Abstract
Background
The woman’s choosing the birth support partner herself increases her satisfaction, comfort and positively affects the process. Moreover, when the health staff provides supportive care to a woman, her physical comfort and satisfaction with birth, and the quality of care increase. This study aimed at investigating effects of companion support during labor on pregnant women’s birth comfort, satisfaction, and postpartum comfort.
Methods
This randomized controlled trial was conducted in Training and Research Hospital between March 01-September 30, 2023 and 104 primigravidae were included. They were assigned to the intervention and control groups in equal numbers. The women in the intervention group received companion support during labor, whereas women in the control group received standard hospital care.
Findings
The Birth Satisfaction Scale total score and its sub-dimensions quality of care provision, women’s personal attributes, and stress experienced during labor were significantly higher in the intervention group than in the control group (p < 0.05). Similarly, Childbirth Comfort Questionnaire scores were higher in the intervention group (p < 0.01), with a particular increase observed in the psychospiritual comfort subdimension. Postpartum Comfort Scale total scores and its subdimensions physical, psychospiritual, and sociocultural comfort were also significantly higher among women in the intervention group compared to the control group (p < 0.05).
Conclusions
The results of the study revealed that companion support during the birth process played a significant role in increasing women’s birth comfort and satisfaction, and that companion support should be encouraged in health policies in order to improve birth services and to provide better support to pregnant women.
Trial registration
ClinicalTrials.gov, NCT06624748. Registered on 3 January 2023.
Keywords: Midwifery, Childbirth, Labor support, Patient satisfaction, Comfort
Statement of significance
| Problem | |
| Birth comfort, which has become an important concept in the birth process, can be achieved by providing effective, continuous care and support during birth. | |
| What is Already Known | |
| Support on birth, pregnant women’s enjoying high birth satisfaction enables them to have positive feelings about the birth process and increases their sense of confidence for future births. | |
| What this Paper Adds | |
| These results indicate the positive effect of companion support on birth experience. Inclusion of companions during the birth process can increase pregnant women’s birth comfort and satisfaction levels. Hospitals should develop flexible policies regarding pregnant women’s requests for having companions during the birth process. |
Introduction
The labor process not only is a complex, multidimensional and unique experience but also is a major crisis a woman experiences in her life. The purpose of support provided during the labor process is to make it easier for the pregnant woman to cope with birth-related issues, to have a positive childbirth experiences and to ensure her adaptation to the childbirth process. This support can be provided not only by health professionals, but also by family and friends [1].
Midwives are the most important people to support the pregnant woman during the childbirth process, but they may not be able to provide it adequately in some cases due to heavy workload [2]. The woman’s choosing the labor support partner herself increases her satisfaction and comfort during childbirth and positively affects the process. Birth support partners not only provide social and psychological support but also can notice danger signs when there are no health personnel, and contribute to precautions and early intervention when they are informed about the process [1].
Several studies have shown that midwife or companion support during labor positively affects both maternal and fetal outcomes [1–4]. Continuous support promotes maternal relaxation, reduces stress hormones, enhances oxytocin release, and contributes to cervical dilation and effective contractions. It also lowers cesarean and intervention rates, shortens labor, reduces medical needs, and improves APGAR scores [1, 4, 5].
Beyond clinical benefits, such support increases maternal comfort, satisfaction, and emotional well-being, helping women manage pain, make informed choices, and participate actively in birth. These factors also improve postpartum comfort. Birth comfort, now a key concept, is linked to effective, continuous care and a supportive birth environment, including physical space, maternal involvement, and perceived control [6–8].
The WHO’s Safe Childbirth Checklist (2015) also highlights the importance of continuous companionship for reducing interventions and enhancing psychological outcomes [1, 3, 4, 6, 8]. However, few studies have examined the combined effects of birth support on comfort during labor, postpartum comfort, and birth satisfaction [2, 5, 9].
These are essential indicators of maternal care quality. This study aims to fill that gap by evaluating how continuous labor support affects maternal comfort and satisfaction holistically, providing scientific evidence to improve maternity care services.
Research hypotheses
Hypothesis 1
H₁: Companion support during labor increases women's birth satisfaction levels.
Hypothesis 2
H₂: Companion support during labor increases women's birth comfort levels.
