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. Issue 1 (18th December 2022)

• Record Type: Journal Article
• Authors: 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; Ponikvar, Barbara Mihevc; Jakovicka, Dārta; Dias, Heloisa; Ruzicic, Jovana; de Labrusse, Claire; Valente, Emanuelle Pessa; Zaigham, Mehreen; Bohinec, Anja; Rezeberga, Dace; Barata, Catarina; Pfund, Anouk; Sacks, Emma; Lazzerini, Marzia;
• Other Names: Ćerimagić Amira investigator.; Drandić Roda Daniela investigator.; Kurbanović Magdalena investigator.; Virginie Rozée investigator.; de La Rochebrochard Elise investigator.; Löfgren Kristina investigator.; Miani Céline investigator.; Batram‐Zantvoort Stephanie investigator.; Wandschneider Lisa investigator.; Lazzerini Marzia investigator.; Valente Emanuelle Pessa investigator.; Covi Benedetta investigator.; Mariani Ilaria investigator.; Morano Sandra investigator.; Chertok Ilana investigator.; Hefer Emek investigator.; Artzi‐Medvedik Rada investigator.; Pumpure Elizabete investigator.; Rezeberga Dace investigator.; Jansone‐Šantare Gita investigator.; Jakovicka Dārta investigator.; Knoka Anna Regīna investigator.; Vilcāne Katrīna Paula investigator.; Liepinaitienė Alina investigator.; Kondrakova Andželika investigator.; Mizgaitienė Marija investigator.; Juciūtė Simona investigator.; Arendt Maryse investigator.; Tasch Barbara investigator.; Nedberg Ingvild Hersoug investigator.; Kongslien Sigrun investigator.; Vik Eline Skirnisdottir investigator.; Baranowska Barbara investigator.; Tataj‐Puzyna Urszula investigator.; Węgrzynowska Maria investigator.; Costa Raquel investigator.; Barata Catarina investigator.; Santos Teresa investigator.; Rodrigues Carina investigator.; Dias Heloísa investigator.; Otelea Marina Ruxandra investigator.; Radetić Jelena investigator.; Ružičić Jovana investigator.; Drglin Zalka investigator.; Ponikvar Barbara Mihevc investigator.; Bohinec Anja investigator.; Brigidi Serena investigator.; Castañeda Lara Martín investigator.; Elden Helen investigator.; Sengpiel Verena investigator.; Linden Karolina investigator.; Zaigham Mehreen investigator.; De Labrusse Claire investigator.; Abderhalden Alessia investigator.; Pfund Anouck investigator.; Thorn Harriet investigator.; Grylka Susanne investigator.; Gemperle Michael investigator.; Mueller Antonia investigator.; Conway Francesca guestEditor.; Costa Raquel guestEditor.; Otelea Marina R. guestEditor.; Sacks Emma guestEditor.;
• Is Part Of: International journal of gynaecology and obstetrics. Volume 159:Issue 1(2022)supplement 1
• Page Start: 9
• Page End: 21
• Publication Date: 2022-12-18
• Subjects: birth -- cesarean -- episiotomy -- Europe -- gender equality -- IMAgiNE EURO -- medicalization -- midwifery -- respectful maternity care; Gynecology -- Periodicals; Obstetrics -- Periodicals; Electronic journals; 618
• DOI: 10.1002/ijgo.14459
• Languages: English
• ISSNs: 0020-7292

Abstract

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 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. Synopsis: Among the individual and country‐level variables investigated, less respectful care, as perceived by women, showed consistent positive associations with indicators of birth medicalization.