, the finding of this study is lower than the other study conducted in Ethiopia, Kenya, Madagascar, Rwanda, and the United Republic of Tanzania which showed that the proportion of facilities that encouraged women to have a companion were 34%,38%,40%,43% and 67% respectively [25]. The finding of this study was similar to the study conducted in the Kigoma Region, Tanzania, which showed that only 12% of mothers companionship during delivery [15]. In contrast, this rate is higher than was reported in a study conducted in rural central Ghana which showed that 58% of mothers utilize companionship during delivery [26]. The finding of this study is lower than the study reported in Nigeria which showed that only 22.1% of mothers companionship during delivery [27].

The finding of this study showed that being primiparous (delivered for the first time) were two times more likely to be accompanied by their labor companion during childbirth in the health facilities than those women who were multiparous. This finding is similar to the study done in Brazil, rural central Ghana, and Kigoma Region, Tanzania, which revealed that being primiparous (delivered for the first time) were more likely to be accompanied by their labor companion during childbirth in the health facilities than those women who were multiparous [23, 15, 26]. This might be due to the fear of childbirth because most of the time primiparous women may face the fear of childbirth and they will be more likely accompanied by their companion and this fear of childbirth can harm a woman’s psychological wellbeing and associated with adverse obstetric outcomes and postpartum mental health difficulties.

In this finding women who had obstetrics or medical complications during labor and delivery were 3.48 times more likely to be utilized labor companion as compared to those women who had never been experiencing any complications during labor and delivery. This result is supported by a study conducted in Tanzania which showed that laboring women who develop complications during childbirth had significantly greater odds of having companionship during delivery than women who had normal labor and delivery [21]. But in contrast, a study in Kenya [24] showed that women who had experienced complications at labor are 66% less likely to have companionship while giving birth in the health facilities. This difference may be encountered due to women with labor and delivery complication needs strict follow up by health care provider alone, to provide appropriate management without intervention, and to avoid additional stress by her family members.

Conclusion

Supportive care is beneficial for women during labor as it positively affected pain perception and feelings of anxiety of the parturient. The finding of this study showed that the utilization of companionship during delivery was low as compared to the previous study. Some of the factors associated with the utilization of companionship during delivery was having a desire to companionship, being primiparous, and having facing complication during pregnancy and delivery. Allowing women to have a companion of choice during delivery can be a low-cost and effective intervention to improve the quality of maternity care. More women are now giving birth in health facilities, but the poor quality of care can put their lives and well-being—and that of their infants—at risk. It is therefore crucial to ensure that women and their newborn infants are provided with respectful, high-quality care throughout pregnancy and childbirth. One potential way to improve the quality of care during childbirth in health facilities may be for women to be continuously supported by another person throughout labor.

Questionary on companionship during labor and childbirth.

(DOCX)

Click here for additional data file.

The SPSS data file on companionship during labor and childbirth.

(SAV)

Click here for additional data file.

23 Jul 2020

PONE-D-20-18273

Utilization of Companionship during delivery and associated factors among women who gave birth at Arbaminch town public health facilities, southern Ethiopia

PLOS ONE

Dear Dr. Alemu,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

SPECIFIC ACADEMIC EDITOR COMMENTS: Two experts in the field reviewed your manuscript. We thank them for their time and efforts. Although some interest was found in your study, several major concerns overshadowed this enthusiasm. These concerns include: the article structure needs significant work with emphasis on stating the novelty of this study; questions about delivery route, how women perceived that they were allowed to have a birth companion, and the exclusion criteria; the data presentation needs to be stronger; and the discussion and conclusion need to better reflect the findings. All of the reviewers' comments must be addressed in your revised manuscript.

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Reviewer #1: While it is interesting to see the variables which are correlated with birth companionship, this piece could be made stronger with qualitative findings particularly since the paper reports that many women did not perceive that they were allowed to have a birth companion.

Reviewer #2: all comment inserted in manuscript and attached. some comments are including:

article structure is weak.structure paragraph is incorrect. major revision is needed.

background is low. what is the importance ,necessary,gap and research question?

What delivery type with normal vaginal delivery or cesarean delivery?

exclusion criteria is not completed.

please explain more about validity and reliability of questionnaire.

what is ethical code?

the table has ambiguity. some lines in table have to delete to clarify it.

discussion is weak and underdeveloped and do not cover all finding such as associated factors.