Hypothesis 3
H₃: Companion support during labor increases women's postpartum comfort levels.
Research design and type
This randomized controlled study was conducted to determine effects of companion support on the labor process. Reporting was performed in line with the CONSORT for parallel group randomized studies [10].
Place of the study
The study was conducted in the delivery room of Sakarya Education and Research Hospital. Pregnant women whose labor has started are admitted to the delivery room by a physician and labor follow-up is carried out by midwives and assistant physicians under the supervision of an obstetrician. The average number of vaginal births given in the hospital monthly is approximately 350. In routine practices at the hospital, no one is allowed to accompany the pregnant woman.
Data collection stages
The women in the intervention and control groups were informed about the study, and a personal information form was administered to the pregnant women who agreed to participate in the study and their companions.
Implementation stages in the intervention group
The pregnant women in the intervention group were asked by whom they wanted to be accompanied during the birth process, and the midwife or obstetrician who was assigned to observe the labor the labor interviewed companions, provided information to the companions on how to support the pregnant women during the labor process and observed this process. After being informed, the companion provided emotional and physical support to the pregnant woman (such as massage, helping her while moving, helping her take a warm shower) and all the interventions performed by the companion and durations of the interventions were recorded by the researcher on the ‘Birth Process Support Form’.
The Childbirth Comfort Questionnaire was administered to the pregnant woman when her cervical dilation reached eight cm. The exact time of administering the questionnaire was carefully monitored to ensure it was given at the correct stage of labor, which is critical for accurate measurement of labor comfort. Two hours after birth, the Birth Satisfaction Scale and the Postpartum Comfort Scale were administered. Data regarding the birth process, including any complications and interventions, was recorded on the Birth Information Form.
Implementation stages in the control group
The women who volunteered to participate in the study were informed about the purpose of the study and the applications. They underwent routine implementation performed in the hospital. In order to ensure that there was no difference in terms of episiotomy implementation and delivery techniques between the groups, women included in the study were followed and delivered by the same midwife. This step was specifically included to control for any potential confounding factors that could arise from different healthcare providers handling the delivery process.
When the cervical dilation reached eight cm, the Childbirth Comfort Questionnaire was administered to the women in the control group. Two hours after the birth, the Birth Satisfaction Scale and the Postpartum Comfort Scale were also administered. Data about the birth process, including the time and nature of medical interventions, was recorded on the Birth Information Form.
Data collection tools
Personal information form
This form prepared by the researchers in line with the literature consists of 14 items questioning the participant’s sociodemographic characteristics, medical and obstetric pregnancy history, and current pregnancy information [1].
Childbirth comfort questionnaire
The questionnaire was developed by Kerri Durnell Schuiling based on Kolcaba’s comfort theory [11]. The lowest and highest possible scores that can be obtained from the questionnaire are 14 and 70, respectively. The validity and reliability study of the Turkish version of the questionnaire was conducted by Potur et al. [12]. In the Turkish version, the number of items was reduced to nine. The Cronbach’s α coefficient was 0.75 [12]. In the present study, the Cronbach’s α coefficient was found to be 0.910, indicating excellent internal consistency for the Turkish version of the questionnaire. Responses given to the items are rated on a five-point Likert-type scale ranging from 1 to 5. The lowest and highest possible scores that can be obtained from the Turkish version of the questionnaire are 9 and 45, respectively. A high score obtained from the questionnaire indicates that the woman’s birth comfort level is high.
Postpartum Comfort Scale (PCS)
The Postpartum Comfort Scale was developed by Karabacak in 2004 based on the 48-item General Comfort Questionnaire developed by Kolcaba in 1994. It was adapted into Turkish by Karakaplan [13, 14]. The PCS is used to assess physical, psychological, sociocultural, and environmental comfort levels of mothers who gave birth through cesarean section or normal spontaneous delivery. The PCS consists of 55 items. Of the 55 items, 28 are positively keyed items and 27 are negatively keyed items. Responses given to the items are rated on a five-point Likert-type scale ranging from 1 to 5. The highest and lowest possible scores that can be obtained from the PCS are 275 and 55, respectively. In the present study, the Cronbach’s α coefficient of the PCS was 0.870, indicating good internal consistency. Scores close to 275 indicate that the postpartum comfort level is high. The highest possible scores that can be obtained from the subscales of the PCS are as follows: Physical Comfort: 100, Psychological Comfort: 80, Sociocultural Comfort: 45, and Environmental Control: 50.
