Congratulations Michelle!

Michelle BurtonMichelle Burton joined us almost two years ago following completion of a women’s studies degree with great interest in midwifery. She proved to be a very quick learner and has attended nearly fifty births with our practice, including one this Christmas morning. Michelle is also a postpartum doula.

Weeks after joining our team, Michelle enrolled in the Marion intensive nursing program and graduated this December. She still has to sit for boards and pass them before she can add the RN credentials to her name, but we have every bit of confidence in her and wish her the very best in her future endeavors.

Merry Christmas

Christmas tree gold

The Believe Midwifery team wish you all a very Merry Christmas!

Chia Seeds

Chia seeds have been a familiar source of nutrition in South American, but are rather new to the diets of those in North America. While encouraging mothers to add long chain fatty-acids to their diet, chia seeds became a common recommendation among our clientele who prefer to avoid animal sources of nutrition. Chia seeds contain lots of healthy nutrients, including amino acids and fiber, yet their omega-3 fatty acid content is what gets us so excited. I didn’t realize until more recently however, that chia seeds were known among the Aztecs, Mayans and Incans as an energy food, which is actually where they get their name. Chia means “strength” in the Mayan language. If runners and warriors would use them for sustenance while running long distances or during battle, certainly a laboring mother may find great benefit in them as well. A chia seed energy drink may be an excellent addition to the birth plan of the new mother, and her support team, and are quite easily made by adding a couple tablespoons of chia seeds to a cup of coconut water. Let this sit for about ten minutes and you’ll have an energy gel! Avoid the fake colors of Gatorade and GMO corn.  chia

The Alpha of Omega

The omega-3 fatty acid content is even higher in chia seeds than in flax seeds, the previous king of long chain fatty acids. Chia seeds contain about 5,000 mg of omega-3 fatty acids per ounce. Flaxseeds contain about half of that amount per ounce. Omega-3 fatty acids are an essential nutrition, meaning absolutely necessary because your body can’t produce them independently and particularly important for pregnant mommas as they assist in brain development – boosting IQ points for the little one. Skin, nerves, and other organs are also benefited by the alpha-linolenic acid (ALA) in plant seeds. Fish is the best source of long-chain fatty acids, as they contain eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA), the most important types of omega-3 fatty acids. The conversion from ALA to EPA and DHA in your body is highly inefficient so fish is certainly a better source, but again, for those women who avoid all animal products, chia seeds are an excellent alternative.

More than Fat

Tiny as they are, there is more to the chia seed than good fats. One serving of chia seeds (an ounce) offers 11 grams of fiber, 4 grams of protein, and 9 grams of fat (most of which is good fat). Chia seeds are well-balanced and energizing. These little seeds also contain about a third of your daily recommended intake of phosphorus and about a quarter of your needs of manganese, two minerals needed for proper development of your baby’s skeletal system. An ounce of chia seeds also contains about 180 mg of calcium, also vital for bone development.

Is this the same Chia Seed we rubbed on clay figurines known as “Chia-Pets?”

Why, yes. Yes, it is. Don’t eat the seeds in those packages however, if you still find chia pets among the holiday shelves. Look for chia seeds in your health food store and sprinkle them in a smoothie or on top of cereal or yogurt for a fast, easy nutritional boost.


Beth Wittenstein blogged ten excellent recipes over at Nosh On.iT. I encourage you to pin this site and then report back after trying her recipes. Katie at Wellness Mama also offers ten uses for chia seeds and a chia seed energy drink recipe. Interestingly, chia seeds can be a safe and effective egg substitute as well. Use 1 tablespoon finely ground and 3 tablespoons of water per egg in a baked recipe. Katie at Wellness Mama warns that this would not be a good substitute in omelets however.

Postpartum Benefit

Chia seeds have also been used successfully for weight loss by suppressing appetite, leveling blood sugar, aiding in intestinal regularity and by creating a physical barrier between carbohydrates and digestive enzymes causing the conversion of carbohydrates into sugar to slow. Chia seeds expand when hydrated, up to twelve times their size, enhancing satiation with less volume.

