Born Free Method: The Podcast

Dr. Verny was recently a guest speaker in my beloved Born Free Method community call, and there were so many hot takes that I am compelled to release this one as a podcast episode. Typically, these calls are reserved for Born Free Method community members, who also get to ask questions live (which you'll hear in the recording), and they get access to the full video recording. If you're interested in learning more enroll HERE.Thomas (he asked that I call him by his first name) is one of my heroes, and he rubs shoulders with other heroes of mine, like Gabor Mate. He is the author of several books, but I recommend starting with The Embodied Mind (also on audible) or The Unborn Child. He is regarded as “the father of pre- and perinatal psychology”, a field which begs the question of how we treat ourselves, others, and even our unborn children might impact our long-term health and the health of our children (present, future). His wisdom is unbelievable. You're going to love this one.* What is perinatal psychology?* What is life?* What is consciousness and the psyche and where do they come from?* The mind versus the brain* Darwinian versus Lamarckian theories of evolution* Transgenerational trauma* Epigenetics* And much much more...Please share with your friends if you found any value, and leave a review on Apple Podcasts or wherever you listen. I take your input seriously!Dr. Verny’s websiteThe Embodied Mind | The Secret Life of the Unborn Child | Nurturing the Unborn ChildNotes for this episode can be found on Substack.Work with Nathan:Beloved Holistics | Born Free Method | Clear & Free | Twins-BreechMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by AudioKraken / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

This one pairs nicely with the 2020 Bonterra Cabernet Sauvignon (Organic)Five Pearls1. Normal physiologic changes in pregnancy that are relevant in anemia: blood volume expands by 50% (increased iron requirement), red blood cell mass increases by 25% in a singleton pregnancy, and increased iron stores in the female body during pregnancy help to sustain the increased demand.2. Low serum ferritin is the most sensitive and specific single lab finding in iron deficiency anemia. And yet, it’s specificity isn’t great.3. The CDC recommends universal screening for iron deficiency anemia in pregnancy along with universal supplementation.4. B12 deficiency and folate deficiency are common causes of macrocytic anemia; folate deficiency much more likely than B12.5. Blood transfusions are almost never indicated in pregnancy, apart from the rare case of a large, concealed placental abruption (Hgb <6 g/dL is associated with abnormal fetal oxygenation --> non-reassuring fetal heart rate patterns, reduced amniotic fluid volume, fetal cerebral vasodilation, and fetal death)Definition of anemia in pregnancyHgb = hemoglobin; HCT = hematocrit- Hgb <11g/dL or HCT <33% in the first/third trimesters- <10.5 g/dL or <32% in the second trimester- everybody should be screened in the 1st trimester and at 24-28 weeks- If hematocrit level is less than 33% in the first and third trimesters or less than 32% in the second trimester, you need to investigate the cause. If iron deficiency is ruled out, other etiologies should be investigated- Living at a high altitude and tobacco use cause a generalized increase in hematocrit and hemoglobin levels, and consideration of these factors may be appropriate when interpreting test resultsClassification of anemiaPhysiologic changes in pregnancy that may lead to anemia- blood volume expands by 40-50% (increased iron requirement)- red blood cell mass increases by 15-25% in a singleton pregnancy- increased iron stores in the female body during pregnancy help to sustain the increased demand**UK guidelines on iron deficiency anemia: https://www.bsg.org.uk/wp-content/uploads/2021/09/Iron-Deficiency-Anaemia-in-Adults.pdf“An SF level of <15 µg/L is indicative of absent iron stores, while SF levels of less than 30 µg/L are generally indicative of low body iron stores. The lower limit of normal for most laboratories, therefore, lies in the range 15–30 µg/L.”Structure of hemoglobin- four polypeptide chains + heme- the six chain types: alpha (α), beta (β), gamma (γ), delta (δ), epsilon (ε), and zeta (ζ)- adult hemoglobin consists of two alpha chains + either two β-chains (hemoglobin A), two γ-drains (hemoglobin F), or two δ-chains (hemoglobin A₂)- hemoglobin F predominates in the developing fetus from 