Women's experiences of disrespect and abuse in Swiss facilities during the COVID-19 pandemic: a qualitative analysis of an open-ended question in the IMAgiNE EURO study.

BACKGROUND: The COVID-19 pandemic has challenged the provision of maternal care. The IMAgiNE EURO study investigates the Quality of Maternal and Newborn Care during the pandemic in over 20 countries, including Switzerland. AIM: This study aims to understand women's experiences of disrespect and abuse in Swiss health facilities during the COVID-19 pandemic. METHODS: Data were collected via an anonymous online survey on REDCap®. Women who gave birth between March 2020 and March 2022 and answered an open-ended question in the IMAgiNE EURO questionnaire were included in the study. A qualitative thematic analysis of the women's comments was conducted using the International Confederation of Midwives' RESPECT toolkit as a framework for analysis. FINDINGS: The data source for this study consisted of 199 comments provided by women in response to the open-ended question in the IMAgiNE EURO questionnaire. Analysis of these comments revealed clear patterns of disrespect and abuse in health facilities during the COVID-19 pandemic. These patterns include non-consensual care, with disregard for women's choices and birth preferences; undignified care, characterised by disrespectful attitudes and a lack of empathy from healthcare professionals; and feelings of abandonment and neglect, including denial of companionship during childbirth and separation from newborns. Insufficient organisational and human resources in health facilities were identified as contributing factors to disrespectful care. Empathic relationships with healthcare professionals were reported to be the cornerstone of positive experiences. DISCUSSION: Swiss healthcare facilities showed shortcomings related to disrespect and abuse in maternal care. The pandemic context may have brought new challenges that compromised certain aspects of respectful care. The COVID-19 crisis also acted as a magnifying glass, potentially revealing and exacerbating pre-existing gaps and structural weaknesses within the healthcare system, including understaffing. CONCLUSIONS: These findings should guide advocacy efforts, urging policy makers and health facilities to allocate adequate resources to ensure respectful and high-quality maternal care during pandemics and beyond.

Quality of maternal and newborn care in Switzerland during the COVID-19 pandemic: A cross-sectional study based on WHO quality standards.

OBJECTIVE: To explore quality of maternal and newborn care (QMNC) in healthcare facilities during the COVID-19 pandemic in Switzerland. METHODS: Women giving birth in Switzerland answered a validated online questionnaire including 40 WHO standards-based quality measures. QMNC score was calculated according to linguistic region and mode of birth. Differences were assessed using logistic regression analysis adjusting for relevant variables. RESULTS: A total of 1175 women were included in the analysis. Limitations in QMNC during the pandemic were reported by 328 (27.9%) women. Several quality measures, such as deficient communication (18.0%, n = 212), insufficient number of healthcare professionals (19.7%, n = 231), no information on the newborn after cesarean (26.5%, n = 91) or maternal and newborn danger signs (34.1%, n = 401 and 41.4% n = 487, respectively) suggested preventable gaps in QMNC. Quality measures significantly differed by linguistic region and mode of birth. Multivariate analysis established a significantly lower QMNC for women in French- and Italian-speaking regions compared with the German-speaking region. Moreover, in several quality indicators reflecting communication with healthcare providers, women who did not answer the questionnaire in one of the Swiss national languages had significantly worse scores than others. A significant lower QMNC was also found for young and primiparous women and for those who experienced cesarean or instrumental vaginal birth. CONCLUSION: Women giving birth in Switzerland during the pandemic reported notable gaps in QMNC. Providers should be attuned to women who are younger, primiparous, and those who had an emergency cesarean or instrumental vaginal birth given the lower QMNC reported by these groups. Women who did not respond in a Swiss national language may need improved communication strategies.

Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the IMAgiNE EURO study in 16 countries.

OBJECTIVE: To explore the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic by facility type among 16 European countries, comparing rates of instrumental vaginal birth and cesarean. METHODS: Women who gave birth in the WHO European Region from March 1, 2020, to February 7, 2022, answered a validated online questionnaire. Rates of instrumental birth, instrumental vaginal birth, and cesarean, and a QMNC index were calculated for births in public versus private facilities. RESULTS: Responses from 25 206 participants were analyzed. Women giving birth in private compared with public facilities reported significantly more frequent total cesarean (32.5% vs 19.0%; aOR 1.70; 95% CI 1.52-1.90), elective cesarean (17.3% vs 7.8%; aOR 1.90; 95% CI 1.65-2.19), and emergency cesarean before labor (7.4% vs 3.9%; aOR 1.39; 95% CI 1.14-1.70) (P < 0.001 for all comparisons), with analyses by country confirming these results. QMNC index results were heterogeneous across countries and regions in the same country and were largely affected by geographical distribution of regions rather than by type of facility alone. CONCLUSION: The study confirms that births in private facilities have higher odds of cesarean. It also suggests that QMNC should be closely monitored in all facilities to achieve high-quality care, independent of facility type or geographical distribution. GOV IDENTIFIER: NCT04847336.

