A Certified Nurse Midwife (CNM) is a registered nurse who has also earned a Master's Degree from a Board-approved nurse midwifery program and who possesses evidence of licensure issued by the California Board of Registered Nursing. She must also be board certified by the American Midwifery Certification Board. Like Nurse Practitioners, CNMs are Advanced Practice Registered Nurses in accordance with Business and Professions Code Section 2725.5. Nurse-midwifery practice is the independent, comprehensive management of women’s health care in a variety of settings, including the obstetric, family planning and gynecologic needs of women throughout the life cycle. Primary care by CNMs includes evaluation, assessment, treatment and referral as required. CNMs practice in collaboration and consultation with a physician as indicated (CCR § 1463(c)). CNMs are licensed to prescribe medications by the California Board of Nursing, and are supplied a furnishing number by the DEA.

Source: www.rn.ca.gov/pdfs/regulations/npr-b-31.pdf

Functional medicine is a systematic approach to identifying the underlying root causes of disease while building a therapeutic relationship between patient and provider. It is not limited to a single type of intervention but holds an inherent open-mindedness about meeting the patient where she is and utilizing a wide range of modalities to address her needs. At the heart of Functional Medicine is the assumption that humans have the ability to heal and that their genetics are (most often) not their destiny. Our lifestyle choices, nutrition, environmental exposures, mindset and behaviors form the exposome within which our health falters or flourishes. Functional medicine is not regulated and does not require a certification. Anyone with a license to practice medicine/nursing can integrate functional medicine principles into their work with patients.

Sources: www.ncbi.nlm.nih.gov/pmc/articles/PMC9173848/

While many annual visits simply check the boxes for a pap and breast exam, a whole woman approach recognizes that our health cannot be broken down into parts. Nowhere is this more clearly illustrated than in our menstrual cycle, which has in recent years come to be properly identified as our sixth vital sign. This designation calls attention to the complex and sophisticated interplay between our hormones, stress response, gut and thyroid health, nutrient status, exposure to dietary and environmental toxins, and the quality of our sleep. When our periods are irregular, absent or symptomatic, it is a clue that some player in this symphony is out of tune, and it may be an early indicator of underlying disease. A thorough intake and assessment are the first steps towards generating solutions that safeguard your long term health and support you to feel your best.

Well woman care also encompasses any symptoms and conditions including vaginal, vulvar and urinary tract infections, PCOS, endometriosis/adenomyosis, fibroids, and painful lumpy breasts.

Conventional medicine provides us with essential tools like antibiotics and hormonal birth control which can deliver much needed short term relief, but our whole woman approach will help us to form a plan together that works for your life and provides you with lasting resolution.

Menopause is not a disease and it’s not an accident of living too long. At some point in her life it becomes more valuable to a society for a woman to stop being able to reproduce and to help guide her community and ensure the survival of her descendents. These “Wisdom Years” matter. They are an opportunity to focus on cultivating your own joy and to give of yourself as you choose, without the demands of a young family and the push and pull of monthly hormonal waves.

That being said, perimenopause and the early years of menopause bring very uncomfortable symptoms for some women and profound physical, emotional and spiritual shifts for most women. This transition is also a critical window for attending to our health (in particular addressing insulin resistance) in order to prevent future metabolic syndrome and dementia. Getting adequate protein, fiber, healthy fats, vitamins, and minerals during this time is essential for ensuring health and vitality in the years to come. Many women find that previous strategies for maintaining their weight, feeling emotionally balanced and energized, and getting good sleep that have worked in the past are no longer serving them.

Navigating these waters on your own can be confusing and I aim to assist women at this stage in developing upgraded strategies to meet the needs of their “new” mind and body. Each woman’s transition is unique. My goal is to research and suss out the most unbiased, comprehensive and evidence-based information available to inform treatment while encouraging each patient to trust her own sense of her body so that we can collaboratively decide on the best approach for her.

Compassionate, respectful, and educational medical care of teens is critically important because it lays the foundation for a young woman’s relationship to her maturing body, her sexual health, and her engagement with healthcare for the rest of her life. When her first experiences accessing care lack these qualities, she misses an opportunity to feel empowered in her budding womanhood and confident in her ability to advocate for, lovingly care for, and carefully protect her own health. In the worst cases, an off-putting early experience may lead her to neglect her own preventive care as an adult.

Pap smears are not recommended until age twenty-one (regardless of sexual activity) but heavy painful periods, mood swings, and acne are common concerns that can be addressed through nutrition, botanical medicine, and/or pharmaceuticals. Birth control and screening for sexually transmitted infections is also critical when appropriate.

In many cultures puberty and the resulting emotional and bodily changes are honored through rituals as girls are seen, embraced, and welcomed into membership with the women of their community. While these formal customs have been all but lost, my commitment to allowing young women time to feel seen, to have their unique questions answered in an unhurried and attentive way, and providing them with gentle, respectful and educational exams are steps in the direction of valuing their important transition into womanhood.

Whether you are trying to avoid pregnancy or are interested in birth control to improve any number of menstrual symptoms, there are a number of options available to you, with new products being developed all the time. I’ve been prescribing birth control for fifteen years and I can help you understand the benefits and side effects inherent to each one.

Many menstrual cycle symptoms and irregularities can be more directly addressed and permanently resolved with dietary and lifestyle changes, nutrient supplementation, and botanical remedies. I feel strongly, however, that each woman must decide what works best for her unique life, and hormonal birth control can be a useful, safe, and simple strategy when used appropriately.

