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Observational Study
. 2022 Dec;159 Suppl 1(Suppl 1):22-38.
doi: 10.1002/ijgo.14458.

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

Marzia Lazzerini  1 , Emanuelle Pessa Valente  1 , Benedetta Covi  1 , Virginie Rozée  2 , Raquel Costa  3   4   5 , Marina Ruxandra Otelea  6   7 , Alessia Abderhalden-Zellweger  8 , Maria Węgrzynowska  9 , Karolina Linden  10 , Maryse Arendt  11 , Serena Brigidi  12 , Céline Miani  13 , Elizabete Pumpure  14   15 , Jelena Radetic  16 , Daniela Drandic  17 , Amira Cerimagic  18 , Ingvild Hersoug Nedberg  19 , Alina Liepinaitienė  20 , Carina Rodrigues  3   4 , Claire de Labrusse  8 , Barbara Baranowska  9 , Mehreen Zaigham  21 , Lara Martín Castañeda  22 , Stephanie Batram-Zantvoort  13 , Dārta Jakovicka  23 , Jovana Ruzicic  16 , Simona Juciūtė  20 , Teresa Santos  24   25 , Michael Gemperle  26 , Urszula Tataj-Puzyna  9 , Helen Elden  10   27 , Marija Mizgaitienė  28 , Ornella Lincetto  29 , Emma Sacks  30 , Ilaria Mariani  1 ; IMAgiNE EURO study group
Affiliations
Observational Study

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

Marzia Lazzerini et al. Int J Gynaecol Obstet. 2022 Dec.

Abstract

Objective: To explore the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic by facility type among 16 European countries, comparing rates of instrumental vaginal birth and cesarean.

Methods: Women who gave birth in the WHO European Region from March 1, 2020, to February 7, 2022, answered a validated online questionnaire. Rates of instrumental birth, instrumental vaginal birth, and cesarean, and a QMNC index were calculated for births in public versus private facilities.

Results: Responses from 25 206 participants were analyzed. Women giving birth in private compared with public facilities reported significantly more frequent total cesarean (32.5% vs 19.0%; aOR 1.70; 95% CI 1.52-1.90), elective cesarean (17.3% vs 7.8%; aOR 1.90; 95% CI 1.65-2.19), and emergency cesarean before labor (7.4% vs 3.9%; aOR 1.39; 95% CI 1.14-1.70) (P < 0.001 for all comparisons), with analyses by country confirming these results. QMNC index results were heterogeneous across countries and regions in the same country and were largely affected by geographical distribution of regions rather than by type of facility alone.

Conclusion: The study confirms that births in private facilities have higher odds of cesarean. It also suggests that QMNC should be closely monitored in all facilities to achieve high-quality care, independent of facility type or geographical distribution.

Gov identifier: NCT04847336.

Keywords: COVID-19; IMAgiNE EURO; WHO standards; maternal; newborn; private; public; quality of care; respectful maternity care.

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Conflict of interest statement

RC was supported by the Social European Fund and Foundation for Science and Technology under a Post‐Doctoral Grant (SFRH/BPD/117597/2016). EPIUnit (UIDB/04750/2020), ITR (LA/P/0064/2020), and HEI‐LAB (UIDB/05380/2020) are financed by the Portuguese Ministry of Science, Technology and Higher Education. Other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Study flow diagram. aMissing information on the 40 WHO standards‐based quality measures and key sociodemographic variables.
Figure 2
Figure 2
Quality of maternal and newborn care (QMNC) indexes in private versus public facilities, whole sample.
Figure 3
Figure 3
Quality of maternal and newborn care (QMNC) indexes by domain in private versus public facilities, country‐specific.
See this image and copyright information in PMC

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