A Note from Miss Michael

To our wonderful clients:

I am so grateful that I get the opportunity to work alongside you to ensure safe pregnancies and optimal health. I am amazed every single day by your strength, your wisdom, and the trust that you place in myself and in Dr. Lane. I want to say how welcomed I have felt by all of you over the past 6 months. As a newer practitioner, I had fears of not being accepted or trusted–and this has proven to be far from reality, much to my joy and honor. I thank the Lord for each of you and all you are teaching me.

I thought it might be interesting for you all to hear about my last six months, as I have acclimated to the practice. These are in no particular order, just thoughts from my head as I write this.

Kristina Michael Photo 2

Miss Kristina Michael CNM joined our practice in June of 2014.

First, I am truly amazed by the level of care that is provided at Believe Midwifery Services. Dr. Lane has worked harder than I think any of us will ever know, to raise our safety and competence at births and as we provide primary care. I have seen the practice both from the outside (I was checking out the website long before I was hired!) and now from the inside as an employee and I cannot be prouder of where I work. I can compare it to in-hospital care and out of hospital care based on my past nursing experience–you truly cannot get better care out there!!

Second, I am truly amazed by the strength of the women we serve. Watching you all labor, go through tough emotional times, learn more about your bodies, and walk through whatever struggles you have so graciously shared with me, has only served to increase my respect for you all. Thank you for trusting me with your thoughts, stories, and questions–I hope you have all figured out by now that in my book (and in Dr. Lane’s!) there are no stupid questions, or any that are too embarrassing to ask!

Third, I have grown as a person as I have adjusted to a crazy schedule, triaged middle-of-the-night phone calls, figured out how to coordinate multiple people in multiple offices, caught multiple babies (each birth being unique!), made connections with other providers, learned ridiculous amounts of information about essential oils, breastfeeding, primary care, etc., and I have dealt with several challenging situations. I am thankful for this, as it all has made me more capable, and better able to serve the practice. I feel that I am growing each and every day in my competence and confidence, and you all have been incredibly patient and gracious toward me as I have learned.

I am so very thankful for all of these things. I could go on for a long while…but before you get bored reading this ;), I thought I would also share a few things that I hope you, as our clients, know. Again, no particular order, just things I have been processing lately.

I hope you know that Dr. Lane and myself truly do appreciate you and the trust that you place in us. We love when you stop in the boutique, hang out, tell us your stories from the week, and let us get to know you and your family. We love the family-centered environment and the personalized care that we provide.

However, I have been learning that midwifery is a very challenging profession. It is our joy to serve you, and we do the very best we can for you. We are a unique practice that seeks to give the best clinical care possible, while providing the most personal care that we can. There are challenges to this goal, however–the unfortunate fact is, there is a limited number of hours in each day, a limited amount of emotional energy, and unfortunately we cannot clone ourselves (as much as we would like to!).

What does this mean? Practically, it means that I (and everyone in the practice!) have had to learn how to prioritize. I work alongside Dr. Lane literally every single day, to look at everyone’s needs and figure out how we can use our resources to serve everyone in the best way possible. I have been learning that that there are times when the needs of one client must come after the needs of another client. I hope you know that there may be times when your non-urgent need falls behind the more pressing need of another–but there are also times when your urgent need is placed at the top of our list, over and above anything else. We may have to reschedule your prenatal or one of our educational offerings so that we can safely attend another mama’s birth–but when it comes time for your birth, we will do the same. We are there for you, when you need us–and it is our joy.

I will be completely honest with you all. In the six months that I have been a part of Believe, I have realized that I cannot be perfect. Neither can Dr. Lane–or Jami or Stacey or Sherry or any of our staff. There are times that we drop the ball. We know that. Our clinical care is always spot-on–we know what we are doing and we are good at what we do! But, there are times that administrative details (things such as FMLA forms, work releases, etc.) fall further to the bottom of our to-do lists that we would like. Know that we are aware of your needs–and we truly work our hardest to meet all of them in as timely a manner as we can. One of the hardest things about this job, I am learning, is how difficult it is to be human–that is, to be unable to meet everyone’s needs exactly in the ideal way.

So, if you are stressing about getting your spa delivered, you can rest assured that we are stressing out too and working as hard as we possibly can to get it to you! If you are waiting for information and it isn’t to you yet, it is likely because we are researching it for you, or we have needed to spend several hours tracking it down for you and coordinating between several different practices (yep, true story! happens often.). If you haven’t gotten a return phone call yet, it may be because I have been up for several nights in a row attending a “baby boom” and I know that if I call you, I can’t be entirely sure of what I would communicate to you in my exhaustion. We love all of you, and it truly breaks our heart when we can’t meet all of your needs in the time that you would like, or when we make an error that causes you inconvenience. This has been one of the tougher lessons for me to learn. Sadly, we just can’t do everything as quickly or in the exact way that you would like, nor are we able to do everything perfectly. If I could say one thing, I would ask for as much grace as you all can extend to us when this happens. It never happens intentionally, we are devastated when you feel that we have failed you, and we work hard every single day to make things better.

Finally, the last thing that I have learned is just how rewarding, and just how hard it is, to be a midwife! I had an idea of what I was signing up for when I went in to midwifery. But, the reality of it all has been an adjustment! Dr. Lane and I (especially Dr. Lane and her family!!) work harder than any of you will ever know to make sure that your health and wellness are cared for to the best of our ability. This means we sacrifice sleep, time to ourselves, time at church, meals, and countless other things so we can be available to you as much as is needed. True confessions of a midwife: Dr. Lane and I are up most nights, in to the wee hours, to catch up your charts and plan your care. I carry my huge birth bag with me wherever I go, in case one of you calls (who needs room for groceries in their car, right?) :). Yep, there are days when I would give just about anything to shower without my phone in the bathroom with me. I’m pretty sure Dr. Lane would pay money to be able to drive without having to respond to an e-mail at each stoplight. Dr. Lane’s husband works full time, then spends every single weekend working at the Carmel or Lafayette office; Noah spends hours watching the kids so that Dr. Lane can be taking care of the business; Keely runs countless errands and takes care of a million small details for us. Simon and Samuel spend hours at the office, doing school work, helping out, and of course providing technology support (right, Simon?) :). My family puts up with me running in and out of the house at all hours of the day and night, missing family events, not being able to plan anything with certainty (there may be a birth!) and wondering if I will ever have time to find a husband. ;)

Because of all this, I have been learning the importance of respecting our own individual time to spend with family, be involved in church, and, yes, even occasionally veg out on Netflix (Call the Midwife, anyone?) ;). I have been finding that these times are so very important for our mental and emotional health–we need to be rested and refreshed sometimes so that we can provide the best care we can to you. A huge thank you to those of you who understand and appreciate this!

Please, please don’t read the above as me complaining about what we “have” to do. It is exactly the opposite, in fact! It is our joy to lead a crazy, unpredictable, super stressful, and ridiculously rewarding job. You all are why we do what we do–and we truly do love to serve you. Me being newer in the practice, I can see how easy it would be as a client to not understand, or forget, how crazy hard your midwives are working behind the scenes to give you the very best that we can. I so appreciate those of you who bring in the occasional jar of granola, note of thanks, “church window” cookies (you know who you are! and…we won’t talk about how many of them I ate that day…), stop in to say hi, talk about us on Facebook, donate breastmilk to other clients of ours, etc. You have no idea how much these gestures encourage us! Thank you.