Intrauterine devices (IUDs) are an excellent birth control option as their impact on your natural hormonal rhythms is far less than with other hormonal methods. I’ve inserted many hundreds of IUDs and feel confident that I can safely and calmly guide you through what can be an uncomfortable but totally worthwhile procedure. If you’ve been considering an IUD but you’ve heard “horror stories” about the insertion process please schedule a consultation to discuss it.

If you’re interested in learning to track your menstrual cycle through the fertility awareness method, I’d be happy to walk you through the steps and provide you with resources to cultivate your own body literacy. These are empowering and valuable skills to have, whether you’re avoiding pregnancy, actively seeking it, or simply desiring a greater depth of understanding and connection to your hormonal rhythms.

Whether you intend to conceive in the coming years or you’ve been actively seeking conception for some time, you can surely sense that the threshold you’re approaching marks one of the most profound transformations you’ve ever made. Setting aside time to prepare your body, mind and spirit lays the groundwork for smooth sailing during this extraordinary and challenging phase of life.

While preparing to conceive we tend to be more motivated to make healthy food and lifestyle choices and to limit our exposure to toxins, and there is good reason for these instincts. Studies show there is a higher statistical significance in health outcomes related to a mother and father’s environmental exposures in the four months prior and during the prenatal period than what that child consumes and is exposed to for the remainder of their lives. Your choices today are powerful preventive medicine for your baby’s lifelong health and thorough counseling can guide you in the day to day decisions that matter most.

If you’ve been struggling to conceive, please know you are not alone and you have a number of options. A holistic plan to optimize fertility starts with the fundamentals: ensuring your body has the nutrients it needs for healthy ovulation and maintaining a pregnancy, calming your nervous system and promoting quality sleep, strategizing to make room for self-care and saying no to energy drains, and identifying and reducing chemical exposures in your diet and environment that may be interfering with your healthy hormones. Lab work helps us to identify nutrient deficiencies, hormone imbalances, and a dysfunctional stress response system. A sperm analysis can identify the need for nutrients or lifestyle changes in your partner.

For many women these steps alone will lead to a healthy pregnancy; for some the addition of vitamin and mineral supplements, botanical medicine and/or bioidentical hormones will provide necessary support. In some cases the use of pharmaceuticals to induce ovulation will be the solution. If these measures do not result in pregnancy they will still improve your likelihood of a positive outcome with interventions you undergo in the care of a fertility specialist moving forward.

I’m a mother of two young children and the joys and angst of this unique time are fresh for me. Above all I hope to provide a warm nest for mothers-to-be to receive support, guidance, and love on their momentous and demanding journey to motherhood.

The odds are stacked against us women in our endeavor to love our bodies. Unrealistic standards set by celebrities and social media, a food industry that designs junk food to be as chemically addictive as any drug, days filled to the brim with work and caring for our loved ones at the expense of our own self-care, and environmental chemicals that alter our microbiome and hormones to favor weight gain all stand to sabotage our good intentions.

Rather than calorie restriction or strict prohibitive diets, I aim to help women fall in love with food; real food made from beautiful, colorful, sun-kissed and nutrient-rich ingredients found in nature. The Mediterranean diet has been proven — in literally thousands of studies to date — to promote every measure of good health including robust metabolism and optimal weight. And the Mediterranean diet is not just about ingredients; it also encompasses a culture of enjoying meals slowly and intentionally with our loved ones, exercising our bodies everyday, and generally moving through our days with the mindset that we have time to take care of ourselves.

If this sounds like an unrealistic dream, don’t lose hope. Consumed by our busy schedules and entrenched in our familiar habits it can be very difficult to make changes without support, but support is here. A holistic plan to optimize weight starts with checking labs to see if hormone levels, insulin resistance, or chronic inflammation are to blame for the pounds you can’t seem to shed. A strategic meal plan emphasizes high fiber, high protein and foods that support a healthy microbiome. Several mind-body tools and lifestyle tactics have been proven to be transformative in the journey to weight loss.

If women have been able to adopt these strategies and are still not getting the results they’re looking for then we can turn to pharmacology for added support. The most important ingredients to any weight management plan are personal motivation and compassionate, knowledgeable guidance.

Insurance reimbursement rates typically compensate for 8 to 15 minute long visits with your provider, for everything from an annual exam to symptoms of a hormone imbalance to an IUD insertion. I practiced this type of health care for years and I know first hand how paradoxical and difficult it is to give thorough, compassionate and effective care within these parameters. I know that women deserve better and I want to be a part of that change. When designing my pay structure I aimed to remain accessible and keep my doors open while preserving the longer visits that allow time for generating real solutions rather than applying band aid medicine. If we are not in network for you my staff will submit an out-of-network claim for your visit which may or may not result in some reimbursement or go towards your out-of-network deductible. *Blue Shield patients see below. The visit fees can also be paid in full from a Health Savings Account or Flexible Spending Account if you have one. Any labs, imaging, or prescriptions that I order will be billed directly to your insurance by those facilities. If your care moves outside of my scope of practice (i.e. you needed a surgical procedure) I would refer you to my collaborating physician, Dr Susanne Ramos, who is contracted with many private insurance plans. I’m committed to making the invaluable tools and solutions from the functional medicine/holistic health space affordable and practical for the women I serve. * While we submit all out-of-network claims in the same fashion, we've found Blue Shield of California claims processing to be especially inconsistent. If you have questions about your explanation of benefits, please contact your insurance first and then our office.