Companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19: a mixed-methods analysis of national and organisational responses and perspectives

  1. Gill Thomson
  2. Marie-Claire Balaam
  3. Rebecca Nowland (Harris)
  4. Nicola Crossland
  5. Gill Moncrieff
  6. Stephanie Heys
  7. Arni Sarian
  8. Joanne Cull
  9. Anastasia Topalidou
  10. Soo Downe

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Abstract

To explore stakeholders’ and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE) COVID-19 UK study.

Setting

Maternity care provision in England.

Participants

Interviews were held with 26 national governmental, professional and service-user organisation leads (July–December 2020). Other data included public-facing outputs logged from 25 maternity Trusts (September/October 2020) and data extracted from 78 documents from eight key governmental, professional and service-user organisations that informed national maternity care guidance and policy (February–December 2020).

Results

Six themes emerged: ‘Postcode lottery of care’ highlights variations in companionship and visiting practices between trusts/locations, ‘Confusion and stress around ‘rules’’ relates to a lack of and variable information concerning companionship/visiting, ‘Unintended consequences’ concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, ‘Need for flexibility’ highlights concerns about applying companionship and visiting policies irrespective of need, ‘‘Acceptable’ time for support’ highlights variations in when and if companionship was ‘allowed’ antenatally and intrapartum and ‘Loss of human rights for gain in infection control’ emphasises how a predominant focus on infection control was at a cost to psychological safety and human rights.

Conclusions

Policies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations.

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  1. Version published to 10.1136/bmjopen-2021-051965
  2. ScreenIT

    SciScore for 10.1101/2021.04.08.21254762: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board StatementIRB: Data collection: Ethics approval: Ethics approval to undertake the interviews was obtained from the Health ethics sub-committee from the lead author’s institution (project no: 0079).
    Consent: Participants were asked if they would like to check any public facing quotes prior to publications as part of the consent process; quotes were returned to seven participants for feedback, and four required slight changes to be made.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variableAll the authors are female, and the four interviewers are experienced in undertaking qualitative interviews.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    The pragmatic restriction of the Trust level data collection to only 25 Trusts (10% of maternity care providers in the UK), and the restriction to maternity-specific documents and guidance may be seen as a limitation, the organisations that were included were selected purposively to reflect a wide range of relevant characteristics. Since this paper is focused on policy and organisational responses to the pandemic, service-users, birth companions and healthcare professionals were not included. In addition, our analysis did not include findings related to postnatal care, or care in neonatal units. These areas, and the unintended (positive and negative) short- and longer-term consequences of different interpretations of the value of companionship when balanced against infection control, are critical areas for examination during the on-going COVID-19 crisis. Future outputs from the ASPIRE project will address these gaps.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

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  3. Version published to 10.1101/2021.04.08.21254762v1 on medRxiv