Association between personal birth companion and maternal mental health in low- and middle-income countries: a systematic review.
Abstract
Objectives
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.