Birth companionship and mistreatment

Birth companionship during facility-based childbirth has been recommended
by the World Health Organization to improve maternal and newborn outcomes.
However, limited evidence exists on how companionship affects women's
experiences of mistreatment during childbirth and their mental health. To
assess the characteristics of birth companionship during intrapartum care
and examine its associations with women's experiences of mistreatment
and postpartum anxiety and depression. We analysed cross-sectional data on
314 women who gave birth in six public health facilities in rural Sindh,
Pakistan. Women were interviewed 42 days postpartum about their childbirth
experiences and postpartum anxiety and depression. Multivariable
regression models were used to examine associations between birth
companionship, mistreatment, and postpartum anxiety/depression. Path
analysis explored whether mistreatment mediated the relationship between
companionship and postpartum anxiety and depression. Most women (83.1%)
had a full-time companion in the labor room, with in-laws (44.6%) being
the most common, followed by family members (26.1%) and friends (15.0%).
Higher levels of companion support were associated with lower levels of
mistreatment, particularly regarding non-confidential care, lack of
supportive care, and ineffective communication. Women receiving low
companion support were 2.86 times more likely to experience postpartum
anxiety and depression compared to those receiving high support.
Informational support emerged as the strongest protective factor against
both mistreatment and postpartum anxiety/depression. Path analysis
revealed that the effect of companion support on postpartum mental health
was mediated by experiences of mistreatment during childbirth. Birth
companionship, especially informational support, plays a crucial role in
reducing mistreatment during childbirth and improving maternal mental
health outcomes. These findings underscore the need for supportive
policies and health system interventions that actively encourage the
engagement of companions from a woman's personal network during labor
and childbirth. Future research should explore strategies to optimize the
role of birth companions in promoting respectful maternity care and
maternal well-being.