Birth Satisfaction Scale (BSS)
The BSS was developed by Martin and Fleming to assess women’s perceptions of birth satisfaction [15]. The BSS has 30 items whose responses are rated on a five-point Likert-type scale ranging from 1 (Strongly disagree) to 5 (Strongly agree). The minimum and maximum possible scores that can be obtained from the BSS are 30 and 150, respectively. As the score obtained from the scale increases, so does the level of birth satisfaction. The validity and reliability study of the Turkish version of the BSS was performed by Çetin et al. [16]. In the present study, the Cronbach’s α coefficient of the BSS was calculated as 0.80, indicating acceptable internal consistency.
Birth information form
The 10-item form is used to question the birth process and the information about the baby (the duration of the first and second stages of labor, episiotomy status, sex of the baby, height, and weight of the baby). The form was also reviewed for face validity, ensuring that the questions accurately captured the necessary information relevant to the study’s aims.
Data analysis
The quantitative data obtained from the study were analyzed using the SPSS (Statistical Package for the Social Sciences) 20.0 (SPSS Inc., Chicago, IL, USA). In the analyses, descriptive statistics and parametric tests were used according to the distribution of the data. Since the data were normally distributed, the Independent Samples t test was used to compare two independent groups. Significance level was accepted as p < 0.05.
Population and sample of the study
The population of the study consisted of pregnant women who were admitted to the maternity clinic to give birth between March 01, 2023 and September 30, 2023. The sample of the study was calculated as 94 (47 in the intervention group and 47 in the control group) using the G-power 3.1.9.2 program (deviation: two-point, effect size: 0.50 (medium), type I margin of error 5%, and study power: 90%), taking into account the known score of 31.55 ± 6.59 47 of the Childbirth Comfort Questionnaire.
Considering the possibility of withdrawals and/or losses during the study, we decided to include 20% more people in both groups. Thus, it was planned to include 112 pregnant women in the study. The study was terminated when 104 pregnant women were reached.
Randomization
Study data were collected by the research midwife. Randomization was performed using the random number table obtained from the website ‘randomizer.org’. Women were assigned to the intervention or control groups by selection through the envelope method according to this scheme. Study data were analyzed by a statistician who was not involved in the study.
Independent variables of the study
Questions included in the personal information form and applications performed within the scope of companion support were the independent variables of the study.
Dependent variables of the study
The mean scores obtained from the Birth Satisfaction Scale, Childbirth Comfort Questionnaire and Postpartum Comfort Scale were the dependent variables of the study.
Inclusion criteria
Those who were primigravidae, were in the gestational age of 37–42 weeks, were planned to give birth vaginally, had no health complications during pregnancy, had no chronic diseases, had no vision, hearing or communication problems, were able to speak and express themselves in Turkish were included in the sample. Informed consent was obtained from both pregnant women and their companions prior to their participation in the study.
Exclusion criteria
Known multiple pregnancy at the time of hospital admission, and the presence of any diagnosed medical or obstetric complication that developed during follow-up before the onset of active labor.
The CONSORT Diagram of the study design is shown in Fig. 1.
Fig. 1.
Study design (CONSORT Diagram)
Results
The results of the study reflect the comparison of various criteria related to the labor process in terms of some characteristics of the participating women who received labor support and those who did not receive labor support.
The mean age of the participants in the intervention and control groups was 26.61 ± 3.77 and 24.29 ± 4.36 years, respectively. Their mean age at marriage was 22.59 ± 3.93 years. During labor, of the participating pregnant women, 73.1% were accompanied by their mothers, 25.0% by their mothers-in-law, elder sisters and other relatives, and 1.9% by their friends. They received an average of 7.53 ± 6.82 min of massage, took a warm shower for 4.42 ± 6.76 min, exercised with a Pilates ball for 10.67 ± 8.51 min, and performed the spiritual practices they desired for 19.71 ± 4.89 min.