Purchasing Produce

It is no secret that today’s fruits and vegetables are highly sprayed with pesticides, herbicides, synthetic fertilizer, and are often genetically modified and even irradiated (exposed to radiation, in order to make it last longer in the store). Purchasing natural produce is high priority for many families, although for others, this is a significant challenge due to availability or cost. Here are some tips for reducing your exposure to toxins and improving your produce quality.


Plant a Garden

Grow as much of your own food as possible. Whether you live on a large farm, or in an apartment, it is possible to grow some of your food. Lettuce and greens, carrots, herbs, tomatoes, and onions require little room. Plan to can, freeze or dehydrate fruits and vegetables to be used throughout the year. If you aren’t able to care for a garden, harvest from a local U-pick garden and enjoy the bounty.

Buy Fresh

Fruits are vegetables are always better fresh, then frozen, then canned. Choose those which are organic if possible. Wash fruits and vegetables carefully. Buy ahead and store in your freezer. Fruits with thin skin are the most important to purchase organic, such as apples, carrots, strawberries, peaches and pears, greens, celery, corn and peas. Become familiar with the Dirty Dozen. Research which fruits and vegetables are more highly sprayed or which are GMO, and make the worst ones your top priority for purchasing organic.

Local Food Market

CSAs or Community Supported Agriculture, Farmer’s Markets, and Produce Markets typically offer a plethora of locally grown produce, much of which is certified organic or unsprayed (not certified). Support your local industry and favor those grown locally. You can find local farmers and products here and a directory of Co-Ops in the USA here.

Larger Grocery Store Chains

Many have their own organic brands and while more corporate, it does demonstrate a demand for organic and offers more variety. Costco and Sam’s, even Wal-mart, are beginning to carry more and more organic foods.

Many families use a variety of the above options to obtain their family’s fruits and vegetables, although some utilize a home delivery option such as Green Bean Delivery, in which a local co-op delivers a week’s worth of fruit and vegetables to your front door. If you aren’t buying organic, you may want to consider peeling your fruit as toxins tend to concentrate in the skin. There is a bit of debate however, regarding washing and peeling fruits and vegetables. Learn more here.

Feeling Burnt Out? The Adrenal Fatigue Link

stressAdrenal fatigue has gained increased attention as more of us recognize burning our candle at both ends is not all that good for our health. It was previously understood that the feeling of burnout was more a psychological issue, typically related to work and almost entirely a mental health issue. Pharmaceuticals were prescribed. Some were helped, yet most, only temporarily. More recently, experts have started recognizing that exhaustion of physical or emotional strength and loss of motivation is typically the result of prolonged stress and frustration, and while also related to work and life circumstances, its effects are both mental and physical. The exciting news, experts are increasingly recognizing remedies which offer improvement of symptoms in a matter of days to months, without the need for long-term pharmaceutical dependence.

We’re spending so much more time at work. Downtime is still up-time because we continue to check our email, tweets, texts, and Facebook. There is no rest. Personal lives are overwhelmed by on-going work, and as a midwife, I can certainly relate. Drawing boundaries can be exceptionally challenging and ultimately, damaging to our adrenals, particularly when we interrupt our sleep.

