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WHO Companion of choice during labour and childbirth for improved quality of care Evidence-to-action brief, 2020

Supporting women to have a chosen companion during labour and childbirth is a low-cost and effective intervention to improve the quality of maternity care,
including women’s experience of childbirth.

Studies have shown that having a companion improves outcomes for women and newborns. Initiatives to increase the number of women giving birth in health-care facilities, however, do not necessarily take this into consideration; often, women’s preferences are not known or respected.

Longer-term health and well-being outcomes

  • Mode of childbirth
    • Increased spontaneous vaginal birth
    • Decreased unnecessary caesarean section
  • Labour and interventions
    • Decreased duration of labour, perineal trauma, use of synthetic oxytocin
  • Newborn care
    • Increased initiation of skin-to-skin contact, early initiation of breastfeeding
    • Decreased low 5th-minute Apgar score, admission to special care nursery, prolonged newborn hospital stay
  • Longer-term outcomes
    • Decreased postpartum depression, difficulty mothering, unsatisfactory mother–infant interactions

Perceptions and experiences of labour companionship: a qualitative evidence synthesis

Bohren MA, Berger BO, Munthe-Kaas H, Tunçalp Ö. Perceptions and experiences of labour companionship: a qualitative
evidence synthesis. Cochrane Database Syst Rev. 2019;(3):CD012449.

It is time to consider labour companionship as a human rights issue

Implications for practice and research

  • Labour companionship helps women, babies and families to have an optimal start to life and a positive birth experience.
  • Not all women get to have a labour companion with them, and this is no longer excusable and should be considered a basic human right.
  • More research is needed into the effectiveness of having an appropriate labour companion for women with psychosocial vulnerabilities and/or specific cultural/ethnic backgrounds.

Continuous support for women during childbirth

Authors’ conclusions: Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences. We found no evidence of harms of continuous labour support. Subgroup analyses should be interpreted with caution, and considered as exploratory and hypothesis-generating, but evidence suggests continuous support with certain provider characteristics, in settings where epidural analgesia was not routinely available, in settings where women were not permitted to have companions of their choosing in labour, and in middle-income country settings, may have a favourable impact on outcomes such as caesarean birth. Future research on continuous support during labour could focus on longer-term outcomes (breastfeeding, mother-infant interactions, postpartum depression, self-esteem, difficulty mothering) and include more woman-centred outcomes in low-income settings.

Bohren MA, Hofmeyr GJ, Sakala C, Fukuzawa RK, Cuthbert A. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2017 Jul 6;7(7):CD003766. doi: 10.1002/14651858.CD003766.pub6. PMID: 28681500; PMCID: PMC6483123.