Latest / Cultural Wars | America Out Loud News / Bridging hospital & holistic: A midwife’s vision for safer, healthier pregnancies

Transcript

Bridging hospital & holistic: A midwife’s vision for safer, healthier pregnancies · Cultural Wars | America Out Loud News

• 0:06
  Welcome to the unto take a deep breath.
• 0:11
  Take the higher roles.
• 0:13
  It's what they always say.
• 0:14
  Let's say if they know the way, they won't take it from me.
• 0:20
  But don't ever dump yourself with swiping just a dream.
• 0:24
  You made your own so kid can scream.
• 0:31
  It never had the chance.
• 0:33
  So watch with board is calm, my friend, because this is whoa.
• 0:44
  It's time at this one.
• 0:54
  All right.
• 0:54
  Welcome back to the Nurses Report with Nurse Gail McCray.
• 0:58
  I'm so happy to be here today, and it's such a beautiful time to have some discussions about what's going on in for mamas and babies in the world.
• 1:10
  We've got all of these options for women now.
• 1:13
  And a lot of women are starting to choose out of hospital births and different types of wellness options for having children, which I have a background in.
• 1:24
  For those of you who don't know, I completed uh the scholastic portion of the certified nurse midwifery degree back before COVID when things weren't crazy.
• 1:34
  And uh so I have a not only a deep interest in women and childbirth, but also the knowledge and background.
• 1:44
  And today I'm being joined by a fellow certified nurse midwife.
• 1:50
  She actually graduated though.
• 1:51
  I didn't, unfortunately.
• 1:54
  Uh, Brianna Bachelor, uh, she's a certified nurse midwife and advanced practice registered nurse in functional and integrative clinical specializations, uh, but particularly in women's health, fertility, metabolic health, and longevity.
• 2:11
  Uh, she has a background in uh labor and delivery and also advanced functional medicine training.
• 2:18
  Uh, she takes a systems-based approach that blends conventional medical knowledge and root cause investigations into uh including lab testings, genetics, peptide work, uh, nutritional management and lifestyle uh into the wellness plan of her patients.
• 2:41
  But uh, she was really born for holistic medicine, and uh she wants to bridge the gap between functional medicine and the traditional hospital-based symptom management approach to wellness, and that's what we need in this world today.
• 2:57
  So I'm very excited to have her here to have some of these conversations to get people thinking about and talking about uh you know what's going on in the hospital-based settings, is that working for you and your family?
• 3:10
  And if it's not, how can you find access to other options?
• 3:14
  So, welcome, Brianna.
• 3:16
  Uh, thank you for coming on today.
• 3:18
  And um tell me a little bit more about yourself.
• 3:22
  What got you into uh becoming a certified nurse midwife and what does that actually mean for people who don't know?
• 3:29
  Yeah, so thanks for having me.
• 3:31
  I'm really excited to be here.
• 3:32
  Um, like you said, I'm a nurse midwife and call myself a functional medicine practitioner, integrated practitioner.
• 3:39
  Um I think after working in labor and delivery for as many years as I did in a hospital system.
• 3:47
  Um, it really changed the way that I had to think about things.
• 3:50
  I always say that I was born in a birthing center, uh, not like actually born in a birthing center, but my training all came from a nurse midwife and mentor who was the most incredible human.
• 4:02
  Um, and she really taught me about the normal physiological process of birth and what that looked like in women's health care.
• 4:11
  Um, so transitioning from a birth center setting into a hospital setting was very eye-opening.
• 4:16
  Um, it allowed me to grow skills that I needed.
• 4:19
  Um, I think that it has helped grow me into the practitioner I am today, and I'm so grateful for that experience and time and knowledge.
• 4:27
  Um, but I kept walking out of the hospital and walking away from the clinic and walking away from these people that I really respected and cared for, going, we have to do something different.
• 4:40
  What we're doing isn't working.
• 4:42
  These patients are getting sicker, our outcomes are getting worse, we're missing something.
• 4:47
  What are we missing?
• 4:48
  And so I decided to utilize the two years I had after a surprise pregnancy of 40.
• 4:55
  Um, and deciding to take a couple years and spend time with my last baby to learn as much as I could and the functional space and root cause medicine and then root cause approach and um really deeply believing that there's a space for both, right?
• 5:11
  That two things can be true.
• 5:13
  Medicine saves lives, medicine heals people, but we do a really good job at sick care, and we are terrible at health care.
• 5:21
  And how can we have a space for both and stop looking at the world as just strictly black and white, you know?
• 5:29
  So absolutely.
• 5:31
  I feel that Western medicine is the best medical approach for acute illness and disease.
• 5:40
  If you get in a car accident, if you have a heart attack or a stroke, or if there's an emergency in your birth, right?
• 5:48
  You need to have access.
• 5:50
  Um, and there's no doubt that the hospital setting in Western medicine will save your life in those circumstances.
• 5:58
  But then what about the 99% of your life?
• 6:02
  That's not that doesn't fall into that category.
• 6:05
  And uh that's the part where I have yet to see a speciality in Western medicine that deals with chronic care and illness that actually increases the well-being and the longevity of a patient.
• 6:26
  Yeah.
• 6:27
  There, I don't know of one.
• 6:29
  Yeah, it's it's dead on.
• 6:31
  Like we, I think live in this world where um it's like in our political space, it's in our healthcare system, it's in the way that we present ourselves every day.
• 6:40
  You have to be one thing or the other.
• 6:43
  And I think it's the detriment to all of us.
• 6:45
  It's really truly going to kill all of us.
• 6:47
  You have to be left or right.
• 6:49
  You have to be believed that you are, you know, everybody should be fully vaccinated or you're an anti vaxxer.
• 6:55
  And we label everybody, and we feel like we have to pick a side instead of being able to say there is a space for both things.
• 7:00
  Of being able to say there is a space for both things.
• 7:04
  Both things can be true.
• 7:04
  Both things can be true.
• 7:06
  And I tell everybody all the time like one of the biggest signs of intelligence as far as I'm concerned is the ability to say I was wrong, or that is an interesting perspective.
• 7:06
  And I tell everybody all the time, I'm like, one of the biggest signs of intelligence, as far as I'm concerned, is the ability to say I was wrong, or that is an interesting perspective.
