. 2022 Aug 11:10.1111/aogs.14438. Online ahead of print. doi: 10.1111/aogs.14438

TABLE 2.

Supplementary quotations

Endemic precarity: A health system under pressure	A top‐down approach to managing the health system shock	From un(der)‐prepared to future flourishing
I guess one of the really big things that felt like it changed on an emotional level rather than a practical level was it just suddenly felt that there was a huge level of uncertainty (Midwifery‐Clinical Research) What we had not thought about was the effect of men being in a vulnerable female space, the effect on women speaking to each other rather than just speaking to their partner, the effect on the staff of having all of these spare bodies around and trying to keep the place clean. (Obstetrics‐Senior Clinician) …it's very difficult to plan ahead because you do not really know what you are planning for. (Midwifery‐Strategic Leadership)	I think there were some of us that got pushed into places that we were… I think that was a bit hard. Also, because services had to change overnight, like my colleagues that cover Antenatal Clinic got told within a couple of days that they were moving to < Name of Hospital > for their clinic… (Midwifery‐Frontline Clinician) It felt like they came into our world and told us how to do something we had been doing, as far as we knew, perfectly well. (Midwifery‐Frontline Clinician) I think it was the way it was brought into us, being told that it was just going to happen straightaway, I think there was a little bit of a feeling of oh, well, is it not a worry for us being overheated and hot anymore? (Midwifery‐Frontline Clinician) …think it was just… the uncertainty I found really, really challenging in that I did not know whether or not in less than two weeks if I'd be working full‐time shifts or if I'd be working from home… (Midwifery‐Frontline Clinician) …it felt slightly tricky because we were not really sure what we were telling people and, in the beginning—and this is not a criticism at all because everybody obviously was dealing with this huge situation that developed out of nowhere and nobody knew what was happening—but I think it highlighted lots of, I guess, issues in the system… (Midwifery‐Clinical Research) I do not quite see why I cannot work from home. But there still seems to be a bit of… I do not know if taboo is the right word but just a lot of suspicion that if you are at home, you just do not really do very much, but actually I think I'm more productive at home. Yes. I guess it's the manager's call maybe, I do not know, or just the culture of the place… (Midwifery‐Frontline Clinician) So pretty much everything apart from gestational diabetes and Type 1, Type 2 in pregnancy disappeared. The preconception clinic was stopped. The rapid access clinic stopped. The community clinics closed. And many of the staff in diabetes were redeployed onto frontline, so there were about three of us left in the diabetes in pregnancy service and we basically ran it, with increasing numbers of pregnant women. (Other Medical‐Frontline Clinician)	…over time it felt better because the systems then were put in place and once people had asked those questions and you knew the answer then if people rang again, it made it easier. (Midwifery‐Clinical Research) I think the good thing about COVID is it's highlighted where some systems maybe needed to be improved and that got better over the course of the time… (Midwifery‐Clinical Research) Normally all the better birth stuff is trying to very much change care according to evidence and if suddenly lots of things happen that are not evidence‐based just because they had to happen, and they never got changed back that would feel like it's a shame. (Midwifery‐Clinical Research) I'm hoping that with research that's going on at the moment, things will not just go back to the way it was or they were but actually whoever is in charge and making big decisions will actually be looking at the research that's coming out and seeing what's good going forward as opposed to just assuming that pre‐COVID times was fine and let us just do that again. (Midwifery‐Frontline Clinician) But then things would change all the time so you would never sometimes know what on earth you were going to come into when you came into work. And I suppose then they did not know, like our managers did not know what would be happening, I do not know. So, sometimes it felt… It's quite unsettling when you do not know what you are going to be doing when you go to work… (Midwifery‐Clinical Research)

Endemic precarity: A health system under pressure

A top‐down approach to managing the health system shock

From un(der)‐prepared to future flourishing

I guess one of the really big things that felt like it changed on an emotional level rather than a practical level was it just suddenly felt that there was a huge level of uncertainty (Midwifery‐Clinical Research)

What we had not thought about was the effect of men being in a vulnerable female space, the effect on women speaking to each other rather than just speaking to their partner, the effect on the staff of having all of these spare bodies around and trying to keep the place clean. (Obstetrics‐Senior Clinician)

…it's very difficult to plan ahead because you do not really know what you are planning for. (Midwifery‐Strategic Leadership)

I think there were some of us that got pushed into places that we were… I think that was a bit hard. Also, because services had to change overnight, like my colleagues that cover Antenatal Clinic got told within a couple of days that they were moving to < Name of Hospital > for their clinic… (Midwifery‐Frontline Clinician)

It felt like they came into our world and told us how to do something we had been doing, as far as we knew, perfectly well. (Midwifery‐Frontline Clinician)

I think it was the way it was brought into us, being told that it was just going to happen straightaway, I think there was a little bit of a feeling of oh, well, is it not a worry for us being overheated and hot anymore? (Midwifery‐Frontline Clinician)

…think it was just… the uncertainty I found really, really challenging in that I did not know whether or not in less than two weeks if I'd be working full‐time shifts or if I'd be working from home… (Midwifery‐Frontline Clinician)

…it felt slightly tricky because we were not really sure what we were telling people and, in the beginning—and this is not a criticism at all because everybody obviously was dealing with this huge situation that developed out of nowhere and nobody knew what was happening—but I think it highlighted lots of, I guess, issues in the system… (Midwifery‐Clinical Research)

I do not quite see why I cannot work from home. But there still seems to be a bit of… I do not know if taboo is the right word but just a lot of suspicion that if you are at home, you just do not really do very much, but actually I think I'm more productive at home. Yes. I guess it's the manager's call maybe, I do not know, or just the culture of the place… (Midwifery‐Frontline Clinician)

So pretty much everything apart from gestational diabetes and Type 1, Type 2 in pregnancy disappeared. The preconception clinic was stopped. The rapid access clinic stopped. The community clinics closed. And many of the staff in diabetes were redeployed onto frontline, so there were about three of us left in the diabetes in pregnancy service and we basically ran it, with increasing numbers of pregnant women. (Other Medical‐Frontline Clinician)

…over time it felt better because the systems then were put in place and once people had asked those questions and you knew the answer then if people rang again, it made it easier. (Midwifery‐Clinical Research)

I think the good thing about COVID is it's highlighted where some systems maybe needed to be improved and that got better over the course of the time… (Midwifery‐Clinical Research)

Normally all the better birth stuff is trying to very much change care according to evidence and if suddenly lots of things happen that are not evidence‐based just because they had to happen, and they never got changed back that would feel like it's a shame. (Midwifery‐Clinical Research)

I'm hoping that with research that's going on at the moment, things will not just go back to the way it was or they were but actually whoever is in charge and making big decisions will actually be looking at the research that's coming out and seeing what's good going forward as opposed to just assuming that pre‐COVID times was fine and let us just do that again. (Midwifery‐Frontline Clinician)

But then things would change all the time so you would never sometimes know what on earth you were going to come into when you came into work. And I suppose then they did not know, like our managers did not know what would be happening, I do not know. So, sometimes it felt… It's quite unsettling when you do not know what you are going to be doing when you go to work… (Midwifery‐Clinical Research)