Womenʼs perspectives on the quality of maternal and newborn care in childbirth during the COVID‐19 pandemic in Latvia: Results from the IMAgiNE EURO study on 40 WHO standards‐based quality measures

Abstract

Objective To investigate women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth during the COVID‐19 pandemic in Latvia, comparing the years 2020 and 2021, among women who went into labor or had a prelabor cesarean. Methods Women giving birth in healthcare facilities in Latvia from March 1, 2020, to October 28, 2021, answered an online questionnaire including 40 WHO standards‐based quality measures. Descriptive and multivariate quantile regression analyses were performed to compare QMNC in 2020 and 2021. Results 2079 women were included in the analysis: 1860 women who went into labor (group 1) and 219 with prelabor cesarean (group 2). Among group 1, 66.4% (n = 99/149) of women received fundal pressure in an instrumental vaginal birth, 43.5% (n = 810) lacked involvement in choices, 17.4% (n = 317) reported suffering abuse, 32.7% (n = 609) reported inadequate breastfeeding support while 5.2% (n = 96) lack of early breastfeeding. A significant reduction in QMNC due to the COVID‐19 pandemic was reported by 29.5% (n = 219) and 25.0% (n = 270) of respondents in 2020 and 2021, respectively (P = 0.045). Multivariate analyses highlighted a significantly lower QMNC index for 2020 compared with 2021 (P < 0.001). Conclusion This first study investigating QMNC in Latvia showed significant gaps in QMNC perceived by respondents, with slightly better results in 2021. Appropriate healthcare strategies to improve health care for women and newborns in Latvia are required. http://clinicaltrials.gov Identifier:NCT04847336.

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

“…Results of this study highlight gaps in all countries (but to a much lower extent in Slovenia), for all domains of QMNC, including provision (Croatia still showing a relatively high index), experience, availability of resources, and reorganization of care. Notably, episiotomy rates remain high in all four countries, indicating routine or liberal use, which is not in line with WHO recommendations, 43 but was also reported in other countries in the IMAgiNE EURO study 44–46 . Other indicators mirror unsatisfactory practices related to essential newborn care, with unsatisfactory rates of skin‐to‐skin contact and early breastfeeding, and insufficient breastfeeding support in all four countries.…”

“…Notably, episiotomy rates remain high in all four countries, indicating routine or liberal use, which is not in line with WHO recommendations, 43 but was also reported in other countries in the IMAgiNE EURO study. [44][45][46] Other indicators mirror unsatisfactory practices related to essential newborn care, with unsatisfactory rates of skin-to-skin contact and early breastfeeding, and insufficient breastfeeding support in all F I G U R E 5 (a) Women who underwent spontaneous labor (b) Women with prelabor cesarean four countries. In 2017, a high number of maternity facilities in each of the countries were at some point designated as "baby friendly" as part of UNICEF's Baby Friendly Hospital Initiative (BFHI).…”

Perspectives of professionals and human rights associations on the IMAgiNE EURO study

“…However, no country, no health system, nor the World Health Organization, to say nothing of our hospitals, was prepared for what 2020–2022 brought us. The articles in this Supplement 1–10 . chronicle the risk of pregnancy during COVID‐19, particularly the vulnerability of women giving birth during a pandemic.…”

“…The IMAgiNE EURO surveys show high levels of medicalization throughout Europe, especially cesarean, instrumental births, and application of fundal pressure 1–10 . This is also coupled with lack of informed consent, lack of support for initiation and continuation of breastfeeding, and lack of respect and dignity for birthing women.…”

“…When women are not provided with respectful care during childbirth this impacts on the rest of their care journey—they may not feel or be supported to initiate or continue breastfeeding, or to bond through skin‐to‐skin contact or rooming‐in with their baby. Lack of informed consent for interventions, 5–7 such as fundal pressure or instrumental birth, is a violation of the right to bodily autonomy and erodes public trust in the healthcare system. The integrity of the person is a basic right in the Charter of Fundamental Rights of the European Union 11 .…”