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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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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. 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. Lancet Reg Health Eur 2022; 13:100268. [PMID: 34977838 PMCID: PMC8703114 DOI: 10.1016/j.lanepe.2021.100268] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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.
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Affiliation(s)
- Marzia Lazzerini
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Benedetta Covi
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Ilaria Mariani
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Zalka Drglin
- National Institute of Public Health, Ljubljana, Slovenia
| | - Maryse Arendt
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg
| | | | - Helen Elden
- Institute of Health and Care sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska university hospital, Dept of Obstetrics & Gynecology, Gothenburg, Sweden
| | - Raquel Costa
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Hei-Lab:Digital Human-Environment Interaction Lab. Faculty of Psychology, Education and Sports, Lusófona University, Porto, Portugal
| | | | | | - Marina Ruxandra Otelea
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- SAMAS Association, Bucharest, Romania
| | - Céline Miani
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | - Serena Brigidi
- Department of Anthropology, Philosophy and Social Work. Medical Anthropology Research Center (MARC). Rovira i Virgili University (URV), Tarragona, Spain
| | - Virginie Rozée
- Sexual and Reproductive Health and Rights Research Unit, Institut National d’Études Démographiques (INED), Paris, France
| | | | - Barbara Tasch
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg
- Neonatal intensive care unit, KannerKlinik, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
| | - Sigrun Kongslien
- Department of health and care sciences, UiT The Arctic University of Norway
| | - Karolina Linden
- Institute of Health and Care sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Catarina Barata
- Instituto de Ciências Sociais, Universidade de Lisboa, Lisboa, Portugal
| | | | | | - Stephanie Batram-Zantvoort
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | - Elise de La Rochebrochard
- Sexual and Reproductive Health and Rights Research Unit, Institut National d’Études Démographiques (INED), Paris, France
| | - Anja Bohinec
- National Institute of Public Health, Ljubljana, Slovenia
| | - Eline Skirnisdottir Vik
- Department of health and caring sciences, Western Norway University of Applied Sciences, Norway
| | - Mehreen Zaigham
- Obstetrics & Gynecology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Teresa Santos
- Universidade Europeia, Lisboa, Portugal
- Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica Portuguesa, Lisbon, Portugal
| | - Lisa Wandschneider
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
| | | | | | - Emma Sacks
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Emanuelle Pessa Valente
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - IMAgiNE EURO study group
- WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
- National Institute of Public Health, Ljubljana, Slovenia
- Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg
- Department of community medicine, UiT The Arctic University of Norway
- Institute of Health and Care sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska university hospital, Dept of Obstetrics & Gynecology, Gothenburg, Sweden
- EPIUnit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
- Hei-Lab:Digital Human-Environment Interaction Lab. Faculty of Psychology, Education and Sports, Lusófona University, Porto, Portugal
- Roda – Parents in Action, Zagreb, Croatia
- Centar za mame, Belgrade, Serbia
- University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
- SAMAS Association, Bucharest, Romania
- Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany
- Department of Anthropology, Philosophy and Social Work. Medical Anthropology Research Center (MARC). Rovira i Virgili University (URV), Tarragona, Spain
- Sexual and Reproductive Health and Rights Research Unit, Institut National d’Études Démographiques (INED), Paris, France
- Neonatal intensive care unit, KannerKlinik, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
- Department of health and care sciences, UiT The Arctic University of Norway
- Instituto de Ciências Sociais, Universidade de Lisboa, Lisboa, Portugal
- Faculty of Health Studies, University of Rijeka, Rijeka, Croatia
- Institut Català de la Salut, Generalitat de Catalunya, Spain
- Department of health and caring sciences, Western Norway University of Applied Sciences, Norway
- Obstetrics & Gynecology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Universidade Europeia, Lisboa, Portugal
- Centro de Investigação Interdisciplinar em Saúde (CIIS) da Universidade Católica Portuguesa, Lisbon, Portugal
- Institut Català d'Antropologia (ICA), Barcelona, Spain
- NGO Baby Steps, Sarajevo, Bosnia-Herzegovina
- Department of International Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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