Individual and country-level variables associated with the medicalization of birth: Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region

• Main Author: Miani, C
• Publication Date: 2022
• Other Authors: Wandschneider, L, Batram-Zantvoort, S, Covi, B, Elden, H, Nedberg, IH, Drglin, Z, Pumpure, E, Costa, R, Rozée, V, Otelea, M, Drandić, D, Radetic, J, Abderhalden-Zellweger, A, Ćerimagić, A, Arendt, M, Mariani, I, Linden, K, Ponikvar, BM, Jakovicka, D, Dias, H, Ruzicic, J, de Labrusse, C, Valente, EP, Zaigham, M, Bohinec, A, Rezeberga, D, Barata, C, Pfund, A, Sacks, E, Lazzerini, M
• Format: Article
• Language: eng
• Source: Repositórios Científicos de Acesso Aberto de Portugal (RCAAP)
• Download full: https://hdl.handle.net/10216/151622
• topic: birth; cesarean; episiotomy; Europe; gender equality; IMAgiNE EURO; medicalization; midwifery; respectful maternity care

Objective: To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. Methods: Online anonymous survey of women who gave birth in 2020–2021. Multivariable multilevel logistic regression models estimating associations between indicators of medicalization (cesarean, instrumental vaginal birth [IVB], episiotomy, fundal pressure) and proxy variables related to care culture and contextual factors at the individual and country level. Results: Among 27 173 women, 24.4% (n = 6650) had a cesarean and 8.8% (n = 2380) an IVB. Among women with IVB, 41.9% (n = 998) reported receiving fundal pressure. Among women with spontaneous vaginal births, 22.3% (n = 4048) had an episiotomy. Less respectful care, as perceived by the women, was associated with higher levels of medicalization. For example, women who reported having a cesarean, IVB, or episiotomy reported not feeling treated with dignity more frequently than women who did not have those interventions (odds ratio [OR] 1.37; OR 1.61; OR 1.51, respectively; all: P < 0.001). Country-level variables contributed to explaining some of the variance between countries. Conclusion: We recommend a greater emphasis in health policies on promotion of respectful and patient-centered care approaches to birth to enhance women's experiences of care, and the development of a European-level indicator to monitor medicalization of reproductive care. © 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.