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The Importance of Optimal Vitamin D

2/15/2026

The 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

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Vitamin D and Nursing

2/1/2026

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Why 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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Vitamin D and Pregnancy

1/15/2026

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What is Vitamin D?
While we often call it a vitamin, Vitamin D actually functions as a hormone within the body. It is essential for bone and tooth health, immune function, brain health, and the regulation of inflammation.

Why is Vitamin D important during pregnancy?
This nutrient is involved in numerous processes that ensure a healthy pregnancy, from aiding implantation to promoting the maturation of fetal lungs.
Benefits for Mom:
Maintaining adequate levels is linked to a lower risk of several complications, including:

Preeclampsia
Gestational Diabetes
Bacterial Vaginosis
Intrahepatic Cholestasis of Pregnancy (ICP): While not a known cause, there is a correlation between low levels of Vitamin D and this rare liver issue.

Benefits for Baby:

Skeletal Development: Vitamin D helps the body absorb calcium and phosphorus, which are critical for building healthy bones.
Reduced Risk of Preterm Birth: One study showed that mothers with adequate levels had a 60% lower risk of preterm birth.
Long-term Health: Proper levels can protect your child from cavities, lower bone density, and potentially autoimmune diseases later in life.

Why is deficiency so common?
Deficiency is an epidemic, affecting up to 95% of pregnant women in some areas. Several factors influence this risk:

Latitude: If you live north of the 37th parallel (Kansas is just above the 37th parallel), your skin cannot synthesize enough Vitamin D from the sun during winter and spring.
Skin Color: Melanin acts as a natural sunscreen. Those with darker skin tones may require up to six times more sun exposure to produce the same amount of Vitamin D as those with lighter skin.
Modern Lifestyle: Spending time indoors and using sunscreen (SPF 30 blocks 95–98% of Vitamin D production) prevents the skin from synthesizing Vitamin D when exposed to sunlight.
Body Weight: High levels of body fat can sequester Vitamin D, making it less available for the body to use.

How will I know if I am Vitamin D deficient?
As part of your prenatal care, your midwife will order a test called Vitamin-D 25 hydroxy to check your level at the start of care, and again around 30 weeks gestation.

What can I do to ensure I’m getting enough Vitamin D?
While food is a great starting point, it is difficult to get enough Vitamin D from diet alone.

Research shows that 4,000 IU of Vitamin D3 daily is safe and effective for reaching functional levels in both mother and baby.
Look for Vitamin D3 (cholecalciferol) rather than D2, as it is more effective at sustaining blood levels.
Vitamin D works best when taken with fatty foods and paired with nutrients like Magnesium, Vitamin K2, and Vitamin A 28.
If feasible, aim for mid-day sun (10:00 AM to 2:00 PM) without sunscreen for a short period (20 minutes or so), taking care not to burn.
Include fatty fish (salmon, mackerel, tuna), egg yolks, beef liver, and fortified milks in your diet.

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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Continuing Ed

1/1/2026

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One of my favorite things about being a midwife is that there will always be a need to continue learning. As we understand more about pregnancy, and birth, there is always something new to be learned. This past year I took a few courses to stay current on evidence based guidelines for care, and to learn more about things some of my clients were experiencing.

I completed a course on iron and ferritin. As a result of what I learned, I’ve added some labs to what I check. Checking on ferritin levels, total iron binding capacity, Vitamin B12 levels along with a few more new labs helps me better evaluate hemoglobin, ferritin and what needs the body may have where ferritin is concerned.

I took a course covering hepatic cholestasis of the liver. Understanding ways we can support the liver well with supplements, and what to watch for if there is cholestasis of the liver has been invaluable for the clients I have served this year who have developed this complication or had it with a prior pregnancy.

I also took a course on handling hemorrhage in the immediate postpartum period. There have been some changes to how to best treat a hemorrhage since I started my practice 6 years ago. It was good to learn the changes so I can update my protocol with the current recommendations and guidelines.

I continue to learn from my clients, which I absolutely love. Whether it’s how to use scan and go at Sam’s Club, or about Idiopathic Postprandial Syndrome, my clients continue to helpe me learn and grow as a midwife and in my daily life.

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The One Solution Myth

12/15/2025

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One of the things that frustrates me, especially when it comes to health is a “one size fits all” solution for health problems. “It worked for me, and for members of my family, my friends etc so it will work for everyone”. This drives me up the wall. We are all unique individuals and what works for one person may or may not work for someone else. So, I have problems with someone claiming they have THE solution for a health problem.

The one size fits all solution that comes up in midwifery care frequently relates to anemia and low ferritin. There are different types of anemia, each with a different cause. Pernicious anemia is caused by a deficiency of vitamin B12. Other types of anemia can be caused by environmental exposure to toxins, chronic inflammation, genetic factors, autoimmune issues and the list goes on. Telling someone they just need to get more copper or B vitamins in their diet may help some people, but it won’t fix the issue for everyone.

In pregnancy, we don’t necessarily have time to figure out the root cause of anemia or low ferritin. We have to treat the symptoms to prevent IUGR, premature labor, an anemic baby with corresponding IQ loss, postpartum hemorrhage, PP depression, pre-eclampsia and other associated risks. What we can do is focus on what I consider the big rocks. The biggest one in my opinion is diet. By dialing in nutrition with a focus on increasing iron absorption, we will also be including other trace minerals and vitamins needed for absorption such as copper, magnesium, vitamin A, B vitamins and more. Exercise, getting quality sleep, reducing environmental exposures to things such as pesticides, and lowering stress levels are other big rocks to work on. Every one of these things will reduce inflammation and in turn lead to a healthier Mom and help baby to thrive before and after birth. Because of the limited time for improvement, we may need to supplement with oral or IV iron to get ferritin to a healthy place for birth.

Working on nutrition and lifestyle, along with supplements including IV infusions are the tools we have to optimize hemoglobin and ferritin throughout pregnancy, and sometimes we need to use all the tools.

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