 I told you that we are glad that today we will have Santosh Jibbali and Somya Tota who are going to be our presenter today. I just want to just let you know about Santosh. So Santosh has six years experience of nursing, working with the government of Telangana, and she is currently undergoing a next practitioner in midwifery training with the support of the government of Telangana and Fernandez Foundation. Her vision is to become a midwife and support women in birthing, while Somya is a public health specialist with four years of experience working in the area of public health policy and research. And she has special interest in maternal and child health, and she joined Fernandez Foundation to support next practitioners in midwifery program for the government of India and Telangana. Her vision is to educate, empower, and support women to have a positive child birth experience. Thank you very much, Somya and Santosh, and you're welcome, and I'll just hand over to you to go ahead and present. Somya. Thank you very much, Goodson, for your kind introduction. Maybe before Somya and Santosh can begin, we'll ask everyone to just keep your video off, so that we just allow our speakers to have their videos on, okay. Goodson, I think you need to give us access to further slides. I'm just doing that, I'm just doing that, thank you. Thank you, thank you. Just give me a minute, I'm just doing that. Okay, thank you, you can go ahead. Yeah, thank you, Goodson. Good afternoon and good evening, everyone. My name is Santoshi, I'm a nurse practitioner midwife trainee of Telangana state, undergoing clinical training with the support of Fernandez midwives. Good morning, good afternoon and good evening, everyone. My name is Somya, with a background in public health and research, I'm currently working with Fernandez Foundation to support midwifery program for the government of India and Telangana. Thank you, VIDM, for giving us this opportunity to share our experience and evidence from public health facilities of Telangana. The topic for the discussion is women choice of birth companion. More than a decade, the promotion of facility-based births has been at the forefront to reduce maternal morbidity and mortality. But now, the government of India is focusing more towards quality of maternal and newborn healthcare. And the efforts from the international organizations to India in this regard is commendable. The World Health Organization, WHO recommends that every woman is offered the option to experience labor and childbirth with a companion of her choice. Encouraging women to have a companion of choice during labor and childbirth is one of the low cost and effective intervention to improve the quality of maternity care. The government of India strongly recommends encouraging birth companion during birthing in all the public health facilities in India since 2016. Now, let us see who is a childbirth companion. Across the globe, a childbirth companion is considered as a person who provides continuous support to women during labor and childbirth. A birth companion must be of women's choice. They can be either husband or partner, mother, friend, or any family member or any healthcare profession of her choice. In 2017, the government of India included the continuous presence of birth companion as one of the quality standard in the Laksh guidelines for improving quality of maternal and newborn care. The Laksh guidelines are the labor room quality improvement initiative standards to assess the quality of labor rooms and maternity duties. However, many healthcare facilities do not encourage birth companion, especially partner, and often women preferences are not respected. Now, let us see the common elements of support provided by a birth companion. They include informational support. A birth companion can give information about labor progress and can advise the mother regarding coping techniques. A birth companion can provide comfort measures such as comforting touch, massage, warm baths or showers, encouraging mobility, and promoting fluid intake and output. There are many situations where a woman hesitate to talk about her birth preferences. In such situations, companion can support her as an advocate by building confidence in her and making her feel that she is not alone. Sometimes tragedies may happen. A companion can help the mother deal with very difficult situation and support in her time of grief or bereavement, thereby helping the mother to cope up with the emotional baggage that she is carrying on. The literature review has helped us to understand that a child-bearing woman can cope up with the pain better if she has a companion of her choice by her side. The other benefits include shorter labor with increased rates of spontaneous vaginal birth, less likely to experience mistreatment during labor and childbirth, decreased usage of intrapartum analgesia or any pain medication and caesarean section and increased satisfaction with her childbirth experience. The studies also reported that women supported in this way have less fear and distress during labor, which also appeared as a buffer against adverse aspects of medical interventions. Finally, the babies of these women are less likely to have low-upgar scores. The objective of our study was to look at the choice of birth companion, among primal and multigravada women, accessing maternity services in public health facilities of Telangana. During our clinical posting, we have collected data from 104 antenatal mothers and the sample was taken randomly from antenatal mothers instead public health facilities in the month of December 2020. The variables considered for the preliminary research are age, parity and choice of birth companion by women. The analysis shows that 62% of the women belong to the age group of 22 to 25 years followed by 23% women belong to 26 to 30 years, while 56% women are primae and 44% women are multigravada. When we tried to understand who is the first choice of companion for women in their first pregnancy, we found that the 41% of the primae women wanted their husband as their birth companion, while 50% of multivomins said that their mother has their birth companion in first pregnancy. This raises a question for further research on why do multivomins were supported by mothers? Do they have an idea that husband can be a companion? When we asked women about whether the hospital permitting to have a companion, 70% women said that they were encouraged to have a birth companion and 30% said not encouraged. When we asked what was the reason for not having a birth companion, all the women said it was due to COVID-19 restrictions. As we conducted this study as preliminary research to understand the choice of birth companion, we identified that husband is the first choice in the primae whereas multi-had mother has first choice. These findings raises a question like is there is a lack of awareness regarding having their husband as their birth companion or is it due to hospital policy for not encouraging the husband in the birthing room or is it due to the cultural norms? This gives us scope for future research and we will continue to research on these parameters. Though they are challenging in providing privacy to each and every women in public health facilities, a carton and chafer companion will important to understand that the active presence of husband or partner can help in improving the birth outcomes. Despite the recommendations given by the