Midwifery Management of Breast Cancer

This is a topic for which I hope to never have personal or professional experience. Earlier this winter however, one of my closest colleagues brilliantly diagnosed breast cancer in one of her pregnant clients. Truly, to say she changed the life of this mother and child is a huge understatement; she literally saved their lives.

Two previous practitioners denied the presence of cancer, yet my colleague persisted. Her perseverance proved fruitful, as aggressive cancer was confirmed. Unfortunately, two subsequent practitioners overstepped their authority and earnestly sought to end the life of the unborn child. My colleague, committed to both the mother and child, reminded the physicians of her her role in coordinating care, as the client’s chosen primary care provider, and she proved an expert clinician.

The emotional turmoil of breast cancer overwhelms all involved, including the healthcare practitioners. Being in a position of support for this midwife reminded me of the important role we have as primary care practitioners. Breast cancer remains the most common cancer in women both in the United States and around the globe.

Assessing Risk

Family history, increasing age, exposure to ionizing radiation, and exogenous estrogen are all risk factors for breast cancer. Exposure to chemicals and viruses have also been correlated, as well as never having a full-term pregnancy or never having breastfed a child. The irony is that most women who develop breast cancer have few, if any, of these known risk factors.

Mammographic density is a newly identified risk factor that implies the role of the breast stroma, which accounts for much of the density reading. The greater the density, the greater the incidence of breast cancer. Indiana now requires patients be notified of their density screening, although to what benefit this offers is yet to be determined.

Two large tumor suppressor genes, BRCA1 and BRCA2, located on chromosomes 17 and 13, account for approximately 5% of all breast cancers. Women who carry one of these mutations have a lifetime breast cancer risk of 40-80%, depending on mutation, penetrance, and other host factors. Interestingly, women with either mutation, who have their fallopian tubes removed, reduce their risk of breast cancer by 50% (Mokbel, 2003).

Our practice does offer screening for BRCA1 and BRCA2, although universal screening for these mutations is not yet recommended. We also frequently refer for genetic screening when risk factors are identified.

Conventional strategies for prevention include a class of drugs called “selective estrogen receptor modulators” (SERM) which include Tamoxifen and Evista. Aromatase inhibitors and COX-2 inhibitors are in clinical trial. No random control trials are available for functional food or exercise programs for breast cancer prevention, as I am aware.

Surgery is a popular prevention strategy, as Angelina Jolie made popular more recently. As reconstruction surgeons improve their craft, prophylactic skin-sparing mastectomies are increasingly chosen with a success rate of greater than 90%.


Significant funds have been invested in educating the public to perform self-breast exams on a monthly basis. This investment may not have paid off, as evidence has demonstrated that the self-breast exam has not decreased mortality. In fact, a 2008 Cochrane Review suggested it may in fact lead to harm. Women who rarely perform breast exams, but do so prior to their annual exam, often find unfamiliar lumps, reporting them to their practitioner during their visit. The clinician responds by ordering diagnostic exams and biopsies which may impose greater risk, than benefit.

We are certainly an advocate for learning the norms of your own body and reporting any concerns to your clinician. However, the clinical breast exam provided by your nurse-midwife, should be performed annually. Evidence has demonstrated that trained clinicians, providing breast exams annually, find masses smaller than those discovered by women who consistently perform self-breast exams each month.

Clinicians have at their disposal a number of options for screening beyond the clinical exam. Magnetic resonance imaging (MRI), ultrasound, and breast PET scans are options, although costly. Thermography cameras and light source imaging are still investigational, so while intriguing, they should not be substituted for mammography quite yet.

Diagnostic & Treatment

Concern by either exam or mammogram leads to biopsy, where diagnosis is confirmed. Breast cancer treatment is a multidisciplinary field that includes nurse-midwifery, as my colleague above demonstrated. Too often it is assumed that nurse-midwives do not have a role in pathologic findings, but in fact, we may play the most vital role. We are the client’s best advocate. We are experts in providing informed consent. We are capable of educating and counseling the client, discerning the plan that best suits the individual, and extending a coordinated plan of care. Nurses are the most trusted profession because we are not only skilled clinicians, but also compassionate.

Surgery, radiation and oncology all play an important role in the treatment of breast cancer. Lumpectomy and mastectomy have offered fairly equivalent survival rates, and breast conservation has been preferred since the 1990 Consensus Statement. It is now standard of care to assess the most proximal lymph nodes to assure cancerous cells have not spread beyond the tumor. Systemic therapy can also be guided by molecular and genetic tests performed on the tumor itself.

Integrative Therapies

Once again, physical exercise can not be ignored. It absolutely reduces breast cancer risk, with evidence suggesting reduction by as much as 30% (Friedenreich and Cust, 2008). The more exercise the better, and the greater the intensity, the greater the benefit.

While scientists can’t detail a specific cause that links exercise with improved breast cancer outcomes, it is thought to be related to three important factors. First, exercise reduces endogenous estrogen. It also improves the body’s ability to regulate insulin. Inflammation may also be reduced with exercise. The emotional benefit can not be underestimated as well. Exercise benefits women through prevention, improves treatment outcomes, and assists with healing.

Nutrition is paramount to good health. One must strive towards a healthy weight. Obesity increases risk for breast cancer in postmenopausal women, with weight loss decreasing risk by 40% (Eliassen et al, 2006). Recommendations for specific dietary choices have yet to be revealed in the literature. The Mediterranean-style diet with high intake of whole grains, fruits and vegetables and olive oil is recommended simply because it encourages overall good health.

Alcohol intake of two or more drinks per day is known to be associated with an increased risk of breast cancer with a dose-response effect in both premenopausal and postmenopausal women. This is thought to be related to alcohol’s ability to increase estrogen and androgen levels, although folate has shown to neutralize this risk. Interestingly, grapefruit has been shown in one study to increase the incidence of breast cancer in postmenopausal women (Monroe et al, 2008). Experts believe this is due to an increase in endogenous hormone levels with the grapefruit. Neither coffee or tea have been found to increase breast cancer risk in the Nurses Health Study (Ganmaa et al, 2008).

Vitamin D deficiency should be assessed in all women, at various points in their life cycle, but particularly as they reach perimenopause. Vitamin D3 has been identified as a playing a significant role in breast cancer prevention (Gissel et al, 2008). Again, we recommend food-based supplementation to enhance absorption.

Melatonin supplementation has been suggested as a method for preventing breast cancer. Poor sleep certainly impacts health negatively, and disrupted sleep has been associated with increased risk for breast cancer. Nighttime shift workers specifically have a higher risk, potentially because increased light at night reduces levels of melatonin. Supplementation of 3 mg prior to bed may prove beneficial. Doses as high as 20-40 mg/day have been studied in women with solid, metastatic tumors (Mills et al., 2005).

