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…


“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.


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


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 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.

Negative Commentary

Being a business owner in the social media age, especially in a field with such emotional investment, is an exceptionally vulnerable endeavor. I certainly couldn’t handle the personal attack our legislative leaders undergo, or the witch hunt our celebrities endure. What our young high schoolers go through today on Facebook, I simply can’t imagine. I am learning that what some require is a little more understanding of the personal trials of extending midwifery. I’ve resisted this in the past, because first of all, this is a service oriented field. Midwives and nurses are willing to sacrifice, which we’ve learned especially this week with nurses contracting ebola after committing to care for a sick patient with a deadly disease. This happened too when AIDS was new to our culture. People ran in fear, but nurses stayed and cared for those in need. The irony of being both a nurse and a business owner is that like most business owners, we get punched in the gut with complaints, and the fact that I just sacrificed my time, my family, and my own health escapes them.

The other reason I have skirted away from sharing some of the hardships of this role is because it is a bit disheartening to clients. It allows one to assume that we aren’t grateful, that we don’t appreciate the honor of being called to one’s birth or recognize the privilege of being asked to take the responsibility of extending primary care. Women develop deep and sincere relationships with their midwife, and us to you. It can cheapen the experience to later whine about what one had to invest in it. For those who are reading and walking away with that impression, please forgive me. I am taking a risk here, and pray the Lord allows my words to land in your heart with grace.

The Black Sheep

Most anyone within the natural birth community in Indiana is well aware that this practice, and more specifically, myself – Dr. Lane, is not well accepted among the homebirth midwifery circles. This has occurred for a few reasons. The primary reason, and the one so many fail to appreciate, is because ten years ago my husband and I choose to birth at home with a prominent midwife in the area and my son lost his life. This was a planned homebirth, after two cesarean sections and was a planned vaginal breech birth. I researched. I prayed. My husband prayed. We sought counsel from several providers. The night before I went into labor, I received an email that my midwives were not willing to take the risk and attend my birth. They argue now that they felt there was too much medical risk, but I know and their email was clear, what they feared was prosecution. I had attended a vaginal breech birth with these midwives previously, and my son had been persistently breech throughout my pregnancy with ultrasound confirmation. The plan to birth at home was consistent. I even have a sticky note, ten years later, of the script we were asked to tell the hospital in the event of a transfer, in effort to protect them.

After receiving their email, I contacted several nursing and midwifery friends for counsel. Being a weekend, I wasn’t able to connect with a new provider. My option was to simply walk into the hospital in labor and then lay down for a cesarean, or pray my sweet baby slides out like butter, transferring with any little indication of trouble. After several nurses (some also direct entry midwives) committed to attending me, and a significant amount of prayer along with my husband’s full support, we continued with our plans to birth at home. We had bags packed and the phone prepared for a transfer to the hospital just ten blocks away at the first whisper of need.

My son was born, after a steadily progressive labor, and he failed to breath. My attendants failed to assist him. Recognizing I likely had the most expertise and they were simply intimidated, I began mouth-to-mouth on my son and asked for the resuscitation equipment. They couldn’t find their supplies and their oxygen tank had been left on and was now empty. I then told my husband to call 911. He and I worked together to breathe for our son. The team of midwives at my birth, all except one, packed their bags and left. They left my son there to die. The image of my husband resuscitating our little boy will forever be burned into my brain.

My son arrived at the hospital within minutes of birth. The paramedics swooped him up and he was out the door. We literally lived that close. He never required heart compressions. This was a respiratory issue. During the ten days of his life, on the respirator, we learned who our supporters were and who just wanted to be part of the gossip or judge, and who our haters were. Yes, there were haters. My midwives disappeared, never to reappear and I didn’t perceive their absence at first, then assumed they were simply trying to avoid legal trouble. I wanted to protect them too. I told the medical staff I had friends at my birth, to avoid their being arrested for practicing midwifery.

