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)