Sarah Thompson, author of Functional Maternity explains what maternal functional medicine is and the role nutrition plays in pregnancy and birth outcomes.  You can listen to this complete podcast episode on iTunes, SoundCloud, or wherever you find your podcasts.

Welcome.  You’re listening to Ask the Doulas, a podcast where we talk to experts from all over the country about topics related to pregnancy, birth, postpartum, and early parenting.  Let’s chat!

Kristin:  Hello!  This is Kristin with Ask the Doulas, and I’m joined today by Sarah Thompson.  Welcome, Sarah!

Sarah:  Thank you!  Thanks for having me.

Kristin:  You are a certified functional medicine practitioner, and you’ve got 15 years’ experience, correct?

Sarah:  Yeah, that is correct.

Kristin:  I’d love to hear more about why you got into specializing in reproductive care, fertility, pregnancy, and postpartum.  Of all the specialties that you could choose, why are you passionate about maternity care?

Sarah:  Well, I think like most people – in my profession, I’m an acupuncturist by trade before functional medicine.  I started off in sports medicine, pain management, and pregnancy was not something that was even on my radar.  And it wasn’t until I actually became pregnant with my first child that I became fascinated by the internal workings of pregnancy.  It was basically an understanding of my own body that I was like, oh, I have to know how this works.  This is so cool.  Why didn’t anybody tell me pregnancy was so cool?  And I immediately decided then and there that I needed to shift my focus because this is where my passion was.  The other thing that drove me was the fact that there weren’t many practitioners offering any sort of alternative care for pregnancy.  Most of the care, obviously, is through OB-GYNs and through midwives and the conventional medicine practice.  And I remember having questions for my midwives, who were fantastic midwives, but they didn’t have the answers, and they kind of struggled with, I don’t know, maybe there’s a book you can find to read on it.  And I didn’t really love those answers.  So I started doing my own diving and my own research and kind of discovered the functional medicine route even through that experience as well and even within the functional medicine realm, there wasn’t a lot of specialization within the reproductive.  Definitely some into the fertility side, but nothing on the maternity side.  And to me, maternity care is probably the most important specialty there is because it’s the beginning – it’s where everything culminates, right?  What a mother does not only influences her health and that pregnancy, but the next generation.

Kristin:  Exactly.  And of course, I mean, as an acupuncturist, you’re already working with women in pregnancy, and they’re coming to you for relief in a variety of conditions or potentially wanting to avoid induction or get baby to flip and so on.

Sarah:  Absolutely.  Acupuncture offers a number of different clinically supported benefits in pregnancy.  We can use it to reduce hypertension.  We can use it to facilitate labor, which is pretty cool.  Flip breach babies.  There’s a number of things that we use acupuncture for.  The cool thing about the combination between acupuncture and functional medicine is functional medicine is that foundation.  It’s how nutrition plays into what we’re asking the body to do with acupuncture at a nutritional and biochemical level.  So I always tell people, I can tell your body to do something with acupuncture, but if the foundation is broken, then it’s not going to work.  So looking at labor induction, with acupuncture, I can tell the body to make prostaglandins and to make oxytocin to facilitate natural labor, but if that person was magnesium deficient or vitamin A deficient or deficient in the nutrients that go into the production and the function of oxytocin and prostaglandins, it’s not going to happen.  And that’s where functional medicine comes into that.

Kristin:  So you look into the lifestyle, and I’m sure you do very lengthy intakes with your patients about their nutrition.  So how does that process work when you’re accepting new pregnant patients?

Sarah:  Sure.  So we offer a couple different options.  I have a functional maternity package, which is unlimited functional medicine appointments, and we follow women through their entire pregnancy and for three months postpartum.  The earlier I can work with somebody, the better.  I kind of joke with my patients and in interviews like this, that everything in pregnancy is preparing.  And oftentimes, what we’re working on in a specific trimester has less to do with that trimester and more to do with preparing for the next trimester.

Kristin:  Makes sense.

Sarah:  So with the functional maternity package, the earlier we can get somebody in, so first trimester, right, the better we can set them up for success throughout their entire pregnancy.  We also offer pre-conception appointments where we talk a lot about the nutrition and the functional aspect of how the ovary and the sperm and everything comes together to support that first trimester.  And that’s not part of the package.  That would be separate, just because some people struggle with conception, and that can sometimes take longer.  But we are always basically trying to build off of in each phase in that pregnancy gestation cascade.