12 -24 wga, after which hemoglobin A begins to increaseIron deficiency anemia- 2% prevalence in general female population (2x higher for black women compared to white)- “An assessment of iron status in pregnant individuals in the United States using data from the National Health and Nutrition Examination Survey (known as NHANES) from 1999 to 2006 found that iron deficiency prevalence increased significantly with each trimester (mean ± standard error, 7%, 14%, and 30%, in the first, second, and third trimesters, respectively) and was higher in Mexican American pregnant women, non-Hispanic Black pregnant women, and women with parity greater than 2”- in pregnancy, higher prevalence by far in 3rd trimester- associated with low birth weight, preterm delivery, and perinatal mortality- there may also be an association with postpartum depression and worse mental and psychomotor performance testing in offspring- diagnosed by lab analysis OR if there's an increase in Hgb by 1g/dL after iron treatment OR by the absence of bone marrow iron stores on bone marrow biopsies- iron storage may be low (iron depletion), or stored + transport iron are low (decreased erythropoiesis), or stored + transport + functional iron are all low (full blown iron deficiency anemia, yeehaw!)- on iron studies, iron deficiency anemia presents as: microcytic, hypochromic, iron store depletion, low plasma iron, increased total iron-binding capacity (TIBC), low serum ferritin, and increased free erythrocyte protoporphyrin- serum ferritin levels are most specific and sensitive for the diagnosis (<10-15 mcg/L is diagnostic)- CDC recommends universal screening of pregnant women along with universal supplementation (unless the patient has hemochromatosis)- typical American diet provide 15 mg of elemental iron per day (recommended: 27 mg daily iron intake)- extended-release formulations are less effective- foods rich in iron: shellfish, beef, organ meats, turkey, beans, and lentils- foods that enhance iron absorption from the gut: citrus, strawberries, broccoli, and peppers- foods that impair iron absorption: dairy, soy, spinach, and coffeeMacrocytic anemia- two general categories: megaloblastic (B12 or folate deficiency, pernicious anemia) and non-megaloblastic (liver disease, myelodysplasia, increased reticulocytes, aplastic anemia, and hypothyroidism)- mean corpuscular volume (MCV) >100 fL is characteristic of macrocytic anemia- if >115 fL, diagnostic for folate acid or B12 deficiency (confirm by checking serum folate acid or B12 levels)Click for source- in the U.S., macrocytic anemia in pregnancy is due almost exclusively to folate deficiency- recall: folic acid should universally be supplemented at 400 mcg per day in pregnancy- however: 40-60% of the U.S. population carries of a variant of a mutation within the gene that encodes for the MTHFR enzyme, and folic acid is useless in that caseMore on folic acid versus folate from Lily Nichols, RDN- folate deficiency can be caused by diets deficient in leafy vegetables, legumes, or animal proteins (or taking antacids) - changing the diet should do the trick (you can also increased folic acid supplementation to 1 mg daily along with increasing iron supplementation)- B12 deficiency can be seen in women who have undergone partial or total gastric resection or in Crohn disease- treatment includes supplementing with 1000 mcg of B12 (intramuscular) monthlyWhat if a patient has laboratory evidence of anemia but is asymptomatic?- mild: reasonable to investigate further through iron studies, RBC indices, etc. (otherwise you may just recommended dietary changes without investigation)- moderate: definitely investigate the etiology (CBC, RBC indices, iron studies, blood smear), consider Hgb electrophoresis if patient is of African, Southeast Asian, or Mediterranean descent; reasonable to treat empirically with iron while awaiting further studies (you should see results in a few weeks)When should transfusion be considered?- almost never in pregnancy, apart from the rare case of a large, concealed placental abruption (Hgb <6 g/dL is associated with abnormal fetal oxygenation --> non-reassuring fetal heart rate patterns, reduced amniotic fluid volume, fetal cerebral vasodilation, and fetal death)- postpartum is a different story: coagulopathy (HELLP, DIC, etc.), uterine atony, placenta previa/accreta, and placental abruption may all result in the need for transfusion postpartum- if the patient becomes symptomatic or hemodynamically unstable then it's a no-brainerWhen should iron infusion be considered?