• 7:17
  Or I didn't think about it that way.
• 7:17
  Or I didn't think about it that way.
• 7:18
  Teach me more, finding a different way to say I want to learn more.
• 7:18
  Teach me more, finding a different way to say, I want to learn more.
• 7:23
  And in medicine specifically, we it takes they say 12 to 15 years to change practice, right?
• 7:23
  And in medicine specifically, we it takes they say 12 to 15 years to change practice, right?
• 7:29
  And we can't.
• 7:29
  And we can't utilize these things saying that this is evidence-based practice when this evidence is this many years old and we now know better, right?
• 7:38
  We now know there's a different way to do things and that there is we're constantly learning, right?
• 7:43
  We're constantly learning and growing.
• 7:45
  And the inability to change that way of thinking is what's causing so many problems now.
• 7:52
  And it's not to say that there's not a place for anecdotal evidence, right?
• 7:56
  I think more specifically in the space of perinatal care, right?
• 8:01
  I was talking to a physician colleague of mine who was talking about like trauma.
• 8:07
  And so often, if you work in OB, you've seen bad outcomes.
• 8:11
  And sometimes we carry them around with us forever.
• 8:14
  And we allow that fear for that one thing that happened one time after practicing for 20 years to be the thing that changes the way we practice in the future because we're holding on to that trauma.
• 8:25
  And there's a space for that, but we also have to take a step back, look at the reality, look at the statistics, look at that evidence-based practice, look at new research and be open and willing to change the way that we're yeah, we call it the risk-benefit analysis.
• 8:42
  I always think about that in every experience that I get into in the world in in our field of medicine is that I feel that practitioners in general in Western medicine, we've stopped considering the actual impacts of the risks and the benefits to the patients.
• 9:05
  Yeah.
• 9:06
  And when we let that fall out, and then we get so funneled into all of these avenues of like protocols and best practice.
• 9:25
  That's one of the things that I remember so vividly from grad schools, like even these best practice protocols.
• 9:32
  I don't, I learned that I can't necessarily trust those protocols because I found out through analyzing the data in some of those best practice protocols that the data didn't actually support the protocol.
• 9:47
  And so, you know, us as practitioners are in this position where we have to do our due diligence to protect the risk-benefit outcomes for the patient.
• 10:02
  But then we have this industry coming up behind us that's really uh hindering our ability to accurately analyze the risks and benefits.
• 10:15
  And so that's really a challenge.
• 10:18
  And in that light, um, you know, was there any specific events that really pushed you into starting your tell first of all, tell me what your business is.
• 10:31
  And then I'd I'd be curious to know, like, you know, what really inspired you to start this business after working in the acute care um in labor and delivery and uh and then in a birth center.
• 10:46
  Yeah.
• 10:47
  Um, I think that just to quickly touch on what you said, the risk benefit analysis should be based off of an individual approach as well, right?
• 10:58
  We might know that one thing leads to better outcomes for most people, but that's not all people, and it should be based.
• 11:05
  I'm sorry, see the gardeners, based off of an individualized approach.
• 11:11
  What about this person and their physiology and their birth plan and their risks and really about shared decision making, right?
• 11:20
  Saying, what is this person want for themselves because there's nobody who knows what's best for them more than them, right?
• 11:26
  So um, yeah, I really decided that I wanted healthier pregnancies, right?
• 11:32
  We have to, and that we have to start caring about women's health long before the pregnancy begins.
• 11:40
  Um, one of the things that I have just constantly played out in my head is that pregnancy is a stress test and pregnancy is an opportunity for the body to reveal something that's been happening for a long time.
• 11:52
  We have higher rates of morbidity and mortality than we ever have.
• 11:58
  The United States has some of the poorest outcomes compared to other industrialized nations.
• 12:05
  And I think that we hear a lot about this.
• 12:07
  We know we have more chronic disease, we know we have poorer outcomes, we know we have increased risks for um mortality, and that 80, they like the statistics show us that 80% of these poor outcomes were preventable, right?
• 12:23
  But when we're looking at prevention, we should be looking at more than just the birth itself, right?
• 12:27
  What caused this to happen?
• 12:30
  And when we consider it to be related to a pregnancy, it's a death within a year of delivery, but shouldn't we be looking more at their past history?
• 12:42
  Like, what were they doing every day?
• 12:44
  What kind of lifestyle did they live?
• 12:45
  What were what labs were we missing?
• 12:47
  What cardiometabolic risk factors did they have to begin with?
• 12:50
  And we do a really good job as midwives and physicians to look at their risk factors for postpartum hemorrhage, for example, how many pregnancies have they had?
• 13:00
  How long have they been in labor?
• 13:02
  Um, have they had any history of uterine surgeries?
• 13:06
  And we look at all these things to say, is she a high risk for a postpartum hemorrhage right now?
• 13:11
  But what about looking at the last 10 years of her life, right?
• 13:15
  What is going to increase those risks then and shouldn't we be doing something about that sooner?
• 13:21
  So I think I went into this space knowing that our outcomes are terrible.
• 13:26
  We need to do a better job.
• 13:28
  And what can we do 10 years before we get pregnant to prevent any of this from happening in the first place?
• 13:34
  We're missing this window because we should be looking at these women long before 28 weeks to see if we have gestational diabetes.
• 13:43
  Like, are we looking at their fasting insulin when we see them for an annual exam?
• 13:48
  Are we asking questions about their diet lifestyle and nutrition well before pregnancy happens or in the beginning of the pregnancy first trimester before we're actually screening them for these for these risk factors?
• 14:00
  Yeah.
• 14:00
  Yeah.
• 14:01
  Wow.
• 14:01
  Wow.
• 14:01
  So that's a that's a really good thing.
• 14:01
  So that's a that's a really good thing.
• 14:03
  I want to just kind of wrap up because I think that a lot of people aren't really taking this into account.
• 14:03
  I want to just kind of wrap up because I think that a lot of people aren't really taking this into account.
• 14:09
  So I remember this from our from taking these courses in graduate school, that it was I what I what really stuck with me is that I looked at the data and the statistics, and I saw that it was safer for a woman to have a child in Yemen than it was in the United States.