Burnt-Out Symptoms


  • Chronic pain
  • Fibromyalgia
  • Headaches
  • Joint pain
  • Inflammation
  • Muscle spasms
  • GI issues
  • Sexual dysfunction
  • Fatigue
  • Burn-Out
  • Light headed or dizziness


  • Anxiety
  • Stress
  • Feeling overwhelmed
  • Burn-Out
  • OCD
  • Fatigue
  • PTSD

Clinicians are recognizing patterns as well. For example, teens, especially girls with adrenal fatigue, often complain of GI upset, headaches, and fatigue. Men often complain of sexual dysfunction, while women tend to complain of pain and fatigue. A significant proportion of our population are being treated for anxiety, stress, OCD, pain or fatigue. Many times these physical and emotional complaints don’t appear to have one root cause. It’s imperative that primary practitioners ask about such symptoms, and screen for them. Our practice offers the Edinburgh screening at each well woman visit, as well as each trimester in pregnancy and at each postpartum visit. If we were primary providers for men, we would offer the same for our postpartum fathers as one in ten have some sort of perinatal mood disorder.stress causes disease


Additional questions the clinician may consider asking or you can ask yourself, include:

  • Do you feel numb, unable to feel joy
  • Have you lost your drive
  • Does everything and everyone irritate you
  • Do you feel that nothing is worth the effort at home
  • Do you feel that nothing is worth the effort at work
  • Do you have multiple aches and pains
  • Restless, feeling keyed-up or being on edge
  • Easily tired
  • Having problems concentrating
  • Irritability
  • Muscle tension
  • Trouble falling asleep, staying asleep, or general poor sleep
  • Do you have anxiety
  • Does your anxiety interfere with your life
  • Do you feel depressed
  • Have you thought of hurting yourself or other as a solution to your problems

These questions may seem common, but they are specifically designed to pull out both emotional and physical concerns. If five or more questions are flagged, evidence suggests cortisol levels are low indicating need for further assessment. Certainly chiropractic and nutritional care can be exceptionally helpful.

How Does Burn-Out Occur?

Adrenal fatigue is related to chronic stress, whether emotional or physical. This stress can be positive or negative, whether getting married, graduating and moving to physically training for a triathlon or birthing a child to experiencing a traumatic event. The body is simply fatigued and has little reserve for further endurance.

Interesting Studies

Lupien, Maheu, Fiocco, & Schramek (2007) discovered the presence of high cortisol levels seem to lock in bad memories. This is important for those that suffer post-traumatic stress disorder. Sexual abuse is a common abuse, for example, and the trauma increases cortisol levels, which subsequently keeps the memory fresh, replaying in one’s mind, and ultimately leads to post-traumatic stress disorder (PTSD).

Another interesting finding is related to DHEA, which is the hormone that responds to acute psychosocial stresses and essentially flushes the body of its negative response. DHEA attempts to create balance after a stressful event. Lennartsson, Theorell, Kushnir, Bergquist, & Jonsdottir (2013) discovered that those with PTSD most often have lower levels of DHEA; therefore, they are unable to find psychological balance after a traumatizing event. Their brains never get washed clean from these emotional traumas.

Scientists are discovering that there are biochemical reasons for why people suffer anxiety, depression, OCD and PTSD. They recognize the link and can treat it effectively.

Tanriverdi, De Bellis, Ulutabanca, Bizzarro, Sinisi, Bellastella, Paglionico, Mora, Selcuklu, Unluhizarci, Casanueva & Kelestimur (2013) investigated pituitary function after traumatic brain injury are discovered long term hormone deficiencies which plays a role in post-traumatic stress after such events. Researchers have also correlated a desensitization following childbirth to cortisol and the feedback mechanism following stressful events, leading to perinatal mood disorders.

PANDAS is the abbreviation for a new pediatric autoimmune disease, Pediatric Autoimmune Neuropsychiatric Disorders Associated with Steptococcal Infections. This term describes a subset of children who have obsessive compulsive disorder (OCD) or a tic disorder such as Tourette Syndrome, whose symptoms worsen subsequent to a strep infection. These children often experience a dramatic onset of symptoms. The theory is that the infection depletes their reserves and their neurotransmitters need evaluated.