Table 1 shows that the intervention and control groups were generally similar in their sociodemographic and obstetric characteristics, except for age and time of admission to the delivery room, where statistically significant differences were found (p = 0.004 and p = 0.013, respectively).
Table 1.
Comparison of the participants who received labor support and the participants who did not receive labor support in terms of some of descriptive and obstetric characteristics (N: 104)
| Variables | Intervention group receiving labor support (n=52) | Control group not receiving labor support (n=52) | T* | p | |||
|---|---|---|---|---|---|---|---|
| n | % | n | % | ||||
| Age (years) | |||||||
| 20-24 | 15 | 28.8 | 28 | 53.8 | -2.898 | 0.004 | |
| 25-29 | 18 | 34.6 | 15 | 28.9 | |||
| 30-34 | 10 | 19.2 | 7 | 13.5 | |||
| ≥35 | 9 | 17.4 | 2 | 3.8 | |||
| Mother's education level | |||||||
| Elementary school | 21 | 40.4 | 29 | 55.8 | -1.176 | 0.074 | |
| High school | 25 | 48.0 | 21 | 40.4 | |||
| University | 6 | 11.6 | 2 | 3.8 | |||
| Mother's employment status | |||||||
| Employed | 5 | 9.6 | 7 | 13.5 | |||
| Not employed | 47 | 90.4 | 45 | 86.5 | |||
| Financial status | |||||||
| Income less than expenses | 18 | 34.6 | 24 | 46.2 | |||
| Income equal to expenses | 33 | 63.5 | 27 | 51.9 | -1.155 | 0.248 | |
| Income more than expenses | 1 | 1.9 | 1 | 1.9 | |||
| Gestational age (weeks) | |||||||
| 38+0-38+6 | 18 | 34.6 | 21 | 40.4 | -0.856 | 0.392 | |
| 39+0-39+6 | 14 | 38.5 | 15 | 28.8 | |||
| 40+0-40+6 | 20 | 26.9 | 16 | 30.8 | |||
| Time for admission to the delivery room | |||||||
| Latent phase | 39 | 75.0 | 26 | 50.0 | 8.758 | 0.013 | |
| Active phase | 13 | 25.0 | 26 | 50.0 | |||
| Undergoing induction | |||||||
| Yes | 40 | 76.9 | 39 | 75.0 | 0.053 | 0.819 | |
| No | 12 | 23.1 | 13 | 25.0 | |||
| Type of delivery | |||||||
| Vaginal birth without episiotomy | 3 | 5.8 | 4 | 7.7 | -0.711 | 0.477 | |
| Birth with and intervention | 0 | 0.0 | 1 | 1.9 | |||
| Vaginal birth with episiotomy | 49 | 94.2 | 47 | 90.4 | |||
| Family structure | |||||||
| Nuclear | 50 | 96.2 | 52 | 100.0 | |||
| Extended | 2 | 3.8 | 0 | 0.0 | |||
| Sex of the baby | |||||||
| Girl | 24 | 46.2 | 27 | 51.9 | |||
| Boy | 28 | 53.8 | 25 | 48.1 | |||
| Birth week | |||||||
| 38th week | 14 | 28.0 | 12 | 24.0 | 2.40 | 0.490 | |
| 39th week | 12 | 24.0 | 19 | 38.0 | |||
| 40th week | 18 | 36.0 | 15 | 30.0 | |||
| 41st week | 6 | 12.0 | 4 | 8.0 | |||
| TOTAL | 52 | 100 | 52 | 100 | |||
*İndependent Samples t-Test
In Table 2, the comparison of the participants who received labor support (N = 52) and the Participants who did not receive labor support in terms of the duration labor and some characteristics of the baby (N = 52) was presented.
Table 2.
Comparison of the participants who received labor support (N = 52) and the participants who did not receive labor support in terms of the duration of labor and some characteristics of the baby
| Variables | Intervention group receiving labor support (N=52) | Control group not receiving labor support (N=52) | p value* |
|---|---|---|---|
| Mean±SD | Mean±SD | ||
| Duration of the first phase (hours) | 9.87±5.27 | 7.96±5.47 | 0.044 |
| Duration of the second phase (minutes) | 10.34±2.72 | 10.01±2.45 | 0.522 |
| Baby’s weight (grams) | 3406.48±329.99 | 3349.71±373.46 | 0.413 |
| Baby’s height (cm) | 49.53±4.27 | 49.86±1.32 | 0.599 |
*Independent Samples t-Test
The duration of the first stage of the delivery was 9.87 ± 5.27 h on average in women who received labor support and 7.96 ± 5.47 h in women who did not receive labor support. The difference between them was statistically significant (p = 0.044). There was no significant difference between the groups in terms of the duration of the second stage and babies’ weights and heights.