- useful for the rare patient who can't tolerate oral iron or those who have severe malabsorption issues- 1% chance of anaphylaxis (iron dextran more likely to cause a reaction than ferrous sucrose)- faster immediate results from IV iron compared to oral for most patients, but by day 40 after treatment, the two routes of comparable- insufficient data to guide decisions around erythropoietin treatment in pregnancyClick for sourceMy approach: * Evaluate for all potential causes of anemia before treatment (Ready —> Aim —> Fire; Not the other way around). Often iron deficiency plays a role, but rarely is it just about iron. * Instead of repleting iron willy-nilly, try to determine if absorption is the underlying issue. Adding acids like apple cider vinegar or HCL capsules to the diet can help with reabsorption. Calcium-rich foods can impede absorption. You can bet that absorption is at least partially responsible if ferritin is low, although ferritin itself is wildly misunderstood (including by me). For example, there is little if any iron found in a molecule of ferritin, so what’s the deal? Well, while ferritin reflects overall “iron stores”, this association is more likely indirect. Ferritin is more likely a powerful antioxidant. My clinical experience tells me that iron deficiency anemia will at least be partially corrected for (with improved outcomes) if low ferritin is managed by focusing on absorption of iron. Bear in mind, also, that the antioxidant response element, which is regulated by Nrf2, a master gene in the regulation of our response to oxidative stress, regulates the expression of the gene that is responsible for ferritin production, meaning foods and supplements meant to regulate Nrf2 can also have an impact on ferritin levels. Note: this means foods and supplements that flood the body with antioxidants may be impactful to iron storage and utilization, but, again, I haven’t figured this out entirely. But others are also asking these questions… * I always aim for a serum ferritin level of at least 50 ng/mL* Adequate nourishment through whole foods, namely beef liver, bivalves like oysters, bone broth, fermented cod liver oil, and farm-fresh eggs are all helpful for the increased demand on RBC production. There’s no question about this. You’ll have adequate amounts of folate (Vitamin B9), other B vitamins, fat-soluble vitamins, Omega 3s, Cu/Zn, Se, Mg, and other nutrients critical for healthy absorption, transport, and storage of iron (and general health before, during, and after pregnancy). * I don’t generally recommend supplemental iron, as you’ll get more bang for your buck (and avoid constipation) by striving to acquire these nutrients from whole food sources. * Address underlying inflammation, which can be tricky to identify while in pregnant state, which is, in some regards, an inflammatory state in and of itself. * We could go much deeper…but for the every day practitioner, this is hopefully a good start. Notes for this episode are found on Substack.Questions? Leave a comment.Work with Nathan:Beloved Holistics | Born Free Method | Clear & Free | Twins-BreechMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by AudioKraken / Pond5Born Free Method: The Podcast is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.Thanks for reading Born Free Method: The Podcast! This post is public so feel free to share it. Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

Maternity care in the United States needs a re-boot. Our induction rates are rising, our c-section rates are rising, pregnancy complication rates are rising, fertility rates are declining, postpartum depression rates are rising...the list goes on.What are we going to do about it?Most people see the answer as simple: more pharmaceuticals, more technology, more "science".But what is science? The scientific method is quite simple: ask questions, make guesses at the answers, test our guesses, and then draw conclusions. Repeat ad infinitum. Most physicians and healthcare professionals aren't using their brains to their full capacity because they are too occupied documenting, billing, and following rules. This will get us nowhere...We need to be curious and start asking hard questions.Furthermore, do physicians hold the answer to our maternity woes? Unlikely. In fact, I would argue that a multi- or transdisciplinary approach to maternity care, with midwifery-led care becoming the default in any country is a major