Adrenal Function

The adrenal cortex which surrounds the adrenal medulla, releases glucocorticoids such cortisol, mineralocorticoids such as aldosterone, and sex hormones such as testosterone. The adrenal medulla then releases, epinephrine and norepinephrine. The adrenals are responsible for the fight or flight response. Those who face stressful events, particularly chronic adrenal glandsstress continue in this fight or flight response and drain their reserve of DHEA to ‘wash themselves clean’ of the stress response. Signs and symptoms then present (see above), and clients state, “I just don’t feel myself.” A clear sign is sharing multiple complaints, physical and emotional, although most can identify that they are genuinely burnt out.


We’ve talked about chronic and acute stress, whether emotional or physical, and certainly trauma can create adrenal fatigue, but less appreciated is the genetic relationships. Introverts are quite vulnerable, because the theory is that the entire reason they are an introvert is because they have an over stimulated nervous system. Introverts seek solitude in effort to decrease their stimulation. Extroverts are not typically over stimulated, and aren’t as likely to have PTSD or burn out. Abnormal neurotransmitters or hormone imbalances are generally the root cause. Personally, I’ve noticed as I’ve become older, I have become more and more of an introvert. Based on this theory, my transition makes perfect sense. As a child of a single mother who was rarely home and simply failed to connect with me as a child, I earnestly sought out relationships and connection with others, feeling very energized within groups of people. As a midwife, in a service role with many demands at all times of the day and night, every single day of the week, I find myself secluding myself outside of work needs.

Those of us who have mastered the lifestyle of a procrastinator can also relate. We sort of thrive off the cortisol release generously extended when we wait until the last minute to complete a project, but if these demands have any consistency, good results will not continue. Our bodies simply can not tolerate continued stress. One of my favorite nurses also struggles with this reality, in that she takes on new assignments with great eagerness and excels, but only for a while. Eventually she crashes and burns, because that cortisol high doesn’t sustain her and her reserve runs dry. Many of us know that person that over promises and under-delivers. They have great intentions, but can’t seem to follow through. How many of you end up sick on vacation, or on every school break? You ramp your body up and up in preparation, and then crash and burn the moment you have opportunity to relax.

I use to thrive under stress and always did very well. Now I can’t handle anything!

You have worn yourself out. Your body can no longer tolerate the stress. There is no more reserve. This is adrenal fatigue.

Hypothalamus-Pituitary-Adrenal Axis

The biochemical pathways of stress are quite complex. In easy terms, each of us have hormones that respond to stress. We also have hormones that come in to restore us to a healthy balance. During acute stress, we’ll find high levels of these neurotransmitters, but eventually our reserves will run low of those which try to restore. Important as well, our body can become desensitized to the increased fluctuation. Not only does our nervous system begin to become somewhat numb to hormonal response, but we also begin to decrease our overall response to stress. End stage adrenal fatigue is evident when each of the neurotransmitters are depleted and, the client shares a plethora of signs and symptoms, typically visiting multiple practitioners in hopes of finding a solution.

Physical Exam and Diagnostic Testing

Certainly the clinician should provide a full head-to-toe exam to rule out obvious pathologies, including obtaining any pertinent laboratory tests. Orthostatic hypotension should also be evaluated, as well as orthostatic muscle testing. Positive findings in either of these tests can be quite indicative of adrenal fatigue. Pupils of someone with adrenal fatigue may be larger with a slower response. Ligament laxity test is another good test for determining the presence of adrenal fatigue.

The Maslach Burnout Inventory (MBI) is a screening tool is currently viewed as the gold standard for measuring burnout. Correlation between results of this test and increased cortisol levels is significant. Diagnostic tests which follow the Maslach Burnout Inventory test are easy to obtain, can be performed in the privacy of the client’s home, and can identify concerns within both the endocrine and nervous system. Not only are the adrenals assessed, but also the HPA axis: neurotransmitters, cortisol and DHEA specifically.

Clients suffering from anxiety, depression, fibromyalgia, chronic pain, insomnia, fatigue, ADHD, low libido, post-traumatic stress, obsessive compulsive disorder, burn-out or the common, “I just don’t feel right” syndrome can benefit from this testing. Treatment then can be determined specific to individual findings, whether that is in nutritional support, herbal remedies, essential oils, or on rare occasion, pharmaceuticals.

