Continuity of Care: Are You Getting It? Part I - OB's
Updated: Sep 4, 2019
I teach a 12-week childbirth education course. Yep, that’s three whole months. Most mamas are well into their second trimester or in their third trimester when they sign up. We always talk about the importance of choosing a health care provider who truly supports the pregnant mother’s birth goals. This is so important and makes such a mark on a mother and baby’s experience of birth that I cannot over emphasize it enough. Even so, it’s extremely rare for families to switch providers at this junction – even if they suspect their provider may not have the exact philosophy to support the birth the mother says she wants. This is for a very understandable and normal reason: all mothers want continuity of care.
What is “continuity of care?” Continuity of care describes a situation in which the expectant mother receives care from a single health care provider throughout her pregnancy, during labor and delivery, and during the postpartum period – therefore, she receives continuous care from one provider. In societies with the best maternal and child outcomes, this is the standard of care mothers receive. For example, in the Netherlands, a mother can receive care from a midwife or a family physician who will attend her at her chosen place of delivery, which can be either the hospital or the home. This type of care creates a safer experience for mother and baby, with less likelihood of miscommunication between health care providers and allows women to feel more confident going into their birth experience.
Here in the U.S., most women deliver their babies in the hospital setting with an obstetrician (OB.) Obstetricians sell themselves as the safest health care provider for pregnant women. What type of care do pregnant women and their babies really receive from OB’s? At first, this does feel like continuity of care. The expectant mother meets each month with her chosen OB. So, this feels like continuity of care during the prenatal period.
What happens during labor and delivery? While a laboring mother will call her OB to let him/her know she is in labor, physicians do not attend the labor process. Sometimes they will stop by the labor and delivery ward to check-in on progress (and often suggest moving things along at that time.) However, OB’s most often just show up when then nurse informs them the mother is in the pushing phase. This means that the laboring mother (who understandably expects continuity of care) is being cared for by the nurse (a stranger she has never met before) who monitors her care and reports back to the OB (telephone game, anyone?) In addition, the mother is not guaranteed her personal doctor. Many OB’s work in group practices (which is an understandable choice to keep up with work demands and to also have a private life) and it’s a crapshoot as to whether her doctor will actually be on call the day she goes into labor. Is this continuity of care? No. This is not continuity of care. This is a kind of bait and switch maneuver. Selling one thing, giving another. Mothers believe they are getting continuity, but, in reality, this is not the case.
What happens postpartum with an OB? While in the hospital, an OB may come in after the birth to check in on the mother. Once she leaves the hospital, that’s it until the six-week check up. No checking in on how the mother is doing, how breastfeeding is going, or how the infant is doing. Infant care is transferred to the pediatrician once the baby is born. Postpartum continuity of care? Nope. Not optimal.
If an OB is your first choice of provider, or your only option due to insurance or medical reasons, understand that you must think about how to provide some measure of continuity of care for yourself because it is not built into the system you are working with. That’s not a value judgment. It’s just reality. Continuity of care is important for the physical, mental, and emotional impacts on your personal experience and also your baby’s experience. This will also affect your partner. Your doctor and the hospital staff provide clinical care. However, it’s important for you and your partner to take active steps to prepare for and create an environment with the most support and understanding so that you are less likely to be adrift during pregnancy, birth, and postpartum. Here are some ideas:
Become aware of the steps you need to take to keep you and your baby in the healthy and normal continuum (also known as “low-risk”)
Once you know these steps, practice daily with love and intention (leave perfection behind – it’s not helpful to you and your baby to try to do everything “perfectly.”)
Find community and a support network: set yourself up with classes and connections with birth, breastfeeding and postpartum professionals who can help you find your way so you can set yourself up for a good transition to family life.
A thorough and practical childbirth education course is a must. This is not jut for first time parents. If your first birth was not positive or did not go the way you wanted, education can make a huge difference the next time around.
Prepare for the postpartum period, too, not just the labor and birth. Many times this is left completely off the radar.
If you have friends and/or family knowledgeable about physiological birth, breastfeeding, and who know how to care for new parents, enlist their help and support.
If you do not have friends or family members with these skill-sets, a doula can be a source of support and knowledge. She can be a personal guide and help you find your navigation skills in a new territory.
If you are not planning on having a doula (and even if you are!), I recommend a Bradley Method® childbirth education course whether you plan for a natural birth or not. A Bradley Method® course delves deep into a lot of choices you have as parents and makes you aware of what you need to prepare for throughout your pregnancy for the labor and birth as well as when baby comes home.
All mamas want continuity of care. That is why most expectant mothers do not switch providers. It is normal not to want to switch providers. Be aware of your choice of provider, though. It is okay to switch providers and I strongly encourage you to do so if you are having any doubts or hesitation about your provider. There are no re-dos and this experience lives with you and your baby for the rest of your lives. This is your birth. You are responsible for your choice. There is no right or wrong choice. There is just the situation, what your provider’s skill-set is, and what the limitations are to what he/she can provide.
There is no substitute for you and your partner being as prepared and aware as possible. When you are not prepared, you are depending on others to come through for you, which may or may not happen. In the case of working with an obstetrician in the hospital, realize that this set up is not continuity of care and there are inherent weaknesses in this model of care. Be truthful with yourself about the situation and ask what you can do to cover the bases (at least physically, mentally, and emotionally) to make sure you have an experience that honors you and your child. Doing so will help ensure that you and your baby have a happy birth day!