WHO strongly recommends supporting women to have a chosen companion during labour and childbirth, including during COVID-19.
When a woman has access to trusted emotional, psychological and practical support during labour and childbirth, evidence shows that both her experience of childbirth and her health outcomes can improve.
In Companion of choice during labour and childbirth for improved quality of care, WHO and HRP present updated information on the benefits of labour companionship for women and their newborns, and how it can be implemented as part of efforts to improve quality of maternity care.
The current COVID-19 pandemic is no exception.
WHO Clinical management of COVID-19: interim guidance strongly recommends that all pregnant women, including those with suspected, probable or confirmed COVID-19, have access to a companion of choice during labour and childbirth.
The importance of a chosen companion during labour and childbirth – latest evidence
Again and again, research shows that women greatly value and benefit from the presence of someone they trust during labour and childbirth.
A companion of choice can give support in practical and emotional ways.
They can bridge communication gaps between a woman in labour and the healthcare workers around her, offer massage or hand-holding to help relieve pain, and provide reassurance to help her feel in control. As an advocate, a labour companion can witness and safeguard against mistreatment or neglect.
The benefits of labour companionship can also include shorter length of time in labour, decreased caesearean section and more positive health indicators for babies in the first five minutes after birth.
Implementing labour companionship as part of respectful maternal and newborn care
WHO is committed to improving women’s and newborns’ experience of care as an integral component of better maternal and newborn health, and to helping countries put evidence-based global guidance into practice.
Support for labour companionship is presented in four different WHO guidelines: intrapartum care for a positive childbirth experience, health promotion interventions for maternal and newborn health, augmentation of labour, and clinical management of COVID-19.
The new Companion of choice updates a 2016 version with an expanded section on implementing companionship during labour and childbirth. It includes a logic model to support the integration of labour companions into maternal care programmes, and case studies from Egypt, Lebanon and the Syrian Arab Republic showing design and implementation in practice.
“From global actors to professional organizations, healthcare providers to community networks and womens’ groups, everyone has a role to play in advocating for labour companions – and for ensuring every women has a right to a companion of her choice to support her during labour and childbirth. Our experience from implementation research shows that women, communities, health workers and management can be engaged to transform health services and find labour companionship solutions,” said Annie Portela, Technical Officer in the WHO Department of Maternal, Newborn, Child and Adolescent Health and Ageing.
The way forward
Many countries do not yet have policies in favour of labour companionship, and many healthcare facilities do not allow women to have a companion.
Raising awareness, engaging in discussion, and providing physical infrastructure such as curtains for privacy and a chair for the companion, are all important steps for ensuring every woman can have a chosen birth companion if she wants one.
Global efforts to improve maternal health – such as the emphasis on increasing facility-based childbirth – do not end with the reduction of maternal mortality and morbidity. Women’s preferences during childbirth must be known and must be supported.
COVID-19 and labour companionship
Most health systems around the world are facing challenges of increased demand for care of people COVID-19, compounded by fear, misinformation and limitations on movement that disrupt access to care.
As countries identify ways to address COVID-19, integrating human rights protections and guarantees is not only a moral imperative, it is essential to successfully addressing public health concerns.
“Pregnancy is not put on pause in a pandemic, and neither are fundamental human rights. A woman’s experience of childbirth is as important as her clinical care,” said Dr Ӧzge Tunçalp, scientist at WHO/HRP.
“In the ‘new normal’ of COVID-19, WHO strongly recommends that the emotional, practical and health benefits of having a chosen labour companion are respected and accommodated. The pandemic must not disrupt every woman’s right to high-quality, respectful maternity care.”