Midwives' perception of advantages of health care at a distance during the COVID-19 pandemic in Switzerland.

OBJECTIVE: To explore midwives' perceptions of the advantages of telemedicine during the COVID-19 pandemic in Switzerland. DESIGN: Cross-sectional study based on an online survey using quantitative methods. SETTING: Midwives working in Switzerland. PARTICIPANTS: Self-selected convenience sample of 630 members of the Swiss Federation of Midwives. MEASUREMENT: Open questions on advantages of health care at a distance and workrelated characteristics were used in the online questionnaire. The information was coded and integrative content analysis was applied. FINDINGS: A good half of the respondents associated telemedicine with either an advantage beyond the pandemic ("Reduced workload", "Improved health care provision", "Greater self-care of clients"), while the others saw a pandemic-related advantage ("Protection from COVID-19", "Maintaining care/counseling in an exceptional situation"), or no advantage at all. Older, more experienced midwives were less likely to see an advantage beyond the pandemic. The motive "Reduced workload" was positively associated with professionals aged younger than 40 years and midwives with up to 14 years of professional experience, and "Protection from COVID-19" was more likely cited by midwives aged 50 and more and by midwives working solely in hospitals. Midwives who stated "Maintaining care" and "Improved health care provision" as motives to embrace telemedicine were more likely to experience health care at a distance as a positive treatment alternative. KEY CONCLUSION: Midwives' perceptions of the advantages of health care at a distance vary substantially with age and years of professional experience, as well as workrelated characteristics. Further research is necessary to acquire a sound understanding of underlying reasons, including the sources of the general attitudes involved. IMPLICATION FOR PRACTICE: Understanding the differences in perceptions of health care at a distance is important in order to improve the work situation of midwives and the health care they provide to women and families. Different sensitivities represent an important source in the ongoing discussion about the future use of telemedicine in health care.

Does therapy always need touch? A cross-sectional study among Switzerland-based occupational therapists and midwives regarding their experience with health care at a distance during the COVID-19 pandemic in spring 2020.

BACKGROUND: The COVID-19 pandemic impedes therapy and care activities. Tele-health, i.e., the provision of health care at a distance (HCD), is a promising way to fill the supply gap. However, facilitators and barriers influence the use and experience of HCD for occupational therapists (OTs) and midwives. We identified use of services and appraisal of experiences of Switzerland-based OTs and midwives regarding the provision of HCD during the lockdown as it pertains to the COVID-19 pandemic in spring 2020. 1. HYPOTHESIS: Profession, age in years, and area of work have a significant and meaningful influence over whether HCD is provided. 2. HYPOTHESIS: Profession, age in years, area of work, possibility of reimbursement by health insurance, and application used have a significant and meaningful influence on the experience of HCD. METHODS: In a cross-sectional survey, 5755 OTs and midwives were contacted to fill out an online questionnaire with 13 questions regarding demographic information, use of HCD, and experiences while providing the service. Eleven potential facilitators and barriers and areas where there was desire for support were identified. RESULTS: The questionnaire was completed by 1269 health professionals (response rate 22.5%). 73.4% of responding OTs (n = 431) and midwives (n = 501) provided HCD during the COVID-19 pandemic lockdown. Profession and area of work had a significant influence on whether HCD was provided. Age only had a significant influence on the use of videotelephony, SMS, and chat services. OTs experienced HCD significantly more positively than midwives (log odds = 1.3; p ≤ .01). Video-telephony (log odds = 1.1; p ≤ .01) and use of phone (log odds = 0.8; p = .01) were positive predictors for positive experience, while use of SMS (log odds = - 0.33; p = .02) was a negative predictor. Among OTs, 67.5% experienced HCD as positive or mostly positive, while 27.0% experienced it as negative or mostly negative. Among midwives, 39.5% experienced it as positive or mostly positive, while 57.5% experienced it as negative or mostly negative. Most respondents desired support concerning reimbursement by health insurance (70.8%), followed by law and data protection (60.4%). CONCLUSIONS: HCD during the early COVID-19 pandemic was generally perceived as positive by OTs and midwives. There is need for training opportunities in connection with HCD during the COVID-19 pandemic.

