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.