Cruciferous vegetables have been shown to be a potent antiproliferative agent in human breast cancer cells. The active phytochemical is indole-3-carbinol (I3C) which can be taken as a supplement at 400 mg/day.


Tumeric might be one of my first recommendations, as it has apoptosis properties and is a strong aromatase inhibitor with antiinflammatory and antioxidant properties. This botanical has only minimally been studied, but because it has a long history of traditional use, its safety is trusted. Standardized extracts providing 1-2 g of curcuminoids per day are typically used for inflammatory conditions.

Five glasses of green tea daily was shown to reduce the incidence of breast cancer in one study (Sun et al, 2006). Iscador and Helixor, trade names for commerical preparations for mistletoe, and mushrooms shiitake, maitake, and reishi may all benefit those with breast cancer, although admittedly, these are outside my own expertise. Ginger of course, has a long history of offering pallative treatment for the nausea associated with chemotherapy.

Lifestyle Modification

Certainly exercise, proper nutrition and sufficient sleep is vital to overall health and improved outcomes in breast cancer women. Stress reduction is also imperative to healing. Interestingly, stress reduction is important beyond improving one’s experience and even improving one’s health outcomes, but it has recently been shown to change gene expression (Dusek et al, 2008). All women suffering with breast cancer should be offered some avenue of support, whether spiritual, talk-therapy, group therapy, dance, yoga, art, or journalism.

Nurse-Midwives & Breast Cancer

Nurse-midwives are not typically experts in breast cancer treatment, although we are in breast cancer diagnosis and advocating for our clients. Coordinating such care is not only within our scope, but is part of the expert role we take responsibility for as primary care providers. Understanding the various treatment options and being familiar with community resources is an important part of offering informed consent. Optimizing care for women who endure breast cancer includes acknowledging the need for a multidisciplinary approach, which may easily be overlooked among individual specialists. Nurse-midwives are trained to provide a holistic approach to care, and our nurse-midwives can do so with an integrative mindset.


Uterine Fibroids

Pelvic tumors are quite common in women, with more than 70% experiencing them by the age of 50 (DayBaird et al, 2003). Many go completely unnoticed, but some cause considerable havoc, disrupting the quality of life for many women. The most common complaints are abnormal uterine bleeding, pelvic pain or pressure, and infertility. Management is largely dependent on the severity of the symptoms, and the woman’s desire for future fertility.

Conventional treatment is either hysterectomy or myomectomy. More recently, innovations have allowed for less invasive options, such as laparoscopic assisted removal of the uterus or fibroid, ablation of the uterine cavity, uterine artery embolization, and magnetic resonance-guided focused ultrasound surgery. Physicians disagree on the best management, and like many areas of women’s health, there is little evidence supporting the long-term effectiveness of most conventional medical treatments. Surgical procedures, medical therapy and watchful waiting all offer advantages and disadvantages.

Fibroids are not cancerous in nature, so there is little motivation to dump millions of dollars into researching optimal fibroid management. Our clients however, seek less expensive and minimally invasive regimens for fibroid management. More specifically, most desire complementary or alternative therapies. The challenge however, is making recommendations in light of minimal research available to support such therapies. Our desire therefore, is to blend the best of both science and art in effort to create an evidence-based plan that appreciates the individual needs of each woman.

An Integrative Approach

There are a greater number of both estrogen and progesterone receptors within the uterine fibroid, making them particularly sensitive to estrogen. Metabolism of estrogen is also altered, all of which leads to vascular abnormalities, which is thought to be why some women experience excessive bleeding.

The body of evidence is growing and convincing identifying pesticides, heavy metals, pharmaceuticals, plasticizers, and even phytoestrogen, as xenoestrogens which disrupt the endocrine system, changing gene expression without DNA sequence changes. This epigenetic change can become persistent and inherited, meaning toxins in one’s environment can negatively impact gene expression in future generations.

Uterine fibroids can be diagnosed most every time by exam with a nurse-midwife. Ultrasound can augment exam, particularly in larger women or when it is necessary to rule out other pathology. Ultrasound does not however, improve long-term clinical outcomes for fibroids. Additional diagnostic testing may be indicated, such as measuring pelvic girth and obtaining a pregnancy test. The midwife may choose to obtain a complete blood count, a metabolic panel, possibly a prolactin level and/or thyroid panel, or even coagulation studies based on the amount of bleeding. Certainly, there may even be indication for MRI, CT and HSG depending on individual circumstances.

Once diagnosis is established and other pathologies are ruled out, complementary and alternative therapies can offer relief from the discomforts caused by fibroids. They may not however, shrink the overall size of the fibroid.

Nutrition, Diet and Supplements

It should be no surprise that diet and exercise is associated with whether one may suffer from uterine fibroids or not. More than one study has made clear: the greater one’s physical activity, the less likely they are to have fibroids (Baird et al, 2007 & Flake et al., 2003). Dietary choices also influence fibroids, in that food choices influence estrogen excretion. Vegetarian women for example, have a three-fold increase in fecal excretion of estrogen and 15-20% lower serum estrogen levels (Gorbach and Goldin, 1987).

Flaxseed and whole grains may be a viable dietary strategy for reducing the risk of uterine fibroids due to their phytoestrogen nature (Atkinson et al., 2006). Whole soy foods should be prioritized to concentrated or processed options, as the literature shows mixed outcomes with regards to benefits and risks of phytoestrogens.

Interestingly, cruciferous vegetables such as broccoli, brussels sprouts, cabbage and cauliflower have a phytochemical, indole-3-carbinol (13C), that alters estrogen metabolism by promoting the formation of less potent estrogen metabolities (Minich and Bland, 2007). Green vegetables have a protective effect.

Omega 3 fatty acids should also be encouraged, while reducing intake of omega 6 fatty acids, to utilize their anti-inflammatory nature for curbing fibroid growth. Vitamin D has shown to significantly inhibit the growth of leiomyomata cells (Blauer et al, 2009). Supplementation for both can be obtained through a single food-based supplementation which our practice highly recommends.

High caffeine and coffee intake may increase early follicular phase estradiol levels compared to those with lower levels of consumption (500 mg/day compared to 100 mg/day), independent of alcohol consumption or tobacco use.

Iron-rich foods would benefit the women who suffer excessive bleeding related to uterine fibroids. Taken with vitamin C, iron absorption would be improved, and the vitamin C would additionally offer the benefit of improving blood vessel walls. Depending on the class of the bioflavonoid, antiinflammatory, antioxidant, and anti-proliferative properties may also be gained.


It may take several months to achieve significant benefit with botanicals, and the fibroids may not shrink. However, further growth may be inhibited and symptoms are quite likely to improve. Many women choose these complementary therapies as they await the natural menopause transition.