The very last thing I want to communicate to you all is perhaps the most important! Coming in as a new provider, I truly hope you all know how valuable and truly amazing Dr. Lane is. I cannot believe how blessed I am to learn from her–and be a client of hers myself! The care that she provides and the knowledge that she has is not something that comes easily–I know she has shed blood, sweat, and tears over and over and over again to be able to gain knowledge, run the business, and keep safe birth options open for our area. She isn’t afraid to make tough decisions in order to be safe in the care that we give. I watch her work tirelessly to learn more, do more, and provide better and better services to you all. Her dedication to you all and the practice is beyond words. She is truly a warrior woman–and one of my heroes. I am forever thankful for all that she does!

Thank you so very, very much for hanging in there with me as I try my best to express these things. I hope they have given you a small window in to how much it means to me to be able to have this job and know you all. It is a huge responsibility, and a huge honor, that you trust me with your care. Know how much I have grown to love each and every one of you, and how truly blessed I feel to be able to walk alongside you and serve you at Believe. Each of you holds a special place in our Believe family–thank you for letting me play a part in your lives.

With much love,

Kristi

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Placenta Medicine

Placentophagy is the scientific name for placenta consumption, although I kinda prefer placenta medicine. I am not sure the latter term is appropriate though, as there is little evidence that consuming one’s placenta is advantageous. Tamrha, our midwifery liaison and placenta guru, wrote a little about placentaphagy here.

Placenta bloodyMothers in our practice have shared their own reasons for choosing to consume their placenta, which primary surround their belief that it will improve their postpartum experience, especially emotionally. Most do seem to be quite pleased with the results, while others share that while they are undetermined if there was any obvious benefit, they were glad they had the option. Improved milk supply is yet another reason for placenta consumption, and one I am eager to see more research support or deny. What I find particularly intriguing, and the reason I had to blog this evening, is because there is evidence that other mammals do not simply eat their placentas to protect themselves from predators, but also because it offers pain relief!

Placenta Consumption in Mammals

Nonhumans are more likely to consume their placentas and this is thought to occur for a number of reasons. As mentioned above, they may simply choose to eliminate any odor or rotting product that may attract predators, or it may be part of keeping their nest or den habitable. It could be argued that they gain nutrients from consuming the placenta, as well as beneficial hormones; however, there is no evidence to support these hypothesis. It seems that the placenta would also hold a number of toxins filtered during the pregnancy that would not be advantageous to consume. Either way, these thoughts motivated scientists to explore other reasons for placentophagia in other mammals.

Interestingly, a 1998 study found that when rats ingested amniotic fluid and their placentas, it enhanced morphine-mediated pain relief, termed placental opioid-enhancing factor (POEF) and in 2009, researchers found rats also demonstrate enhanced maternal care-taking behavior after ingesting both amniotic fluid and their placentas (Kristal, 2009; and Kristal, Abbott & Thompson, 1998). It would seem that rats, or potentially any other mammal, that ingests its amniotic fluid could experience decreased pain in labor which could be sustained following birth with ingestion of the placenta. Researchers also found that placental opioid-enhacing factor (POEF) was effective even when one mammal consumes another mammal’s amniotic fluid and placental tissue, so this benefit is neither species- or gender-specific (Abbot et al, 1991; Kristal et al., 1986; Thompson, Abbot, Doerr, Ferguson & Kristal, 1991).

Did I hear someone say they’d consume an amniotic popsicle in labor for pain relief? Well, it appears this benefit is only demonstrated when the amniotic fluid and placenta are consumed raw. After the placenta is heated more than 35 degrees or is more than 24 hours old at room temperature, the beneficial properties are lost (Kristal et al, 2012). Another interesting point was that the same researchers found that greater quantity of ingestion did not increase the pain relief, and in some cases, the larger doses created in inhibitory effect (Kristal et al., 1988; Kristal, Thompson, & Grishkat, 1985).

Human Placentophagy

Although more than 4,000 mammals have been found to ingest their placentas, researchers have not found either physiologic benefit or an anthropologic findings. The Vietnamese and Chinese have traditional medicines utilizing human placenta. Traditional Chinese Medicine (TCM) recognizes the placenta to correct the balance of yin and yang, and to improve milk supply by improving qi and nourishes the blood (Bensky, Clavey, & Stoger, 2004). Midwives have been advocating this practice in the United States and Mexico since the 1970s. Interestingly, TCM recommends placenta ingestion on an individual basis, while midwives who recommend this practice, tend to believe placentophagy is beneficial for everyone. As placenta preparation training programs increase in popularity, so too has placentophagy in the United States (Selander, Cantor, Young, & Benyshek, 2013).

Our Midwife’s Recommendation

Miss Kristina Michael CNM and myself are often asked if we are advocates of placentophagy. We aren’t opposed and do appreciate the anecdotal accounts of women we care for; however, we question both the potential for ingesting toxins the body had otherwise filtered out within the placenta, and question if this might be a mode for Rh or ABO antibody formation in susceptible women. Further, we have to reserve our recommendation in the absence of supporting evidence.

When asked for a recommendation, we whole-heartily recommend Tamrha Richardson. We know she is trained in safety guidelines and blood-borne pathogens. There are no regulations or oversight when it comes to placenta medicine. She not only sought out training specifically for placenta preparation, but continues to seek education through our practice on proper care of human tissues and bodily fluids.

References

Abbott, P., Thompson, A. C., Ferguson, E. J., Doerr, J. C., Tarapacki, J. A., Kostyniak, P. J., & Krista, M. B. (1991). Placenta opiod-enhancing factor (POEF): generalizability of effects. Physiology & Behavior, 50(5), 933-940.

Bensky, D., Clavey, S., & Stoger, E. (2004). Chinese herbal medicine: Materia medica (3rd.). Seattle, WA: Eastland Press.

Kristal, M. B. (2009). The biopsychology of maternal behavioral enigma (or De gustibus non disputadum est). Neuroscience & Biobehavioral Reviews, 4(2), 141-150.

Kristal, M. B., Abbott, P., & Thompson, A. C. (1988). Dose-dependent enhancement of morphine-induced analgesia by ingestion of amniotic fluid and placenta. Pharmacology, Biochemistry, and Behavior, 31(2), 351-356.

Kristal, M. B., DiPirro, J. M., & Thompson, A. C. (2012). Placentophagia inhumans and nonhuman mammals: Causes and consequences. Ecology of Food and Nutrition, 51(3), 177-197.

Kristal, M. B., Thompson, A. C., & Abott, P. (1986). Ingestion of amniotic fluid enhances opiate analgesia in rats. Physiology & Behavior, 35(6), 809-815.

Kristal, M. B., Thompson, A. C., & Grishkat, H. L. (1985). Placenta ingestion enhances opiate analgesia in rats. Physiology & Behavior, 35(4), 481-486.

Selander, J., Cantor, A., Young, S. M., & Benyshek, D. C. (2013). Human maternal placentophagy: a survey of self-reported motivations and experiences associated with placenta consumption. Ecology of Food and Nutrition, 52(2), 93-115.