The hospital informed my husband and I that we did not have parental rights. They explained that we could visit our son, but he could not receive my breastmilk and we could not make decisions in his care. He would be moved into a nursing home and could not come home with us. The details of all ten days now are etched in my mind as if they happened yesterday. At the time I rode through each moment as if my body was robotic and my mind was numb. I remember a moment at his bedside with my sweet husband, and our son having webbed toes, he mentioned how cute it would be to see him grow up and wear flip flops. My husband’s toes are also webbed and he is self-conscious of this fact, but on our sweet baby, it was endearing. We laughed. I later read in his medical record that the “mother sits at the bedside laughing, uncaring that her son is in critical care.”

We were interrogated. Lectured. Blamed. Hated. We were prayed for and told that we must discern who we had wronged, and fix it so the Lord could hear our prayers and save our son. We were told if we just believed enough, he would be raised. We were told that we cared more about having a homebirth, than our son’s life. In fact, to this day, and having learned all I know now, while I may not make the same decision today, I whole-heartily believe we made the best decision for our son with the information we had at the time. I also have every bit of confidence that I was obedient and felt the Lord was directing us in our decisions. Ten years later, I am beginning to see why we had to endure this trial.

I became the subject of a police investigation. The prosecutor pursued me with reckless homicide, child endangerment and medical neglect. Our supporters became sparse and our midwives sought legal counsel. They crafted their defense and in all accounts, I was the one to blame. There aren’t many willing to go to jail for another. These midwives had children, spouses, lives. If the police were willing to blame me, it was easy to make me the scapegoat. We retained counsel and I hid in my home, fearing every car that came around the corner was coming to handcuff me. We feared having our older children removed from our home. I questioned every decision we’d made. I questioned why I had to endure, where had I not discerned the Lord’s direction. I watched the midwifery internet circles I had just days prior sought refuge within, thought they were friends, speak horribly about me, even comment that I deserved what I got. I printed every comment but sat quietly.

Our attorney had advocated for us at the hospital, realizing our parental rights had been removed illegally. In fact, a judge had ordered that we were completely within our rights and all rights should be returned to us two days after his birth, but we were oblivious to this. My son was given artificial breastmilk through his feeding tube as I pumped my breasts at his bedside. They violated us both. They ignored our basic human rights. He underwent multiple brain scans and had very little brain activity. He was not brain dead, but he was a vegetable. In the ten days he laid in that bed, he deteriorated quickly. I was a nurse. I could care for him. I could dedicate all my time to caring for that sweet child. I knew though, if I were his nurse, I would want him set free. My husband made the decision for us, to remove life support. This was a brief moment, because we had a small window of time. The ethics committee might argue.

Our son was perfect. He was saved. He need not suffer. If he had been older and needed to accept the Lord for eternal life, we would have prayed indefinately and waited for a miracle. I asked the nurses if I could please pump my engorged breasts before we took him off life support and scurried away. When I returned, they had already done so without me present and we weren’t provided a room to hold him as he passed in private. I am so angered by the lack of compassion and the punishment the nursing staff made us endure, but I think often of the poor family beside us, and later directly outside the cubby we were squished within, who watched our son die in front of them and the trauma they too, certainly suffered.

After an hour of my baby gasping in my arms and within my husband’s arms, he took his last breath. We were not allowed additional time. I suppose the hospital staff felt we got what we deserved. After all, I was too educated to choose to birth at home. We had chosen to donate his heart valves and corneas, which are the only few options when one is not brain dead and therefore, must die of anoxia. We met with the organ transplant team and had a tiny glimmer of light that some good may come of his life. Someone would be helped from our tragedy. We soon learned that the coroner refused these families opportunity because he too, was angered. Our transplant team said he was simply “being a jerk and trying to punish us.” The law allowed for this injustice.

Our son’s burial was the hardest of all. What was suppose to be a closed casket turned into finding my son naked, wrapped in hospital blankets. The clothes we provided were thrown away. Still I have thoughts of digging my son out of the ground to wrap him in warm clothes and soft blankets. There were many days that I had to lean hard on the Lord to maintain the simplest of sanity.

