Sexual and reproductive health

Why having a companion during labour and childbirth may be better for you

18 March 2019 – A new Cochrane qualitative evidence synthesis provides new key insights into the experience of women, families and healthcare providers on having a companion present during labour and childbirth, and factors affecting implementation of labour companionship globally. This new review complements a Cochrane intervention review published in 2017 that explored the effect of continuous support for women during childbirth and which concluded that outcomes for women and babies were improved in the presence of continuous support.

Pregnant woman in labour with her birth partner

What is labour companionship?

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Labour companionship refers to support provided to a woman during labour and childbirth. It may be provided by a partner, family member, friend, doula or healthcare professional.

Women have traditionally been attended by a companion throughout labour and childbirth. In some settings, however, initiatives to encourage women to give birth in health facilities have not always respected this tradition. This may mean that women give birth in a health facility alone or without the support of someone she trusts.

There is global interest in improving the quality of maternal and newborn care, including initiating, supporting and sustaining programmes designed to improve the quality of maternal health care. This includes a strong focus on respectful care as an essential component of high-quality care. Labour companionship is a key component of providing respectful maternity care and has been recommended most recently as part of WHO recommendations on intrapartum care for positive childbirth experience and included as one of the WHO standards for improving the quality of maternal and newborn care in health facilities.

The role of labour companions

The qualitative evidence synthesis analysed 51 studies from 22 countries, and revealed that labour companions played a number of roles in supporting women. They provide informational support about the process of childbirth, and bridge communication gaps between clinical staff and women. Companions also provide practical support, including encouraging women to remain mobile during labour, providing emotional support and non- pharmacological pain relief such as massage and meditation. Companions act as advocates for the women, speaking up in support of her and her preferences. Labour companions also help women feel in control and build their confidence through praise, reassurance, and continuous physical presence.

Compassion and trust are essential

Women who wanted a companion present during labour and childbirth identified compassion and trustworthiness as the most important characteristics of a labour companion. In general, companionship appeared to help women to have a more positive birth experience.

Other findings of the review showed that women had mixed perspectives about wanting to have a male partner present. Male labour companions generally felt that their presence made a positive impact on both themselves and on the relationship with their partner and baby, although some felt anxious witnessing labour pain. Some male partners also felt they were not well integrated into the care team or decision-making.

The review also noted that women who had doula support may develop close bonds with their doulas, often meeting with them before birth to build rapport and understand expectations. For refugee, migrant and foreign-born women in high-income settings, community-based doulas (doulas from the same ethnic, linguistic and/or religious background) were particularly helpful in providing culturally-competent care.

Implementation is not universal

Despite the benefits of labour companionship, implementation of this approach is not universal. Introducing labour companionship may be complex and require a reorganisation and restructuring of services and engagement with numerous stakeholders. Consideration must be taken to ensure that women have a choice over who is present during labour and birth, and that privacy is maintained for all women on a labour ward.

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