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