Quality of care at childbirth during the COVID-19 pandemic in Belgium: A cross-sectional study based on WHO standards

Objectives: To examine quality of maternal and newborn care (QMNC) around childbirth in facilities in Belgium during the COVID-19 pandemic and trends over time. 

Design: A cross-sectional observational study. 

Setting: Data of the Improving MAternal Newborn carE in the EURO region study in Belgium. 

Participants: Women giving birth in a Belgian facility from 1 March 2020 to 1 May 2023 responded a validated online questionnaire based on 40 WHO standards-based quality measures organised in four domains: provision of care, experience of care, availability of resources and organisational changes related to COVID-19. 

Primary and secondary outcome measures: Quantile regression analysis was performed to assess predictors of QMNC; trends over time were tested with the Mann-Kendall test. 

Results: 897 women were included in the analysis, 67% (n=601) with spontaneous vaginal birth, 13.3% (n=119) with instrumental vaginal birth (IVB) and 19.7% (n=177) with caesarean section. We found overall high QMNC scores (median index scores>75) but also specific gaps in all domains of QMNC. On provision of care, 21.0% (n=166) of women who experienced labour reported inadequate pain relief, 64.7% (n=74) of women with an instrumental birth reported fundal pressure and 72.3% (n=86) reported that forceps or vacuum cup was used without their consent. On experience of care, 31.1% (n=279) reported unclear communication, 32.9% (n=295) reported that they were not involved in choices,11.5% (n=104) stated not being treated with dignity and 8.1% (n=73) experienced abuse. Related to resources, almost half of the women reported an inadequate number of healthcare professionals (46.2%, n=414). Multivariable analyses showed significantly lower QMNC scores for women with an IVB (-20.4 in the 50th percentile with p<0.001 and 95% CI (-25.2 to -15.5)). Over time, there was a significant increase in QMNC Score for € experience of care' and € key organisational changes due to COVID-19' (trend test p< 0.05). 

Conclusions and relevance: Our study showed several gaps in QMNC in Belgium, underlying causes of these gaps should be explored to design appropriate interventions and policies. 

Trial registration number: NCT04847336.