Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Apr 4.
doi: 10.1111/birt.12915. Online ahead of print.

The Association Between Women's Perception of Birth During the Pandemic, Companion of Choice and Support From Health Professionals: A Cross-Sectional Study in 20 Countries in the WHO European Region

Stephanie Batram-Zantvoort  1 , Céline Miani  1   2 , Ilaria Mariani  3 , Emanuelle Pessa Valente  3 , Mehreen Zaigham  4   5 , Ingvild Hersoug Nedberg  6 , Magdalena Kurbanović  7 , Elizabete Pumpure  8   9 , Anja Bohinec  10 , Antigone Sarantaki  11 , Barbara Baranowska  12 , Alessia Abderhalden-Zellweger  13 , Elise de La Rochebrochard  2 , Raquel Costa  14   15   16 , Marina Ruxandra Otelea  17 , Alina Liepinaitienė  18   19 , Jelena Radetic  20 , Amira Ćerimagić  21 , Maryse Arendt  22 , Martina König-Bachmann  23 , Stefano Delle Vedove  3 , Karolina Linden  24 , Sigrun Kongslien  6 , Daniela Drandić  25 , Darta Kreslina  8 , Zalka Drglin  10 , Dimitra Metallinou  11 , Urszula Tataj-Puzyna  12 , Michael Gemperle  26 , Virginie Rozée  2   27 , Heloísa Dias  28 , Marija Mizgaitienė  29 , Jovana Ruzicic  20 , Imola Simon  30 , Simona Fumagalli  31 , Helen Elden  24 , Eline Skirnisdottir Vik  32 , Barbara Mihevc Ponikvar  10 , Aikaterini Lykeridou  11 , Beata Szlendak  12 , Claire de Labrusse  13 , Tiago Miguel Pinto  16 , Simona Jazdauskienė  33 , Christoph Zenzmaier  23 , Ilana Chertok  34 , Emma Sacks  35 , Marzia Lazzerini  3   36 ; IMAgiNE EURO Study group
Collaborators, Affiliations
Free article

The Association Between Women's Perception of Birth During the Pandemic, Companion of Choice and Support From Health Professionals: A Cross-Sectional Study in 20 Countries in the WHO European Region

Stephanie Batram-Zantvoort et al. Birth. .
Free article

Abstract

Background: Mitigation measures implemented in response to the COVID-19 pandemic led to significant changes in maternity care across Europe, including restrictions on companions during labor and birth. This cross-sectional study explores the association between the presence of a companion of choice and a positive perception of the birth experience. Additionally, it explores the association between health professionals' attention, assistance, and availability during labor and birth and a positive perception of birth.

Methods: We utilized a structured, validated online questionnaire, available in 25 languages, to assess the quality of maternal care during the COVID-19 pandemic from women's perspectives. We conducted logistic regression to explore associations between variables related to the presence of a companion of choice, health professionals' attention, assistance, and availability, and positive perceptions of birth, when controlled for confounders, including birth mode and medical interventions.

Results: Responses from 48,039 women across 20 countries in the WHO European Region were included. Always having a companion of choice during birth (aOR: 2.11) and always receiving adequate care from health professionals (assistance aOR: 2.12, attention aOR: 36.64, availability aOR: 2.12) were associated with positive birth perception. Instrumental births (aOR: 0.76), episiotomies (aOR: 0.74), fundal pressure (aOR: 0.52), and cesarean births (planned aOR: 0.80, unplanned prelabor aOR: 0.60, unplanned in-labor aOR: 0.52) were associated with less positive birth perceptions.

Discussion: This study highlights the critical role of having a chosen companion and receiving adequate attention, assistance, and availability from health professionals in promoting positive birth perceptions, even in times of crisis such as the COVID-19 pandemic. Ensuring the presence of a companion of choice and comprehensive professional support is crucial for delivering high-quality, respectful maternity care.

Keywords: COVID‐19; WHO standards; companion of choice; disrespect and abuse; maternal experiences; positive birth perception; respectful maternity care.

PubMed Disclaimer

References

    1. K. Coxon, C. F. Turienzo, L. Kweekel, et al., “The Impact of the Coronavirus (COVID‐19) Pandemic on Maternity Care in Europe,” Midwifery 88 (2020): 102779.
    1. T. S. Eri, E. Blix, S. Downe, C. Vedeler, and A. B. V. Nilsen, “Giving Birth and Becoming a Parent During the COVID‐19 Pandemic: A Qualitative Analysis of 806 Women's Responses to Three Open‐Ended Questions in an Online Survey,” Midwifery 109 (2022): 103321.
    1. World Health Organization, Companion of Choice During Labour and Childbirth for Improved Quality of Care (World Health Organization, 2020).
    1. White Ribbon Alliance, Respectful Maternity Care (Universal Rights of Childbearing women, 2011).
    1. D. Drandić, K. Hartmann, C. Barata, and R. Torguet, “Parent Organizations' Experiences of the Pandemic Response in Maternity Care in Thirteen European Countries,” European Journal of Midwifery 6, no. December (2022): 1–10.