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

Stephanie Batram-Zantvoort; Céline Miani; Ilaria Mariani; Emanuelle Pessa Valente; Mehreen Zaigham; Ingvild Hersoug Nedberg; Magdalena Kurbanović; Elizabete Pumpure; Dārta Krēsliņa; IMAgiNE EURO Study Group; Dace Rezeberga; Dārta Jakovicka; Gita Jansone-Šantare; Anna Šibalova; Elīna Voitehoviča

doi:10.1111/birt.12915

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

Stephanie Batram-Zantvoort (Corresponding Author)
, Céline Miani
, Ilaria Mariani
, Emanuelle Pessa Valente
, Mehreen Zaigham
, Ingvild Hersoug Nedberg
, Magdalena Kurbanović
, Elizabete Pumpure
, Dārta Krēsliņa
, IMAgiNE EURO Study Group
, Dace Rezeberga (Member of the Working Group)
, Dārta Jakovicka (Member of the Working Group)
, Gita Jansone-Šantare (Member of the Working Group)
, Anna Šibalova (Member of the Working Group)
, Elīna Voitehoviča (Member of the Working Group)

Research output: Contribution to journal › Article › peer-review

9 Downloads (Pure)

Abstract

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.

Original language	English
Pages (from-to)	677-689
Journal	Birth
Volume	52
Issue number	4
DOIs	https://doi.org/10.1111/birt.12915
Publication status	Published - Dec 2025

Keywords*

companion of choice
COVID-19
disrespect and abuse
maternal experiences
positive birth perception
respectful maternity care
WHO standarts

Field of Science*

3.2 Clinical medicine
3.3 Health sciences

Publication Type*

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

Access to Document

10.1111/birt.12915Licence: CC BY

The Association Between Women's Perception of BirthDuring the Pandemic, Companion of Choice and SupportFrom Health ProfessionalsLicence: CC BY

Cite this

Batram-Zantvoort, S., Miani, C., Mariani, I., Valente, E. P., Zaigham, M., Nedberg, I. H., Kurbanović, M., Pumpure, E., Krēsliņa, D., IMAgiNE EURO Study Group, Rezeberga, D., Jakovicka, D., Jansone-Šantare, G., Šibalova, A., & Voitehoviča, E. (2025). 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. Birth, 52(4), 677-689. https://doi.org/10.1111/birt.12915

@article{e7ae0163b732458aa5962d99cf4913a8,

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",

abstract = "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.",

keywords = "companion of choice, COVID-19, disrespect and abuse, maternal experiences, positive birth perception, respectful maternity care, WHO standarts",

author = "Stephanie Batram-Zantvoort and C{\'e}line Miani and Ilaria Mariani and Valente, \{Emanuelle Pessa\} and Mehreen Zaigham and Nedberg, \{Ingvild Hersoug\} and Magdalena Kurbanovi{\'c} and Elizabete Pumpure and Anja Bohinec and Antigone Sarantaki and Barbara Baranowska and Alessia Abderhalden-Zellweger and \{de La Rochebrochard\}, Elise and Raquel Costa and Otelea, \{Marina Ruxandra\} and Alina Liepinaitienė and Jelena Radetic and Amira {\'C}erimagi{\'c} and Maryse Arendt and Martina K{\"o}nig-Bachmann and Vedove, \{Stefano Delle\} and Karolina Linden and Sigrun Kongslien and Daniela Drandi{\'c} and Dārta Krēsliņa and Zalka Drglin and Dimitra Metallinou and Urszula Tataj-Puzyna and Michael Gemperle and Virginie Roz{\'e}e and Helo{\'i}sa Dias and Marija Mizgaitienė and Jovana Ruzicic and Imola Simon and Simona Fumagalli and Helen Elden and Vik, \{Eline Skirnisdottir\} and Ponikvar, \{Barbara Mihevc\} and Aikaterini Lykeridou and Beata Szlendak and \{de Labrusse\}, Claire and Pinto, \{Tiago Miguel\} and Simona Jazdauskienė and Christoph Zenzmaier and Ilana Chertok and Emma Sacks and Marzia Lazzerini and \{IMAgiNE EURO Study Group\} and Dace Rezeberga and Dārta Jakovicka and Gita Jansone-{\v S}antare and Anna {\v S}ibalova and Elīna Voitehovi{\v c}a",

