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; IMAgiNE EURO study group

doi:10.1016/j.lanepe.2021.100268

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 KurbanovićJovana 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, IMAgiNE EURO study group

Obstetrics and Gynaecology (Lund)

Research output: Contribution to journal › Article › peer-review

Abstract

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.

Original language	English
Article number	100268
Journal	The Lancet regional health. Europe
Volume	13
DOIs	https://doi.org/10.1016/j.lanepe.2021.100268
Publication status	Published - 2022

Bibliographical note

Subject classification (UKÄ)

Health Care Service and Management, Health Policy and Services and Health Economy

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Lazzerini, M., Covi, B., Mariani, I., Drglin, Z., Arendt, M., Nedberg, I. H., Elden, H., Costa, R., Drandić, D., Radetić, J., Otelea, M. R., Miani, C., Brigidi, S., Rozée, V., Ponikvar, B. M., Tasch, B., Kongslien, S., Linden, K., Barata, C., ... 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, Article 100268. https://doi.org/10.1016/j.lanepe.2021.100268

@article{5ee1be5f9bfd41bda9d48bf944197352,

title = "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",

abstract = "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.",

author = "Marzia Lazzerini and Benedetta Covi and Ilaria Mariani and Zalka Drglin and Maryse Arendt and Nedberg, {Ingvild Hersoug} and Helen Elden and Raquel Costa and Daniela Drandi{\'c} and Jelena Radeti{\'c} and Otelea, {Marina Ruxandra} and C{\'e}line Miani and Serena Brigidi and Virginie Roz{\'e}e and Ponikvar, {Barbara Mihevc} and Barbara Tasch and Sigrun Kongslien and Karolina Linden and Catarina Barata and Magdalena Kurbanovi{\'c} and Jovana Ru{\v z}i{\v c}i{\'c} and Stephanie Batram-Zantvoort and Casta{\~n}eda, {Lara Mart{\'i}n} and Rochebrochard, {Elise de La} and Anja Bohinec and Vik, {Eline Skirnisdottir} and Mehreen Zaigham and Teresa Santos and Lisa Wandschneider and Viver, {Ana Canales} and Amira {\'C}erimagi{\'c} and Emma Sacks and Valente, {Emanuelle Pessa} and {IMAgiNE EURO study group}",

note = "{\textcopyright} 2021 The Author(s).",

year = "2022",

doi = "10.1016/j.lanepe.2021.100268",

language = "English",

volume = "13",

journal = "The Lancet regional health. Europe",

issn = "2666-7762",

publisher = "Elsevier",

}

Lazzerini, M, Covi, B, Mariani, I, Drglin, Z, Arendt, M, Nedberg, IH, Elden, H, Costa, R, Drandić, D, Radetić, J, Otelea, MR, Miani, C, Brigidi, S, Rozée, V, Ponikvar, BM, Tasch, B, Kongslien, S, Linden, K, Barata, C, Kurbanović, M, Ružičić, J, Batram-Zantvoort, S, Castañeda, LM, Rochebrochard, EDL, Bohinec, A, Vik, ES, Zaigham, M, Santos, T, Wandschneider, L, Viver, AC, Ćerimagić, A, Sacks, E, Valente, EP & 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, vol. 13, 100268. https://doi.org/10.1016/j.lanepe.2021.100268

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 et al.
In: The Lancet regional health. Europe, Vol. 13, 100268, 2022.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic

T2 - online survey investigating maternal perspectives in 12 countries of the WHO European Region

AU - Lazzerini, Marzia

AU - Covi, Benedetta

AU - Mariani, Ilaria

AU - Drglin, Zalka

AU - Arendt, Maryse

AU - Nedberg, Ingvild Hersoug

AU - Elden, Helen

AU - Costa, Raquel

AU - Drandić, Daniela

AU - Radetić, Jelena

AU - Otelea, Marina Ruxandra

AU - Miani, Céline

AU - Brigidi, Serena

AU - Rozée, Virginie

AU - Ponikvar, Barbara Mihevc

AU - Tasch, Barbara

AU - Kongslien, Sigrun

AU - Linden, Karolina

AU - Barata, Catarina

AU - Kurbanović, Magdalena

AU - Ružičić, Jovana

AU - Batram-Zantvoort, Stephanie

AU - Castañeda, Lara Martín

AU - Rochebrochard, Elise de La

AU - Bohinec, Anja

AU - Vik, Eline Skirnisdottir

AU - Zaigham, Mehreen

AU - Santos, Teresa

AU - Wandschneider, Lisa

AU - Viver, Ana Canales

AU - Ćerimagić, Amira

AU - Sacks, Emma

AU - Valente, Emanuelle Pessa

AU - IMAgiNE EURO study group

PY - 2022

Y1 - 2022

N2 - 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.

AB - 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.

U2 - 10.1016/j.lanepe.2021.100268

DO - 10.1016/j.lanepe.2021.100268

M3 - Article

C2 - 34977838

SN - 2666-7762

VL - 13

JO - The Lancet regional health. Europe

JF - The Lancet regional health. Europe

M1 - 100268

ER -