Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the IMAgiNE EURO study in 16 countries

Abstract

Objective To explore the quality of maternal and newborn care (QMNC) during the COVID‐19 pandemic by facility type among 16 European countries, comparing rates of instrumental vaginal birth and cesarean. Methods Women who gave birth in the WHO European Region from March 1, 2020, to February 7, 2022, answered a validated online questionnaire. Rates of instrumental birth, instrumental vaginal birth, and cesarean, and a QMNC index were calculated for births in public versus private facilities. Results Responses from 25 206 participants were analyzed. Women giving birth in private compared with public facilities reported significantly more frequent total cesarean (32.5% vs 19.0%; aOR 1.70; 95% CI 1.52–1.90), elective cesarean (17.3% vs 7.8%; aOR 1.90; 95% CI 1.65–2.19), and emergency cesarean before labor (7.4% vs 3.9%; aOR 1.39; 95% CI 1.14–1.70) (P < 0.001 for all comparisons), with analyses by country confirming these results. QMNC index results were heterogeneous across countries and regions in the same country and were largely affected by geographical distribution of regions rather than by type of facility alone. Conclusion The study confirms that births in private facilities have higher odds of cesarean. It also suggests that QMNC should be closely monitored in all facilities to achieve high‐quality care, independent of facility type or geographical distribution. ClinicalTrials.gov Identifier NCT04847336

Womenʼs assessment of the quality of hospital‐based perinatal care by mode of birth in Romania during the COVID‐19 pandemic: Results from the IMAgiNE EURO study

“…Third, most births by elective cesarean occurred in private facilities and previous research highlighted that women who delivered in private facilities perceived better care than those delivering in public facilities 9,23 ; however, is uncertain whether this reflects objective quality or rather a subjective judgment. 9 Finally, some key indicators in the experience of care domain, such as the lack of involvement in choices and the lack of privacy (both reported as more frequent in mothers with SVB compared with elective cesarean), may have affected the perception of other indicators.…”

Quality of maternal and newborn care in Switzerland during the COVID‐19 pandemic: A cross‐sectional study based on WHO quality standards

“… 41 This seems to be a possible explanation for the higher QMNC scores for women giving birth in private facilities. Additionally, women giving birth in private facilities differ from those giving birth in public facilities, usually higher social status and fewer comorbidities, 42 and this may also explain a higher QMNC. In our questionnaire we did not have details on women's comorbidities and complications, thus we lacked information to better compare groups.…”

Perspectives of professionals and human rights associations on the IMAgiNE EURO study

“…The IMAgiNE EURO surveys show high levels of medicalization throughout Europe, especially cesarean, instrumental births, and application of fundal pressure 1–10 . This is also coupled with lack of informed consent, lack of support for initiation and continuation of breastfeeding, and lack of respect and dignity for birthing women.…”

“…However, no country, no health system, nor the World Health Organization, to say nothing of our hospitals, was prepared for what 2020–2022 brought us. The articles in this Supplement 1–10 . chronicle the risk of pregnancy during COVID‐19, particularly the vulnerability of women giving birth during a pandemic.…”

“…With the increase in medicalization, including cesarean and instrumental vaginal birth (IVB), women reported feeling that they were treated with less dignity and respect 1 . Results also show that women cannot buy high‐quality respectful care, with the high incidence of cesarean or IVB in private facilities indicating potential violation of human rights if the intervention was unnecessary and carried out for convenience or to save time 3 …”