Women's perspectives on the quality of hospital maternal and newborn care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Slovenia, Croatia, Serbia, and Bosnia-Herzegovina

OBJECTIVE: To assess the quality of maternal and newborn care (QMNC) in countries of the former Yugoslavia. METHOD: Women giving birth in a facility in Slovenia, Croatia, Serbia, and Bosnia-Herzegovina between March 1, 2020 and July 1, 2021 answered an online questionnaire including 40 WHO standards-based quality measures. RESULTS: A total of 4817 women were included in the analysis. Significant differences were observed across countries. Among those experiencing labor, 47.4%-62.3% of women perceived a reduction in QMNC due to the COVID-19 pandemic, 40.1%-69.7% experienced difficulties in accessing routine antenatal care, 60.3%-98.1% were not allowed a companion of choice, 17.4%-39.2% reported that health workers were not always using personal protective equipment, and 21.2%-53.8% rated the number of health workers as insufficient. Episiotomy was performed in 30.9%-62.8% of spontaneous vaginal births. Additionally, 22.6%-55.9% of women received inadequate breastfeeding support, 21.5%-62.8% reported not being treated with dignity, 11.0%-30.5% suffered abuse, and 0.7%-26.5% made informal payments. Multivariate analyses confirmed significant differences among countries, with Slovenia showing the highest QMNC index, followed by Croatia, Bosnia-Herzegovina, and Serbia. CONCLUSION: Differences in QMNC among the countries of the former Yugoslavia during the COVID-19 pandemic were significant. Activities to promote high-quality, evidence-based, respectful care for all mothers and newborns are urgently needed. CLINICALTRIALS: gov Identifier: NCT04847336

Individual and country-level variables associated with the medicalization of birth: Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region

Objective: To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. Methods: Online anonymous survey of women who gave birth in 2020–2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. Results: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P< 0.001). Country-level variables contributed to explaining some of the variance between countries. Conclusion: We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care

Quality of health care around the time of childbirth during the COVID-19 pandemic: Results from the IMAgiNE EURO study in Norway and trends over time

Objective: To describe maternal perception of the quality of maternal and newborn care (QMNC) in facilities in Norway during the first year of COVID-19 pandemic. Methods: Women who gave birth in a Norwegian facility from March 1, 2020, to October 28, 2021, filled out a structured online questionnaire based on 40 WHO standards-based quality measures. Quantile regression analysis was performed to assess changes in QMNC index over time. Results: Among 3326 women included, 3085 experienced labor. Of those, 1799 (58.3%) reported that their partner could not be present as much as needed, 918 (29.8%) noted inadequate staff numbers, 183 (43.6%) lacked a consent request for instrumental vaginal birth (IVB), 1067 (34.6%) reported inadequate communication from staff, 78 (18.6%) reported fundal pressure during IVB, 670 (21.7%) reported that they were not treated with dignity, and 249 (8.1%) reported experiencing abuse. The QMNC index increased gradually over time (3.68 points per month, 95% CI, 2.83– 4.53 for the median), with the domains of COVID-19 reorganizational changes and experience of care displaying the greatest increases, while provision of care was stable over time. Conclusion: Although several measures showed high QMNC in Norway during the first year of the COVID-19 pandemic, and a gradual improvement over time, several findings suggest that gaps in QMNC exist. These gaps should be addressed and monitored

Zbiranje nekaterih osebnih identifikatorjev v zbirkah podatkov s področja zdravstvenega varstva

