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British Journal of Healthcare and Medical Research - Vol. 10, No. 2
Publication Date: April 25, 2023
DOI:10.14738/jbemi.102.14506.
Ventour, D., & Gardiner, K. (2023). Knowledge, Attitude and Practice of Partner’s Presence in OT for Elective C-Section: A Caribbean
Perspective. British Journal of Healthcare and Medical Research, Vol - 10(2). 479-493.
Services for Science and Education – United Kingdom
Knowledge, Attitude and Practice of Partner’s Presence
in OT for Elective C-Section: A Caribbean Perspective
Dale Ventour
Anaesthesia & Intensive Care,
The University of the West Indies, Mt. Hope, Trinidad
Kadija Gardiner
Anaesthesia & Intensive Care,
Port-of-Spain General Hospital, Port-of Spain, Trinidad
ABSTRACT
Objective: It is current practice in our setting to not admit a partner in the
Caesarean room even though this is becoming commonplace in various countries.
This study is designed to determine the views of healthcare workers, postpartum
mothers and their accompanying partners on having a partner present during an
elective Caesarean section at Port of Spain General Hospital, Trinidad, West Indies.
Design: 94 participants were selected, a questionnaire was given to healthcare
workers, patients and partners in November/ December 2021 to investigate the
viewpoint of anaesthetists, obstetricians, midwives, operating room nurses,
pregnant/post-partum mothers and their accompanying partners. Results: 70% of
respondents were in favour of a partner being present in the operating room for an
elective Caesarean section and thought it would help to keep the mother at ease by
allowing her to hold hands with the partner, talk to them and be accompanied by
them to the recovery room. Healthcare workers did not think that male partners
had a role to play in the operating room as they would not know what to do and may
actually pose a security threat if the operation did not go exactly as planned.
Conclusions: Healthcare workers were neutral to the concept of a partner being
present in the Caesarean room, while mothers and partners supported the idea.
Future studies are needed to confirm if these observations are comparable among
other public hospitals in other territories in the developing world where partner
accompaniment is not a priority to mothers.
Keywords: Perspective, Healthcare, CaesarCaesarean section, Support, Theatre
INTRODUCTION
Several randomized trials have shown that women who are supported during labour by a
partner (e.g., husband), experience less anxiety, have more spontaneous deliveries, require
less anaesthesia, and need fewer medical interventions.
1 One study examined the overall
experience of a planned Caesarean birth and under the theme “emotional roller coaster of
birth”, one woman recounted her feelings about her partner by saying: I think he wasn’t
prepared for it (the surgery) either because he never held my hand. If I just had someone be
able to hold my hand, I think I would have felt better but I didn’t even have that.
2 The fear of
anaesthesia was often compounded by the fact that the support person was not allowed in the
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British Journal of Healthcare and Medical Research (BJHMR) Vol 10, Issue 2, April- 2023
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operating room while the anaesthesia was placed. The women needed to rely on the nursing
staff for support. One woman explained: To make it worse there is no one in the room with
you except the nurses and the anaesthetist, but they are strangers.
2 In Princess Margaret
Hospital (PMH), Swindon, UK, over 90% of elective lower segment Caesarean sections (LSCS)
are performed under regional anaesthesia and, in the vast majority, the woman is
accompanied by her partner.
3 According to the National Institutes of Health Consensus
Development Task Force on Caesarean childbirth of 1981 - ‘Hospitals are encouraged to
liberalize their policies concerning the option of having the father or father surrogate attend
the Caesarean births.
4 Marut and Mercer, using interview data collected two days after
Caesarean birth, concluded that mothers “having a partner with them had a more positive
perception of the [birth] experience than those who did not”.
5 A study by Sakala found that
anaesthetists were the most sceptical to the idea of partner presence during Caesarean
section among gynaecologists, midwives, nurses and anaesthetists.
6 Another study supported
the view that healthcare workers were the ones preventing entry to companions at the time
of the operation, “The nurse said that the doctor wouldn’t let me be present, and that I could
stay waiting in the corridor and that when the baby was born, I could be with them – but that
I could not enter the operating room”.
7
MATERIALS AND METHOD
The Research Instrument
The instrument of choice was a self-administered questionnaire formatted from a previous
study by Sakala et al and identical for all participant .
6 The questionnaire was sent in
November and December 2021 during the pandemic, it evaluated the attitudes of the staff,
mothers and partners to the presence of partners in the theatre during an elective caesarean
delivery. We selected 200 healthcare workers, choosing this number from Sakala’s paper but
received a response rate of 48.5% (97). The first item of the questionnaire asked whether
persons thought partners should be allowed in theatre. Section 1 was omitted if the answer
to the initial question was “no”. All persons were then asked to complete sections 2 and 3.
