Sun, 12 Apr 2026 20:21:52 -0700WeeblyWed, 01 Apr 2026 07:00:00 GMThttps://www.blessedeventbirth.com/evidencebasedcareinpregnancyandbirth/risk-screening-and-home-birthIn the world of maternity care, "low-risk" isn't just a casual term; it is a specific clinical designation. As a midwife in Kansas, my primary job isn't just to catch babies—it’s to be a diligent gatekeeper of safety.
The safety of out-of-hospital birth depends entirely on the screening process. We don't simply "hope for the best"; we use continuous, rigorous screening from your first prenatal visit until the moment your baby is born to ensure that home birth remains a safe option for you and your baby.

What the Research Says:
The MANA Stats Study:
If you are looking for peace of mind, the data is your best friend. One of the most significant studies in North American midwifery, published by Cheyney et al. (2014) in the Journal of Midwifery & Women’s Health, followed nearly 17,000 planned home births.

The study found that for women who met "low-risk" criteria:

•  93.6% had spontaneous vaginal births.
• The rate of C-sections was significantly lower than the national hospital average.
• Neonatal outcomes were excellent, proving that the "community setting" is a safe and viable option for healthy pregnancies.

The "Risk-Out" Reality
A common misconception is that midwives will take any client who wants a home birth. In reality, we are always screening for risk. We look for "green lights" like:

• A single baby in a head-down position.
• Absence of chronic conditions like Type 1 diabetes or heart disease.
• Labor that begins naturally between 37 and 42 weeks.

If a "red flag" appears—such as the development of preeclampsia or gestational diabetes that requires insulin—we "risk out." This means we transition your care to a clinical setting where higher-level interventions are available. This isn't a failure; it’s responsible clinical management.

Safety in the "What Ifs"
Even in a low risk pregnancy, we prepare for the unexpected.  Your home birth "kit" isn't just blankets and birth pools; the midwife brings: 

• Neonatal resuscitation equipment
• Resources to manage postpartum bleeding
• Equipment for regular monitoring of fetal heart tones throughout labor

Furthermore, a hallmark of a safe home birth is a seamless transfer plan. Research shows that roughly 10-12% of home births move to a hospital, but the vast majority of these are for non-emergencies like maternal exhaustion. Having a plan in place ensures that if the "low-risk" status changes, your safety remains the priority.

Choosing a home birth in Kansas isn't about rejecting modern medicine; it’s about choosing the appropriate level of care for a healthy, physiological process. When we respect the science of risk screening, we create a birth environment that is not only beautiful and intimate but clinically sound.

Sources:
https://pubmed.ncbi.nlm.nih.gov/24479690/
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(19)30119-1/fulltext
https://www.ksrevisor.gov/statutes/chapters/ch65/065_028b_0003.html

]]>Sun, 15 Mar 2026 07:00:00 GMThttps://www.blessedeventbirth.com/evidencebasedcareinpregnancyandbirth/national-trend-occuring-locallyRecent headlines have sounded the alarm on a troubling national trend: early prenatal care is on the decline across the United States. While the national data is concerning, the situation in Manhattan, Kansas, and the surrounding Flint Hills region is shaped by a unique set of local circumstances.
The Fort Riley Hiring Freeze
The primary driver of this shift began on January 20, 2025, with a Department of Defense hiring freeze that remains in effect today. Because Fort Riley cannot hire civilian providers to replace those who leave or to restore staffing levels following last year’s cuts, they have been forced to prioritize care.
Currently, maternity services at Fort Riley are limited to active-duty service members. This shift has pushed military family members into the civilian healthcare system, creating an immediate strain on local resources.
In Manhattan, the civilian "safety net" is small. Women’s Health Group is the only OB practice serving the area and providing care at Via Christi Hospital. With the sudden influx of patients from Fort Riley, both the practice and the hospital are serving higher patient loads.
The results are visible in the scheduling:

• Delayed Physician Access: Most patients don't see an actual OB until they are 20 weeks or further into their pregnancy.
• Initial Triage: Early appointments are often handled by nurses or clinical staff rather than doctors, unless the pregnancy is flagged as high-risk.​

Unfortunately, this isn't a problem that can be solved overnight. Several systemic barriers stand in the way:

• The Physician Shortage: While hiring more OBs seems like the obvious answer, there is a nationwide shortage of specialists entering the field, making recruitment in rural or mid-sized markets incredibly competitive.
• Labor & Delivery Closures: As smaller regional hospitals continue to shut down their maternity wards, Manhattan becomes a "catch-all" for even more patients from outlying areas.
• Midwifery Limitations: In many states, midwives help bridge this gap. However, Kansas medical provider licensure remains a complex hurdle. Depending on whether a midwife is licensed through the Board of Nursing or the Board of Healing Arts, their scope of practice varies wildly. Furthermore, Kansas currently has no licensure path for Certified Professional Midwives (CPMs).

