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Aug 14, 2026
008 · HtS Expertise Across the Street
008 · HtS Expertise Across the Street
00:00
43:39
Transcript
0:00
This is Harvest the Signal, where the smallest signals can change the biggest systems. And now, here's your host, Jodi Lynn Owen. [gentle music] What is the system trying to teach us?
0:14
That's the question behind every field note, and this week's is the expertise across the street. I'm Jodi Lynn Owen, coming to you today with my midwife and my systems hats on, and this is Harvest the Signal.
0:32
I'm going to disclose something here in the beginning. I had to record this twice.
0:37
I was a bit salty when I did the first read through, and I was talking with my hands a lot, and I just kept walloping the microphone, and it's really hard to edit all that out. So this is the second go-around.
0:52
If you look at the time we normally take to review a field note, you'll see this one is, relatively speaking, quite long, and that is because it is really full, and as I started to go through my original field note, I kept saying, "Oh, let me just add this in, and let me tell you about that, and let me throw this up, and let's just name it all.
1:14
Let's throw it down in this one." So I wanted to re-record it, and I am intentionally going to build a case for a model of postpartum care that we should all study.
1:26
But I went to stack up factors that have created what we do have and factors that can come together to build a better future.
1:36
Along the way, as I was talking, I really noticed that I was going to be talking about a lot more than just a postpartum model in order to expose what I think all those factors are.
1:50
And today, while you're listening, along this journey, I am going to talk about getting OBs into practice where they can share their best selves, talk about
2:04
getting doulas into a role that exposes the very best of what they have to offer without asking them to plug holes we created by thinning out resources for health systems.
2:16
And I share what I think is real expertise located right next door or across the street to the folks who seem to be looking in every other place except next door or across the street for solutions.
2:30
So thank you in advance because this is a bit of a longer one.
2:34
Now, I'm talking to you through this one from inside a profession that has spent decades practicing a version of postpartum care that much of American maternity care is only now beginning to imagine at scale.
2:49
And that's where I wanted to focus my field note. When one of our clients in this midwifery world has a baby, the birth is neither the beginning nor the end of our relationship. It is a chapter of it.
3:04
After the baby is born, midwives do something called home visits. We leave our clinic or our birth center, and we go to where the new parent or the new parents and the baby are.
3:14
Now, this is probably a ridiculous explanation of a very simple concept, but I really want to share what it's like to be inside that experience. So we go into the home.
3:27
We sit beside the family while they are figuring out breastfeeding or how they're going to feed their baby. We check blood pressure, bleeding, healing. We weigh babies.
3:40
We talk about sleep, pain, nutrition, mood, all the big changes between the adults in the family with the new baby, with ourselves. If we've given birth, our relationship with ourself changes dramatically.
3:54
We talk about contraception.
3:56
We talk about bowel movements for mom and baby, sore nipples, stitches, milk supply, and I guess in general, all of the extraordinary amount of bodily fluid management involved in being home with a new human in the first few days after you've given birth.
4:13
We are not just collecting these hard points of data or sharing our tips and tricks or having structured conversations, which we are, but we watch how a mother moves when she stands up.
4:25
We notice whether she winces or seems to get dizzy. We see where the baby sleeps and how the family is functioning around them.
4:35
We wait until the baby is actually hungry so we can watch an organically occurring on-demand feed.
4:43
A hungry baby has behaviors worth observing, and the lactating body responds to that baby in ways that a staged or even a described feeding can miss.
4:54
Watching that interaction in real time sometimes takes a long time to get to, but it gives us important clinical information about feeding, physiology, and how this dyad is doing together with each other.
5:10
We don't do this once. We do this several times over time because postpartum is not an appointment. It's a transition, and transitions are not locked in place. They move.
5:27
Now, don't get all romantic on me, okay? This is exhausting whole body work. We sit on floors a lot. We pretend cats are cute.
5:38
We wash dishes and talk to partners and husbands and new grandparents to help ease their minds or give them concrete tasks that turn their fretting into action that serves the new family.
5:51
We sit in a lot of traffic, and we hold place for the realities of this time because a person can be doing beautifully on Monday, and they can be struggling by Tuesday afternoon.
6:02
Milk comes in Sleep deprivation accumulates, feeding changes, blood pressure can rise, moods can shift. A baby who seemed to be feeding really well may not be gaining appropriately.