• 14:09
  So I remember this from our from taking these courses in graduate school, that it was I what I what really stuck with me is that I looked at the data and the statistics and I saw that it was safer for a woman to have a child in Yemen than it was in the United States.
• 14:28
  So there was like something like 50 countries and many of them second world countries that had better birth outcomes both for the mom and the baby than the United States.
• 14:28
  So there was like something like 50.
• 14:38
  And I love the way that you're linking that to not just the process of the way that we manage labor and delivery and pregnancy care for women, but also to their overall wellness and what they're dealing with before and when they come into the pregnancy.
• 14:59
  Because I don't think we really talk much about that, but that's actually something that women and families should really actually resonate on.
• 15:09
  Like if you're a woman that's trying to get pregnant or you know, thinking about starting a family, your emergency situations that may occur during your pregnancy or during your childbirth.
• 15:24
  First of all, you said they're 80% of them are preventable.
• 15:28
  80%.
• 15:28
  That's wild.
• 15:29
  That's a big number.
• 15:30
  I mean huge number.
• 15:32
  Pregnancy doesn't break women.
• 15:35
  And somehow we have this theory that oh, this preclampsia, it is a placental problem.
• 15:40
  When the placenta comes out, all is right with the world.
• 15:42
  And there might be parts of that that's true, but preclampsy didn't come out of nowhere.
• 15:47
  Your pregnancy exposes what the body's been already compensating for for a long time.
• 15:52
  And that's where we're missing the mark, right?
• 15:54
  And you and I both know that, like you and I talked earlier about like this childbearing age, right?
• 16:01
  And most women who are healthy, right?
• 16:03
  Who are healthy, we don't go see our doctors every year.
• 16:07
  We don't go see a provider every year.
• 16:09
  And there's so many missed opportunities for real screening, right?
• 16:14
  I think that we think, oh, you're 24.
• 16:17
  Uh, there's it's unnecessary for me to be talking about in the next 10 years of your life, you might be looking at having a pregnancy.
• 16:24
  But these conventional labs that we're running are missing the mark on so many underlying root cause things that could potentially increase the risks of infertility, increase the risks of pregnancy complications, postpartum healing and recovery.
• 16:41
  Then we transition that into perimenopause and menopause.
• 16:44
  And when we're pregnant and women's health care doesn't happen in like phases, it's like it really is stages, like it is this transition from one place to the next.
• 16:57
  And if we take care of women early on, and we can educate and look for risk factors early on, then we can prevent any of this from happening in the first place.
• 17:05
  So and loving our bodies and taking care of ourselves during our prime years.
• 17:11
  That's one of the things.
• 17:12
  So just to add on to that and to amplify what you're saying.
• 17:16
  I was diagnosed with irritable bowel disorder in my 20s, and you know, I dealt with it.
• 17:23
  I went through, did some cleansing, and you know, I waxed and waned on it, and it was caused by toxicity and deficiencies earlier in my life, and probably trauma that that came into that factor that cause, you know, this irritable bowel in my 20s that I tried to cure them for myself, but then I went and got pregnant.
• 17:46
  And then I found out how bad my body, how bad a shape my body really was in from all of those years of deficiency because I'd spent 10 years not being able to uptake the nutrition from my food, right?
• 17:59
  Because that's what happens when you have something going on in your bowels.
• 18:03
  You can't absorb, you can't take that nutrition in and send that.
• 18:07
  So then you enter into pregnancy already so deficient.
• 18:12
  I became osteoporotic because of my back-to-back pregnancies.
• 18:16
  When I was in my early to mid-30s, I mean, I was not old, but because my IBS that I had had in my 20s impacted me so badly, it created so much deficiency in my, you know, mitochondrial function that I wasn't able to effectively sustain these pregnancies.
• 18:38
  I was a mess.
• 18:38
  I mean, I was getting IVs, IV fluids and nutrition like three days a week for the whole nine months of both of my pregnancies, and then I was put on medications for it and all this, and all of that could have been avoided had you know had a more effective strategy for addressing and then reversing the damage of you know, having irritable bowels in those 10 years in my 20s that really wrecked my body.
• 19:05
  I mean, I'm still recovering from it now.
• 19:08
  I'm sure, but there's like a pathway to those things, right?
• 19:11
  Like, first of all, IBS is like conventional health care's way of saying, we know there's something going on with your gut, but we don't really know what it is, and then we label it.
• 19:19
  And we end up with these patients who have things like IBS, fibromyalgia, chronic fatigue syndrome pops, and they just they walk away feeling so labeled by all of these things that really no one's actually saying, what can we do to fix that and what actually caused that to happen in the first place?
• 19:39
  IBS is a diagnosis, right?
• 19:42
  There's it's symptoms, it's putting a title on a cluster of symptoms that we don't know what to do with, right?
• 19:48
  And then we put them on a PPI, right?
• 19:51
  We put them on medications because now they have indigestion and PPIs make lower the acidity of the stomach.
• 19:57
  That's proton pump inhibitors, yes, and that makes things significantly worse because what does the acidity in the stomach do?
• 20:04
  It helps us absorb nutrients, it helps to break down the food, so we better absorb them.
• 20:09
  It helps protect our body from leaky gut, it helps protect us from opportunistic critters and the commensal, the good bacteria thrives in an environment that's really acidic because it's like you.
• 20:19
  And so we end up with this path of just this stepwise problem.
• 20:23
  And what you're right, when you're pregnant, your baby will take what it needs from you.
• 20:28
  If you don't have sufficient calcium, guess where it comes from?
• 20:31
  Your you, your bones, it takes directly from you.
• 20:34
  Then we have these women who have a very difficult time recovering from labor and pregnancy, and postpartum depletion is a real thing, right?
• 20:43
  And then we're asking this woman to then make milk for her baby and to and to thrive and take care of this new life.
• 20:50
  And it just it spirals and cycles.
• 20:52
  And I mean, you know, like I have four kids.
• 20:55
  It's exhausting, right?
• 20:57
  Where you're as women, we are asked to do a million things and we're constantly circling and running.
• 21:00
  Million things and we're constantly circling and running.
• 21:02
  And you know, you've got a list of in your head constantly, these like micro tasks in your head every day, appointments and and you know, soccer practice and ballet and the house and the laundry and the meal planning and the prepping.
