The impact of birth companion on respectful maternity care and labor outcomes among Indian women: a prospective comparative study


  • Isha Seth Department of Obstetrics and Gynecology, Amrita Hospital, Faridabad, Haryana, India
  • Sunayana Department of Obstetrics and Gynecology, Kalpana Chawla Government Medical College, Karnal Haryana, India
  • Savita Singhal Department of Obstetrics and Gynecology, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India
  • Aditya Seth Department of Orthopedics, KIMS-Sunshine Hospital, Hyderabad, Telangana, India
  • Aksha Mohan Garg Department of Orthopedic, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, India



Childbirth, RMC , Labor outcomes


Background: Childbirth is a transformative experience for women, and the presence of a birth companion has been shown to have positive effects on the labor process. This study aimed to investigate the influence of having a birth companion on respectful maternity care (RMC) and labor outcomes. The study was conducted at Pandit Bhagwat Dayal Sharma post graduate institute of medical sciences, Rohtak, India, from February 2020 to March 2021.

Methods: The study included two groups: group 1 (n=200) with a birth companion and group 2 (n=200) without a birth companion. Participants were recruited from laboring women at the labor ward, ensuring representation and minimizing bias. Inclusion criteria encompassed women between 37-41 weeks gestational age in active labor, with specific prerequisites for having a birth companion. Data were collected using a pre-set questionnaire to assess RMC, pain scores, behavior of medical personnel, and patient satisfaction. Secondary outcomes included the mode of delivery, duration of labor, complications, and the women's experience with their birth companion.

Results: The study revealed significant differences between group 1 and group 2 in various aspects. Group 1 exhibited lower rates of physical and verbal abuse, improved consented and confidential care, and higher overall scores for RMC. Group 1 also reported lower pain scores, more favorable behavior from healthcare providers, and better overall hospital experiences. Additionally, group 1 had fewer instrumental deliveries and cesarean sections, as well as a shorter duration of labor compared to group 2.

Conclusions: This study demonstrates that having a birth companion during labor significantly improves RMC, pain management, and labor outcomes. Women accompanied by a birth companion experience reduced rate of abuse, increased satisfaction with healthcare providers, and a more positive overall labor experience. Encouraging the presence of birth companions during childbirth can enhance women's experiences, promote RMC, and contribute to improved labor outcomes.


Lunda P, Minnie CS, Benade P. Women’s experience of continuous support during childbirth: a meta synthesis. BMC Pregnancy Childbirth. 2018;18:167.

Wang M, Song Q, Xu J, Hu Z, Gong Y, Lee A, Chen Q. Continuous support during labour in childbirth: a cross sectional study in a university teaching hospital in shanghai, China. BMC Pregnancy Childbirth. 2018;18:480.

Bohren MA, Tuncalp O, Adanu R, Balde MD, Maung TM et al. How women are treated during facility-based childbirth: Development and Validation of measurement tools in four countries- phase 1 formative research study protocol. Reprod Health. 2015;12(1):60.

Sen G, Reddy B, Iyer A. Beyond measurement: The driver of disrespect and abuse in obstetric care. Reprod Health Matters. 2018;26(53):6-18.

World Health Organisation. WHO recommendations on respectful maternity care during labor and childbirth. Geneva: WHO Reproductive Health Library. 2018;1-11.

Diaz-Tello F. Invisible wounds: Obstetric violence in the United States. Reprod Health Matters. 2016;24(47):56-64.

Jha P, Christensson K, Svanberg AS. Cashless childbirth, but at a cost: A grounded theory study on quality of intrapartum care in public health facilities in India. Midwifery. 2016;39:78-86.

Bohren MA, Vogel JP, Hunter EC, Lutsiv O. The mistreatment of women during childbirth in health facilities globally: A mixed methods systematic review. PLOS Med. 2015;12(6):1-32.

Sharma G, Penn-kekana L, Halder K. An investigation into mistreatment of women during labor and childbirth in maternity care facilities in Uttar Pradesh, India: A mixed method study. Reprod Health. 2019;16(7):1-16.

Kathuria P, Khetarpal A, Singh P, Khatana S, Yadav G, Ghuman NK. Role of birth companion in COVID-19: indispensable for her and an auxiliary hand for us. Pan Afr Med J. 2020;37:62.

Garra G, Singer AJ, Domingo A, Thode Jr HC. The Wong-Baker pain FACES scale measures pain, not fear. Pediatric emergency care. 2013;29(1):17-20.

Bruggemann OM, Parpinelli MA, Osis MJD, Cecatti JG, Neto AS. Support to woman by a companion of her choice during childbirth: a randomised controlled trial. Reprod Health. 2007;4:5.

Khresheh R. Support in the first stage of labour from a female relative: the first step in improving the quality of maternity services. Midwifery. 2010;26:e21-4.

Javad NM, Afshari P, Montazeri S, Latifi SM. The effect of continuous support by a companying person during labor process. Jundishapur Scientific J Med. 2008;7:32-38.

Kashanian M, Javadi F, Haghighi MM. Effect of continuous support during labor on duration of labor and rate of caesarean delivery. Int J Gynecol Obstet. 2010;109:198-200.

Langer A, Campero L, Garcia C, Reynoso S. Effects of psychological support during labor and childbirth on breastfeeding, medical interventions and mother’s well-being in a Mexican Public hospital: a randomised clinical trial. BJOG: Int J Obstet Gynecol. 1998;105(10):1056-63.

Mosallam M, Rizk DEE, Thomas L. Women’s attitudes towards psychosocial support in labor in United Arab Emirates. Arch Gynecol Obstet. 2004;269:181-7.

Dickinson JE, Paech MJ, McDonald SJ, Evans SF. The impact of intrapartum analgesia on labor and delivery outcomes in nulliparous women. Aust N Z J Obstet Gynecol. 2002;42(1):59-66

Balde MD, Nasiri K, Mehrtash H, Soumah A, Bohren M A, Diallo B A et al. Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey. BMJ Global Health. 2020;5:e003564.

Sharma G, Penn-Kekana L, Halder K, Filippi V. An investigation into mistreatment of women during labour and childbirth in maternity care facilities in Uttar Pradesh, India: a mixed methods study. Reprod Health. 2019;16:7.

Fathi Najafi T, Latifnejad Roudsari R, Ebrahimipour H. The best encouraging persons in labour: A content analysis of Iranian mother’s experiences of labor support. PLoS one. 2017;12(7):e0179702.

Banda G, Kafulafula G, Nyirenda E, Taulo F, Kalilani L. Acceptability and experience of supportive companionship during childbirth in Malawi. BJOG Int J Obstet Gynecol. 2010;117:937-45.






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