Advertisement

Large gaps in the quality of healthcare experienced by Swedish mothers during the COVID-19 pandemic: A cross-sectional study based on WHO standards

  • Mehreen Zaigham
    Correspondence
    Corresponding author at: Department of Obstetrics & Gynaecology, Lund University and Skåne University Hospital, 205 01 Malmö, Sweden.
    Affiliations
    Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden

    Department of Obstetrics & Gynaecology, Skåne University Hospital, Malmö, Sweden
    Search for articles by this author
  • Karolina Linden
    Affiliations
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
    Search for articles by this author
  • Verena Sengpiel
    Affiliations
    Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynaecology, Gothenburg, Sweden

    Department of Obstetrics and Gynaecology, Institute for Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden
    Search for articles by this author
  • Ilaria Mariani
    Affiliations
    Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” - WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
    Search for articles by this author
  • Emanuelle Pessa Valente
    Affiliations
    Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” - WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
    Search for articles by this author
  • Benedetta Covi
    Affiliations
    Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” - WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
    Search for articles by this author
  • Author Footnotes
    1 Contributed equally.
    Marzia Lazzerini
    Footnotes
    1 Contributed equally.
    Affiliations
    Institute for Maternal and Child Health - IRCCS “Burlo Garofolo” - WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy
    Search for articles by this author
  • Author Footnotes
    1 Contributed equally.
    Helen Elden
    Footnotes
    1 Contributed equally.
    Affiliations
    Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden

    Region Västra Götaland, Sahlgrenska University Hospital, Department of Obstetrics and Gynaecology, Gothenburg, Sweden
    Search for articles by this author
  • for the IMAgiNE EURO Study Group
  • Author Footnotes
    1 Contributed equally.
Open AccessPublished:January 23, 2022DOI:https://doi.org/10.1016/j.wombi.2022.01.007

      Abstract

      Background and Problem

      Existing healthcare systems have been put under immense pressure during the COVID-19 pandemic. Disruptions in essential maternal and newborn services have come from even high-income countries within the World Health Organization (WHO) European Region.

      Aim

      To describe the quality of care during pregnancy and childbirth, as reported by the women themselves, during the COVID-19 pandemic in Sweden, using the WHO ‘Standards for improving quality of maternal and newborn care in health facilities’.

      Methods

      Using an anonymous, online questionnaire, women ≥18 years were invited to participate if they had given birth in Sweden from March 1, 2020 to June 30, 2021. The quality of maternal and newborn care was measured using 40 questions across four domains: provision of care, experience of care, availability of human/physical resources, and organisational changes due to COVID-19.

      Findings

      Of the 5003 women included, n = 4528 experienced labour. Of these, 46.7% perceived a poorer quality of maternal and newborn care due to the COVID-19. Fundal pressure was applied in 22.2% of instrumental vaginal births, 36.8% received inadequate breastfeeding support and 6.9% reported some form of abuse. Findings were worse in women undergoing prelabour Caesarean section (CS) (n = 475). Multivariate analysis showed significant associations of the quality of maternal and newborn care to year of birth (P < 0.001), parity (P < 0.001), no pharmacological pain relief (P < 0.001), prelabour CS (P < 0.001), emergency CS (P < 0.001) and overall satisfaction (P < 0.001).

      Conclusion

      Considerable gaps over many key quality measures and deviations from women-centred care were noted. Findings were worse in women with prelabour CS. Actions to promote high-quality, evidence-based and respectful care during childbirth for all mothers are urgently needed.

      Abbreviations:

      CS (Caesarean section), COVID-19 (Coronavirus disease 2019), IMAgINE-Euro (Improving Maternal Newborn Care in Europe), QMNC (Quality of maternal and newborn care), WHO (World Health Organization)