• 21:02
  And you know, you've got a list of in your head constantly, these like micro tasks in your head every day, appointments and and you know, soccer practice and ballet and the house and the laundry and the meal planning and the prepping, and in addition, you're working and you're doing all of these things, and somehow all of that time goes by and we transition into perimenopause and we feel like shit, and we're wondering why, right?
• 21:17
  And in addition, you're working and you're doing all of these things, and somehow all of that time goes by and we transition into perimenopause and we feel like shit and we're wondering why, right?
• 21:27
  When it started 20 years before, right?
• 21:27
  When it started 20 years before, right?
• 21:29
  And
• 21:29
  And so this is where I hope my practice changes things.
• 21:33
  And I can really encourage these young women to seek care sooner, to start asking better questions, to understand what labs we order, where we're missing the mark and what we're missing and why we should be doing those things.
• 21:49
  And looking at things from just a different perspective, right?
• 21:53
  I mean, at this point, like up to 10 to 15% of women are diagnosed with some sort of hypertensive disorder in pregnancy.
• 22:01
  One in eight women have postpartum depression.
• 22:03
  Pretuned birth is at 10%.
• 22:06
  Like I said, 80% of these deaths, maternal deaths, neonatal deaths can't be preventable.
• 22:13
  Um, gestational diabetes is upwards of 10%.
• 22:16
  These are significant numbers.
• 22:17
  And this means that we're not doing something right.
• 22:20
  And we should be looking at it much sooner than just the pregnancy.
• 22:25
  We should.
• 22:26
  And yet the medical industry that's currently functioning will not give our women and anyone, you know, even for people who are just struggling with chronic disease, will not give them access to care, integrative care, like the practice that you're operating.
• 22:45
  It's cash pay, right?
• 22:47
  It's getting people to, you know, maybe if you're lucky, you can receive payments from their what are those called the HSAs, the um the organizations that you can solve pay out of.
• 23:03
  I mean, and so, and so we've got these insurance companies covering these modalities that encourage, you know, proton pump inhibitors, which are anti-acid medications, and all these other medications that basically numb the symptoms of the um chronic illness that a person is dealing with.
• 23:24
  But don't fool yourself.
• 23:27
  Like there is nothing about those types of medications that's actually getting down to the reason why your body is sending the signal, which is the symptom that there's something wrong.
• 23:41
  Every time you have a symptom, your body is telling you beep, beep beep, hey, red light's flashing.
• 23:46
  There's something wrong.
• 23:47
  There's something I'm not getting.
• 23:49
  Right.
• 23:49
  And when we go to a doctor and they give us a medication to stop that symptom, that doesn't mean that we've addressed why the symptoms started.
• 23:58
  We're just telling our body to shut up and move along.
• 24:02
  And that's another whole part of this is the psychosocial and mental aspects of like, how do we get in this position where we justify telling our body and our symptoms that they're not important or valuable?
• 24:15
  Yeah, and that they don't know anything, right?
• 24:17
  And that's where I think this grace space goes is because again, it's not to say that there isn't a time and a place for some of these medications, right?
• 24:26
  Like autoimmune disorders, Hashimoto's is a great example of that, right?
• 24:31
  We know that the body's immune system is designed to look for danger, to respond to it, to shut it down, and then to shut down the response and then to settle, right?
• 24:46
  And when something flips and that doesn't happen, we end up with autoimmune disorders.
• 24:51
  And so Hashimoto's, we have somebody who comes to me and says, I'm on levathyroxin, I'm on armor thyroid, I'm taking low dose of no trust and whatever.
• 25:01
  They're on all these medications for their thyroid.
• 25:03
  Arguably, yes, they do need to continue to take that medication for this amount of time.
• 25:08
  They might need to be on it for the rest of their life.
• 25:11
  But what caused that immune system not to sh to stand down in the first place, right?
• 25:17
  What can we do?
• 25:19
  What could we have done five years ago when your body was starting to show these symptoms?
• 25:25
  Like you said, that something might not be right that could have prevented you from needing this medication now or forever, right?
• 25:32
  And this is where I want that gray space to exist because two things can be true.
• 25:36
  You there is a place and a time for certain things, right?
• 25:40
  Like this isn't black or white, it's not that simple.
• 25:43
  It's not to say you don't need this thing at some point or you might not need it, but you're right where we're missing the mark is saying, why is your body having this symptom?
• 25:52
  What is signaling this problem in the first place?
• 25:55
  Let's do a deeper dive and recover.
• 25:57
  Like type two diabetes is another great example, right?
• 26:01
  Like it is reversible, and it's ignorant to say that it's not, and you're just doomed to be labeled with this thing forever and be on medication forever is absurd, right?
• 26:10
  It's crazy.
• 26:10
  I mean, how long have we known now that type 2 diabetes is reversible?
• 26:14
  And yet the standard model of care is not to address it, but just to give medications like metformin that have profoundly impactful long-term side effects, and you know, and significant deficiencies, right?
• 26:31
  And then they end up with pernicious anemia.
• 26:34
  And I mean, why are we waiting that long to supplement with B12?
• 26:37
  I don't know, you know, I it really begs to ask like bigger questions, and we just need more healthcare providers out there asking those bigger questions.
• 26:45
  Yeah, restoring back to our roots, which is we came here to do no harm, but to help and heal.
• 26:53
  Yeah.
• 26:54
  And it's so easy to get distracted in this world we live in where everyone is so busy and everything is so expensive, and you know, there's just so we have so much on our plates.
• 27:04
  It's like when you're listing out all these things that women have to deal with, and you know, in addition to pregnancy and childbirth, you know, how do we how do we really make good decisions as a society when we are under such an immense level of stress?
• 27:23
  Yeah.
• 27:24
  That's you know, another whole topic.
• 27:27
  Yeah.
• 27:28
  I mean I it's about time to go to break.
• 27:34
  But go ahead, give me your last word.
• 27:36
  That's fast.
• 27:36
  I tell my patients always the first place, best place to start is to control the controllables.
• 27:41
  Like there's so many things that we don't have access to and don't we can't control, right?
• 27:46
  We can't control unfortunately what's floating around in the air.
