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

IMAgiNE EURO study group, Céline Miani (Coresponding Author), Lisa Wandschneider, Elizabete Pumpure, Dārta Jakovicka, Dace Rezeberga

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)
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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.

Original languageEnglish
Pages (from-to)9-21
Number of pages13
JournalInternational Journal of Gynecology and Obstetrics
Volume159
Issue numberSuppl. 1
DOIs
Publication statusPublished - Dec 2022

Keywords*

  • Female
  • Humans
  • Pregnancy
  • COVID-19/epidemiology
  • Medicalization
  • Multilevel Analysis
  • Pandemics
  • World Health Organization

Field of Science*

  • 3.3 Health sciences
  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database

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