In search of respect and continuity of care: Hungarian women's experiences with midwifery-led, community birth

Nicholas Rubashkin; Brianna Bingham; Petra Baji; Imre Szebik; Sarolta Kremmer; Saraswathi Vedam

doi:10.1111/birt.12818

In search of respect and continuity of care: Hungarian women's experiences with midwifery-led, community birth

Birth. 2024 Feb 26. doi: 10.1111/birt.12818. Online ahead of print.

Authors

Nicholas Rubashkin^{1

2}, Brianna Bingham², Petra Baji³, Imre Szebik⁴, Sarolta Kremmer⁵, Saraswathi Vedam^{6

7}

Affiliations

¹ Department of Obstetrics, Gynaecology, & Reproductive Sciences, University of California at San Francisco, San Francisco, California, USA.
² Institute for Global Health Sciences, University of California at San Francisco, San Francisco, California, USA.
³ Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
⁴ Institute of Behavioural Sciences, Semmelweis University Faculty of Medicine, Budapest, Hungary.
⁵ Program in Midwifery B.SC, Semmelweis University Faculty of Health Sciences, Budapest, Hungary.
⁶ School of Population & Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
⁷ Division of Midwifery, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.

PMID: 38409862
DOI: 10.1111/birt.12818

Abstract

Introduction: To describe and compare intervention rates and experiences of respectful care when Hungarian women opt to give birth in the community.

Methods: We conducted a cross-sectional online survey (N = 1257) in 2014. We calculated descriptive statistics comparing obstetric procedure rates, respectful care indicators, and autonomy (MADM scale) across four models of care (public insurance; chosen doctor or chosen midwife in the public system; private midwife-led community birth). We used an intention-to-treat approach. After adjusting for social and clinical covariates, we used logistic regression to estimate the odds of obstetric procedures and disrespectful care and linear regression to estimate the level of autonomy (MADM scale).

Findings: In the sample, 99 (7.8%) saw a community midwife for prenatal care. Those who planned community births had the lowest rates of cesarean at 9.1% (public: 30.4%; chosen doctor: 45.2%; chosen midwife 16.5%), induced labor at 7.1% (public: 23.1%; chosen doctor: 26.0%; chosen midwife: 19.4%), and episiotomy at 4.44% (public: 62.3%; chosen doctor: 66.2%; chosen midwife: 44.9%). Community birth clients reported the lowest rates of disrespectful care at 25.5% (public: 64.3%; chosen doctor: 44.3%; chosen midwife: 38.7%) and the highest average MADM score at 31.5 (public: 21.2; chosen doctor: 25.5; chosen midwife: 28.6). In regression analysis, community midwifery clients had significantly reduced odds of cesarean (0.35, 95% CI 0.16-0.79), induced labor (0.27, 95% CI 0.11-0.67), episiotomy (0.04, 95% CI 0.01-0.12), and disrespectful care (0.36, 95% CI 0.21-0.61), while also having significantly higher average MADM scores (5.71, 95% CI 4.08-7.36).

Conclusions: Hungarian women who plan to give birth in the community have low obstetric procedure rates and report greater respect, in line with international data on the effects of place of birth and model of care on experiences of perinatal care.

Keywords: Hungary; cesarean; community birth; mother-baby-friendly care.

Grants and funding

K12 HD001262/HD/NICHD NIH HHS/United States