The importance of breaking down silos in pregnancy care

As a GP Obstetrician, I’ll never forget the experience of a patient, colleague and friend whom I’ll call Anne.

After delivering in a private hospital at 37 weeks, Anne’s initial breastfeeding experience was complicated. Because she struggled to feed her baby, (whom I’ll call Eli), Eli quickly lost more than 10% of his birth weight. A paediatrician was called to review the situation and advocated a complicated weight maintenance regime that included expressed breastmilk and formula.

Anne was sent home on Day 3 with instructions to follow the recommended feeding regime and follow up with the paediatrician. On Day 5 she was visited by the child health nurse who suggested a further change in feeding regime.

By this stage, Anne was not sleeping, had received three different pieces of advice around breastfeeding, and was due to see the lactation consultant, paediatrician, child health nurse and obstetrician – all separately. Given her feeding regime now took 90 minutes and that Eli usually slept for only 40 minutes post-feed, the prospect of attending four separate appointments, each at different locations was crushing.

By the time that Anne came to see me at three weeks post delivery, she was a sleep-deprived shadow of her former self and openly admitted that ‘This baby thing had knobs on it’.

I sat there, offering emotional support, while thinking to myself, ‘This is nuts. How can we expect our patients to attend separate appointments and act as communicator and coordinator of their healthcare requirements, at a time in which having a shower is considered a great achievement?’

The creation of silos in medicine

Large silos are a feature of the Australian farming landscape. They are used to store things like grain, coal, cement, food products and sawdust. Their role is to keep those things separate from each other so they cannot be contaminated or compromised.

In medicine, the past 20 years has seen the emergence of ‘silo mentality’ through the specialisation of care. Each area of care is separated from each other, shut off from the other providers of care.

It was thought that increased specialisation would lead to increased knowledge and efficiency and thus better patient outcomes. Instead, it has led to fragmentation of care and unmet patient needs as specialisation requires the patient to:

  • Monitor their own health needs
  • Know exactly which kind of specialist help their situation requires
  • Figure out how and where to access this help from
  • Coordinate their own care- often across several different locations
  • Communicate their healthcare needs to each separate provider

This is a big ask of people who are unwell, time poor and/or aren’t aware of all the healthcare options available to them.

A new model for pregnancy (and health) care

As noted above in the (very typical) case of Anne, our current system for pregnancy care is broken. We have developed a siloed system that creates barriers to accessing appropriate care. We have failed to recognise the impact this has on both the patient individually and the care that is provided. The solution? We need to break down the silos and focus on delivering high-quality care at a time and place that best meets the patient’s needs.

My desire to be part of the solution is what led to the founding of One for Women.

Every woman’s experience of pregnancy and the fourth trimester is different. Every woman’s needs are specific and unique. It’s unrealistic for providers based in different locations and across different systems (public, private and community care) to meet those specific and unique needs.

That’s why One for Women has been set up as a clinic where all pregnancy and fourth trimester needs can be met in a single location; one where providers can communicate to each other to achieve the best possible outcome for the patient.

My hope and dream for One for Women is that it not only changes the existing paradigm for pregnancy care, but that it might also break down silos across the entire health care industry.

Will we succeed? Only time will tell. But I feel it’s crucially important that we at least try.

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