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Objectives: This study aimed to investigate the impact of having a companion during vaginal birth on postpartum depression and birth satisfaction. Methods: This prospective cohort study included 220 postpartum women aged 18–45 who delivered vaginally at Ankara Etlik City Hospital between August 2023 and February 2024. During labor, each woman had the option to be accompanied by a companion person (such as a mother, partner or spouse, sibling, or friend) of her choice; those who opted not to have a relative present received the standard support provided by the hospital's routine birth protocol. Participants were divided into three groups based on the type of support received during childbirth: spousal support, support from others (non-spousal support), and no support. Data were collected within six weeks postpartum using the Edinburgh Postnatal Depression Scale (EPDS) and the Birth Satisfaction Scale-Revised (BSS-R). Results: Women supported by their spouses during childbirth had significantly higher BSS-QC (Quality of care provision), BSS-SL (Stress experienced during labor), and BSS-R total scores compared to those without support. BSS-SL scores were particularly higher for those with spousal support versus support from others or no support. Non-spousal support also resulted in higher BSS-QC scores than no support at all. BSS-WA (Women's personal attributes) scores and EPDS scores were similar between the groups. Additionally, no significant differences in BSS-QC, BSS-SL, BSS-WA, and BSS-R total scores were observed between women with high (≥13) and low (<13) EPDS scores, but a negative correlation between EPDS and BSS-R total scores was noted (r=-0.203, p = 0.003). Conclusion: Women receiving spousal support during childbirth reported significantly higher birth satisfaction, particularly in care quality (BSS-QC) and stress management (BSS-SL). The presence of a companion, whether spousal or non-spousal, positively influenced birth satisfaction, though it did not significantly affect postpartum EPDS scores. [ABSTRACT FROM AUTHOR]