Presence of a Chosen Birth Companion Inside the Operating Theatre During Cesarean Section: A Systematic Review and Meta-Analysis

¹Department of Obstetrics and Gynecology, Worabe Comprehensive and Specialized Hospital, Worabe, Central Ethiopia, Ethiopia

*Corresponding Author: Dr. Habtamu Fekadu Andeta, MD, Department of Obstetrics and Gynecology, Worabe Comprehensive and Specialized Hospital, Worabe, Central Ethiopia,, Ethiopia, Email: [email protected], [email protected]
ORCID: https://orcid.org/0009-0003-5270-6902

Received Date: October 28, 2026

Published Date: November 06, 2026

Citation: Andeta HF. (2026). Presence of a Chosen Birth Companion Inside the Operating Theatre During Cesarean Section: A Systematic Review and Meta-analysis. Mathews J Gynecol Obstet. 10(2):53.

Copyrights: Andeta HF, © (2026).

ABSTRACT

Background: The World Health Organization (WHO) strongly recommends a chosen birth companion during childbirth. However, companions are routinely excluded from the operating theatre during cesarean section due to concerns regarding surgical site infection (SSI), theatre crowding, and medico-legal liability. Clinical evidence regarding companion presence during cesarean delivery remains fragmented.

Objectives: To systematically evaluate the effect of a chosen birth companion's presence inside the operating theatre during cesarean section on maternal perioperative anxiety, SSI, birth satisfaction, and neonatal outcomes.

Data Sources: PubMed/MEDLINE, Cochrane Library, and Embase were systematically searched from database inception through August 1, 2026, without language restriction.

Eligibility Criteria: Randomized controlled trials, quasi-randomized trials, and prospective or retrospective cohort studies comparing the physical presence of a chosen birth companion inside the operating theatre during cesarean section versus standard care without a companion.

Risk of Bias and Synthesis: Risk of bias was appraised using Cochrane RoB 2.0 for randomized trials and ROBINS-I for non-randomized studies. Pooled effect sizes were synthesized using DerSimonian-Laird random-effects models (Standardized Mean Difference [SMD] for continuous outcomes; Risk Ratio [RR] for dichotomous outcomes). Quality of evidence was graded using GRADE.

Results: Eight studies (comprising 1,156 participants) met full eligibility criteria. Companion presence in the operating theatre was associated with a statistically significant reduction in maternal perioperative anxiety (SMD -0.68, 95% CI: -0.85 to -0.52; p < 0.00001; I² = 0%; moderate certainty). Surgical site infection rates did not differ between accompanied and unaccompanied groups (RR 1.00, 95% CI: 0.50 to 2.02; 30 events in 691 patients; I² = 0%; low certainty). Birth satisfaction was significantly improved in the companion group (SMD +0.74, 95% CI: +0.48 to +1.00; moderate certainty), while neonatal Apgar score < 7 at 5 minutes showed no difference (RR 0.88, 95% CI: 0.42 to 1.84; high certainty).
Conclusions: Presence of a chosen birth companion during cesarean section significantly reduces maternal anxiety and enhances birth satisfaction without increasing surgical site infection risk. Operating theatre protocols should accommodate supervised birth companions under established hygiene guidelines.

Keywords: Birth Companion, Cesarean Section, Operating Theatre, Maternal Anxiety, Surgical Site Infection, Respectful Maternity Care, Intraoperative Support