Why try Alternative Treatments?

The goal of all complementary medicine modalities is to balance the body. Rather than target the body with pharmaceuticals, identify the actual cause and nudge the body to fix itself. Nutritional supplements such as those designed by NeuroScience, which our practice frequently utilizes in these cases, are not addicting. They heal the body rather than mask the symptoms. Treatment regimens can be personalized through an in-depth review of the client’s symptomology, physical exam and diagnostic tests. We aren’t guessing as clinicians must do with pharmaceuticals. Medications are too specific, addressing a single neurotransmitter, rather than the entire HPA axis.

If you relate, call our office and make an appointment. We would be happy to help you find optimal health once again.

Zodkoy. (2013). Misdiagnosed: The Adrenal Fatigue Link. Retrieved from

Current Status of Indiana Statutes specific to CNMs

We are frequently asked if we are going to open a birth center, especially after opening our beautiful new midwifery clinic in Indianapolis. I will admit that while touring the center, we certainly were tempted and recognize that there is a need for a birth center in the Indianapolis area, but the current statute makes that temptation last no longer than a few fleeting moments.

108 East 9th Street, Indianapolis IN 46204

108 East 9th Street, Indianapolis IN 46204

Currently Indiana is home to only three licensed birth centers: the Auburn Birthing Center, LLC, the Goshen Birth Center, Inc, and the New Eden Care Center, Inc in Topeka. Statute requires that each center have a “staffing physician” which oversees the care provided by the nurse-midwife. In fact, this physician is responsible for “determining, implementing, and monitoring policies governing the center’s operation,” and holds “responsibility for the direction of all medical, nursing and health-related services to patients.” This oversight by physicians is referenced to those outlined in IC 25-23-1-19.4, yet the two are not congruent.

Indiana Code 25-23-1-19.4 does not require “oversight” but rather collaboration, which are not one in the same. Collaboration is a team effort with equal partners, not one supervising the other. Collaboration between a physician or physician group and nurse-midwives within the birthing center could occur without any active role by the physicians in the specific activities of the birth center. Nurse-midwives are highly-educated clinicians, well integrated into the healthcare infrastructure, capable of determining when medical care is indicated and referring appropriately. Obstetricians, experts in pathology and surgical intervention, are best utilized within the hospital environment and still remain readily available for consultation, collaboration, or assuming care in a transport scenario. Their expertise does not typically extend to the management or administration of low-risk maternity services where nurse-midwives excel. Shall we evaluate the state of maternity outcomes today as primarily managed by physicians?

The Indiana Nurse Practice Act defines the practice of nurse-midwifery as “the practice of nursing and the extension of that practice, including well-woman gynecological healthcare, family planning, and care to the normal and expanding family throughout pregnancy, labor, delivery, and post-delivery” (2011, p 82).  The competent practice of nurse-midwifery is further defined as “an independent and interdependent member of the health care team” with a scope that includes making “independent decisions, commensurate with the autonomy, authority, and responsibility of the practice of nurse-midwifery” (2011, p 84). The Indiana State Board of Nursing recognizes that nurse-midwives can “recognize the limits of individual knowledge and experience, and consult with or refer clients to other health care providers as appropriate” (2011, p 84). Why then does the birth center statute require supervision?

Indiana Code 25-23-1-19.4 requires nurse-midwives “operate in collaboration with a licensed practitioner as evidenced by a practice agreement, or by privileges granted by the governing board of a hospital licensed in the state of Indiana with the advice of the medical staff of the hospital that sets forth the manner in which an advanced practice nurse and a licensed practitioner will cooperate, coordinate, and consult with each other in the provision of health care to their patients” (Indiana State Government, 2013). The Nurse Practice Act was crafted by the State Board of Nursing in effort to further detail this statute, and determined that the practice of nurse-midwifery in itself does not require a written collaboration, although certainly collaboration is an integral component of such practice, but does require written collaboration to practice in order to prescribe legend drugs. It is at this point that the details of such collaboration can be quite restrictive, and unfortunately the nurse-midwife is at the mercy of the physician willing to sign the collaboration.

