The current COVID-19 pandemic put a burden on healthcare services around the globe and impacted many areas of care delivery, including maternity services. Prioritizing ringfenced community care to keep women away from hospitals may be the best strategic response to ensure pregnant and laboring women receive optimal care. By analyzing the structure of maternity services in Poland and their response to the current crisis, we show that while the available model allows to provide large share of prenatal services outside hospital settings, it allows no alternative to hospital births. In addition, medicalization, inequalities in access and fragmentation of care hinder services' ability to respond in a way it ensures best possible care.
Objective
To compare women's perspectives on the quality of maternal and newborn care (QMNC) around the time of childbirth across Nomenclature of Territorial Units for Statistics 2 (NUTS‐II) regions in Portugal during the COVID‐19 pandemic.
Methods
Women participating in the cross‐sectional IMAgiNE EURO study who gave birth in Portugal from March 1, 2020, to October 28, 2021, completed a structured questionnaire with 40 key WHO standards‐based quality measures. Four domains of QMNC were assessed: (1) provision of care; (2) experience of care; (3) availability of human and physical resources; and (4) reorganizational changes due to the COVID‐19 pandemic. Frequencies for each quality measure within each QMNC domain were computed overall and by region.
Results
Out of 1845 participants, one‐third (33.7%) had a cesarean. Examples of high‐quality care included: low frequencies of lack of early breastfeeding and rooming‐in (8.0% and 7.7%, respectively) and informal payment (0.7%); adequate staff professionalism (94.6%); adequate room comfort and equipment (95.2%). However, substandard practices with large heterogeneity across regions were also reported. Among women who experienced labor, the percentage of instrumental vaginal births ranged from 22.3% in the Algarve to 33.5% in Center; among these, fundal pressure ranged from 34.8% in Lisbon to 66.7% in Center. Episiotomy was performed in 39.3% of noninstrumental vaginal births with variations between 31.8% in the North to 59.8% in Center. One in four women reported inadequate breastfeeding support (26.1%, ranging from 19.4% in Algarve to 31.5% in Lisbon). One in five reported no exclusive breastfeeding at discharge (22.1%; 19.5% in Lisbon to 28.2% in Algarve).
Conclusion
Urgent actions are needed to harmonize QMNC and reduce inequities across regions in Portugal.
Objective
To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID‐19 pandemic in Switzerland.
Methods
Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards‐based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables.
Results
A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n = 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 487, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French‐ and Italian‐speaking regions compared with the German‐speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth.
Conclusion
Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.
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