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Nedberg IH, Vik ES, Kongslien S, Mariani I, Valente EP, Covi B, Lazzerini M, Roda DD, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Morano S, Chertok I, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Vaska A, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Quality of health care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Norway and trends over time. Int J Gynaecol Obstet 2022; 159 Suppl 1:85-96. [PMID: 36530008 PMCID: PMC9877678 DOI: 10.1002/ijgo.14460] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe maternal perception of the quality of maternal and newborn care (QMNC) in facilities in Norway during the first year of COVID-19 pandemic. METHODS Women who gave birth in a Norwegian facility from March 1, 2020, to October 28, 2021, filled out a structured online questionnaire based on 40 WHO standards-based quality measures. Quantile regression analysis was performed to assess changes in QMNC index over time. RESULTS Among 3326 women included, 3085 experienced labor. Of those, 1799 (58.3%) reported that their partner could not be present as much as needed, 918 (29.8%) noted inadequate staff numbers, 183 (43.6%) lacked a consent request for instrumental vaginal birth (IVB), 1067 (34.6%) reported inadequate communication from staff, 78 (18.6%) reported fundal pressure during IVB, 670 (21.7%) reported that they were not treated with dignity, and 249 (8.1%) reported experiencing abuse. The QMNC index increased gradually over time (3.68 points per month, 95% CI, 2.83-4.53 for the median), with the domains of COVID-19 reorganizational changes and experience of care displaying the greatest increases, while provision of care was stable over time. CONCLUSION Although several measures showed high QMNC in Norway during the first year of the COVID-19 pandemic, and a gradual improvement over time, several findings suggest that gaps in QMNC exist. These gaps should be addressed and monitored.
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Affiliation(s)
- Ingvild Hersoug Nedberg
- Department of Health and Care Sciences, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | - Eline Skirnisdottir Vik
- Department of Health and Caring SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Sigrun Kongslien
- Department of Health and Care Sciences, Faculty of Health SciencesUiT The Arctic University of NorwayTromsøNorway
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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2
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Drandić D, Drglin Z, Mihevc Ponikvar B, Bohinec A, Ćerimagić A, Radetić J, Ružičić J, Kurbanović M, Covi B, Valente EP, Mariani I, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Women's perspectives on the quality of hospital maternal and newborn care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Slovenia, Croatia, Serbia, and Bosnia-Herzegovina. Int J Gynaecol Obstet 2022; 159 Suppl 1:54-69. [PMID: 36530003 PMCID: PMC9877897 DOI: 10.1002/ijgo.14457] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess the quality of maternal and newborn care (QMNC) in countries of the former Yugoslavia. METHOD Women giving birth in a facility in Slovenia, Croatia, Serbia, and Bosnia-Herzegovina between March 1, 2020 and July 1, 2021 answered an online questionnaire including 40 WHO standards-based quality measures. RESULTS A total of 4817 women were included in the analysis. Significant differences were observed across countries. Among those experiencing labor, 47.4%-62.3% of women perceived a reduction in QMNC due to the COVID-19 pandemic, 40.1%-69.7% experienced difficulties in accessing routine antenatal care, 60.3%-98.1% were not allowed a companion of choice, 17.4%-39.2% reported that health workers were not always using personal protective equipment, and 21.2%-53.8% rated the number of health workers as insufficient. Episiotomy was performed in 30.9%-62.8% of spontaneous vaginal births. Additionally, 22.6%-55.9% of women received inadequate breastfeeding support, 21.5%-62.8% reported not being treated with dignity, 11.0%-30.5% suffered abuse, and 0.7%-26.5% made informal payments. Multivariate analyses confirmed significant differences among countries, with Slovenia showing the highest QMNC index, followed by Croatia, Bosnia-Herzegovina, and Serbia. CONCLUSION Differences in QMNC among the countries of the former Yugoslavia during the COVID-19 pandemic were significant. Activities to promote high-quality, evidence-based, respectful care for all mothers and newborns are urgently needed. CLINICALTRIALS gov Identifier: NCT04847336.
