Category: Prenatal Care

National Trend Occuring Locally

3/15/2026

Recent 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/

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My Ferritin Eye Opener

12/1/2025

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In the interests of being as healthy as I can be, as well as being a midwife who practices what she preaches, I decided to test my ferritin. For curiosity's sake I had my husband’s ferritin checked as well. Getting the lab results was eye opening in more than one way.

I’m not going to share my number, but if I was pregnant and a client, I would need to work on getting my ferritin in a better place. I will be making changes to do exactly that.

What was eye opening to me were the differences between acceptable ranges for women compared to men. Lab results will list a reference range for each test. Reference ranges are determined by sampling 120 individuals who are assumed healthy to determine the upper and lower limits of the reference range. The ranges can vary based on if the lab is using a nationwide sample group, or a local group. They can also vary depending on the age, gender and other factors of the people in the sample group. Doctors tend to rely on the reference ranges provided by the lab to determine if someone has an issue and may not be familiar with functional or optimal ranges.

The laboratory I use shows a reference range of 15-150 for females and a range of 30-400 for males. I was shocked at the significant difference between ranges for men and women! While men have more muscle than women and there is a difference in blood volume of men compared to women (men tend to have just under a liter more blood than women), it’s eye opening to see how vast the difference is. Women of childbearing age have regular blood loss through menstruation, men do not, so if anyone needs to keep on top of ferritin levels, it’s women. The reference range recommendations by the World Health Organization have an upper limit for men of 200, and 150 for women, and a lower limit of 30 for both men and women. Functional medicine providers recommend a lower limit of 70.

Testing ferritin in pregnancy is still uncommon, but it needs to be the standard of care for everyone whether pregnant or not. The lack of agreement on what levels should be highlights a fundamental problem in the medical community. Instead of looking at population averages, we should be looking at functional levels. Once someone gets into the functional range, paying attention to how they feel and are functioning will let providers and clients tweak things further to optimize ferritin at the individual level. That is my goal with every client I serve.

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Preeclampsia

8/1/2025

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What is preeclampsia?
Preeclampsia is a serious condition that usually starts after 20 weeks of pregnancy, in most cases symptoms start in the third trimester. Sometimes, it can occur after baby is born. It is a life threatening condition both for Mom and baby if left untreated.

How common is preeclampsia?
Preeclampsia occurs in approximately 2% to 8% of pregnancies worldwide, and the cases of preeclampsia in the United States match the global percentages.

Who is at risk?
Certain factors can increase your chance of developing preeclampsia:
• Having had preeclampsia in a previous pregnancy.
• Being pregnant with more than one baby (like twins or triplets).
• Having chronic high blood pressure (before pregnancy).
• Having Type 1 or Type 2 diabetes before pregnancy.
• Having kidney disease.
• Having certain autoimmune disorders (like lupus).
• Obesity (having a high BMI).
• This being your first pregnancy.
• Being 35 years old or older, or being very young (under 15).
• Having a family history of preeclampsia (like your mother or sister had it).
• Using in vitro fertilization.
• Race or ethnicity (studies show a higher risk for Black women and Indigenous women in North America, though this may be linked to differences in healthcare access and social factors).

What causes preeclampsia?
We don’t know what causes preeclampsia. There are theories but nothing definitive. Inadequate blood volume expansion may be a cause or contributing factor. Research indicates impaired blood flow to the placenta is a possible cause. The impaired blood flow could be caused by an issue with the placenta itself, or the mother may have heart problems that are made worse by the demands of pregnancy.

What are the symptoms of preeclampsia?
• Severe headaches that don't go away with regular pain medicine.
• Changes in your vision, like blurry vision, seeing spots, or being sensitive to light.
• Pain in your upper belly, usually under your ribs on the right side.
• Shortness of breath, which can be caused by fluid building up in your lungs.
• Nausea or vomiting that's worse than typical morning sickness.
• Sudden weight gain or swelling in your face and hands (some swelling in feet is normal during pregnancy, but sudden, noticeable swelling can be a red flag).

Other signs providers look for include low levels of blood cells called platelets (thrombocytopenia), or higher-than-normal liver enzymes or kidney problems shown in blood tests.

What is the treatment for preeclampsia?
The only way to truly stop or "cure" preeclampsia is to deliver the baby. However, the timing of delivery depends on how severe the preeclampsia is and how far along the pregnancy is.
Before delivery, management often includes:
• Medications to lower blood pressure: Common choices are labetalol, nifedipine, and hydralazine.
• Magnesium sulfate to prevent seizures: This medication is very important for preventing eclampsia (seizures related to preeclampsia) and is often given intravenously.
If preeclampsia is severe or the mother or baby's health worsens, early delivery may be recommended, sometimes even before the baby is full-term.

What can I do to decrease my risk of preeclampsia?
Since we are unsure what causes preeclampsia, we can’t definitively say what lowers the risk. The consensus is to eat nutrient dense foods, eat enough protein to support your pregnancy, exercise on a regular basis and have regular prenatal care.

Sources:
https://www.mayoclinic.org/diseases-conditions/preeclampsia/symptoms-causes/syc-20355745
https://www.ncbi.nlm.nih.gov/books/NBK570611/
https://www.health.harvard.edu/a_to_z/preeclampsia-and-eclampsia-a-to-z
https://pmc.ncbi.nlm.nih.gov/articles/PMC9962022/
https://pubmed.ncbi.nlm.nih.gov/37762960/
https://pmc.ncbi.nlm.nih.gov/articles/PMC9962022/
https://pmc.ncbi.nlm.nih.gov/articles/PMC10779413/

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Measles and Pregnancy

4/15/2025

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The United States is currently experiencing a measles outbreak in several states, including Kansas. Measles is a highly contagious viral illness that can lead to serious complications, especially for pregnant women and infants. If you are expecting, it is important for you to understand the risks and what you can do to minimize those risks.
What are the risks?
Measles during pregnancy poses significant risks to both the mother and the developing baby.