Table 3 demonstrates that the pregnant women in the intervention group had significantly higher mean scores than those in the control group in the overall Childbirth Comfort Questionnaire (CCQ) and its three subscales—physical, psychospiritual, and environmental comfort (p < 0.05 for all). These results suggest that the supportive care provided during labor contributed positively to the women’s comfort in all domains. The differences between the groups were not significant in terms of the scores they obtained from the overall Childbirth Comfort Questionnaire and its physical comfort and environmental comfort subscales, but significant in terms of the scores they obtained from the psychospiritual comfort subscale. In the psychospiritual comfort subscale, the intervention group had significantly higher scores compared to the control group (p < 0.05), indicating that the supportive care helped enhance pregnant women’s emotional well-being and confidence during labor. This increase in psychospiritual comfort contributed meaningfully to the overall childbirth comfort experienced by the women in the intervention group.
Table 3.
Differences between the pregnant women in the intervention and control groups in terms of the scores they obtained from the overall childbirth comfort questionnaire (CCQ) and its subscales
| Variables | Intervention group receiving labor support (N=52) | Control group not receiving labor support (N=52) | p value* |
|---|---|---|---|
| Mean±SD | Mean±SD | ||
| Physical comfort sub-dimension | 16.55±3.73 | 17.13±3.63 | 0.427 |
| Environmental comfort subscale | 10.23±2.33 | 9.48±2.10 | 0.089 |
| Psychospiritual comfort subscale | 6.07±2.94 | 4.25±2.63 | 0.001 |
| CCQ total score | 32.86±5.57 | 30.86±5.39 | 0.066 |
Bold values indicate statistically significant differences
SD Standard deviation
*Independent Samples T test
In Table 4, the results of the analysis of the mean scores the participants obtained from the overall Postpartum Comfort Scale (PSC) and its subscales were presented.
Table 4.
Results of the analysis of the mean scores the participants obtained from the overall postpartum comfort scale (PSC) and its subscales
| Variables | Intervention group receiving labor support (N=52) | Control group not receiving labor support (N=52) | p value* |
|---|---|---|---|
| Mean±SD | Mean±SD | ||
| Physical comfort sub-dimension | 47.67±5.93 | 44.21±5.24 | 0.002 |
| Environmental comfort subscale | 45.57±5.84 | 45.863.28 | 0.757 |
| Psychospiritual comfort subscale | 35.50±6.30 | 35.46±6.94 | 0.976 |
| PSC total score | 128.75±13.00 | 125.53±11.34 | 0.183 |
Bold values indicate statistically significant differences
SD Standard deviation
*Independent Samples T test
The participants in the intervention group receiving labor support obtained a significantly higher mean score from the physical comfort sub-dimension (47.67 ± 5.93) than did the participants in the control group not receiving labor support (44.21 ± 5.24) (p = 0.002). Although the intervention group had higher mean scores than the control group in the physical and environmental comfort subscales, the differences were not statistically significant (p > 0.05). These results indicate that the supportive care provided during labor had a stronger impact on psychospiritual aspects of comfort compared to physical and environmental factors.
In Table 5, participants in the intervention group who received labor support had significantly higher scores in the ‘Personal Characteristics of Women’ subscale of the Birth Satisfaction Scale (26.19 ± 4.08) compared to the control group (23.50 ± 4.00; p < 0.05). There were no differences between the intervention and control groups in terms of the mean scores they obtained from the overall Birth Satisfaction Scale and its Quality of Care and Stress Experienced during the Birth Process sub-dimensions.
Table 5.
