3.2.1. Focus on infection control
According to stakeholders in both countries, at the beginning of the COVID-19 pandemic, there was a strong focus on reducing infection rates. Several interviewees indicated that this was due to strong societal pressure to ‘flatten the (epidemic) curve’ and uncertainty relating to the risks posed by COVID-19 to pregnant women and babies, particularly at the beginning of the pandemic. There was also fear amongst policymakers and healthcare providers regarding capacity within the healthcare system (i.e., staff and beds), due to the strain on resources relating to COVID-19 infections. These factors were perceived to have influenced the introduction of strict measures in maternity care during the early days of the pandemic.
‘The RCM, in normal circumstances, takes the clear position that women should be given the full range of birthplace options, with evidence-based guidance to aid their decision-making and that midwives should staff women and not buildings. However, the current crisis requires those leading and managing services to make difficult decisions to ensure the safety of pregnant women, their babies and the staff supporting them’ (UK Royal College of Midwives, RCM_23, March 2020).
As the pandemic progressed, more information became available that suggested that pregnant women and babies were not at serious risk of severe COVID-19 complications (though this situation has changed with the advent of the delta variant, that arrived after the end of the data collection period for this paper) [12]. However, maternity and neonatal care remained focused on infection control, especially in the UK, largely due to the fear of staff becoming infected with COVID-19. This fear was exacerbated by a shortage of personal protective equipment (PPE) in the healthcare sector.
‘But that’s the message I’m hearing back and back from the trust, is that we only just kept our home birth services staffed and staff was super worried about going into people’s homes and we had to put a lot of restrictions on to make them feel safer.’ (UK stakeholder 12, Maternity Voices Partnership)
This contrasted to the situation in the NL, where, according to the interviewees, there was a shortage of PPE but there was little fear amongst maternity care providers of becoming infected.
‘I didn’t experience that the midwives were so scared of becoming infected. Of course, there were a few, but most of the measures were taken to prevent a shortage of midwives [if they had to go on sick leave because of COVID-19 infection]’ (NL stakeholder 7, Royal Dutch Organisation of Midwives).
According to a number of the interviewees, the negative impact of restrictions on women was justified by the need to reduce the spread of infection. However, others indicated that the restrictions were not proportionate and that more attention should have been placed on women’s experiences and psychological wellbeing.
‘So it [perinatal experience] is a really crucial life event. And however difficult the circumstances, the wishes and the needs and the sort of thoughts and everything else to do, the women should remain paramount.’ (UK stakeholder 18, Independent Midwifery Advisor)