Naturopathic doctor & midwife Dr. Doni discusses the medicalization of pregnancy and explains what your doctor may not tell you about how to address fertility issues.
The Medicalization of Pregnancy and Birth
This pattern traces back to the Flexner Report in 1910 which strongly supported the medicalization of pregnancy and birth. Within 50 years of this report, there was a major shift from fewer than 5% of women having their babies in hospitals (instead of at home with a midwife) to over 97%. The thinking was that few pregnancies were “normal” and so they all required medical intervention. During that same time period, the rate of cesarean sections increased to 25% of all births (and is even higher now in some hospitals). C-sections are important life-saving, surgeries but they also come with great risk to both mom and baby. Evidence shows that when cesarean rates are above 15%, the risk of infant and maternal death increases.
Overall, the cost of maternity care increased during this time period, while the positive “outcomes” (the number of successful births) decreased. It might be hard to believe, but the maternal mortality rate has increased in the U.S. since 2000. Studies have shown that this increase is due to inadequate prenatal care in some cases and overuse of medical intervention – cesareans in particular – in others.
Why did This Happen?
Back in the late 1800s there was prejudice against women’s intelligence and capability. With that perspective, pregnancy and birth, which had previously been managed by midwives, became more and more managed by male physicians. Medical research increased in the 1900s, but most of the research was not related to women’s health issues so this approach was never challenged.
The perception that hospital births were safer, paired with a societal norm that women had fewer rights, continued until the 1960s when gender stereotypes began to change. The pill became available in 1960, bringing both a choice in fertility and yet another medical intervention. This perpetuated the view that the only way to address women’s health issues is to take a pill.
In the 1970s, the view of pregnancy and birth started to shift away from medical management and toward supporting a normal, healthy process; childbirth classes and labor support professionals (also known as doulas) became more available. In 1993, the first randomized, controlled study of epidurals during labor showed that they increased the likelihood of cesareans (which, as we have already seen, have been associated with an increased risk of death for mother and child). Because of this finding, the study was deemed to be unethical and so it was ended early. Subsequently, a community of birth support professionals grew to help inform women about ways to support spontaneous vaginal births.
To read more about the effect of medical interventions on births, and to become informed about your options, I recommend visiting the Henci Goer website.
Natural Approaches to Fertility and Pregnancy
Because women have been lead to believe that medical interventions are the only option when it comes to managing their health, they often go quickly to seek interventions for getting pregnant as well. And yet it is well established, in medical textbooks and research, not to mention thousands of years of experience that pregnancy can happen without medical intervention. It must also be said that, considering most medical research is funded by pharmaceutical companies, there is little funding for research on lifestyle, diet, and nutrients approaches to support women’s health and fertility.
I believe that so much more can be done to educate women about their health and their bodies. I believe too, that science has so much more to tell us about how to support our bodies to do what they are made to do (even when medical procedures are needed).
This is why I became a naturopathic doctor, a midwife, and a doula (I don’t currently attend births), and why I recommend working with a naturopathic doctor, midwife and doula for your fertility, pregnancy and birth. I believe that women deserve more support to help them enjoy pregnancy, birth, and postpartum as natural life experiences with adequate, but not overly-done, medical care.
I do this by continuing to study, both in my practice and in research, the science of how women’s bodies work and how they respond to stress. In fact, it was when researching how stress affects labor as a midwifery student that I learned that a certain amount of stress is necessary for a healthy labor to progress, but too much stress can stop labor. I have since applied that principle to women (as well as men and children) even when not pregnant. If we can optimize the types of stress we are exposed to, and give our bodies the support they need while stressed, we are more likely to be healthy.
It is when women are healthiest that they are most likely to conceive a pregnancy.
In over 17 years of listening to women’s stories, analyzing “out of the box” testing (I’ll describe more below) and providing support with diet changes, sleep and exercise, herbs and nutrients, as well as homeopathy and mindfulness, I’ve seen that women’s bodies can change, can heal, can be without menstrual pain, can get pregnant with the right support, can have vaginal births and healthy babies, and can thrive.
It is not always easy to accomplish, and while there are cases that are not as successful as we’d like, what I hear from women is that by approaching their health from this perspective, no matter the outcome, they are healthier and more empowered about their health then they ever thought possible.
Addressing Fertility Issues – Naturally
When I help women with fertility, these are the areas I look to address:
Stress – emotional and physical – is known to inhibit both adrenal and ovarian function. What that means is, when you are under lots of stress, whether from working full-time, studying for a master’s degree, and/or trying to make ends meet financially, it negatively affects your body’s ability to keep up. Cortisol and adrenaline levels become too high or too low, and your ovaries stop ovulating as consistently as they should. Without ovulation, pregnancy becomes impossible.
We can address adrenal distress by helping your body recover from stress and helping you make choices that support your body when you are stressed. I often recommend testing cortisol and adrenaline levels so we can find out exactly how stress has affected your health. Then we can use those results to create a strategic plan just for you.
