4.3. Recommendations for policy and practice
Based on our data, we propose three recommendations for maternity care practice to plan for and manage a future crisis such as a pandemic. These recommendations reinforce new NHS England policy documents on post-pandemic preparedness [26-28].
First, a systematic if-then plan for making decisions during times of crisis should be created and stress-tested at all levels of the health care organisation in advance of any such event. Special attention should be placed on optimising multidisciplinary collaboration and staff wellbeing, and including meaningful and proportionate service-user involvement in every phase of decision-making
Second, care provision should be closely and effectively tailored to service-user values in all maternity and neonatal care systems to ensure service changes during times of crisis automatically take service user values into account, including those who are most vulnerable, to minimise the risk of over-applying blanket risk-reduction or rescue policies, and to permit staff to make exceptions where this is likely to reduce psychological as well as physical harms.
Third, effective and accessible community provision should be the norm for as many maternity services as possible, to ensure provision is more resilient to future system-wide shocks, especially when these threaten the availability of centralised services.

5. Conclusions

This study identified similarities and differences in maternity and neonatal care policy in the UK and the NL in three key domains: choice of birthplace; companionship; and attention to women from disadvantaged and ethnic minority background. Based on the included national guidelines and policy analysis, and interviews with national stakeholders, both countries had an infection control focus. The differences between the two countries appear to have been influenced by factors such as the fear of providers contracting COVID-19, how personalised care was embedded in the maternity care system, and the extent to which multidisciplinary collaboration and service-user involvement were prioritised. We recommend that countries should: 1) make a systematic plan for decision-making and the protection of staff and service user wellbeing during times of crisis, including service-user involvement and multidisciplinary collaboration; 2) integrate women’s and families’ values into the maternity and neonatal care system, including the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics or other unexpected events.

Acknowledgments