TABLE 3.
| Key quality measures of QMNC (40 items) | Spontaneous vaginal birth | Instrumental vaginal birth | Emergency cesarean during labor | Emergency cesarean before labor | Planned or elective cesarean | adj P value d | |
|---|---|---|---|---|---|---|---|
| No. (%) (n = 698) | No. (%) (n = 134) | No. (%) (n = 111) | No. (%) (n = 67) | No. (%) (n = 165) | |||
| Provision of care | |||||||
| 1 | No pain relief during labor (for SVB, IVB, emergency cesarean during labor) | 122 (17.5) | 5 (3.7) | 7 (6.3) | <0.001 | ||
| 2a | Mode of birth: Instrumental vaginal birth | ‐ | 134 (100.0) | ‐ | ‐ | ‐ | ‐ |
| 2b | Mode of birth: emergency cesarean during labor | ‐ | ‐ | 111 (100.0) | ‐ | ‐ | ‐ |
| 2c | Mode of birth: Emergency cesarean before labor | ‐ | ‐ | ‐ | 67 (100.0) | ‐ | ‐ |
| 2d | Mode of birth: Planned or elective cesarean | ‐ | ‐ | ‐ | ‐ | 165 (100.0) | ‐ |
| 3a | Episiotomy (in SVB) | 64 (9.2) | ‐ | ‐ | ‐ | ‐ | ‐ |
| 3b | Fundal pressure (in IVB) | ‐ | 22 (16.4) | ‐ | ‐ | ‐ | ‐ |
| 3c | No pain relief after cesarean | ‐ | ‐ | 9 (8.1) | 10 (14.9) | 12 (7.3) | 0.598 |
| 4 | No skin to skin | 7 (1.0) | 3 (2.2) | 21 (18.9) | 10 (14.9) | 19 (11.5) | <0.001 |
| 5 | No early breastfeeding | 36 (5.2) | 15 (11.2) | 19 (17.1) | 10 (14.9) | 39 (23.6) | <0.001 |
| 6 | Inadequate breastfeeding support | 112 (16.0) | 31 (23.1) | 17 (15.3) | 13 (19.4) | 24 (14.5) | 0.647 |
| 7 | No rooming‐in | 74 (10.6) | 27 (20.1) | 29 (26.1) | 33 (49.3) | 37 (22.4) | 0.002 |
| 8 | Not allowed to stay with the baby as wished | 15 (2.1) | 2 (1.5) | 5 (4.5) | 10 (14.9) | 5 (3.0) | 0.287 |
| 9 | No exclusive breastfeeding at discharge | 123 (17.6) | 38 (28.4) | 34 (30.6) | 25 (37.3) | 58 (35.2) | <0.001 |
| 10 | No immediate attention when needed | 119 (17.0) | 28 (20.9) | 28 (25.2) | 18 (26.9) | 34 (20.6) | 0.014 |
| Experience of care | |||||||
| 1a | No freedom of movement during labor | 51 (7.3) | 21 (15.7) | 18 (16.2) | ‐ | ‐ | 0.001 |
| 1b | No consent requested for vaginal examination in prelabor cesarean | ‐ | ‐ | ‐ | 9 (13.4) | 11 (6.7) | 0.117 |
| 2a | No choice of birth position (in SVB) | 238 (34.1) | ‐ | ‐ | ‐ | ‐ | ‐ |
| 2b | No consent requested (for IVB) | ‐ | 54 (40.3) | ‐ | ‐ | ‐ | ‐ |
| 2c | No information on newborn after cesarean | ‐ | ‐ | 9 (8.1) | 10 (14.9) | 12 (7.3) | 0.032 |
| 3 | No clear/effective communication from HCP | 107 (15.3) | 27 (20.1) | 28 (25.2) | 18 (26.9) | 32 (19.4) | 0.057 |
| 4 | No involvement in choices | 132 (18.9) | 30 (22.4) | 34 (30.6) | 23 (34.3) | 26 (15.8) | 0.037 |
| 5 | Companionship not allowed | 235 (33.7) | 45 (33.6) | 39 (35.1) | 29 (43.3) | 50 (30.3) | 0.636 |
| 6 | Not treated with dignity | 75 (10.7) | 14 (10.4) | 22 (19.8) | 17 (25.4) | 17 (10.3) | 0.005 |
| 7 | No emotional support | 105 (15.0) | 36 (26.9) | 42 (37.8) | 17 (25.4) | 29 (17.6) | <0.001 |
| 8 | No privacy | 57 (8.2) | 14 (10.4) | 18 (16.2) | 13 (19.4) | 14 (8.5) | 0.167 |
| 9 | Abuse (physical/verbal/emotional) | 58 (8.3) | 18 (13.4) | 14 (12.6) | 11 (16.4) | 12 (7.3) | 0.360 |
| 10 | Informal payment | 19 (2.7) | 9 (6.7) | 4 (3.6) | 2 (3.0) | 5 (3.0) | 0.293 |
| Availability of physical and human resources | |||||||
| 1 | No timely care by HCPs at facility arrival | 54 (7.7) | 11 (8.2) | 12 (10.8) | 11 (16.4) | 4 (2.4) | 0.024 |
| 2 | No information on maternal danger signs | 231 (33.1) | 48 (35.8) | 47 (42.3) | 24 (35.8) | 51 (30.9) | 0.261 |