Weeks after my son’s birth and death, and thick into the hatred we received from the community, from Indiana midwives, from my previous hospital associates and from my family, we received his autopsy report. My son had suffered multiple brain injuries during my pregnancy. He had no capacity to breath. I was devastated that my son, while cradled in my body was being harmed. I remember my husband’s relief at the news and I simply couldn’t relate. I was so unaware of the moment my son suffered within me. I felt as if I failed to protect him and then lived my life oblivious to his suffering.

I called the pathologist at the state’s lab for more information. That man, I literally pray for daily. I can’t remember his name but it wouldn’t surprise me to learn he was an angel, a true messenger of God. He spent a great deal of time talking with me, comforting me and protecting me. He was a great physician. He shared that the prosecutor had made the hour trip to his office to threaten him into making clear my son’s death resulted from murder. He said because they were so determined to charge me, he had my son’s brain flown to Florida, to be given a second opinion by another pathologist. He too found evidence of multiple brain injuries – one months prior to his birth and one weeks prior. The second was the most ominous and left his brain completely foam. He said, “When they charge you. Please call me. I will defend you, and so will the pathologist in Florida.”

We had no reason to share these findings publicly. People had already made up their mind about me. They never sought truth. They wanted to find me guilty of neglect, of recklessness. Midwives especially, because if this were my fault, then it meant that they could remove themselves from the possibility of ever having to face a similar situation. Death is a reality we can’t except for babies. No one wants to recognize that some breech babies are breech because they haven’t the neurological development to turn cephalic. They were already compromised. His five foot cord is thought to be the cause.

My sweet husband and our son, Lyric Bram.

My sweet husband and our son, Lyric Bram.

The National Advocates for Pregnant Woman came to my defense and ended the pursuit against me, but not after weeks of interrogation by my attorney who continued the abuse already initiated by the hospital. He did his job and I am grateful. However, he clearly thought I was an idiot. While defending me in what the prosecutor thought was an unassisted birth and gave him grounds for reckless homicide and medical neglect, I shared that I did in fact have a team of direct entry midwives. They were my friends and so in effort to protect them, I didn’t share they were medically trained. He wanted records from the midwives who had cared for me through my pregnancy, and the physician we were consulting with when planning a vaginal birth at home. Then he asked how much I paid them, and I shared, $1,200. He said, “Well, I think you got your money’s worth.” I was stunned into silence.

Sadly, I had to remain silent on all details of my birth because under the eye of the prosecutor, if I shared I had hired direct entry midwives, while it might protect me from reckless homicide and medical neglect, it would open me up for charges of conspiracy to commit a crime for hiring someone to commit a felony. My birth story was incriminating no matter what I said and in my silence, I witnessed the character of everyone around me unfold. If you don’t give people a story, they will make one up.

It seems much of my first year I was in a fog. I couldn’t care for myself, or the kids. My husband and oldest daughter carried the burden. I was so fearful. So very betrayed. I was terrified to live in a country that could violate someone so horrendously and have no recourse. So many others reached out to me with similar scenarios. Women abandoned by their midwives and they too lost their babies. Some had been violated and manipulated by the hospital, their children removed from their home simply for not following protocol. I lost hope. I scoured legal briefs about birth, breastfeeding and parenting. I further researched vaginal breech birth, vaginal birth after cesarean and poor birth outcomes.

Donating my milk was a comfort for me and after ten months of pumping and sharing, I now have a number of babies and adults who benefitted from the milk my son was never allowed. I found refuge at Witham Hospital as a staff nurse. The nurses and physicians there listened to me, and not simply out of curiosity, but with sincere compassion. They healed me and supported me through my next pregnancy and birth, a beautiful, all natural water birth. Frontier Nursing University held my hand through the remainder of my studies and supported me as I defended my innocence legally. As a private school, they easily could have rid themselves of the controversy and dismissed me. They recognized that I was making the best decision for my family with the options and resources I had at the time. They welcomed me back for my doctorate and I will forever be grateful.