note = "{\textcopyright} 2025 The Author(s). Birth published by Wiley Periodicals LLC.",

year = "2025",

month = dec,

doi = "10.1111/birt.12915",

language = "English",

volume = "52",

pages = "677--689",

journal = "Birth",

issn = "0730-7659",

publisher = "Wiley-Blackwell Publishing Ltd",

number = "4",

}

Batram-Zantvoort, S, Miani, C, Mariani, I, Valente, EP, Zaigham, M, Nedberg, IH, Kurbanović, M, Pumpure, E, Krēsliņa, D, IMAgiNE EURO Study Group, Rezeberga, D , Jakovicka, D, Jansone-Šantare, G, Šibalova, A & Voitehoviča, E 2025, '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', Birth, vol. 52, no. 4, pp. 677-689. https://doi.org/10.1111/birt.12915

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. / Batram-Zantvoort, Stephanie (Corresponding Author); Miani, Céline; Mariani, Ilaria et al.
In: Birth, Vol. 52, No. 4, 12.2025, p. 677-689.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - The Association Between Women's Perception of Birth During the Pandemic, Companion of Choice and Support From Health Professionals

T2 - A Cross-Sectional Study in 20 Countries in the WHO European Region

AU - Batram-Zantvoort, Stephanie

AU - Miani, Céline

AU - Mariani, Ilaria

AU - Valente, Emanuelle Pessa

AU - Zaigham, Mehreen

AU - Nedberg, Ingvild Hersoug

AU - Kurbanović, Magdalena

AU - Pumpure, Elizabete

AU - Bohinec, Anja

AU - Sarantaki, Antigone

AU - Baranowska, Barbara

AU - Abderhalden-Zellweger, Alessia

AU - de La Rochebrochard, Elise

AU - Costa, Raquel

AU - Otelea, Marina Ruxandra

AU - Liepinaitienė, Alina

AU - Radetic, Jelena

AU - Ćerimagić, Amira

AU - Arendt, Maryse

AU - König-Bachmann, Martina

AU - Vedove, Stefano Delle

AU - Linden, Karolina

AU - Kongslien, Sigrun

AU - Drandić, Daniela

AU - Krēsliņa, Dārta

AU - Drglin, Zalka

AU - Metallinou, Dimitra

AU - Tataj-Puzyna, Urszula

AU - Gemperle, Michael

AU - Rozée, Virginie

AU - Dias, Heloísa

AU - Mizgaitienė, Marija

AU - Ruzicic, Jovana

AU - Simon, Imola

AU - Fumagalli, Simona

AU - Elden, Helen

AU - Vik, Eline Skirnisdottir

AU - Ponikvar, Barbara Mihevc

AU - Lykeridou, Aikaterini

AU - Szlendak, Beata

AU - de Labrusse, Claire

AU - Pinto, Tiago Miguel

AU - Jazdauskienė, Simona

AU - Zenzmaier, Christoph

AU - Chertok, Ilana

AU - Sacks, Emma

AU - Lazzerini, Marzia

AU - IMAgiNE EURO Study Group

A2 - Rezeberga, Dace

A2 - Jakovicka, Dārta

A2 - Jansone-Šantare, Gita

A2 - Šibalova, Anna

A2 - Voitehoviča, Elīna

PY - 2025/12

Y1 - 2025/12

N2 - 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.

AB - 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.

KW - companion of choice

KW - COVID-19

KW - disrespect and abuse

KW - maternal experiences

KW - positive birth perception

KW - respectful maternity care

KW - WHO standarts

UR - https://www.webofscience.com/wos/alldb/full-record/MEDLINE:40183500

UR - https://pubmed.ncbi.nlm.nih.gov/40183500/

UR - https://www.scopus.com/pages/publications/105002438704

U2 - 10.1111/birt.12915

DO - 10.1111/birt.12915

M3 - Article

C2 - 40183500

SN - 0730-7659

VL - 52

SP - 677

EP - 689

JO - Birth

JF - Birth

IS - 4

ER -

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

Abstract

Keywords*

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