6:14
And then we have this whole other issue that pregnancy does not necessarily end when the baby arrives.
6:22
The conditions of pregnancy can and do follow someone straight home from the birth center or the hospital where they delivered.
6:29
A mother who entered birth with undertreated anemia may emerge from it even further depleted, now trying to recover from blood loss while producing milk and functioning on fragments of sleep.
6:42
Someone who managed glucose really carefully through their pregnancy may discover that the body's needs have changed yet again, and they have to learn an entirely new rhythm of food prep, eating, and monitoring at precisely the moment when preparing a meal for oneself can feel like an ambitious undertaking.
7:01
Physical recovery in the postpartum is deeply informed by the level of physical activity during pregnancy.
7:08
So all of these things, and much more, get pulled through the pregnancy into the postpartum time because physiology does not respect the administrative boundary we in the systems have drawn around birth.
7:21
It doesn't care one iota. Neither does the family, and neither should the care. Something that has stayed with me over the years is the reaction I've seen when friends who are OBs or doctors have their own babies.
7:35
Some have expressed genuine shock at what happens between day one and the traditional six-week postpartum visit. Now, every new parent gets to be shocked by this.
7:47
So I'm not saying that from an accusatory point of view, but I want to talk about postpartum models, and this is a really great illustration of it.
7:55
These new parents who are also doctors are people who have cared for hundreds of pregnancies. They know pregnancy. They know birth. They know postpartum complications.
8:06
But their professional experience has given them a detailed view of day one and a detailed view of day 42, and remarkably little access to the lived territory between them. For midwives, that territory is not a void.
8:22
It is not a chasm. It is not unknown. It is the work. We walk into homes or have people come into the clinic many, many times between day one and 42, and we behold the magnitude of change.
8:39
There is joy, confusion, and dysregulation moving through each individual and the family unit. We notice the partner who looks terrified.
8:49
We ask the questions that open the door to things no one planned to talk about, and that's because we see it over and over again, and we know the normality of some of those things rising up, so we know how to name them.
9:03
This is postpartum care as I learned it, and as midwives are actively practicing it right now at this very moment while you are reading or listening to this.
9:12
I promise you there's midwives in people's homes, sitting on the floor, covered in someone else's cat's hair, taking care of a family in this exquisite way.
9:22
All that said, let's talk about the fact that everyone suddenly wants to redesign postpartum care. For decades, the standard postpartum experience for the vast majority of American families has been remarkably thin.
9:39
You have a baby, you leave the hospital. Depending on what happened during the birth, you might have a one-week follow-up. If you had a cesarean birth, someone may check on your incision.
9:50
Then often, the next substantial event on the calendar is the postpartum visit at six weeks. Think about what I shared about my experience and care during the postpartum time that midwives give.
10:02
Many, many, many times between day one and 42. Now think about that routine model. Day one, day 42. All of us in obstetrics and midwifery monitor a pregnancy for nine months, hopefully. Sometimes it's much less.
10:18
Sometimes we get a full 10. But toward the end, we might see someone weekly and sometimes several times a week if they need extra monitoring for any reason. And then the baby arrives.
10:30
And at that very moment, when a woman is bleeding, healing, sleep-deprived, establishing feeding, undergoing enormous hormonal change, caring for a newborn, and moving through one of the largest physical and psychological transitions of her entire lifespan,
10:48
the infrastructure around her suddenly goes dark. We built a system around the birth event. We did not build one around the postpartum transition and certainly not around matrescence.
11:04
In 2018, ACOG articulated a different standard on paper, postpartum care as an ongoing process rather than a singular encounter.
11:15
The maternal health world has since talked about earlier contact, additional visits, remote patient monitoring, lactation support, behavioral health screening, care navigation, and better ways of keeping people connected after discharge.
11:31
Virtual care companies have sprouted up to address this, creating additional touch points and new ways to connect with people between traditional visits.
11:38
But the plan on the ground where the vast majority of people receive care has changed very little, if at all. A large part of the reason is economic.
11:51
The recommendation changed, but the payment architecture really did not.
11:55
For years, the model has been a global maternity reimbursement model, and that means you are allowed to bill one time for everything that happens from the first time you meet a person until after their birth and one time from the moment of birth until six weeks postpartum.
