Background: Labor companionship has been demonstrated to enhance the childbirth experience and contribute to better maternal and neonatal outcomes. Despite this evidence, the practice remains underexplored in Rwanda. The present study aimed to investigate the perspectives and experiences of both women and healthcare providers concerning labor companionship in selected hospitals across Rwanda. Methods: We conducted a mixed-method study surveying 393 postpartum mothers within 48 hours of delivery and interviewing 23 healthcare providers and 16 mothers. Data were analyzed using frequencies, percentages, Chi-square tests, and logistic regression. Results: 95% (n=373) of mothers brought a chosen companion to the health facility, but only 11.2% (n=42) were allowed their companion’s presence during childbirth. About 47% who had companions present had reservations, mainly due to embarrassment (47%), gossip fears (14%), and privacy issues (40%). Mother’s age, education, economic status, and pregnancy planning status influenced companion presence. Barriers to labor companionship occurred at individual, provider, and institutional levels. Conclusion: This study underscores labor companionship’s role in boosting maternal-neonatal health in Rwanda, though implementation remains limited due to location, education, and socio-economic disparities. It advocates for policies and guidelines facilitating companionship during labor and delivery and emphasizes the need for healthcare provider training to enhance its application.