Spokes in the wheel – women and allied health

A pregnant woman’s needs may be diverse and many. Women come to pregnancy often with physical, social or emotional problems that pre-date the pregnancy. In order to meet her needs effectively, she often requires access to a wide range of caregivers and support while pregnant, during her birth, or in the weeks postpartum.

For example, a woman may be suffering from emotional challenges, perhaps exacerbated by an unplanned pregnancy. A skilled psychologist and/or social worker could be invaluable support, in conjunction with her midwifery care. A woman may have specific nutritional needs (such as gestational diabetes or anaemia) where working with a nutritionist will be helpful. The list of allied health professionals that women may need to access during their pregnancy, birth or postpartum experience is vast: from radiographers, physiotherapists and psychologists, to social workers, nutritionists, naturopaths, and more.

Women and families: at the centre of a network of care

The need for childbearing women to access a range of services has the potential to create a network of effective and supportive relationships, or a tangled web of confusing, and sometimes conflicting, advice. The following two examples are both commonly seen in maternity care around the world and demonstrate how a woman can fall through the cracks when different health care providers involved in the women’s care don’t connect with each other.

Janina

Janina sees one doctor through her pregnancy, whose sole focus is managing her diabetes. She then visits her midwife or obstetrician who only discusses her pregnancy. Janina doesn’t understand the connection between her pregnancy and the diabetes, and the impact on her birth or the early postpartum hours. This situation has inherent potential for miscommunication, misinformation, and healthcare errors.

Luisa

Luisa is in a violent intimate partner relationship and is seeing a counselor and a domestic violence worker. She’s given strategies around being safe and leaving her abusive relationship. The hospital, doctor and midwife, however, are imposing a rigid schedule of visits on her, which are hard for her to attend. The hospital doesn’t understand the stresses Luisa’s under within her relationship, and how this schedule impacts her. Women who are in violent relationships are more likely to die, especially in pregnancy. Fear, lack of communication, and not knowing where to get support are often key factors that either support her, or further exacerbate her difficult (and maybe life threatening) situation. In order to save women’s lives, we need to solve this problem.

What’s the solution?

It’s often difficult for allied health practitioners and medical specialists, as they rarely know the whole picture of the woman and her family, especially if they don’t have a relationship with the other caregivers involved. Their role is often task-oriented and focused on a specific goal that sits within their field. To ensure we avoid the tangle resulting from this task-orientated approach and instead create a clear connected pathway for the woman to travel, we have to acknowledge that not only does the woman need effective relationships with different practitioners in her care, there needs to be a process that brings those relationships together in an effective way: connection between the caregivers, the woman, and each other.

Failure to foster positive relationships, collaborate across disciplines, and coordinate a woman’s care within an atmosphere of balanced power and woman-centeredness, is putting lives at risk.

It’s time to make a change.

Over to you

What other relationships with health professionals can you think of that may be important for women during pregnancy, birth, or the early weeks of parenting?

Can you see areas in which a lack of connection between these caregivers and the woman’s doctors and midwives could cause problems for her care?

How could these connections between caregivers be best facilitated?

Share your thoughts in the comments.