The Role of Birth Companionship in Women’s Experiences of Mistreatment during Childbirth and Postpartum Depression

Introduction 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. Competing Interest Statement The authors have declared no competing interest. Clinical Trial The study has been registered with clinicaltrials.gov (registration number: NCT05146518). Clinical Protocols https://doi.org/10.1371/journal.pone.0263635 Funding Statement Each authors’ time, named in the manuscript, is funded by Medical Research Council, United Kingdom. The Reference ID of the grant is: MR/T003375/1 The funders had and will not have a role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study protocol, the informed consent forms, and other appropriate documents were approved by the Ethics Review Committee of the Aga Khan University (Ref. ID: 2019-1683-5607) and Research Ethics Committee of the London School of Hygiene & Tropical Medicine (Ref. ID: 17886). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability Data will be available upon request