Izhodišča: Zadnje čase so spet aktualne razprave o zbiranju podatkov o Enotni matični številki občanov (EMŠO), zato je v prispevku prikazana problematika zbiranja navedenega identifikatorja v zakonsko določenih zbirkah podatkov s področja zdravstvenega varstva. V prispevku so najprej predstavljene zakonske osnove za zbiranje EMŠO in številke zdravstvenega zavarovanja. Metodologija: Iz bolnišnične statistike je predstavljena podrobnejša analiza poročanih podatkov za leto 2007 in prikazan trend beleženja identifikatorjev v zadnjih nekaj letih na primeru Perinatalnega informacijskega sistema Slovenije. Predstavljen je primer poglobljene analize zbirke podatkov s področja zdravstvenega varstva in z njo povezana problematika beleženja identifikatorjev. Rezultati: Beleženje identifikatorjev v Sloveniji je nepopolno, kar zelo ovira oceno obsega določene bolezni in dodatne poglobljeneanalize. Zaključki: EMŠO je nujno potreben identifikator, vendar prihaja zaradi dejstva, da ga izvajalci ne sporočajo dovolj dosledno, do velikih problemov pri poglobljenih analizah. Za povečanje kakovosti zbirk podatkov s področja zdravstvenega varstva je potrebno tudi čim popolnejše beleženje osebnih identifikatorjev, saj le tako lahko pridemo do kakovostnih rezultatov.Introduction: Lately the debates on EMŠO data collection have emerged again and the problems of collecting this identifier in legally defined healthcare databases are described in the article. Firstly, the legal bases for collecting EMŠO and health insurance number are described. Methodology: Based on hospital statistics the detailed analysis of reported data for year 2007 and the trend of reported identifiers in the last few years in a case of Perinatal information system of Slovenia are presented. The detailed analysis of healthcare databases and problems of identifiers\u27 collection is presented. Results: The identifiers\u27 collection in Slovenia is imperfect and this is reflected in difficulties in estimating the range of some diseases and additional detailed analysis. Conclusions: EMŠO is a very important and usefulidentifier, however, due to its insufficient collecting it leads to big problems in performing detailed analyses. To enhance the quality of healthcaredatabases more consistency collecting of personal identifiers is needed as only this will enable higher quality of the results

Women's perspectives on the quality of hospital maternal and newborn care around the time of childbirth during the COVID ‐19 pandemic ::results from the IMAgiNE EURO study in Slovenia, Croatia, Serbia, and Bosnia‐Herzegovina

Objective: To assess the quality of maternal and newborn care (QMNC) in countries of the former Yugoslavia. Method: Women giving birth in a facility in Slovenia, Croatia, Serbia, and Bosnia-Herzegovina between March 1, 2020, and July 1, 2021 answered an online questionnaire including 40 WHO standards- based quality measures. Results: A total of 4817 women were included in the analysis. Significant differences were observed across countries. Among those experiencing labor, 47.4%–62.3% of women perceived a reduction in QMNC due to the COVID-19 pandemic, 40.1%– 69.7% experienced difficulties in accessing routine antenatal care, 60.3%–98.1% were not allowed a companion of choice, 17.4%–39.2% reported that health workers were not always using personal protective equipment, and 21.2%–53.8% rated the number of health workers as insufficient. Episiotomy was performed in 30.9%–62.8% of spontaneous vaginal births. Additionally, 22.6%–55.9% of women received inadequate breastfeeding support, 21.5%–62.8% reported not being treated with dignity, 11.0%–30.5% suffered abuse, and 0.7%–26.5% made informal payments. Multivariate analyses confirmed significant differences among countries, with Slovenia showing the highest QMNC index, followed by Croatia, Bosnia-Herzegovina, and Serbia. Conclusion: Differences in QMNC among the countries of the former Yugoslavia during the COVID-19 pandemic were significant. Activities to promote high-quality, evidence- based, respectful care for all mothers and newborns are urgently needed

Individual and country-level variables associated with the medicalization of birth : multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region

Objective: To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. Methods: Online anonymous survey of women who gave birth in 2020-2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. Results: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P < 0.001). Country-level variables contributed to explaining some of the variance between countries. Conclusion: We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care

Migrant women's perception of quality of maternal and newborn care around the time of childbirth: IMAgiNE EURO results

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