Kristin:  And as far as nutrition, do you have different recommendations based on history or a guideline for each client based on what their current diet is and so on?

Sarah:  Absolutely.  So we do have – I have handouts I give to patients all the time that are the generic dietary guidelines for each trimester of pregnancy and things that I want them to focus on, foods I want them to focus on.  But that’s also modified based off of the individual.  So a mother who may have PCOS prior to conception, she might need a different nutritional pattern and guidelines than somebody who didn’t.  Or if somebody struggled with conception – they had recurrent miscarriages; they carry MTHFR genetic mutations that change the way their body processes the latent B vitamins and those sorts of things, then they’re going to need a different guideline than just the generic guideline.  So we have our generic that basically will say things like, this is what’s happening in the maternal body at this time.  This is what we’re looking at in fetal development.  These are the things we focus on in a general trimester guideline.  But for you, because of this, we’re going to add these things in.

Kristin:  Makes sense.  And then with gestational diabetes and other conditions, then you would, of course, focus on those specific needs?

Sarah:  Absolutely.  Yeah.  That definitely changes some of the guidelines when somebody pops up with gestational diabetes or preeclampsia and some of these more severe conditions.

Kristin:  Yes.  And you are also an author, so how did you manage a busy practice and taking on a book project, which is huge?

Sarah:  It was a huge project.  It was a lot of fun.  It was something that I had had in the back of my head for years, and it was a resource and a guide that I was hoping, you know, somebody else would write.  You know, following my mentors and these things and going, okay, so when are you guys going to write this book?  Okay, we need this resource!  And finally, somebody said, just write it.  And I said, all right, I will, because we need it.  We need this out here for people, whether it’s a practitioner or a mother who just conceived or somebody who’s looking to conceive.  The book was designed to be an introduction to the use of functional medicine and nutrition in pregnancy care.  So it’s a little bit more in depth than just your kind of general guide to pregnancy and nutrition.  We dive very deep into the inner workings and biochemistry and physiology of the maternal body and how nutrition plays into these different biochemical processes.  So it’s a little bit more in-depth, but definitely something that a pregnant mother could pick up and read and get a lot of information out of, as well as a practitioner.

Kristin:  And how do we find your book?  It’s available on Amazon and a variety of places.  Are you in bookstores, as well?

Sarah:  I will be in bookstores.  If you go to your local bookstore and request it, they can order it for you.

Kristin:  Great!

Sarah:  But it is primarily right now on Amazon.

Kristin:  And the title for our listeners?

Sarah:  The book is called Functional Maternity: Using Functional Medicine and Nutrition to Improve Pregnancy and Childbirth Outcomes.

Kristin:  That’s great.  So do you have any future projects in mind beyond book number one, or what are you working on outside of your practice?

Sarah:  We are looking at maybe creating some courses based off the book that are designed for practitioners and for expectant mothers that guide into a little bit more into the different conditions or general nutritional guidance for pregnant moms, so that’s something that might be popping up this summer.  We’re also contemplating our own supplement line at this point, something that has been brought up and requested from numerous practitioners at this point.  So we’re diving into the world of possibly setting up a supplement line based on functional medicine and maternity care and the research behind it.  So those are some things to keep an eye out for.  And on the website, we do have a blog full of articles, and there will be some free e-book downloads on there.  I have a pre-conception and fertility e-book that will be available as a free download on there, hopefully in the next couple of weeks.

Kristin:  Great!  We’ll share that for our listeners in our notes.  So as far as – you not only take patients, and are you doing both in person and virtual right now, or how are you practicing?

Sarah:  We have – our practice runs in office and virtually.  I have patients all over the world, actually.

Kristin:  It would seem like that, from your website, yeah.  That’s fantastic.  So Michigan clients can access you virtually?

Sarah:  Absolutely, yeah.  And we have patients as far away as Australia and Canada.  We follow them through their pregnancy and guide them through nutrition and functional medicine if things pop up.  It’s something that definitely can be used for people who are just looking to support a natural healthy pregnancy and for people who are experiencing complications.  It’s a great avenue for all people in any type of pregnancy.

Kristin:  Sarah, how does one, if they wanted to find a practitioner to go in person in their area, how do you best recommend finding a functional medicine practitioner?

