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An OBGYN On Why We Need Postpartum Care—And How Doulas Can Be Part Of The Solution

Co-Founder Nathan Riley, MD

There’s so much attention on you when you’re pregnant, but once baby is here, it can feel like you—a person who just grew a human and got them out of your body!—is a bit of an afterthought. New parents need care—period. But the reality is that most new mothers and fathers aren’t getting the care, support, and education they need to feel calm and confident in the fourth trimester. 

We talked with Nathan Riley, OBGYN and our head of digital health strategy here at Major Care, to get a clinician’s perspective on how postpartum care typically happens in our medical system and why postpartum doulas—especially virtual ones—can be a key part of the solution. 

MC: Can you describe what postpartum care generally looks like here in the US?

Well, for mothers who have a baby in the hospital, when you’re getting ready to be discharged, you’ve given a folder with maybe a few handouts and told to make an appointment at around 6 weeks after birth. Then, at 6 weeks, you haul all of your stuff to your provider’s office for 10 minutes of interaction while they go through a computer checklist. The doctor is in there for a few minutes. They check your vagina, vulva, perineum, talk to you about contraception. It’s a bit like, hey you’re here, then you’re on your way and you don’t see anyone after that. If it’s just a matter of making sure you’re not dead, well, ok that’s been accomplished. 

MC: Yes, it’s often pretty brief and in general, surface-level care. So, what do you think is missing from this typical postpartum care experience?

What about all of the other parts about what it means to have a baby that aren’t being addressed? Most people are “considered ok” after that appointment, but what about the emotional, spiritual, psychological aspects? OBGYNs are not trained to do that, and we can’t expect them to do that.

MC: That’s true—providers are already working on extreme time limits and other pressures. 

What we are really missing is a person who can sit with another person in an exciting and scary place and help them navigate that emotionally. That’s what missing from the postpartum visit— all of the stuff about this as a very challenging part of being human. Doulas and others who provide quality maternal care see that and recognize it. It’s a humbling, challenging, human experience. It’s not just a collection of data. It’s not just “How much are you bleeding?” it’s  Oh my god, you just gave birth, tell me about that!” There’s so much power in that experience. It’s been lost in how we’ve tried to pathologize the birth experience. We need to honor the sacred and physiological process that is birth and postpartum. If we can get back to that, we will be on the right track.

MC: Why do you think virtual doula care can be a solution to this problem? 

The improvement isn’t going to come from the medical model. A doula isn’t a medical professional—and thank god they aren’t! Doulas understand the incredible journey that is this transition. 

If we integrate doulas, including virtual doulas, correctly, they can also be a first-line screen to identify people who should go to see their doctor because of a medical issue. For example, our systems get these really expensive emergency room visits that are unnecessary 99% of the time. People are coming in for issues with their stitches, their vulva feels itchy, pretty minor stuff. It’s really inconvenient for the patient and it is extremely expensive for the country. People don’t realize how complicated it is when you’re forcing women to go in and out of the hosital for every little need, because they don’t have anyone in their community they can ask their questions to.  For those two reasons alone, we need to be doing something different in caring for women during the postpartum time. 

The reality is that majority of what people need after birth is not medical care. The doula can provide other aspects of care that we are missing, plus be a screener to help us know what people do need more medical care. 

The COVID-19 pandemic offered an opportunity to show the system that women dont have to go to the clinic every 4 weeks. We can do so many things over a video camera, including comprehensive maternity care. Covid proved that and we learned that home-based model can work. Given the limitations of our system to send people to everyone’s homes, the telehealth platform is a beautiful compromise. 

What we have here at Major Care, the virtual postpartum doula model, is a simple thing that we could roll out right now. It is an elegant solution that can keep people out of the ER. Why not just log in through your phone, find out if what you’re experiencing is a good reason to go to the hospital, and then make a decision from there? By linking people up with a handy device they already have in their hand anyway, they get their questions answered by a doula and they go back to living their life and bonding with their baby. 

MC: Can you tell us a little bit about Beloved Holistics, your new service where you provide free collaborative OBGYN care online? 

Long ago, privileged white men saw an opportunity to make money off of maternity care to move birth into the hospital. It became a battle between the smear campaign against “dirty” midwives vs the clean and sterile option of the hospital. Fast forward several hundred years later, and where we are today is that most women can’t access quality healthcare, because the system isn’t set up for healthcare—it’s set up to make money. Everyone is out there trying to get rich. The hospital system has you by the ovaries because you need to go there. They’ve created a commodity out of something you are in need of. 

So, I believe you should be able to get care without worrying about the cost. By gifting my service, it allows me to care for people one-to-one and to provide them with all of my healing powers. There is no transactional nature to it. I provide it on a limited basis, so when my time is taken up, it’s taken up. I gift it in the way that the earth gifts her bounty—there is no more until there is more.