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
AuthorMiani, Céline; Wandschneider, Lisa; Batram-Zantvoort, Stephanie; Covi, Benedetta; Elden, Helen; Nedberg, Ingvild Hersoug; Drglin, Zalka; Pumpure, Elizabete; Costa, Raquel; Rozée, Virginie; Otelea, Marina Ruxandra; Drandić, Daniela; Radetic, Jelena; Abderhalden-Zellweger, Alessia; Ćerimagić, Amira; Arendt, Maryse; Mariani, Ilaria; Linden, Karolina; Ponikvar, Barbara Mihevc; Jakovicka, Dārta; Dias, Heloisa; Ruzicic, Jovana; de Labrusse, Claire; Valente, Emanuelle Pessa; Zaigham, Mehreen; Bohinec, Anja; Rezeberga, Dace; Barata, Catarina; Pfund, Anouk; Sacks, Emma; Lazzerini, Marzia
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.