Chaste tree berry, Ginger, Turmeric, Shepherd’s Purse, Yarrow, and Red Raspberry Leaf are among the most common herbs utilized for managing fibroid symptoms. Each offers their own advantage whether balancing a hormonal imbalance or offering symptoms relief such as excess bleeding. The nurse-midwives at Believe Midwifery can discern and recommend botanicals as appropriate to each individual. If more aggressive treatments are necessary, Believe Midwifery Services is also equipped to offer necessary diagnostics and pharmaceuticals, or refer as appropriate.

Thinking about Mary

I read today that stories infuse the ordinary with meaning and the tragic with truth. As a midwife, I long to share the beautiful details of the many births I am privileged to attend. I always say I’ll write a book someday, when so much time has lapsed that the details blur and no one will recognize themselves within my narration. There is such great beauty in what we do, watching God’s glory unfold, witnessing the vulnerability of fathers, their tenderness and tears, and the courage, as women become mothers. It is no exaggeration to say I am in awe each and every time a precious baby emerges from its mother.

As a mother myself, I appreciate the gratitude one has for their birth attendant, but let me be quite clear, that appreciation does not compare to how honored we are to be part of your journey. Every single woman who has crossed my path has made an impression on me, and has taught me about relationships, sacrifice, dedication, and grace. I am still learning, and growing as a midwife, as a woman and mother, a wife, and most importantly, a child of God. Today I wanted to share my thoughts about Mary, the mother of Jesus, and hope they touch your heart, infusing your ordinary with meaning and maybe offering your tragedy some truth.

As a child, I was always a bit of a go getter. I talked too much. I was always underfoot. I joined all the clubs and everyone was a friend. It seems a bit ironic to me now that Mary was always the woman with whom I most empathized. She was so passive and seemingly submissive, hidden even, in the background. I suppose I identified with being called. It may seem like a cliche and I am certainly not comparing my own calling to the holiness of her own, but I have no doubt that I was very specifically given a heaven-endowed mission. In fact, I remember the specific day I was told to “hang on,” that He had big plans for me and as a child, I was quite certain that meant I would have a yet unrevealed super-power, and maybe even an invisible plane.

I’ve shared this story (and its more grim details) with my staff on occasion, and with humility I will share with you. I was an unwanted child. Don’t pity. There is beauty in this story. However, in truth, my mother truly despised me. She wasn’t and isn’t today a bad woman. I think she wanted to be a good mother, but she was young, from a troubled home herself, without a husband, all alone, and we were just very different temperaments.

When I was quite young, and very alone, the Lord revealed Himself to me. He was the one and only constant I had in a home that had no love and never spoke of Our Father. He was so present in my life that today, I don’t feel the absence of parents and I truly don’t have any bitterness or sorrow. I have compassion for them and appreciation that I was a challenge for them. They tried and that was enough. My truth still remains. The Lord gave me a vision of hope, a mission to live for, and He has fulfilled His promise… short the invisible plane. This life, my being a midwife, is my evolving Wonder Woman. My children, and very good-looking husband, are my amazing side-kicks. We jet out in the night, catching babies, nurturing young families, and serving our community.

Back to Mary… Gabriel announced her mission. She well understood. She trusted the path, as have I. Men would persecute her, as I too have endured. Her child would be persecuted, mocked, hated, and even crowned with thorns. Mary chose to obey.

I have shared with staff during our tougher days that this is the Lord’s practice to build up, and it’s His to tear down. What I must do is obey. There are days that I cooperate while admittedly complaining a little. I am reminded though that Mary approached her mission with a thinking mind and a sensitive heart. It is she I remember. She accepted a path that yielded both great joy and deep pain. She willingly participated, for all of her days. This very truth is my own, and will continue to be until my very last breath.

There are many lessons in such a life, one with a clear mission. There is never question that the Lord is near. He has proven to be my counselor, my friend, my comfort, my teacher, my Father, and while not biblical, I think He has a little comedian in Him as well. Our relationship is intimate and for that, I will forever be grateful – quite literally, Amen!

Obedience draws us into God’s heart, away from the world’s influences. The midwifery career is set apart. It isn’t entirely accepted by society. Although the profession has grown tremendously in the last few decades, we’re still a joke to many. Any shame however, is replaced by righteousness. The obedience He demands however, navigates us through complexities that are difficult to comprehend outside the profession. Midwives are frequently faced with scenarios that demand a loyalty that challenges the “standard of care,” or man’s approval. We obey and respond, “Yes, Lord, I will do that. I will educate, counsel, and support by client in the face of persecution, and even possible prosecution.” There have been times that I have also had to obey and draw boundaries which caused upset to my client. These are most difficult to me, because I want to please, but I remind myself, I am not working for man.

The work of a midwife largely goes unrecognized, as it should be. We are hidden. It is our goal to empower women, couples, families – not to make them depend on us. We need not reap rewards here, but rather, as Mary did, store up each precious moment in our heart. Mary knew her mission helped shine light in an ever-darkening world. We seek to be that light too. We seek to offer choice, protection, compassion, and mercy while recognizing our duty is to do so with the greatest of wisdom.

Mary told the angel, “I am the Lord’s servant. May it be to me as you have said.”

As I seek to better understand and practice obedience, may these become my own words. May I continue to store up sweet memories in my heart and be reminded of them during the toughest days. May I continue in faith. Cindi, Kristi, and all my midwifery sisters in faith, let this be an encouragement to you. We are so very blessed.


Moxibustion is a traditional Chinese medical intervention used to assist in turning the breech baby to a cephalic (head down) position. Heat is generated at the Zhiyin (BL67) point, located on the outer corner of the fifth toenail. The specific herbal preparation used is Mugwort (Artemisia vulgaris). We sell this herb in the Red Raspberry Boutique just for this purpose. Incidentally, there is evidence that suggests mugwort can assist in the treatment of stroke rehabilitation, pain, cancer care, ulcerative colitis, hypertension, osteoarthritis, constipation, and child chronic cough.

breech birthThe theory is that moxibustion stimulates the production of placental oestrogens, alterations in prostaglandin levels, and promotes uterine contractions, which leads to a stimulation of fetal movements and a higher probability of vertex presentation of the fetus.

This procedure has been familiar to me my entire nursing career, and we’ve utilized it a multitude of times in our practice. In our early years, my husband would help take our pantry door off the hinges, lay it over the couch, and assist me in laying the pregnant momma head down as we utilized rolled mugwort sticks to heat her outer toes. This was comical in itself, but even more so when the next pregnant momma presented for her appointment to find a momma on her head and our using herbal sticks near her toes that may or may not smell like cannabis.