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Affiliation(s)
| | - Zalka Drglin
- National Institute of Public HealthLjubljanaSlovenia
| | | | - Anja Bohinec
- National Institute of Public HealthLjubljanaSlovenia
| | | | | | | | | | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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Pumpure E, Jakovicka D, Mariani I, Vaska A, Covi B, Valente EP, Jansone‐Šantare G, Knoka AR, Vilcāne KP, Rezeberga D, Lazzerini M, Roda DD, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Morano S, Chertok I, Artzi‐Medvedik R, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Women's perspectives on the quality of maternal and newborn care in childbirth during the COVID-19 pandemic in Latvia: Results from the IMAgiNE EURO study on 40 WHO standards-based quality measures. Int J Gynaecol Obstet 2022; 159 Suppl 1:97-112. [PMID: 36530013 PMCID: PMC9878132 DOI: 10.1002/ijgo.14461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth during the COVID-19 pandemic in Latvia, comparing the years 2020 and 2021, among women who went into labor or had a prelabor cesarean. METHODS Women giving birth in healthcare facilities in Latvia from March 1, 2020, to October 28, 2021, answered an online questionnaire including 40 WHO standards-based quality measures. Descriptive and multivariate quantile regression analyses were performed to compare QMNC in 2020 and 2021. RESULTS 2079 women were included in the analysis: 1860 women who went into labor (group 1) and 219 with prelabor cesarean (group 2). Among group 1, 66.4% (n = 99/149) of women received fundal pressure in an instrumental vaginal birth, 43.5% (n = 810) lacked involvement in choices, 17.4% (n = 317) reported suffering abuse, 32.7% (n = 609) reported inadequate breastfeeding support while 5.2% (n = 96) lack of early breastfeeding. A significant reduction in QMNC due to the COVID-19 pandemic was reported by 29.5% (n = 219) and 25.0% (n = 270) of respondents in 2020 and 2021, respectively (P = 0.045). Multivariate analyses highlighted a significantly lower QMNC index for 2020 compared with 2021 (P < 0.001). CONCLUSION This first study investigating QMNC in Latvia showed significant gaps in QMNC perceived by respondents, with slightly better results in 2021. Appropriate healthcare strategies to improve health care for women and newborns in Latvia are required. CLINICALTRIALS gov Identifier:NCT04847336.
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Affiliation(s)
- Elizabete Pumpure
- Department of Obstetrics and GynecologyRiga Stradins UniversityRigaLatvia,Riga Maternity HospitalRigaLatvia
| | | | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | | | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Gita Jansone‐Šantare
- Department of Obstetrics and GynecologyRiga Stradins UniversityRigaLatvia,Riga Maternity HospitalRigaLatvia
| | | | | | - Dace Rezeberga
- Department of Obstetrics and GynecologyRiga Stradins UniversityRigaLatvia,Riga Maternity HospitalRigaLatvia
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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de Labrusse C, Abderhalden‐Zellweger A, Mariani I, Pfund A, Gemperle M, Grylka‐Baeschlin S, Mueller AN, Valente E, Covi B, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Quality of maternal and newborn care in Switzerland during the COVID-19 pandemic: A cross-sectional study based on WHO quality standards. Int J Gynaecol Obstet 2022; 159 Suppl 1:70-84. [PMID: 36530005 PMCID: PMC9877813 DOI: 10.1002/ijgo.14456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. METHODS Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. RESULTS A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n = 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 487, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. CONCLUSION Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.
