Table 1.

Table of characteristics of included studies for companion of choice at birth

	Study	Study design	Setting	Description of Intervention	Specific study outcomes considered in this review
1	Alexander et al., 2014	Mixed-methods study	Ghana	No intervention	Women’s views about social support during childbirth
2	Al-Mandeel et al., 2013	Prospective cohort study	Kingdom of Saudi Arabia	No intervention	Women’s preferences and attitudes towards companions during childbirth
3	Banda et al., 2010	Pre-post intervention survey	Malawi	Support during labour by lay companions arriving at the hospital with labouring women was introduced in the hospital.	Women’s experiences
4	Breart et al., 1992	RCT	Belgium, France, Greece	Permanent presence of a midwife compared to varying degrees of presence. Fathers were allowed to be present
5	Bruggerman et al., 2007	RCT	Brazil	Support was ‘presence of a chosen companion during labour and delivery’. Companions received verbal and written information to orient on their role. In 47.6% of the sample the woman’s companion was her partner, for 29.5% it was her mother. The control group received care where a companion during labour and birth was not permitted.	Satisfaction with labour and delivery
6	Brown et al., 2007	RCT	South Africa	Hospitals in the intervention group were given training and access to the WHO Reproductive Health Library. A multidimensional educational package was implemented at the intervention hospitals over 2 months
7	Campbell et al., 2006	RCT	USA	Continuous support by an additional support person (doula group), was compared with women who did not have this additional support person (control group). The doula group had two two-hour orientation sessions about labour support. Control group had support people of their own choosing.
8	Campbell et al., 2007	RCT	USA	Same trial as above but this secondary analysis focused on maternal perceptions of infant, self and support from others at 6–8 weeks postpartum.	Satisfaction with care
9	Campero et al., 1998	Qualitative postpartum interviews	Mexico	Mothers receive psychosocial support from a doula, compared with women without a doula, who gave birth following normal hospital routine. In the former group, doulas were incorporated into the labour and delivery rooms and introduced to physicians and nurses, and their responsibilities in accompanying the pregnant women were explained to hospital staff.	Mother’s view of their experience
10	Cogan et al., 1988	RCT	USA	Support provided by a Lamaze childbirth preparation instructor. Support included continuous presence, acting as a liaison with hospital staff, providing information, and teaching relaxation and breathing measures to the woman and a present family member. Usual care: intermittent nursing care. Family members were allowed to be present.
11	Dickinson et al., 2002	RCT	Australia	Group 1 –continuous physical and emotional support by midwifery staff, and women were encouraged manage their labour with the assistance of a midwife with the intention of avoiding epidural analgesia. Group 2 –continuous midwifery support was not provided and women were encouraged to have epidural analgesia as their primary method of pain relief in labour The women in each of the two groups were at liberty to choose an alternative form of analgesia at any time.
12	Dickinson et al., 2003	RCT and post survey	Australia	Same intervention and control group as above but post survey conducted 6 months postpartum The women in both groups were at liberty to choose an alternative form of analgesia at any time.	Maternal satisfaction of childbirth
13	El-Nemer et l, 2006	Qualitative	Egypt	No intervention	Women’s experiences of hospital care
14	Gagnon et al., 1997	RCT	Canada	Intervention group: 1-to-1 care consisting of a nurse during labour and birth who provided emotional support, physical comfort, and instruction for relaxation and coping techniques. Care was provided by on-call nurses who were hired specifically for the study and had received a 30-h training program and quarterly refresher workshops. Training included critical reviews of the literature concerning the effects of the intrapartum medical and nursing practices, as well as discussions of stress and pain management techniques. Control group received usual nursing care by the regular unit staff, consisting of intermittent support and monitoring.