Evidence has supported this practice in spite of the method of action being somewhat elusive. The systematic review and meta-analysis cited below included 392 potentially relevant articles specific to moxibustion. Seven random control trials were included. Interestingly, moxibustion consistently demonstrated a positive correlation for assisting the breech presenting baby in finding its way head down, but this study also found that moxibustion might decrease the need for oxytocin. Adverse events included six cases of premature deliveries, four cases of premature rupture of membranes after treatment, and one case of bleeding at week 37, but this also involved “excessive pressure on the rear of the placenta” during an external version. These outcomes did not differ from the control group.


Zhang, Q., Yue, J., Liu, M., Sun, Z., Sun, Q., Han, C., & Wang, D. (2013). Moxibustion for the correction of nonvertex presentation: a systematic review and meta-analysis of randomized controlled trials. Evidence-Based Complementary and Alternative medicine. DOI 10.1155/2013/241027

Seeking Business Manager

One thing Gretchen and I always reminded each other is that this job requires someone inspired by change. Although the two of us were somewhat inspired by the practice’s ever-evolving and exceedingly quick growth, even we were challenged to stay ahead of the tide. It is difficult to make clear expectations for staff when roles are continually evolving. It is also a delicate balance with whether to move ahead, risking taking too big a leap, or standing firmly in place and missing a necessary opportunity.

Last year we recognized we were out-growing our home office and opened clinics in both Carmel and Lafayette. We also added a second nurse-midwife, both of which were dreams come true. While a challenging year, our blessings overflow. It can no longer be ignored that if we seek to nurture this work in a manner that will allow continued goodness to unfold, we must be guided by a skilled business manager.

Miss Michael and I learned today that a business manager and an office manager are not equivalent. In fact, we are not seeking an office manager or an administrative assistant. We require someone to take on the administrative duties so that we can turn our attention exclusively to practicing midwifery. Ideally, this person would be educated in business management or health administration so that their business expertise exceeds our own.

It would be our hope that this person could provide customer service and support, manage employee records, payroll, client financial accounts, tackle public relations and aggressively market, as well as offer liaison for our various business accounts such as our scheduling program, electronic health records, phone management, and faxes. This person would not oversee accounting beyond client accounts and would not hold any clinical responsibility.

While we’d love a master’s prepared business manager with Ivy League preparation and Fortune 500 success, our desire is even more great. We seek a person who has emotional-intelligence, is humble yet confident, compassionate yet draws clear boundaries, innovative, creative, and self-motivated. This person should also work well among our team, because our relationships are strong, both with each other and with our clients.

This person would work exclusively within the offices, both in Carmel and Lafayette, three days a week. If you can vision yourself within our mission, please send your resume to Dr. Penny Lane. We are eager to fill this position!

Gut Instincts

Miss Michael CNM and I have a strong draw towards functional medicine. Neither of us are yet formally trained, but we dive into any and all literature about the discipline we can locate. Our nutritionist, Megan Barnes, is currently in a graduate program that combines nutrition and functional medicine. She is brilliant and generously shares her passion with the clinical staff. It is not lost on any one of us that the health of one’s gut is vital to overall health, most especially mental health.

Not too long ago I read a study that discussed the gut as a second brain. My son and I have also had long conversations about this, as he is fascinated with the mind and the vast majority of his high school studies have surrounded the biological nature of the human brain and nutrition. What about gut instincts?

Today I have stumbled upon an article by Christopher Bergland, thanks to Cheri Goble, a Webster-certified chiropractor in Lafayette. She graciously shared a journal with me where I found the article, “Gut Instincts: Neuroscientists have Identified how the Vagus Nerve Communicates with the Brain.” There were many points that resinated with me, so I thought I’d share because we do see a fairly high number of clients with anxiety, depression, and irritable bowel.

When I was a young nurse, I worked in a high-acuity hospital with a diverse clientele. Life or death hung on the edge of every shift and although in many ways, those days inspired me, working with residents who were demanding and cruel and even worse, suffering the abuse extended by more experienced nurses was more than my vulnerable soul could bear. My irritable bowel became so intense that I would black out while at work and was extended medical leave.

It is no exaggeration to say that the face of a certain physician or nurse could cause me to pause mid-assessment, blood pressure cuff still attached to the patient, so I could sprint to the restroom in hopes of avoiding major calamity. I know you did not ask for such horrifyingly personal stories about your midwife, but I am here to tell ya, I share because I know I am not alone. Many clients have shared similar stories. In fact, while the job of a midwife is beautiful beyond description, it can also be horrifyingly stressful. Many excellent midwives have crumbled under the pressure and my best nurses have sacrificed their mental health in effort to soldier on when they are needed.

Are there people, places or situations that make you anxious? Christopher Bergland calls this a “fear-conditioned” response and apparently scientists in Switzerland have recently identified how this vagus nerve conveys threatening “gut feelings” to the brain. The vagus nerve is quite interesting in that it meanders down your body from your cerebellum and brain stem to your abdomen, touching most major organs along the way. The Jounal of Neuroscience reports on another study that identifies how “gut instincts” travel to the brain via the vagus nerve and are linked to various responses to fear.

The vagus nerve is constantly sending messages to the brain. The vast majority, between 80 and 90 percent of the nerve fibers in the vagus nerve, are dedicated simply to communicating the state of your viscera to your brain.

“Visceral feelings and gut instincts are literally emotional intuitions transferred up to your brain via the vagus nerve,” states Christopher Bergland.

A close friend of mine suffers from a plethora of food allergies. This person also suffers with anxiety. We have talked recently about how anxiety is often the reflection of inflammation in one’s body, and therefore, her anxiety may be a direct cause of her diet. How unfortunate for her! Admittedly, my husband has suffered his entire life with severe anxiety, as has all the men on his father’s side. I don’t doubt there is a genetic link, and his neurotransmitter test results were among the worst I have ever seen. There is a physiologic basis to anxiety that pharmaceuticals can not band-aid.

Healthy vagus nerve communication between your gut and your brain uses neurotransmitters such as acetylcholine and GABA like the brakes on your car. These neurotransmitters literally lower heart rate and blood pressure, and help your organs slow down so that youcan rest and digest. The question by scientists is then, can we disconnect the return messages from the gut to the brain so as to avoid anxiety and depression?

In one experiment in which the vagus nerve of rats were somehow “not fully functioning,” it was found that they were less afraid of open spaces and bright lights compared to those with intact nerves. Interestingly though, while they demonstrated a lower level of innate fear, they had a longer retention of learned fear. This seems to indicate that the vagus nerve is necessary to unlearn a conditioned response of fear. This also allows scientists to conclude that an innate response to ear appears to be influenced significantly by “gut instinct” signals sent from the stomach to the brain confirming the importance of healthy vagal tone to maintain grace under pressure and to overcome fear conditioning.

My Suggestion

Choose your foods wisely. Easier said than done, I know. I teach this daily and better than anyone, I respect the great impact each decision we make about food has on our health, but I also struggle to apply it in my life. For this reason, I have scheduled an appointment with our new health coach, Crystal Lawburgh. It is time to shed the weight I have accumulated due to the stress of independently managing a homebirth midwifery practice.