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Blomquist J.L.
        • Quiroz L.H.
        • Macmillan D.
        • McCullough A.
        • Handa V.L.
        Mothers’ satisfaction with planned vaginal and planned cesarean birth.
        Am. J. Perinatol. 2011; 28: 383-388
        • Salmon P.
        • Drew N.C.
        Multidimensional assessment of women’s experience of child- birth: relationship to obstetric procedure, antenatal preparation and obstetric history.
        J. Psychosom. Res. 1992; 36: 317-327
        • Smarandache A.
        • Kim T.H.
        • Bohr Y.
        • Tamim H.
        Predictors of a negative labor and birth experience based on a national survey of Canadian women.
        BMC Pregnancy Childbirth. 2016; 16: 114
        • Christiaens W.
        • Bracke P.
        Assessment of social psychological determinants of satisfaction with childbirth in a cross-national perspective.
        BMC Pregnancy Childbirth. 2007; 7: 26
        • The Lancet Global Health
        Enhancing, and protecting, maternal and neonatal health care.
        Lancet Glob. Health. 2018; 9: e1
        • Vazquez-Vazquez A.
        • Dib S.
        • Rougeaux E.
        • Wells J.C.
        • Fewtrell M.S.
        The impact of the Covid-19 lockdown on the experiences and feeding practices of new mothers in the UK: preliminary data from the COVID-19 New Mum Study.
        Appetite. 2021; 156104985
        • Ceulemans M.
        • Verbakel J.Y.
        • Van Calsteren K.
        • Eerdekens A.
        • Allegaert K.
        • Foulon V.
        SARS-CoV-2 infections and impact of the COVID-19 pandemic in pregnancy and breastfeeding: results from an observational study in primary care in Belgium.
        Int. J. Environ. Res. Public Health. 2020; 17: 6766
        • Karavadra B.
        • Stockl A.
        • Prosser-Snelling E.
        • Simpson P.
        • Morris E.
        Women’s perceptions of COVID-19 and their healthcare experiences: a qualitative thematic analysis of a national survey of pregnant women in the United Kingdom.
        BMC Pregnancy Childbirth. 2020; 20: 600
        • Ravaldi C.
        • Wilson A.
        • Ricca V.
        • Homer C.
        • Vannacci A.
        Pregnant women voice their concerns and birth expectations during the COVID-19 pandemic in Italy.
        Women Birth. 2020; (S1871-5192(20)30280-30288)
        • Chmielewska B.
        • Barratt I.
        • Townsend R.
        • Kalafat E.
        • van der Meulen J.
        • Gurol-Urganci I.
        • et al.
        Effects of the COVID-19 pandemic on maternal and perinatal outcomes: a systematic review and meta-analysis.
        Lancet Glob. Health. 2021; (S2214-109X(21)00079-6)
      1. Trends in maternal mortality. 1990–2015: estimates by WHO, UNICEF, UNFPA, World Bank Group, and the United Nation Population Division. Geneva: World Health Organization, rg2015.

        • Högberg U.
        Maternal deaths in Sweden, 1971–1980.
        Acta Obstet. Gynecol. Scand. 1986; 65: 161-167
      2. Mödrahälsovård, Sexuell och Reproduktiv Hälsa – SFOG. Available at: https://www.sfog.se/natupplaga/ARG76web4a328b70-0d76-474e-840e-31f70a89eae9.pdf [Accessed 10 Aug 2021].

        • Stephansson O.
        • Petersson K.
        • Björk C.
        • Conner P.
        • Wikström A.K.
        The Swedish Pregnancy Register - for quality of care improvement and research.
        Acta Obstet. Gynecol. Scand. 2018; 97: 466-476
        • World Health Organization
        Beyond the Numbers: Reviewing Maternal Deaths and Complications to Make Pregnancy Safer.
        World Health organization, Geneva2004 (Available: http://whqlibdoc.who.int/publications/2004/9241591838.pdf?ua=1 [Accessed 10 Aug 2021])
      3. World Health Organization. Global strategy for women’s, children’s and adolescent’s health 2016-2030. Available: http://www.who.int/life-course/partners/global-strategy/global-strategy-2016-2030/en/ [Accessed 10 Aug 2021].

