3.1.2. Companionship
In both countries, the initial
response was to limit companionship for women during the antenatal,
natal, and post-partum periods. Many organisations in the UK and NL
recommended no companionship during antenatal check-ups (KNOV_1;
BEN_01; NVOG_4; CPZ_7; ISUOG_6; SoR_11; NHSE_1; RCOG_1c; RCM_8).
In the early days of the pandemic there was some guidance in the NL
documentation to make exceptions to companionship restrictions in the
antenatal period (CPZ_7).
‘Pregnant women can face difficult and emotional decisions. In
such situations, it is realistic that health care providers deviate from
this advice’ [no companionship during antenatal check-ups]’ (Dutch
College for Perinatal Care, CPZ_7, 27 March 2020).
There were differences between UK and NL policies for companionship
throughout childbirth. In the NL, only one person could be present, but
this could be throughout labour and birth (KNOV_1, _4). In the UK, in
the early phases of the pandemic, recommendations were that birth
companions were not allowed during early labour in spontaneous birth or
during the early phase of induction of birth (RCM_8, _28; AIMS_8).
When the woman was in established labour, only one birth companion was
allowed to be present (RCOG_1g). The documentary evidence we reviewed
did not advise on how established labour should be confirmed, but there
are reports that this requirement may have led to unwanted vaginal
examinations (AIMS_5; BR_8_18_23). In the UK, concerns were
expressed that an unintended consequence of the restrictions on
companionship was that some women chose an unassisted birth (AIMS_2,
‘Restrictions imposed by the majority of trusts (86%) have meant
many women are alone in hospital during early labour which can last
hours or even days. Although all trust policies allowed birth partners
to attend once labour is established, the unpredictable nature of birth
has meant that in some circumstances women have given birth alone’
(Association for Improvements in the Maternity Services, AIMS_8).
When the first COVID-19 wave had passed its peak, various service-user
organisations in both countries began lobbying for companionship rules
to be relaxed. In the UK, the focus was on companionship during early
labour, while in the NL, the concern was focused on enabling the
presence of a second companion (AIMS_2; BR_1, _14; NBvD_3; GB_2).
The pressure resulting from these efforts led to restrictions slowly
being relaxed.
‘Especially in a clinical setting, where there are often unknown
caregivers, a trusted person is so incredibly important. For these
women, it is important that they are seen and heard during birth, with
an extra person of their own choice. This allows a good start for them
now and for the future of the baby that they are bringing into the
world. For some women, this will be a doula, midwife or birth
photographer, or their mother; for others, a trainee care provider is
welcome.’ (The Birth Movement, GB_2, 22 May 2020).
In the UK, companionship on the post-partum ward was limited; in some
hospitals, visitors on the post-partum ward were not permitted, while in
others, visitors were restricted to a specific timeslot (AIMS_6;
NHSE_8; BR_1, _8, _16, _17, _23; SANDS_1; RCM_7, _28). In the
NL, there was no national guidance about post-partum companionship
restrictions in hospital. However, interviewees suggested that in many
Dutch hospitals, only the woman’s partner could visit the post-partum
ward but without being restricted to a timeslot. Furthermore, there was
national guidance restricting visitors to all Dutch homes. This impacted
on the presence of maternity care assistants and family (BO_1;
KNOV_31). From 11 May 2020, women that had just given birth could
appoint one family member to visit them during the first week
postpartum; during the second COVID-19 wave, the number of visitors was
linked to national or regional infection rates (KCKZ_4, _13; BO_4;
KNOV_44). In the UK, rules about companionship in the home were limited
in maternity care organisation documents, but rules regarding home
visits were linked to nationwide lockdown measures, leading to fewer
physical visits from maternity care professionals (RCM_15).
At the beginning of the pandemic, guidelines were published which
advised that newborn babies should be separated from COVID-positive
parents (NVK_05; BAPM_3). Moreover, in both countries from May 2020
onward, increased attention was placed on whether parents (not
necessarily infected with COVID-19) were seen as visitors to the
neonatal ward, thereby limiting their visiting hours (GB_1; ICM_1,
policy due to increased focus on the negative impact of limited
parent-infant (KNOV_15; BAPM_5, _6, _7; RCOG_9, _2a; SCOT_3).
‘Neonatal services present a unique situation in terms of
“visitors” and it is essential that the mother and her partner are
never considered to be visitors within the neonatal unit – they are
partners in their baby’s care, and their presence should be encouraged’
(British Association of Perinatal Medicine, BAPM_5, 6 May 2020).