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Background: Advancements in medical interventions have contributed to the prevention of innumerable deaths of women and newborns globally, leading to the medicalization of childbirth, which may have inadvertently contributed to a dehumanization of the birthing experience by denying women the social and emotional support that they enjoyed when giving birth in the home environment. The WHO places equal importance on the quality of clinical care and the quality of experience of care. Emotional support, provided by a birth companion of choice, is critical for enhancing the experience of care during labour and birth. This study explores advocacy for women to have a birth companion, as well as perceptions of women about having a birth companion during labour and birth in a rural sub-district of Limpopo Province in South Africa.  Methods: A cross-sectional study based on a continuous electronic RMC client satisfaction survey, on an on-line platform, which was completed by 506 women in a postnatal ward of a rural district hospital. Observations of interactions between midwives, women in labour and their birth companions during labour and birth were conducted in the same hospital. The survey data was analysed using descriptive statistics in Excel, and comprises both univariate and bi-variate analyses. The qualitative data from the observations was analysed using thematic analysis techniques.  Results: Over 80% of women who completed the survey reported that they were informed about what a birth companion is and encouraged to register a birth companion at the health facility where they were attending antenatal care. Almost half of the women (49%) who were encouraged to bring a birth companion, had a birth companion during labour, whereas 15% of those not encouraged to bring a birth companion, had a birth companion during labour. The respondents who were feeling neutral, happy and very happy about having a birth companion were most likely to recommend having a birth companion to their family member or friends.  Conclusion: The findings show that encouraging and supporting the presence of a woman’s companion of choice during labour and childbirth is an effective intervention that is respectful of women’s autonomy and agency and which is crucial for improving quality of clinical care and the experience of care during labour and birth

Birth companion of choice: a survey amongst women who have given birth at a rural hospital in Limpopo, South Africa