What is "Full Spectrum" Care?


When I talk about being a midwife and providing care to community, I refer to my care as “full spectrum”. This means I take care of a broad spectrum of people through a broad spectrum of experiences and outcomes, related to reproductive health. It means I go beyond taking care of families and individuals through pregnancy, birth, and postpartum, and also include midwifery support for abortion, adoption, pregnancy loss, fertility, birth control, pap smear, IUDs, and more. This broad spectrum of care is within a traditional midwifery scope of practice: which included community care for life passages including puberty, pregnancy, menopause, death, basic pediatrics and adult healthcare, and deep knowledge of reproductive health and needs. This care in community is essential and important, and the knowledge in one person to take care of it all is very meaningful in community for building trusting relationships with those supporting your health.

The division and breakdown of reproductive health services into specialties is a new development in medicine, and one which I would argue is not going very well. Clients often speak to me about how strange it is they could see a midwife for this pregnancy and birth, but if they wanted an abortion in the future they often would go to a clinic and see a doctor who’s a total stranger to them who they may never see again. And then their family doctor will do a pap smear, but they’ll go to the sexual health clinic for their IUD, and a pediatric clinic for their 6-month old’s cough, and a specialized clinic if their sister wants advanced fertility testing. Now of course, part of this is specialization, and when health care workers can focus on one aspect of care they can learn it really well and offer deeper insights, but when you see too many specialists in pursuit of your own healthcare the bigger picture of who you are is often lost and the care just boils down to a service provided that day only. Taking care of a full spectrum for our clients can help them get care in fewer, trusted places who know the whole of them and their history more carefully.

I was first introduced to this terminology through the “full spectrum doula” movement as an explanation and naming of the care doulas, midwives, and other care workers in community have always done: provide for all kinds of people through all kinds of experiences. “Full spectrum” doulas provide doula care for birth and postpartum, as well as for abortions, adoption, pregnancy losses, gynecological appointments, surrogacy, fertility, etc. They provide informational, practical, and sometimes spiritual support for people through all sorts of reproductive experiences.

While the care full spectrum doulas provide is nothing new, describing the care specifically as “full spectrum doula” work is a relatively recent development most likely traced to The Doula Project and the hard work of Miriam Zoila Perez in New York City in the mid 2000’s. Other full spectrum doula collectives cropped up throughout the United States to serve their communities (you can see a map of most full spectrum doula collectives in North America here).

I was introduced to the concept through Full Spectrum Doulas in Seattle. I had signed up for a swanky 4-day DONA doula training at a local University, and on the last day when they discussed community resources, they mentioned Full Spectrum Doulas. While much of the week had felt like going over common-sense support strategies and learning about our local hospitals (helpful, but not exactly what I’d hoped for), I felt like it had all been worth it to learn about this organization in our city doing the work I really wanted to do. I met up for coffee with their Core Organizers to hear more about what they were about and how I could get involved. They were doing excellent work on the ground and I ended up training with them to be an abortion doula, becoming a Core Organizer, and conducting abortion doula trainings over a few years while I lived in Seattle finishing my BA.

The full spectrum doula movement in the US has done great work at bringing attention to doula communities that outcomes besides healthy, happy births, deserve doula support. They’ve also helped other communities (abortion communities, adoption communities, etc.) see that doula-style care can and should be an integral part of these reproductive experiences. My greatest happiness in watching and participating in the evolution of the full spectrum doula movement is the current pushing to embrace a truly full spectrum. While most full spectrum doula projects originally focused almost exclusively on abortion doula work (critical, necessary work), most are now pushing their own boundaries to expand and include the full spectrum they long boasted about.

I’d like to see this same evolution with midwifery care, particularly out-of-hospital midwifery care, in the US and around the world. While a portion of midwives are, and always have tended to a full spectrum of experiences, the majority of midwives are predominantly caring for people during pregnancy, labour, birth, and early postpartum. I’d like to see us reclaim a more traditional scope of practice, including a broader, more full spectrum approach to care for our communities.