World Health Organization and National Guidelines, majority of healthcare facilities do not encourage women to have a birth companion of their choice. Healthcare provides must strictly commit to luck standards by ensuring curtains or partitions for privacy as this will help facilitate the presence of husband or partner as it is women's first choice of preference. We want to conclude this presentation by reading the recommendation from W H O clinical management of COVID-19 which states that the guidelines strongly recommended that all pregnant women including those with suspected, probable or confirmed COVID-19 have access to a companion of choice during labor and childbirth. We want to take this opportunity to acknowledge our friends, mentors and health care staff who supported us in conducting the public health facilities of Telangana. So the picture you are looking at is taken in one of the public health facility where the first batch of midwives in India are encouraging women to have a companion of their choice. And this is so encouraging for all of us as they are setting ground for the future midwives. Finally, we look forward to an India where the professional midwife advocate and offer midwifery care to every pregnant women across this country by encouraging a companion of her choice regardless of her socioeconomic status or the medical complications that her pregnancy is surrounded with. Thank you everyone for giving us this opportunity. Thank you. Thank you very much Somya and Santosh for that wonderful presentation and would like to now just ask if you could take some questions. Yeah, if we could take some questions. If you do have any questions, please, we will be glad to. You ask, you unmute yourself or you can type in the chat box. So this is the time. Issa, good morning. You could at some point or ask you to read some of the questions or the comments in the chat box. Any questions, you can unmute yourself and ask. Issa, are you about, okay. Velpula Anush, you want to ask a question? Okay, thank you. Issa, are you about to read some of the comments in the chat window? Okay, does that mean that the presentation was very... Okay, so one of the questions for you, Somya, is from John. He says, have you thought about a qualitative study on why they prefer husbands or mothers? Have you thought about a qualitative study on why they prefer husbands or mothers? Then the other question, I'll read about five and then you will respond. It's a comments, congratulations to mentors and midwifery trainees for bringing this change and implementing evidence-based practice in the country. The other one was just nice explained great presentation for you. What are the challenges not to allow both companions? What are the challenges not to allow both companions? Maybe those are the two questions that you'd like to respond to. Somya and Sandosh. Thank you, Goodson. So first, I think Joanne asked regarding the qualitative study. Thank you, Jo, for asking that question. We actually started this preliminary research to understand what women wanted. So when we got to know that women's first choice is their husband or even partner, then we immediately thought of doing a qualitative study to understand why women need husband compared to mother or mother-in-law or any family member. So we'll definitely do that in phase two and we will publish that results also as soon as possible. Second. Thank you, I have a question. Oh, okay, you can go ahead. Well, thank you very much for this presentation. Please, I'd like to know is that a policy in India that Allah bet companion during labor? That allow or do not allow? That allow best companion. Is this a policy in India that allow best companion during labor? Yeah. So I have mentioned in the presentation about the luxury standards. So it is actually Labour Room Qualitative Improvement Initiative, clearly states that the number of births conducted in the presence of companion is considered as one of the quality standard. So based on the number of births conducted in the presence of a companion will be given a rank and based on that a facility will be assessed. So that is one of the important criteria in this quality standards. So like that even government of India given guidelines regarding this, even I have shown in the presentation since 2016, like there are many, even if we take globally the wide ribbon alliance which released the RMC Charter. It also says that women's, I mean birth companion is women's choice and it is also women's right. So there are many guidelines and there are many policies which I mean which clearly states and encourages women to have birth companion. So at the same time it is also responsibility of the health facilities as well to encourage and advocate regarding the birth companion. Thank you so much. Yeah, there's a question that you did not answer which was saying what are the challenges not to allow best companions. Let me just add another one which is from Gutham, forgive me for the pronunciation. What if the birth giving woman doesn't want the husband as the companion? In that case how would the midwives help the mother in the process of birthing? What if the birth giving woman doesn't want the husband as the companion? In that case how would the midwives help the mother in the process of birth giving? Please you can take those two questions. Thank you for asking this question. I think we have heard stories like this in the not only in public health facilities even in private where women don't want their partners or husbands to be as companions. So first we need to understand maybe this will be also one of the indicator in our research that we are going to do in phase 2. But for now what we have understood is like there are some situations. For example a woman might face domestic violence or she might have she might not have good relation with the partner. So that is one of the main challenge for women for not wanting husband or partner to be as companion. And also there are some cultural norms that we have come across. Like usually men in the birthing room is I mean many women do not know about that. So that is something we need to bring awareness. If the mother or if the mother do not want her husband to be as a companion then the next option can be she can choose friend or any of her family even if she doesn't want her family member to be as a companion then she can choose straight away midwife or even doula sometimes. Doula is a non-medical person who provides physical emotional support. The same way partner provides support to the women a doula can provide. So she has every right to choose whomever she wants so she can choose midwife, doula and even I think in the question they asked how a midwife can be as a companion. So they can provide all the coping strategies, massage techniques which we have mentioned in the presentation. So midwives can be also a companion to the mother. And one more thing provides psychological support also during labour and charitable. Thank you so much for taking those questions. Those questions would allow two more questions before we go into concluding. If there are any two more questions I think what we're seeing now is just comments. I think Mooche is agreeing with the earlier comment that it would be better if translated by qualitative one which you have commented about. And Fentow says thank you so much presenter for your wonderful presentation and Ramadhevi also says good presentation. Somya.