Sarah:  With those who are pregnant, it gets really hard, simply because the functional medicine trainings do not offer, really, specialized maternity care.  I don’t know many practitioners out there who have additional training in supporting pregnancy with functional medicine.  And it’s something that I’m trying to change.  That’s one of my missions is I would love to see functional medicine practitioners doing a little bit more in-depth training in maternity care simply because a lot of the things that we do in functional medicine can’t be done in pregnancy.  A lot of the testing that we use is different in pregnancy.  I like to use an example that I also mentor practitioners around the country, as well, and I had a functional medicine practitioner from another state contact me slightly in a panic that he had run heavy metal testing on a woman who was in her third trimester, and copper levels had come up elevated.  And he was wanting to come up with a protocol to bring her copper levels down without causing complications within the pregnancy.  A lot of the supplements that we would use for that are contraindicated in pregnancy.  And I had to stop him very abruptly because having elevated copper levels in the third trimester of pregnancy is 100% normal.  And in his training – he had not done additional training in pregnancy support and these different physiological changes that occur in pregnancy that, outside of pregnancy, could be considered toxic patterns, but in pregnancy, are 100% normal.

Kristin:  Okay, so he was in panic mode –

Sarah:  He was, and it was 100% normal.  And if he had done that, he would have caused complications within that pregnancy.

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Kristin:  It’s so great that, not only are you mentoring, but you plan to further education functional medicine practitioners.  I do find that even in my work as a doula, there aren’t a lot of specialists.  There are so many other healthcare practitioner referrals that we can make, but very few really specialize or have the knowledge base around maternity.  They might have a focus on, say, gestational diabetes if they’re a naturopathic doctor or a functional medicine doctor and so on, but as far as other conditions, they don’t have that background.

Sarah:  Yeah, and if somebody was looking for a practitioner in their area – you know, a functional medicine certification is an adjunct to a medical license.  It’s not its own separate, you know, licensure.  It’s off of a license.  So finding a practitioner whose base licensure is specialized in pregnancy care definitely would be – like a midwife or an OB-GYN or an acupuncturist who specializes in pregnancy.  Those sorts of things, a naturopath who specializes in women’s health, might definitely put them in a better advantage to find somebody who has the additional training and the additional knowledge in these different aspects of maternity care.

Kristin:  Makes sense.  So I’m curious about your approach in the postnatal phase.  That is also a specialty of yours and something we’re very passionate about at Gold Coast.

Sarah:  You know, postpartum care is often neglected.  I think the conventional medicine world kind of says, well, you had a baby.  Good luck.  We’ll see you in six weeks.  You’re doing great.  Keep going.  Where we know that the maternal body, the baby itself, they are still in this hormonal pattern of pregnancy postpartum, and we have the fourth trimester, what we call it now, those three months postpartum.  And that’s why with my functional maternity package, we include those three months postpartum as part of that package, because there is a lot of maternal change that happens very quickly during that time frame, and it is definitely still a phase hormonally of pregnancy.  And so we do monitor, especially the first six weeks; we’re talking to patients every week postpartum, typically.  Checking in, seeing what’s changing, how’s breast milk, how are we feeling emotionally, and discussing what is happening in her body so that she understands what’s normal and what’s not and how we can do things to support those different changes in the body.  Things like thyroid hormone changes that occur postpartum, the drop in hormones and why and why that happens; changes in breast milk production; how do we support that.  And any time we’re looking at postpartum, we have to go backwards.  It’s that preparing for preparing aspect.  What’s happening in the postpartum phase oftentimes isn’t because of what a mother is doing in the postpartum phase; it has to do with what happened in the third trimester and during the birth itself.

Kristin:  And I’m sure there’s a lot of focus, for mothers who choose to breastfeed, on their nutrition and water intake and so on?

Sarah:  Absolutely.  Yeah, one of the things we focus on a lot is something like vitamin D.  That’s kind of one of my examples I use a lot.  Newer research shows that the current recommended daily allowance of vitamin D is 600 international units, and that is far from what a mother actually needs in pregnancy and significantly less than what a mother needs postpartum.  The demand for vitamin D goes up quite a bit in the postpartum phase if she is breastfeeding.  So babies need, when they’re breastfeeding, about 400 international units of vitamin D, and for a baby to get that through the breast milk, a mother needs to consume a minimum of 6,000 international units per day in her diet.  That’s a lot of vitamin D!

Kristin:  It is, especially if you live somewhere cold and you’re not getting it from the sun.