The options for each question were phrased so as to be mutually exclusive and were arranged
from more liberal to more restrictive using a Likert scale. The options ranged from strongly
agree (5) to strongly disagree (1). The questions reported in this paper covered 3 general
areas: section 1 - conditions for admission; section 2 - appropriate behaviour for mother in
O.R.; section 3 - appropriate behaviour for partner in O.R. (see Appendix 1).
ETHICS
After ethical approval was granted by the Ethics Committee, questionnaires were distributed
virtually to all obstetric physicians (consultants, registrars and senior house officers), all
anaesthetic physicians as well as all theatre and midwifery nursing staff. This study took place
during the height of the Covid-19 pandemic, as a result there were numerous restrictions in
place that resulted in limited access to wards and a further need to maintain safety by limiting
contact with participants to reduce the risk of transmission. The questionnaire was done on
a Google form, again due to pandemic restrictions and distributed to the list of participants
from the chosen sample. It was returned anonymously except for professional identification
as to the above five categories for evaluation. Mothers and partners were not allowed to
collaborate on their response.
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Ventour, D., & Gardiner, K. (2023). Knowledge, Attitude and Practice of Partner’s Presence in OT for Elective C-Section: A Caribbean Perspective.
British Journal of Healthcare and Medical Research, Vol - 10(2). 479-493.
URL: http://dx.doi.org/10.14738/jbemi.102.14506.
RESULTS
Ninety-four questionnaire responses were returned with distribution as shown in Table 1
Table 1 showing the number of participants from each role
ROLE NUMBER
Anaesthetist 39
Obstetrician 20
Theatre RN 10
Midwife RN 12
Pregnant mothers 10
Partners 3
Total 94
67% of respondents were in the age group 25-40, 24% in the 41–56-year-old age group, 5%
in the over 57 years old category and 4% made up the age group 18-24. Ethnic backgrounds
for respondents were as follows: 46% Africans, 29% East Indians, 23% Mixed, 1% Chinese,
1% Syrian/Lebanese. Females made up 79% of respondents while 21% were male.
The majority of respondents agreed that partners should be allowed in the Caesarean section
room (70%). These persons were then asked to answer Section 1, the conditions for
admission to theatre. The remaining respondents (30%) were then asked to move onto
Section 2 along with the previous respondents.
Access to Theatre
The Opportunity for Partner to Be in the O.R Should Be Willingly Offered:
Participants responded more favourably to this (85%), a small number of persons were
undecided (15%) and no respondent disagreed to a partner being present in the operating
room.
The Opportunity for Partner to Be in the O.R Must Be Requested:
Even though most participants agreed to partners being willing offered the opportunity to be
present in the operating theatre, they also felt more favourably about partners having to
request permission to enter the operating room (67%). In this case respondents did disagree
with partners having to request admission to the theatre (29%).
A Support Person Other Than the Partner Should Be Allowed in The O.R.:
Participants expressed similar sentiments to this question (39% disagreed and 45% agreed).
Ten respondents were undecided at that time (16%).
Partner Should Not Be Allowed in The O.R. For A General Anaesthetic:
Participants generally agreed that the partner should not be allowed once the method of
anaesthetic would be a general anaesthetic (55%). 32% participants did not agree. Only 14%
of participants were undecided.
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Partner Can Enter the O.R. If The Type of Anaesthetic Used is a Regional Technique:
This statement was supported by the majority of participants who agreed that once a regional
technique was being done, there would be no issue allowing the partner to be present in the
O.R. (77%). A similar number of persons disagreed and were undecided (14% and 9%
respectively)
It is Appropriate to Allow Partner in the O.R. For Elective Cases:
Participants were more favourable to partner presence in an elective Caesarean section (91%).
A minimal number of participants disagreed (3%) or were undecided (6%).
It Is Appropriate to Allow Partner in the O.R For Emergency Cases:
Participants responded less favourably to this question as they believed that it was not
appropriate to allow a partner in the O.R for an emergency case (58%). A large number of
participants were undecided about this question (26%)
Partner Should Not Be Excluded from Entering the O.R. Even If the Mother Has Not
Received Antepartum Care At POSGH:
Participants agreed that partners should not be excluded (50%) and they were less in favour to
partners being excluded (23%). Participants also felt unsure about whether or not the partners
should be excluded (27%).
Partners Who are Not Present During Mothers’ Antenatal Care Should Still Be Allowed
to Accompany Them in The O.R.:
Participants agreed that partners can still be allowed in the operating room (48%), they were
less in favour for their exclusion despite the partner not being present during antenatal care
(36%). A small number of participants were not certain (16%).
Mandatory Educational Sessions on Childbirth Via Caesarean Section Should Be
Compulsory Prior to Admittance to O.R.:
Participants responded more favourably to having educational sessions prior to operating
room admittance (85%). Very few participants disagreed (11%) or were undecided (4%).
