# Impact of Birth Companionship on Maternal Outcomes: A Retrospective Cohort Study at King Faisal General Hospital, Al-Ahsa, Saudi Arabia (2024)

## TL;DR

This study found that having a birth companion during childbirth is linked to lower maternal anxiety but not to improved clinical outcomes like shorter labor or fewer cesareans.

## Contribution

The study provides new evidence on the psychological and clinical effects of birth companionship in a Saudi Arabian hospital setting.

## Key findings

- Birth companionship was associated with significantly lower anxiety scores during labor.
- Women with a birth companion had a higher adjusted risk of episiotomy.
- No significant associations were found between companionship and mode of delivery or neonatal outcomes.

## Abstract

Background

The World Health Organization emphasized the importance of having a birth companion for every woman during childbirth. However, the routine practice of allowing or providing a birth companion is still defective in several countries.

Objectives

This study aimed to assess the impact of childbirth companionship on maternal outcomes.

Methods

This retrospective cohort study included women giving birth at King Faisal General Hospital, Al-Ahsa, Saudi Arabia. The minimum sample size was calculated using G*Power for a two-tailed comparison of two independent means (α=0.05, power=80%, Cohen’s d=0.5), yielding a required sample of 130 women. To enhance statistical power and account for potential missing data, all eligible participants were included, resulting in a final sample of approximately 167 women. Women were categorized into an exposed group (experienced labor and delivery with a birth companion) and an unexposed group (without birth companionship). Primary outcomes included mode of delivery, duration of labor, time of initiating breastfeeding, and neonatal birth weight. Secondary outcomes included anxiety during labor. Statistical analyses were performed using R, with group comparisons conducted using appropriate parametric or nonparametric tests, followed by multivariable regression adjusted for key confounders (e.g., mother’s age, parity, and comorbidities) and false discovery rate correction for multiple testing. A p-value < 0.05 was selected as the significance level for the interpretation of statistical tests.

Results

This study included 167 women, out of whom 67 had a birth companion (40.1%). Women with a companion were younger, more educated, and more often primiparous. Birth companionship was not associated with labor duration, mode of delivery, neonatal outcomes, skin-to-skin contact, or breastfeeding initiation, but was associated with a higher rate of episiotomy (risk difference: 46%, 95% CI: 32%-61%, p<0.001). Women with a birth companion reported significantly lower overall anxiety scores compared to those without a companion (mean difference: -4.8, 95% CI: -6.4 to -3.2, p<0.001). After adjustment, having a birth companion was associated with a higher maternal anxiety-related total score (adjusted β=5.16, 95% CI: 3.32-7.00) and increased odds of episiotomy (adjusted OR=5.40, 95% CI: 2.06-14.87, p=0.003), while no significant associations were observed with prolonged labor, cesarean delivery, neonatal medical care, skin-to-skin contact, or delayed breastfeeding after correction for multiple testing.

Conclusion

The presence of a birth companion is associated with positive feelings of calmness and emotional support, as well as less anxiety during delivery. These findings support including birth companions in maternity care policies, with guidance to ensure safe and effective support, alongside routine clinical care.