Impact of continuous labour companion- who is the best: A comprehensive meta-analysis on familiarity, training, temporal association, and geographical location

Abstract Background: Continuous labour support is widely acknowledged for potentially enhancing maternal and neonatal outcomes and smoothing the labour process. However, existing literature lacks a comprehensive analysis of the optimal characteristics of labour companions, particularly in comparing the effects of trained versus untrained and familiar versus unfamiliar labour companions across diverse geographical regions and pre and post-millennial. This meta-analysis addresses these research gaps by providing insights into the most influential aspects of continuous labour support. Methodology: A thorough search of PubMed, Google Scholar, Science Direct, International Clinical Trials Registry Platform (ICTRP), ClinicalTrials.gov, Research4Life, and Cochrane Library was conducted. Study selection utilised the semi-automated tool Rayyan. The Cochrane risk-of-bias (RoB2) tool and funnel plots gauged the risk of bias. Statistical analysis employed RevMan 5.4, using Mantel-Haenszel statistics and random effects models to calculate risk ratios with 95% confidence intervals. Subgroup analyses were performed for different characteristics, including familiarity, training, temporal associations, and geographical locations. The study was registered in INPLASY. (Registration number: INPLASY202410003) Results: Thirty-five randomised controlled trials (RCTs) were identified from 5,346 studies. The meta-analysis highlighted significant positive effects of continuous labour support across various outcomes. There was a substantial improvement in the 5-minute APGAR score < 7, with an effect size of 1.52 (95% CI 1.05, 2.20). Familiar labour companions showed a higher effect size in reducing tocophobia, 1.73 (95% CI 1.49, 2.42), compared to unfamiliar companions, 1.34 (95% CI 1.14, 1.58). Differences were noted between trained and untrained companions, favouring untrained companions in reducing tocophobia and the cesarean section rate. Studies conducted after 2000 had a more significant impact on decreasing labour duration. Geographical variations indicated more pronounced effects in Asia and Africa than in Europe. Discussion and Conclusion: The meta-analysis underscores the benefits of labour companionship, particularly in facilitating the parturient experience of spontaneous labour. The impact is more pronounced in specific subgroups, such as familiar companions, untrained companions, recent studies, and studies conducted in Asia and Africa. The study recommends integrating labour companionship into obstetric care pending further research, standardisation, and awareness initiatives to enhance maternal and neonatal outcomes. Challenges such as study heterogeneity, insufficient data on companion training, and temporal outcome variations are acknowledged.