Consent Must Be Signed by Partner Outlining the Risks of Surgery Before Admission to
The O.R.:
Participants agreed more favourably that consent should be applicable prior to surgery
(62%). 26% of participants did not think partners should be made to sign consent, few
participants were uncertain (12%).
All participants were asked to respond to section 2, and this consisted of ninety-four (94)
persons.
Spousal Support/Comfort
Mother Can Touch, Hold, Or Even Breast Feed Her Baby During Surgery:
Participants agreed more favourably to this question (80%). A similar number of participants
were both undecided as well as not in favour of this practice (12% and 8% of persons
respectively).
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Ventour, D., & Gardiner, K. (2023). Knowledge, Attitude and Practice of Partner’s Presence in OT for Elective C-Section: A Caribbean Perspective.
British Journal of Healthcare and Medical Research, Vol - 10(2). 479-493.
URL: http://dx.doi.org/10.14738/jbemi.102.14506.
Mother Can Be Allowed to View the Delivery with A Mirror or By Lowering Anaesthesia
Screen:
There was a slight trend toward participants agreeing that mothers should be allowed to view
the delivery of their baby (51%). A smaller number of participants were not in agreement and
felt that they perhaps should not be allowed to see (35 %) with some undecided participants
(14%).
Mother’s View Should Be Obstructed with The Anaesthesia Screen:
There was no significant difference in favorability among participants for this question (41%
of persons agreed and 38% disagreed). 21% of participants were undecided.
Mother Will Be More Anxious with Partner Present:
The majority of participants were less in favour of this statement (70%) and disagreed. A
small number of participants did however think that they would be more anxious (9%). 21%
of participants were undecided.
Mother Will Be at Ease with Partner Present:
Participants agreed that mothers will be at ease, showing high favorability (77%). Very few
participants disagreed or were undecided (23% together)
Communication Between Mother and Partner Can Occur While Surgery Ongoing:
A similar number of persons were in favour of having communication between mother and
her partner as compared to her being more at ease (77%). 23% of participants yet again were
not in favour or unsure.
Mother Cannot Hold Hands/Be in Close Proximity with Partner During Surgery:
Participants were less in favour of this, disagreeing with the inability of the mother to hold
hands or be in close proximity with the partner (67%). Few participants agreed that it should
not be allowed to occur (13%), 20% of participants were undecided.
If Mother is Uncooperative Partner Should No Longer Be Allowed to Enter the O.R.:
Participants agreed more favourably to not allowing a partner to enter the operating room if
the mother was uncooperative (51%) than those who thought they should be allowed despite
their behaviour (32%). 17% of participants were undecided.
Partners’ Participation at Caesarean Section
Partner Entering the O.R. Before Anaesthesia Should Be Encouraged:
Participants were less in favour of partners entering the operating theatre before anaesthesia
commenced (48%). A high number of participants also saw no issues with partners being
present (38%). 14% of participants were undecided.
Partner Should Not Sit in Close Proximity to Anaesthetic Staff:
Participants agreed and were more in favour of partners not sitting close to anaesthetic staff
while in the operating theatre (56%). A smaller number of participants disagreed and thought
they should be allowed to sit close to staff (25%), with even fewer participants being
undecided (19%).
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her more security, tranquillity and comfort, which may reflect in strengthening the
relationship.11 This also contributes to the greater involvement of fathers in the family's
health and quality of life. The health team should be prepared to welcome the parturient, her
partner and other family members, respecting all the meanings of that moment, with the duty
to facilitate the creation of bonds, transmitting confidence, tranquillity and guaranteed the
rights of women in the health actions.11
In conclusion, there was an overall positive attitude by all healthcare workers to having
partners present during a caesarean section provided the parturient has undergone a regional
anaesthetic technique. To broaden the perspective a similar questionnaire should be
administered to the mothers and partners to gain 360-degree insight.
Acknowledgement
No acknowledgements to declare
There is no funding allocated to this manuscript. The authors have no conflict of interest to
declare.
Reference
1. Kadour-Peero E, Miller N, Vitner D, et al. Who may accompany the parturient to the delivery room?
Archives of gynecology and obstetrics. 2019;300:293-297.
2. Puia D. First-time mothers’ experiences of a planned cesarean birth. The Journal of perinatal education.
2018;27(1):50-60.
3. Taylor I, Bullough A, Van Hamel J, Campbell D. Partner anxiety prior to elective Caesarean section under
regional anaesthesia. Anaesthesia. 2002;57(6):584-605.
4. Rosen MG. NIH Consensus Development Task Force statement on cesarean childbirth. American Journal
of Obstetrics and Gynecology. 1981;139(8):902-909.