12:12
And whatever you do within that space is reimbursed at the same rate, regardless of how much you do. So all of those visits those midwives are doing, they are doing it for no extra pay.
12:26
They are including it as part of the model of care that you are paying for when you pay that same fee.
12:33
There are exceptions to this, of course, for higher risk and maternal fetal medicine visits and specialist visits, but there's very few exceptions.
12:42
And the insurance companies, for the most part, will deny any claims they possibly can that exist outside of that global reimbursement model.
12:50
That practice leaves very little financial room to build the kind of longitudinal postpartum care ACOG was recommending in 2018.
12:59
And one of the clearest examples of what happens when the economics change came with reimbursable remote patient monitoring.
13:06
As soon as we got that billing code, suddenly sending a patient home with a blood pressure cuff and maintaining an additional layer of clinical connection became operationally possible and feasible.
13:19
The care idea was not new at all, but the ability to pay for it was.
13:24
Beginning in January of 2027, so coming up soon, this global maternity payment model is scheduled to give way to a fee-for-service structure that makes individual pieces of maternity and postpartum care separately visible for reimbursement.
13:41
And I'm saying the word visible, and I'm not saying the word reimbursable, because I have thoughts about that.
13:47
I expect the change that is coming to actually create real movement, which I want to talk about, but I also expect payers to do their job and try not to pay. So they are going to quickly look for a ceiling.
14:00
How many encounters, at what rate, under what conditions? I would not be surprised at all if the arithmetic eventually lands remarkably close to what maternity care is reimbursed at now.
14:11
But even if the total reimbursement changes less than we hope it does or less than it should, unbundling the payment matters for a much more universally important reason.
14:22
It makes the individual pieces of postpartum care economically visible. And once care is economically visible, we can measure it, because everything in healthcare is measured through billing codes.
14:34
And that may be one of the most important lenses for us to understand why maternal health outcomes are so atrocious in this country. Because once we are able to see it, we can name it and quantify it.
14:46
And that only becomes visible through this economic system. So the payment architecture actually winds up spinning around and determining the care architecture.
14:58
I know we all hope we come up with innovations and designs for care and then the payments follow. That just doesn't happen or it rarely happens.
15:08
It's just not how it works unless you're in the nonprofit world or if you're working with an incredible MCO that is just uber committed to its members and making things great for them and trying to help them achieve excellent health.
15:22
So in recent weeks, and this was what spurred this entire
15:28
episode to come to life, I have watched very smart people that I admire a lot create frameworks and diagrams and infographics depicting what a more longitudinal, responsive postpartum care model could look like.
15:47
And there is something genuinely strange and slightly upsetting about this. Healthcare has a habit of searching vertically for expertise when sometimes it should search laterally.
15:58
We look upward, inward towards academic medicine, specialty societies, large health systems, consultants, technology companies, research institutes, and thought leaders.
16:09
And those are really important sources of expertise, but they are not the only sources because clinicians seated immediately adjacent to obstetrics, y'all, can tell you what it does look like.
16:23
Not theoretically, not as a proposed future state, not even as a pilot, literally as what happens every Tuesday.
16:32
Independent midwifery practices and birth centers have spent decades building systems in which postpartum care is longitudinal, relational, responsive, and delivered in a patient's home and or in the clinic setting.
16:48
That does not mean that every healthcare organization should just copy a midwifery practice. It means there is an existing system worth studying. So before you design the future, look sideways.
17:01
Otherwise, we risk drawing speculative maps of territory that somebody next door or across the street has been walking for decades. There is a very strange feature of institutional knowledge.
17:17
Expertise can be geographically, professionally, and institutionally close and still be epistemically invisible.
17:25
Obstetricians and midwives may care for the same families during the same biological process and sometimes right across the street or next door to each other and still operate from sufficiently different models of care that one discipline can contain knowledge the other barely sees.
17:44
The proximity of two professions does not mean that they have equal visibility or invisibility into each other. Many of us midwives, we entered midwifery after working as doulas and some of us for many years.
18:01
The experience gives us intimate knowledge of the world and the worldview of obstetrics. We have spent hours in hospitals. We have watched how care is delivered and how systems are organized.
18:15
And I actually want to add something here that is not in the writing. We receive patients every day into midwifery care who come to us carrying significant medical trauma from their obstetric care.
18:28
They sit down and tell us their stories.
