Perinatal care in SARS-CoV-2 infected women: the lesson learnt from a national prospective cohort study during the pandemic in Italy
Authors: Corsi Decenti Edoardo , Salvatore Michele Antonio , Mandolini Donatella , Sampaolo Letizia , D’Aloja Paola ,   the Italian Obstetric Surveillance System COVID-19 Consortium, Alberi Irene , Arena Saverio , Brunelli Roberto , Cagnacci Angelo , Camandona Franco , Casucci Paola , Caudullo Sebastiano , Cetin Irene , Ceccaroni Marcello , Ciavattini Andrea , Cromi Antonella , Rì Pietro Dal , Di Cerbo Lidia , Di Sebastiano Francesca , Farsetti Daniele , Franchi Massimo Piergiuseppe , Iurlaro Enrico , Leo Livio , Liberati Marco , Sacchi Lucia Li , Livio Stefania , Locci Mariavittoria , Lovotti Massimo , Marozio Luca , Martini Claudio , Maso Gianpaolo , Mecacci Federico , Meloni Alessandra , Mignuoli Anna Domenica , Mondo Luisa , Morano Danila , Patanè Luisa , Paradiso Rocco , Pellegrino Antonio , Perotti Francesca , Perrone Enrica , Piccino Roberta , Prefumo Federico , Ramenghi Luca , Rocca Morena , Sala Alessia , Sangaletti Marina , Savasi Valeria , Schettini Sergio Crescenzo Antonio , Simeone Daniela , Simeone Serena , Steinkasserer Martin , Taddei Fabrizio , Tesorone Marina , Trojano Vito , Tronci Caterina , Veneziano Micaela , Vergani Patrizia , Vimercati Antonella , Donati Serena 
Published: December 2023

Abstract
Background
Despite the growing importance given to ensuring high-quality childbirth, perinatal good practices have been rapidly disrupted by SARS-CoV-2 pandemic. This study aimed at describing the childbirth care provided to infected women during two years of COVID-19 emergency in Italy.

Methods
A prospective cohort study enrolling all women who gave birth with a confirmed SARS-CoV-2 infection within 7 days from hospital admission in the 218 maternity units active in Italy during the periods February 25, 2020-June 30, 2021, and January 1-May 31, 2022. Perinatal care was assessed by evaluating the prevalence of the following indicators during the pandemic: presence of a labour companion; skin-to-skin; no mother–child separation at birth; rooming-in; breastfeeding. Logistic regression models including women’ socio-demographic, obstetric and medical characteristics, were used to assess the association between the adherence to perinatal practices and different pandemic phases.

Results
During the study period, 5,360 SARS-CoV-2 positive women were enrolled. Overall, among those who had a vaginal delivery (n = 3,574; 66.8%), 37.5% had a labour companion, 70.5% of newborns were not separated from their mothers at birth, 88.1% were roomed-in, and 88.0% breastfed. These four indicators showed similar variations in the study period with a negative peak between September 2020 and January 2021 and a gradual increase during the Alpha and Omicron waves. Skin-to-skin (mean value 66.2%) had its lowest level at the beginning of the pandemic and gradually increased throughout the study period. Among women who had a caesarean section (n = 1,777; 33.2%), all the indicators showed notably worse outcomes with similar variations in the study period. Multiple logistic regression analyses confirm the observed variations during the pandemic and show a lower adherence to good practices in southern regions and in maternity units with a higher annual number of births.

Conclusions
Despite the rising trend in the studied indicators, we observed concerning substandard childbirth care during the SARS-CoV-2 pandemic. Continued efforts are necessary to underscore the significance of the experience of care as a vital component in enhancing the quality of family-centred care policies.