Impact of Birth Companion on Maternal and Neonatal Outcomes in Primigravida Women During Labour: A Prospective Observational Study

Abstract

Introduction: Birth companionship is a low-cost, evidence-based intervention recognized by the World Health Organization as part of respectful maternity care. While it has shown impactful effects on childbirth outcomes, limited data exist regarding its impact on primigravida women, a group often more vulnerable to prolonged labour, anxiety, and medical interventions.

Methods: The aim of this study is to assess the effect of a birth companion on maternal and fetal outcomes in primigravida women during labour. This prospective observational study included primigravida women admitted in active labour at two tertiary centres in Chennai between March 2024 and March 2025. A total of 500 patients were included and divided into two groups: Group A (n=250) with a chosen female birth companion present throughout labour, and Group B (n=250) without a companion. Data were collected using structured proforma on labour duration, mode of delivery, maternal satisfaction, neonatal APGAR scores, NICU admission, and breastfeeding initiation. Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 26.0 (IBM Corp., Armonk, New York, USA). Comparisons between groups were performed using the Chi-square test for categorical variables and the independent t-test for continuous variables. A p-value of less than 0.05 was considered statistically significant. 

Results: Women with a birth companion showed significantly shorter labour durations, including a reduced first stage (6.7 ± 1.3 hrs vs. 7.5 ± 1.6 hrs; p<0.001) and second stage of labour (42.3 ± 9.8 mins vs. 51.7 ± 12.1 mins; p<0.001). The cesarean section rate was significantly lower in the companion group (9.2% vs. 16.0%; p=0.01), along with a lower rate of instrumental deliveries (10.4% vs. 13.6%; p<0.05). Women with a birth companion also required less IV analgesia (35.6% vs. 61.2%; p<0.001), with a higher proportion having no analgesia use (64.4% vs. 38.8%; p<0.001). Maternal satisfaction (score ≥8) was greater in the companion group (65.2% vs. 40.8%; p<0.001). Neonatal outcomes were also improved in the companion group, with higher APGAR scores at 5 minutes (91.2% vs. 84.4%; p=0.03), fewer NICU admissions (5.6% vs. 11.6%; p=0.01), and earlier initiation of breastfeeding within 1 hour (72.8% vs. 55.6%; p<0.001). The incidence of fetal distress was lower in the companion group (8.8% vs. 15.2%; p<0.05), while the initiation of immediate skin-to-skin contact was significantly higher (76.4% vs. 55.2%; p<0.001).

Conclusion: The presence of a birth companion during labour significantly improves maternal and neonatal outcomes among primigravida women. Women supported by a companion had shorter first and second stages of labour, higher rates of spontaneous vaginal delivery, and reduced need for iv analgesia and cesarean section. Importantly, they also reported higher maternal satisfaction scores and better emotional well-being. Neonatal outcomes also improved notably. Infants born to women with companions had higher APGAR scores, fewer NICU admissions, . This study supports routine implementation of birth companion policies in institutional deliveries, particularly in public health settings