Journal
INTERNATIONAL JOURNAL OF GYNECOLOGY & OBSTETRICS
Volume 159, Issue -, Pages 9-21Publisher
WILEY
DOI: 10.1002/ijgo.14459
Keywords
birth; cesarean; episiotomy; Europe; gender equality; IMAgiNE EURO; medicalization; midwifery; respectful maternity care
Categories
Funding
- IMAgiNE EURO project
- Ministry of Health, Rome - Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste - Italy
- Bielefeld University through the Gender Epidemiology Junior Research Group
- Projekt DEAL
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This study investigates the potential associations between individual and country-level factors and the medicalization of birth in 15 European countries during the COVID-19 pandemic. The results reveal that less respectful care is associated with higher levels of medicalization. The study recommends a greater emphasis on promoting respectful and patient-centered care approaches to enhance women's experiences of care.
ObjectiveTo investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic. MethodsOnline 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. ResultsAmong 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. ConclusionWe 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.
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