Thompason, A. C., Abbot, P., Doerr, J. C., Ferguson, E. J., & Kristal, M. B. (1991). Amniotic fluid ingestion before vaginal/cervical stimulation products a dose-dependent enhancement of analgesia and blocks pseudopregnancy. Physiology & Behavior, 50(1), 11-15.

Neurotransmitter Testing

The nurse-midwives in our practice see a number of clients who suffer with depression, anxiety, intrusive thoughts, difficult sleeping, premenstrual syndrome and premenstrual dysphoric disorder. These cases are not simply treated in a single visit by extending a script for an anti-depressant and a referral to a therapist. While pharmaceutical treatments are a treatment modality available from our midwives, and talk-therapy is certainly beneficial, we feel strongly that these symptoms represent a much more complex issue that requires a though investigation.

Following an extensive evaluation of the client’s history and current symptoms, our nurse-midwives offer each client a thorough physical exam, often including laboratory and diagnostic testing. Our nutritionist is always consulted in such scenarios, as optimal health can not be achieved without securing proper nutrition. The nurse-midwife and nutritionist then collaborate in effort to provide each client an individualized plan for healing utilizing a functional and integrative approach.

Frequently, in these cases, our nurse-midwives seek to test the neurotransmitters. Just as it is common practice to test a diabetic’s blood sugar prior to administering insulin, it is useful to test neurotransmitters as an objective means for assessing nervous system function and its attendant symptoms relating to mood, sleep, and cognition. Assessing neurotransmitter levels identifies an individual’s specific imbalances, objectively establishes the need for intervention, guides therapeutic decisions and quantitatively monitors intervention effectiveness. Too often, clients with any emotional health complaints are provided a script with somewhat randomness and there is no awareness of why these symptoms are presenting. We know that ten clients with the same symptoms may have ten very different neurotransmitter imbalances.

Due to the significant contribution of neurotransmitters to not only neurological functioning, but also endocrinological and immunological actions, clinicians and researchers are interested in the function and measurement of neurotransmitters as they have the potential to serve as clinically relevant biomarkers for specific disease states or to monitor treatment efficacy. (Cook, 2008 & Marc, 2010).

There are several ways to measure neurotransmitters, including through urine, blood and spinal fluid. Our practice typically utilizes urine, due to the fact that it is non-invasive and is more stable compared to spinal fluid or blood. More importantly, the current body of literature provides evidence that neurotransmitters excreted in the urine may effectively serve as biomarkers of nervous system function. Studies have demonstrated that intact neurotransmitters are transported from the central nervous system to the periphery, followed by renal filtration of neurotransmitters and excretion in the urine. We utilize a lab that is one of the most respected in the industry.

Dr. Lane and Miss Michael frequently measure epinephrine, norepinephrine, dopamine, serotonin, phenylethylamine (PEA), gamma-aminobutyric acid (GABA), glutamate, histamine, glycine and taurine. The primary objective is to bring all of the neurotransmitters into balance by correcting deficiencies through supplementation, carefully guided by our team of experts. Management of conditions typically consists of three phases. The first, lasting one to two weeks, is designed to bring balance into inhibitory neurotransmitters (GABA, glycine and serotonin). The second phase, generally lasting three to six months, focuses on restoring balance between the inhibitory and excitatory neurotransmitters (glutamate, aspartate, epinephrine, norepinephrine and PEA). Once a healthy neurotransmitter balance is achieved, the client enters a maintenance phase in which doses are reduced. At this point, the client generally notices improvement in mood, energy and/or cognitive function.

The root causes of neurotransmitter imbalances must be addressed in order to maintain the newfound biochemical balance. Lifestyle, diet, and further diagnostic testing are commonly required for more difficult cases or in those cases where symptom improvements are transient.

Marc, D. T., Ailts, J. W., Ailts Campeau, D. C., Bull, M. J., & Olson, K. L. (2010). Neurotransmitters excreted in the urine as biomarkers of nervous system activity: validity and clinical applicability. Neuroscience and Biohavioral Reviews, 35, 635-644.

Tribute to Gretchen

Gretchen was our primary nurse for several years, and many families, as well as staff, developed very close relationships with her. This past year, Gretchen transitioned from the rigors of homebirth midwifery to the rigors of the Florida beach assisting my good friend, Cindi, at her birth center, Gentle Birth Options. We are all a bit envious of her and miss her dearly.

The Bigelows have offered this tribute in honor of Gretchen’s contribution to our practice…

OUR TRIBUTE TO GRETCHEN KNIGHT

“Believe Midwifery Services, this is Gretchen,” answered a cheerful voice on the other end of the phone line. And thus began our journey with midwifery care. My husband and I were expecting our first child, and we knew we wanted to try to have a homebirth, but our options were limited. Through a bit of internet searching, we found Believe Midwifery Services, and if the friendliness & helpfulness of the receptionist was any indication, we were on the right track. A few weeks later we arrived at the Thorntown office to attend our “Meet the Midwife” meeting. I felt anxious, knowing this meeting would likely be our deciding factor, but, again, there was sweet Gretchen as we walked though the door, welcoming us as though we were dear friends. Choosing to continue care within the practice was not a difficult decision.

Gretchen headGretchen assisted us in nearly every prenatal appointment, and she had a remarkable way of making me smile about morning sickness as I answered preliminary questions. Often she would be working on the computer while we met with our midwife, but she would overhear a bit of conversation and anticipate Dr. Lane’s needs. I can still see her retrieving a page from the printer as Dr. Lane was mentioning a form she wanted us to complete. Gretchen was handing it to us before Dr. Lane could turn to her to ask her to print it! It was as though she was an extension of Dr. Lane herself.

When the time came for our child to be born, Gretchen was the first to arrive at our home. She was calm and quiet and set the tone for the next several hours of labor. She listened carefully and was encouraging, while giving me the space I needed to stay focused. The birth of our first son was so peaceful and sacred to me. They are memories I will treasure forever.

After birth came the hard work. Breastfeeding presented challenge after challenge, from latch to supply issues and frightening weight loss of baby. I fought with everything I had, and I was upheld with the skill and support of Believe’s staff and family. Gretchen helped arrange milk deliveries from other mamas who stepped up to help us. She checked in often to see how I was doing and offered encouragement. She didn’t let up until our baby was thriving.

We were thrilled when, two years later, we discovered we were expecting another child. Not using Believe Midwifery Services never crossed our minds. So with joy, I called and scheduled our first appointment. We had another round of prenatal appointments with dear Gretchen, and we appreciated all of her nurturing along the way. We were able to attend several of Believe’s educational classes she had begun to teach. It was easy to catch her passion for homebirth and safe care for women and babies.

Gretchen's two babiesA few days past my due date my water broke, but my labor was not consistent. Any mama who has lived through PROM (Premature Rupture of Membranes) understands how incredibly exhausting and challenging emotionally that time can be. Contractions would start and stop randomly and rest was elusive. The birth team came and went multiple times. After nearly 36 hours of labor, Gretchen came to our home to check the baby’s heart tones. Yes, she was preforming her job as a nurse well. But her hug and words of support bolstered my heart. She did more than provide health care; she provided heart care. Our second son made his arrival several hours later. I was so weary in my body, but so grateful for yet another beautiful birth and our precious son. In the weeks following his birth, during some challenging moments, Gretchen was there to put her arm around me and tell me we were going to make it. And we did.

