3.2.2. Facilitators and barriers for personalised care
In both countries, as the pandemic continued, there was more discussion in documents and also reflected by interviewees about the balance between safety and personalisation. However, depending on different facilitators and barriers for personalised care, the results of this balancing process differed. Some interviewees reported that in countries and regions with more embedded personalised care, such as continuous choice for and access to home birth services, it was easier to uphold these services.
‘We must continue to protect and guard the physiology [of pregnancy and birth] as much as possible’ (Royal Dutch Organisation of Midwives, KNOV_1, 22 March 2020).‘But it seems to me. And with my cynical hat on, a lot of trusts went great, we don’t have to provide home births anymore and it was used as an excuse. And what always happens is that is that the sort of the wagons are circled around the labour ward. All the other options are dropped. And that has a really detrimental impact in so many ways (UK stakeholder 18, Independent Midwifery Advisor)
Many interviewees felt that making exceptions to the rules for specific needs or to enhance equity was important in principle, but that this was particularly difficult to do in practice during the pandemic. Respondents felt that pregnant women could not ask for exceptions to be made for them, because they respected the rules, and because health care providers were seen as heroes during the COVID-19 pandemic. Several Dutch participants indicated that they thought it was difficult for health care providers to make exceptions, due to the sense of unity among health care providers. The national policy of the professional organisations was also aimed at preserving unity among maternity care providers. According to some Dutch interviewees, this sense of unity limited maternity care providers in making decisions on whether to make a special case for any specific individual.
‘We [maternity care providers] are not going to make an exception for you. We need to be consistent. Maternity care providers who made an exception did so under conditions of strict secrecy’ (NL stakeholder 3, The Birth Movement)
In the UK there were issues regarding making exceptions as well. According to the UK interviewees, this was mainly due to advice provided in national guidance, which devolved decisions to individual regions, Trusts, and units, which were then made dependent on local resources, capacity, and infection levels.
‘And I think there is a bit of a vacuum because there isn’t strong guidance from the centre, but that Trusts should be looking at relaxing those restrictions and maternity services. So, I guess that’s just left to the local dynamics.’ (UK stakeholder 7, Birthrights)
The lobbying of service user organisations may have had an effect on the increased emphasis on personalised care in the UK in the public and policy agenda that informed and influenced policy at local and national level. There are more service user organisations in the UK than in the NL, and service user organisations in the UK are more formalised. This may have been beneficial for women and families in vulnerable situations.
‘The personalisation of care must remain a priority during this period. We suggest that Trusts should be advised to consider individual requests for support to birth at home, for example, on a case-by-case basis, bearing in mind the needs of the woman (including her mental health needs) as well as what can be done to mitigate staffing constraints.’ (Association for Improvements in the Maternity Services, AIMS_2, 9 April 2020)