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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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Things to Know About Supplements

3/1/2026

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Pregnancy 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.

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The Importance of Optimal Vitamin D

2/15/2026

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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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