Looking AheadWith no end in sight for the federal hiring freeze and local caseloads continuing to climb, the window for early prenatal care may continue to shrink. For families in the Manhattan area, navigating pregnancy now requires more patience—and earlier planning—than ever before. For those interested in a home birth, contacting a midwife as soon as possible is vital since the area midwives do book up quickly. 

Sources:
https://www.shrm.org/topics-tools/news/talent-acquisition/trump-extends-federal-hiring-freeze-merit-based-eo
https://www.nbcnews.com/health/health-news/pregnant-women-delaying-prenatal-care-cdc-report-rcna259575
www.bartonassociates.com/blog/ob-gyn-employment-opportunities-market-trends-and-essential-faqs/]]>Sun, 01 Mar 2026 08:00:00 GMThttps://www.blessedeventbirth.com/evidencebasedcareinpregnancyandbirth/things-to-know-about-supplementsPregnancy places extra nutritional demands on Mom’s body.  Supplements can be a helpful tool to help meet those demands, but sometimes your body doesn’t get the full benefit because you may be taking them at the wrong time, or with the wrong foods. So here’s some things to know about taking the most common supplements used during pregnancy.

Iron supplements

• Calcium will block absorption
  
• Vitamin C will increase absorption
  
• Prenatal vitamins have both iron and calcium, so the iron in your prenatal vitamin will be blocked by the calcium.
  
• Be mindful of when you have calcium in any form and when you have iron rich foods or take an iron supplement.  Try to separate calcium intake from iron by 2 or more hours.
  
• Your body will absorb the most iron in the morning due to the effects of hepcidin, a hormone that  reduces iron absorption. It peaks at around 1:30 and then drops off during the night.
  
• Ferrous Bisglycinate is absorbed well by the body and is less likely to cause side effects like constipation
  

Magnesium:

• Calcium inhibits absorption of magnesium
  
• Magnesium Glycinate has a high absorption rate and is gentle on the stomach.
  

Vitamin D

• Take Vitamin D in the form of D3
  
• Vitamin D is a fat-soluble vitamin, so absorption is higher when taken with food that has some fat.
  

Supplements aren’t regulated, so it’s a buyer beware market when choosing supplements.  Here are some tips to make sure you are getting quality supplements that are worth the money.

• Don’t buy a supplement that doesn’t state the specific form of whatever it is.  For example, if it just says magnesium instead of magnesium glycinate.
  
• Don’t buy anything in the form of oxide such as ferritin oxide. Oxide means it has undergone oxidation and isn’t very usable by your body.
  
• Look for third party certifications such as USP, or NSF international. 
  

Supplements can be incredibly helpful during pregnancy. Be mindful of quality when purchasing, and the things you can do to increase your body’s absorption of them.

]]>Sun, 15 Feb 2026 08:00:00 GMThttps://www.blessedeventbirth.com/evidencebasedcareinpregnancyandbirth/the-importance-of-optimal-vitamin-dThe Importance of Optimal Vitamin DVitamin D is vital for your body to effectively absorb and use iron. Optimizing Vitamin D levels is important because Vitamin D acts as a biological "switch" that regulates how your body utilizes the iron it receives.

• Suppression of Hepcidin (The Master Regulator): Vitamin D is a potent suppressor of hepcidin, the hormone that controls iron flow. Hepcidin’s job is to block iron absorption and release; Vitamin D directly reduces hepcidin, essentially "unlocking" the gates that allow iron to move into the bloodstream.   
  
• Support for Erythropoiesis: Vitamin D is directly involved in the production of red blood cells (erythropoiesis). Even if you have ample iron, your bone marrow needs adequate Vitamin D to efficiently turn that iron into new, healthy red blood cells.   
  

