The problem of “too much too soon” and “too little to late in maternity care” and the role of the doula…

In the field of maternity care two seemingly opposing problems affect health outcomes for both mother and infants – these problems are generally termed as “too much too soon” meaning too much medical intervention done prematurely in labor and “too little too late” meaning delay in timely treatment leading to adverse health outcomes.

As a birthing person this feels all too familiar and frustrating. During labor you seem to be alternately being pushed and rushed into interventions and then when you request intervention it is often denied, postponed or delayed.

This can lead to perceptions of care during labor that are frustrating at the least and traumatising at worst. In extreme scenarios both too much too soon and too little too late lead to tragic outcomes, severe morbidity and even loss of life.

As a busy and stressed healthcare provider these problems at either end of the spectrum can be a difficult balancing act to pull-off. As a healthcare facility what barriers exist that prevent implementation of strategies to eliminate or reduce scenarios at either end of the spectrum?

In wealthy settings with well equipped hospitals the adverse outcomes more frequently result from too much intervention too soon. In rural areas and poorer healthcare settings it is frequently problems arising from too little intervention too late that lead to adverse health outcomes.

In the first setting doulas often work to balance the pressure of doing too much too soon.

Step 1) Doulas begin educating and informing birthing people of the process of labor and common interventions – this better facilitates informed choice during the process of labor which increases the agency of birthing patients and improves their perceptions of care during labor.

Step 2) Doulas advocate for a pause between provider recommendation and the birthing person’s consent for most procedures. This further puts the brakes on too much too soon.

Step 3) Doulas offer continuity of care and make themselves familiar with birthing people much before their admission in labor. They understand the psycho-social background of the birthing family and attempt to bridge the gap between providers and families. Together with medical staff, doulas can facilitate a holistic view of the birthing person and infant bringing in critical dimensions at key moments to facilitate better health outcomes. An example would be – informing medical providers of the birthing person’s history of abuse or trauma or phobias that may become relevant during labor or encouraging the birthing person to ask questions and clarify procedures that concern or scare them so the provider is able to reassure the birthing person and/or suggest alternatives where possible.

Doulas in low resource settings help to work to mitigate the problem of too little too late

  • Skilled birth attendants educate pregnant women prenatally and encourage the to seek care and link them to resources accessible to them
  • Pregnant people matched with doulas were two times less likely to have birth complications

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