BMJ Open (Dec 2024)

Quality of care at childbirth during the COVID-19 pandemic in Belgium: a cross-sectional study based on WHO standards

  • ,
  • Marzia Lazzerini,
  • Emanuelle Pessa Valente,
  • Enrico Lopriore,
  • Mariana Pereira,
  • Helen Elden,
  • Ilaria Mariani,
  • Anna Galle,
  • Christoph Zenzmaier,
  • Nicos Middleton,
  • Antonella Nespoli,
  • Dace Rezeberga,
  • Mehreen Zaigham,
  • Karolina Linden,
  • Sandra Morano,
  • Raquel Costa,
  • Heloísa Dias,
  • Rozée Virginie,
  • Elizabete Pumpure,
  • Dārta Jakovicka,
  • Maryse Arendt,
  • Barbara Tasch,
  • Barbara Baranowska,
  • Urszula Tataj-Puzyna,
  • Catarina Barata,
  • Teresa Santos,
  • Zalka Drglin,
  • Anja Bohinec,
  • Serena Brigidi,
  • Lara Martín Castañeda,
  • Claire De Labrusse,
  • Anouck Pfund,
  • Harriet Thorn,
  • Joana Oliveira,
  • Simona Fumagalli,
  • Marina Ruxandra Otelea,
  • Helga Berghman,
  • Silke D’Hauwers,
  • Nele Vaerewijck,
  • Arianna Bomben,
  • Stefano delle Vedove,
  • Martina König-Bachmann,
  • Simon Imola,
  • Elisabeth D'Costa,
  • Ourania Kolokotroni,
  • Eleni Hadjigeorgiou,
  • Maria Karanikola,
  • Ioli Orphanide Eteocleous,
  • Lenka Laubrova Zirovnicka,
  • Miloslava Kramná,
  • Elise de La Rochebrochard,
  • Antigoni Sarantaki Kristina,
  • Dimitra Metallinou,
  • Aikaterini Lykeridou,
  • Stefano Delle Vedove,
  • Gita Jansone-Šantare,
  • Anna Šibalova,
  • Elīna Voitehoviča,
  • Dārta Krēsliņa,
  • Alina Liepinaitienė,
  • Andželika Kondrakova,
  • Marija Mizgaitienė,
  • Simona Juciūtė,
  • Thomas Van den Akker,
  • Beata Szlendak,
  • Paulina Pawlicka,
  • Tiago Miguel Pinto,
  • Sofia Marques,
  • Ana Meireles,
  • Maria Arminda Nunes,
  • Alejandra Oliden,
  • Alessia Abderhalden-Zellweger,
  • Susanne Grylka,
  • Michael Gemperle,
  • Antonia Mueller

DOI
https://doi.org/10.1136/bmjopen-2024-086937
Journal volume & issue
Vol. 14, no. 12

Abstract

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Objectives To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time.Design A cross-sectional observational study.Setting Data of the Improving MAternal Newborn carE in the EURO region study in Belgium.Participants Women giving birth in a Belgian facility from 1 March 2020 to 1 May 2023 responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources and organisational changes related to COVID‐19.Primary and secondary outcome measures Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann‐Kendall test.Results 897 women were included in the analysis, 67% (n=601) with spontaneous vaginal birth, 13.3% (n=119) with instrumental vaginal birth (IVB) and 19.7% (n=177) with caesarean section. We found overall high QMNC scores (median index scores>75) but also specific gaps in all domains of QMNC. On provision of care, 21.0% (n=166) of women who experienced labour reported inadequate pain relief, 64.7% (n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1% (n=279) reported unclear communication, 32.9% (n=295) reported that they were not involved in choices,11.5% (n=104) stated not being treated with dignity and 8.1% (n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). Multivariable analyses showed significantly lower QMNC scores for women with an IVB (−20.4 in the 50th percentile with p<0.001 and 95% CI (−25.2 to −15.5)). Over time, there was a significant increase in QMNC Score for ‘experience of care’ and ‘key organisational changes due to COVID-19’ (trend test p< 0.05).Conclusions and relevance Our study showed several gaps in QMNC in Belgium, underlying causes of these gaps should be explored to design appropriate interventions and policies.Trial registration number NCT04847336.