While foods are our building blocks, we genuinely can alter our health through healthy thoughts and positive self-talk. Our parasympathetic nervous system balances our sympathetic nervous system. We can calm ourselves through verbal direction or by engaging our vagus nerve through deep breathing techniques. We can also effect our neurotransmitter responses via the vagus nerve, improving recovery and decreasing post-traumatic stress disorder. The stomach plays a role in how we respond to stress.

Visit your chiropractor if you are anxious or suffer any emotional health issue. Pressure on the vagus nerve may be to cause. Improving blood flow to any and all organs is always of benefit to one’s health. Dr. Vicki Danis sees clients in our Carmel office every Wednesday. Our entire staff “pop” in her office each week.

How long is she going to let you go?

Early in my career, while writing clinical practice guidelines for my practice, I researched post-dates. How would I manage pregnancies that progressed towards 42 weeks? I can’t say I specifically remembered this being addressed in my midwifery studies, although as a nurse I had come to understand that one in 1,000 babies don’t tend to survive the 40 week pregnancy and that increases four-fold towards 42 weeks. Certainly, it is typically argued that the safest management would be early induction and at the facility where I completed my residency, 41 weeks and 3 days is that magical date.

One of the beauties of private practice, at least for me, is that I was tasked with the responsibility of writing my own guidelines. I suppose many midwives share or adopt those from other practices. Others may not have the freedom, but rather are supervised and therefore their management plan is dictated to them. I set off to gather studies on post-dates and critically evaluate professional recommendations. This seems like an unsurmountable feat for many solo midwives, but I really appreciated how it helped me thoroughly understand the science and rationales behind individual management plans and offer an extensive informed consent.

My investigation taught me that the etiology of post-date pregnancies is largely unknown, although the most frequent cause is error in dating. We know that women whose mothers had longer pregnancies, find they often do as well. Interestingly, the first time momma and those pregnant with baby boys are more inclinded to have prolonged pregnancies.

I was also reminded that the fears associated with post-date pregnancies include an aging placenta, growth restriction, meconium aspiration, asphyxia, low fluid levels, an oversized baby, and shoulder dystocia. Women are more inclinded to have dysfunctional labor, operative delivery, pelvic trauma, hemorrhage, and infection, with post-date pregnancies, yet cesarean section is twice as likely at 42 weeks compared to 40 weeks. It seemed to me that many of the maternal risks were associated with induction of labor, and many risks to baby could be monitored for as the pregnancy progressed.

That led me to investigate screening criteria; however, I only found studies that assessed outcomes if the pregnancy endured without fetal well-being assessments or studies of early induction. I did not find studies that offered close monitoring of mom and baby, and how those outcomes compared to induction of labor at a predetermined gestational date.

It seemed that the recommendations for induction in effort to avoid the risks of post-dates did not consider the risks of induction itself.

Induction is associated with increased perinatal mortality and morbity, perineal damage, operative delivery, shoulder dystocia, admission to neonatal intensive care and even autism (Duck University in the Journal of the American Medical Association). Cesarean delivery is associated with higher risks of complications, such as endometriosis, hemorrhage, and thromboembolic disease.

I also began to realize that professional recommendations on post-date pregnancies, specifically those that recommended early induction, were based on studies prior to the 1990s. At that time, fetal surveillance of pregnancies beyond 41 weeks did not occur.

What if we offered fetal surveillance after 41 weeks and determined our management on the status of mom and baby?

It is understood that a reactive fetal non-stress test offers the pregnancy a 1 in 1,000 risk of demise within the next seven days. If we offered these twice per week, doubling our screening, and have reactive strips – the lowest risk status available for pregnant women – then why intervene and face the risks of induction and potentially cesarean section?

Many of the studies I reviewed offered detailed information about the losses in each post-date pregnancy, and most outcomes would not have changed with earlier induction. One could argue that routine induction for postdates may increase perinatal mortality and morbidity, as this has yet to be discerned.

The current standards for induction are no more than a response to the fact that some babies, who are already injuried, have a tendency towards both post-dates and demise. The maturing fetal brain is part of the cascade that initiates labor. If the fetal brain does not provide the necessary hormones for labor initation due to either anomaly or trauma, then the pregnancy will prolong and the inevidible poor outcome will be contributed to post-dates.

Women aren’t going to argue this rationale because they generally don’t want to endure prolonged pregnancies. The risks of medical intervention has become acceptable, but risks of expectant management, the unforlding of nature, is no longer tolerated and ultimately ends up litigated in court. The tendency towards induction is understood, but this rationale should not be confused with sound evidence. This is a common misconception in maternal child health. Standard of care is more often driven by convenience and fear of litigation, not scientific data.

Our practice finds just over ten percent of our moms birth after 42 weeks, and another ten percent birth prior to 40 weeks. Our average is 41 weeks and 3 days. Rarely do women continue beyond their 43rd week of pregnancy, although we have had one extend to nearly 46 weeks (her mother did the same). We discuss with each client our understanding of the science concerning post-dates and we share the standard of care and the community expectation. We initiate fetal well-being testing at 41 weeks and continue this bi-weekly with a biophysical starting weekly at 42 weeks. Our practice does not support expectant management without fetal surveillance.

As a blantantly Christian practice, I have shared my thoughts from a creative perspective with a number of clients. I don’t do this until after the client has found their own conviction regarding post-dates, but I find it particularly interesting that throughout the Bible we find the number 40 to be significant. It is generally a time of testing, trial or probation. Moses for example, lived 40 years in Egypt and 40 years in the desert before God selected him to lead his people out of slavery. Moses was also on Mount Sinai for 40 days and nights, on two separate occasions (Exodus 24:18, 34:1-28), receiving God’s laws. Spies were sent to investigate the land God promised the Israelites for 40 days (Numbers 13:25, 14:34). The prophet Jonah warned ancient Ninevah for forty days, Ezekiel laid on his right side for 40 days to symbolize Judah’s sins (Ezekiel 4:6), and Elijah went 40 days without food or water at Mount Horeb. Did I mention that even Jesus was tempted by Satan 40 days and nights, and appeared to his disciples for 40 days after his resurrection from the dead.

Anyway, man has determined that the 40 week pregnancy initiates with the last menstrual period because that is an easy date for us to document. However, conception doesn’t occur for another two weeks, with the woman’s ovulation. If pregnancy is initiated at conception, then by God’s terms, the 40 week journey of pregnancy would continue 42 weeks from the last menstrual period.

