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

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

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.Particip...

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Main Authors: 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
Format: Article
Language:English
Published: BMJ Publishing Group 2024-12-01
Series:BMJ Open
Online Access:https://bmjopen.bmj.com/content/14/12/e086937.full
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Summary: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.
ISSN:2044-6055

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