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.
Lazzerini, Marzia;
Covi, Benedetta;
Mariani, Ilaria;
Drglin, Zalka;
Arendt, Maryse;
Nedberg, Ingvild Hersoug;
Elden, Helen;
Costa, Raquel;
Drandić, Daniela;
Radetić, Jelena;
+24 more...Otelea, Marina Ruxandra;
Miani, Céline;
Brigidi, Serena;
Rozée, Virginie;
Ponikvar, Barbara Mihevc;
Tasch, Barbara;
Kongslien, Sigrun;
Linden, Karolina;
Barata, Catarina;
Kurbanović, Magdalena;
Ružičić, Jovana;
Batram-Zantvoort, Stephanie;
Castañeda, Lara Martín;
Rochebrochard, Elise de La;
Bohinec, Anja;
Vik, Eline Skirnisdottir;
Zaigham, Mehreen;
Santos, Teresa;
Wandschneider, Lisa;
Viver, Ana Canales;
Ćerimagić, Amira;
Sacks, Emma;
Valente, Emanuelle Pessa;
IMAgiNE EURO study group;
(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.
The Lancet regional health. Europe, 13.
100268-.
ISSN 2666-7762
DOI: https://doi.org/10.1016/j.lanepe.2021.100268
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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.