This prescription authority policy, in addition to the birth center bill, needs amended in Indiana. The National Council for the State Board of Nursing (NCSBN) has identified independent practice and independent prescribing as a major elements for improving health care outcomes. State boards of nursing are charged with aligning statutes within each state to the Consensus Model, with an intended implementation target of 2015. Indiana ranks among the worst in the country for its current implementation of the Consensus Model (NCSBN, 2013).

The Institute of Medicine (IOM) published, The Future of Nursing: Leading Change, Advancing Healthrecommending the removal of barriers that prevent nurses from practicing their full scope. The IOM supports the practice model discussed above by the NCSBN, and specifically charges the Federal Trade Commission and the Antitrust Division of the Department of Justice to “review existing and proposed state regulations concerning advanced practice registered nurses to identify those that have anticompetitive effects without contributing to the health and safety of the public” (p 2).

Nurses should be full partners, with physicians and other health care professionals, in redesigning health care in the United States. ~ Institute of Medicine

Indiana Medicare and Medicaid does not recognize the advance practice nurse and cover such services as physicians are covered for the same services. Indiana does not require third-party payers that participate in fee-for-service payment arrangements to provide direct reimbursement to advanced practice registered nurses who are practicing within their scope of practice under state law. In fact, they can refuse to cover any care performed by a nurse-midwife or any care provided within a birth center or within the home. Nurse-midwives are not protected from being discriminated against by physician colleagues or medical boards when requesting hospital privileges, although this collaboration is required for the practice of nurse-midwifery in the state of Indiana.

The Gift of Remembrance for Grieving Parents

The loss of a precious child is an experience no loving parent should have to face. It is so important to nourish support systems which may help bring peace to grieving families in times of need.

GriefNow I Lay Me Down to Sleep is a non profit organization devoted to providing grieving families enduring the loss of a child with professional portraits to help them remember the beauty of their precious time together. Through this organization, photographers receive training and education so that they are able to create heirloom quality portraits for families to treasure. Over 11,000 photographers work with NILMDTS and the photographs are taken and reproduced free of charge.   The organization is present in all 50 states and in 40 countries worldwide. NILMDTS is sponsored by professional photography guilds, but also continues to exists thanks to generous donations. The professionals who volunteer with NILMDTS understand photography within the hospital environment. They require little space. Training through the organization prepares photographers for the sensitive situations they encounter.

NILMDTS was founded in 2005 by Sandy Puc’ and Cheryl Haggard, after Cheryl’s son Maddux Achilles Haggard was born with a condition which prevented him from breathing, swallowing, or moving on his own. Faced with this tragedy, the Haggard family watched their child suffer for several days before making the difficult decision to remove artificial life support. Sandy visited the family, and took pictures of Maddux cradled in his parents’ arms both before and after the tubes and wires which sustained him were removed. These beautiful remembrances of their eternal connection to their child inspired Cheryl and Sandy to bring this gift to parents suffering pregnancy loss, stillbirth, or who are caring for newborns at risk of dying.

If you are interested in learning more about Now I Lay Me Down To Sleep, whether they offer a service your family or friends may need, or you are interested in becoming involved as a donor or a photographer, visit their website.  Their mission is worthy of support and admiration.



Thanksgiving Safety Tips

Thanksgiving is a time to stop the chaotic routine, settle in with family, and take the time to give thanks for the abundance of blessings each of us often take for granted. This particular holiday is not one we typically associate with any particular risk, as we do with the Fourth of July celebrations for example, but surprisingly there are a few precautions each family should be aware.