• 27:50
  Like we can't control what is being pushed through the ventilation system in a building that we might work in.
• 27:55
  We can't control any of those things, right?
• 27:57
  But to some extent, right?
• 27:59
  But we can control what we put bring into our home, the food that we choose to consume and feed our family.
• 28:00
  Can control what we put bring into our home, the food that we choose to consume and feed our family.
• 28:04
  We can choose uh, you know, control the products that we choose to use and put in and on our body.
• 28:04
  We can choose, you know, control the products that we choose to use and put in and on our body.
• 28:10
  We can control how we sleep, how we rest, how we love, how we raise our children, the things that are important to us, the things that we hold dearest, right?
• 28:10
  We can control how we sleep, how we rest, how we love, how we raise our children, the things that are important to us, the things that we hold dearest, right?
• 28:18
  And I think if we realize and can see the bigger picture that we are ultimately the ones who have control over all of this, then we can find peace in the things we can't control and focus more importantly on the things.
• 28:18
  And I think if we realize and can see the bigger picture that we are ultimately the ones who have control over all of this, then we can find peace in the things we can't control and focus more importantly on the things that we can.
• 28:31
  So absolutely the victim mentality.
• 28:35
  We'll start the next segment with that.
• 28:37
  Yeah.
• 28:37
  We'll be right back.
• 28:38
  I'm Doug Evans, author of the sprout book.
• 28:40
  And I'm also a father with a three-year-old daughter.
• 28:44
  And that's why we grow sprouts.
• 28:47
  Did you know that you could take seeds, add water, and get fresh organic vegetables in three to five days without soil, sunshine, or fertilizer for under a dollar a serving?
• 29:00
  That's the miracle of sprouting.
• 29:02
  And I want to share that with you.
• 29:04
  Go to the sprouting company.com/slash out loud and use the code out loud for a special offer.
• 29:12
  Successful weight loss is about changing the gut brain relationship with food.
• 29:16
  I'm Dr.
• 29:17
  Kelly Victory with the wellness company.
• 29:19
  If you don't like needles, you'll love oral dissolving terzepatide RX.
• 29:24
  This doctor design solution works by targeting the GLP1 and GIP receptors that influence appetite and metabolism.
• 29:31
  Terzepatide helps with food portion reduction and satiety while changing how the brain responds to engineered sugars and unhealthy fats.
• 29:40
  And unlike injections, these are fast absorbing sublingual tablets placed under the tongue paired with an energy boost of B6 and B12.
• 29:48
  Visit TWC.
• 29:55
  Virus protection and immune boosting just got easier.
• 29:58
  Enter the daily V stack using cellular absorption technology.
• 30:01
  We put vitamins A, C, D, zinc, and Quircetin together with a multi-mineral complex for complete protection.
• 30:10
  The Daily V Stack is basically an oral IV of six products all in one at an affordable price.
• 30:16
  Go to chemicalfree body.com forward slash out loud, get the daily V stack, protect yourself, boost your immune system, and save 20% on your first order.
• 30:27
  Oral hygiene hasn't changed in 50 years, but our diet and the way we eat has creating an environment in your mouth for bacteria to wreck havoc on your teeth and gums for better oral health.
• 30:38
  Get spry dental defense, an oral care line designed to combat acid creating bacteria.
• 30:45
  The toothpaste, mouthwash, mints, and gum all contain xylitol, a natural ingredient shown to dramatically improve oral health.
• 30:53
  Sprite can be found online and at all fine natural retailers.
• 30:57
  Have you been looking for a healthy snack for on the go?
• 31:01
  Well, not all energy bars are soft and sugary.
• 31:05
  Bear bars are a crunchy savory bar made from just six simple natural ingredients.
• 31:12
  Bear bars are plant-based, organic gluten-free, contain six grams of protein and are low temperature dried for unique crunch.
• 31:20
  Most energy bars are based on chocolate or fruit and are held together with syrups or sweeteners.
• 31:27
  To learn more, just visit barebar.com slash outloud.
• 31:34
  Well, I challenge you to find a broad array of great voices, a deeper bench of experience or a more dedicated collection of passionate patriots than here on AmericaOut Loud.
• 31:51
  Now is our time, my fellow Americans.
• 31:55
  America Outloud.news, liberty, and justice for all.
• 32:05
  All right, welcome back.
• 32:06
  We just took a short break.
• 32:08
  I'm talking to Brianna Bachelor, who is a certified nurse midwife and uh functional practitioner.
• 32:16
  And she's got a private practice in Southern California where she is offering um care to women who don't necessarily believe that the standard Western model of care is right for them.
• 32:32
  Stepping outside of standard medical practices, let's find something that integrates a little more of an inclusive style of care for uh patients, anybody who's interested, which of course I always am.
• 32:50
  Everyone knows that about me.
• 32:52
  And so um before the break, we were talking a lot about kind of what has gotten us into such an unhealthy position in um women's health and childbirth in the United States and kind of ways that we can address that.
• 33:09
  And in this um next part of this segment of this show, I wanted to really kind of delve more into some of the uh other issues around midwifery, about you know what it takes to be a midwife and why we choose to go into midwifery and um what the actual evidence shows about the safety and and outcomes for women who choose midwives versus having their babies in hospital because that's probably the number one thing that I always hear is like, oh gosh, I have to have my baby in a hospital because it's I will feel safe there.
• 33:46
  But I think both of us found out during um our nurse practitioner education that we are being misled about the outcomes for women who choose to give birth outside of hospitals.
• 34:00
  And um, I'd like to hear more about that from you, Brianna.
• 34:03
  Yeah, I mean, midwives have been around forever, right?
• 34:06
  Midwives existed long before OBGYNs ever did.
• 34:09
  Um, and we have a long history.
• 34:11
  Um, you and I got to attend a school that had a really significant history, right?
• 34:15
  Midwives came over from Europe and the United States, and then our school was born.
• 34:20
  And so I think there's a lot of beauty in that.
• 34:22
  But I mean, we know very clearly, the evidence is very obvious that midwives, when midwives are integrated into the maternity system, um, outcomes improve.
• 34:34
  Physiologic birth support, lower unnecessary interventions, um, early recognition of complications, collaborative care with physicians.
