Quality of care at childbirth during the COVID-19 pandemic in Belgium: a cross-sectional study based on WHO standards

Abstract

Objectives: To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time.

Design: A cross-sectional observational study.

Setting: Data of the Improving MAternal Newborn carE in the EURO region study in Belgium.

Participants: Women giving birth in a Belgian facility from 1 March 2020 to 1 May 2023 responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources and organisational changes related to COVID-19.

Primary and secondary outcome measures: Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann-Kendall test.

Results: 897 women were included in the analysis, 67% (n=601) with spontaneous vaginal birth, 13.3% (n=119) with instrumental vaginal birth (IVB) and 19.7% (n=177) with caesarean section. We found overall high QMNC scores (median index scores>75) but also specific gaps in all domains of QMNC. On provision of care, 21.0% (n=166) of women who experienced labour reported inadequate pain relief, 64.7% (n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1% (n=279) reported unclear communication, 32.9% (n=295) reported that they were not involved in choices,11.5% (n=104) stated not being treated with dignity and 8.1% (n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). Multivariable analyses showed significantly lower QMNC scores for women with an IVB (-20.4 in the 50th percentile with p<0.001 and 95% CI (-25.2 to -15.5)). Over time, there was a significant increase in QMNC Score for 'experience of care' and 'key organisational changes due to COVID-19' (trend test p< 0.05).

Conclusions and relevance: Our study showed several gaps in QMNC in Belgium, underlying causes of these gaps should be explored to design appropriate interventions and policies.

Trial registration number: NCT04847336.

Keywords: Maternal medicine; Midwifery; PUBLIC HEALTH; Quality in health care.

Figure 1. Flowchart of the study sample of women. IMAgiNE EURO, Improving MAternal Newborn carE in the EURO region.

Figure 2. Lineplot showing the experiences of care and reorganisational changes due to COVID-19 indexes by study trimester. Figure shows the median (full line) and IQR (dotted line); the p values are obtained with Mann‐Kendall test for monotonic trend (H0: no monotonic trend).