The EDD is the estimated due date and it should be well understood that this is an estimate. We appreciate this, although in effort to decrease interventions later in pregnancy, whether increased fetal survelliance or induction, we do encourage a dating ultrasound when the last menstrual period or conception is unclear. We also appreciate that Dr. Franz Karl Naegele, father of the due date calculator, offered his formula based on a 28 day cycle. This is not true however, for all women. Estimating the due date, even with a known last normal menses or conception, must be done in conjunction with an understanding of each individual woman’s cycle length. Naegele’s rule also assumes that all women ovulate 14 days after the initiation of menses. This is also not true for all women. Can I say how happy it makes me that the majority of our women come into their first prenatal with a chart of their previous cycles and tell me when their estimated due date is, while also appreciating their own histories and typical gestation patterns!

No doctor can predict when a baby will crawl or walk or get his first tooth, so it is unreasonable to think that a doctor can predict the very day baby will be born. We can estimate and encourage, but we ultimately trust that in the presence of reassuring fetal monitoring, baby will come at the best time determined by mom and baby. If there is indication to intervene prior to that date, we won’t hesitate. After years in practice, we have faced this scenario three times. There is certainly no reason to push our luck, and we aren’t committed to homebirth at all costs. However, the risks of both prolonged pregnancy and induction of labor should be considered, as well as the community’s expectation. Quite frankly, and very anecdotally, babies born at 41 week sleep and breastfeed so much better than babies born at 40 weeks, and when we have the occasional birth prior to 40 weeks, we are all concerned for how well mom will cope postpartum.

Finally, I have suspicion that if more midwives had the freedom to practice without the 42 week deadline, there would be less intervention with herbs or pharmaceutical modalities and subsequently, we’d find better homebirth and birth center outcomes, particularly with VBAC mothers. I suppose however, they would have to be trained to properly assess fetal status, which has not yet occurred even within the intrapartum period… that’s a matter for another post. (See my doctoral project for more arguement on that point.)




A Different Model

This last year has potentially been the hardest thus far in the practice, and it had nothing what-so-ever to do with clinical outcomes. We had a great year as far as births go; lots of beautiful homebirths. We also gained the phenomenal midwife, Kristina Michael CNM, and honestly, the Lord exceeded my expectations ten-fold. However, we faced a plethora of administrative trials, including as many of you know, closing both the Thorntown and Indianapolis offices and opening new offices in Carmel and Lafayette.

We did not simply spend more money than anticipated and work our fingers to the bone, but we faced two laws suits in the process. One was with the landlord at the Indianapolis site. Although the health department validated the site as unsafe due to a sewer gas leak, and the landlord refused to fix it forcing us to relocate, we were sued for violating our lease.

We were blessed with incredible landlords at both the Lafayette and Carmel site (honestly, wonderful landlords); however, our contractor not only did a poor job on the build out but he abandoned the job after failing the occupancy inspection at least five times. We paid him 75% up front in good faith, and are now learning our lesson. Ironically, it is him suing us for the remainder of his fee in spite of abandoning the job!

We’ve also had a number of employee and client challenges that almost all surrounded unrealistic expectations. I can share that thanks to another complaint to the Better Business Bureau, we have received an A+ rating. Ironically, we have learned that in our suffering, we have gained great relationships and increased credibility.

What I Wish I’d Known

What I wish both myself and our society better understood when first opening the practice is that the insurance model is not a good fit for midwifery care. Clients want a different model of healthcare, but they expect it to be delivered in a conventional manner. This pushes midwives to try and shove their midwifery-model-of-care into a conventional-model focused on insurance procedural codes. This just doesn’t fit the preventive care model where we offer a great deal of counseling and education, labor sitting and postpartum support. Conventional medicine is less about prevention, or even genuine healing, and more about correcting problems and applying band-aids. It profits when you’re sick. Insurance companies reimburse based on procedural codes created by physicians for their interventions. The more they perform, the greater their pay.

We decided several years ago that we did not fit within this model, and so stopped accepting third party payments, yet so many of our clients feel as if we were uncaring or insensitive in this decision. Many are incredibly grateful for the care received during their birth, yet when filing for reimbursement, they become demanding and bitter when we are unable to provide them assistance. For whatever reason, we have been unsuccessful in communicating that we do not have a billing department. We do not have any knowledge of procedural codes. We don’t even have an administrative team. There is no back office. We are midwives, providing midwifery care.

Our Expertise is the Holistic Approach

Miss Michael and I seek to be really good herbalists, educators, and healers with a functional medicine foundation. We prioritize nutrition and lean heavily on the counsel of Megan Barnes, our brilliant nutritionist and dietician. We value breastfeeding and expect every woman to succeed. None of this is valued by our healthcare insurance industry. Holistic medicine is not appreciated in conventional medicine as it is not procedural-based, and therefore, does not bring in high dollar reimbursement.

The multitude of home visits we accomplished this past year was time intensive and exceptionally costly. In fact, it cost the practice more than what was brought in last year. Praise the Lord we have never acquired debt in this practice (beyond Dr. Lane’s student loans) and had savings to ride the tide, although goggles are applied because our savings is depleted. The truth is our staff don’t earn sufficient wages, in spite of their inhuman working hours, to obtain services from our own practice.

Becoming a Successful Business Woman

To be successful, one must not only be an excellent clinician but also a successful business person. Unfortunately, midwifery school does not offer a business curriculum. We’ve learned about zoning, workman’s comp, business insurance, registering with the Secretary of State, CLIA waivers, tax identification, gaining sign permits, copyright infringement, website design and development, sales tax, fire marshall expectations, contracts, I-9s and W-4s, payroll taxes, and surviving social media.

We’ve suffered the mistake of contracting staff, rather than hiring them as employees. We’ve learned to draw boundaries for clinical safety, although this means terminating staff and enduring their retaliation. We’ve been audited. We’ve successfully defended ourselves to the Labor Board, Better Business Bureau, Unemployment and with the Attorney General.

We’ve even been investigated by Homeland Security after our landscaper reported us for running an illegal practice. Apparently when the police didn’t know how to investigate the complaint, they reached out to the health department who were also befuddled. The counsel of Homeland Security was then sought and of course, after defending ourselves yet again and demonstrating ourselves as not only legitimate, but highly credible, we were asked to share about midwifery and homebirth with the Boone County Health Department. The police continue to live under the misconception that there is no regulation, or even education, for midwives. One hurdle at a time.

The contractor I mentioned above has also had his attorney draft a letter stating that I put myself out to the community as a fraud because I have don’t have a medical license. Yes, while your eyes are rolling and you are cackling in disgust, know that we are paying yet again to defend ourselves against this sort of ignorance so you continue to have the option to birth at home.

Persecution Comes with the Territory

Did I mention we’ve been accused of bringing women in from out of state to sell their babies? My daughter attended an Emergency Medical Technician course not too long ago, and during her clinical hours in the emergency room, she was informed by her mentoring medic that she should be aware of a midwife in Thorntown that brings women into the local hotels to birth, so she can sell their babies. What are the chances that would be said to my own daughter!?! I am so glad it was though and that I raised my daughter to speak the truth because she was very clear his statement was not only inappropriate and inaccurate, but her mother was the midwife he was slandering. While my initial requests to meet with this emergency response team, and educate them about homebirth-based midwifery, was welcomed, after having to cancel our meeting to attend a birth, my follow-up requests went unanswered.