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Submitted filename: PONE-D-20-18273_reviewer-1.pdf

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5 Aug 2020

Author’s Point-by-Point Response to the Reviewer's and Editors Reports

Title: Utilization of Companionship during delivery and associated factors among women who gave birth at Arba Minch town public health facilities, southern Ethiopia: A cross-sectional study

Corresponding author: Biresaw Wassihun /bireswas@gmail.com

Authors

1. Kassaw Beyene

2. Gebresilasea Gendisha

3. Biresaw Wassihun

Manscurpuit number: PONE-D-20-18273

Journal: Plos one

Article type: Research article

Point by point response to Reviewers and Editors

First of all, the authors would like to thank Plos one Journal editors and the respective reviewers for reviewing our manuscript and providing the necessary comments to be corrected. As per the comments given, we have made corrections point by point to comment. The authors tried to answer all the issues raised by editorial team and reviewers.

Point by point response to Editor

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.""

Response: Thank you very much we had apply journal requirement

2. Please include additional information regarding the survey or questionnaire used in the study and ensure that you have provided sufficient details that others could replicate the analyses. For instance, if you developed a questionnaire as part of this study and it is not under a copyright more restrictive than CC-BY, please include a copy, in both the original language and English, as Supporting Information. If the original language is written in, non-Latin characters, for example Amharic, Chinese, or Korean, please use a file format that ensures these characters are visible

Response: ok we will provide All Questioners as additional information upon summation

3. We note that you have indicated that data from this study are available upon request. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly

Response: no restriction on data we can attach as supplementary files.

4. Please state whether you validated the questionnaire before testing on study participants. Please provide details regarding the validation group within the methods section.

Response: Thank you very much we had validated all tool using Cronbach alpha and we had discussed in detail in the Methods section of the manuscript

5. Thank you for stating the following in the Funding Section of your manuscript:

[Arba Minch University as a requirement for postgraduate studies supports this research

financially.] We note that you have provided funding information that is not currently declared in your Funding Statement. However, funding information should not appear in the Acknowledgments section or other areas of your manuscript. We will only publish funding information present in the Funding Statement section of the online submission form.

Response: Thank you very much we had removed it

Point by point response to Reviewers

Question 1: background is low what is the importance, necessary, gap, and research question.

The structure paragraph is incorrect. Article structure is weak.

Response 1: We would like to say thank you very much for your invaluable comments and suggestions. We considered and modified and rewrote again background section based on your constructive issues, coherence, and comprehensibility of the manuscript

Question 2: What delivery type with normal vaginal delivery or cesarean delivery?

Response 2: those mothers who have a normal vaginal delivery

Question 3. exclusion criteria are not completed

Response 3: We amend it and corrected it accordingly. Those women who are seriously ill and unable to communicate during the data collection period were excluded

Question 4. please explain more about validity and reliability of questionnaire

Response 4: We amend it and corrected it accordingly. After pre-testing the questionnaire, Cronbatch’s Alpha was calculated by using SPSS window version 25.0 to test internal consistency (reliability) of the item and Cronbatch’s Alpha greater than 0.7 was considered as reliable. Data were collected by trained midwives and nurses. During data collection regular supervision was done by the supervisors

Question 5. please edit your table? there are a ambitious table with lot of rows

Response 5: It was corrected according to your suggestion

Question 6. some lines in table have to delete to clarify it.

Response 6. It was corrected accordingly

Question 7. discussion is weak and underdeveloped and do not cover all finding such as associated factors.

Response 7. In discussion section, correction was made accordingly based on both reviewers comment and suggestion

Question 8. the paragraph structure is incorrect.

Response 8. correction was made according to you nice comment and suggestion

Question 9. Edite your words example South Africa (??)

Response 9. Words correction was made accordingly based on both reviewers comment and suggestion

Question 10. The references are incomplete

Response 10: Correction was made thanks in-depth, for your nice comment

Submitted filename: Response to reviwers biresaw.docx

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4 Sep 2020

PONE-D-20-18273R1

Utilization of Companionship during delivery and associated factors among women who gave birth at Arbaminch town public health facilities, southern Ethiopia

PLOS ONE

Dear Dr. Alemu,

Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process.

SPECIFIC ACADEMIC EDITOR COMMENTS: There is still a major concern that the manuscript was not properly copyedited before resubmission. The authors must hire someone to proof their manuscript before resubmission.

Please submit your revised manuscript by Oct 19 2020 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org. When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file.

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We look forward to receiving your revised manuscript.

Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

Reviewers' comments:

Reviewer's Responses to Questions

Comments to the Author

1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation.

Reviewer #1: (No Response)

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2. Is the manuscript technically sound, and do the data support the conclusions?

