Table 1.

Opportunities for health care team members to better align clinical encounters with patient-family needs.

Health care team members need…	Opportunities for quality health care encounters
…to do no harm	Affirm health and safety as positive concepts. Recognize that the absence of negative symptoms or adverse medical events is not equivalent to well-being. Health care is about service to people as a part of optimizing their potential, not only treating pathology. Share power. Demonstrate trustworthiness by ‘walking with’ patients, who may not know the range of options available and may be fearful of a system which can harm. Set expectations. Share the prevalence of postpartum healthy symptoms, and communicate strategies for recovery Recognize stressors. Pregnancy is not the first “stress test” for many, especially Black birthing people. Allostatic load and weathering affect health across the life course, which can be another layer to perinatal physiology. Strive for reproductive justice (RJ). Consider the RJ framework and definitions of postpartum equality, equity, and justice. Provide care that protects each person’s human right to bodily autonomy, to have children, not to have children, and to parent their children in safe and healthy environments.
…to be accommodating	Believe patients. Affirm that you see them as a person, with value, and that you are here for them. Convey respect, hopefulness, and partnership for what’s next. Set patients up to thrive. Lead with resources and ask what is working for patients, to further engage in collaborative care planning around emerging needs. Celebrate successes. Include intentionally. In written, visual and verbal communication with patients and families, through documentation, and when coordinating with other clinicians, use inclusive and respectful language to describe people, their history and needs, and opportunities. Be responsive. Proactively uplift patient agency and self-efficacy, by asking, “What’s going well?” Address feelings of shame and blame by normalizing ambivalence about parenthood. Listen in order to hear and understand issues as patients experience them. Validate patients as worthy of care and support.
…to uplift	Implement anti-racist practices. Recognize that health experiences including patient pain, coping strategies, and communication may be rooted in structural oppression and lived experiences of discrimination. Engage with humility and de-stigmatize health issues. Create safe spaces. Design clinic lighting, imagery, structure, and positioning of the built environment for patient and family access and privacy. Listen to patients, without interrupting, to understand their needs. Facilitate informed consent or decline. Explain assessments and procedures, and the rationale for them, and obtain permission before physical contact. Respect the patient as the expert in their preferences and values. Counsel to patient needs and values. Facilitate this shared decision making by first ascertaining patient goals, such as “Do you think you want to have another baby? If so, when?” and then offering medical expertise in a conversation, like “Would you like to use birth control to help accomplish this goal?” Define the purpose. Separate medical assessments of healing from “all-clear” signals of postpartum recovery. Confirm there is a distinction between being able to do something and implying it should occur, such as resuming vaginal intercourse. Affirm patients as the protagonists. Communicate to patients about their leading role in their stories, such as “your strength pushing on hands and knees was the key…without your actions, we wouldn’t have been able to assist the way we did.” Facilitate ongoing dialogue. Invite patients to confidentially share their experiences and recommendations through advisory committees and other feedback mechanisms. Promote continuity of care. Maintain ongoing person-focused support through care transitions, including postpartum discharge, primary care, and with specialists. Engage community organizations for program access and thought leadership. Assess for equity. Identify, measure, evaluate, and strengthen healthcare practices, disaggregated by patient ethnicity-race. Consider the context of clinical care, including nurse-patient staffing ratios and language access.