The study was authored by Ristina Rosauli Harianja and Muhammad Akbar Nurdin from the Faculty of Public Health, Universitas Cenderawasih, Jayapura, Papua, Indonesia. The researchers examined dozens of scientific studies from Indonesia and abroad to answer one critical question: how effective are module-based educational media in preparing husbands to become genuine birth companions?
Why This Matters
The World Health Organization (WHO) has long recommended labour companionship — the presence of a chosen support person during labour and birth as one of the most important practices for creating a positive childbirth experience. Evidence from Cochrane meta-analyses shows that continuous support during childbirth increases the likelihood of spontaneous vaginal delivery, reduces negative birth experiences, and improves several maternal outcomes.
In Indonesia, husbands are often the most likely candidates to serve as birth companions, given their emotional closeness, role in family decision-making, and responsibility for transportation and financial arrangements. However, a husband's physical presence in the delivery room does not automatically translate into effective support. Many husbands arrive without sufficient understanding of the labor process, how to communicate supportively, or basic comfort techniques they can offer their wives.
This situation is further complicated by cultural norms, restrictive health facility policies, and gender perceptions that still treat the delivery room as an exclusively female space.
How the Research Was Conducted
Harianja and Nurdin conducted a structured narrative literature review, searching scientific databases including PubMed, Scopus, ScienceDirect, Google Scholar, and GARUDA. The search focused on articles in Indonesian and English published primarily between 2015 and 2025, with several landmark studies from before 2015 also included where directly relevant.
Sources reviewed spanned systematic reviews, observational studies, qualitative studies, quasi-experimental designs, and reports on educational interventions. The synthesis was organized around four main themes: the role of labour companionship in quality maternity care, the husband's position as a birth companion, the effectiveness of module-based educational media, and the barriers and facilitators of implementation.
Key Findings
Across the studies reviewed, a consistent pattern emerged: husbands who received structured education through modules, booklets, e-modules, or educational videos showed improvements across four core dimensions:
- Knowledge of the labor process, stages of delivery, and warning signs
- Understanding of their role as an active and supportive companion
- Motivation and emotional readiness to be present and engaged
- Practical skills, including calming communication techniques, helping with positioning, and coordinating with healthcare providers
One study cited in the review Salehi et al. (2016) found that the presence of a trained and prepared husband significantly reduced women's anxiety during childbirth. Indonesian studies also reported that booklet-based health promotion increased husbands' participation in accompanying birth, while the SUMPING e-module (Support Suami Pendamping) demonstrated improvements in role understanding and husbands' independence in providing birth support.
According to the review, effective husband support during childbirth covers four domains: emotional support (reassuring and encouraging the wife), informational support (helping her understand what is happening), instrumental support (assisting with basic needs such as positioning and hydration), and advocacy support (facilitating communication with healthcare staff without overriding the mother's own voice and decisions).
A Critical Note: Evidence Still Needs Strengthening
Harianja acknowledges that while the positive signals are consistent, the specific body of evidence for husband-focused birth companion modules remains at a low to moderate level. Most local studies used quasi-experimental designs without strong control groups, involved small sample sizes, and measured only immediate post-education knowledge scores.
"Modules are best understood as an important supporting strategy, particularly when integrated with companion-friendly facility policies, healthcare provider training, and interactive antenatal education," the researchers write in the article.
Future research needs to measure more comprehensive outcomes, including husbands' self-efficacy, the quality of actual support observed during labor, mothers' experience of being accompanied, satisfaction with care, analgesic use, labor duration, and potential effects on referral decisions.
Implications for Policy and Practice
The findings carry direct relevance for health facilities across Indonesia, from community health centers (puskesmas) and independent midwifery practices to hospitals. Three practical recommendations are put forward:
- Health facilities must shift their paradigm from simply "allowing husbands to be present" to "preparing husbands to provide effective and safe support," including developing birth companion standard operating procedures and brief orientation sessions at the delivery ward.
- Modules should be concise, visual, and action-oriented, containing concrete steps husbands can actually take from recognizing signs of labor and danger signs, to non-pharmacological comfort techniques and supportive communication.
- A multimodal approach works best: combining printed modules, e-modules, short videos, readiness checklists, and simulation exercises within antenatal classes enables both knowledge transfer and the development of practical skills.
About the Authors
Ristina Rosauli Harianja is a researcher and lecturer at the Faculty of Public Health, Universitas Cenderawasih, Jayapura, Papua, Indonesia. Her areas of expertise include maternal health, health education, and childbirth companionship. She can be reached at: rosaulli_ristinn@yahoo.co.id
Muhammad Akbar Nurdin is also affiliated with the Faculty of Public Health, Universitas Cenderawasih, with a focus on public health and health promotion.
Research Source
Title: The Effectiveness of Education Based on Modules on Knowledge, Attitudes, and Involvement of Husbands in Childbirth Support: Literature Review Journal: Asian Journal of Healthcare Analytics (AJHA) Volume/Issue/Pages: Vol. 5, No. 1, 2026: 145–158 DOI: https://doi.org/10.55927/ajha.v5i1.16439 Open Access: https://journal.formosapublisher.org/index.php/ajha
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