The Lancet Regional Health. Europe (Feb 2022)

Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic: online survey investigating maternal perspectives in 12 countries of the WHO European Region

  • Marzia Lazzerini,
  • Benedetta Covi,
  • Ilaria Mariani,
  • Zalka Drglin,
  • Maryse Arendt,
  • Ingvild Hersoug Nedberg,
  • Helen Elden,
  • Raquel Costa,
  • Daniela Drandić,
  • Jelena Radetić,
  • Marina Ruxandra Otelea,
  • Céline Miani,
  • Serena Brigidi,
  • Virginie Rozée,
  • Barbara Mihevc Ponikvar,
  • Barbara Tasch,
  • Sigrun Kongslien,
  • Karolina Linden,
  • Catarina Barata,
  • Magdalena Kurbanović,
  • Jovana Ružičić,
  • Stephanie Batram-Zantvoort,
  • Lara Martín Castañeda,
  • Elise de La Rochebrochard,
  • Anja Bohinec,
  • Eline Skirnisdottir Vik,
  • Mehreen Zaigham,
  • Teresa Santos,
  • Lisa Wandschneider,
  • Ana Canales Viver,
  • Amira Ćerimagić,
  • Emma Sacks,
  • Emanuelle Pessa Valente

Journal volume & issue
Vol. 13
p. 100268

Abstract

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Summary: Background: Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking. Methods: Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures. Findings: 21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported that health workers were not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the health workers’ number as “insufficient”. Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes. Interpretation: Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed. Funding: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. Study registration: ClinicalTrials.gov Identifier: NCT04847336

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