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. 2025 Dec;52(4):677-689.
doi: 10.1111/birt.12915. Epub 2025 Apr 4.

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

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. 2025 Dec.

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.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flow diagram. 1We used 45 key variables (40 key quality measures and five key sociodemographic questions). 2Independent variables are as follows: dignity, emotional support, involvement, abuse, and communication. Dependent variables are as follows: companion of choice, adequate assistance by a health professional, adequate number of health professionals, and immediate attention by a health professional.
See this image and copyright information in PMC

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