part of the solution. Born Free Method: The Podcast is hosted by Nathan Riley, MD, a dual board-certified OBGYN, and the conversations here extend beyond the hospitals, beyond the clinics, beyond the profession of "medicine". It implores you to get back to what matters most: birthing families. On this podcast, you'll enjoy conversations with those inside and outside the medical industrial complex. You'll enjoy clinical summaries of ACOG's practice bulletins (formerly heard at the Obgyno Wino Podcast). You'll enjoy personal essays from Nathan himself on the nature of birth(work). And you'll enjoy occasional recordings of guest appearances to the Born Free Method's twice monthly community calls. Be loved!Work with Nathan:Beloved Holistics | Born Free Method | Clear & Free | Twins-BreechMedical Disclaimer: Born Free Method: The Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to the public for educational and entertainment purposes only.Music provided by AudioKraken / Pond5 Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

The Episode was made possible by Immune Intel AHCC® & WeNatalIn the 19th century, a young surgeon named J. Marion Sims headed to Montgomery, Alabama, seeking a route to fame and power. He saw an opportunity in a highly morbid condition known as vesicovaginal fistula, whereby a false passage between the bladder and vagina forms as a consequence of difficult childbirth, and began experimenting with techniques to find a cure. The issue was that nobody in their right mind was willing to volunteer for this type of surgery, so he coerced Black enslaved women. The first of his patients to have been presumably “cured” was Anarcha. If this is the first time that you have heard her name, you are likely not alone. This conversation gives a voice to the Mothers of Gynecology, an appropriate moniker for the women who suffered at the hands of surgeons like J. Marion Sims and whose sacrifices led to the advent of the profession of gynecology. Visit the show notes for more. Connect with J.C. Hallman:WebsiteInstagramReference from the show:Say Anarcha, by J.C. HallmanThe Anarcha ArchivA short history of anaesthesia: from unspeakable agony to unlocking consciousnessMore information on vesicovaginal fistulaArguments of Sims’ apologizesMedical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present, by Harriet A. WashingtonNathan Bozeman wiki pageSpeak! Move! Change! Mbongi eventJ. Marion Sims was a b*tch t-shirtsConnect with Nathan:Instagram | YoutubeMidwife in need of collaboration?Want to consult with Nathan?My Online Courses: Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

The Episode was made possible by Immune Intel AHCC® & WeNatalI met Teshna while attending a birth in Albany, NY. My friend for whom I had traveled to Albany to assist with the birth of his fourth child had recommended I check out her practice. It was a very modest chiropractic studio, but the experience with Teshna was anything but ordinary. She introduced me to a unique blend of classical chiropractic care and other techniques meant to help me clear my limiting beliefs. She had me say out loud various phrases about my life and how I perceive love in my life, and then she used muscle testing to determine if I “really believed” what I was saying. As it turns out, I’ve been lying to myself about much that I held in my world. And then the magic trick…She corrected these incongruencies using simple touch, red light, and a few other techniques. It was like magic, and I wouldn’t have believed it if I hadn’t experienced it myself. Meet Teshna Beaulieu, who is likely the most unusual healer I’ve ever met. Visit the show notes for more. Connect with Teshna:WebsiteInstagramReference from the show:Dr. Teshna’s book “Fit for Love”Neuroemotional Technique (Dr. Scott Walker, Teshna’s mentor)A 3 DAY Training called "Meridian Therapy and Tapping (MTT)”. One-hour Forgiveness Process webinar to introduce people to my work and MTT.Free 1-DAY MTT Immersion to introduce people to more aspects of MTT where they learn how to muscle test themselves, powerful stress reduction protocol, and test and clear their blocks about different subjects like love and many more. 1 Year All Access Membership where people can attend all events and also get the recorded modules of the 3 DAY MTT Training as well as a weekly coaching/ session group call.Connect with Nathan:Instagram | YoutubeMidwife in need of collaboration?Want to consult with Nathan?My Online Courses:Born Free Method: Pregnancy and Postpartum SupportClear + Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

