Woman, companion and midwife interpersonal dynamics during childbirth: A phenomenological study in south African midwife-led birth units

Background Supportive interpersonal relationships during childbirth are essential to the delivery of quality midwifery care, particularly in a midwife-led setting. However, little is known about how midwives, birthing women, and companions co-experience and interpret their supportive interpersonal relationships in resource-limited, midwife-led settings. Aim To explore how midwives, birthing women, and companions experience and make meaning of their interpersonal relationships during childbirth in selected Midwife-led Birth Units (MLBUs) in the Eastern Cape Province, South Africa. Methods An interpretative phenomenological analysis (IPA) approach was used. Semi-structured interviews were conducted with 12 purposively sampled participants (four midwives, four birthing women, and four companions). Data were analysed using a systematic, idiographic process to develop experiential themes at the personal and group levels. Findings Four key themes were identified: A. The Role of the Companion in Childbirth Support; B. Midwives' Attributes and Behaviours; C. Trust, Safety, and Collaboration in Childbirth; and D. Antenatal Care as a Foundation for Building Relationships. Participants emphasised how positive interpersonal relationships promoted calmness, cooperation, and emotional safety, while negative interactions led to anxiety, silence, and feelings of abandonment. Conclusion The study highlights the importance of interpersonal relationships in shaping women's childbirth experiences. Supportive companions and positive midwives' behaviours fostered calmness, trust, and cooperation during labour. In contrast, negative interactions and poor communication led to anxiety, silence, and feelings of abandonment among women. Antenatal care was identified as an important opportunity to build trust and establish supportive relationships between women and healthcare providers. Strengthening respectful, compassionate, and collaborative maternity care practices is essential for improving women's childbirth experiences and the quality of care.