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

Objectives: 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 ASPIRE COVID-19 study. Setting: Maternity care provision in England. Participants: Interviews were held with 26 national governmental, professional, and service-user organisation leads (July-Dec 2020). Other data included public-facing outputs logged from 25 maternity Trusts (Sept/Oct 2020) and data extracted from 78 documents from eight key governmental, professional, and service-user organisations that informed national maternity care guidance and policy (Feb-Dec 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’ emphasizes 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. Strengths and limitations of this study • This is the first paper to consider links between policy and practice in companionship and visiting in maternity care during the COVID-19 pandemic. • Data triangulation across national level stakeholders in policy and practice and public facing Trust documentation provides nuanced and context related perspectives on why and how companionship and visiting was impacted. • Stakeholders included national representatives from all key agencies involved in maternity care. • Practice related issues were collected from 25 Trusts websites and social media-based public facing information, which may or may not reflect actual care practices. • The paper focuses on antenatal and intrapartum care, with postnatal (including neonatal) care to be the focus of future publications. • The study does not include information directly reported by parents or healthcare professionals