TABLE 3.
Multiple logistic regression comparing quality measures between women who went into labor (n = 1860) and women who had a prelabor cesarean (n = 219) when adjusted for year of labor and other sociodemographic variables a , b , c , d
| Provision of care | Adjusted OR (95% CI) | P value | Experience of care | Adjusted OR (95% CI) | P value | Availability of physical and human resources | Adjusted OR (95% CI) | P value | Reorganizational changes due to COVID‐19 | Adjusted OR (95% CI) | P value |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 1. No pain relief during birth | NA | NA | 1. No freedom of movements during birth | NA | NA | 1. No timely care by HCPs at facility arrival | 1.26 (0.80–1.97) | 0.312 | 1. Difficulties in attending routine antenatal visits | 1.08 (0.76–1.52) | 0.679 |
| 2. Mode of birth | NA | NA | 2a. No choice of birth position (in SVB) | NA | NA | 2. No information on maternal danger signs | 1.37 (1.00–1.87) | 0.045 | 2. Any barriers in accessing the facility | 1.16 (0.84; –1.62) | 0.365 |
| 2a. IVB | |||||||||||
| NA | NA | ||||||||||
| 2b. EC during birth | |||||||||||
| 3a. Episiotomy (in SVB) | NA | NA | 2b. No consent requested (for IVB) | NA | NA | 3. No information on newborn danger signs | 1.25 (0.89–1.75) | 0.193 | 3. Inadequate info graphics | 1.02 (0.72–1.46) | 0.907 |
| 3b. Fundal pressure (in IVB) | NA | NA | 2c. No information on newborn (at cesarean) | 1.02 (0.65–1.58) | 0.946 | 4. Inadequate room comfort and equipment | 1.59 (0.89–2.83) | 0.120 | 4. Inadequate ward reorganization | 1.49 (1.09–2.03) | 0.012 |
| 3c. No pain relief after cesarean | 0.77 (0.34–1.76) | 0.543 | 3. No clear/effective communication from HCP | 1.14 (0.83–1.58) | 0.426 | 5. Inadequate number of women per rooms | 0.66 (0.28–1.57) | 0.350 | 5. Inadequate room reorganization | 0.91 (0.64–1.28) | 0.574 |
| 4. No skin‐to‐skin contact | 6.69 (4.65–6.62) | <0.001 | 4. No involvement in choices | 1.06 (0.79–1.42) | 0.700 | 6. Inadequate room cleaning | 0.97 (0.34–2.80) | 0.959 | 6. Lack of one functioning accessible hand; washing station | 0.91 (0.58–1.44) | 0.701 |
| 5. No early breastfeeding | 5.35 (3.52–8.14) | <0.001 | 5. Companionship not allowed | 1.40 (1.04–1.88) | 0.027 | 7. Inadequate bathroom | 1.12 (0.66–1.91) | 0.665 | 7. HCP not always using PPE | 1.41 (0.99–2.01) | 0.058 |
| 6. Inadequate breastfeeding support | 1.58 (1.16–2.15) | 0.004 | 6. Not treated with dignity | 1.18 (0.83–1.66) | 0.352 | 8. Inadequate partner visiting hours | 1.00 (0.74–1.34) | 0.982 | 8. Insufficient HCP number | 1.29 (0.88–1.91) | 0.193 |
| 7. No rooming‐in | 3.14 (2.00–4.94) | <0.001 | 7. No emotional support | 1.29 (0.95–1.77) | 0.106 | 9. Inadequate HCP number | 1.05 (0.59–1.84) | 0.878 | 9. Communication inadequate to contain COVID‐19‐related stress | 1.14 (0.82–1.59) | 0.438 |
| 8. Not allowed to stay with the baby as wished | 1.35 (0.61–3.01) | 0.458 | 8. No privacy | 0.85 (0.61–1.19) | 0.354 | 10. Inadequate HCP professionalism | 1.62 (0.88–2.97) | 0.120 | 10. Reduction in QMNC due to COVID‐19 | 1.09 (0.79–1.52) | 0.601 |
| 9. No exclusive breastfeeding at discharge | 1.76 (1.30–2.38) | <0.001 | 9. Abuse (physical/verbal /emotional) | 1.17 (0.80–1.73) | 0.420 | ||||||
| 10. No immediate attention when needed | 1.55 (1.11–2.15) | 0.009 | 10. Informal payment | 1.83 (1.03–3.26) | 0.039 |
Abbreviations: EC, emergency cesarean; HCP, healthcare provider; IVB, instrumental vaginal birth; PPE, personal protective equipment; QMNC, quality of maternal and newborn care; SVB, spontaneous vaginal birth.
ORs were calculated taking women who underwent birth as the reference and adjusting for sociodemographic variables (i.e. year of childbirth, maternal age, maternal education, born in Latvia), parity, type of professional assisting the birth, newborn admission to neonatal intensive or semi‐intensive care unit, and multiple birth.
All the indicators in the domains of provision of care, experience of care, and resources are directly based on WHO standards. Indicators identified with letters (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 domain 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 woman was hospitalized) supplied with water and soap or with disinfectant alcohol solution.
Bold values are statistically significant.