High Standards

Which brings me to the second reason I am an outcast in the homebirth community, I work darn hard to set high standards. This is a calling for me. I have been victim to poor midwifery care. I know the price one pays. When I worked to open my practice, there were no other legally practicing nurse-midwives in Central Indiana. Another opened at the same time as myself, but we laid new ground. She had refuge among the direct entry group and I worked against the persecution. New couples would interview each of us and most all shared they had met with the other midwives, and had been warned about me. I watched social media outlets speak about my being reckless and having lost my own son’s life. It was said that I had no experience, and while I was a new midwife, I had attended more than 2,000 births within the hospital, birth center and home. I was a very good nurse and established a very well respected midwifery practice in a short amount of time and with little to no support. After two years, I was awarded by the Indiana State Board of Nursing for my work.

I was isolated. I was set apart. I knew this was God’s will. I wanted to create something different. I wanted to offer excellent care that wasn’t found in the hospital, and based on the number of homebirth families being abandoned, it wasn’t happening at home either. It is easy to stand by women when births go well, but they don’t pay thousands of dollars to you to celebrate with them after they did all the work. They hire you for the hard births. That is where we must excel as midwives.

I think a combination of urban legend and self-protecting midwives surrounding my son’s birth and death, and then later sheer intimidation at my growing practice in spite of complete lack of support from the home birth committee continued to solidify my being the outsider. As the years past, the Lord validated my trial as necessary. If my son’s life was going to be short no matter his birth setting and if I had a heart for homebirth, I needed to learn the weaknesses so that I could improve them. I also needed to discover my allies.

There were times that I was asked to support the direct entry bill in Indiana. I was conflicted. I had many direct entry midwife friends outside the state who taught me a great deal and who I respect. I was concerned about their professional group, and was concerned about their grievance policy. At the time, if I wanted to file a complaint, I would have to share my concern within a group of local midwives (of which my midwife was the leader and would be present) and then I would be asked to leave while she defended herself. Her group of peers (and friends) would then determine her discipline. Even if she was found purposely negligent and this was the direct cause of his death, which I couldn’t argue, the most strict punishment was loss of certification for a single year. Why endure the pain of sharing? I was confident that the Lord would do His will, in His time, in His perfect way. I had a calling that now demanded all my time. I stayed focused on my path.

I also taught within a direct entry midwife program to help support our family as my practice grew, and although MEAC certified, this program did not meet high school standards in my opinion. References were not required for written work, even at the graduate level. Plagiarism to the point of coping and pasting directly from published literature was not disciplined anymore than requesting the student to talk with someone in the writing lab. Courses were taught based on midwifery tradition and the cycle of the moon, rather than evidence-based midwifery data. Again, I felt women deserved better. It was and continues to be my opinion that midwives can work to the best of both science and art while still honoring the midwifery-model-of-care. We can extrapolate all that is good and share this with families so they can determine their own course of action. The point is offering respectful and compassionate care.

It seems ironic to me that I have a reputation of despising direct entry midwives when I have always practiced legally and could easily have reported each of those who have practiced outside the law. I don’t report. I don’t speak ill. However, two years ago, I did testify against the direct entry bill. Why? Because when I testified in front of the House, the bill only required a high school diploma. Midwives do not simply catch babies, and they do not simply handle birth emergencies. They are primary care providers that must have the clinical expertise to determine a woman an appropriate candidate for homebirth. How can this be done without the skill set of providing a physical exam? My primary objective in testifying was to make our legislative leaders aware there already was a legal option, and it would be wonderful if they could get behind nurse-midwives!

There was argument that legalizing direct entry midwifery would allow for regulation. There were adversaries to midwifery in support because they felt it would give them the ability to prosecute and at the time there was no such avenue. I testified that this belief was false. In fact, practicing midwifery without a license was a felony. Practicing medicine without a license was a felony and we had case law for both of those. However, the attorney general’s office and most of our county prosecutors simply aren’t aware of this. In fact, the attorney general had been unaware of nurse-midwifery until a client of mine reported me for what she called abandonment. We provided our version of the events and the attorney general’s office not only ruled in our favor, but asked if I could be a liaison for nurse-midwifery in Indiana. We did not abandon. We referred the client to another provider when our continued care would have been inappropriate. This is our responsibility.

