Speaking to the Lusa agency, Raquel Costa, a researcher at the Institute of Public Health of the University of Porto (ISPUP), revealed that the study, developed within the scope of the IMAGINE EURO project, aimed to evaluate the health care provided to women and new born children.

The research, which was selected for the cover of the February issue of the journal “The Lancet Regional Health – Europe”, was based on a questionnaire, developed according to the standards defined by the World Health Organization (WHO), which covered four dimensions: care delivery, care experience, human resources and structures, and organisational changes related to the Covid-19 pandemic.

Between March 2020 and March 2021, 21,027 women from 12 European countries (Italy, Sweden, Norway, Slovenia, Portugal, Germany, Serbia, Romania, France, Croatia, Luxembourg and Spain) responded to the questionnaire, of which 1,685 were Portuguese.

“We have a prevalence of instrumented delivery that is three times higher than the average in other countries (11%)”, said Raquel Costa, stressing that this is a practice on which the WHO does not establish any principle of recommendation or non-recommendation.

The WHO establishes, however, as a non-recommended practice the performance of episiotomies (incisions made in the perineum to enlarge the birth canal), whose percentage that in Portugal was fixed at 41%, representing twice the European average (20%).

Similar to performing episiotomies, the Kristeller maneuver, which involves the use of external pressure on the uterus and which is not recommended by the WHO, was performed in 49% of Portuguese women with instrumented vaginal deliveries, a value higher than the European average (41%).

No consent

In addition to these data, the study concluded that 63% of Portuguese women were not asked for “any consent” to perform an instrumented delivery, a value that contrasts with the European average (54%).

“One in five women report that they perceive they have been the victim of physical, emotional or verbal abuse. This is an indicator that concerns us because they are probably preventable communication problems, there are communication strategies that can help health professionals and mothers”, observed Raquel Costa.

In Portugal, 28% of women reported that there was still no effective communication on the part of health professionals, 41% said they had not been involved in the choices during childbirth and 32% said they had not been treated with dignity.

The study also focused on the impact of the covid-19 pandemic on the provision of care, and unlike the other indicators, the national numbers “do not differ from other countries”.

The decrease in routine consultations throughout pregnancy and the scarcity of maternal and child care during the pandemic period were the main impacts felt.