Labor companionship refers to support provided to a woman during labor & childbirth, & may be provided by a partner, family member, companion, doula or healthcare professional.^[1] Having a companion of choice throughout childbirth is an important component of good quality & respectful maternity care for women & has become standard in many countries. The WHO recognizes companionship of choice during childbirth as an important component of good quality & respectful maternity care.^[2] Companionship, including continuous emotional & social support during childbirth, improves maternal & newborn health outcomes as well as women’s satisfaction with the process of delivery.^[3]

Continuous support during labor has clinically meaningful benefits for women & infants including increased spontaneous vaginal birth, shorter duration of labor & decreased caesarean birth and instrumental vaginal birth, use of regional analgesia, low five minute APGAR score & negative feelings about childbirth experiences.^[4]

According to a 2018 study in Malawi, more than 60% of pregnant women reported moderate to high childbirth fear; illiterate, unemployed, & young pregnant women were more likely to report such levels of childbirth fear. The literature on perceptions & experiences of pregnancy has described a certain level of childbirth fear as a normal, protective psychological aspect of pregnancy & childbirth that may help a pregnant woman to prepare for & resolve challenging childbirth issues during pregnancy.^[5]

Two complementary theories are helpful to understand the effects of labour support on childbirth outcome. The first theoretical explanation considers the presence of a Companion during labour in stressful, threatening & disempowering clinical birthing environments. Labour room environment is a plethora of equipment’s, used by professionals & the medical jargons, procedures, interventions, lack of privacy & unfamiliar persons, Professionals may lead to increased maternal fear & anxiety. The second explanation focused on labour pain.

Research has consistently shown that women greatly value & benefit from the presence of someone they trust to support them throughout labour & childbirth. Women who have a companion of choice during labour & birth (hereafter referred to as labour companion) report that this support helps them feel safe, strong, confident, & secure.

There is evidence that labour companionship improves maternal & perinatal outcomes, including enhancing the physiological process of labour. Based on this evidence, a companion of choice during labour & childbirth is recommended in three World Health Organization (WHO) guideline recommendations. Moreover, the WHO Standards for improving quality of maternal & newborn care in health facilities includes a quality statement that every woman should be offered the option to experience labour & childbirth with the companion of her choice, & it is considered an important intervention to improve women’s experience of care.^[6]

Birth companionship has been introduced & is currently being advocated for expansion in 2,235 facilities including 179 medical college facilities in India under the “LaQshya Scheme” (Labour room quality improvement initiative).

So, the study was conducted to assess the experience of labouring women & health care workers with female birth companion & to see its effects on maternal & fetal outcomes.

This study is an observational study conducted in the department of Obstetrics & gynaecology at Gandhi Medical College, Bhopal for a period of 18 months after clearance from the institutional ethical committee. Admitted nulliparous patients undergoing labor were included in the study after informed consent. Perception & experience of patients & health care providers was assessed through questionnaires & data entered on pre structured proforma and then comparison was done with the control group.

Sample size- 400

Inclusion criteria-Nulliparous patients with gestational age more than 28 weeks admitted in the Department of Obstetrics and gynaecology, Gandhi Medical College, Bhopal.

Exclusion criteria- Multiparous patients, nulliparous patients with gestational age less than 28 weeks.

Data collection and methods- After taking informed consent from the patients data was collected in Proforma & Preformed questionnaires (internally validated) & then was entered in the master chart.

Statistical analysis planned- Collected data was presented in master chart using MS Excel. Then Epi info7.0 was used to t

In this study we found, maximum participants are in age group of 18-24 & 25-30 and only 2 participants are beyond the age of 36. The chi-square statistic is 3.2333 (p-value 0.027156). 85.5% participants belonged to high-risk pregnancy group & 14.5% of the participants belonged to low-risk pregnancy group. The chi-square statistic is 0.1037 (p-value 0.047425). Maximum birth companions are mother in laws. The chi-square statistic is 46.4025 (p-value < 0.00001). Rate of vaginal Deliveries is 95% with a birth companion & 34% without a birth companion. Rate of caesarean section is 5% with a birth companion and 66% without a birth companion. The chi-square statistic is 162.5068 (p-value is < 0.00001).

Table 01: Distribution of perception of pain by the participants

Almost 60% participants perceived less pain with birth companion and 45% of participants perceived less pain without a birth companion. The chi-square statistic is 13.3461.                (p-value 0.003945)

Table 02: Distribution of perception of anxiety by the participants

61% participants perceived less anxiety with birth companion and 27.5% of participants perceived less anxiety without a birth companion. The chi-square statistic is 13.3461.               (p-value 0.003945)

Table 03: Distribution of perception of fear by the participants

67% participants perceived less fear with birth companion and 35% of participants perceived less fear without a birth companion. The chi-square statistic is 13.3461.(p-value 0.003945)