18:31
And for years, I have wished that the system that created this model of care had to sit next to me to hear those stories too, because there is a lot of pain in the gap between what people expected and what they experienced.
18:46
And families are processing that pain while pouring everything they have into raising a new baby and becoming a family. I want to be really careful here because I have worked with obstetricians I love and value deeply.
19:02
I am profoundly grateful for the work they do. This is not about an individual obstetrician causing trauma.
19:10
It is about a system that often prevents obstetricians from reaching their full capacity as physicians and frankly, as human beings in the clinical setting. They are constrained at every turn.
19:24
There often isn't enough time for the kind of empathy a new parent needs.
19:30
There often isn't enough time for the kind of thoughtful education or shared decision-making opportunities that an obstetrician would prefer to engage in.
19:41
And there definitely is not enough space made for sorrow or joy or the kind of relationship that allows a patient to feel agency in their own care while being cared for and guided by their provider.
19:57
One of my favorite things to do when we have residents come through the clinic is to ask them before they applied to medical school, what did they imagine becoming and how is that changing now that they're in their residency.
20:13
And I think if you ask any doctor who they imagined becoming before they went to medical school, nobody would say, "Oh, I imagined working in a system that would make it almost impossible for me to be the magnitude of the person I want to be."
20:30
Nobody imagines a system that will squeeze out the very things that called them to medicine, curiosity, empathy, education, relationship, and the opportunity to grow through caring for another human being.
20:45
So when I talk about trauma in obstetric care, I am not pointing at any individual obstetrician. I am pointing at a system that harms patients and constrains the people caring for them.
20:59
And there is a lot of research that shows that that system also harms the people caring for them.
21:06
I don't think we even have the beginning-est, slightest idea of who our obstetricians could be if the system allowed them to become the physicians they imagined they would be.
21:19
Now that we talked about that, because I think it's a very influential factor in this discussion, I wanna go back to how do we innovate a postpartum model.
21:30
And I talked about a version of this idea that we have to look in other fields to learn for our own in a field note called It's Not About The Money, Honey.
21:41
And that piece explored our ability to see meaningful connections between things that don't initially appear related.
21:49
We create new ideas by seeing broadly enough to recognize what can be carried from one context into another.
21:56
We notice a principle over here, a pattern over there, an approach from a field that is not even ours, and ask, what happens if we bring that into this problem. And that's one reason narrow expertise,
22:13
however high level that expertise is, can sometimes work against innovation.
22:20
If we only look for answers inside the intellectual boundaries that we've already drawn around a problem, we dramatically constrain what we're capable of finding.
22:30
Postpartum care is a striking example of this because we don't even have to travel very far.
22:37
This is not obstetrics learning from geology or economics, although both have quite a lot to offer us over here in healthcare world.
22:45
The adjacent field I hope is obvious by now, independent, out-of-hospital, community-based midwifery. Now, I'm going to digress one more time because I can practically hear someone thinking it. Great. Let's do it, J. Lo.
23:02
Let's hire doulas, and we'll solve this problem. I want to address that. I am an enormous believer in doula care. I was a doula. It's how I became who I am in this profession.
23:14
Doulas bring continuity, presence, advocacy, preparation, knowledge of the birth environment. We bring sustained attention to the person moving through it.
23:27
One of the most important things I learned as a doula was to teach parents how to ask great questions, be quiet while they ask them, and then help them work through the answers.
23:38
It was and remains an extraordinary coaching role. And today, different than when I was in the role, the advocacy doulas provide has raised the level of accountability for everyone. We need doulas.
23:52
Some of the trauma I talked about earlier is reduced because a doula is in the room, but we need doulas to be doulas.
24:00
We have developed a really unfortunate habit in American maternal health care of identifying a gap and asking a doula to stand in it. Continuity problem, doulas. Navigation problem, doulas. Trust problem, doulas.
24:15
Disparities, doulas. Postpartum support, doulas.
24:20
Doulas have shown us that all of those things can be improved, but our deserved enthusiasm for doula care risks becoming a way of asking one profession to compensate for failures in the rest of the system.
24:36
I have seen physicians post things, this is almost a quote, "Thank goodness the doula noticed the patient was bleeding heavily and went to find someone." What? Where was your staff? Why was that the doula's job?
24:51
And I have been the doula in situations like that.