I could write a few chapters about the many urban legends that have surrounded my practice, but choosing to work as an independent midwife means we are choosing to stand tall against the persecution. We are joining the movement. We are advocating for the rights of our clients and choosing to work against the tide in effort to offer a unique model of care. We prioritize the rights of our clients. We have a message, a passion, and a calling.

The New Year

Our goal this next year is simply to improve upon the work we have already created. We need to gather our clientele, encourage them and build them up, supporting them in informed parenting and desires for healthy living. We want to deepen our understanding of functional medicine and share our herbal knowledge. Classes are being improved and offered more frequently. The blog is getting more attention, extending a plethora of information so you can get excited about optimizing your health!

We are offering not only single primary care visits, but packages of care for more complex issues. We see a number of clients with menopausal complaints, emotional health struggles, PMDD and infertility, but they don’t fully invest and fall short of their goal. The expectation when visiting our practice is to gain a different model of care, but this isn’t always matched with an understanding that true healing requires time and personal investment.

The physician can extend a single visit, ask a few questions, palpate a few body regions, write a prescription and perform a few procedures. They are procedural-based providers, and while incredibly valuable clinicians, many times are offering no more than a band-aid. We want to heal you! This requires an initial visit, and a lengthy one at that, as well as a nutritional consult and health coaching. No chronic condition will be healed without proper nutrition, and Megan offers invaluable guidance. After we gather your prior records, receive results from testing, and combine our observations and recommendations, we can create a plan which is discussed in a follow-up visit. This is all provided for $500. Complex visits simply are not well addressed in a single visit. If you want a different outcome, you must invest in a different model of care.

Meet Rachel Hall

This past year, we reached out to Dr. Elliott at Living with Intention, and found a like-minded group of practitioners. We were so thrilled!! Miss Michael later had lunch with Rachel Hall and was quite impressed with her expertise, and has since referred several of our clients her way. I asked Rachel to share a bit about herself and her services for our clients. Here are her thoughts…


Rachel Hall MS, LMHC

Rachel Hall MS, LMHC

Rachel Hall is a Licensed Mental Health Counselor as well as a Licensed School Counselor who provides counseling to people of all ages. She has been practicing since 2006 and has a passion for working with adolescents and adults struggling with anxiety, depression, grief and loss, as well as trauma-related issues. She received her Bachelor of Arts degree from Hanover College, her Masters degree in school counseling from Butler University, and her Post-Masters certification in community mental health from Indiana Wesleyan University.

Rachel’s utilizes numerous counseling techniques including cognitive behavioral and dialectical behavioral strategies. She is especially passionate about helping trauma victims regain their self-worth to become victorious over their experience. Rachel is one of the small number of therapists in the area trained in EMDR (Eye Movement Desensitization and Reprocessing) therapy.

EMDR is an innovative, extensively researched psychotherapy approach that helps a person see disturbing and traumatic experiences in a new and less distressing way. Many people have also found relief from anxiety, depression, and addictions with the skilled use of EMDR. It is recommended by the United States Department of Defense as well as the American Psychiatric Association for treating trauma related disorders.

Traumatic events can become “frozen” in our memory, consistently triggering negative and unhealthy responses. The eye movements used in EMDR sessions support more adaptive processing in the memory network so that we no longer “relive” the event when we bring it to mind. We still remember what happened, but it disturbs us less in the present and we become more connected to our inner strength and power

​Rachel works diligently to provide a safe and non-judgmental place where clients can experience personal growth and wellness. She believes that, given the right guidance and support and with a little hard work, each person can achieve their God-given potential in life.

The Dia Method

Somewhere along the way, I came across the Dia Method. Moms are always looking for strategies for toning up their belly postpartum, and I certainly wish I had been instructed on the importance of abdominal specific exercises after my own babies. The abdominal muscles separate beautifully as the baby grows, but after birth, if we aren’t successful at bringing those back together, then that separation fills up with adipose tissue causing apron bellies. Multiple babies without loosing sufficient weight in between or without toning the abdomen increases abdominal girth and ultimately, obesity.

Having had three cesarean sections myself, of my five pregnancies, and large babies (my last was ten pounds, eleven ounces), and then leading a crazy lifestyle as a midwife (no sleep, lots of stress, and minimal time to prepare or plan a healthy meals) – my toned abdomen is now nothing more than a memory.


The Dia Method may offer hope. This ten minute workout was discussed in the May 2014 Journal of Obstetrics and Gynecology, in a study conducted by Weill Cornell Medical School, titled, “Postnatal Exercise can Reverse Diastasis Recti.” It isn’t only effective for new moms, but also those of us with grandchildren, and results were seen in twelve weeks.

In addition to a complete postnatal workout system, the Dia Method strengthens the core while also strengthening your abdominal muscles and your pelvic floor. This product is available in nine DVDs, including 6 workouts and 3 essential guides to achieve and maintain a toned abdomen. There is also a 3-Phase Fat Burn Nutritional Plan for loosing baby weight, and is promoted as safe for breastfeeding.

The Dia Method is available as a prenatal system, and a postnatal system.


Here is a great review by Erin. Have you used the Dia Method? Share your thoughts in the comment section.

If you’re interested in trying it out, use code DPLCNM for a 20% off coupon!

If you have a set you’d like to donate to the practice, we’d be thrilled! Dr. Lane would love to give this workout a personal testimony, but our moms would also be excited to borrow it from the lending library.

Postpartum Hemorrhage

Not too long ago, I was participating in a phone conference with a number of fairly influential women, regarding national homebirth matters. One of the attendees was participating moments after managing a fairly complex hemorrhage within the hospital. Discussion matured, and a passionate debate unrolled regarding the level of care attainable, or would maybe most appropriate in the homebirth setting. My long-standing argument, which I’ve shared many times, is that homebirth-based midwives are not only capable of providing a higher level of care than a level one facility, but we are responsible to do exactly this. The location of such care is irrelevant.

My argument is beyond the comprehension of many however, which was validated even among homebirth allies when said midwife was leaving our conference call to attend to her client and another participant asked, “Can you imagine what would have happened had you attended this mother in the home setting?”

Most of us responded in frustration, “We’d have provided the same management!” Again, the setting itself has little to do with the level of care capable, but rather, it is the level of expertise among the staff and the equipment and supplies available that effect outcomes.