This I shared during my testimony, as well as the fact that two direct entry midwives were under investigation because it was evidence that if a direct entry midwife was reckless, she would be investigated and held accountable under the current law. One of those cases I had been consulted on, and that midwife was convicted after the deaths of two babies in this state. The other case fizzled out. I am not loyal to midwifery or homebirth to a fault. I am loyal to safe care. I have offered such expertise in a number of legal cases, and am currently working on three cases out of state – none of which I am even aware if I am working for the defense or the prosecution. My testimony remains the same either way, because it is driven by evidence.

Setting Boundaries

My good midwifery friend, Kate Shantz, once told me that I had a boundary disorder, meaning I don’t draw them well. When I first opened my practice, I just wanted to serve families in whatever way they desired. This too often meant I was taken advantage of and when I started to draw boundaries, clients were upset. Why would I demand to be paid, when I had offered free care for so long? I also learned that those who don’t pay, don’t value my service but if I give it out free, they will continue to accept it and criticize me along the way. No matter how I try to please, I will always fall short. I have given more free care away at this point, than what I have been paid. This is a challenging boundary to draw but will ultimately allow us to better serve our clients.

Many feel that hiring a midwife means they are hiring a best friend. While we are available to you 24/7, this doesn’t mean you can demand attention continually and for all things that your best friend would not even tolerate. I learned to under promise and over deliver, but in doing so, I disappointed clients who had created inappropriate expectations. I’ve had many staff believe too, that when joining the practice, they now have a midwife at their finger tips to answer any and all questions and while I would sincerely like to meet these needs, it is hard to sleep when you are not allowed to silence your phone or ignore a single text because anyone could be a momma in labor. Staff have struggled to draw boundaries and become bitter when I have to do that for them.

Most always we realize we aren’t a good fit, whether staff or client, within the first few visits. It surprises me the level of anger that can boil up from just a few encounters. Women are emotional while pregnant, and sometimes we are the victim of the emotional roller coaster, especially postpartum. I will forever adore the women who are humble enough to admit they were victim to these negative emotions and were overly critical or hostile, and return to us with complete forgiveness. When negative commentary hits Facebook, I rarely comment. I observe. I don’t send out my troops to defend which is common within the midwifery community. In fact, my long-term clients aren’t the type to engage in such scenarios. They appreciate intelligence, professionalism, and high moral character. They would excuse themselves from negative commentary. Other times, it is a client who felt wronged, and I know exactly who they are and the facts of the story. I also know the Better Business Bureau has told them their complaint was invalid and so has the Attorney General, because you can bet if they are speaking openly on Facebook they are angry and have already taken measures to report me to everyone who will listen. These clients also know I can’t defend myself so they can add to their story and get compassion from the crowd in effort to validate their story. Thanks again to those who know my character well enough to know these attacks don’t hold merit.

If you’ve read this far, you’re likely concerned that we have a plethora of angry clients and staff. It feels that way sometimes. As most can relate, one upset client can feel like a legion of angry warriors and as a woman who is earnestly trying to meet and satisfy every single client in our practice, each less than absolutely thrilled client is one I take very personal. The reality of being a midwife and a business woman is that although we are only of very few practices in the country that offers three highly trained personnel at each birth, and can offer genuine primary healthcare with very low transfer rates, clients don’t often recognize the level of expertise and clinical skill they have in hiring our practice. We have excellent relationships with collaborating practitioners. We have made a very good name for ourselves within the community. We serve with a great deal of commitment, but we do draw boundaries.