• 34:44
  Um midwives are trained to protect normal physiology and not only that, but normal physiological birth while recognizing medical care when it's needed, right?
• 34:56
  And I think the fact that a lot of our patients and a lot of people don't have access to like boutique birth centers or um they don't have access to like maybe home birth midwives in their area, and not all people are eligible candidates for it.
• 35:00
  A lot of our patients and a lot of people don't have access to like boutique birth centers, or um, they don't have access to like maybe home birth midwives in their area, and not all people are eligible candidates for it.
• 35:19
  And that goes back to what we were talking about before, saying that our population is sicker than it's ever been.
• 35:19
  And that goes back to what we were talking about before, saying that our population is sicker than it's ever been.
• 35:25
  But when we look at these large meta-analyses and we look at the research, when we look
• 35:25
  But when we look at these large meta-analyses and we look at the research, when we look at low risk women, right?
• 35:32
  From 37 weeks and zero days to 41 weeks and six days in pregnancy, a low risk population of women.
• 35:40
  We know that the outcomes are the same, if not better when there is a midwife involved in that care.
• 35:50
  That means that birth center births, home births when planned have better outcomes, you know, if not similar outcomes.
• 35:57
  And I think that that's where people get scared.
• 35:59
  They're like, but I'm not going to, you know, like you said, have my baby in at home because what if something happens?
• 36:07
  But when we look at those outcomes, we know that they are better, if not the same than they are in a hospital setting for that low-risk population of people, where that variation happens is when we have complications in pregnancy and things that would put you outside of that scope.
• 36:24
  And then I think we also need to look at having midwives in that hospital setting, right?
• 36:29
  So that we can still have that normal physiological birth that we want.
• 36:33
  And that's not to say that some OBGYMs don't support normal physiological birth to, you know, in it to a to a you know, place, but we know that midwives are better prepared and more able to support in that setting than a lot of OBGYMs have the time or knowledge to do.
• 36:50
  So I remember uh one of the things that kind of struck me when I was going through the education to become a certified nurse midwife, was that I realized that in the medical field, we have primary care doctors that we go to for pretty much all of our care.
• 37:11
  And if something's wrong, the primary care doctor refers us to a specialist.
• 37:16
  Right.
• 37:17
  They refer us to an oncologist if we have cancer or a cardiovascular doctor if we have you know clotting disorders or you know, whatever a psychiatrist if we have mental health issues, right?
• 37:30
  But that's not what happens in the field of childbirth.
• 37:34
  In the field of childbirth, you're automatically assigned to a specialist.
• 37:39
  You're automatically assigned to a surgeon, okay, because that's what OBGYNs are.
• 37:44
  They are practitioners that are trained in worst case scenarios.
• 37:49
  They're not trained in natural normal births.
• 37:52
  They get like something like 5% of their training is in natural births, and then the majority of their training is in worst case scenarios.
• 38:00
  And it's exactly the opposite for us, and that's the thing.
• 38:03
  It's like so sending a sending a woman to a OBD to a specialist right out the gate when there's nothing wrong with her, really doesn't make any sense.
• 38:14
  What really makes sense is to send them to the primary care provider, like you know, like a nurse midwife out the gate where we're where 90% of our education is tailored towards natural healthy births.
• 38:27
  And then as professionals, as primary care providers, if there's a problem, and if of course, like you said, we will recognize it and then refer them if necessary.
• 38:39
  And that's how every other spectrum of the medical field is run.
• 38:43
  But for some reason, not in midwifery.
• 38:47
  No, and if like we want to improve outcomes, we have to bring that physiologic holistic thinking into the hospital system, right?
• 38:55
  Because most women in the United States give birth in a hospital.
• 38:58
  I mean, this is actually like you said, where they were receiving care.
• 39:02
  And the inability for midwives to safely come into these hospital settings and practice at the fullest ability of our scope, I think is what's hindering things.
• 39:13
  And we have so many physicians saying evidence-based practice, what is ACOG say?
• 39:17
  What is, you know, the CMQQ, CMQCC say, and what are all of these big, you know, governing bodies in this world of obstetrics and perinatal care actually saying.
• 39:28
  Well, they're actually saying that midwives improve outcomes.
• 39:31
  The CMQCC specifically said that risks are lower, postpartum hemorrhage lower, um, preterm birth, lower.
• 39:41
  Um things like recognition of shoulder socials, cesarean rates all lower when we have midwifery care integrated into these systems.
• 39:51
  And more specifically where I live in Orange County, um, I we've really been pushed out of the system.
• 39:58
  And that's something that I ask myself regularly, why?
• 40:02
  Like, why are they pushing us out when you don't get to pick and choose?
• 40:06
  You don't get to say we're gonna follow this hypertensive disorders and pregnancy algorithm from CMQCC.
• 40:13
  And but we're not going to choose to acknowledge that midwifery care improves outcomes and that it should be important for us to integrate that into the system.
• 40:22
  And so it's very difficult for us to constantly fight.
• 40:27
  We're not only fighting for these wishes of the patients and fighting for longer time and you know, different positions and more opportunities to provide a normal physiological birth, but we're fighting for our license for our rights, for our ability to practice to the fullest scope and to try and like push our way into the system is difficult.
• 40:51
  I feel very fortunate that I have found a hospital setting that I where I feel valued, where I have a team that I collaborate really well with, where I have physicians open and learning and asking me questions and where I have the ability to comfortably call them and say, hey, I'm seeing a red flag, I need your support now, and that they show up and management that really emphasizes our importance and has really fought for us to be in this hospital setting because this is where I feel like at this point in my life I can do the most good is being in this environment and more specifically, I work in a very low-income area with very low-income patients who don't have access to the same things other communities have.
• 41:37
  So this is where I feel like I'm making the biggest impact.
• 41:40
  And I know not all midwives have that.
• 41:42
  So what a wonderful opportunity.
• 41:45
  I wanted to just take a second here and inform the listeners because I just realized some people might not understand the difference between a certified nurse midwife and a licensed midwife.
• 41:57
  Yeah.
• 41:58
  And uh that's really what we're referring to when we talk about outcomes and although licensed midwives, so licensed midwives go through usually a two to three hour year licensing program to become midwives.
