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.

Keywords: COVID-19; European region; childbirth; hospital; maternal; newborn; quality of care; questionnaire; survey.

FIGURE 1

Study flow diagram. ¹ 40 quality measures and five key socio‐demographic variables were considered as key variables

FIGURE 2

Provision of care. Data are reported as median frequency on the total sample (gray dot) and as median frequency on the same of women giving birth in each region (colored dots). All the indicators in the domain of provision of care are directly based on WHO standards. Indicators identified with letters (e.g. 3a, 3b) were tailored to take into account different mode of birth (i.e. spontaneous vaginal, instrumental vaginal, and caesarean section). These were calculated on subsamples (e.g. 3a was calculated on spontaneous vaginal births; 3b was calculated on instrumental vaginal births). CS, caesarean section; HCP, health care provider; IVB, instrumental vaginal birth; SVB, spontaneous vaginal birth

FIGURE 3

Experience of care. Data are reported as median frequency on the total sample (gray dot) and as median frequency on the same of women giving birth in each region (colored dots). All the indicators in the domain of experience of care are directly based on WHO standards. Indicators identified with letters (e.g. 2a, 2b) were tailored to take into account different mode of birth (i.e. spontaneous vaginal, instrumental vaginal, and caesarean section). These were calculated on subsamples (e.g. 2a was calculated on spontaneous vaginal births; 2b was calculated on instrumental vaginal births). ECS, emergency caesarean section; HCP, health care provider; IVB, instrumental vaginal birth; SVB, spontaneous vaginal birth

FIGURE 4

Availability of physical and human resources. Data are reported as median frequency on the total sample (gray dot) and as median frequency on the same of women giving birth in each region (colored dots). All the indicators in the domain of availability of physical and human resources are directly based on WHO standards. HCP, health care provider

FIGURE 5

Reorganizational changes due to COVID‐19. Data are reported as median frequency on the total sample (gray dot) and as median frequency on the same of women giving birth in each region (colored dots); indicator 6 in both panels was defined as: At least one functioning and accessible hand‐washing station (near or inside the room where the mother was hospitalized) supplied with water and soap or with disinfectant alcohol solution. HCP, health care provider; PPE, personal protective equipment; QMNC, quality of maternal and newborn care

FIGURE 6

QMNC index by major socio‐economic regions. QMNC, quality of maternal and newborn care

FIGURE 7

QMNC index by other variables used in quantile regression analysis. CS, caesarean section; IVB, instrumental vaginal birth; OB‐GYN, obstetrics and gynecology; QMNC, quality of maternal and newborn care; SVB, spontaneous vaginal birth