Stress also causes a condition called leaky gut, which involves increased permeability of your intestinal walls. So the “leak” is of undigested food and toxins produced by bacteria in the gut through the intestinal wall to the tissue area where your immune system is on guard, ready to protect you. As it protects you, it sends out messages of inflammation throughout your body which can negatively affect your ovary function – making ovulation less likely – and it increases “stress” messages that feed back to your adrenal glands and increase adrenal distress.
Leaky gut can be healed. It is a matter of taking a food panel to find out which foods are triggering your immune system and then shifting your diet to avoid those foods. Taking certain enzymes, nutrients and herbs also help the intestinal cells grow back and essentially stop the “leak” – this is one of the cornerstones of my Stress Remedy 21-day Program.
Sugar and Carbs
The diet myth over the past three decades has been that fat is the issue. In actuality – and studies are now proving this – sugar was the real problem all along. Refined sugars (white and brown sugar) as well as processed grains and carbs (pastries, cereals, breads, etc.) are a lot of work for your body to metabolize. Insulin must be produced in order to carry the carb and sugar load into your cells, where it can be used for energy. But there is a limit to this process, and when you hit that limit the sugars are turned into fat storage instead of energy leading to weight gain, obesity, elevated cholesterol levels, fatty liver, and inflammation throughout the body. This situation is also known to inhibit the ovaries, potentially causing Polycystic Ovarian Syndrome (PCOS).
There is much you can do to reverse this process, starting by changing your diet to avoid sugars as much as possible. It also helps to avoid processed and packaged foods that often contain added sugars, and instead choose actual food, like fruits and vegetables, along with healthy fats and proteins. My specially formulated Stress Remedy Pea Protein Shakes help with this, as do my Stress Remedy programs.
MTHFR and Methylation Issues
Once adrenal distress, leaky gut, and carbohydrate issues have developed – what I refer to as the “three problem networks” in my book, The Stress Remedy – then methylation slows down. Methylation is what B vitamins do in our bodies, it is needed for making new healthy cells – such as when growing a baby – and for making neurotransmitters (like serotonin and dopamine), to detoxify estrogens, and for making energy in our cells in general. Without healthy methylation, women are more likely to experience PMS and PMDD, depression and anxiety, breast cancer, miscarriages, and side-effects to the pill and other synthetic hormones such as those used in fertility treatments.
Methylation problems are often also influenced by a common genetic mutation (known as a polymorphism) called MTHFR. This influences a woman’s ability to turn folic acid (a man-made substance) into the form of folate our bodies can use to methylate properly. What this means is that, if a woman with this mutation takes folic acid, her body is not able to use it well, so she does not benefit from it. Meanwhile, folic acid is still the most commonly recommended nutrient for women trying to conceive and most doctors are not testing or addressing the MTHFR mutation so women are left confused and having repeated miscarriages. It is estimated that about 50% of women have some form of this genetic mutation.
Short of every woman being tested for methylation effectiveness and MTHFR mutations (which would be great and should be implemented), my recommendation is that every woman should take actual folate (food based) or 5MTHF (5-methyltetrahydrofolate), which are the active forms of folate that can be used by the body, instead of taking folic acid (which is synthetic and not efficiently used). If you have completed testing for your genetic mutations, we can get much more detailed about addressing your methylation.
Additionally, based on the results of a study that is currently underway, women should also be tested for another B vitamin – B12 – and the corresponding methylation-related gene mutations (MTR and MTRR) because low B12 levels in mothers are associated with increased risk of diabetes for their babies (later in life).
This is exactly why I now recommend that women take a multivitamin or prenatal containing both folate and methylcobalamin (B12), as well as additional folate, B12, and other B vitamins, as well as choline, prior to and during pregnancy, as well as while breastfeeding. Find out about my Pregnancy Solutions Protocol here.
Progesterone levels should be normal and healthy after ovulation and during pregnancy. In fact, low progesterone in early pregnancy is known to be one of the most common causes of miscarriage. What I find is that many women have low progesterone during their cycle and in early pregnancy and yet progesterone levels are not regularly tested and addressed by most practitioners.
Stress, adrenal distress, leaky gut, imbalanced gut bacteria, and overwhelmed carbohydrate metabolism are all reasons for less progesterone being produced. To address this, we need to go back to addressing the three problem networks. Adrenal distress, leaky gut, and carb metabolism can improve with diet changes, adequate sleep, stress reduction and exercise. While you start working on that, we can also use natural, bio-identical progesterone to fill in for what your ovaries are not making, thus supporting your fertility and preventing miscarriages.
Improve Your Health, Improve Your Fertility
For help with implementing a fertility plan – to increase your fertility and likelihood of conceiving without medical intervention – check out my Women’s Wellness Package here, which includes the tests that will give us the information we need to make a comprehensive plan for you. The goal is to improve your health, which also improves your fertility.
If you’d like to get started on your own, you can try the Stress Remedy 7 and 21 day programs, which provide support for changing your diet and supporting your health.
I believe that women are more empowered now than ever before. More empowered to make choices for themselves and for their families, even if different than the medical standard, because they know that their health is in their own hands. That the choices they make today, affect how they feel and how their body responds. And that their bodies are capable of functioning optimally, with the right support. To find out more about my approach, sign up to my Weekly Wellness Wisdom newsletter.
15th November 2016