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

Céline Miani^{1

2}, Lisa Wandschneider¹, Stephanie Batram-Zantvoort¹, Benedetta Covi³, Helen Elden^{4

5}, Ingvild Hersoug Nedberg⁶, Zalka Drglin⁷, Elizabete Pumpure^{8

9}, Raquel Costa^{10

11

12}, Virginie Rozée², Marina Ruxandra Otelea^{13

14}, Daniela Drandić¹⁵, Jelena Radetic¹⁶, Alessia Abderhalden-Zellweger¹⁷, Amira Ćerimagić¹⁸, Maryse Arendt¹⁹, Ilaria Mariani³, Karolina Linden⁴, Barbara Mihevc Ponikvar⁷, Dārta Jakovicka²⁰, Heloisa Dias²¹, Jovana Ruzicic¹⁶, Claire de Labrusse¹⁷, Emanuelle Pessa Valente³, Mehreen Zaigham^{22

23}, Anja Bohinec⁷, Dace Rezeberga^{8

9}, Catarina Barata²⁴, Anouk Pfund¹⁷, Emma Sacks²⁵, Marzia Lazzerini³; IMAgiNE EURO study group

Collaborators, Affiliations

Collaborators

IMAgiNE EURO study group:
Amira Ćerimagić, Daniela Drandić Roda, Magdalena Kurbanović, Rozée Virginie, Elise de La Rochebrochard, Kristina Löfgren, Céline Miani, Stephanie Batram-Zantvoort, Lisa Wandschneider, Marzia Lazzerini, Emanuelle Pessa Valente, Benedetta Covi, Ilaria Mariani, Sandra Morano, Ilana Chertok, Emek Hefer, Rada Artzi-Medvedik, Elizabete Pumpure, Dace Rezeberga, Gita Jansone-Šantare, Dārta Jakovicka, Anna Regīna Knoka, Katrīna Paula Vilcāne, Alina Liepinaitienė, Andželika Kondrakova, Marija Mizgaitienė, Simona Juciūtė, Maryse Arendt, Barbara Tasch, Ingvild Hersoug Nedberg, Sigrun Kongslien, Eline Skirnisdottir Vik, Barbara Baranowska, Urszula Tataj-Puzyna, Maria Węgrzynowska, Raquel Costa, Catarina Barata, Teresa Santos, Carina Rodrigues, Heloísa Dias, Marina Ruxandra Otelea, Jelena Radetić, Jovana Ružičić, Zalka Drglin, Barbara Mihevc Ponikvar, Anja Bohinec, Serena Brigidi, Lara Martín Castañeda, Helen Elden, Verena Sengpiel, Karolina Linden, Mehreen Zaigham, Claire De Labrusse, Alessia Abderhalden, Anouck Pfund, Harriet Thorn, Susanne Grylka, Michael Gemperle, Antonia Mueller

Affiliations

¹ Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
² Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Aubervilliers, France.
³ WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.
⁴ Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
⁵ Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁶ Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
⁷ National Institute of Public Health, Ljubljana, Slovenia.
⁸ Riga Maternity Hospital, Riga, Latvia.
⁹ Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia.
¹⁰ Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal.
¹¹ Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
¹² Lusófona University/HEI-Lab: Digital Human-Environment Interaction Labs, Lisbon, Portugal.
¹³ University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
¹⁴ SAMAS Association, Bucharest, Romania.
¹⁵ Roda - Parents in Action, Zagreb, Croatia.
¹⁶ Center for Moms, Belgrade, Serbia.
¹⁷ School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
¹⁸ NGO Baby Steps, Sarajevo, Bosnia and Herzegovina.
¹⁹ Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg.
²⁰ Faculty of Medicine, Riga Stradins University, Riga, Latvia.
²¹ Administração Regional de Saúde do Algarve, Algarve, Portugal.
²² Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
²³ Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden.
²⁴ Instituto de Ciências Sociais, Universidade de Lisboa, Lisbon, Portugal.
²⁵ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

PMID: 36530006
DOI: 10.1002/ijgo.14459

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

Céline Miani et al. Int J Gynaecol Obstet. 2022 Dec.

. 2022 Dec:159 Suppl 1:9-21.

doi: 10.1002/ijgo.14459.