It has been an amazing journey. I couldn’t have asked for better care. We are so grateful that God brought Believe Midwifery Services into our lives. We wish the very best for Gretchen and her future. My hope is that one day I will call and again hear, “Believe Midwifery Services, this is Gretchen.”
Sincerely & with much love,

The Bigelows

Tips for Success

We are often contacted for advice by nurse-midwives seeking to open their own homebirth practice, and while there is a plethora of specific clinical and business tips we could offer, here are some of the more important tips and one’s we are keeping close to our hearts this year…

First, create clear boundaries so your clients and staff have appropriate expectations. This one piece of advice will make or break your efforts. This isn’t as easy as it sounds, because we aren’t always aware of our own expectations until boundaries are crossed. Talk with experienced midwives and learn from their hard lessons.

Second, don’t spend time feeling sorry for yourself. Midwifery is a tough job in a number of ways. The successful homebirth midwife takes responsibility and doesn’t complain. After a setback, move on. Third, embrace change. Consider it a challenge! Change can be energizing and bring out the best in you. When we opened our practice just seven years ago, we didn’t have GPS or Electronic Health Records or even the Neo Tee! It was just myself offering all visits, answering all phone calls, attending all births, and collecting all money. Today we have a full staff with a multitude of responsibilities to coordinate. There will be growing pains. Adapt. Your strength revolves around the way you respond to situations. Maintain control of your emotions and actions. Extend grace and be compassionate, but most importantly, draw boundaries.

Don’t waste a single minute stressing out about things you can not control. Traffic. Long lines. However, don’t let that stop you from moving mountains and laying new ground. Never accept, “We’ve never done that before or that can’t be done.” Sometimes you have to help people think creatively so you can integrate yourself into the larger healthcare infrastructure. Take calculated risks. Weigh the benefits and the risks before jumping in with both feet. Step away if appropriate.

You are set apart. You are in many aways alone. Don’t worry about what others think. Speak up for yourself and defend your position. Be fair and kind, but don’t become emotional through persecution. It is evidence you are creating change and a necessary part of the process. Don’t burn bridges, but don’t build bridges with everyone either. Choose your paths wisely.

Learn from your failures. There will be many. Don’t let it happen again. Analyze it. Pick it apart. Dissect it. Study it. Fix it. Create a better plan. Then don’t dwell. Invest in your future. You have a mission. Keep yourself focused. Failure is quite simply a learning experience that will contribute knowledge toward eventually reaching your goal. We teach a lot of classes, and within those we share our own failures.

Don’t envy others. Successful people do not resent the other’s people’s success. Show genuine happiness and use other’s successes to fuel your own quest. Midwives can be especially territorial. However, we need each other to give voice to the profession and create a larger demand for our services. There is far too much work to do and having another midwife carry the load should be very encouraging. You will have different assets and draw from a diverse clientele base. Don’t fret. Inspire others.

Enjoy time alone. Network certainly, but treasure quiet time alone. The longer I work as a midwife, the more introverted I’ve become. Spend time reflecting and planning ahead. Persevere. Results won’t be immediate. Just take one step in front of the other. Be ready to work, and work long hard hours. Your success won’t be measured in big salary, fancy titles, and amazing benefits.

Did I mention boundaries… that was my biggest lesson.

What if something goes wrong…?

The primary question that causes distress about homebirth is, “what if something goes wrong?” Admittedly not all practices are clinically equipped to handle emergencies; however, most are non-interventive and can significantly decrease the incidence of emergency in the first place. Even midwives who lack academic or clinical training have proven better outcome statistics for mothers than our physicians in the hospital. This hasn’t proven true for our neonates, and certainly there are components of care which have significant room for improvement even with our mommas who birth in the home setting, but the benefits exclusive to homebirth are rarely recognized.

Risk assessment isn’t as simple as “are there any risk factors to this pregnancy,” but rather, where would the care of this individual woman be best managed? Would a medical facility offer greater resources without imposing greater risk or would birthing in the home with the resources we can provide be a safer option? This doesn’t even account for satisfaction.

The Indiana State Nurses Association offers a weekly publication which I rather enjoy, called the ISNAbler written by Blayne Miley, Director of Policy & Advocacy. He shared today:

Fourteen Indiana Hospitals Penalized for Hospital Acquired Condition Rates
Medicare reimbursement for October 2014-September 2015 will be reduced by one percent for hospitals in the top 25 percent nationally of hospital acquired conditions rate over the past three years. The conditions measured are central-line associated bloodstream infections, catheter-associated urinary tract infections, and eight serious complications, including blood clots, bed sores, and falls. The fourteen Indiana hospitals that make the list are Eskenazi Hospital, Indiana University Health’s Methodist Hospital, Community North Hospital, Community Heart & Vascular, Lebanon’s Witham Health Services, Community Howard Regional in Kokomo, Dupont Hospital in Fort Wayne, Franciscan Alliance hospitals in Crown Point and Munster, Memorial Hospital in Jasper, Methodist Hospital in Gary, Physicians’ Medical Center in New Albany, Saint Joseph Regional hospital in Plymouth, and Union Hospital in Terre Haute. This constitutes 16% of the Indiana hospitals assessed in the program, which is better than the national average of 22%.

This is a $7 million dollar loss in Medicare payments for five Indianapolis hospitals and I can’t even comprehend the impact especially on the heals of laying off thousands of nurses this past year. You’re birthing in the hospital? What if something goes wrong?

Hospital acquired infection, wrong patient errors, medication errors and even events rare but catastrophic such as neonatal kidnappings are not risks associated with homebirth. These are grave risks in the hospital and are part of the risk assessment when considering the most appropriate place to birth.

When the H1N1 virus was active within the community, we transferred a mother for retained placenta and she was not permitted to bring in her two hour old neonate. The hospital was unsafe!

Natural disasters often prove the hospital to be an unsafe place to birth, such as during the Katrina floods. ebola is our current threat. Why not support trained and equipped nurse-midwives in maintaining a safe environment for mothers and babies outside the germ invested hospital? Maybe offering some sort of accreditation so the community and healthcare professionals knew a minimum standard would offer the necessary reassurance.

Probiotics

Our guts are full of bacteria, good and bad. The good help our immune system and support our digestive system. While we strive to individualize our approach to care, we are big fans of probiotics and recommend them to most of our clients.

Live, Active Cultures

A great diversity of bacteria grow and thrive in your gut. This complexity is an important contributor to the health benefits of bacteria. The variety seems to be important; however, there must also be a balance so that there is no dominating strain. Using quality probiotic products is important in maintaining proper digestion, and ultimately, overall health.

Certainly a healthy diet is important, such as consuming yogurt, dark chocolate, kimchi, kefir, miso and avoiding foods and medications that destroy gut health. A healthy person should consume at least five billion live bacteria daily and even when eating the proper foods, the acidic environment in the stomach can challenge our efforts. Taking a supplement is highly recommended. Doing so while pregnant has proven benefits to the health of the fetus and neonate.

