# 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

## TL;DR

This study shows that having a chosen companion and good professional support during childbirth improves women's birth experiences, even during the pandemic.

## Contribution

The study identifies specific factors linked to positive birth perceptions during the pandemic in the WHO European Region.

## Key findings

- Having a companion of choice during birth was strongly associated with a positive perception of the birth experience.
- Adequate attention, assistance, and availability from health professionals significantly improved birth perception.
- Medical interventions like cesarean births and episiotomies were linked to less positive birth perceptions.

## Abstract

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.

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.

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.

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.