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; Karolina Linden; Verena Sengpiel; Ilaria Mariani; Emanuelle Pessa Valente; Benedetta Covi; Marzia Lazzerini; Helen Elden; IMAgiNE EURO Study Group

doi:10.1016/j.wombi.2022.01.007

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

Women Birth. 2022 Nov;35(6):619-627. doi: 10.1016/j.wombi.2022.01.007. Epub 2022 Jan 24.

Authors

Mehreen Zaigham¹, Karolina Linden², Verena Sengpiel³, Ilaria Mariani⁴, Emanuelle Pessa Valente⁴, Benedetta Covi⁴, Marzia Lazzerini⁴, Helen Elden⁵; IMAgiNE EURO Study Group

Affiliations

¹ 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. Electronic address: mehreen.zaigham@med.lu.se.
² Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
³ 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.
⁴ Institute for Maternal and Child Health - IRCCS "Burlo Garofolo" - WHO Collaborating Centre for Maternal and Child Health, Trieste, Italy.
⁵ 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.

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.

Keywords: COVID-19; Childbirth; Cross-sectional study; Maternal; Newborn; Quality of care; Respectful maternity care; Sweden; WHO.

MeSH terms

COVID-19* / epidemiology
Cesarean Section
Cross-Sectional Studies
Delivery of Health Care
Female
Health Facilities
Humans
Infant, Newborn
Maternal Health Services*
Pandemics
Pregnancy
Sweden / epidemiology
World Health Organization