5. Marut JS, Mercer R. The cesarean birth experience: implications for nursing. Birth defects original article
series. 1981;17(6):129-152.
6. Sakala EP. Perinatal professionals' view of fathers in the cesarean room. Journal of Psychosomatic
Obstetrics & Gynecology. 1985;4(4):285-293.
7. Almeida A, Brüggemann OM, Costa R, Junges CF. Separation of the woman and her companion during
cesarean section: a violation of their rights. Cogitare Enferm. 2018;2(23):e53108.
8. Lavender T, Walkinshaw SA, Walton I. A prospective study of women's views of factors contributing to a
positive birth experience. Midwifery. 1999;15(1):40-46.
9. Cain Jr RL, Pedersen FA, Zaslow MJ, Kramer E. Effects of the father's presence or absence during a
cesarean delivery. Birth. 1984;11(1):10-15.
10. dos Santos LM, da Silva Carneiro C, de Santana Carvalho ES, Paiva MS. Health staff perception about the
presence of the companion during childbirth. Rev Rene. 2013;13(5)
11. Ribeiro JF, de Sousa YE, de Sousa Luz VLE, et al. THE FATHER'S PERCEPTION ON HIS PRESENCE
DURING THE PARTURITIVE PROCESS. Journal of Nursing UFPE/Revista de Enfermagem UFPE.
2018;12(6)
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Section 2: Appropriate behaviour for mother in the O.R
Strongly
Disagree
Disagree Undecided Agree Strongly
Disagree
Mother can touch, hold or even breast
feed her baby during surgery
1 2 3 4 5
Mother can be allowed to view the
delivery with a mirror or by lowering
anaesthesia screen
1 2 3 4 5
Mother’s view should be obstructed with
the anesthesia screen
1 2 3 4 5
Mother will be more anxious with partner
present
1 2 3 4 5
Mother will be at ease with partner
present
1 2 3 4 5
Communication between mother and
partner can occur while surgery ongoing
1 2 3 4 5
Mother cannot hold hands/ be in close
proximity with partner during surgery
1 2 3 4 5
If mother is uncooperative partner should
no longer be allowed to enter the O.R.
1 2 3 4 5
Section 3: Appropriate behaviour for partner in the O.R
Strongly
Disagree
Disagree Undecided Strongly
Agree
Agree
Partner entering the O.R. before
anaesthesia should be encouraged
1 2 3 4 5
Partner should not sit in close proximity
to anaesthetic staff
1 2 3 4 5
Partner should be allowed to view the
surgery and take pictures
1 2 3 4 5
Partner can hold the baby in the O. R 1 2 3 4 5
Partner should not be asked to leave the
O.R if complications arise
1 2 3 4 5
Partner can accompany and stay with
mother in the recovery room
1 2 3 4 5
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Ventour, D., & Gardiner, K. (2023). Knowledge, Attitude and Practice of Partner’s Presence in OT for Elective C-Section: A Caribbean Perspective.
British Journal of Healthcare and Medical Research, Vol - 10(2). 479-493.
URL: http://dx.doi.org/10.14738/jbemi.102.14506.
APPENDIX 2
Questionnaire data
What is your role?
How old are you?
41%
21%
11%
13%
11%
3%
Anaesthetist
Obstetrician
Theatre RNs
Labour/Delivery RNs
Pregnant mothers
Partners
4%
67%
24%
5%
18-24
25-40
41-56
57+
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What is your ethnicity?
What is your gender?
46%
29%
23%
1%
African
East Indian
Mixed
Chinese
Syrian/Lebanese
21%
79%
Male
Female
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491
Ventour, D., & Gardiner, K. (2023). Knowledge, Attitude and Practice of Partner’s Presence in OT for Elective C-Section: A Caribbean Perspective.
British Journal of Healthcare and Medical Research, Vol - 10(2). 479-493.
URL: http://dx.doi.org/10.14738/jbemi.102.14506.
What is your religion?
Do you think partners should be allowed in the theatre during elective Caesarean
section?
24%
20%
17%
6%
5%
2%
8%
18%
Roman Catholic
Pentecostal
Hindu
Anglican
Muslim
Jehovah's witness
Seventh Day Adventist
Others
70%
30%
Yes
No
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Bar graph 1 showing responses for conditions for admission
Bar graph 2 showing responses for appropriate behaviour for mother in the O.R.
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493
Ventour, D., & Gardiner, K. (2023). Knowledge, Attitude and Practice of Partner’s Presence in OT for Elective C-Section: A Caribbean Perspective.
British Journal of Healthcare and Medical Research, Vol - 10(2). 479-493.
URL: http://dx.doi.org/10.14738/jbemi.102.14506.
Bar graph 3 showing responses for appropriate behaviour for partner in the O.R.