We quite possibly make it all look so easy, that it is easier to complain. My heart spills for you here. This job is hard. Being a midwife is very hard. It is self-sacrificing. It requires the sacrificing of our family. It was commented this afternoon by a previous client that we turn over staff quickly, that working for me must be an exceptional challenge. Yes, it is. I demand a high standard of care. I take the responsibility of caring for your wife and baby very seriously. I expect my staff to train, to answer when I call, to show up and perform well, and to dedicate themselves to being a professional. If their skills aren’t competent, if they can’t make the commitment, if they don’t understand their role then I don’t keep them employed. This does cause for some bitter departures. It is what you expect from me when you hire me as your midwife. While I have upset many more than I would ever desire, we always, always, always draw the line at safe care. We are very, very good at what we do. That may intimidate. That may frustrate. You may vent on Facebook, but I am here to tell you, I draw these boundaries because I have seventeen years experience. I know my role well. I know the cost if we don’t do it well. I am on a mission and I am accountable. This is my son’s legacy.


No Longer Working for Free

As our practice has grown, so has our administrative expenses, especially because we strive to meet every Indiana statute and exceed every professional standard. It can be difficult keeping costs at a point that clients can invest, while still covering costs. For the first several years of our practice, we participated in the Medicaid program and accepted payments from third party payers. Indiana Medicaid reimbursed a single prenatal at $30, and not often prior to 32 weeks because nurse-midwives are not primary providers within our state (violating Federal law, but that is another matter). Moving to a cash only practice was one of smartest decision we’ve ever made and was crucial in establishing a thriving practice.

At $30 a prenatal, the hourly rate of my nurse-midwife is not even compensated, not to mention the wages of our assistants and receptionist. No supplies were covered, no equipment, no payment for space, heat, phone or administrative costs. Medicaid is a huge loss to midwifery practices, unless such practices are willing to take clients late in pregnancy, offer very few visits and for very brief sessions, and include a number of procedures which are high ticket items. This opposes the midwifery-model-of-care. Midwives value time intensive and low interventive care. Unfortunately this does not turn a profit when working within the Medicaid program or when contracted with third party payers and consumers seeking the midwifery-model-of-care do not always appreciate the reality of this concept so seek care elsewhere.

Recently we trained a new administrative assistant in processing birth certificates. She entered the number of prenatal visits with one of our clients as 22. The system kicked back a response that this was entered in error because it was outside the standard. She sought advice and one of our midwives confirmed that this was an accurate number. This particular client was determined as high risk and so was provided close monitoring through her pregnancy. She was diagnosed with gestational diabetes and had a high risk finding in her blood screen. She was also at an advanced maternal age. The obstetrician we consulted for opinion on her blood screening felt she should be risked out of midwifery care entirely and offered a primary cesarean section at 38 weeks of pregnancy.

We offered the option of transferring to a medical practice and offered to continue as her primary providers with our own strategy. The benefits and risks of both were discussed, as well as our experience and expertise in working with the issues she was currently facing. She and her husband chose to continue in our care and so we extended twenty-two nurse-midwifery consultations and nearly as many nutritional consults, and we had a successful homebirth at 41 weeks of pregnancy. All of this – all her prenatal visits, nutritional consults, twice weekly non-stress tests, labor management, birth with two nurse-midwives and an assistant, postpartum home visits, and neonatal care through six weeks for total fee of approximately $5,500. This pregnancy would easily have exceeded 50 thousand dollars in a medical practice. We were honored to care for this family and are motivated to continue doing what we do because of outcomes such as this.

Did we push our luck? No. Our care extended the same management she would have had in any traditional practice, but because we invested heavily in her pregnancy and because she committed to optimizing her pregnancy, we succeeded in maintaining a very stable diabetic without any additional co-morbidity issues. This allowed us to approach her birth with minimal intervention. Extending a high level of care is not about the birth setting, but about the team. Technology travels. We live in a modern society. Investing with great expertise is the key.

