Quality of maternal and newborn care deteriorates during COVID-19 pandemic

Researchers from across Europe have identified deficiencies and inequalities in the care of mothers and newborns in Europe during the COVID-19 pandemic, according to a study published in The Lancet Regional Health – Europe.

“Actions to promote high-quality, evidence-based and respectful care during childbirth for all mothers are urgently needed,” Helen Elden, PhD, RNM, senior lecturer and associate professor of reproductive and perinatal health at the University of Gothenburg in Sweden, told Healio.

Helen Elden

“Since our study was based on women-reported experiences of health care, the results can be of immense importance to doctors. Doctors can use the results of our study to improve the provision and experience of health care provided to women during routine antenatal checkups and during birth,” said Elden, who also leads the university’s sexual, reproductive and perinatal health research group.

The researchers conducted their online cross-sectional survey of 21,027 women in 12 European countries between March 1, 2020, and June 30, 2021, including 18,063 respondents who had undergone labor.

Overall, the researchers said, 49.9% of the respondents who had undergone labor felt the pandemic had negatively affected maternal and newborn care. More specifically:

• 41.8% said they had difficulties in accessing antenatal care.
• 20.8% said they did not receive any pain relief method during labor.
• 42.8% of women with spontaneous vaginal birth could not choose their birth position.
• 20.1% of women with spontaneous vaginal birth received episiotomies.
• 53.6% of women who had instrumental vaginal births did not provide consent.
• 41.2% of women who had instrumental vaginal births received fundal pressure.
• 62% were not allowed to be accompanied by their companion of choice in the labor room.
• 30.3% said they did not experience clear communication from health workers.
• 34.7% said they did not feel involved in decision-making related to medical interventions.
• 21% said there was an insufficient number of health care professionals compared with the workload.
• 31.1% said they had difficulties in getting adequate help with breastfeeding.
• 23.9% felt they were not always treated with dignity.
• 12.5% said they suffered abuse.

Also, 34.4% reported that health care workers did not always use personal protective equipment, yet these deficiencies probably were due to the lack of such gear at the start of the pandemic, the researchers said, adding that the use of protective equipment improved from 2020 to 2021.

Women in Croatia, Romania and Serbia reported the lowest maternal and newborn standards of care, while women in France, Luxembourg, Spain, Sweden and Germany reported the highest standards. Italy, Norway, Portugal and Slovenia also were included in the survey.

Elden, who led the research for the Swedish part of the study, said “it was surprising to find large inequities in the quality of health care provided to mothers in different countries within Europe.

“Women with a migrant background and those who underwent cesarean delivery were also more likely to report a lower quality of health care,” she added.

The survey’s results are in line with research from before the pandemic showing inequities in maternal and newborn health care indicators, the researchers said, but they could not compare data from before and after the pandemic because comparable data are lacking for most countries.

Further studies, the researchers continued, should explore how much of these gaps in care could be attributed to the pandemic and if they will persist beyond it.

“We are planning to publish more data on the experiences reported by the women included in the study. Data collection is ongoing, which makes it possible to present data from women who gave birth after March 2021,” Elden said.

“There is also an ongoing survey that aims to look at how health care workers have experienced changes in the quality of maternal and neonatal care during the pandemic. We hope to publish these findings during 2022-2023,” she added.

Reference:

• Lazzerini M, et al. Lancet Reg Health Eur. 2022; doi:10.1016/j.lanepe.2021.100268.

For more information:

Helen Elden, PhD, RNM, can be reached at helen.elden@gu.se.