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Affiliation(s)
- Claire de Labrusse
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Alessia Abderhalden‐Zellweger
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Ilaria Mariani
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Anouck Pfund
- School of Health Sciences (HESAV)HES‐SO University of Applied Sciences and Arts Western SwitzerlandLausanneSwitzerland
| | - Michael Gemperle
- Research Institute for MidwiferyZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | | | - Antonia N. Mueller
- Research Institute for MidwiferyZHAW Zurich University of Applied SciencesWinterthurSwitzerland
| | - Emanuelle Pessa Valente
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Benedetta Covi
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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5
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Otelea MR, Simionescu AA, Mariani I, Valente EP, Nanu MI, Nanu I, Handra CM, Covi B, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Vaska A, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Women's assessment of the quality of hospital-based perinatal care by mode of birth in Romania during the COVID-19 pandemic: Results from the IMAgiNE EURO study. Int J Gynaecol Obstet 2022; 159 Suppl 1:126-136. [PMID: 36530009 PMCID: PMC9877960 DOI: 10.1002/ijgo.14482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess women's perceptions of the quality of maternal and newborn care (QMNC) received in hospitals in Romania during the COVID-19 pandemic by mode of birth. METHODS A validated anonymous online questionnaire based on WHO quality measures. Subgroup analysis of spontaneous vaginal birth (SVB), emergency cesarean, and elective cesarean and multivariate analyses were performed, and QMNC indexes were calculated. Maternal age, educational level, year of birth, mother born in Romania, parity, type of hospital, and type of professionals assisting the birth were used for multivariate analysis. RESULTS A total of 620 women completed the survey. Overall, several quality measures suggested gaps in QMNC in Romania, with the lowest QMNC indexes reported for provision of care and availability of resources. Women who had either elective or emergency cesarean compared with those who had SVB more frequently lacked early breastfeeding (OR 2.04 and 2.13, respectively), skin-to-skin contact (OR 1.73 and 1.75, respectively), rooming-in (OR 2.07 and 1.96, respectively), and exclusive breastfeeding at discharge (OR 2.27 and 1.64, respectively). Compared with elective cesarean, emergency cesarean had higher odds of ineffective communication by healthcare providers (OR 1.65), lack of involvement in choices (OR 1.58), insufficient emotional support (OR 2.07), and no privacy (OR 2.06). Compared with other modes of birth, a trend for lower QMNC indexes for emergency cesarean was observed for all domains, while for elective cesarean the QMNC index for provision of care was significantly lower. CONCLUSION Quality indicators of perinatal care remain behind targets in Romania, with births by cesarean the most affected. CLINICALTRIALS GOV IDENTIFIER NCT04847336.
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Affiliation(s)
| | - Anca Angela Simionescu
- Department of Obstetrics and GynecologyUniversity of Medicine and Pharmacy Carol DavilaBucharestRomania,Department of Gynecology and ObstetricsFilantropia Clinical HospitalBucharestRomania
| | - Ilaria Mariani
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Michaela Iuliana Nanu
- Social Obstetrics and Pediatric Research UnitNational Institute for Mother and Child HealthBucharestRomania
| | - Ioana Nanu
- Social Obstetrics and Pediatric Research UnitNational Institute for Mother and Child HealthBucharestRomania
| | | | - Benedetta Covi
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating Center for Maternal and Child HealthInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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6
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Costa R, Barata C, Dias H, Rodrigues C, Santos T, Mariani I, Covi B, Valente EP, Lazzerini M, Drandić D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal: Results from the IMAgiNE EURO study. Int J Gynaecol Obstet 2022; 159 Suppl 1:137-153. [PMID: 36530002 PMCID: PMC9878220 DOI: 10.1002/ijgo.14507] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS-II) regions in Portugal during the COVID-19 pandemic. METHODS Women participating in the cross-sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards-based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID-19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region. RESULTS Out of 1845 participants, one-third (33.7%) had a cesarean. Examples of high-quality care included: low frequencies of lack of early breastfeeding and rooming-in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve). CONCLUSION Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.
