Regional differences in the quality of maternal and neonatal care during the COVID-19 pandemic in Portugal: Results from the IMAgiNE EURO study

• Main Author: Costa, R
• Publication Date: 2022
• Other Authors: Barata, C, Dias, H, Rodrigues, C, Santos, T, Mariani, I, Covi, B, Valente, EP, Lazzerini, M, Ćerimagić, A, Drandić, D, Kurbanović, M, Virginie, R, de La Rochebrochard, E, Löfgren, K, Miani, C, Batram-Zantvoort, S, Wandschneider, L, Morano, S, Chertok, I, Hefer, E, Artzi-Medvedik, R, Pumpure, E, Rezeberga, D, Jansone-Šantare, G, Jakovicka, D, Knoka, AR, Vilcāne, KP, Liepinaitienė, A, Kondrakova, A, Mizgaitienė, M, Juciūtė, S, Arendt, M, Tasch, B, Nedberg, IH, Kongslien, S, Vik, ES, Baranowska, B, Tataj-Puzyna, U, Węgrzynowska, M, Otelea, MR, Radetić, J, Ružičić, J, Drglin, Z, Ponikvar, BM, Bohinec, A, Brigidi, S, Castañeda, LM, Elden, H, Sengpiel, V, Linden, K, Zaigham, M, De Labrusse, C, Abderhalden, A, Pfund, A, Thorn, H, Grylka, S, Gemperle, M, Mueller, A
• Format: Article
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: https://hdl.handle.net/10216/151564
• topic: childbirth; COVID-19; IMAgiNE EURO; maternal care; newborn care; Portugal; quality of care; respectful maternity 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. © 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.