I have left the conventional medical model for good in search of brighter pastures! With the amount of painting, dancing, and kissing my baby and wife that I've been doing over the past several days, I encourage you all to try living a life free of the medical industrial complex! I have been liberated, and now I've got the bandwith the shake things up and create the life of my dreams.  The new iteration of my podcast will be titled The Holistic OBGYN Find me at: www.BelovedHolistics.com

Important PSA for healthcare professionals... Theme music by Evan Handyside

Practice Bulletin #136 - Published July 2013 (Reaffirmed 2017) 1. Know your reproductive endocrinology like the back of your hand! 2. AUB-O is classically associated with cycles that differ in length by `10 days or more. Patient with AUB-O also generally don't experience the classical cyclical breast tenderness, mucoid cervical discharge, premenstrual cramping, or bloating seen in ovulatory bleeding. 3. Anovulation is the most common etiology of AUB in 13-18-year olds. Transfusion or...

Practice Bulletin #135, Published June 2013 (Reaffirmed 2017) 1. It's none of your damn business why a woman desires a 2nd trimester abortion. There are also a lot of scenarios in which 2nd trimester abortion skills are necessary but that have nothing to what many perceive to be a seemingly easy decision to terminate a pregnancy. 2. If you don't feel confident in your skills as a provider to perform 2nd trimester abortions, do your patients the service of developing a referral relationship...

Practice Bulletin #1114, Published July 2010 (Reaffirmed 2018) 1. Pelvic pain and infertility are characteristic. Severe dyspareunia and dyschezia are indicative of deeply infiltrative disease. 2. The etiology is unknown, but currently thought to be due to the implantation of endometrial glands and stromal cells outside the uterus within the peritoneal cavity due to retrograde menstruation 3. Histologic evaluation of a surgical specimen is the gold standard for diagnosis. Visualization of...

July 2021 Journal Club I'm joined by Emmie Sturgess, DO, an OBGYN, MFM, and friend of the show to review relevant articles from the major OBGYN journals. I promise it's not as boring as it sounds... Show Notes Theme music by Evan Handyside

Welcome to Beloved Holistics Radio, a podcast for the holistic OBGYN! Expect summaries of ACOG's practice bulletins, important voices with birth keepers and birth warriors, and discussions around the most up-to-date research and publications. www.BelovedHolisticsRadio.com

Practice Bulletin #183, Published October 2017 w/ co-host Sara Rosser, CPM (@sararosser) 1. PPH is defined as 1000 mL for either vaginal or cesarean birth. 2. Go with your gut in diagnosing PPH, and do it fast! You can't rely on vital signs or lab work to make the call to action in the acute setting. 3. Uterine atony is the most common cause of PPH. Manage through uterine massage, uterotonics, tamponade, and UAE. Opening up her abdomen to place compression sutures, ligate the uterine...

Practice Bulletin #175 - Published December 2016 (Reaffirmed 2020) w/ co-host Sara Rosser, CPM (@sararosser) 1. US may be harmful if overutilized. 2. Important uses include pregnancy dating/viability, fetal growth, and amniotic fluid assessment. 3. US pregnancy dating is most accurate in the 1st trimester. If significant discordance exists between US dating  and LMP dating, it may be appropriate to adjust due date. 4. Fetuses at risk for FGR should be monitoring by serial growth ultrasound....

June 2021 Journal Club I'm joined by Emmie Sturgess, DO, an OBGYN, MFM, and friend of the show to review relevant articles from the major OBGYN journals. I promise it's not as boring as it sounds...because...I mean...come on...WINE. Show Notes Wine pairing: 2016 Primitivo di Manduria from Antico Sigillo Theme music by Evan Handyside Logo design by JD Dotson ([email protected])

"To help you further understand why we did not get the vaccine, what follows is my assessment of the C19 situation so far. Like I said, there is no doubt that many people were getting very sick over the first half of 2020. What is most challenging for me is the narrative that ensued thereafter, which seems at best misleading and at worst nefarious." www.ObgynoWino.com

Practice Bulletin #129 - Published September 2012 (Reaffirmed 2016) 1. In any hypoestrogenic state, resorption begins to overwhelm building, leading to decreased bone density. 2. Treatment is warranted if T-score ≤ 2.5 on DXA scan or if patient has history of vertebral facture or other type of fragility fracture 3. FRAX tool can be helpful in determining usefulness of treating patients in the osteopenic range (T-score - 1 to ≥ -2.5). It predicts risk of osteoporotic fracture over next 10...

Practice Bulletin #132 - Published December 2012 (Reaffirmed 2017) 1. The clinical diagnosis of APS is made through a careful clinical history that takes into account thrombotic events, history of pregnancy loss, and development of preterm preeclampsia. 2. Lab studies to detect specific antibodies can confirm your diagnosis, but these lab studies are not indicated when clinical criteria are not met. 3. The three relevant antibodies on your board exam are: lupus anticoagulant,...

Practice Bulletin #128 - Published July 2012 (Reaffirmed 2016) 1. "Normal menstruation" is classified by ACOG as: 5 days of bleeding with cycle length of 21-35 days 2. PALM-COIEN is a classification system for abnormal uterine bleeding. 3. Get good at SIS and hysteroscopy! A meta-analysis found intrauterine cavitary anomalies in roughly 50% of women with AUB 4. Fibroids tend to present as heavy periods. Polyps tend to present as intermenstrual bleeding. Adenomyosis presents with painful and...

