The Association Between Women’s Perception of Birth During the Pandemic, Companion of Choice and Support From Health Professionals: A Cross-Sectional Study in 20 Countries in the WHO European Region.

Background

Mitigation measures implemented in response to the COVID-19 pandemic led to significant changes in maternity care across Europe, including restrictions on companions during labor and birth. This cross-sectional study explores the association between the presence of a companion of choice and a positive perception of the birth experience. Additionally, it explores the association between health professionals’ attention, assistance, and availability during labor and birth and a positive perception of birth.

Methods

We utilized a structured, validated online questionnaire, available in 25 languages, to assess the quality of maternal care during the COVID-19 pandemic from women’s perspectives. We conducted logistic regression to explore associations between variables related to the presence of a companion of choice, health professionals’ attention, assistance, and availability, and positive perceptions of birth, when controlled for confounders, including birth mode and medical interventions.

Results

Responses from 48,039 women across 20 countries in the WHO European Region were included. Always having a companion of choice during birth (aOR: 2.11) and always receiving adequate care from health professionals (assistance aOR: 2.12, attention aOR: 36.64, availability aOR: 2.12) were associated with positive birth perception. Instrumental births (aOR: 0.76), episiotomies (aOR: 0.74), fundal pressure (aOR: 0.52), and cesarean births (planned aOR: 0.80, unplanned prelabor aOR: 0.60, unplanned in-labor aOR: 0.52) were associated with less positive birth perceptions.

Discussion

This study highlights the critical role of having a chosen companion and receiving adequate attention, assistance, and availability from health professionals in promoting positive birth perceptions, even in times of crisis such as the COVID-19 pandemic. Ensuring the presence of a companion of choice and comprehensive professional support is crucial for delivering high-quality, respectful maternity care.

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Overview publication

Title	The Association Between Women’s Perception of Birth During the Pandemic, Companion of Choice and Support From Health Professionals: A Cross-Sectional Study in 20 Countries in the WHO European Region.
Date	April 4th, 2025
Issue name	Birth (Berkeley, Calif.)
Issue number	pubmed:40183500
DOI	10.1111/birt.12915
PubMed	40183500
Authors	Batram-Zantvoort S, Miani C, Mariani I, Valente EP, Zaigham M, Nedberg IH, Kurbanović M, Pumpure E, Bohinec A, Sarantaki A, Baranowska B, Abderhalden-Zellweger A, de La Rochebrochard E, Costa R, Otelea MR, Liepinaitienė A, Radetic J, Ćerimagić A, Arendt M, König-Bachmann M, Vedove SD, Linden K, Kongslien S, Drandić D, Kreslina D, Drglin Z, Metallinou D, Tataj-Puzyna U, Gemperle M, Rozée V, Dias H, Mizgaitienė M, Ruzicic J, Simon I, Fumagalli S, Elden H, Vik ES, Ponikvar BM, Lykeridou A, Szlendak B, de Labrusse C, Pinto TM, Jazdauskienė S, Zenzmaier C, Chertok I, Sacks E & Lazzerini M
Info	IMAgiNE EURO Study group, König-Bachmann M, Zenzmaier C, Simon I, D'Costa E, Galle A, D'Hauwers S, Ćerimagić A, Kolokotroni O, Hadjigeorgiou E, Karanikola M, Middleton N, Eteocleous IO, Drandić D, Kurbanović M, Zirovnicka LL, Kramná M, Rozée V, de La Rochebrochard E, Löfgren K, Miani C, Batram-Zantvoort S, Sarantaki A, Metallinou D, Lykeridou A, Chertok I, Artzi-Medvedik R, Lazzerini M, Valente EP, Mariani I, Bomben A, Vedove SD, Morano S, Nespoli A, Fumagalli S, Pumpure E, Rezeberga D, Jakovicka D, Jansone-Šantare G, Šibalova A, Voitehoviča E, Krēsliņa D, Liepinaitienė A, Kondrakova A, Mizgaitienė M, Juciūtė S, Arendt M, Tasch B, Lopriore E, Van den Akker T, Nedberg IH, Kongslien S, Vik ES, Baranowska B, Tataj-Puzyna U, Szlendak B, Pawlicka P, Costa R, Barata C, Santos T, Dias H, Pinto TM, Marques S, Meireles A, Oliveira J, Pereira M, Nunes MA, Otelea MR, Radetić J, Ružičić J, Drglin Z, Bohinec A, Brigidi S, Oliden A, Castañeda LM, Elden H, Linden K, Zaigham M, de Labrusse C, Abderhalden-Zellweger A, Pfund A, Thorn H, Grylka S, Gemperle M, Mueller A, Sacks E
Keywords	COVID‐19, WHO standards, companion of choice, disrespect and abuse, maternal experiences, positive birth perception, respectful maternity care
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