When I work with midwifery clients, I typically offer them a stack of cards which lists a variety of options they may have during their childbearing experience and I ask them to prioritize them. Among these options are the desire to eat and drink when they desire, to wear whatever they desire, to hold their baby immediately after birth or to not be separated, to have support through breastfeeding, or to birth in water. What I found most intriguing in the first few years, was that although the professional organization for our obstetrical colleagues had deemed nurse-midwives fickle and homebirth a fad, my clients weren't choosing the desire to birth at home among the top of their priorities. They were almost always choosing a safe birth as their utmost priority, only ever to be superseded by the desire to be cared for someone they trust. These two points, without a single exception in more than a thousand births, were always the top two priorities.
Maybe that reflects my particular clientele-base, or that of a nurse-midwifery practice, but trust and safety were overwhelmingly the goal for my clients. It wasn't about being part of a growing movement to birth within their own home; it was more about being an active participant in their care. Today, although I am attending fewer births, this ideal translates to what my clients seek from me as their primary care provider, or their functional and integrative clinician.
Rapport
The realization and recognition that two people - the clinician and the client - share similar values, beliefs, knowledge, and behaviors concerning wellness, their roles in the therapeutic relationship, and similar mindset regarding healing is paramount to the connection we have with our clients. This relationship extends further into our Eden community. When our members gather in our educational programs, move in #yoga together, challenge each other in our book club meetings, or circle up in our workshops, or even mingle in our IV Nutrition Lounge or along a #hike, we are building a safe place for them to live and love their life in a truly healing way.
This is a bit of a dance though, right? Rapport can build an environment that allows an otherwise intimidating space to feel relaxing and allows two people to be responsive to one another. Building good rapport is essential to an effective coaching or mentoring relationship, as the coachee or mentee can only fully benefit from the relationship when they trust and have report with their coach or mentor - which really is our role as your clinician.
The Trust Element
Can I trust this other person to keep my best interest in mind? Is the other person committed to the journey, committed to the process? Even if they don't have all the information needed for a complete map, are they committed to walking the walk with me? Will they refer me when needed or bring in other collaborating team members? Will they follow through? Do they care about me as a person? Here's the thing though, this can be read as the consumer or as the practitioner. We want clients who are committed and engage in a therapeutic relationship too.
Gathering Ourselves
As clinicians, we do need to walk the walk. Several years ago, it became apparent to me I couldn't. It wasn't that I wasn't fully committed or spoke out both sides of my mouth, but my lifestyle as a midwife didn't allow for sleep, or a healthy schedule, or even safety and healthy boundaries. I was regularly engaging my sympathetic nervous system, enduring hostility and abuse, and was consistently failing to meet my basic needs. Access to healthy food and time for necessary movement was not my reality. I had to make huge adjustments, and that meant leaving the profession for a few years. Today, my self-care is my utmost priority. I fill my cup and give from my overflow and this is the only way one can truly serve and work towards healing with another individual.
Practitioners need to self-evaluate continually when we work in the health and wellness industry. We can also make improvements, right? Am I respecting my needs for sleep? Am I utilizing healthy coping skills? Am I eating well? Am I moving my body enough and getting outside into nature? Am I engaged in talk therapy? Do I invest in my relationships? Am I digging in and taking time to be mindful? Where is your practitioner on their own journey? First, as a practitioner, we check ourselves.
Being Present & Getting The Story
After we have evaluated our ability to be present with you as a client, it's important to utilize our best tools for hearing your story. This requires working in a practice environment in which there is peace and tranquility, time for truly listening, and resources for supporting the clinician so she can engage in the clinical needs of her clients. Functional and integrative practitioners don't abandon their conventional training; we know how to take a great medical history and we remain true to this still, but we also learn how to find patterns and connections.
Functional medicine provides additional tools which complements our previous experience and training as clinicians. So often I am criticized for separating out my history consultation from my physical exam appointment. Honestly, I would prefer a third appointment still and each of these appointments are an hour long, at least. One can't truly evaluate system biology and understand the person in front of them without listening to their story. We want to understand how the client arrived at this point, what can we do to determine and understand the underlying cause of their problems, and again, it's taking a great medical history through the lens of a functional medicine mindset that will bring us to this point of gaining this new understanding and insight. We gather ourselves and we gather information from our client.
Here's the thing too though, too often clients are focused on the problem and what's wrong, but have no real understanding of what wellness feels like or means to them. Those that feel okay or not overtly sick don't see value in optimizing their health because we are so accustomed to looking down a path of illness, rather than towards the goal of complete vitality.
