Defragmenting Silos: Why Perinatal Collaboration is the Only Way Forward

In my world, fragmented care looks like silos. It’s the invisible walls between departments, settings, and professionals that leave patients feeling like they don’t know—or aren’t allowed to understand—their own bodies. When we work in silos, we aren’t just inconveniencing families; we are creating gaps that leave them falling through the cracks.

Obstetric, postpartum, and primary care currently function in separate silos with no shared “home” for each patient’s health. Critical information—like risk factors or complications—does not reliably follow the patient across settings. I experienced this firsthand when navigating a miscarriage with an IUD—even as an OB nurse, the system felt impossible to navigate.

I recently took that perspective to the panel at Perinatal Collabapalooza. We dove deep into one of the most pressing issues in maternal health: defragmenting care and improving collaboration across disciplines.

My role is to help keep care aligned with the evidence so that we can all stay focused on the person. When patients feel heard, they stay engaged. When they stay engaged, we save lives.

Better collaboration starts with better communication. If you're looking to streamline your clinical communication and ensure your patient's story never gets lost in the handoff, grab the Free Zero-Stress Guide to OB/GYN SOAP Notes. It’s designed to help you chart with confidence while keeping the focus on evidence-based care.

The Danger of the Fourth Trimester

The most dangerous crack in the system is the transition from hospital to home. For many families, especially those facing existing inequities, this transition is abrupt. We know from CDC Maternal Mortality data that cardiovascular disease is a leading cause of maternal death, yet patients often leave the hospital without a clear plan for heart health once obstetric care ends.

If I could redesign the postpartum journey tomorrow, a check-in at two weeks would be a non-negotiable. Waiting six weeks to see a provider leaves far too many risks unaddressed. A whole-person baseline should include:

• Cardiovascular screening: Standardized blood pressure monitoring to catch late-onset preeclampsia.
• Mental health assessment: Identifying those struggling before they reach a crisis point.
• Lactation support: Ensuring the feeding plan is sustainable and providing the resources to make it so. (Sometimes breastfeeding looks like a bottle, and that needs to be part of the supported plan.)
• Pelvic health assessment: Checking for dysfunction or pain early, rather than dismissing it. When we teach people not to trust their own bodies or ignore their physical foundation, we fail them.

Breaking Barriers: Systemic Racism and Hierarchy

We have to be honest about the barriers to continuity. Implicit bias and systemic racism are not just social issues; they are clinical ones. They dictate whose symptoms are believed and how quickly care is escalated. In maternity care, the delayed recognition of warning signs for Black, Indigenous, and marginalized patients is a direct result of these systemic failures, undermining safety at every level.

The AWHONN Respectful Maternity Care (RMC) Framework emphasizes that care works best when teams move away from hierarchy and ego. Whether an observation comes from a bedside nurse, a doula, a lab report, or the patient themselves, it must be taken seriously.

Often, patients express that something isn’t normal, only to be told, “Now, now, you don’t really know what you’re talking about.” This patronizing dismissal is a form of gaslighting that disproportionately affects marginalized communities. When we teach people not to trust their own bodies, we fail them. It makes for an incredibly lonely—and dangerous—experience.

When patients are taught to doubt themselves, they stop trusting us. And when they stop trusting us, the clinical risk skyrockets.

What Improving Collaboration Looks Like

Respectful collaboration means removing egos and recognizing that every credential brings essential expertise. Doulas, lactation professionals, and community partners often have the clearest picture of how a person is actually recovering. I involve these partners in policy and position design, not as an afterthought, because their collaboration with nurses is key to empowering ALL communities.

I’ve seen this work. Group prenatal care and home visit models demonstrate that we can bridge the gap. We see this especially in high-stakes transitions, such as the birth of a NICU baby, where communication between the family and the interdisciplinary team determines the outcome.

Moving the Needle

We can reduce conflicting advice by grounding our perinatal conversations in shared, evidence-based standards. While providers may have different styles, safety expectations must be consistent. We use structured communication and validated tools to remove subjectivity and keep the focus on the human being in front of us.

If you do one thing this month to improve the way we care for families, let it be this: Look at one point in your workflow where a patient’s voice is minimized or lost—and change it. Better collaboration starts with better communication that ensures the patient’s story is never lost.

When patients feel heard, they stay engaged. When they stay engaged, we save lives.

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