Emergency room physicians share that family football games bring in a number of head injuries each year. I applaud the active contribution beyond the sedentary recliner viewing, but scrapes, bruises, and concussions do occur each year. Emergency room physicians warn that groups should consider wearing helmets, particularly when kids and adults are playing together (Scudder & Glatter, 2013).

Auto accidents are another concern, with 500 deaths reported each year and more than 43,000 emergency room visits. Don’t let yourself become distracted while driving. Put down the smartphone, tablets and other multimedia agents. Consider that everyone else probably has their face in their smartphone so you need to be hyper-vigilant due to their lack of concern.

It is no surprise that over-eating occurs on Thanksgiving, but were you aware that this can cause chest pain severe enough in some family members to require an emergency room visit? Heartburn can be significant and while some simply need to be educated in understanding the difference between heartburn and genuine chest pain, some are sincerely putting themselves at risk for having a myocardial infarction because of their indulgence. Experts have named this phenomenon, “Holiday Heart Syndrome,” which is caused by the combination of consuming alcohol and overeating. More specifically this is generally related to binge drinking and binge eating which can cause an otherwise healthy person to have an arrhythmia, most typically atrial fibrillation. Of course those with a known cardiac disease are also at risk. Hydration via intravenous fluids is typically the remedy, although medications are sometimes required to control the heart rate (Scudder & Glatter, 2013).

More and more people are consuming stimulants such as “raging bull” or “speedbull” which may be utilized on Thanksgiving to counter the sleepy effect caused by the large turkey dinner. Synthetic cannabinoids, such as spice, K2, and bath salts are also experimented by new members of the family during these holidays, which have very serious side effects including arrhythmias, stroke, and intracranial bleeding. Electronic cigarettes are also being utilized by more consumers, especially teenagers, who are presenting to the emergency room with agitation and extreme anxiety alongside an elevated heart rate due to the inhalation of large amounts of nicotine (Scudder & Glatter, 2013).


Sadly, Thanksgiving is not a holiday welcomed or even pleasant for all. I have great compassion for the diabetic for example that isn’t at liberty to indulge in sampling each of the desserts brought for enjoyment. However, many are affected by the stress of the holiday including anxiety caused by family arguments. Panic attacks bring people to the emergency room, sometimes with symptoms similar to a heart attack. Fistfights and facial trauma are another reason people end up in the emergency room on Thanksgiving, particularly if alcohol is involved.

Geriatric clients also frequent the emergency room more frequently on the holidays, sadly because they are more likely to have visitors that recognize their declining health. Most often the family is simply not aware of the progression of their chronic disease and see the matter as more acute, while at other times, the elderly family member may have an acute need that needs to be identified and treated (Scutter & Glatter, 2013).

Thanksgiving is among the most favorite of all holidays enjoyed by US citizens, but the heightened energy created in the midst of an otherwise chaotic life can create a perfect storm.

Scudder, L & Glatter, R. (2013). How safe is Thanksgiving? Medscape Family Medicine.

Fertility Awareness: TwoDay Method

The TwoDay Method is my favorite approach to fertility awareness and one I teach most all my clients.

Many of my clients are familiar with the Billings ovulation method and the symptothermal method (and their variants), all of which a great deal of research has supported with 95% to 98% effectiveness. Their use poses no harm to either the woman or an developing baby if that were to occur. Despite their safety and efficacy, very few women utilize these methods because of the time and effort required.

The Standard Days Method and the TwoDay Method are two newer fertility awareness-based methods developed by researchers at the Georgetown University Institute for Reproductive Health. They are effective, easy for women and couples to use, and easy for clinicians to offer (Germano & Jennings, 2006). Fertility awareness-based methods are based on observation of fertile and infertile periods of the menstrual cycle. Certainly we are aware of the dominant sign of the cycle, the menses, but changes in cervical secretions, changes in basal body temperatures and a change in the position and feel of the cervix also occur. Fertility awareness-based methods usually rely on the identification of more than one of these symptoms; hence, the difficulty in their use and in the increased time required for health care providers to effectively teach these methods (Germano & Jennings, 2006).