24:55
It is horrifying to recognize an emergency when you are not the person credentialed, equipped, or responsible for managing it, and then you somehow have to make the system respond.
25:10
So to the doulas who have noticed the bleeding, seen the change, recognized that something wasn't right, and raised their voices when no one else was responding, thank you.
25:22
I know what it feels like to stand in that position literally with blood pouring onto your shoes. I know women's lives have been saved because doulas were watchful and willing to speak up.
25:34
But those moments should make us ask what the system is relinquishing onto them. A doula's continuous relationship with a family should be baked into maternal health care.
25:45
At this point, I think it's nearly non-negotiable. But doula care is not centered on clinical evaluation and management, and it should not be.
25:54
A doula is not there to clinically assess postpartum bleeding, interpret changing blood pressure patterns, evaluate healing, assess the physiology of lactation, or integrate what happened during pregnancy and birth into an evolving postpartum clinical picture.
26:09
Some doulas, of course, carry additional credentials that expand their scope into some of those spaces, but those are very different roles, and that distinction does not diminish doula care. I hope you really hear that.
26:22
I want to protect it. The answer isn't to value doulas less. It's to stop using their extraordinary value as an excuse not to build the clinical infrastructure around them and the families they are serving.
26:38
Washington State offers a particularly uncomfortable illustration of how distorted the incentives can become.
26:47
Under our current Medicaid structure, comprehensive doula reimbursement can reach and does reach about $3,500 per pregnancy in that same global kind of reimbursement model. It's almost exactly the same.
27:01
While the global reimbursement for clinical maternity episodes for both obstetricians and midwives has been about $1,750. I am not arguing to pay doulas less.
27:14
I am arguing to look carefully at what our payment system shows us. It's telling us a story.
27:20
We have simultaneously under-reimbursed clinical maternity care and increasingly looked to doulas to fill the gaps that that very underinvestment helped to create, and I would argue did create.
27:35
The imbalance is felt by obstetricians and midwives, and it is not repaired by asking doulas to become something they were never trained to be or by paying them less.
27:46
We cannot solve a workforce architecture chasm by overburdening the profession that happens to be standing closest to the cliff.
27:57
And if we are serious about redesigning postpartum care, which I hope we are, the interesting opportunity is not deciding which profession can absorb more of another profession's work.
28:09
It is asking what becomes possible when each profession is able to contribute the expertise it actually has.
28:19
This is where my history as a swimmer and my ability to hold my breath is really paying off because I'm a little fired up about this.
28:26
But this is also where my work in interprofessional education and collaboration shapes how I see the problem.
28:34
We have spent years talking about team-based care in healthcare, and the biggest innovation we've come up with is a whiteboard in the birth room where we write down the team members' names and the care plan.
28:46
And that has been really important, but genuine interprofessional practice asks something harder of us than putting names on a whiteboard or different credentials on the same organizational chart.
28:59
It asks us to understand what each profession uniquely knows and to build a system in which people can practice fully within that expertise without being asked to stretch beyond it simply because the system has a hole in it.
29:15
And I think this is where we have to be careful not to flatten these professions into versions of one another. Midwifery is not miniature obstetrics. Obstetricians are not high-risk midwives.
29:32
And midwives are not low-risk obstetricians. Doulas are not less clinical versions of either one.
29:40
These are distinct professions with different training, different scopes, different ways of seeing, and different expertise to bring to the same person.
29:51
The opportunity in interprofessional care is not to blur those distinctions.
29:56
It is to understand them well enough to build a system where each profession can contribute what it uniquely knows and where the family benefits from all of that expertise working together.
30:11
That means the obstetrician does not have to provide every layer of care. Neither does the ARNP. Neither does the CNM. Neither does the midwife or the doula or the care coordinator or even the physical therapist.
30:27
The design question becomes, what would it look like to create postpartum care in which each profession can practice to the top of its scope while remaining genuinely interwoven with the others?
30:43
That is a different problem from simply adding visits. It is also why I'm so interested in the reimbursement changes coming to postpartum care.
30:53
If the payment architecture creates room for more touch points, the next question should not be how to squeeze additional encounters into the model we already have so that we can bill for more encounters.
31:05
It should be, what care architecture does this new flexibility make possible? Some connections will be in person, some can happen in the home, some will be virtual.
