Between October 2024 and January 2025, the number of prenatal appointments attended declined. This decrease can be traced back to lower client enrollment during those months, likely due to staff transitions and reduced capacity to match new clients with doulas. Since prenatal visits typically begin in the third trimester, fewer new enrollments earlier in the fall translated into fewer appointments in the winter. Additionally, as some doulas left the organization, client caseloads were temporarily paused or reassigned, which disrupted continuity of care. In February, attendance began to increase again as new doulas were onboarded, enrollment picked up, and outreach efforts resumed to remind clients of the importance of prenatal visits.

Referral sources such as clinic partners and public health nurses are instrumental in ensuring clients begin prenatal care early and remain engaged. These partners can help reinforce the value of doula support and encourage timely scheduling. Within SisterWeb, intake and scheduling staff also play a key role in getting clients matched with doulas and setting up initial visits. Field nurses and outreach teams help reconnect with clients who have missed appointments, reminding them to follow up and attend their sessions.

Regular communication and reminders are essential for maintaining strong attendance at prenatal appointments. Many doulas use text check-ins to confirm schedules, answer questions, and keep clients engaged between visits. In-person rapport building, especially in the early stages, increases the likelihood that clients will prioritize upcoming sessions. For less responsive clients, emphasizing the value of face-to-face support—and explaining how it benefits their birth outcomes—can help improve follow-through. Adding prenatal appointments to client calendars through Zoom schedulers or other tools also helps reduce missed visits.

To improve prenatal appointment attendance, SisterWeb can continue emphasizing early engagement at intake and ensure clients receive immediate follow-up once matched with a doula. Providing clear explanations of what to expect during each prenatal visit—and reinforcing how it supports their pregnancy journey—can build stronger buy-in. Outreach teams and public health nurses should be looped in regularly to help re-engage clients who may be at risk of falling off. Strengthening internal scheduling workflows and creating auto-reminders for upcoming visits can further support consistent attendance.