Increased Risk of Complications for the Mother: Measles during pregnancy has been associated with an increased maternal risk of hospitalization, pneumonia, need for oxygen support or mechanical ventilation, and even death.
Risks to baby: Measles infection during pregnancy can lead to serious outcomes for the baby, including miscarriage, premature birth, low birth weight, baby having a measles infection at birth if Mom contracts measles near the time of birth, and stillbirth.

How can I find out if I have immunity to measles?
Your doctor or midwife can order a blood test to check for measles antibodies if you don’t have any records of vaccination.
What Can I do to reduce exposures to measles if I'm pregnant?
If you are pregnant and not vaccinated against measles, it's essential to take extra precautions during an outbreak:

Avoid Exposure: Try to avoid contact with individuals who have or may have measles. Limit time spent in crowded public places where the risk of exposure might be higher.
Practice Good Hygiene: Wash your hands frequently with soap and water for at least 20 seconds. Avoid touching your face.
Wear a Mask: Since measles is spread through the air and can linger in the air for up to 2 hours, consider wearing an N95 mask in public places to reduce the likelihood of inhaling the virus.

What if I get exposed to measles while I’m pregnant?
If you are exposed to measles while you are pregnant, it’s important to let your midwife or doctor know as soon as you are aware you’ve been exposed. Calling is preferred so you are not running the risk of spreading measles. Your doctor may recommend immunoglobulin (antibodies) treatment within six days of exposure to help reduce the risk of developing measles.
Should I get a measles vaccination while I’m pregnant?
No. The vaccine uses live virus and is not recommended for pregnant women because it could harm baby. After baby is born, it is considered safe to get vaccinated even if you are breastfeeding.

Sources:
https://s3.amazonaws.com/cdn.smfm.org/attachments/1318/f3d6ed022bb2ecc5eaee0e1ce3dbe4af.pdf

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Group B Strep

4/1/2024

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What is GBS?
Group B Strep (GBS) is anaerobic bacteria that is usually found in the digestive tract. In 10-30% of pregnant women, it can colonize or grow in the vagina.

Why is GBS a concern during pregnancy?
Most women carrying GBS will have no symptoms. Carrying GBS is not harmful to you, but there is a small chance it can affect your baby around the time of birth.

How will I know if I have GBS?
GBS is detected by doing a vaginal swab and running a culture. The recommendation is to test between 36 to 38 weeks gestation.

If I test positive for GBS, will I still have GBS when my baby is born?
GBS is transient so your status can change. Up to 33% of women who test positive at 36 weeks may be negative at birth, and up to 10% of women who test negative at 36 weeks may be positive at birth. Without doing a rapid test (which is not the standard of care in the US), GBS status at the time of birth is unknown. For the clients I serve who test positive at 36 weeks, they have the option to repeat the test to see if their status has changed.

What are the risks of GBS to my baby?
GBS can occasionally cause serious infection in newborns. Many babies come into contact with group B Strep during labor or around birth, and the vast majority will not become ill. Of Moms who test positive for GBS and choose not to have antibiotic treatment, up to 2% of babies born will develop a GBS infection. For Moms who test positive and choose to have antibiotic treatment, the risk of baby being infected drops down to .2 to .4% If the GBS infection is not treated, babies can become seriously ill. With prompt treatment, most babies will make a full recovery, a small number of babies who are infected die. Early detection of GBS disease is vital so treatment can be started as soon as possible.

The two main types of GBS disease in newborns are:

Early-onset GBS disease: Occurs within the first week of life and is more common. This is what GBS testing is focusing on preventing.
Late-onset GBS Disease:Occurs 1 week to 3 months after birth and is less common.

How many babies die from early onset GBS disease?
Two to three babies (4 to 6%) out of 50 babies with early onset GBS disease will die.

What are the symptoms of early-onset GBS infection in newborns?

Being floppy and unresponsive
Grunting when breathing, or working hard to breathe when you look at their chest or tummy
A high or low temperature
Very fast or slow heart rate
Very fast or slow breathing
Crying and inconsolable

The overwhelming majority of babies with early-onset GBS disease are diagnosed within the first hour after birth, which indicates the baby was most likely infected before birth.

What is the treatment for GBS infection in babies?
The treatment for GBS infection in babies depends on the severity of the infection. Antibiotics are the main treatment for GBS infection. Antibiotics do not discriminate between strains of bacteria, so if you get IV antibiotics during labor, or your baby is given antibiotics after birth, I recommend taking probiotics to rebuild a healthy microbiome.

In Summary:
While the risk is low of a newborn getting a GBS infection, there is a risk and I want clients to be aware of that. I don't want any client to have a baby who gets GBS disease. I cannot provide antibiotic therapy, so if that is desired, we will work to transfer care for a hospital birth. I trust that clients are capable of weighing the risks and benefits and making the decision they are comfortable with and is best for their family. I will monitor baby for signs of GBS infection and make sure the client knows what to look for and how to access help if baby needs it.

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National Trend Occuring Locally

My Ferritin Eye Opener

Preeclampsia

Measles and Pregnancy

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