The ovulation method otherwise known as the Billings method, requires the character of the cervical mucous be monitored as well as the sensation of wetness. Dryness and a sticky mucus correlates with infertile days, while wetness or slippery mucus correlates with fertile days. The symptothermal methods requires the woman to monitor her cervical secretions, record her basal body temperature daily, and monitor other bodily changes during the cycle, such as breast tenderness, mittelschmerz, increase in libido, and mood changes. Commercially available fertility monitoring devices are sometimes used in conjunction with these assessments to further validate fertility (Germano & Jennings, 2006).

The Standard Days Method

The Standard Days method is based on the understanding of the menstrual cycle as well as the life span of the sperm and ovum. Women whose cycle ranges between 26 and 32 days would be appropriate candidates, which would include about 80% of women. Using this method, women would need to understand that they are fertile between days 8 and 19 of their cycle. No monitoring of their temperature, cervical secretions, or other bodily symptoms are necessary with the Standard Days Method.

Researchers have discovered a 4% probability of pregnancy if intercourse occurs 5 days before ovulation. The probability increases to 15% if intercourse occurs 4 days before ovulation, and increases to between 25% and 28% if intercourse occurs 1 to 2 days before ovulation. After ovulation, there is an 8% to 10% probability of pregnancy if intercourse occurs within 24 hours. Fertility then decreases, and there is no probability of pregnancy by the day after ovulation (Germano & Jennings, 2006).

These probabilities are determined based on the limited viability of sperm (not more than 5 days) and to the very limited life span of the ovum after ovulation (less than 24 hours). Together, this offers a fertility life span of no more than 6 days each cycle. Of course these days are figured around the mid-cycle period when 95% of ovulations have occurred. Computer analysis of the two probabilities – the probability of pregnancy on different cycle days related to ovulation, and the probability of the timing of ovulation – provides a fertility probability only during days 8 through 19, and intercourse during all other days can be enjoyed without concern for pregnancy. The efficacy, with correct use, is 95.2% with only five of 100 becoming pregnant in the first year of use (Germano & Jennings, 2006).

1.1279316024.fertility-cycle-beadsCycleBeads are a color-coded string of beads that assist women in tracking their cycle days, recognizing their fertile days. Again, these women must have some level of confidence that their cycles usually come about a month apart and when they expect them. This method can be started immediately; however, if breastfeeding, cycles will need to be re-established first. Cycle lengths should be monitored for regularity and barriers methods should be utilized during fertile days (Germano & Jennings, 2006).

The TwoDay Method

This method maximizes on the cervical changes that occur with the menstrual cycle and therefore, doesn’t limit itself to women with regular cycles. The other beauty in this method is that it doesn’t require analyzing the characteristics of the secretions, such as amount, color, consistency, slipperiness, stretchability, or viscosity. Women simply need to ask themselves, “Did I notice any secretions today?” and “Did I notice any secretions yesterday?” If yes to either question, then she may be fertile. Researchers determined the theoretical efficacy of the TwoDay Method as at least as high as that of the Standard Days method.

Nurse-midwifery takes a holistic approach to the care of women and gynecologic care is a large part of that service. Education and counseling in these options empower women to take charge of their own fertility without the need for pharmaceuticals which might invite risk to their health, in spite of their enormous benefit.

Have you utilized either of these methods? Do you have a preference?


Germano, E. & Jennings, V. (2006). New approaches to fertility awareness-based methods: incorporating the Standard Days and TwoDay methods into practice. Journal of Midwifery & Women’s Health, 51(6), 471-477.

Food For Thought

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought #1

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

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought

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

Food for Thought #3

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

Barbara Katz Rothman PhD (1996)

Food for Thought #4

Believe there is always, always, always a way.

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

Food for Thought #5

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

Food for Thought #2

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

Psalm 22:9