15	Gagnon et al., 1999	Secondary analysis of RCT	Canada	Same intervention and control groups as above
16	Gordon et al., 1999	RCT	USA	Support provided by a trained doula. The control group received “usual care” which did not include the support of a doula. The partner was present in 80% of all birth included in the study.	Mothers’ evaluations of their experiences
17	Hemminki et al., 1990	RCT	Finland	Reports on a pilot study with support provided by lay woman to labouring women arriving to one hospital without their male partners. Reports also on three trials testing 1:1 support by midwifery students from enrolment until transfer to the postpartum ward. The midwifery students volunteered, were not specially trained in support and responsible for the other routine intrapartum care. The control group was ‘cared for according to the normal routine of the midwife and by a medical student, if s(he) was on duty’. Over 70% of fathers were present.	Mothers’ evaluations of their experiences
18	Hodnett et al., 1989	RCT, stratified by type of prenatal classes (Lamaze vs general)	Canada	Support provided by a community ‘lay’ midwife or midwifery apprentice and included physical comfort measures, continuous presence, information, emotional support, and advocacy. The control group received usual hospital care which includes the intermittent presence of a nurse. All but 1 woman also had husbands or partners present during labour. Support began in early labour at home or in hospital and continued through delivery.	Women’s perceived control during childbirth
19	Hodnett et al., 2002	Multi-centre RCT with prognostic stratification for parity and hospital	Canada, USA	Continuous support from staff labour and delivery nurses who had volunteered and received a 2-day training workshop in labour support. The nurses with training were part of the regular staffing complement of the unit. Control group received intermittent support from a nurse who had not received labour support training	Birth experience and future preferences for labour support
20	Hofmeyr et al., 1991	RCT	South Africa	Support by carefully trained, volunteer lay women, for at least several hours (supporters not expected to remain after dark). Control group received intermittent care on a busy ward. Husbands/family members were not permitted	Mothers’ perceptions of labour
21	Kabakian-Khasholian et al., 2015	Qualitative	Egypt, Lebanon, Syria	No intervention	Women’s and health care providers perceptions about labour companionship
22	Kashanian et al., 2010	RCT	Iran	Support provided by an experienced midwife in an isolated room. Midwife-led support included close physical proximity, touch, and eye contact with the labouring women, and teaching, reassurance, and encouragement. The midwife remained with the woman throughout labour and delivery, and applied warm or cold packs to the woman’s back, abdomen, or other parts of the body, as well as performing massage according to each woman’s request. Control group included women admitted to the labour ward (where 5–7 women labour in the same room), did not receive continuous support, and followed the routine orders of the ward. They did not have a private room, did not receive one-to-one care, were not permitted food, and did not receive education and explanation about the labour process. The only persons allowed in the delivery room were nurses, midwives, and doctors.’
23	Kennel et al., 1991	RCT + retrospective non-random control group	USA	Continuous support provided by a trained doula during labour and birth. Observed group received the routine intermittent presence of a nurse and continuous presence of an ‘inconspicuous observer’ who ‘kept a record of staff contact, interaction and procedures’. The observer was away from the bedside and never spoke to the labouring woman. A retrospective non-random control group was used.
24	Klaus et al., 1986	RCT	Guatemala	Continuous emotional and physical support by a lay doula with no obstetric training. Control group: usual hospital routines (described as no consistent support)
25	Kopplin et al., 2000	RCT	Chile	Psychosocial support during labour from a companion chosen by the pregnant woman. The companions were trained by trial staff to provide emotional support, promote physical comfort and encourage progress of labour, without interfering with the activities of the obstetricians or midwives. They were with the labouring woman continuously from admission to delivery. Women were encouraged to pick a companion who had experienced a vaginal birth. Control group did not have companion. Both groups laboured in a room with other women where curtains were pulled for privacy	Experience with childbirth
26	Kumbani et al., 2013	Qualitative	Malawi	No intervention	Women’s perception of perinatal care
27	Langer et al., 1998	RCT	Mexico	Continuous support from 1 of 10 retired nurses who had received doula training throughout labour, birth, and the immediate postpartum period. Support included emotional support, information, physical comfort measures, social communication, ensuring immediate contact between mother and baby after birth, and offering advice about breastfeeding during a single brief session postnatal. Control group: women received ‘routine care’.	Satisfaction
28	Lindow et al., 1998	RCT	South Africa	The intervention group received oxytocin followed by routine monitoring by labour ward midwives in addition to the presence of a support person for 1 h. The support persons were from among the hospital cleaning staff from the same racial and linguistic group as the woman. They provided encouragement. The control group received oxytocin and routine monitoring of labour ward midwives.
29	Madi et al., 1999	RCT	Botswana	Continuous presence of a female relative (usually her mother) in addition to usual hospital care Control group: usual hospital care, which involved staff: patient ratios of 1:4, and no companions permitted during labour
30	Maimbolwa et al., 2001	Mixed-methods	Zambia	No intervention	Women’s and health care providers perspectives about labour companionship in hospitals.
31	Manning-Orenstein, 1998	Non-randomized intervention	USA	Women chose between a doula support group or a Lamaze birth preparation group.
32	McGrath et al., 2008	RCT	USA	Support consisted of a doula who met the couple or woman at the hospital as soon as possible after Random assignment (typically within an hour of their arrival at the hospital) and remained with them throughout labour and delivery. Doula support included continuous bedside presence during labour and delivery, although her specific activities were individualised to the needs of the labouring woman. Other support included close physical proximity, touch, and eye contact with the labouring woman, and teaching, reassurance, and encouragement of the woman and her male partner. All doulas completed training requirements that were equivalent to the DONA International doula certification Control group: routine obstetric and nursing care which included the presence of a male partner or other support person	Perceived experience with the doula
33	McGrath et al., 1999	RCT	USA	The Epidural group received epidural analgesia, the control group received narcotic medication followed by epidural analgesia if necessary. The doula group received continuous doula support with narcotic or epidural analgesia if necessary.