The Episode was made possible by Immune Intel AHCC® & WeNatalAre you ready for a power hour? You are likely already familiar with my guests on today’s episode, but if not, meet Lily and Lisa. Lily Nichols is the author of two of the most important nutritional books ever written pertaining to pregnancy: “Real Food for Pregnancy” and “Real Food for Gestational Diabetes”. Lisa Hendrickson-Jack is the author of “The Fifth Vital Sign”. Lily’s work has been most relevant once you’re already pregnant; Lisa’s work has been beloved by those trying to conceive. Naturally, Lily and Lisa have combined forces to write the new bible for fertility: “Real Food for Fertility”. Guys, when I say I have found my new favorite reference, I mean it with over 2400 citations, “Real Food for Fertility” combined nutritional and metabolic science with fertility awareness tracking. We could have chatted for 6 hours in this interview, but we had to keep it to 60 min, so we dive deep into lifestyle modification and nutrition to improve egg and sperm quality, and you’re going to be wowed!Visit the show notes for more.Connect with Lily Nichols:WebsiteInstagramXConnect with Lisa Hendrickson-Jack:WebsiteInstagramLinkedIn Reference from the show:WHO laboratory manual for the examination and processing of human semenBook “Real Food for Fertility” Read the first chapter for free or download the 2400+ reference listConnect with Nathan:Instagram | YoutubeMidwife in need of collaboration?Want to consult with Nathan?My Online Courses:Born Free Method: Pregnancy and Postpartum SupportClear + Free: Your Holistic Solution to Persistent HPVThis episode was made possible by:Immune Intel AHCC® - code BELOVED10 for 10% offWeNatal - Free bottle of fish oil with purchase of Him + Her prenatalsMedical Disclaimer: The Holistic OBGYN Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These... Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

The Episode was made possible by Immune Intel AHCC® & WeNatalBabies die. Fetuses die. We all die. And yet, we are so death illiterate that even seasoned veterans in the health professions often struggle with how to show up when death inevitably shows up on the doorstep. This topic is especially challenging - but even more important - when the “D” word arises in the context of pregnancy and childbirth. Join me in this very heartfelt conversation with Tamara MacIntyre, an end-of-life architect and retired chiropractor about death, grief, souls, loss, and love. Visit the show notes for more.Connect with Tamara:Websites: The Prana Foundation & Conscious DeathInstagramLearn about Tamara's work:WebsiteLet’s cope Instagram References and Links from the show:Nora McInerney's TED talkDie Wise, by Stephen JenkinsonA new Course Launch called "Life's Limitations: Reframing Diagnosis & Loss in the Pregnancy and Pediatric Practice'Course Sales Funnel: reframingloss.com - the course is October 19th, 2024 (4 hours CE for some regulated health professionals)Connect with Nathan:Instagram | Youtube | TiktokMidwife in need of collaboration?Want to consult with Nathan?My Online Courses:Born Free Method: Pregnancy and Postpartum SupportClear + Free: Your Holistic Solution to Persistent HPVThis episode was made possible by:Immune... Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

The Episode was made possible by Immune Intel AHCC® & WeNatalI don’t think I have prepared for any interview as hard as I prepared for this one. My guest today is Marc Gafni, former rabbi, Hebrew mystic, and author of a number of books, most notably “A Return to Eros”, “Your Unique Self”, and his most recent book, “First Principles and First Values: Forty-Two Propositions on Cosmoerotic Humanism, the Meta-Crisis, and the World to Come”. I recommend you take his writing in through small sips versus trying to binge any of them on a weekend. They are potent. In this conversation, we discuss:the Divine Feminine and how the world’s religions have got it wronghow the comparison of masculine and feminine is fraught with disastrous outcomespostmodernity and the evolution of love and a new grammar of value through which a shared story of value can be developed in order to solve the world’s problemsshame as the root of all evil and how a new sexual narrative - the sex erotic - is the only “cure” for shamethe importance of these principles in addressing the myriad of issues that plague maternity care worldwideLimitations