• 42:00
  To when we talk about outcomes and although licensed midwives, so licensed midwives go through usually a two to three hour year licensing program to become midwives.
• 42:13
  Uh, they uh don't uh have national licensure or uh they have a state by state regulations that's overseen by a smaller body.
• 42:13
  They don't uh have national licensure or uh they have a state-by-state regulations that's overseen by a smaller body, um, and they don't have to necessarily have uh medical background and experience.
• 42:25
  Um, and they don't have to necessarily have uh medical background and experience.
• 42:30
  And that is not the case with certified nurse midwives, uh, like Brianna here.
• 42:35
  So she was an RN, and then she went through a practitioner program to become a nurse practitioner.
• 42:42
  And the specialty uh circuit circles around uh certified nurse midwifery.
• 42:48
  So her uh nurse practitioner license as a primary care provider.
• 42:54
  So we've got so she's got gosh, what, eight years of of education to get her to the point of being able to be a primary care provider as a certified nurse midwife.
• 43:06
  And it really, it's not to say that licensed midwifery is any any way better or worse.
• 43:14
  Um, again, it's like another tool in the toolbox, and some are better than others, and in even integrating them into our workplace, I think would could be helpful if we could get them into um, you know, more uh like not I don't want to say regulated, but um just having like a standard scope that all of the licensed midwives can um can test to to show their proficiency.
• 43:51
  And that's that's something that the certified nurse midwives like you, Brianna have.
• 43:54
  You have taken a national exam that shows your proficiency as a primary care provider.
• 44:01
  So we're not just nurses, we're not just midwives.
• 44:04
  We are prime, you are, I'm not.
• 44:06
  You are a primary care provider with a full scope of practice as an independent practitioner.
• 44:13
  And our expertise is in natural birth.
• 44:18
  And uh what that offers to the clients.
• 44:20
  I love what you're saying about integrating us into the hospitals because it's really the only way.
• 44:27
  And considering the better outcomes that we have, I don't, I don't think anybody understands why there aren't more of a more of you and why you're not running every labor and delivery in the country.
• 44:40
  Yeah.
• 44:40
  There's, I think a lot of like we we even get clients that or patients that come into the hospital and ask questions like, well, what is the difference between an adula and a midwife?
• 44:48
  And I'm like, oh my gosh, like we really need to be educating the community more on what midwives actually do.
• 44:55
  I mean, I do low low risk deliveries.
• 44:59
  Um, I can manage medical emergencies with the support and collaboration of a physician.
• 45:06
  Um, I assist on cesareans every single day I'm in the hospital.
• 45:11
  That means when there's a complication and my patient needs to go back, I'm at her side supporting her through that process.
• 45:18
  And I do postpartum discharges and rounds, I have full prescriptive authority.
• 45:23
  And so I think that there is this like question where they're like, well, I mean, I I don't you remember one of our you know, colleagues and teachers saying something about um how she hates that we're called mid-level providers because she's like, there's nothing mid-level about the care we're providing, and we may not be trained to do the same things the physicians are, but what I think where we miss the window is the ability to really collaborate.
• 45:47
  Like if you've worked in a hospital, you know how important every person is in that environment.
• 45:53
  Transport, um, our scrub techs, our management, the respiratory team, our neonatology, our NICU nurses, like we all, you're right, we have this specialty, and not one of us can do our job well without the other person.
• 46:05
  And if we stop looking at this as competition and a way to point fingers and say what you're doing isn't right or what you're doing isn't right, if we can really use this as an opportunity to collaborate and have a conversation about how we can support each other, that's where we're going to improve outcomes, right?
• 46:22
  So I think that we're just we're missing the boat.
• 46:25
  There is a birth center local to me that was trying who just opened, um, and she was we were trying to initiate emergency response in the birth center, like what's going to happen on the rare occasion that something really goes wrong.
• 46:41
  And I will tell you, there's a lot of people out there doing some really incredible work.
• 46:45
  There's a company in Washington that's trying to bring it into different states who really is into training these emergency responders to recognize how maternal emergencies need to be handled in a different way.
• 47:03
  And they explained it as there is a stay in play and load and go, and stay in play would be something that's not urgent that we don't have to like load up into the ambulance and take them to the hospital immediately.
• 47:15
  Oh, like a load and go would be STEMI stroke, right?
• 47:19
  Something significant, and that the maternal emergencies needed to be in that category because by the time we're outside of the hospital and something happens, a shoulder dystocia, a prolapsed cord, a postpartum hemorrhage, those are significant, and valuing the voice and the expertise that the midwife who says we're leaving now, get the patient work going and being able for us to have the ability to recognize those emergencies and transfer when appropriate and manage those emergencies while we're there is really going to be key.
• 47:50
  So there's a lot of work to be done, not just in the hospital setting, but in the community as well.
• 47:55
  Yeah, there's definitely a big lack in uh understanding of what the full scope of midwifery is.
• 48:04
  And even let's touch on with doulas uh for for the listeners.
• 48:08
  Adula for every so that everyone knows is somebody who's trained in basically uh advocacy and wellness for the client.
• 48:18
  So you hire them independently.
• 48:21
  They uh advocate for you, they create and make sure your birth plan is followed, and um, they support you during labor in in any way that you need.
• 48:31
  They don't have tech typically any medical background.
• 48:35
  Uh their role is as an advocate.
• 48:38
  So uh, you know, even up to the licensed midwife, right?
• 48:43
  It's a completely different role.
• 48:45
  Uh so the doula does the advocacy, the licensed midwives have some medical training, but most of their care is for home births and out of hospital births.
• 48:57
  I had both of my children through licensed midwives, which, you know, they're excellent.
• 49:00
  Wives, which you know, they're excellent.
• 49:02
  They have plenty of what, especially when they have a lot of experience, they probably have just as much, if not more expertise than a lot of the certified nurse midwives.
• 49:02
  They have plenty of what, especially when they have a lot of experience, they probably have just as much, if not more expertise than a lot of the certified nurse midwives.
• 49:14
  Um, and then certified nurse midwives, right?
• 49:14
  Um, and then certified nurse midwives, right?
• 49:16
  We're that bridge between the outside world, the women who want no interventions and the hospital setting to really help offer that supportive care to uh women who want.