Authors

Collaborators

IMAgiNE EURO study group:
Amira Ćerimagić, Daniela Drandić Roda, Magdalena Kurbanović, Rozée Virginie, Elise de La Rochebrochard, Kristina Löfgren, Céline Miani, Stephanie Batram-Zantvoort, Lisa Wandschneider, Marzia Lazzerini, Emanuelle Pessa Valente, Benedetta Covi, Ilaria Mariani, Sandra Morano, Ilana Chertok, Emek Hefer, Rada Artzi-Medvedik, Elizabete Pumpure, Dace Rezeberga, Gita Jansone-Šantare, Dārta Jakovicka, Anna Regīna Knoka, Katrīna Paula Vilcāne, Alina Liepinaitienė, Andželika Kondrakova, Marija Mizgaitienė, Simona Juciūtė, Maryse Arendt, Barbara Tasch, Ingvild Hersoug Nedberg, Sigrun Kongslien, Eline Skirnisdottir Vik, Barbara Baranowska, Urszula Tataj-Puzyna, Maria Węgrzynowska, Raquel Costa, Catarina Barata, Teresa Santos, Carina Rodrigues, Heloísa Dias, Marina Ruxandra Otelea, Jelena Radetić, Jovana Ružičić, Zalka Drglin, Barbara Mihevc Ponikvar, Anja Bohinec, Serena Brigidi, Lara Martín Castañeda, Helen Elden, Verena Sengpiel, Karolina Linden, Mehreen Zaigham, Claire De Labrusse, Alessia Abderhalden, Anouck Pfund, Harriet Thorn, Susanne Grylka, Michael Gemperle, Antonia Mueller

Affiliations

¹ Department of Epidemiology and International Public Health, School of Public Health, Bielefeld University, Bielefeld, Germany.
² Sexual and Reproductive Health and Rights Research Unit, Institut National d'Études Démographiques (INED), Aubervilliers, France.
³ WHO Collaborating Centre for Maternal and Child Health, Institute for Maternal and Child Health IRCCS "Burlo Garofolo", Trieste, Italy.
⁴ Institute of Health and Care Sciences, The Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
⁵ Department of Obstetrics and Gynecology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁶ Department of Health and Care Sciences, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway.
⁷ National Institute of Public Health, Ljubljana, Slovenia.
⁸ Riga Maternity Hospital, Riga, Latvia.
⁹ Department of Obstetrics and Gynecology, Riga Stradins University, Riga, Latvia.
¹⁰ Epidemiology Research Unit (EPIUnit), Institute of Public Health, University of Porto, Porto, Portugal.
¹¹ Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal.
¹² Lusófona University/HEI-Lab: Digital Human-Environment Interaction Labs, Lisbon, Portugal.
¹³ University of Medicine and Pharmacy Carol Davila, Bucharest, Romania.
¹⁴ SAMAS Association, Bucharest, Romania.
¹⁵ Roda - Parents in Action, Zagreb, Croatia.
¹⁶ Center for Moms, Belgrade, Serbia.
¹⁷ School of Health Sciences (HESAV), HES-SO University of Applied Sciences and Arts Western Switzerland, Lausanne, Switzerland.
¹⁸ NGO Baby Steps, Sarajevo, Bosnia and Herzegovina.
¹⁹ Beruffsverband vun de Laktatiounsberoderinnen zu Lëtzebuerg asbl (Professional association of the Lactation Consultants in Luxembourg), Luxembourg, Luxembourg.
²⁰ Faculty of Medicine, Riga Stradins University, Riga, Latvia.
²¹ Administração Regional de Saúde do Algarve, Algarve, Portugal.
²² Department of Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
²³ Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö and Lund, Sweden.
²⁴ Instituto de Ciências Sociais, Universidade de Lisboa, Lisbon, Portugal.
²⁵ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.

PMID: 36530006
DOI: 10.1002/ijgo.14459

Abstract

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.

Keywords: Europe; IMAgiNE EURO; birth; cesarean; episiotomy; gender equality; medicalization; midwifery; respectful maternity care.

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References

REFERENCES

1. World Health Organization. WHO Recommendations: Intrapartum Care for a Positive Childbirth Experience. WHO; 2018.
1. MacFarlane AJ, Blondel B, Mohangoo A, et al. Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study. BJOG. 2016;123:559-568.
1. Seijmonsbergen-Schermers AE, van den Akker T, Rydahl E, et al. Variations in use of childbirth interventions in 13 high-income countries: a multinational cross-sectional study. PLoS Med. 2020;17:e1003103.
1. OECD iLibrary. Health at a glance 2019: OECD indicators. Caesarean sections. Accessed July 1, 2021. https://www.oecd-ilibrary.org/sites/fa1f7281-en/index.html?itemId=/conte...
1. World Health Organization. WHO Statement on Caesarean Section Rates. WHO; 2015. Accessed July 1, 2021. http://apps.who.int/iris/bitstream/handle/10665/161442/WHO_RHR_15.02_eng...

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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

Collaborators

Affiliations

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

Authors

Collaborators

Affiliations

Abstract

References

REFERENCES

MeSH terms

LinkOut - more resources

Full Text Sources

Medical