Smartphones in the nursery: Parental smartphone use and parental sensitivity and responsiveness within parent-child interaction in early childhood (0-5 years): A scoping review.

The omnipresence of smartphones has not stopped at the door to the nursery. It is especially important to better understand the impact of parental smartphone use on relationships at the beginning of children's lives. Babies and toddlers are essentially dependent on caregivers' sensitive and responsive behaviors within the context of the development of attachment patterns. Disturbances in parental sensitivity can have a negative impact on attachment-related interactional processes between parents and children and on child outcomes, such as self-regulatory capacity. The goal of this review is to compile existing research on the impact of parental mobile device use through technoference or absorption on parental sensitivity and responsiveness within parent-child interactions in the early years (0-5). We conducted a thorough search of the databases PsycInfo and PubMed, additionally consulting data sources such as Google Scholar and Google. In this review, we included 12 studies with a variety of methodical approaches. The research so far indicates that parental smartphone use may be associated with changes in parental sensitivity and responsiveness. Absorption in the device appears to contribute to this association more strongly than short interruptions of relating per se (technoference). However, to better understand these processes, more in-depth, longitudinal research is needed.

La omnipresencia de los teléfonos inteligentes no se ha detenido a la puerta de la guardería. En especial, es importante entender mejor el impacto del uso de teléfonos inteligentes por parte de los padres en sus relaciones al comienzo de las vidas de sus niños. Los bebés y niños pequeñitos son esencialmente dependientes del comportamiento sensible y atento de quienes les cuidan, dentro del contexto del desarrollo de patrones de afectividad. Las interrupciones en la sensibilidad de los padres pueden tener un impacto negativo en los procesos interaccionales relacionados con la afectividad entre padres y niños y en los resultados en el niño tales como la capacidad de autorregularse. El propósito de la presente revisión es compilar la investigación existente acerca del impacto que el uso de aparatos móviles por parte de los padres a través de la tecno-conferencia o absorción tiene sobre la sensibilidad y la atención dentro de las interacciones padres-niños en los primeros años (0-5). Llevamos a cabo una investigación exhaustiva de los bancos de datos PsycInfo y PubMed, consultando adicionalmente las fuentes de datos como el Investigador Google y Google. En esta revisión incluimos 12 estudios con una variedad de acercamientos metodológicos. La investigación hasta ahora indica que el uso de los teléfonos inteligentes por parte de los padres pudiera estar asociado con cambios en la sensibilidad y atención de los padres. La absorción en los aparatos parece contribuir a esta asociación más fuertemente que interrupciones cortas o relacionadas de por sí (tecno-conferencia). Sin embargo, para entender mejor estos procesos, se necesita una más profunda y longitudinal investigación.

L'omniprésence des téléphones smartphones ne s'est pas arrêtée à la porte de la chambre du bébé. Il est particulièrement important de mieux comprendre l'impact de l'utilisation parentale des smartphones sur les relations au début de la vie des enfants. Les bébés et les petits enfants sont essentiellement dépendants des comportements sensibles et réactifs des aidants naturels dans le contexte du développement de patterns d'attachement. Des perturbations de la sensibilité parentale peuvent avoir un impact négatif sur les processus interactionnels liés à l'attachement entre les parents et les enfants et sur les résultats de l'enfant, comme par exemple la capacité régulatoire. Le but de ce passage en revue est de compiler les recherches qui existent sur l'impact de l'utilisation parentale des appareils mobiles à travers la technoférence ou l'absorption sur la sensibilité parentale et la réaction au sein des interactions parent-enfant durant les premières années (0-5 ans). Nous avons fait une recherche approfondie des bases de données PsycInfo et PubMed, et également consulté des sources de données telles que Google Scholar et Google. Dans cette revue nous incluons 12 études avec une variété d'approches médicales. Jusqu'à présent les recherches indiquent que l'utilisation parentale du smartphone peut être lié à des changements dans la sensibilité parentale et la réaction. Le fait d'être absorbé par le téléphone semble contribuer à cette association plus fortement que de courtes interruptions à la relation en elle-même (technoférence). Cependant, afin de mieux comprendre ces processus, des recherches plus approfondies et longitudinales sont nécessaires.