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Affiliation(s)
- Raquel Costa
- EPIUnitInstituto de Saúde Pública, Universidade do PortoPortoPortugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)PortoPortugal,Lusófona University/HEI‐Lab: Digital Human‐Environment Interaction LabsPortoPortugal
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de LisboaLisbonPortugal,Associação Portuguesa Pelos Direitos da Mulher na Gravidez e PartoLisbonPortugal
| | - Heloísa Dias
- Administração Regional de Saúde do AlgarveAlgarvePortugal
| | - Carina Rodrigues
- EPIUnitInstituto de Saúde Pública, Universidade do PortoPortoPortugal,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR)PortoPortugal
| | - Teresa Santos
- Universidade EuropeiaLisbonPortugal,Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica PortuguesaLisbonPortugal
| | - Ilaria Mariani
- WHO Collaborating CenterInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Benedetta Covi
- WHO Collaborating CenterInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Emanuelle Pessa Valente
- WHO Collaborating CenterInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
| | - Marzia Lazzerini
- WHO Collaborating CenterInstitute for Maternal and Child Health IRCCS “Burlo Garofolo”TriesteItaly
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Miani C, Wandschneider L, Batram-Zantvoort S, Covi B, Elden H, Nedberg IH, Drglin Z, Pumpure E, Costa R, Rozée V, Otelea MR, Drandić D, Radetic J, Abderhalden-Zellweger A, Ćerimagić A, Arendt M, Mariani I, Linden K, Ponikvar BM, Jakovicka D, Dias H, Ruzicic J, de Labrusse C, Valente EP, Zaigham M, Bohinec A, Rezeberga D, Barata C, Pfund A, Sacks E, Lazzerini M, Drandić Roda D, Kurbanović M, Virginie R, de La Rochebrochard E, Löfgren K, Miani C, Batram‐Zantvoort S, Wandschneider L, Lazzerini M, Valente EP, Covi B, Mariani I, Morano S, Chertok I, Hefer E, Artzi‐Medvedik R, Pumpure E, Rezeberga D, Jansone‐Šantare G, Jakovicka D, Knoka AR, Vilcāne KP, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj‐Puzyna U, Węgrzynowska M, Costa R, Barata C, Santos T, Rodrigues C, Dias H, Otelea MR, Radetić J, Ružičić J, Drglin Z, Ponikvar BM, Bohinec A, Brigidi S, Castañeda LM, Elden H, Sengpiel V, Linden K, Zaigham M, De Labrusse C, Abderhalden A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A. Individual and country-level variables associated with the medicalization of birth: Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region. Int J Gynaecol Obstet 2022; 159 Suppl 1:9-21. [PMID: 36530006 DOI: 10.1002/ijgo.14459] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. METHODS Online anonymous survey of women who gave birth in 2020-2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. RESULTS Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P < 0.001). Country-level variables contributed to explaining some of the variance between countries. CONCLUSION We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care.
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Affiliation(s)
- Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.,Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Aubervilliers, France
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Helen Elden
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ingvild Hersoug Nedberg
- Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Zalka Drglin
- National Institute of Public Health, Ljubljana, Slovenia
| | - Elizabete Pumpure
- Riga Maternity Hospital, Riga, Latvia.,Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia
| | - Raquel Costa
- Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal.,Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.,Lusófona University/HEI-Lab: Digital Human-Environment Interaction Labs, Lisbon, Portugal
| | - Virginie Rozée
- Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Aubervilliers, France
| | - Marina Ruxandra Otelea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.,SAMAS Association, Bucharest, Romania
| | | | | | - Alessia Abderhalden-Zellweger
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | | | - Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Karolina Linden
- Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | | | - Heloisa Dias
- Administração Regional de Saúde do Algarve, Algarve, Portugal
| | | | - Claire de Labrusse
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
| | - Mehreen Zaigham
- Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.,Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden
| | - Anja Bohinec
- National Institute of Public Health, Ljubljana, Slovenia
| | - Dace Rezeberga
- Riga Maternity Hospital, Riga, Latvia.,Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de Lisboa, Lisbon, Portugal
| | - Anouk Pfund
- School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland
| | - Emma Sacks
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy
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