There has been debate on how much Vitamin D is safe, and if high levels of Vitamin D can cause kidney stones for years. Multiple studies have found that Vitamin D supplementation does not increase the risk of developing kidney stones. 
The medical consensus is  that Vitamin D deficiency is present at levels below 20, and severe deficiency occurs when levels are below 12. Lab values typically show 30 -75  is considered within normal. Functional medicine recommendations vary, with levels between 50 and 100. I encourage clients to work on getting levels to 50 or higher to make sure there is plenty of Vitamin D available for baby in the prenatal period. 
Sources:
https://pubmed.ncbi.nlm.nih.gov/31005969/
https://pmc.ncbi.nlm.nih.gov/articles/PMC5241241/
https://etd.library.emory.edu/concern/etds/tb09j596c
https://www.thejh.org/index.php/jh/article/view/89

]]>Sun, 01 Feb 2026 15:00:00 GMThttps://www.blessedeventbirth.com/evidencebasedcareinpregnancyandbirth/vitamin-d-and-nursingWhy is Vitamin D important for nursing?
​Your demand for Vitamin D does not end at delivery; in fact, requirements are even higher during breastfeeding than they are during pregnancy. Maintaining adequate levels is crucial for several reasons:

• Impact on Baby’s Health: A mother’s Vitamin D levels directly affect the baby's levels because the nutrient is passed via the placenta during pregnancy and through breast milk after birth.
• Preventing Deficiency: Chronic deficiency in infants can lead to rickets, a softening of bone tissue that causes skeletal deformities like bowlegs, and can even cause dental enamel defects that lead to cavities later in childhood.
• Long-Term Protection: Adequate Vitamin D intake early in life is linked to a lower risk of autoimmune diseases, such as Type 1 diabetes, and may even protect against high blood pressure and arterial stiffness in children.

Why is breastmilk frequently low in Vitamin D?
Vitamin D deficiency is a global epidemic, affecting up to 95% of pregnant and lactating women in some regions. Because most mothers have insufficient levels, their breast milk does not naturally contain enough Vitamin D to meet an infant's needs.

The key to Vitamin D transfer is the specific form that moves into breast milk. Research indicates that  Vitamin D3 (cholecalciferol)—the "parent" form found in supplements and produced by the sun—is the form that transfers through breast milk, rather than the major circulating storage form (25-hydroxyvitamin D). Because Vitamin D3 has a short half-life in the blood, consistent daily intake via sun or supplements is more important for a nursing baby than the mother's overall blood storage levels.

How much Vitamin D does Mom and baby need?
There is a significant gap between official guidelines and current research for lactating women:

• Official Recommendations: The standard RDA is 600 IU per day for lactating women. Additionally, the American Academy of Pediatrics recommends that breastfed infants receive 400 IU of oral Vitamin D drops daily.
• Latest research: Research has shown that high-dose maternal supplementation can be an effective alternative to giving the baby drops. Studies show that a maternal dose of 4,000 to 6,400 IU of Vitamin D3 daily is safe and provides enough Vitamin D for Mom and enough in breast milk for baby.
• Higher dose safety: Randomized controlled trials using 4,000 IU daily have observed no adverse events or safety concerns, such as high blood calcium associated with the formation of kidney stones.

Ways to get enough Vitamin D

• Sun Exposure: The primary natural source is sunlight, but this is limited by latitude, living north of the 37th parallel (which Kansas is) does not have enough exposure in the winter and spring for your skin to produce adequate Vitamin D. Melanin (darker skin requires up to 6x more sun exposure), and sunscreen use (SPF 30 blocks 95-98% of production) also block or reduce production of Vitamin D through the skin.
• Supplement with D3: Choose Vitamin D3 over D2, as it is more effective at sustaining blood levels.
• Nutrient Synergy: Vitamin D works best when taken with fatty foods and synergistic nutrients like Magnesium, Vitamin K2, and Vitamin A.​

Think of Vitamin D as the "master contractor" of a construction site. While you provide the bricks (calcium) and wood (phosphorus) to build your baby’s growing body, the master contractor is required to tell the workers where to put those materials to ensure the structure is sound. Without enough contractor presence (daily D3), the "supplies" in your milk cannot be used effectively by your baby.

Sources:
https://pmc.ncbi.nlm.nih.gov/articles/PMC7905986/
https://www.medicalnewstoday.com/articles/161618
https://nutritionsource.hsph.harvard.edu/vitamin-d/
​https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/expert-answers/vitamin-d-deficiency/faq-20058397
https://lilynicholsrdn.com/vitamin-d-pregnancy/



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