Sarah:  Exactly.  And like I said, the current RDA is only 600, so far lower than what newer studies are showing that women need.  And this changes from that pregnancy phase to postpartum phase.  And so we actually need more in the postpartum phase than we did in the pregnancy phase.

Kristin:  And then is that also a focus with preeclampsia?  You mentioned preeclampsia earlier.

Sarah:  Yep.  So we look at a number of things with preeclampsia, and interestingly, every nutrient known to man, a deficiency in those nutrients is associated with an increased risk of preeclampsia, yet the treatment of preeclampsia once it occurs, treating with those nutritional deficiencies, fixing those nutritional deficiencies, doesn’t improve the symptoms as dramatically as we would expect, and it’s because the damage has been done.  A nutritional deficiency in the first trimester or pre-conception coming into the first trimester and second trimester changes placental development, and if that placental development gets shifted into a dysfunctional pattern, then now we have the increased risk of developing preeclampsia sometime in the second and third trimester.  So we can’t fix damage that’s already been done, right?

Kristin:  That makes sense.

Sarah:  And so people who come to me with acute preeclampsia, really, our goal is to keep that woman pregnant and healthy as long as we can, knowing that this is a progressive disease.  I have patients who come to me wanting pre-conception help for a second pregnancy or a third pregnancy where a previous pregnancy, they had preeclampsia, and they’re wanting to prevent it.  That’s our preventative phase is that pre-conception first trimester phase.

Kristin:  That makes sense.  I had preeclampsia with my first and then was focused, like the moment I found out that I was pregnant, on trying to prevent and seeking alternative practitioners and hiring doulas.  Yes, so that makes a lot of sense.  And many of our listeners are not aware of eclampsia and some of the effects after having baby and how to manage that, as well.

Sarah:  Yeah, I think there’s definitely, as you know, a great myth out there, delivery cures preeclampsia, and that’s not the case.  It is a progressive condition, and a lot of women experience postpartum symptoms of the disease.

Kristin:  Yes.  And so as far as treating patients – now, I know that, obviously, optimally, it’s better to work with you from the point of conception, early, but what about those patients who are struggling in the postpartum phase, or they’re dealing with eclampsia or other conditions?  How do you work with them and manage not having the time to really get into what they’re deficient in and so on?

Sarah:  And sometimes we do.  Like, we can still run lab work.  We can figure out, is it a vitamin D deficiency?  Vitamin D deficiency is associated with an increased risk of so many pregnancy complications.  But we definitely do crisis management, is what we’ll call it.  All right, here’s what we’re going to do.  We don’t have time to do a lot of the stuff.  We’re going to do these pretty hefty protocols sometimes, and it depends on the patterns, right?  HELLP syndrome, for example.  One of the classic things that we see with HELLP syndrome is the filling of hemoglobin into the maternal blood flow from the baby.  The placenta is dysfunctional, and fetal hemoglobin pops into mom’s blood, and that’s why we see increased hemoglobin levels in HELLP syndrome.  It’s not that mom is now making more hemoglobin.  It’s that baby’s hemoglobin is now flooding her system.  And that creates a whole cascade of complications.  Sometimes we’ll use supplements, right?  Here, we’re going to give you this manganese and this super oxide because we know that it helps to treat the iron toxicity associated with that spilling of hemoglobin.  So it’s an acute management of that scenario with what we can do, with the idea of preventing more extreme complications.  Sometimes we can get those complications to reverse, even, in the lab work, which is really cool to see, and it’s always fun to surprise physicians.  They’re like, wait, how did that happen?  We’re like, oh, it’s functional medicine.  It’s really cool.  You should look into it.  And we do those sorts of things with the idea of, again, this is a progressive disease, and our goal is to mitigate it as much as possible to get mom and baby further into gestation so that we have a more viable pregnancy.  So we do crisis management, and sometimes the things that moms don’t love, right, it’s like, I want you to eat liver every single day, and they’re like, no, I don’t want to do that.  That’s what we’re going to do.  Or things like, I want you to have – sometimes it’s simple things that don’t sound like they do a lot, but they do.  Things like, I want you to have a glass of milk at every meal, and I want you to eat five eggs a day.  And there’s methodology to why we do this, but it’s kind of this really quick, intensive dietary approach that floods her body with specific things that we need to help mitigate this dysfunction.  So yeah, we work a lot with crisis management, things like small for gestational age babies and intrauterine growth restriction.  That’s something we work with quite a bit in that kind of third trimester type stuff where it’s like, oh, I went in, and my baby’s growing three weeks behind; what do I do?  Those are things that we hammer certain nutritional protocols with the idea of understanding that something is happening between the placenta and the baby or something’s happening in mom’s diet that is limiting the amount of nutrition that can go to baby.  And so we have to kind of figure out the why behind it.  The key to functional medicine is understanding the why.  Why is this happening?  Not just here’s the band aid for it, but we have to understand the why.  Is it narrow blood vessels in the placenta?  Is it something that happened in mom?  I’ve had a couple of cases just in the last couple months of, oh, moms who’ve gotten COVID at certain times of gestation, and when they’re done, their baby is smaller, and that’s something we’re definitely seeing, and it’s something we have to treat.  So when I have moms who pop up with COVID, we have a protocol to help prevent that change in placenta and fetal growth.  So there’s a lot of things that do become crisis management in pregnancy, and we are limited on time.  One of the downfalls of working sometimes in pregnancy is that we are limited and the maternal body changes so much from trimester to trimester, month to month, week to week, that you have to understand the different physiological and hormonal changes that occur throughout gestation, the nutritional components, and how that changes your treatments, how that changes your approach to that individual as they come in.