Choosing the Right Supplement

Our boutique sort of took off on its own, in that we were simply trying to secure products that were of the best quality for our clients and hadn’t recognized that an abundance of items were piling up that would fill shelves. Retail management certainly isn’t our passion, but researching vendors, manufacturing processes, ethical sales, and discerning quality drives our efforts. We want to extend the best to our clients, and are passionate about sharing our discoveries.

Probiotics should be stable and have a reasonable shelf life. This means the bacteria should be in a dry, suspended state, or if live and active, they should be refrigerated. The bacteria should be able to survive the stomach acid so that it can reach the intestines to grow and provide you with its symbiotic benefits. This is controlled in its manufacturing process, typically by creating the probiotic in capsule form so it isn’t released until after passing through the stomach. The specific bacteria blend should be common to a healthy gut as well. One specific species simply doesn’t represent the diversity required for optimal health.

When you think about the number of bacteria, (estimated to be 10 times the number of cells in the body, or around 10 trillion organisms), you begin to see that getting health, consistent dose over time is critical to having an influence on your gut. ~Dr. Tory Parker

Prebiotics

Probiotics require food to survive. This is in one way how good bacteria is beneficial to the gut, in that they compete with the bad bacteria for nourishment and when in sufficient quantity, they can starve out the unwanted stains. Prebiotics are bacterial nutrients, such as soluble fibers. This may be in the form of whole fruits, vegetables, whole grains, and beans. If you aren’t getting enough fiber in your diet, change that, and while doing so begin supplementation.

Megan, our nutritionist, has created these probiotic blends for our practice, for either adults or infants, and we also offer a Flora product for infants and one from Rainbow Light.

Ayurveda

Ayurveda is a modality of healthcare I have only briefly been introduced. It is known as the “science or knowledge of life.” According to Ayurveda, life is the inseparable and integral union of mind, body, and spirit. The key is balance. Health is not simply the absence of disease, but a balanced state of the three doshas, the seven bodily tissues, the wastes created by the body, and the digestive fire; it also involves a joyful and content state of the senses, mind, and spirit; and finally, true health exists when one is centered in his or her true self (Lad, 1984).

The Five Elements and Three Doshas

Space, air, fire, water and earth are the classical five elements valued in Ayurveda. These aren’t elements such as those found on the Periodic Table, but rather, archetypal patterns of behavior. These behaviors are then manifested through the assistance of data, pitta, and kappa – the three doshas. In order to understand the Ayurveda perspective, one must understand the relationship between doshas and the elements (Patel, 2010).

Vata is associated with the space and air elements and governs movement of all kinds. It is required for physical motion, nerve impulses, thinking, respiration, circulation, ingestion, peristalsis, elimination of wastes, menstruation, and childbirth. Pitta is associated with fire and water and governs transformation. It is key for any processing to occur in the body, including metabolism, digestion, maintenance of body temperature, comprehension, appetite, and thirst. Kapha is associated with water and earth, and represents structure and stability. It is essential for growth and nourishment in the body, including physical (bone and muscle) structure, lipid structure, repair and regeneration, lubrication, stamina, sleep, water and electrolyte glance, and memory (Patel, 2010).

Each have qualities, such as dry, light, cold, rough, subtle, mobile, clear or sharp, penetrating, hot, light, liquid, mobile, oily, or even heavy, cold, cull, oily, liquid, smooth, dense, soft, static, cloudy, hard and gross (Lad, 2002). All three doshas are said to exist in all people, yet they vary in presentation and overall balance. One’s prakruti, or state of balance, is termed their unique constitution. This unique combination of doshas is consistent throughout one’s lifetime, yet they may fall out of balance (Patel, 2010).

Diet, daily practices, forms of exercise, emotional digestion and various other daily choices can either support or exacerbate any of the doshas. Imbalance is then termed, vikruti, and subsequently leads to disease. These concepts are truly quite intriguing. Agni for example, is responsible for digestion. One must be mindful of maintaining balance not only through a healthy diet, but in both mind and spirit. When out of balance, basic principles are followed to prevent one’s dosha from working harder than necessary. For example, drinking warm water, eating the largest meal at noon, cook food thoroughly and chew completely, utilize warm spices, and eating only when hungry. Eating with awareness is essential, such as avoiding the television while eating. Agni must multitask when digesting food and processing images and sounds from the television, which can disrupt the doshas. Daily stooping is vital for releasing ama, or excess doshas (Patel, 2010).

Panchakarma includes cleansing work on specific doshas. This may include emesis, purgation, therapeutic enemas, and even blood letting. Following the cleanse, rejuvenation is normally required. The specific cases are individualized and should be managed by a practitioner. The key principle of restoring balance is to remove the root cause, and then remedy the imbalances with opposites. Diet, lifestyle, herbs, sense therapies, meditation, karma and detoxification treatments are various modalities of treatment. Yoga and Jyotisha (the study of astronomy and astrology) are also utlized (Patel, 2010).

Ayurveda would guide me to create a routine, get more sleep, seek warmth, enjoy gentler exercises, eat more soup and listen to grounding music. Who would argue with that? Abhyanga is another technique for balancing the doshas, all three simultaneously. This involves warm oil specific to the dosha (warm verses cool) in a daily self-massage (Patel, 2010).

Ayurveda and Women’s Health

There is a depth to the understanding and recommendations for pregnant woman, including understanding her season, field, water and seed. Breastfeeding as well has its own complexity, although very basically, mothers should consume a warm, moist and nutritious diet. Ayurveda respects the cycle of the woman’s menstrual cycle, and the transition into menopause. An imbalance in the doshas upon entry into menopause will create a plethora of pathologies, such as osteoporosis and memory loss. One must take the time to balance their doshas.

 

Ten Reasons NOT to Choose Believe Midwifery

It is the heart of every midwife is to meet the needs of each and every woman we interact. The hard truth is that we aren’t equipped to do so. Midwives are as complex and as diverse as the women we serve. Before choosing our practice, please consider these points. After decades of experience, we have come to understand our strengths and those who we best serve.

 

