Quality of care at childbirth: Findings of IMAgiNE EURO in Italy during the first year of the COVID‐19 pandemic

Abstract

Objective Investigate the quality of maternal and newborn care (QMNC) during childbirth in the first year of COVID‐19 pandemic in Italy, from the mothers' perspective, as key service users. Methods Women who gave birth in an Italian facility from March 1, 2020 to February 29, 2021 answered an online questionnaire including 40 WHO Standard‐based Quality Measures. Descriptive and multivariate quantile regression analyses were performed. Results In total, 4824 women were included, reporting heterogeneity of practices across regions: among 3981 women who underwent labour 78.4% (63.0%–92.0%) were not allowed a companion of choice, 44.6% (28.9%–53.3%) had difficulties in attending routine antenatal visits, 36.3% (24.9%–61.1%) reported inadequate breastfeeding support, 39.2% (23.3%–62.2%) felt not involved in medical choices, 33.0% (23.9%–49.3%) experienced unclear communication from staff, 24.8% (15.9%–39.4%) were not always treated with dignity and 12.7% (10.1%–29.3%) reported abuses. Findings in the group of women who did not experience labour were substantially similar. Multivariate analyses confirmed a significant lower QMNC index for regions in southern Italy compared to North and Central regions. Conclusion Mothers reported substantial inequities in the QMNC across Italian regions. Future studies should monitor QMNC over time. Meanwhile, actions to ensure high QMNC for all mothers and newborns across Italy are urgently required.

Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the IMAgiNE EURO study in 16 countries

“…the scoring system attributes the same scores to all quality measures) and some of its measures may be open to subjectivity. Therefore, we acknowledge that—as recommended in our previous papers 24 , 26 , 27 , 28 —when assessing QMNC it is critical to evaluate specific indicators (such as the rate of cesarean) as well as overall QMNC score. In the present paper we made the choice to document the rates of IVB and cesarean because they are objective indicators, and reducing cesarean rates while promoting “physiological birth” is identified as a priority by health policies in the European region.…”

“…Limitations of the IMAgiNE EURO study have been acknowledged elsewhere. 26 , 27 , 28 Briefly, they include case selection toward women with relatively high levels of education, and a potential selection toward those with a higher interest in participating. Specific to the present study, while the rate of births in private facilities was well aligned with the expected national rate for France (20.0%) and Portugal (17.1%), our sample was over‐represented in Italy (18.0% in our sample vs 11.6% in the national statistics) and under‐represented for Switzerland (9.5% vs 20.2%), while no official data are currently available for Romania (supporting information Table 4 ).…”

“…The process of questionnaire development and validation 24 , 31 , 32 , 33 and previous use has been reported elsewhere. 26 , 27 , 28 The 40 key indicators contributed to a composite QMNC index for each of the four domains evaluated (scoring from 0–100 points, with higher scores indicating higher adherence to WHO standards), to be considered a complementary synthetic measure of QMNC. 26 , 27 , 28 …”

“…Previous papers have reported preliminary findings of IMAgiNE EURO. 26 , 27 , 28 The aim of the present study was to compare the rates of instrumental births (i.e. IVB or cesarean), IVB, and cesarean in parallel with overall maternal perspectives on QMNC during the COVID‐19 pandemic in private versus public facilities.…”