During my first year in practice, I attended a birth that was fairly uneventful. Wonderful waterbirth. At the time, I had the ambition of simply supporting the birthing couple in doing whatever felt right for their birth, and had yet to draw boundaries that while clients may not initially appreciate, are really in their best interest. Chiropractics for women who’ve had a previous cesarean for example, or childbirth classes for the first time momma. In this scenario, I was not yet encouraging mothers to step out of the spa to birth their placentas, and following this particular birth, momma stayed put for quite a little while. Once moving to the bed, the placenta birthed fairly quickly and all was well; however, as we assisted baby at the breast, mom gently laid back, closed her eyes and lost consciousness. She had very little visual bleeding. The experienced midwife (or nurse) is well aware that this can indicate the presence of a large clot occluding the cervix, and behind that is a boggy uterus hemorrhaging.

At the time, I was working with a phenomenal nurse, Paula Miller, and an apprentice with great instincts, Amy Kirbow. Not one of us spoke. In all sincerity, we all worked in concert. We had trained together, this exact scenario, a number of times. Paula obtained vital signs, while I assessed mom’s bleeding and fundal measurement, and Amy drew up medications to control the bleeding. Our initial efforts were minimally helpful. Additional medications were required, as well as a bi-manual massage, and intravenous fluids. While I pulled out a scary amounts of clots from her uterus, Amy hung IV fluids and Paula obtained intravenous access. Our client was quickly stable, and as we gathered ourselves, stepped back and took a deep breath, it was then, for the first time, that we pondered, “Should we transfer to the hospital?”

We hadn’t a moment to consider this before because we had so much to coordinate and all our necessary supplies were available to us, without any awareness that we hadn’t a brick and mortar hospital surrounding us. When we did appreciate our actual environment and societal expectation of being in the hospital for such event, we questioned, “What more could they do?” We were able to administer intravenous antibiotics with the entire team at her side for the rest of the day, and we could provide medication for her to continue taking for the next few days. A blood transfusion could be provided only in the hospital, but it didn’t prove to be necessary. Follow-up labs validated a significant hemorrhage, but her continued stability supported our decision to remain at home. Had she become symptomatic during her recovery period, we would not have hesitated to attain support from our physician colleagues.

To be frank, after this birth, I asked myself, “What the hell was I thinking – homebirth!?!” Then it occurred to me, had we been in the hospital, her outcomes might have been worse. In remote facilities, after the placenta is birthed and the perineum repaired, the physician departs. After mom is tucked in with baby on the breast, the nurse begins her postpartum tasks, gathering supplies, charting at the nurse’s station, and quite likely would not even present at the bedside to even recognize this hemorrhage, let alone coordinate it so smoothly. Even had they all been present, blood bank staff are not continually present in remote facilities, so even they would have had to travel from home.

Hemorrhages since have continued to prove the same. In fact, only once have we transferred because of a postpartum hemorrhage and that was because the Spanish-speaking mother transferred after our medical translator left and when she refused life-saving medications, I gave them against her consent. It was battery. I needed a translator to explain why I violated her. Upon arrival to the hospital, the nurse’s obtained a plethora of labs, including blood cultures. Once the physician arrived (having traveled from home) he interrogated the nurses, confirmed she was stable, demanded a translator and then released her within two hours back into our care with full support. This mother has since birthed two more incredibly gorgeous babies in our practice.

This past year, we experienced two of the most abundant hemorrhages I have ever witnessed. These scenarios are absolutely horrifying no matter your birthing environment. The variable determining whether any similar scenario will end well is the training of the team, and how well they communicate their actions. A homebirth-based midwifery team is uniquely equipped to work in concert. The American Academy of Pediatrics and American Heart Association recognize that communication among the team is critical. A group of experts who can not coordinate their management is recipe for disaster. Our practice routinely practices mock codes. We invest in high quality equipment, and bring in a plethora of supplies to each birthing scenario. We also staff each birth with a minimum of three trained attendants. Homebirth is not mutually exclusive from a very high standard of care. The variable is the competency of your team.




Infertility Consults

It is such a delight when a woman recognizes the nurse-midwife as a resource for infertility. These consults quite frequently initiate the same way… “We’ve been seeing an infertility specialist and after initiating their protocol we started to feel uncomfortable, as if maybe we should figure out the problem rather than push through with aggressive interventions. What are the risks if we get pregnant and never discovered the problem?”

A few years ago I spoke at an infertility fair about how to optimize one’s health for enhancing conception, and was sponsored by the March of Dimes. They felt my presentation would help balance all the intervention intensive approaches otherwise offered (and absolutely have their place).

Honestly, I am so grateful for our physician colleagues, but it does surprise me every time I hear a client share that while getting a pap, as part of a fifteen minute visit, she happened to mention trying to conceive and because it took more than a few months, a prescription for Clomid was offered. How does is it not questioned why this woman is not cycling or ovulating? Healthy women have regular menses and ovulate, so the absence of such should be investigated.

Read further about Polycystic Ovarian Syndrome here, a common cause of infertility which is best managed by optimizing health.

Diet and Exercise

This is no joke. If you are struggling to get pregnant, you absolutely must see a nutritionist. If after learning how to improve your diet, you struggle to implement it, see a health coach. Not only do we have Megan Barnes, a Registered Nutritionist and Dietician, on staff, but we have Crystal Lawburgh, a professional health coach. The two are a powerful combination.

Consider these two points. A brisk walking twenty minutes each day has shown to achieve a 7% weight loss (Sheehan, 2004). In one study, loss of as little as 5% of their initial body weight successfully achieved spontaneous pregnancy (Kiddy et al, 1992). Point two, consuming tea and coffee can affect the inflammatory milieu in PCOS women, reducing insulin sensitivity. Drinking 6 cups of green tea or 3 or more cups of coffee per day demonstrated a 33% and 42% lowering in the incidence of diabetes (Hayes, 2008).

Our Approach

Miss Michael and I offer a number of options that blend both medical and functional approaches. A thorough history, physical exam, laboratory screenings and on occasion, diagnostic testing are obtained, as well as a nutritional consult. These are all evaluated and then a plan is created and implemented on follow-up visit. Quite frequently, if it is determined our client has an insulin sensitivity issue (and don’t be deceived, one does not need to be obese), we recommend one or more of the following supplements:

Chromium is an absolute go-to for blood sugar regulation, with very little side effects. I wrote a little about chromium here. While I am well versed in its ability to enhance glucose metabolism, and even decease cardiovascular risk, I didn’t know until recently that it may benefit atypical depression (Pattar et al., 2006). Cinnamon is another excellent supplement which is easily folded into the diet each day, offering improved glucose regulation and even improved blood pressure. Both have sufficient evidence to make each trusted recommendations.

Yoga, biofeedback, aromatherapy, acupuncture, and a number of other modalities may enhance one’s ability to conceive as well.

Keep us in mind for enhancing conception and optimizing pregnancy! We even have monthly classes for those interested.

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