The United Kingdom and the Netherlands maternity care responses to COVID-19: a comparative study    

Abstract

Background: The national health care response to coronavirus (COVID-19) has varied between countries. The United Kingdom (UK) and the Netherlands (NL) have comparable maternity and neonatal care systems, and experienced similar numbers of COVID-19 infections, but had different organisational responses to the pandemic. Understanding why and how similarities and differences occurred in these two contexts could inform optimal care in normal circumstances, and during future crises. Aim: To compare the UK and Dutch COVID-19 maternity and neonatal care responses in three key domains: choice of birthplace, companionship, and families in vulnerable situations. Method: A multi-method study, including documentary analysis of national organisation policy and guidance on COVID-19, and interviews with national and regional stakeholders. Findings: Both countries had an infection control focus, with less emphasis on the impact of restrictions. Differences included care providers’ fear of contracting COVID-19; the extent to which personalised care was embedded in the care system before the pandemic; and how far multidisciplinary collaboration and service-user involvement were prioritised. Conclusion: We recommend that countries should 1) make a systematic plan for crisis decision-making before a serious event occurs, and that this must include authentic service-user involvement, multidisciplinary collaboration, and protection of staff wellbeing 2) integrate women’s and families’ values into the maternity and neonatal care system, ensuring equitable inclusion of the most vulnerable and 3) strengthen community provision to ensure system wide resilience to future shocks from pandemics, or other unexpected large-scale events.

Impact of the COVID-19 pandemic on midwifery-led service provision in the United Kingdom in 2020-21: Findings of three national surveys

“…Our surveys provide more evidence that in the UK, the reconfiguration of maternity services during the pandemic was driven towards centralised, hospital-based care ( Berg et al, 2021 ). At the beginning of the pandemic there was a strong focus on infection control and trying to reduce infection rates especially among staff, including those who may have been worried about becoming infected when attending home births ( Berg et.al, 2021 ).…”

“…Our surveys provide more evidence that in the UK, the reconfiguration of maternity services during the pandemic was driven towards centralised, hospital-based care ( Berg et al, 2021 ). At the beginning of the pandemic there was a strong focus on infection control and trying to reduce infection rates especially among staff, including those who may have been worried about becoming infected when attending home births ( Berg et.al, 2021 ). Decisions to centralise care in hospitals with obstetric units may also reflect the widespread belief that hospitals are the safest place to give birth ( Coxon et.al, 2017 ), and that birth outside a hospital, in a midwifery unit or at home, is as an ‘alternative’ option, ‘outside’ the norm ( Yuill et al, 2020 ).…”

“…Around one third of FMUs were closed during the first wave of the pandemic and a similar number reported the scaling back or cancellation of home birth services, but our findings may be indicative of an overall stronger commitment to the maintenance of home birth and community services during the pandemic in NHS organisations with FMUs. This explanation also finds some support from a cross-national study comparing maternity service responses to the pandemic in the UK and the Netherlands, which found that in the Netherlands, which has a longstanding tradition of support for home birth, there was an explicit policy to encourage women to give birth at home, even when testing positive with COVID-19 ( Berg et al, 2021 ).…”