• 49:16
  We're that bridge between the outside world, the women who want no interventions and the hospital setting to really help offer that supportive care to uh women who want the safety and security of a primary care educated professional and uh and without necessarily signing up with an OBGYN.
• 49:41
  Yeah.
• 49:42
  So they're really important to understand those roles and to, and and really I think that's a lot of the outcomes here is recognizing that not just as the practitioners, but we really need the community to start to understand more about these differences and step into a role of advocating for themselves.
• 50:06
  Yeah.
• 50:06
  And like I said, this goes like well beyond just pregnancy, right?
• 50:11
  Like pregnancy outcomes start long before that conception period.
• 50:17
  Women who have gestational diabetes and pregnancy are like a two to three-fold increased risk of developing like type two diabetes later in life.
• 50:25
  Like they say up to upwards of 50%.
• 50:28
  Women who have preclampsia have a higher risk of cardiovascular disease later, which is already one of the leading causes of death in women in the United States anyway.
• 50:36
  And so pregnancy specifically gives us this like window into a woman's future health, and we need to be like doing a better job because the future of medicine isn't about like choosing sides.
• 50:49
  It's not about saying that conventional care and root cause medicine are both right or wrong.
• 50:56
  It's about understanding like physiology and being able to utilize both when they're appropriate, you know.
• 51:01
  Yeah.
• 51:02
  So in terms of like uh long-term goals, what is what do you uh what would you like to see come of the work you're doing and um the implementation of uh of more integrative care.
• 51:21
  How can we make that happen?
• 51:23
  How can the community get involved?
• 51:25
  Yeah, I think that like finding a provider who can look at the bigger picture is going to be key for most of these people, right?
• 51:36
  Like the knowledge and understanding that just because the your primary care doctor or the OBGYN that you have been seeing is the one that you saw with your last pregnancy, or the one that you've been seeing for 10 years, or that your mama and sister use doesn't mean that you have to stick with that.
• 51:54
  Like finding a provider who really will listen to you, hear your concerns and look at a deeper root cause is going to be like the first part of that journey for you long term.
• 52:09
  Um, and then knowledge for the patient, like being your own advocate, trying to do the best you can at understanding and working really hard on creating a digital product that will allow people an opportunity to see here's the questions that you should ask.
• 52:25
  Here's the labs you should be asking for.
• 52:27
  These labs are going to tell you this information, not just current labs, but past labs.
• 52:32
  Let's look at as providers.
• 52:34
  We should be looking at patterns and saying, hey, where were we, you know, six months ago?
• 52:38
  Where are we at now?
• 52:40
  What is our goal and look or where are we looking to get?
• 52:43
  Who are you know more willing to ask their questions?
• 52:46
  And the the best way to advocate for yourself is knowledge, right?
• 52:50
  And if we don't have patients walking around or women walking around understanding what these things are, or that they have other options, right?
• 52:58
  Are there other options for gestational diabetes screening?
• 53:01
  What questions should we be asking and why?
• 53:03
  What is the best way to prepare our bodies for not just birth, but that postpartum recovery, right?
• 53:09
  And having the ability to focus on, you know, things outside of that pregnancy, like our nutrition and our sleep.
• 53:15
  And like I said before, those things that are really controllable, um, I think are going to be like the stepping stones of all of this.
• 53:22
  So do you know of any resources that women can access where women can potentially find to access um, you know, finding practitioners that might be more integrative.
• 53:39
  No, and that's something that I would love to develop, not just that, but other specialties, like subspecialties, like you said, because there's so often an opportunity.
• 53:50
  I work with some men as well, and I find that the women and men who really need a referral for cardiometabolic disorders or risk factors or who carry a genetic risk factor for increased cardiometabolic disease, and that, you know, which is what they say, like 3% of cancers are actually you know, have a genetic predisposition, right?
• 54:11
  The rest of its environmental, multi-factoral diet lifestyle, et cetera.
• 54:15
  But for these people who need referrals, I would love to be referring to a cardiologist who looks at whole health, who asks questions about diet and sleep and stress and toxin load, and who's looking at a bigger picture.
• 54:28
  Um, so I don't know, maybe that's something you and I can collaborate on.
• 54:31
  Yeah, I know there's a so hard to find practitioners, even pediatricians.
• 54:37
  Like sometimes I need somebody to help me and you know, ask me bigger questions and you know, more specifically when it comes to things like vaccines.
• 54:46
  Like I think parents are so afraid.
• 54:47
  They feel like they have to be one side or the other when very often it's just an opportunity for shared decision making, questions, and the correct support.
• 54:57
  And I know that there are providers out there that do that, but it's finding a way for all of us to kind of come together, I think, and create like here's my specialty, here's how I can support these people and and finding one united front and you know, making the wave and being lobbyists and really changing the way our healthcare system is ran.
• 55:15
  Yeah, it's really sad the way that we've stigmatized health care providers into that mentality of one or the other.
• 55:24
  Um, and I feel that it's one of the biggest causes for the increase in uh poor outcomes in health care, is that you know we've turned health care into a political business uh politicised business rather than a environment for discovering and facilitating and creating wellness of the individual.
• 55:52
  And uh I want people to recognize how important it is to make those first moments of your family's life together as um as healthy and as um engaging in uh balanced stable wellness as we can make them.
• 56:00
  Together as um as healthy and as um engaging in uh balanced stable wellness as we can make them.
• 56:13
  And that is what you're doing, Brianna.
• 56:13
  And that is what you're doing, Brianna.
• 56:15
  So thank you for doing that.
• 56:15
  So thank you for doing that, and I look forward to seeing your practice grow.
• 56:16
  And I look forward to seeing your practice grow.
• 56:20
  Thanks for coming on.
• 56:20
  Thanks for coming on.
• 56:21
  Thank you for having me.
• 56:21
  Thank you for having me.
• 56:22
  It was awesome.
• 56:22
  It was awesome.
• 56:23
  It was good to see your face.
• 56:23
  It was good to see your face.
• 56:25
  And everybody have a great day.
• 56:25
  And everybody have a great day.
• 56:26
  We'll see you next time on the Nurses Report.
• 56:26
  We'll see you next time on the Nurses Report.
• 56:31
  It's time and this sings.