        • Tunçalp Ӧ.
        • Were W.M.
        • MacLennan C.
        • et al.
        Quality of care for pregnant women and newborns-the WHO vision.
        BJOG. 2015; 122: 1045-1049
        • World Health Organization
        Standards for Improving Quality of Maternal and Newborn Care in Health Facilities.
        World Health organization, Geneva2016 (Available: https://www.who.int/maternal_child_adolescent/documents/improving-maternal-newborn-care-quality/en [Accessed 10 Aug 2021])
        • World Health Organization
        The Prevention and Elimination of Disrespect and Abuse During Facility-Based Childbirth.
        World Health organization, Geneva2014 (Available: http://www.who.int/reproductivehealth/topics/maternal_perinatal/statement-childbirth/en/ [Accessed 10 Aug 2021])
        • Oladapo O.T.
        • Tunçalp Ö.
        • Bonet M.
        • et al.
        WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing.
        BJOG. 2018; 125: 918-922
        • Lazzerini M.
        • Covi B.
        • Mariani I.
        • Drglin Z.
        • Arendt M.
        • Nedberg I.H.
        • et al.
        IMAgiNE EURO study group. Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic: online survey investigating maternal perspectives in 12 countries of the WHO European Region.
        Lancet Reg. Health Eur. 2022; 13100268https://doi.org/10.1016/j.lanepe.2021.100268
        • Norman M.
        • Navér L.
        • Söderling J.
        • Ahlberg M.
        • Hervius-Askling H.
        • Aronsson B.
        • et al.
        Association of maternal SARS-CoV-2 infection in pregnancy with neonatal outcomes.
        JAMA. 2021; 325: 2076-2086
        • Villar J.
        • Ariff S.
        • Gunier R.B.
        • et al.
        Maternal and neonatal morbidity and mortality among pregnant women with and without COVID-19 infection: the INTERCOVID Multinational Cohort Study.
        JAMA Pediatr. 2021; 175: 817-826
        • Zaigham M.
        • Andersson O.
        Maternal and perinatal outcomes with COVID-19: a systematic review of 108 pregnancies.
        Acta Obstet. Gynecol. Scand. 2020; 99: 823-829
        • Naurin E.
        • Markstedt E.
        • Stolle D.
        • Enström D.
        • Wallin A.
        • Andreasson I.
        • et al.
        Pregnant under the pressure of a pandemic: a large-scale longitudinal survey before and during the COVID-19 outbreak.
        Eur. J. Public Health. 2021; 31: 7-13
      4. IMAgiNE EURO Improving Maternal Newborn Care in the European Region. Available at: https://www.burlo.trieste.it/ricerca/imagine-euro-improving-maternal-newborn-care-euro-region (Accessed 10 Aug, 2021).

        • von Elm E.
        • Altman D.G.
        • Egger M.
        • et al.
        The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies.
        Lancet. 2007; 370: 1453-1457
        • World Health Organization Regional office for Europe
        Assessments of Sexual, Reproductive, Maternal, Newborn, Child and Adolescent Health in the Context of Universal Health Coverage in Six Countries in the WHO European Region. A Synthesis of Findings From the Country Reports.
        World Health Organization, 2020
      5. National Institute of Health and Care Excellence (NICE). Intrapartum care for healthy women and babies. (NICE clinical guideline 190). Published: 01/12/2014. Available at https://www.nice.org.uk/guidance/cg190/resources/intrapartum-care-for-healthy-women-and-babies-pdf-35109866447557 (Accessed 10 Aug 2021).

