Perceptions of maternity care-seeking and care-giving experiences during a health-system shock: a qualitative study with healthcare professionals and policymakers in the UK, with a focus on care for marginalised groups.

Background: Healthcare professionals (HCPs) and policymakers had to reorganise and adapt to maternity services rapidly during the pandemic, and as a result, women's care-seeking and experience within maternity services were affected. Aims: This study aims to explore HCPs' and policymakers' perspectives of maternity care-seeking and experiences, with a particular focus on marginalised groups. We take a future-focused approach to informing policy to rebuild UK maternity services which remain beleaguered. Method: Semi-structured in-depth interviews were undertaken with 21 HCPs and 20 policymakers across the four nations of the UK to discuss their perception of maternity care-seeking and experiences during the pandemic. Data were analysed using Template Analysis, based on an extended version of the Candidacy framework. Results: HCPs struggled to navigate reconfiguration of services and implement changes. It was challenging to strike a balance between the need to protect women from the virus while maintaining high-quality care. The transition to virtual care hindered HCPs' ability to identify patients' claim to candidacy, affecting the ability to deliver safe and high-quality care. The standardisation of self-monitoring and virtual care, although beneficial for some, adversely affected those with medical and social complexity. Policy had failed to address inequalities prior to service reconfiguration, making it harder for HCPs to engage with marginalised groups. This included service users with social complexity: lack of social support, mental health problems or belonging to a minority group relating to sexual orientation or gender identity; or medical complexity: those who had to perform self-monitoring of symptoms during pregnancy for any complication, including hypertension, gestational diabetes, additional scans for predisposition to genetic complications, or previous pregnancy loss. A lack of ethnic diversity within leadership roles meant guidelines failed to consider the needs of minority groups who subsequently received substandard maternity care. Conclusions: This study affirms the negative effects the pandemic had on maternity care-seeking and experience, while highlighting the need for policy to prioritise marginalised groups, patient-centredness and the well-being of HCPs and policymakers to rebuild a resilient maternity service.