  1. If rescheduling an appointment would not be acceptable, even at the last minute, please do not choose our practice. The midwifery-model-of-care prioritizes continued support with each laboring mother during her birth process. This means that once a woman is actively laboring, our entire birth team will support her until both she and baby are stable, at least three hours postpartum. Our midwives do not utilize staff to “labor sit” and notify us just prior to delivery. If labor is prolonged, the presence of the midwife remains. This has meant hours, even days, of continued support. Although prenatal appointments may need to be canceled, and rescheduled, this also means that when you are the laboring mother, you become our top priority and receive the same undivided attention.
  2. If when asked if you plan to breastfeed, your response is, “I am going to try,” we are not the provider for you. We have a very high expectation for breastfeeding success. Only rarely do women who birth physiologically experience difficulties that prevent them from exclusively breastfeeding. If this is your experience, we will support you in every way to optimize your experience, but we expect complete success with every breastfeeding couple. An inability to breastfed, in a baby born at home, represents a pathologic issue. In our practice, this has allowed us to discover two cardiac anomalies, a brain malformation, and a life-threatening infection. Choosing not to breastfeed, or giving it your best effort, handicaps our assessment skills and places us outside our comfort zone.
  3. If you are seeking a close personal relationship more than an excellent clinician, please do not choose our team of midwives. Midwives value the relationships they build with the families they serve. Many are life-long and mutually endearing. There certainly are midwives who choose to approach their care in a manner that extends close friendships to each client they serve, even making them a member of family. We respect this approach, but we do not share its vision. Our midwives prioritize high quality care, with the greatest of clinical integrity and professional standards. This does not mean that we lack compassion or sincere relationships, but it does mean we draw boundaries so we can best serve each of our clients without exhausting ourselves. It also means that we may share truths that are hard to hear, including that you might not be the best candidate for homebirth. We value your safety, even when it means sharing hard truths.
  4. If you feel our price is too expensive, please don’t invest. It is important that you value the services we provide. Good homebirth outcomes are dependent upon trust, which is dependent upon respect. It is our opinion that our services are grossly under priced, and that our competitors do not compare to the full scope of services we offer, nor can they match our outcome statistics. It is our hope certainly, that your pregnancy and birth progress with the greatest of ease; however, this rarely demonstrates the vast experience and expertise your investment secures. Dr. Lane and Miss Michael offer twenty-eight years of combined nursing experience with twenty of those attending births. Those who have had challenging pregnancies and births, or complications with their neonates, can attest that to value in their investment.
  5. If you have doubts about the quality of midwifery care, even after educating yourself, let us recommend a respected physician. Midwives have demonstrated themselves to be the experts at optimizing pregnancy and childbirth outcomes. This is not to discredit physicians, as they unarguably the experts in managing pathologic states that arise in pregnancy. Don’t blame your physician for turning to the scalpel when challenges present in labor; you hired a surgeon to manage your birth process! The same concept is true for midwives. If you want to be healthy and have a safe birth, heed the advice of your midwife. You will be asked to educate yourself, attend our childbirth preparation classes, attend regular prenatal visits, prepare your home for birth, accept our nutritional advice, exercise, sleep and seek happiness. We are not interested in sitting idol, awaiting opportunity to tackle emergencies and we are not interested in being bullied into meeting your demands without any effort for a mutually respectful relationship.
  6. If you prefer the medical model but found our practice more affordable than a hospital birth, please reconsider. Our prenatal visits are lengthy. We sit and talk. We want to understand your desires, your concerns, your fears, your investment. We want to share our clinical expertise, using discernment and intuition, and encourage you to find your own conviction. We will not perform vaginal exams at each visit to appease your curiosity. We will not induce your labor to satisfy your family’s schedule. We will not write a prescription when the best cure is rest and hydration. We demand you invest as much in your own health as we do! We are not the easy approach.
  7. If you prefer to seek care in an office setting where most all the patrons are immunized, our practice is not the right one for you. It is our responsibility to inform you of current recommendations. We want you to understand what the standard of care is and what options are available to you. This includes informing you of current immunization schedules and recommendations during pregnancy. However, we respect your informed decision. Our clientele base is one that is largely unimmunized, or selectively delay. Our staff are also not forced into accepting immunizations, including Tdap and the flu vaccine. We do ask clients to keep their sick children at home and our staff are cognizant of exposing our clients to illness, but we do confess, we are not your standard healthcare facility. We have also never had a single staff member miss work for the flu!
  8. If you are already bored reading through this list because you really don’t like to read, we most certainly are not the best fit for you. Our greatest fear is to have a family experience a less than optimal outcome and then share that “had we known, we would have done it differently.” We want each client to fully understand their options, the benefits and risks, alternative options, and the community expectation. We earnestly try to refrain from offering our opinion and try to mask any personal passion. This is your experience, not ours. Good or bad, you will suffer the consequence of your decisions. We never want to be in the position to have persuaded you incorrectly. The evidence is sufficient and we trust each couple to find conviction, making the best decision for their individual family. This means we have an extensive list of informed consents for every routine screening, procedure and controversial scenario. We do expect you to read these prior to the appropriate prenatal and be prepared for discussion with our midwives. Our client agreement, which is discussed at our very first meeting, details our practice model. Not reading this, or our website, sets clients up for inappropriate expectations and failed communication.
  9. If you put your midwife on a pedestal, you may be disappointed. We require sleep. We can’t always fit all the demands into a single clinic day. We may not return your voice mail as quickly as you desire. We may need to redraw labs. We may run late on our appointments. We don’t have a billing staff to create an itemized invoice for your insurance company. We can’t turn around FMLA paperwork immediately. We require food to endure long labors. We can’t work for free, and we won’t beg for payment. We have more than one client and therefore, can not make every need of yours the top priority. We triage, addressing needs in order of their significance. We sacrifice greatly, but we do draw boundaries.
  10. If you are concerned we might not be the right fit, please compare us to other birth options. Our community is blessed with a number of options for home and hospital birth, with midwives of all variety. We can even recommend a number of physicians who will respect your visions for a satisfying birth. We are not the best choice for everyone, but we are the most experienced nurse-midwifery group. We have found our niche and are very good at what we do. Our information sessions can help you determine if we are the right midwifery team for you.

Traditional Chinese Medicine

Recently, we were blessed to care for mamma of Chinese descent, who has training in Chinese Medicine. Married to an English man, her translator shared concern that this mamma’s needs would not be well met. She asked about fresh rice, ginger and eggs immediately postpartum. “How are you going to assure she gets what she needs in the several weeks to come?” asks the translator?

These experiences are intimidating, in that we seek to respect every wish of the client but are quite naive to her needs. What an honor to be asked to share in this event though, and to be trusted to respect their cultural traditions and beliefs! Fresh rice was prepared, ginger was grated and eggs were whipped. Mom had all her needs met, including preparation of her placenta for consumption.

Chinese Medicine Fundamentals

Developed more than 2,000 years ago, Chinese medicine is based on natural phenomenons such as heaven and earth, cycles of growth and decline, the seasons, movement and stillness, and every observable process seen in our world, both animate and inanimate (McGee, 2010). One of the fundamental ideas, which many are aware, is the theory of yin and yang. These are opposite qualities in that Yin represents form, substance, stillness, moisture, darkness, the interior, and coolness, while yang represents energy, activity, transformation, heat, the exterior, brightness, and dryness. The two can consume one another, in that yin’s moisture can extinguish yang’s heat, or yang’s activity can transform yin’s stillness and inertia (McGee, 2010).

Chinese medicine translates these concepts into the body viewing our form and substance as yin, and the body processes are yang. Therefore, the uterus would be yin, and the movement of the egg being released from the ovary as yang. While opposites and consumptive of one another, yin and yang can destroy each other or become one another (McGee, 2010).

Another fundamental theory is the concept of vital substances, with the most significant being qi (“chee”), blood, and essence. Qi is a vital energy and has a yang nature in its movement, its warmth, and is transforming nature. Blood is dark and fluid, thus more yin, and serves as a substantial nourishment of both body and mind. Essence is a fundamental, highly refined substance, with both yin and yang qualities. It governs growth and reproduction, and declines with age. The body functions and lives through the presence and activities of these substances (McGee, 2010, p 102).

Chinese medicine also theorizes that the body is composed of a complex web of channels, which is the basis of acupuncture. Needles are utilized to adjust the function and balance of the body, using the fine needles or with acupressure, manual stimulation (McGee, 2010, p 102).