Results of the analysis of the mean scores the participants obtained from the overall birth satisfaction scale (BSS) and its subscales
| Variables | Intervention group receiving labor support | Control group not receiving labor support | p value* |
|---|---|---|---|
| Mean±SD | Mean±SD | ||
| Quality of Care sub-dimension | 33.96±4.35 | 33.61±2.95 | 0.636 |
| Personal Characteristics of Women subscale | 26.19±4.08 | 23.50±4.00 | 0.001 |
| Stress Experienced during the Birth Process subscale | 49.03±7.04 | 49.71±6.12 | 0.604 |
| Birth Satisfaction Scale total | 109.19±11.19 | 106.82±8.64 | 0.231 |
Bold values indicate statistically significant differences
SD Standard deviation
*Independent Samples T test
Discussion
In the present study, the effects of companion support during labor on the labor comfort, birth satisfaction, and postpartum comfort of the pregnant woman were investigated. There was a significant difference between the groups in terms of age, and the control group had a younger age. However, no significant difference was found in the total scale scores between the groups.
It is thought that this may be due to the fact that the average age of the women in both groups is in the young adult age group.
The results showed that companion support positively affected the birth experiences of the participating pregnant woman. These results are consistent with those of studies in the literature. For instance, the meta-analysis conducted by Hodnett et al. revealed that women who were provided with continuous support during labor had shorter labor times, underwent fewer interventions, and had higher satisfaction levels [4].
In the present study, although there was no significant difference, it was found that women who received companion support had higher birth comfort levels, and a significant difference was found in the psychospiritual comfort sub-dimension. Akin et al. studies reported that support at birth increased comfort levels by providing psychospiritual, sociocultural and environmental relief and had a positive effect [17]. Which suggests that a supportive companion can facilitate the birth process by reducing the anxiety of the pregnant woman and applying relaxing techniques.
Similarly, in Şenoğlu Karaçam’s and Kabakian-Khasholian & Portela’s studies, psychological and physical support provided during the birth process increased pregnant woman’s birth comfort levels, Purandere et al. studies, without family members, women feel lonely and vulnerable. Birth comfort can be defined as the physical comfort and psychological peace of the pregnant woman during the birth process [1, 5, 18]. Jafari et al. stated that improving the physical structure and layout of the delivery room was associated with mothers’ participating in the birth process and having a sense of control. In another study, supportive care given during birth positively affected the quality of care and birth satisfaction by increasing pregnant women’s physical comfort [7].
In the study, it was found that the postpartum physical comfort sub-dimension of women who received companion support was significantly higher, which indicates that support provided during birth improves pregnant women’s comfort not only during birth but also after birth. In particular, partner support during birth has been found to increase positive birth experiences and to be associated with lower depression and anxiety symptoms even two years after birth. Having family members such as mothers and siblings as social support, people they can trust and feel comfortable with in terms of privacy during the postpartum period, and expressing physical needs easily make women feel good [19]. In their study Fathi Najafi et al. indicated that support provided during birth increases women’s satisfaction and their comfort in the postpartum period [2]. Companion support provided during birth also has positive effects on the physical and emotional well-being of the pregnant woman in the potpartum period. In their study of Kurt Can, Ejder Apay, it was determined that factors such as hospital facilities and meeting expectations increase the level of satisfaction and therefore physical comfort [20].
In the study, the mean score of the women’s personal characteristics subscale of the birth satisfaction scale was found to be significantly higher in the intervention group. This subscale reflects women’s perceptions of their own confidence, emotional readiness, and sense of control during childbirth. The higher scores in the intervention group suggest that labor support helped women feel more empowered and emotionally prepared during labor.
In their study Martin and Fleming study, stated that high birth satisfaction enabled pregnant women to have positive feelings about the birth process and increased their sense of confidence for future births [15]. In particular, partner support during birth has been found to increase positive birth experiences, birth satisfaction, also has positive effects on the physical and emotional well-being of the pregnant woman and to be associated with lower depression and anxiety symptoms even two years after birth [21, 22].
Maternal satisfaction during birth is affected by factors, such as health problems experienced by the mother and baby, interventions performed, and the type of birth, and is considered a key factor in determining the quality of birth services [9, 23, 24]. A support model in which pregnant women can communicate, are informed, and express their feelings during birth increases their satisfaction with birth [9].
