Association between personal birth companion and maternal mental health in low- and middle-income countries: a systematic review
Waqas Hameed, Bilal Iqbal AvanObjectives
To examine the relationship between personal birth companions and maternal mental health during labour and the postpartum period in low- and middle-income countries.
Design
Systematic review using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines.
Data sources
We performed a systematic search of Embase, Medline, PsycINFO, Global Health and Scopus from inception to 24 September 2024.
Eligibility criteria
Peer-reviewed studies—either observational or experimental—that reported an association between personal birth companions and maternal mental health were included.
Data extraction and synthesis
Data were extracted using a structured template and Joanna Briggs Institute tools were used for quality assessment. Due to heterogeneity across studies, a narrative synthesis was conducted.
Results
Our review included 10 studies (6 observational, 4 experimental) conducted across seven countries, primarily in South Asia. Overall, we found promising evidence from experimental studies—conducted primarily on primigravida women and those with uncomplicated pregnancies—that the presence of birth companions from personal networks (particularly husbands) positively affects maternal mental health. The relative change in maternal anxiety between intervention and control groups ranged from −0.85% to 120% with most p values <0.001 favouring the intervention effect, while for depressive symptoms the relative changes were 4.5% and 22.8% with statistically insignificant effects. However, with the exception of two studies, none of the observational studies showed a statistically significant relationship, although the direction of effect supported a positive association. One observational study also found that characteristics of birth companionship (ie, type and level of support) increased the odds of postpartum anxiety and depression (2.86 (95% CI 1.52 to 5.39)).
Conclusions
Our review indicates promising evidence that birth companions from a woman’s personal network may have a positive effect on maternal mental health and well-being, especially for nulliparous women and those with uncomplicated pregnancies. However, there is a dire need for more rigorous experimental research across countries in different regions and income strata.