Back to the point of this article, while midwifery care can offer a significantly lower cost than the standard medical model, should we work for free? Consumers have become accustomed to free healthcare, either while covered by Medicaid or by a third party payer. When insurance companies reduce their reimbursement, clients are unaware because they are seemingly unaffected. It is standard for homebirth-based nurses to be denied payment when claims are filed, or for various supplies and medications to be reimbursed below cost. The midwife in private practice must share her “professional earnings” to cover the cost of the entire team and its overhead.

Interestingly, while a large number of midwifery practices are working on a cash-only basis and more physician practices follow suit, some are recognizing the multitude of ways they give away their services for free. An article in the Houston Chronicle in February of 2003 (yes, more than ten years ago) discusses the expectation consumers have of phoning their provider for advice, a prescription or a work release but don’t want to pay for this service. In comparison, they appreciate when calling their attorney, during business hours, they will be billed by the minute. They have no expectation of obtaining such advice after hours.

A few years ago, our office reached out to a contractor for a service required in our practice and while the spouse worked to correct our issue after office hours, one of our nurse-midwives sat and talked to his wife. This started as a simple, friendly discussion and ended with the nurse-midwife diagnosing a medical concern, ordering labs, and providing a pharmaceutical at no cost to the wife. Without hesitation, the husband left a bill for several hundred dollars for his work. No one batted their eye at the irony, because one expects a plumber, electrician, or computer technician to charge for their work, but a midwife… well, we are expected to do this out of the kindness of our hearts.

I’ve toiled with this irony my entire career. We know this when we enter the field. We recognize we will be overworked and underpaid. We enjoy serving and don’t seek to become rich. As a business owner however, we must cover our expenses if we are going to continue to offer our services. Telemedicine is the new buzz word among Indiana legislature and certainly not a concept our practice is very familiar. This new and innovative concept seeks to extend care to clients via Skype or Go To Meetings. Some practices have started charging for email responses, or $5 a minute for phone calls. This Houston (2003) article states, “I think the patients know that if they are going to take a doctor’s time, they are going to have to pay for it,” Dr. Allen M. Dennison of Barrington, R.I. Is that really true?

Published more than a decade ago, this article states that the administrative costs of running a medical practice has grown tremendously (spoken even prior to the implementation of electronic health records) and “most primary-care doctors now spend on average of two to three hours a day on tasks for which they are not compensated, such as returning phone calls and filling out insurance forms,” (na, 2003, Houston Chronicle).

“If you call your attorney at 4 o’clock in the afternoon on a Friday, they are going to send you a bill. I don’t understand why I shouldn’t send a bill if someone wakes me out of a dead sleep at 4 a.m.” Dr. Paul Williams, past president of the Pennsylvania chapter of American Academy of Family Practitioners

There is the perception that if a practitioner charges for their time, we are “nickel-and-diming” our clients. At the same time, as operating costs increase and our resources are stretched, clients expectations don’t change. They still expect every call to be returned on their time table, prescriptions to be called in immediately, advice to be given freely so they are inconvenienced with having to visit the clinic, and medical records to be transferred same day. When we fail to meet these demands, complaints increase. Charging appropriately for our work would allow us to better meet the demands of our clients, and ultimately increase customer satisfaction. However, how does a midwife offer homebirth services to all who desire it, in all financial classes, and still meet the needs of all her clients?

Another irony that is commonly ignored is the fact that the high dollar incomes of physicians allows for a stay-at-home wife or a nanny and housekeeper. When a midwife, who are predominately all female, work outside the home and keep the hours required of a midwife, how does she satisfy the needs of her family and home when her income is less than what she made as a bedside nurse? After seven years in practice, and as the owner of this business, Dr. Lane has yet to earn what she did as a bedside nurse working only twenty-four hours per week, with full medical and retirement benefits.

This post offers no answers. The solution escapes us quite frankly. How does a practice offer the highest standard of care for nearly a year per client, twenty-four hours a day, with exceptionally well educated staff and a high staffing ratio, and with equipment that rivals a level one facility at a cost lower than the price of a website build, a set of orthodontic braces, a semester of college, or a nice landscaping job?


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."


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