Practice Bulletin #169 - Published October 2016 (Reaffirmed 2016) w/ co-host Sara Rosser, CPM (@sararosser) 1.  Multifetal gestations have overall increased risk of morbidity for both mom and baby. 2. Chorionicity is an important piece of information for managing these pregnancies. Monochorionic pregnancies carry higher risks than dichorionic pregnancies. 3. Outside of dx of cervical insufficiency: available data doesn't support cervical cerclages, bed rest, tocolytics, or pessaries...

Practice Bulletin #156 - Published December 2015 (Reaffirmed 2018) w/ co-host Sara Rosser, CPM (@sararosser) 1. Women with obesity are at increased risk for fetal congenital anomalies, c-section, preeclampsia, fetal macrosomia, childhood behavioral/developmental issues, and other bad outcomes. 2. Pre-conception weight loss to normalize BMI improves maternal and neonatal outcomes. 3. Weight loss while pregnant is not recommended. 4. There are a variety of special considerations intrapartum...

Practice Bulletin #146 - Published August 2014 (Reaffirmed 2019) 1. When pregnancy goes beyond 41 wga, there are increased risks for mom and baby, but absolute risk is overall still very low.  these risks are still low in absolute.  2. Pregnancy dating by LMP combined with early ultrasound is far more reliable than LMP alone. 3. "Membrane sweeping" decreases the chance of a pregnancy going beyond 41 wga, but consent your patient first! 4. If fluid checks out, particularly if BPP is...

Practice Bulletin #126, Published March 2012 (Reaffirmed 2016) 1. Rapidly dividing cells - like those in the gonads - are the most susceptible to chemo, so suppressing with GnRH analogues prior to chemo may be protective against ovarian toxicity, but data is mixed. 2. BRCA mutation carriers are at increased risk for both breast and ovarian cancers, therefore prophylactic BSO is recommended at age 40 or after childbearing is complete 3. 5 years of tamoxifen use decreases the annual risk of...

Practice Bulletin #187, Published May 2017 (Reaffirmed 2016) 1. Neonatal complication risk is overall low (5%), including brachial plexus injuries, clavicle fracture, humerus fracture. HIE/death are also possible, but extremely unlikely. 2. The faster that a shoulder dystocia is resolved, the less likely HIE/death. 3. It's nearly impossible to predict shoulder dystocia, but risk seems to be higher with larger fetuses and diabetic mothers. 4. Insufficient evidence to conclude that early...

Practice Bulletin #101, Published January 2010 (Reaffirmed 2016) 1. Most COCs combine a progestin (i.e. synthetic progesterone) for contraceptive effects with 10-35 mcg of an estrogen (usually ethinyl estradiol) to stabilize the endometrium and reduce unwanted spotting 2. COCs are a safe bet for management of heavy menstrual bleeding. If patient responds to COCs, they are most cost-effective for the first year, then it's more effective to switch to a levonorgestrel intrauterine system 3. The...

"How can we reimagine our relationship with Mother Nature? This seems like a privileged luxury of the few, but it's far more important than a philosophical suggestion. Based on the preceding examples found through the challenges of monocultural farming and efforts to sterilize the human body, it should be obvious that we are a part of a variety of ecosystems that rely on us reciprocally. As such, in allowing the Earth to deteriorate, we are inadvertently corrupting any possibility for the...

SPECIAL EPISODE - Interview w/ Sara Rosser, CPM (and my dear sweet friend!) In episode 66, Sara Rosser, a CPM at the famous Farm in Summertown, TN, is joining the Obgyno Wino team to co-host coverage of future OB-related practice bulletins. She is also anticipating her second surrogacy pregnancy on behalf of a gentleman who is otherwise unable to start a family. Between her choice to offer herself as a surrogate and her family's adoption of their beautiful son, Silas, from Ethiopia, Sara has...

Practice Bulletin #105, Published July 2009 (Reaffirmed 2017) 1.  Combined oral contraceptives may be poorly absorbed in patients who have undergone malabsorptive bariatric surgery (e.g. Roux-en-Y) 2. Micronutrient and macronutrient deficiences are common in pregnancy after Roux-en-Y. These include iron, calcium, vitamin B12, protein, folate, and vitamin D. It's reasonable to screen widely for nutrient and micronutrient deficiencies pre-pregnancy or early in pregnancy and supplemental as...

SPECIAL EPISODE - Interview w/ Brad Bootstaylor, MD, OB/GYN and MFM (and all-around awesome guy!) Dr. B is back on the show to talk about the unfortunate turn of events that forced him to leave his collaborative OBGYN practice in Atlanta, GA. At the hospital where Dr. B worked for 20 years and even served as chair of the Department of OBGYN, a non-clinical professional committee determined - apparently arbitrarily - not to renew Dr. B's hospital privileges, essentially forcing him out of...

Practice Bulletin #95 - Published July 2008 (Reaffirmed 2017) 1. Normal physiologic changes in pregnancy that are relevant in anemia include increased blood volume, increased red blood cell mass, and increased iron stores. 2. Low serum ferritin is the most sensitive and specific single lab finding in iron deficiency anemia. 3. The CDC recommends universal screening for iron deficiency anemia in pregnancy along with universal supplementation. 4. B12 deficiency and folic acid deficiency are...