within the work of Jordan Peterson, Yuval Harari, Wilhelm Reich, and even Brené BrownBrace yourself…you are entering the complex mind and heart of Marc Gafni…Visit the show notes for more.Connect with Marc:WebsiteLinkedInInstagramXTikTokFacebookLearn about Marc's work:Free Unique Self Mini-CourseUnique Self-Emergence Training ProgramFree Weekly Broadcast with Dr. Marc GafniReferences and Links from the show:Marc’s books:A Return to Eros: The Radical Experience of Being Fully AliveYour Unique Self: The Radical Path to Personal EnlightenmentThe Erotic And The Holy: Kabbalistic Tantra for Everyday LivingJoin Marc in Holland for 5-Day Intensive Mystery School, November 13-17, 2024, at erosmysteryschool.comFirst Principles and First Values: Forty-Two Propositions on Cosmoerotic Humanism, the Meta-Crisis, and the World to Come2024 Born Free Twins-Breech Conference:Join 150 birth workers and 20+... Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

The Episode was made possible by Immune Intel AHCC® & WeNatalShawnee and I met through a 2023 trip to South Africa with Restore Forward and Sevonna Brown. She then introduced me to the film Aftershock, which highlights the ripple effect that results from a woman dying in childbirth, and it was Shawnee’s daughter, Shamony, whose death inspired the film. Shamony is survived by Omari and their two little children. Shawnee and Omari are thus no stranger to the lived experience of losing another black woman at the hands of the most cumbersome and expensive healthcare system on the planet. Why are black families suffering in ways that white families will never have to understand? What can be done to rectify the system? How do we heal as a collective? We do our best to answer these questions in this humbling conversation…Visit the show notes for more.Connect with Omari:LinkedInInstagramConnect with Shawnee:LinkedInInstagramLearn about their work:WebsiteInstagramReferences and Links from the show:Speak! Move! Change!The ARIAH FoundationThe Spirit of a Woman Leadership Development Institute The Anarcha ArchiveBlack Americans’ views about health disparities, experiences with health care from the Pew Research CenterAftershock film (trailer)Restore ForwardCDC data on Black fathers (versus other races)2024 Born Free Twins-Breech Conference:Join 150 birth workers and 20+ amazing presenters in Louisville, August 8-11, to learn some new skills, make some new friends, and show up holistically for your birthing clients!Visit the website and registerConnect with Nathan:Instagram | Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe

The Episode was made possible by Immune Intel AHCC® & WeNatalI left the conventional medical model because I was worried about being punished for prioritizing patient autonomy over my institution's liability. I thought that the only way that I could reasonably offer vaginal breech birth support for families in need was in the home. But after I met today’s guest, my presumptions were drawn into question. Denny Hartung is an OBGYN and FACOG happily working within a small, community hospital in Wisconsin, and he’s doing just fine. How is this possible? Why aren’t his privileges being questioned? Tune in to find out…And if you want to meet Denny in person and work through some simulations with this walking legend, join us at the 2024 Born Free Twins-Breech. Grab your ticket before we fill up!Visit the show notes for more.Connect with Denny:WebsiteLinkedInReference from the show:Info on Critical Access HospitalsBreech Without BordersBreech provider directory (Breech Without Borders)2024 Born Free Twins-Breech Conference:Join 150 birth workers and 20+ amazing presenters in Louisville, August 8-11, to learn some new skills, make some new friends, and show up holistically for your birthing clients!Visit the website and registerConnect with Nathan:Instagram | Youtube | TiktokMidwife in need of collaboration?Want to consult with Nathan?My Online Courses:Born Free Method: Pregnancy and Postpartum SupportClear + Free: Your Holistic Solution to Persistent HPVThis episode was made possible by:Immune Intel AHCC® - code BELOVED10 for 10% offWeNatal - Free bottle of fish oil with purchase of Him + Her prenatalsMedical Disclaimer: The Holistic OBGYN Podcast is an educational program. No information conveyed through this podcast should be construed as medical advice. These conversations are available to... Get full access to Born Free Method: The Podcast at nathanrileyobgyn.substack.com/subscribe