| 3 | No information on newborn danger signs | 284 (40.7) | 66 (49.3) | 49 (44.1) | 26 (38.8) | 62 (37.6) | 0.435 |
| 4 | Inadequate room comfort and equipment | 8 (1.1) | 1 (0.7) | 1 (0.9) | 1 (1.5) | 0 (0.0) | 0.871 |
| 5 | Inadequate number of women per rooms | 38 (5.4) | 10 (7.5) | 4 (3.6) | 3 (4.5) | 6 (3.6) | 0.465 |
| 6 | Inadequate room cleaning | 5 (0.7) | 1 (0.7) | 1 (0.9) | 3 (4.5) | 0 (0.0) | 0.111 |
| 7 | Inadequate bathroom | 19 (2.7) | 1 (0.7) | 2 (1.8) | 2 (3.0) | 0 (0.0) | 0.726 |
| 8 | Inadequate partner visiting hours | 169 (24.2) | 38 (28.4) | 31 (27.9) | 14 (20.9) | 37 (22.4) | 0.371 |
| 9 | Inadequate HCP number | 57 (8.2) | 16 (11.9) | 18 (16.2) | 10 (14.9) | 11 (6.7) | 0.022 |
| 10 | Inadequate HCP professionalism | 7 (1.0) | 1 (0.7) | 2 (1.8) | 3 (4.5) | 5 (3.0) | 0.256 |
| Reorganizational changes due to COVID‐19 | |||||||
| 1 | Difficulties in attending routine antenatal visits | 133 (19.1) | 20 (14.9) | 15 (13.5) | 21 (31.3) | 49 (29.7) | 0.001 |
| 2 | Any barriers in accessing the facility | 101 (14.5) | 14 (10.4) | 20 (18.0) | 11 (16.4) | 37 (22.4) | 0.078 |
| 3 | Inadequate infographics | 104 (14.9) | 21 (15.7) | 21 (18.9) | 17 (25.4) | 26 (15.8) | 0.521 |
| 4 | Inadequate wards reorganization | 155 (22.2) | 25 (18.7) | 21 (18.9) | 24 (35.8) | 25 (15.2) | 0.041 |
| 5 | Inadequate room reorganization | 189 (27.1) | 41 (30.6) | 32 (28.8) | 22 (32.8) | 40 (24.2) | 0.613 |
| 6 | Lacking one functioning accessible hand‐washing station | 25 (3.6) | 4 (3.0) | 5 (4.5) | 4 (6.0) | 4 (2.4) | 0.957 |
| 7 | HCPs not always using PPE | 58 (8.3) | 10 (7.5) | 9 (8.1) | 9 (13.4) | 14 (8.5) | 0.706 |
| 8 | Insufficient number of HCPs | 124 (17.8) | 28 (20.9) | 26 (23.4) | 21 (31.3) | 32 (19.4) | 0.071 |
| 9 | Communication inadequate to contain COVID‐19‐related stress | 134 (19.2) | 26 (19.4) | 31 (27.9) | 26 (38.8) | 38 (23.0) | 0.001 |
| 10 | Reduction in QMNC due to COVID‐19 | 181 (25.9) | 34 (25.4) | 43 (38.7) | 25 (37.3) | 45 (27.3) | 0.083 |
Abbreviations: HCP, healthcare professional; IVB, instrumental vaginal birth; PPE, personal protective equipment; QMNC, quality of maternal and newborn care; SVB, spontaneous vaginal birth.
All the indicators in the domains of provision of care, experience of care, and resources are directly based on WHO standards.
Indicators with a specified denominator (e.g. 3a, 3b) were tailored to take into account different mode of birth (i.e. spontaneous vaginal, instrumental vaginal, and cesarean). These were calculated on subsamples (e.g. 3a was calculated on spontaneous vaginal births; 3b was calculated on instrumental vaginal births).
Indicator 6 in the domains of reorganizational changes due to COVID‐19 was defined as: at least one functioning and accessible hand‐washing station (near or inside the room where the mother was hospitalized) supplied with water and soap or with disinfectant alcohol solution.
P values were obtained from the logistic regression model testing quality measures difference by mode of birth adjusted for sociodemographic and obstetric variables (i.e. maternal age, education, year of birth, parity, presence of an obstetrician/gynecologist at birth, multiple birth), language of questionnaire completion, type of hospital, newborn admission to neonatal intensive care or special care baby unit, and mother's admission to intensive care. Bold values are statistically significant.