The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented.

Reviewer #1: Partly

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3. Has the statistical analysis been performed appropriately and rigorously?

Reviewer #1: I Don't Know

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4. Have the authors made all data underlying the findings in their manuscript fully available?

The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified.

Reviewer #1: Yes

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5. Is the manuscript presented in an intelligible fashion and written in standard English?

PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here.

Reviewer #1: No

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6. Review Comments to the Author

Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Reviewer #1: I would recommend a round of intensive copy-editing to improve the readibility of the paper. This was a comment made in the previous round of feedback and this challenge persists.

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Reviewer #1: No

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16 Sep 2020

Author’s Point-by-Point Response to the Reviewer's and Editors Reports

Title: Utilization of Companionship during delivery and associated factors among women who gave birth at Arba Minch town public health facilities, southern Ethiopia: A cross-sectional study

Corresponding author: Biresaw Wassihun /bireswas@gmail.com

Authors

1. Kassaw Beyene

2. Gebresilasea Gendisha Ukke

3. Biresaw Wassihun

Manscurpuit number: PONE-D-20-18273

Journal: Plos one

Article type: Research article

Point by point response to Reviewers and Editors

First of all, the authors would like to thank Plos one Journal editors and the respective reviewers for reviewing our manuscript and providing the necessary comments to be corrected. As per the comments given, we have made corrections point by point to comment. The authors tried to answer all the issues raised by editorial team and reviewers.

Point by point response to Editor

1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming.""

Response: Thank you very much we had apply journal requirement

2. Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters)

Response: ok we will provide

Point by point response to Reviewers

Question 1. Reviewer #1: I would recommend a round of intensive copy-editing to improve the readibility of the paper. This was a comment made in the previous round of feedback and this challenge persists

Response: thank you for your nice comment. All of the comments was edited

Question 2. Please state whether you validated the questionnaire before testing on study participants. Please provide details regarding the validation group within the methods section.

Response: Thank you very much we had validated all tool using Cronbach alpha . Before actual data collection occurred two-day training was provided for data collectors and the supervisor about techniques of data collection and briefed on each question included in the data collection tool. The pretest was done on 5% (21) of mothers receiving care in a health center that was not included in the study before the actual study period. After pre-testing the questionnaire, Cronbach's Alpha was calculated by using SPSS window version 25.0 to test internal consistency (reliability) of the item, and Cronbach's Alpha greater than 0.7 was considered as reliable. Data were collected by trained midwives and nurses. During data collection, regular supervision was done by the supervisors

Question 3: background is low what is the importance, necessary, gap, and research question.

The structure paragraph is incorrect. Article structure is weak.

Response : We would like to say thank you very much for your invaluable comments and suggestions. We considered and modified and rewrote again background section based on your constructive issues, coherence, and comprehensibility of the manuscript

Question 5: What delivery type with normal vaginal delivery or cesarean delivery?

Response : those mothers who have a normal vaginal delivery

Question 6. exclusion criteria are not completed

Response : We amend it and corrected it accordingly. Those women who are seriously ill and unable to communicate during the data collection period were excluded

Question 7. please edit your table? there are a ambitious table with lot of rows

Response : It was corrected according to your suggestion

Question 8. some lines in table have to delete to clarify it.

Response . It was corrected accordingly

Question 9. discussion is weak and underdeveloped and do not cover all finding such as associated factors.

Response . In discussion section, correction was made accordingly based on both reviewers comment and suggestion

Question 10. Edite your words example South Africa (??)

Response 9. Words correction was made accordingly based on both reviewers comment and suggestion

Submitted filename: Response to reviwers biresaw.docx

Click here for additional data file.

23 Sep 2020

Utilization of Companionship during delivery and associated factors among women who gave birth at Arbaminch town public health facilities, southern Ethiopia

PONE-D-20-18273R2

Dear Dr. Alemu,

We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements.

Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication.

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Kind regards,

Frank T. Spradley

Academic Editor

PLOS ONE

25 Sep 2020

PONE-D-20-18273R2

Utilization of Companionship during delivery and associated factors among women who gave birth at Arba Minch town public health facilities, southern Ethiopia

Dear Dr. Alemu:

I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now with our production department.

If your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information please contact onepress@plos.org.

If we can help with anything else, please email us at plosone@plos.org.

Thank you for submitting your work to PLOS ONE and supporting open access.

Kind regards,

PLOS ONE Editorial Office Staff

on behalf of

Dr. Frank T. Spradley

Academic Editor

PLOS ONE