COVID-19: Safety and personalisation for UK maternity care provision during and after a pandemic.

Annually, over 1,200,000 UK residents (pregnant women and neonates) need maternity care. All relevant authorities emphasise the critical importance of antenatal, intrapartum, postnatal and neonatal services, birth companionship, keeping mother/baby together, and breastfeeding, even during COVID-19. International disaster reports consistently value community provision. These principles align with NHS England Better Births safety and personalisation policies. UK maternity Trusts have responded differently to COVID-19. Some have reduced tests, contacts, community intrapartum provision, and birth companionship options. These decisions are associated with reports of unattended home births, delays in self-referral for unusual symptoms, and psychological distress. In other Trusts, and in countries such as The Netherlands, increased community care provision, and new innovations (including remote access to tests and contacts) are being trialled. With stakeholders, and using normalisation and behavioural change theories, we will identify which organisational responses have worked best for maternity care organisation during COVID-19. We will undertake policy level UK/Netherlands analyses, using official documents, national level interviews, and a geo-mapped on-line survey of women's experiences before, during and after COVID-19. We will then undertake in-depth maternity/neonatal case studies in 8 UK Trusts, selected on available staffing levels at the crisis peak, and on case-mix. We will include retrospective and prospective documentary reviews, on-line staff and parent interviews, routine clinical outcomes data (including infections), and modelling of what worked to optimise safety and personalisation for women, parents, and staff. A final stakeholder event will co-develop a practical, theoretically informed organisational model for both routine and crisis-affected maternity and neonatal services.