31:18
Maternal fetal medicine expertise can increasingly enter a patient's care remotely. Virtual maternal health platforms can create additional touch points between traditional visits.
31:29
Remote monitoring can extend clinical observation beyond the walls of the practice or the home. Technology matters, but technology does not answer the underlying design question.
31:41
We still have to decide who should be connected to the patient, when, for what purpose, and what each person should be equipped to notice.
31:50
There are accessible ways to organize this that respect professional scope, use reimbursement intelligently, and give families substantially more continuity without requiring obstetricians to suddenly start making postpartum home visits.
32:08
This is work I spend a great deal of time thinking about through the lens of interprofessional collaboration because we don't need another infographic showing that postpartum care should be more connected.
32:19
We need to start designing the connections. If healthcare turns its gaze sideways to midwifery, I don't think the most important lesson will be to schedule more postpartum visits.
32:32
More appointments can still produce fragmented care. The deeper lesson is continuity.
32:38
When we walk into someone's home three days after they give birth, we do not encounter a blood pressure reading, a depression screening score, a lactation problem, or an incision.
32:48
We encounter all of them together in the context of a whole human and a whole family and a whole community.
32:56
And because we knew this family before the baby arrived, we have something else healthcare systems often struggle to create, a baseline. We know what this person looked like when she was well.
33:07
We know what she worried about during pregnancy. We know what mattered to her. We know what was difficult about the birth, and that baseline knowledge saves lives. That is not merely relationship-based care.
33:21
It is information. Continuity creates context. Context makes signals easier to see. And seeing signals earlier changes what becomes possible. A feeding problem can be addressed before it becomes a weight gain problem.
33:39
A rising blood pressure can be caught before someone becomes critically ill. A mood change can become a conversation before it becomes a crisis.
33:48
A recovery problem can be identified while it is still relatively easy to solve. And that is what good postpartum infrastructure does. It does not wait until the end to ask how everything went.
34:01
It doesn't point fingers when things don't go as planned, but it creates enough connection along the way to know how things are going and to have the right care at the right time from the right professional.
34:15
I have worked very closely with doctors where we intentionally decided we are going to collaborate in order to address some of these issues in our tiny little world. That's what we're gonna do.
34:27
And one thing that came out of this that I'm going to put out here for you system thinkers to think about is this. When we work together, we catch things early.
34:36
When we catch things early, we are causing readmits to happen in order to get treatment on board before a full-blown crisis exists.
34:44
This matters deeply because we are preventing so many downstream health outcomes, including and up to organ damage that can follow a person for the rest of their lives.
34:56
So those preventions that convert into readmits, we need a way to count that as a positive find. And right now, it is counted as a ding against providers.
35:07
So I bring this up in a lot of meetings because I really want to find an answer to this. If you are listening and you have an answer, let me know, please. I really wanna know.
35:17
And I would love to have that discussion with you if you've thought about this also. So I think my third side note here so far, I want healthcare to redesign postpartum care. I want better reimbursement.
35:28
I want more technology. I want remote patient monitoring and earlier intervention and better coordination and more support for families. We need to build all of it.
35:39
But before we declare the future state, let's have the intellectual humility to study the people already living in parts of it. Go to the birth centers. Talk to independent midwives. Study the postpartum schedules.
35:56
Go on a home visit with a midwife. Ask what they look for when they're walking through the door. Ask what happens on day three, day seven, week two, week four. Ask how they know when something has changed.
36:09
Ask what their model allows them to see. Not because midwifery has every answer, it certainly does not, but because innovation isn't only the production of new knowledge.
36:21
Sometimes it's the recognition of knowledge your existing frame has taught you not to see. And that is what Harvest the Signal is about. Before you build, look around. Before you invent, look adjacent.
36:40
Before you draw the map, find out who's already walked the territory.
36:46
And when the people next door have spent decades learning the terrain, maybe invite them into the room before you decide what the future should look like.
36:57
One more signal, and that's your cue that I'm about to drop something new for the listener, and in this case, something else new. So join me if you will.
37:06
I want to take you back to an early day in my midwifery career when I was doing a postpartum home visit after a beautiful home birth two days prior.
37:15
I parked my little Toyota RAV4 on the side of the road, retrieved my home visiting bag from the back of the car. And yes, we really do have them and they are amazing, wonderful bags.