Kristin:  Makes sense.  Well, we are running out of time.  Any last tips for our listeners as they’re navigating pregnancy and the postpartum phase?

Sarah:  Absolutely.  So, you know, there’s all sorts of different diets out there, and I don’t prescribe to any one dietary theory.  I believe in nutrition; individual nutrients; what they do in the body.  And we see from study after study after study that diet is key to pregnancy outcomes, fetal development, and postpartum recovery, and if I had one single tip to give to the moms out there who are listening, it would be eat a variety of whole foods.  And it seems so simple, but it’s something that is often times very difficult.  80% of women of reproductive age aren’t even eating the minimum requirements for vegetables, and that’s where our vitamins come from.  Primarily, it’s from the vegetables and the legumes and the plant-based foods that we eat.  And something as simple as switching to whole foods, kind of cutting out the processed stuff as much as possible, really does have a big impact pre-conception, first trimester, pregnancy, postpartum, the whole gamut.

Kristin:  And any tips on protein intake?

Sarah:  Yeah.  Protein is important.  We need lots of protein, and definitely in the prenatal diet, we focus a lot on protein.  And I have patients who eat meat, and I have patients who don’t eat meat.  And we can easily get the adequate amount of protein that we need in pregnancy, but it’s just making sure you do get the protein.  Legumes are protein.  Nuts and seeds are proteins.  Obviously, meats.  Obviously, eggs, dairy, cheese.  All those things really do play a part.  I’m not anti any food.  I think all foods have a place in the diet.  We’ve just lost a lot of our traditional knowledge on how to use certain foods, and I think it’s important that people know how to properly use foods in the diet.  You know, things like legumes needing to be soaked before you cook them and things like that really unlock the nutrition within those foods, as well.

Kristin:  I’m so thrilled to have you as a resource, and I look forward to connecting again in the future and sending clients your way.  Sarah, would you recap a bit about how our listeners and clients can find you?  I know you’re on Instagram and some other social media platforms?

Sarah:  Definitely, we have social media.  Instagram and Facebook, we are at functional.maternity.  And we have a website.  From there, there is a link on that website to access the clinic, Sacred Vessel Acupuncture.  You can use either website to communicate with me.  I always offer a 15-minute free phone consultation for anybody who is interested in becoming a patient before they ever schedule, so that’s something that’s nice because people have a lot of questions about functional medicine and what we can offer and specific conditions, so I think it’s nice to be able to get that free phone consultation and just ask some basic questions beforehand.  And like I said, the book is Functional Maternity.  You can find that on Amazon, and then you can also request it at your local bookstores.

Kristin:  Perfect.  And you can find information on your website about the book, as well?

Sarah:  You can, absolutely.

Kristin:  Thank you so much, Sarah!  Have a great rest of your day!

Sarah:  Thank you.  You, as well.  Thanks for having me.

Thanks for listening to Gold Coast Doulas.  Follow us on Instagram, Facebook, and YouTube.  If you like this podcast, please subscribe and give us a five-star review.  Thank you!  Remember, these moments are golden.