TY - JOUR
T1 - Individual and country-level variables associated with the medicalization of birth
T2 - Multilevel analyses of IMAgiNE EURO data from 15 countries in the WHO European region
AU - Miani, Céline
AU - Wandschneider, Lisa
AU - Batram-Zantvoort, Stephanie
AU - Covi, Benedetta
AU - Elden, Helen
AU - Nedberg, Ingvild Hersoug
AU - Drglin, Zalka
AU - Pumpure, Elizabete
AU - Costa, Raquel
AU - Rozée, Virginie
AU - Otelea, Marina Ruxandra
AU - Drandić, Daniela
AU - Radetic, Jelena
AU - Abderhalden-Zellweger, Alessia
AU - Ćerimagić, Amira
AU - Arendt, Maryse
AU - Mariani, Ilaria
AU - Linden, Karolina
AU - Ponikvar, Barbara Mihevc
AU - Jakovicka, Dārta
AU - Dias, Heloisa
AU - Ruzicic, Jovana
AU - de Labrusse, Claire
AU - Valente, Emanuelle Pessa
AU - Zaigham, Mehreen
AU - Bohinec, Anja
AU - Rezeberga, Dace
AU - Barata, Catarina
AU - Pfund, Anouk
AU - Sacks, Emma
AU - Lazzerini, Marzia
AU - Ćerimagić, Amira
AU - Drandić Roda, Daniela
AU - Kurbanović, Magdalena
AU - Virginie, Rozée
AU - de La Rochebrochard, Elise
AU - Löfgren, Kristina
AU - Miani, Céline
AU - Batram-Zantvoort, Stephanie
AU - Wandschneider, Lisa
AU - Lazzerini, Marzia
AU - Valente, Emanuelle Pessa
AU - Covi, Benedetta
AU - Mariani, Ilaria
AU - Morano, Sandra
AU - Chertok, Ilana
AU - Hefer, Emek
AU - Artzi-Medvedik, Rada
AU - Pumpure, Elizabete
AU - Rezeberga, Dace
N1 - Publisher Copyright: © 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
PY - 2022/12/1
Y1 - 2022/12/1
N2 - 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.
AB - 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.
KW - Europe
KW - IMAgiNE EURO
KW - birth
KW - cesarean
KW - episiotomy
KW - gender equality
KW - medicalization
KW - midwifery
KW - respectful maternity care
UR - http://www.scopus.com/inward/record.url?scp=85144447002&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ijgo.14459
DO - https://doi.org/10.1002/ijgo.14459
M3 - Article
C2 - 36530006
SN - 0020-7292
VL - 159
SP - 9
EP - 21
JO - International Journal of Gynecology and Obstetrics
JF - International Journal of Gynecology and Obstetrics
IS - S1
ER -