Understanding the Client's Timeline
One of the more important tools a functional medicine practitioner utilizes is the client's timeline. We work to identify the unfolding of our client's life. We can think multi-generational and what transgenerational health, illness, and #trauma has impacted our client's life today. How have patterns developed over time? What might have accelerated, complicated, or improved various aspects of our client's health and wellness trajectory? This #timeline helps us be more mindful about our ages and stages of life, which we so often forget or even re-narrate for whatever reason. This allows us to meet our client where they are at today.
Evidence tells us that our health status is impacted by the prior three or four generations, not to mention our own prenatal or gestational history. We need to understand nutritional status, stressful windows, environmental exposures, and so much more throughout the entire lives of our clients so we can really understand how each individual has developed the particular patterns with which they present during our consultation. What makes them who they are today?
There are additional tools even, which functional medicine clinicians are trained to utilize to help us really dig in and identify these patterns and to see the underlying trigger or root cause of dis-ease. It is a system biology perspective so we can see the entire person, today and yesterday and into tomorrow. The relationship building is important because most people don't know what to share and don't want to share too much, but also forget critical aspects of their history (like only having one kidney) so as a clinician, we have to build a dialogue that helps the client feel comfortable enough to share and even time enough so they can ponder on their own history. We then have to determine what is relevant and what contributes to the patterns we see today, the story which is emerging.
Lifestyle Medicine
As part of a functional and integrative consult, clinicians will offer what is now being coined as "lifestyle medicine." This approach evaluates lifestyle behaviors and not only helps create a map for optimal modification, but helps to implement these changes. We become a sort of health coach. Food choices are discussed and tips offered, as well as more detailed discussions about individualized plans. We dig into activity, movement, stretching, and strength building. Stress and healthy relationships are explored. Toxic habits are also identified while tools are offered for moving out of a dependence on this coping behaviors. Here's the key though - when a clinician practices functional medicine, they are offering lifestyle medicine, but if someone offers lifestyle medicine such as a health coach, chiropractor, or primary care provider, this does not mean they are doing so with a functional mindset.
When we skip the discussion on sleep, we fail to address the most important time in our body's timeline of detoxification and restoration. This is when we physically recuperate. If we sleep less than six hours a night, we are adding six to ten pounds of weight to our waistline. Sleep is essential to survival. If this isn't right, this is where we start. Sadly, this is a growing concern among clients in that in 1942, eleven percent of the population had fewer than six hours of sleep each night and by 2013, this had escalated to forty percent (Gallup poll).
We are sleeping less and we're seeing less restoration. This impact is significant. Our work schedules are more demanding, as are our daily responsibilities. Our pace of life is faster and harder, with work stress leading to longer work hours and disrupted sleep. In the past twenty years, we've added 158 hours to our annual calendar of responsibilities and since 1969, the working mother's scheduled has gained an additional 241 hours a year. Sleep deprivation is substantial. Depression may be the symptom of poor sleep, but part of the story will then be insomnia. This is lifestyle medicine. This is understood through a therapeutic conversation where trust is cultivated.
Sleep happens at night, but relaxation can happen during the day and certainly, this can help restore health during the day. Restoration can decrease stress hormones and decrease your heart rate. Is your practitioner experienced in prescribing relaxation exercises? Is mindfulness a tool in your practitioner's tool belt? This may include discussing biofeedback, meditation, progressive muscle relaxation, autogenic training, Tai Chi, Chigong, or yoga.
Listen, seriously, this is important stuff. Relaxation techniques can significantly enhance expression of genes associated with energy metabolism, mitochondrial function, insulin secretion and telomere maintenance and reduced expression of genes linked to inflammatory response and stress-related pathways, such as down-regulating NF-kB-dependent pathways. These habits will change your physiologic response and mitigate oxidative stress and promoting mitochondrial resiliency.
Movement is critical. Every hour spent sitting watching television takes 22 minutes off your life (British Journal of Sports Medicine). Sitting is the new smoking. While we want you to move, we also want you to engage in specific movements - stretching and strength training is vital. My statistics here could go on and on, but the reality is that if you aren't moving, you are worsening your physical and mental health by the minute. Move. Move. Move.
Nutrition and hydration is a big aspect of functional medicine. We give this to our clients in an organized way, individualized to the client. We have classes and resources galore in this regard. Stress is another aspect of our evaluation. How do you deal with stress? What triggers you? What's working? Is trauma present? We dig into the stress response in depth. One can eat well and move, but stress alone can kill your health.
Potentially the most destructive though is loneliness. We experience ourselves as part of the larger community or biological entities with which we surround ourself. Our environment determines our gene expression, so it is less our DNA and far more about our nurturing of ourselves with our environments. Community is important and we are building this here in our practice, within our membership. We want to understand you and help you craft a plan that fits your needs and meets your goals.
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