To be healthy, fertile, and energetic, women need not only an adequate quantity of qi, blood, and essence, but also the proper cyclic movements of these as well. ~McGee, 2010, p 103

The relationship and harmony of yin and yang underscores every aspect of women’s health within Chinese Medicine. An easy and predictable monthly cycle depends on the balance of energy and restfulness. Qi moves the blood in the monthly cycle, filing and then emptying the channels, and then essence maintains the ovaries and fertility. The proper biphasic curve of the monthly basal body temperature is again, a balance.

Chinese medicine, without the modern concepts of hormones and biochemistry, describes women’s health with clarity and logical consistency ~McGee, 2010, p 103

Practitioners attempt to discern where the balance has been disrupted and then prescribe treatments that restore the woman to a rightful balance using acupuncture, herbal remedies, and lifestyle recommendations. The assessment is quite complex and addresses premenstrual syndrome, irregular cycles, polycystic ovarian syndrome, dysmenorrhea, endometriosis, vaginal infections, frequent miscarriage, infertility, menopause, and many others. Regular acupuncture and herbal medicine may be utilized in some women for many weeks in effort to optimize health and achieve long term change. However, many can also be treated with monthly acupuncture, a small dose of herbs or even, more or less simply, diet and lifestyle changes.

Current Day Assessment

acupressure modelWestern research of Chinese medicine is still in early development. One of the strengths certainly, of Chinese medicine is that its nature is very individualized. Tailoring treatment and coordinating a research project with any specificity is therefore, challenged. Randomized control trials are exceedingly difficult. While hundreds of Chinese journals publish a plethora of articles, high quality data is largely lacking. This does not mean the research isn’t without merit. In fact, it is intriguing and demands further exploration.

Acupuncture has a larger body of evidence, and is where the bulk of evidence exists in women’s health, more-so than even herbal medicine. Dysmenorrhea and infertility in particular have the greatest support in today’s literature, especially in conjunction with IVF (McGee, 2010).

Women is little nature, a child of heaven and earth, a product of cosmic forces. ~Dr. Ngyuen Van Nghi

Chinese medicine recognizes that women, with monthly expression of these natural cycles, are indeed human displays of created, cosmic forces. The belief is that the physical, emotional, biochemical, and hormonal realities women endure are connected to heaven and earth, yin and yang, and the ebb and flow of the tides and moons. Chinese medicine has a long history, but requires further research to test its reputation as an effective therapy for women’s health.

McGee, L. (2010). Traditional Chinese Medicine. Integrative Women’s Health, Maize & Low Dog. Oxford University Press: New York.

Our New Prenatal Vitamin

Megan Barnes, Registered Dietician and Nutritionist, joined our practice at the end of 2013 and has been an incredible addition to our clinical team. Her knowledge-base is astonishing. Those of you who have sought consultation with her will agree! She is a recent Purdue graduate and currently enrolled in a graduate program for functional medicine and nutrition. (Yes, I know, I am equally ecstatic that she has chosen to work with our midwifery team. What an incredible blessing.)

So… as you can imagine, I take every opportunity to pick her brain. Today she allowed me to conduct a little interview of sorts and I wanted to share that with each of you.

Megan, why did you decide to create your own, unique prenatal vitamin?

Many of the prenatal formulations are not really optimized for pregnancy care. The bulk are, quite simply, just glorified multivitamins. Vitamins are not typically formulated in a manner that optimizes absorption whether created specifically for pregnancy or a more standard multivitamin.

The supplement market is sort of an interesting thing in that when vitamins were initially synthesized it was decided that it was cheaper to synthesize synthetic versions, and now we’re learning that these aren’t well absorbed or utilized by the body. In fact, we are learning that there are circumstances in which this can be detrimental, even at normal levels.

Megan states, “I really wanted to create a prenatal vitamin that provided nutrients in their best forms, which would be the form found in nature, and in appropriate amounts. If you’re going to take a prenatal vitamins, you might as well get the most benefit from it.”

How did you come up with this specific blend for your prenatal vitamin?

Megan spent a great deal of time researching prenatal vitamins in effort to find a brand she could recommend for our boutique. In doing so she became increasingly concerned with the minimal value of prenatals available today on the market. Nearly all are formulated in a way that the body is unable to utilize, so even when spending more money for what was thought to be a better brand, women are essentially excreting their investment because their bodies simply can not utilize the formulations.

For example, if you look at the label of this respected brand of prenatal vitamins [unnamed], the B vitamins are synthetic, there is no activated folate, the vitamin D is D2 rather than D3, there are a number of minerals in formulations which are hard to absorb, and there are a number of ingredients for flavoring and coloring which I believe could be avoided. My disclaimer is that not everyone needs a prenatal. They should get what they need from a healthy diet, with a probiotic supplementation and a high grade cod liver oil.

Megan and I both felt it was urgent to create a proprietary blend that we could stand behind and recommend to our own clients. While Megan states she might continue to perfect the formulary, this blend has so much more to offer pregnant women than what can be found elsewhere. We are most eager to update the design of the label and discover a perfect name!

Megan further discussed the importance of utilizing the best forms of vitamins and minerals, and doing so in a manner that complements each other. Folate and B12, for example, are dependent upon each other like two turning gears. Both are required in appropriate forms for either to work. Often what you’ll find, in various supplements, are components which are not well utilized by the body, and so in trying to convert them, the body is overwhelmed and then poorly converts other components of the vitamin. Proper form and proper amounts is vital for utilization within the body.

Our new proprietary prenatal blend additionally offers both versions of vitamin K, and a full spectrum of both vitamin E and vitamin A. Typically vitamins offer only one form of each, which again, are not well utilized by the body. Certainly, more benefit is obtained from the full spectrum of each.

Iodine, from kelp, is added, one of the greatest deficiencies among women today, and various minerals which are not considered trace but we know women aren’t getting sufficient quantities are also included to our new proprietary blend. Choline, Megan explains, is a trace mineral not often included in prenatal vitamins but is frequently under consumed, but so very important for fetal brain development.

What is not added to our new proprietary prenatal vitamin is artificial colors, flavors, and unnecessary fillers.

Discuss for me the important difference between Folate and Folic Acid?

Folate is a chemical that is synthesized in a cycle so four various forms are created, with the most active being 5 methyltetrahydrofolate. This chemical is important for cell replication and regulating DNA, so certainly it is vital for fetal growth and development. When expert clinicians and researchers realized a folate deficiency was a contributing factor for neural tube defects, such as spina bifida, it was quickly added to all prenatal vitamins and is now fortified in many of our foods. This campaign was so successful in fact, that folate deficiency is one of the more uncommon deficiencies in childbearing women within our country today.

Unfortunately, while there is clear epidemiological evidence that folic acid supplementation has improved outcomes, as many as forty to fifty percent of the population lacks the necessary enzyme for converting folic acid into folate. These women simply don’t receive the same benefit and are therefore, at increased risk of pregnancy complications.

Folic acid is very inexpensive and easy to make so it continues to be utilized in essentially all prenatal vitamins on the market today. Change is slow and not completely because of cost issues, but also because new knowledge circulates exceedingly slow within the profession.

You were quite eager to add the new Butter and Cod Oil blend to our boutique. Can you tell us more about this blend and how it benefits our clients?

