The phrase “it takes a village” originates from an African proverb that emphasizes that for children to thrive, they need to receive collective support from many people (i.e., a village). However, the same sentiment can be extended to mothers, particularly during the perinatal period—the time during pregnancy and the year following childbirth.
A team-based approach (e.g., collaborative care model) is when a pregnant person’s maternity care provider collaborates with other professionals to seamlessly manage perinatal care. While this approach has been shown to improve both physical and mental health outcomes and reduce racial disparities, it has still not been widely adopted in maternity care—even though these disparities and mental health challenges are key drivers of poor pregnancy outcomes. Regardless, pregnant people can create their own holistic care teams to meet their diverse pregnancy and postpartum needs.
While most people may only think of an obstetrician-gynecologist or OB/GYN (a medical doctor specializing in women’s reproductive health) as the primary perinatal provider, many other providers can assist during this time. Below, I will outline additional providers you might want to consider when developing a personalized maternity care team.
Medical Professionals
- Primary Care Physician (PCP): A primary care physician (PCP) may have been your main point of health care contact outside of the perinatal period; however, preconception and prenatal care, postpartum, and newborn care are disciplines included within the scope of practice for PCPs. A PCP can be particularly helpful to collaborate with your maternity care provider(s) to offer continuity of care in monitoring and treating pre-existing health conditions throughout pregnancy and postpartum.
- Certified Nurse-Midwife: The midwifery model of care is complementary but distinct from that of the medical obstetric practice. Midwives are experts in the care of typical (or lower-risk) pregnancies. Their model of care emphasizes collaborative decision-making to promote the pregnant person as an active partner in care and avoid unnecessary intervention. You can have (and may need) both a midwife and OB/GYN as part of your team, particularly since midwives cannot perform surgeries (e.g., caesarean section or C-section delivery).
- Maternal-Fetal Medicine (MFM): Maternal-fetal medicine subspecialists are obstetricians with advanced training in the care of complicated pregnancies in which there are health concerns for the pregnant person and/or baby. You might be referred to MFM if you have a pre-existing health condition, develop a pregnancy-related condition, experienced a complication in a previous pregnancy, are pregnant with multiples, or there is a condition affecting your baby. Depending on the reason for the referral, you may work with the MFM team for a single visit or throughout your pregnancy.
- Psychiatrist: Psychiatrists are experts in the diagnosis and treatment of mental health conditions through medication management. There is a sub-specialty of general psychiatry called reproductive psychiatry that focuses on mental health complications related to reproductive cycle transitions, including pregnancy and postpartum. This is important because upwards of 1 in 5 women experience pregnancy-related mental health complications, and having a previous mental health episode creates an increased risk of reexperiencing symptoms. Reproductive psychiatrists have specialized training in helping weigh the risks and benefits of psychotropic medications for safe medication management of both pregnant or postpartum person and their baby.
Mental & Social Health Professional
- Mental Health Therapist: Therapists can work with you using research-supported, non-medication approaches to treat mental health issues. There is a certification in perinatal mental health (PMH-C) that therapists can obtain, which recognizes therapists who have completed advanced training in the care of clients impacted by perinatal mood and anxiety disorders during pregnancy and postpartum. This is important because mental health conditions are the most common complication of pregnancy and childbirth and can mirror typical pregnancy or postpartum symptoms, causing maternal mental health issues to be written off by untrained providers. The greatest risk factor for developing perinatal mood and anxiety disorders (PMADs) is a previous history of mental health conditions. So, whether you are experiencing PMAD symptoms or are taking a proactive approach due to previous struggles, adding a therapist to your care team can be especially beneficial given the high prevalence of perinatal mental health issues.
- Social Worker: Social workers can serve in a variety of capacities depending on the treatment system in which they are providing care. Optimally, within a maternity collaborative care model, social workers can act as care managers who serve as the point of contact by tracking and monitoring the health and wellness information across treatment encounters while also facilitating collaboration and communication between providers. Social workers can also offer additional recommendations and referrals on whom to add to your care team when necessary.
Allied Health Professionals
- Dietician: Registered dietitians (RDs) are professionals trained in providing nutrition counseling customized to an individual’s perinatal needs to promote maternal and fetal/newborn health. RDs can assist with developing dietary interventions to manage conditions such as acid reflux, weight gain (too much or too little), and gestational diabetes. Systematic reviews demonstrate that pregnant individuals who used RDs during pregnancy had a reduced risk of low birth weight and preterm infants.
- Physical Therapist: Physical therapists are licensed doctors who specialize in diagnosing and treating movement dysfunction and injury to improve a person’s quality of life and ability to function. A physical therapist can focus on the unique physical needs of a person’s body during pregnancy and postpartum to support perinatal care with issues such as pain, diastasis recti (abdominal muscle separation), and pelvic floor functioning. It is important to note that physical therapy can help support postpartum recovery regardless of mode of delivery (i.e., vaginal or c-section).
- Doula: Doulas are non-medical professionals who provide continuous, one-on-one care and labor support. The four pillars of labor support include emotional support, hands-on physical support, education, and advocacy. Continuous labor companionship has demonstrated improvements in birth experiences and the health and well-being of birthing persons and babies. Doulas are a cost-effective and research-supported method of providing this type of labor support!
- Lactation Consultant: Lactation consultants are professionals specializing in providing breastfeeding and lactation support. While there is often lactation support available through birth settings after delivery, you can also schedule individualized prenatal lactation counseling during pregnancy. After childbirth, you can then receive ongoing lactation support throughout the postpartum period in areas such as hands-on practices, including positioning and latch; milk expression and storage; feeding multiples; returning to work strategies; and weaning.
It’s important to recognize the bidirectional relationship between breastfeeding and mental health. On the one hand, mental health conditions such as postpartum depression and anxiety (i.e., PMADs) can negatively impact breastfeeding outcomes while also being exacerbated by it. On the other hand, breastfeeding success can have positive impacts on maternal mental well-being. Support from lactation consultants can play an important role in supporting breastfeeding goals, which can, in turn, promote maternal mental health.
Bottom line: a common myth of motherhood is that pregnancy, childbirth, and being a mother are “natural” and, as such, “you should be able to do it all.” In reality, there’s nothing easy about it. Creating a maternity care team aligned with your values can promote the best outcomes for your mental and physical health.
