Continuity | SilverWillow Doula

When a woman finds out she is pregnant, everything changes. Irrelevant if it her first or tenth baby, her personal and family dynamics will change forever. This can be a stressful, anxious time. Not always, but it can be. Now imagine that the people joining you on this journey are not always available? In fact, you may have never met the same midwife twice antenatally. So, when you have a personal, burning question, are you feel comfortable asking a stranger? Or is it easier to ask Dr. Google?

I have been pregnant twice, and have had two completely different experiences. During my first pregnancy, I had many different midwives antenatally and various people coming and going during my birth. I have since had a birth ‘debrief’ and my notes were discussed as if it was a ‘nice, normal birth’. Maybe I was making a mountain out of a molehill? I did not feel it was nice, and certainly not normal. That’s not how I felt. My views and thoughts about my birth experience can not be documented by someone else. It wasn’t their experience. During my second pregnancy, and despite being considered ‘high risk’ (I HATE that term – don’t get me started on negative language in maternity care!), I had a beautiful cesarean section, and my postnatal recovery went wonderful, we took to breastfeeding well and I adapted to being a mummy of two fairly smoothly.

Of course both pregnancies were different, as are my two babies. But similarly, I was different both times. A different woman – One, anxious and scared to question things and the other, confident and sure of her informed decisions.  One of the biggest factors that I believe made a difference was the care given during my second pregnancy. I had one midwife. She supported me. She was available for me physically and emotionally. She had my back. Despite not being there for the birth, she was there the following day. This led to me feeling relaxed and confident that I had someone available who I knew, and who knew me should I have any worries or concerns.

Continuity of care is identified as the delivery of ongoing care throughout pregnancy, birth, and the postpartum period by an individual or small group of individuals. Building a relationship with someone, and becoming comfortable with them allows you to develop trust, and the ability to explore anxieties and insecurities. You can also grow and develop together, increasing knowledge and confidence through this mutual journey.

There are huge benefits to providing continuity during the perinatal period. In 2016, the Cochrane review found that providing continuity in midwifery care reduced the likelihood of preterm births and still births significantly. But its not just about whether the baby lives or dies. Developing a trusting relationship with her care giver, allows her to have a positive experience of pregnancy and birth. A negative birth experience can have repercussions for a long time! The holistic sense of safety is achieved through continuity models of care.

Its not just women who benefit from the same birth worker, that friendly face arriving at an anxious time. Imagine you’re a first time dad and your partner has been in pain on and off for hours. Who do you want at your door? That nice lady who is a calming presence and knows how you like your tea made, or a complete stranger? Or your newborn has been unable to feed well, your partner who is 3 days’ post partum is teary and unsure of what to do and how to settle baby. Wouldn't’t it be nice to give that nice lady a call and ask her for some friendly advice rather than speaking to a stranger and having to relay your whole pregnancy and birth story? Yet again!

And us birth workers benefit too! Getting to know our women, how they want their birth and helping them as much as possible to achieve it is such an honour. I go on call from 38 weeks of a pregnancy. Who can honestly say they like being woken up at 2am and expected to go out for who knows how long? Me! I’m not going to a strangers’ house. I’m going to my friend, who also happens to be a client, as she begins a new journey. I feel privileged and lucky to call this my job. Getting to know women, developing a trust, respecting her values, supporting their choices, allows her to have a safe pregnancy and an empowered birth.

Healthcare is an ongoing, developing business, with constant research into providing the best care in the most cost efficient way. In 2016 the National Maternity Review published the ‘Better Births’ document, which recommended that women have a community based, named midwife providing continuity throughout their pregnancy, birth and the postnatal period. I’ve already mentioned the emotional benefits of providing this continuity. But it saves money too! Less likelihood of preterm birth, cesarean section and interventions during labour. It doesn’t take a genius to realise this would save the NHS a fortune.

Given this, some would suggest continuity of care is a no brainer. Why isn’t this the norm?

In 2017, the University of Birmingham conducted an online survey of 798 midwives from around the country to explore their perspectives of different ways of working. Barriers to providing continuity care included practical ones such as caring responsibilities. Do they have young children that require childcare? Many people don’t have someone they can call on if they get called out at 2am. In these cases, regular shift patterns are likely to work better. What if they don’t drive? Or live far away from their normal place of work? Maybe they have a health condition that requires some sort of pattern in order to remain in control. Midwives wellbeing and work-life balance is a major factor that needs considering when introducing this new way of working.

That is where doulas come in. We are not midwives. We might know a thing or two about pregnancy and birth but we not replace healthcare professions. However, we do provide continuity. In a time where midwifery staffing levels are low, a doula can only enhance maternity care. We are that friendly face that is able to give you emotional support and to provide the continuity that women should have. We hold your space, walking alongside you as you go through this journey. What a privilege and an honour!