Having a labour companion improves outcomes for women and babies, concludes a Cochrane Review of research, involving 51 studies, mostly from developed countries. Some of the studies report that women who do not have a companion view this as a form of suffering, stress and fear. Such women also describe poor quality of care, including mistreatment, poor communication and neglect.

Birth partners can be the woman’s partner, another family member, a friend, a doula or a healthcare professional. Women want this person to be a compassionate and trustworthy advocate.

If the companion is a lay person, adequate preparation is required, something that is rarely provided. Without this, companions can end up feeling helpless and become a burden on health professionals.

The research review identified a number of roles for birth companions.

• Physical support: soothing and massaging; observing and identifying issues to report to healthcare professionals; and, in some cases, compensating for service weaknesses.
• Communication between the woman and health professionals and representing the woman’s interests.
• Bearing witness to the birth process by being by the woman’s side throughout.
• Providing emotional support: helping the woman to feel in control and confident, offering praise and reassurance, and covering for non-continuity of professional care in facilities where this is not provided.
• For women of a minority ethnic community, a companion from her own community can ensure culturally competent care.
• For fathers-to-be who are birth companions, their presence can facilitate their own bonding with the baby and contribute to the couple relationship, as well as having a positive impact on themselves.

The studies identify a range of barriers to women having birth companions. Sometimes there are physical constraints, such as busy labour wards. Sometimes there is lack of knowledge about the benefits of having a birth companion and the practice can be viewed as an expendable measure. Some health professionals are untrained in how to work with companions or have negative attitudes towards them. Sometimes there are fears about spreading infection.

The studies show that most male partners are not integrated into antenatal classes or training sessions before the birth. Some feel actively excluded, or feel their presence is merely tolerated and not considered necessary. Some doulas also feel excluded and ignored.

The studies show that male partners agree that the birth partner is the woman’s choice and not all women want a male partner to be present.

Bohren MA, Berger BO, Munthe-Kaas H, Tunçalp Ö (2019), Perceptions and experiences of labour companionship: A qualitative evidence synthesis (Review), Cochrane Library

Photo: Ben Lowery. Creative Commons.