1. Introduction
The World Health Organization (WHO) considers respectful maternity care
(RMC) to be based on the principles of universal human rights [1].
The WHO define RMC as “care organised for and provided to all women in
a manner that maintains their dignity, privacy and confidentiality,
ensures freedom from harm and mistreatment, and enables informed choice
and continuous support during labour and childbirth” [1]. In the
United Kingdom (UK), the National Health Service (NHS) England Better
Births maternity review emphasises the need for both safety and
personalisation in maternity and neonatal care [2]. Safe care is
more than good perinatal outcomes: it also includes the importance of
women having choices and making decisions based around their personal
circumstances, values, social norms, and needs [2].
The coronavirus (COVID-19) pandemic has impacted health care capacity
worldwide, including maternity and neonatal care. At the beginning of
the pandemic, there was uncertainty about the effect of COVID-19
infections on perinatal health outcomes, and actions were taken to
protect pregnant women and babies [3, 4]. Changes in maternity care
provision were made to reduce infection rates and to protect maternity
and neonatal care capacity [5]. These changes included switching to
online and telephone consultations, limiting birth partner
companionship, and ensuring extra hygiene precautions during
breastfeeding for COVID-19 positive mothers [5]. While it can be
considered acceptable to limit some rights to contribute to security,
safety, and emergency resource management [6], some of the changes
have raised fierce opposition [7]. Complaints have been made about
restrictions in women’s birth choices, and about women being alone
during labour or while attending potentially highly sensitive
appointments (i.e. anomaly scans). For some, this has been seen as a
direct violation of women’s rights [8].
The UK and the Netherlands (NL) are European countries with similar
social structures and norms, comparable maternity care systems, and, by
population size, experienced similar numbers of COVID-19 infections. In
principle, therefore, they should not differ drastically in the way they
balance human rights in the areas of safety and personalisation in
maternity care [9]. However, key differences in maternity and
neonatal services organisation have been noted, particularly in terms of
rules about companionship during labour and birth, and accessibility to
community maternity care provision [5].
This paper reports on the findings from a multi-method study that was
undertaken to compare the UK and Dutch COVID-19 maternity and neonatal
care responses. We considered that
an understanding of why and how similarities and differences occurred in
similar health and social contexts could help inform how to optimise
maternity and neonatal care in future, both in normal circumstances, and
during future crises. Therefore, our research question was: how and why
did maternity and neonatal care policies adapt to the COVID-19 pandemic
in the UK and the NL?
2. Methods