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
(2022) In International Journal of Gynecology & Obstetrics 159(S1). p.9-21- Abstract
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... (More)
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.
(Less)
- author
- Miani, Céline
; Wandschneider, Lisa
; Batram-Zantvoort, Stephanie
; Covi, Benedetta
; Elden, Helen
; Nedberg, Ingvild Hersoug
; Drglin, Zalka
; Pumpure, Elizabete
; Costa, Raquel
; Rozée, Virginie
; Otelea, Marina Ruxandra
; Drandić, Daniela
; Radetic, Jelena
; Abderhalden-Zellweger, Alessia
; Ćerimagić, Amira
; Arendt, Maryse
; Mariani, Ilaria
; Linden, Karolina
LU
; Ponikvar, Barbara Mihevc
; Jakovicka, Dārta
; Dias, Heloisa
; Ruzicic, Jovana
; de Labrusse, Claire
; Valente, Emanuelle Pessa
; Zaigham, Mehreen
LU
; Bohinec, Anja
; Rezeberga, Dace
; Barata, Catarina
; Pfund, Anouk
; Sacks, Emma
and Lazzerini, Marzia
(Less) - author collaboration
- organization
- publishing date
- 2022-12
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Pregnancy, Female, Humans, Medicalization, Multilevel Analysis, Pandemics, COVID-19/epidemiology, European People, World Health Organization
- in
- International Journal of Gynecology & Obstetrics
- volume
- 159
- issue
- S1
- pages
- 13 pages
- publisher
- Wiley-Blackwell
- external identifiers
-
- scopus:85144447002
- pmid:36530006
- ISSN
- 1879-3479
- DOI
- 10.1002/ijgo.14459
- language
- English
- LU publication?
- yes
- additional info
- © 2022 The Authors. International Journal of Gynecology & Obstetrics published by John Wiley & Sons Ltd on behalf of International Federation of Gynecology and Obstetrics.
- id
- b46a3b2d-e18b-4972-9f03-bd2ff6d2ebac
- date added to LUP
- 2022-12-24 10:05:05
- date last changed
- 2025-01-24 00:53:09
@article{b46a3b2d-e18b-4972-9f03-bd2ff6d2ebac,
abstract = {{<p>OBJECTIVE: To investigate potential associations between individual and country-level factors and medicalization of birth in 15 European countries during the COVID-19 pandemic.</p><p>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.</p><p>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.</p><p>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.</p>}},
author = {{Miani, Céline and Wandschneider, Lisa and Batram-Zantvoort, Stephanie and Covi, Benedetta and Elden, Helen and Nedberg, Ingvild Hersoug and Drglin, Zalka and Pumpure, Elizabete and Costa, Raquel and Rozée, Virginie and Otelea, Marina Ruxandra and Drandić, Daniela and Radetic, Jelena and Abderhalden-Zellweger, Alessia and Ćerimagić, Amira and Arendt, Maryse and Mariani, Ilaria and Linden, Karolina and Ponikvar, Barbara Mihevc and Jakovicka, Dārta and Dias, Heloisa and Ruzicic, Jovana and de Labrusse, Claire and Valente, Emanuelle Pessa and Zaigham, Mehreen and Bohinec, Anja and Rezeberga, Dace and Barata, Catarina and Pfund, Anouk and Sacks, Emma and Lazzerini, Marzia}},
issn = {{1879-3479}},
keywords = {{Pregnancy; Female; Humans; Medicalization; Multilevel Analysis; Pandemics; COVID-19/epidemiology; European People; World Health Organization}},
language = {{eng}},
number = {{S1}},
pages = {{9--21}},
publisher = {{Wiley-Blackwell}},
series = {{International Journal of Gynecology & Obstetrics}},
title = {{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}},
url = {{http://dx.doi.org/10.1002/ijgo.14459}},
doi = {{10.1002/ijgo.14459}},
volume = {{159}},
year = {{2022}},
}