Asheville Doula: What is true Continuity of care?

You may or may not have heard a lot about continuity of care in the birth world or in your own pregnancy. NCBI explains: “Traditionally, continuity of care is idealized in the patient's experience of a 'continuous caring relationship' with an identified health care professional. ... Continuity in the experience of care relates conceptually to patients' satisfaction with both the interpersonal aspects of care and the coordination of that care.”

In pregnancy this typically looks like meeting all of the doctors or midwives in that particular medical practice and then seeing one of them after birth for a follow-up visit or two. But is that true continuity of care? Is that truly continuous?

While one can appreciate the effort towards patient connection I can’t help but feel completely dissatisfied by this model.

As doulas we are in a unique position to fill in gaps of standard, one-size-fits-all healthcare. Doulas focus primarily on the emotional health and needs of their clients. Our work allows us to do so because we are not medical staff, we aren’t employed by the hospital or medical establishment, we are employed directly by the birthing person. The birthing person is our “boss” and no other outside force or organization. This allows us the privilege of supporting each person’s individual emotional and educational needs during pregnancy, birth, and postpartum.

The average pregnant person will see their provider once a month or so until the third trimester. After the third trimester pregnant people will see their provider once a week until birth. During birth their OBGYN or midwife will pop in and out during active labor and catch baby. At that point patients typically see their provider at two weeks postpartum, then six weeks postpartum, and then…. Nothing. After six weeks postpartum, after nearly a year, care is gone.

After arguably the most monumental thing your body and spirit could do, after nearly a year of growth and changes, after clearly being in the most vulnerable state of your life, that relationship and care basically ends at a few weeks postpartum.

Is that a continuous care relationship? Truly, it doesn’t sound like much of a relationship at all.

We all understand the physical constraints of medical providers. But what about doulas? What about the person you hired for emotional and educational support? In many doula trainings birth workers are encouraged to taper out the relationship with the birthing person a few weeks postpartum as well.

I’m honestly not sure why but it seems as if everyone leaves in the postpartum time. Doctors, midwives, doulas. There’s a whole build up and flurry of activity and anticipation surrounding birth but then postpartum we are saying goodbye? And we are shocked at postpartum depression is rampant? Isn’t it clear what’s happening?

New mothers need, and deserve, just as much support and tending to in the postpartum as they did during pregnancy. If not MORE SO. With lack of sleep, breastfeeding or bottle feeding challenges, isolation, hormones dropping, body and emotional changes, parents need MORE support- not less. Certainly not a “tapering off” of care.

I believe the answer is a shift in peoples’ perception of postpartum and a true offering of real continuity of care. I believe we can be the generation that changes the narrative around postpartum needs. No more “bounce back” nonsense. No more pretending to have life together. No more mothers going back to work 2 weeks postpartum (like I did with my first baby.)

We need more postpartum doulas. We need more family members buying postpartum doula hours for new families instead of buying stuffed animals and fancy baby clothes. We need a better awareness of the raw realities of postpartum and how challenging it is.

We need more postpartum classes and education for new parents. Birth lasts hours… Postpartum and life with a new child is virtually never-ending… Yet almost every new parent is unprepared.

New mothers need people willing to listen to their birth stories, meals brought without question, dishes done, sunlight, showers, encouragement, and a whole hell of a lot more than just a six week follow-up visit to talk about birth control.

And I suppose I’m sort of radical in a way that I, as a doula and student midwife, do not taper off my care. I fully believe in true continuity of care. I still check in on clients who are years postpartum. I aim to develop true relationships. Real relationships don’t end. I feel this is what doulas should be doing. I think doula care should extend beyond birth. I am a friend and resource for life after being hired as a doula.

Doulas are in a unique position to provide that continuity of care and I believe that extends beyond the birth room.