3.1.2. Companionship
In both countries, the initial response was to limit companionship for women during the antenatal, natal, and post-partum periods. Many organisations in the UK and NL recommended no companionship during antenatal check-ups (KNOV_1; BEN_01; NVOG_4; CPZ_7; ISUOG_6; SoR_11; NHSE_1; RCOG_1c; RCM_8). In the early days of the pandemic there was some guidance in the NL documentation to make exceptions to companionship restrictions in the antenatal period (CPZ_7).
‘Pregnant women can face difficult and emotional decisions. In such situations, it is realistic that health care providers deviate from this advice’ [no companionship during antenatal check-ups]’ (Dutch College for Perinatal Care, CPZ_7, 27 March 2020).
There were differences between UK and NL policies for companionship throughout childbirth. In the NL, only one person could be present, but this could be throughout labour and birth (KNOV_1, _4). In the UK, in the early phases of the pandemic, recommendations were that birth companions were not allowed during early labour in spontaneous birth or during the early phase of induction of birth (RCM_8, _28; AIMS_8). When the woman was in established labour, only one birth companion was allowed to be present (RCOG_1g). The documentary evidence we reviewed did not advise on how established labour should be confirmed, but there are reports that this requirement may have led to unwanted vaginal examinations (AIMS_5; BR_8_18_23). In the UK, concerns were expressed that an unintended consequence of the restrictions on companionship was that some women chose an unassisted birth (AIMS_2,
‘Restrictions imposed by the majority of trusts (86%) have meant many women are alone in hospital during early labour which can last hours or even days. Although all trust policies allowed birth partners to attend once labour is established, the unpredictable nature of birth has meant that in some circumstances women have given birth alone’ (Association for Improvements in the Maternity Services, AIMS_8).
When the first COVID-19 wave had passed its peak, various service-user organisations in both countries began lobbying for companionship rules to be relaxed. In the UK, the focus was on companionship during early labour, while in the NL, the concern was focused on enabling the presence of a second companion (AIMS_2; BR_1, _14; NBvD_3; GB_2). The pressure resulting from these efforts led to restrictions slowly being relaxed.
‘Especially in a clinical setting, where there are often unknown caregivers, a trusted person is so incredibly important. For these women, it is important that they are seen and heard during birth, with an extra person of their own choice. This allows a good start for them now and for the future of the baby that they are bringing into the world. For some women, this will be a doula, midwife or birth photographer, or their mother; for others, a trainee care provider is welcome.’ (The Birth Movement, GB_2, 22 May 2020).
In the UK, companionship on the post-partum ward was limited; in some hospitals, visitors on the post-partum ward were not permitted, while in others, visitors were restricted to a specific timeslot (AIMS_6; NHSE_8; BR_1, _8, _16, _17, _23; SANDS_1; RCM_7, _28). In the NL, there was no national guidance about post-partum companionship restrictions in hospital. However, interviewees suggested that in many Dutch hospitals, only the woman’s partner could visit the post-partum ward but without being restricted to a timeslot. Furthermore, there was national guidance restricting visitors to all Dutch homes. This impacted on the presence of maternity care assistants and family (BO_1; KNOV_31). From 11 May 2020, women that had just given birth could appoint one family member to visit them during the first week postpartum; during the second COVID-19 wave, the number of visitors was linked to national or regional infection rates (KCKZ_4, _13; BO_4; KNOV_44). In the UK, rules about companionship in the home were limited in maternity care organisation documents, but rules regarding home visits were linked to nationwide lockdown measures, leading to fewer physical visits from maternity care professionals (RCM_15).
At the beginning of the pandemic, guidelines were published which advised that newborn babies should be separated from COVID-positive parents (NVK_05; BAPM_3). Moreover, in both countries from May 2020 onward, increased attention was placed on whether parents (not necessarily infected with COVID-19) were seen as visitors to the neonatal ward, thereby limiting their visiting hours (GB_1; ICM_1, policy due to increased focus on the negative impact of limited parent-infant (KNOV_15; BAPM_5, _6, _7; RCOG_9, _2a; SCOT_3).
‘Neonatal services present a unique situation in terms of “visitors” and it is essential that the mother and her partner are never considered to be visitors within the neonatal unit – they are partners in their baby’s care, and their presence should be encouraged’ (British Association of Perinatal Medicine, BAPM_5, 6 May 2020).