37:25
When you are visiting the midwife that I know you're going to visit, ask them to show you their bags. I have gone through my bags with doctors all across this country, and it's one of my most favorite activities.
37:35
It's really fun to show what we can put into a bag. So anyway, I walked up the pathway and I knocked on the front door. The mother opened the door. Her hair was done up.
37:47
She was wearing a beautiful dress with a matching belt tied very neatly around her waist. She looked wonderful. In fact, I realized instantly she looked too wonderful.
37:59
Now, I was newer in the profession and I had not seen this before, so I didn't have perfect language for what I was seeing, but I knew the picture was not right.
38:09
I knew to connect her immediately to mental health support, and I did. But I brought that case into a learning group I was participating in through the Brazelton Institute at Boston Children's and Harvard Medical School.
38:22
And that's where I learned about this concept of compensatory regulation in the postpartum period. Dysregulation is a normal, healthy, and welcome part of early postpartum life.
38:34
It is expected, and over time we learn the rhythms and trajectories that commonly accompany it. Compensatory regulation looks very different than dysregulation.
38:46
Someone may appear extraordinarily organized, controlled, and on top of everything.
38:52
But because I knew the expected rhythm of early postpartum care and I had a baseline for this individual person, the incongruity became a signal instantly recognized as worth investigating.
39:07
Dysregulation feels chaotic, but it's something we all have to go through. We have to break down in order to build up who we are becoming in that period of early parenthood. That is the whole theory of matrescence.
39:22
Sometimes the signal is the amount of work someone is doing to make sure no chaos is visible, and perfection can create a lot of noise. But I never would have noticed it if I hadn't shown up and knocked on the door.
39:36
A chart could not have told me. A depression screening would not have told me. A blood pressure reading could not have told me. The information was in the whole picture.
39:46
The person I knew, the moment in postpartum I knew she was moving through, the environment around her, and the enormous amount of effort I could see suddenly going into looking perfectly fine.
39:59
That is part of what continuity gives us. Not simply more data, but a better ability to interpret what that data means. A three-day postpartum mother is not a six-week postpartum mother.
40:14
Adding intentional, interconnected layers to care during this time lets us step in with bolsters, supports, or warm introductions to the right care from the right provider at the right time to meet the right need.
40:30
Because sometimes the signal is in the blood pressure. Sometimes it's in the feeding. Sometimes it's the way someone gets off the couch. And sometimes it's the matching belt. But we cannot know what we do not see.
40:44
Whether the thing hidden from view is knowledge living in an adjacent field of study or practice, or a mother and baby in the earliest days of their lives together.
40:56
As I was writing this, I thought if I could write a love letter to midwives, this is what it would be.
41:04
A complete recognition that the work that is being done by midwives all over the world to tend to families, new babies, new mothers, new fathers, new grandparents, in the exquisite way that midwives do, and to be seen as experts, and to be seen as a people holding a system that works.
41:27
That is my love letter to you.
41:30
And what I hope the outcome from this very long field note is that people inside some of the places where there's a table where decisions are being made hear this, or maybe they see a little quote that you pulled and posted from this, and they think about calling you, and then they make the call, and they come and see you.
41:51
And they talk about how you can build a system together to serve the families in your shared community. So this is where I encourage you to noodle through these ideas while you are walking the dog or driving home.
42:06
If today's field note changed the way you think about how you want to design care for the postpartum time, or who you want to learn from, or if you are designing postpartum care in your own setting and want to talk through the technical or the reimbursement or especially the interprofessional architecture of that care, especially if you're redesigning for January, please reach out to me.
42:31
I am so here for those conversations. I read every reply, and in fact, the next Harvest the Signal may begin with something you've stopped accepting but haven't yet put into words.
42:43
You can connect with me on LinkedIn by my name or on threads at Harvest the Signal, and let's keep this conversation moving.
42:50
And speaking of moving, I would love to be the voice in your ear while you get to where you are going. We can explore patterns hiding in plain sight or even across the street together.
43:03
So please hit subscribe and we'll do it again. I'm Jodi Lynn Owen wearing my midwife and my systems hats. Until next time, keep looking for the signal. This has been Harvest the Signal with Jodi Lynn Owen.
43:18
The smallest signals can change the biggest systems. Be sure to like, follow, and share so you never miss an episode or the opportunity to compare your field notes with your colleagues.
Harvest the Signal
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