3.2.3. Learning how to work together during a time of crisis
The interviewees indicated that the unexpectedness of the COVID-19 pandemic caused tension and stress because there did not appear to be a clear plan of action, at least in the early stages. On the other hand, some interviewees felt that the acute crisis caused by COVID-19 created a sense of a common purpose. Action had to be taken quickly and health care workers pulled together to make it happen. In both countries, there was multidisciplinary collaboration before the pandemic, but the response at the beginning of the pandemic was to issue monodisciplinary guidelines. According to the interviewees, and based on the guidelines collected (such as the RCM/RCOG joint guidelines), as the pandemic progressed, it became evident that multidisciplinary collaboration was required to ensure policy alignment, prevent delay in care, and provide coordinated information to service users and the media; both at the care provider and stakeholder level.
‘So, if you look at the collaboration, there were some incidents in the beginning. Parties were still communicating a certain message from their own sector. And later on in the process, things got better and better: there was more of a joint effort’ (NL stakeholder 11, College of Perinatal Care).
According to the interviewees, one of the important factors about working together during a crisis is the ability to understand each other’s interests, opinions, and expertise. The interviewees indicated that when the importance of collaboration became widely felt among all professional groups within maternity care, respect for each other’s expertise and perspective developed. Although some experienced or witnessed some friction in collaboration, many Dutch interviewees seemed proud of the collaboration in maternity and neonatal care,
‘Well, one party reported to the press on how they were going to do it, but then it was totally out of sync with the rest, which created a bit of a disagreement’ (NL stakeholder 6, Ministry of Health, Welfare and Sport).
According to some interviewees in both countries, service user participation was missed out on many levels, including developing guidelines, implementing policy, and providing feedback on practice. The longer the crisis went on, the more service user participation took place. However, some interviewees considered the amount of participation to be insufficient to provide women with a real voice in decision-making about balancing their safety and other rights.
‘It was a such a technical discussion about how to reduce COVID-19 [infection rates] and the social aspect and the impact was forgotten. That would perhaps be my main recommendation. Why aren’t there women, pregnant women, people who don’t come from healthcare at the table? They were just not asked.’ (NL stakeholder 3, The Birth Movement)

4. Discussion

This study examined the similarities and differences in maternity and neonatal care policy during the COVID-19 pandemic between two European countries, the UK and the NL, and stakeholder views about the drivers behind these policies. The focus on infection control in both countries meant that little attention was paid to the impact of restrictions by policy makers. Furthermore, it was difficult for care providers to make exceptions for women and families in vulnerable situations. The most striking differences between the UK and the NL related to birth place choices for women and companionship during birth. Differences in policy during COVID-19 between the two countries seemed to be influenced to a greater or lesser degree by differences in the extent of fear of maternity care providers contracting COVID-19, the degree to which community based care is normative, the extent to which personalised care was embedded in the maternity care system, and the involvement of service user organisations in policy making.