Yes, this cod liver oil is awesome! It is a blend of cod liver oil which has been fermented to high grade butter oil. Extraction of oil by fermentation is the most natural form of extracting oils. Rather than utilizing harsh chemicals or damaging mechanical processes, fermentation breaks down the cell walls over time, extracting the oil while also offering the benefit of high quality bacteria to the blend.

The butter oil in this blend is very concentrated and of high quality. “Butter has really gotten a bad rap in our culture lately,” says Megan, “but it actually has a lot of nutritional benefit when it comes from cows that have been raised well and fed well.” These cows have been allowed to pasture, are predominantly grass-fed, and aren’t given antibiotics so they have a high population of bacteria in their cuts. This provides for byproducts in their milk which is very beneficial to us, including high quality vitamin A, vitamin D and K2. The latter, K2, is not produced by our bodies as it comes specifically from bacteria, so a high grade bacteria from the milk of happy and healthy cows is an incredible resource for optimizing health.

Megan talked a bit about the concentration of the butter oil, explaining that butter is already the fattest part of the milk and where all the fat-soluble vitamins are found, so when you concentrate butter by removing all the proteins and solids, you get a really concentrated nutrition.

Megan also shares that, “This butter and cod liver oil blend also offers all of the omega oils balanced perfectly.” It is important to understand that this butter and cod oil blend is a whole foods supplement. Traditionally people would ferment their vegetables in animal fats for their supplementation. We don’t do this today, but it was widely used and is therefore, not a new idea.

I am glad you mentioned fatty acids, because my next question was about omega oils. Can you talk about those and what you mean by “balanced perfectly?”

It really just means they come in a natural balance, and it is not that they are all equal, but in amounts that our body needs them. Omega 9 is not technically essential, but it is really important. Our body can make 9, but if we aren’t getting enough of 3 and 6 we can’t do that.

Omega 3 and 6 are really important, and most people get 6 fairly well from their diet because they are already enriched in all of our processed foods, and nuts, but omega 3 is much harder to come by. We really need a good ratio of those, with the recommendation 1:1 or 1:2, although it is estimated that most people are getting a ratio of 1:15 or 1:20 (omega 3 to omega 6). This is problematic because while we need both, they actually funnel through the same enzyme pathway, meaning they compete for those enzymes. If you are getting a ton of vitamin 6 and some of the precursors for omega 3 (flaxseed, walnuts and other plant-based sources), because they are competing, then we are never going to get to the active ingredient our bodies need because we have overwhelmed the system. The animal version of omega 3 from animals, such as fish oil, is so important because it does balance out the omega 6 that most of us are already getting in our diets.

Tell me about sourcing and testing of the fish oil.

Sourcing and testing is important. We have to consider where the fish come from, what have they been eating, what have they been exposed to, what waters have them been in… and with the brand of cod liver oil we are recommending, the fish are Norwegian where the water is cold, clean, and very, very low in pollution and as we talked about, no chemicals are used in the extraction process.

They also test their product vigorously. Every lot of the Royal Blue Butter & Cod Oil blend is tested for PCBs, metals and etceteras… and every small run is tested three times for pathogens (standard food screens). They also direct other standard tests not required so they can accumulate information for better understanding of the product. All testing is done by third party labs and per FDA regulations for food and safety.

Cod fish however, is not one of the fish varieties that have demonstrated high metal contaminates, with one qualification, it should be wild, not farm raised. All of the fish utilized in this brand is caught wild.

Many years ago, at a midwifery conference, a well respected epidemiologist had shared that the only omega supplement she would recommend would be Udo’s Oil. What are your thoughts on that?

Udo’s oil is a great brand, and one we carry in our boutique. However, this is exclusively a plant-based product. Only the vegan or vegetarian should be recommended this product, because we do need omegas from animal sources. Cod liver oil is safe and incredibly beneficial for optimizing health.

We have a few other omega oils in the boutique and they are a good basic option. What one should understand is that most supplements have fish oils, but they aren’t omega’s or they aren’t in sufficient ratio. The Carlson’s fish oils and doTerra are two brands we carry with good formulation, but they lack fat soluble vitamins and I am unaware of their processing method.

Schedule a Consult with Megan TODAY!

Read about what Megan can offer here and book an appointment or call our office at (317) 434-2229 to schedule in either the Lafayette office or Carmel. Megan can provide consults to men, women, and children.

Food for Thought

Food for Thought

"It is much more important to know what sort of patient has a disease than what sort of disease a patient has." Sir William Osler

Food for Thought

Happiness is underrated and critically important to health. Seriously! Unfortunately, many people just have no idea how to be happy. Aviva Romm

Food for Thought

Physicians simply do not have time to be what patients want them to be: open-minded, knowledgeable teachers and caregivers who can hear and understand their needs. Snyderman and Weil

Food for Thought #1

They say that time changes things. But you actually have to change them yourselves. Andy Warhol

Food for Thought

To think is easy. To act is hard. But the hardest thing in the world is to act in accordance with your thinking. Johann Wolfgang von Goether

Food for Thought

"Birth isn’t about avoiding one set of realities in favor of another. It’s about embracing all facets of birth--contradictory, messy, or unpleasant as some might be--as vital to the whole." Rixa Freeze PhD

Food for Thought

Why I appreciate being a certified nurse-midwife, as opposed to choosing another route for midwifery: I feel learning the science is vital so the art of midwifery is safe and effective. Dr. Penny Lane, nurse-midwife

Food for Thought

When the debate is lost, slander becomes the tool of the loser. Socrates

Food for Thought

To accomplish great things, we must not only act but also dream; not only plan, but also believe. Anatole France

Food for Thought

"Science and uncertainty are inseparable companions. Beware of those who are very certain about things. There are no absolute truths in biological sciences - only hypotheses... 'We need to train medical students and residents more in the art of uncertainty and less in the spirit that everything can be known or that it even needs to be known.'" Grimes (1986)

Food for Thought

American physicians are rewarded for doing things to patients, not for keeping them well. Grimes, 1986

Food for Thought

The false idol of technology. "Having a widget screwed into one's scalp has become an American birthright." Grimes, 1986

Food for Thought

"Between 1985 and 1987, a hospital instituted a successful program to reduce its cesarean rate. The rate fell from 18% to 12%, losing the hospital $1 million in revenues - no small sum in those days." Goer & Romano, 2012, p 37

Food for Thought

"Obstetricians are much more likely to perform a cesarean when they wrongly believe the baby weighs 4000 g or more based on sonographic estimates than when the baby actually weighs this much but the obstetrician did not suspect it." Goer & Romaro, 2012, p 35

Food for Thought

"If you play God, you will be blamed for natural disasters." Marsden Wagner (2006)

Food for Thought

An education isn't how much you have committed to memory, or even how much you know. It's being able to differentiate between what you know and what you don't. Anatole France

Food for Thought #3

"Birth is not only about making babies. Birth also is about making mothers - strong, competent, capable mothers, who trust themselves and know their inner strength."

Barbara Katz Rothman PhD (1996)

Food for Thought #4

Believe there is always, always, always a way.

When you have exhausted all possibilities, remember this: you haven't. THOMAS EDISON

Food for Thought #5

"All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident." Arthur Schopenhauer

Food for Thought #2

Yet you brought me safely from my mother’s womb and led me to trust you at my mother’s breast.

Psalm 22:9