        • Lazzerini M.
        • Mariani I.
        • Semenzato C.
        • Valente E.P.
        Association between maternal satisfaction and other indicators of quality of care at childbirth: a cross-sectional study based on the WHO standards.
        BMJ Open. 2020; 10e037063
        • Lazzerini M.
        • Semenzato C.
        • Kaur J.
        • Covi B.
        • Argentini G.
        Women’s suggestions on how to improve the quality of maternal and newborn hospital care: a qualitative study in Italy using the WHO standards as framework for the analysis.
        BMC Pregnancy Childbirth. 2020; 20: 200
        • Wild D.
        • Grove A.
        • Martin M.
        • et al.
        Principles of good practice for the translation and cultural adaptation process for patient-reported outcomes (PRO) measures: report of the ISPOR Task Force for Translation and Cultural Adaptation.
        Value Health. 2005; 8: 94-104
        • Afulani P.A.
        • Phillips B.
        • Aborigo R.A.
        • Moyer C.A.
        Person-centred maternity care in low-income and middle-income countries: analysis of data from Kenya, Ghana, and India.
        Lancet Glob. Health. 2019; 7: e96-e109
        • Ronnje L.
        • Lansberg J.K.
        • Vikhareva O.
        • Hansson S.R.
        • Herbst A.
        • Zaigham M.
        Complicated COVID-19 in pregnancy: a case report with severe liver and coagulation dysfunction promptly improved by delivery.
        BMC Pregnancy Childbirth. 2020; 20: 511
        • Kolkova Z.
        • Bjurstrom M.F.
        • Lansberg J.K.
        • Svedas E.
        • Hamer M.A.
        • Hansson S.R.
        • et al.
        Obstetric and intensive-care strategies in a high-risk pregnancy with critical respiratory failure due to COVID-19: a case report.
        Case Rep. Womens Health. 2020; 27e00240
        • Zaigham M.
        • Holmberg A.
        • Karlberg M.L.
        • Lindsjö O.K.
        • Jokubkiene L.
        • Sandblom J.
        • et al.
        Intrauterine vertical SARS-CoV-2 infection: a case confirming transplacental transmission followed by divergence of the viral genome.
        BJOG. 2021; 128: 1388-1394
        • Claeson M.
        • Hanson S.
        COVID-19 and the Swedish enigma.
        Lancet. 2021; 397: 259-261
        • Linden K.
        • Domgren N.
        • Zaigham M.
        • Sengpiel V.
        • Andersson M.E.
        • Wessberg A.
        Being in the shadow of the unknown - Swedish women’s lived experiences of pregnancy during the COVID-19 pandemic, a phenomenological study.
        Women Birth. 2021; (S1871-5192(21)00159-1)
        • Ribeiro S.
        Emergency efforts are needed otherwise Covid healthcare can be stopped (Article in Swedish).
        Dagens Nyheter [Internet]. 2020; (Mar 20 [cited 10 Aug 2021]. Available from:)
        • Ludvigsson J.F.
        The first eight months of Sweden’s COVID‐19 strategy and the key actions and actors that were involved.
        Acta Paediatr. 2020; 109: 2459-2471
      6. WHO recommendations Intrapartum care for a positive childbirth experience. Available at: https://apps.who.int/iris/bitstream/handle/10665/272447/WHO-RHR-18.12-eng.pdf (Accessed 10 Aug 2021).

      7. Hansson M. A meaningful work in a strained context - exploring midwives’ work situation and professional role. Doctoral thesis. Sahlgrenska Academy, University of Gothenburg. 9-nov-2021. ISBN 978-91-8009-462-7 (PRINT), 978-91-8009-463-4 (PDF). URI: http://hdl.handle.net/2077/69310.

        • Asefa A.
        • Semaan A.
        • Delvaux T.
        • Huysmans E.
        • Galle A.
        • Sacks E.
        • et al.
        The impact of COVID-19 on the provision of respectful maternity care: findings from a global survey of health workers.
        Women Birth. 2021; (S1871-5192(21)00154-2)
        • Sweet L.
        • Wilson A.N.
        • Bradfield Z.
        • Hauck Y.
        • Kuliukas L.
        • Homer C.S.E.
        • et al.
        Childbearing women’s experiences of the maternity care system in Australia during the first wave of the COVID-19 pandemic.
        Women Birth. 2021; (S1871-5192(21)00158-X)
        • Reingold R.B.
        • Barbosa I.
        • Mishori R.
        Respectful maternity care in the context of COVID-19: a human rights perspective.
        Int. J. Gynaecol. Obstet. 2020; 151: 319-321
        • Miller S.
        • Abalos E.
        • Chamillard M.
        • Ciapponi A.
        • Colaci D.
        • Comandé D.
        • et al.
        Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide.
        Lancet. 2016; 388: 2176-2192
        • Nystedt A.
        • Hildingsson I.
        Women’s and men’s negative experience of child birth–a cross-sectional survey.
        Women Birth. 2018; 31: 103-109
        • Rishard M.
        • Fahmy F.F.
        • Senanayake H.
        • Ranaweera A.K.P.
        • Armocida B.
        • Mariani I.
        • Lazzerini M.
        Correlation among experience of person-centered maternity care, provision of care and women’s satisfaction: cross sectional study in Colombo, Sri Lanka.
        PLoS One. 2021; 16e0249265
        • Bohren M.A.
        • Vogel J.P.
        • Hunter E.C.
        • Lutsiv O.
        • Makh S.K.
        • Souza J.P.
        • Aguiar C.
        • Saraiva Coneglian F.
        • Diniz A.L.
        • Tuncalp O.
        • et al.
        The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review.
        PLoS Med. 2015; 12e1001847