The WHO has concluded that midwives are the most appropriate people to support pregnant women during birth in terms of identifying complications that may occur during birth at an early stage [25]. When midwives provide support during birth, women feel safer and perceive birth as a more positive experience [26]. Being constantly with the pregnant woman during birth and providing support to her help midwives perceive themselves as good midwives. However, the workload in the delivery room may prevent midwives from providing continuous support to women [27]. In a study conducted by Shahshahan et al. in Iran, women’s birth satisfaction increased if they had a companion who constantly supported them during birth [28].
Birth satisfaction can be defined as a general evaluation of the mother’s emotional and physical experiences during the birth process and has a significant effect on her psychological well-being in the postpartum period. As reported in several studies, supportive care provided during birth helps mothers evaluate the birth process more positively [4]. Kabakian-Khasholian and Portela stated that continuous support provided during birth enabled the mother to feel more secure and to have an increased sense of control during the birth process [5]. According to the results of the Birth Satisfaction Scale administered in the study demonstrated that mothers who received companion support during the birth process had higher birth satisfaction scores.
High levels of birth satisfaction help the mother experience less stress in the postpartum period and reduce the risk of postpartum depression [8]. Within this context, increasing birth satisfaction is of critical importance for both maternal and infant health suggesting that healthcare providers should adopt a supportive and understanding approach during the birth process.
Conclusion and recommendations
The results of the present study indicate that companion support provided during the birth process has positive effects on the birth comfort, satisfaction and postpartum comfort of the pregnant woman suggesting that birth services should be improved and pregnant women should be provided with better support. Information about the importance of companion support should be added to prenatal education programs and pregnant women should be encouraged to choose the person who would accompany them during the birth process. Midwives and other health professionals should be trained on how to guide companions who will provide support during the birth process.
Hospitals should develop flexible policies regarding pregnant women’s requests for having companions during the birth process. Arrangements should be made to provide training to accompanying mothers as well as pregnant women in childbirth preparation classes.
Inclusion of companions during the birth process can increase pregnant women’s birth comfort and satisfaction levels. It is recommended that more research should be conducted on this subject, and the effects of companion support should be investigated in people with different demographic characteristics and cultures. It is also recommended that qualitative studies should be conducted to examine the roles and experiences of companions during the birth process in more detail.
Limitations of the study
The results of this study are limited to pregnant women who gave birth at Sakarya Education and Research Hospital and were included in the sample, and they cannot be generalized to all pregnant women. To enhance the generalizability of the findings, future studies should include larger samples from different geographical regions. There is a notable difference in the average age between the control group and the intervention group, with the control group having a lower average age. This difference should be taken into account when interpreting the results. Future studies could further explore the impact of age on the outcomes of companion support during labor.
Acknowledgements
As the research team, we would like to thank the midwives, doctors, pregnant women and their companions who contributed to the data collection process.
Authors’ contributions
M.B.C. contributed to conceptualization, methodology, formal analysis, ınvestigation, resources, writing - original draft, writing - review & editing, visualization. B.A. contributed to conceptualization, methodology, formal analysis, ınvestigation, resources, writing - original draft, writing - review & editing, visualization. S.C.K. contributed to conceptualization, methodology, data collectıon, resources. H.U.Y. contributed to conceptualization, formal analysis, writing - original draft, review & editing.
Funding
No financial disclosure was received.
Data availability
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
Before the study was conducted, ethical approval was obtained from the “Sakarya University, Faculty of Medicine Dean’s Office, Clinical Research Ethics Committee” (decision date: October 11, 2023; decision number 02) and permission was obtained from the management of the hospital where the study would be conducted. Were enrolled in Clinical trials (registration date/number: 2023/1021, identifier: NCT06624748 the name of the publicly accessible registry: Selçuk University, the URL address:
https://register.clinicaltrials.gov/prs/app/template/ViewPastRelease.vm?version=33%26;popup=true%26;uid=U0004VBN%26;ts=26%26;sid=S000E653%26;cx=pob4yf. the date of initial participant enrollment: March 1, 2023). The study was conducted in line with the Principles of the Declaration of Helsinki, and Publication Ethics.
The research objectives were explained to the participants, and informed written consent was obtained from them.
Consent for publication
Written informed consent for publication was obtained from all participants whose data are included in this manuscript.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.