31.5% participants felt the birthing experience is excellent, 43% felt the birthing experience is good and 25.5% felt the birthing experience is not good with a birth companion. Without a birth companion 14% participants felt that the birthing experience is excellent, 37% felt the birthing experience is good and 49% felt that the birthing experience is not good.  The chi-square statistic is 13.3461 (p-value 0.003945). 7.5% of the babies of mothers with birth companion are referred to SNCU and 89% babies are motherside. 12% of the babies of mothers without birth companion are referred to SNCU and 85.5% babies are motherside. The chi-square statistic is 13.3461 (p-value 0.003945). 70% of birth companions are helpful. The chi-square statistic is 3.2831 (p-value 0.069995). 76.5% of birth companion are cooperative. The chi-square statistic is 6.6763 (p-value 0.00977). Experience of health care workers is excellent in 34% of cases, good in 53% of cases and not good in 13% of cases. The chi-square statistic is 2.0013 (p-value 0.157161). ICU stay of participants is 5.5% with birth companion and 6% without birth companion. The chi-square statistic is 0.0461 (p-value 0.829938).

The experience of labor and delivery is excellent for majority of women with birth companion. Similar results were also found in a study conducted by Senanayake H M et al 2013[7]. Maternal fulfilment was essentially higher in the gathering with a birth companion of choice with training. But in our study, we did not provide any training to the birth companion. Paul Chaote et al 2021 too found that most ladies were extremely happy with having a companion during labor (96-close to 100%). Study conducted by Isha Seth et al 2023 suggests that women accompanied by a birth companion experience reduced rate of abuse, increased satisfaction with healthcare providers, & a more positive overall labor experience.

In our study we found, 61% participants perceived less anxiety with birth companion and 27.5% of participants perceived less anxiety without a birth companion. Anti Chakma et al 2019 also found that having a birth companion during labour & birth to provide mental, emotional support as well as physical support and reduces anxiety in laboring women.

In our study we found that birth companions can reduce pain by back rubbing, massaging and providing support to laboring women. Almost 60% participants perceived less pain with birth companion. In a study conducted by Gill Thomson et al 2019[8] they found that pharmacological techniques of pain relief can decrease torment yet make negative side-impacts. Non-pharmacological techniques may not diminish work torment however can work with holding with experts & birth allies. Isha Seth et al 2023 in their study too found that group with birth companion reported lower pain scores, more favorable behavior from healthcare providers, & better overall hospital experiences.

In our study too, we found that women without a birth companion are more fearful at the time of delivery and labor as compared to women with a birth companion. 67% participants perceived less fear with birth companion and 35% of participants perceived less fear without a birth companion. The discoveries of review conducted by Berlington M. J. Munkhondya et al 2020 propose that companion incorporated labor planning is a promising mediation to diminish labor dread while expanding labor self-viability & maternal help.

In our study, 70% of the healthcare workers found companions to be helpful to laboring women and reducing their workload. Even most of the birth companions are found to be cooperative. In the study conducted by Paul Chaote et al 2021[9] wellbeing suppliers found mates exceptionally accommodating on the grounds that they helped with their responsibility, cautioned the supplier about changes in the lady's status, & offered close to home help to the lady. In a study conducted by Tanvi Sarwal et al 2023[10] 95% of suppliers concurred that the presence of a BC during work will be useful, in offering profound help, supporting the lady's certainty, giving solace measures, helping in the early commencement of breastfeeding, lessening post pregnancy anxiety, refining work, diminishing the requirement for absence of pain & expanding chances of unconstrained vaginal births.

In our study we found that number of vaginal deliveries is more with a birth companion. Rate of vaginal Deliveries is 95% with a birth companion. Kanak Dubey et al 2023 in their study found that unconstrained vaginal births were essentially higher in bunch with a birth companion. Maternal fulfilment was fundamentally higher in bunch with a birth companion. No measurable contrast was seen between the mean length of labor, method of conveyance, & NICU stay of the child. Isha Seth et al 2023 in their study found that the group with birth companion had fewer instrumental deliveries & caesarean sections, as well as a shorter duration of labor compared to group without birth companion. But in contrast to the study conducted by Kanak Dubey et al 2023, we found that NICU admissions are less amongst the babies of women with birth companion. There are lesser number of ICU admissions of participants as well when they had a birth companion.

The results of our study showed a significant reduction of childbirth fear, anxiety and pain, enhanced childbirth self-efficacy, and increased birth companion social support in the intervention group compared with the control group. It is evident from the present study’s findings that adequate childbirth preparation in primigravid women is vital to simultaneously improve their psychosocial well-being and enhancing their ability to give birth.

In the current study, birth companion support revealed a greater change in the intervention group than in the control group in terms of anxiety, pain and fear. These results were desirable, as primigravid women are generally more apprehensive about childbirth and need concrete social support before and after childbirth.

There are lesser number of caesarean sections and more vaginal deliveries, lesser number of NICU admissions and lesser number of admissions in ICU with birth companions.

Health care workers also found birth companions as helpful to them as well as laboring women as they were continuously present with the participant and helped in managing complications, acted as a bridge between the participant and healthcare worker, provided physical and emotional support, relieved anxiety and fear of the participants. Therefore, women should be accompanied by birth companions at the time of labor.

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