Dr. Sarah Mickeler is the founder of West End Mamas, which aims to bring a sense of community back to moms who may feel isolated in their journey. This month, West End Mamas has opened their second location in York Region. This clinic is the first of its kind in the greater York Region area to offer mothers at all stages with comprehensive health services.
We caught up with Mickeler this week.
SDTC: What got you passionate about women’s health; in particular prenatal and postpartum care?
SM: I saw my first prenatal patient when I had been in practice for about a year. And honestly, I had no idea what to do with her. I think this is a relatively common experience with new chiropractors: while we may get the theoretical information in school, if you graduate never having seen a pregnant patient, it can be super overwhelming the first time you do. So, while I seemed to do a good job with her, I didn’t feel comfortable not really knowing what I was doing or why what I was doing worked. So, I decided to take a bunch of courses on pregnancy and postpartum care all over North America.
I discovered that I really liked the work, and it turned out I was really good at it too. I found a deep sense of satisfaction from being able to provide women with really excellent care during what can be a very vulnerable time in their lives. Working with perinatal women makes me excited and truly makes my job not feel like work. This is such important work, and I’m just so honoured to be able to do it.
Did becoming a mother change your approach with your patients? If so, how?
Having a baby changed everything. Suddenly I was able to connect with them on a deeper level than I ever have before. I was able to really identify what their issues would be BEFORE they even had them. I was really uncomfortable during my own pregnancy and didn’t exactly have the birth that I wanted, but I honestly think I experienced all of that so I could better help my patients.
I can now anticipate what they might be feeling before they even feel it. They’ll come in at week 28 with hip pain, and I’ll ask them if they feel like they’re a rotisserie chicken at night (basically having to flip from side to side to side to side all night long), and they all look at me like, “YES! HOW DID YOU KNOW??!!!” and honestly, it’s because I’ve been there. When they have heartburn, I can sympathize. I threw up almost every single day of my pregnancy. I went super overdue with my son and I’m able to really sympathize with those patients that feel like they’ve been pregnant for a hundred years. It’s made me a remarkably better practitioner and I know for sure that my patients, and everyone who comes into the practice, appreciates that perspective.
What issue do you encounter most often with your patients?
The most common prenatal issue we see is pelvic girdle pain (PGP). Your pelvic girdle is really your entire pelvis, so PGP can mean pain in your lower back, your tailbone, your pubic bone (hello, “lightning crotch”) and even hip pain. This is usually remarkably easy to treat for us, simply because we see HUNDREDS of patients with it every month, and we know what works.
While some patients will be fine with seeing just one practitioner for this, others require a multi-disciplinary approach to it, and that’s the beauty of West End Mamas. If you need a dual-pronged approach to treatment, we just send you down the hall to the next practitioner, and we know you’ll be in great hands with them.
The most common postpartum issues are also pelvic girdle pain (and the treatment for postpartum PGP is very similar to pregnancy-related PGP), as well as the dreaded “feeding hunchback.” No matter how you are feeding your baby—breast or bottle—you’re likely looking down at them while you’re doing it, which causes back pain for so many women. This can lead to neck and upper back pain—so common during postpartum!
What treatment do you wish more people knew about?
I really wish that more women knew the entire range of services that are available to them during pregnancy and postpartum.
But besides that, there are three things I wish women knew. I wish they knew that they didn’t have to be in pain during pregnancy. I wish they knew that they have more options for birth than most of them realize. I wish they knew to better prepare for the postpartum period, and that having the right support can make the difference between barely surviving postpartum and actually thriving.
Lastly, I wish we spent more time focusing on fetal positioning. We have a bit of an epidemic right now of babies that are being born posterior (or “sunny side up,” as you may have heard it called). While it’s long, arduous and painful, the actual nuts and bolts of labour isn’t actually that complicated. You dilate, and your baby rotates. Easy, right? The problem is, because we sit and recline so much, so many of our babies are ending up posterior (that means that they’re head down, but their occiput, or the back of their head, isn’t quite where it should be for an optimal birth). A posterior baby may make for a more difficult birth, resulting in C-section roughly 50% of the time. But there are things we can do to avoid having a posterior baby. There’s bodywork that can be done, as well as daily exercises to try to encourage that kiddo into a better position for birth. Having a head-down baby is good, but where that baby is actually positioned in the pelvis and uterus is sooooooo important for improving birth outcomes, and so few people are talking about it. I wish we considered fetal positioning more, in an effort to give pregnant people a chance for a better birth.
Walk us through a day in your life, from getting up until going to bed?
A typical day for me starts somewhere between 4 and 5 a.m. Those early hours of the morning are so productive for me. I take that time to evaluate what happened the day before, what I need to get done on the current day, and to really plan and strategize about where I want the clinics to go, improving on things that weren’t done well, and making space for future growth. No email, no social media, no slack, no Trello. Just me, a notebook and some reflection. Once I’m done that, starting at around 5 a.m., I can get down to business.
My four-year old son gets out of bed at around 7:30 a.m., so we then move into family time. We eat breakfast together as a family (him, me, my husband), and then get him off to school. My husband usually does drop-off in the morning and I head straight up to my home office, on the second floor of our home.
Once the office opens at 8 a.m., I need to be ready to hit the ground running and be ready for questions all day long. I usually work from home, answering questions and taking meetings, but visit the office once a week to make sure that everything is running smoothly.
My son is in aftercare, so I usually get dinner prep started at around 4:30 p.m. We usually pick our son up from school at around 5 p.m., have dinner together (all three of us) and then get my son to bed for 7 p.m.
The evenings are for crafty things. I like to sew and make things or catch up on the most recent Netflix obsession. Often my husband and I will just hang out in the living room and chat for hours. I usually crawl into bed at around 9:30 with a good book (I’m currently reading The Last Romantics by Tara Conklin) and then lights out for me at around 10 p.m.
I only practice with patients once a month now. I wish I had time for more, but with two clinics (one in Toronto and another in York Region), my focus is on running the business. I actually really love this new role of mine. I feel like I’m impacting so many more women this way than I ever did before.
If you’re thinking, “Hmm, I don’t see exercise in there anywhere,” you’re right. You don’t. I’m working on it.
What is the most rewarding part of your job?
Aside from seeing women feel better during pregnancy and have remarkably better births than they otherwise might have had without our help, and watching them find all of the support that they could possibly need postpartum, the most rewarding part is mentoring my team and watching them flourish as practitioners. I feel very confident that our team is among the best you will find (in both of our locations). We all feel very strongly about informed choice, about the fact that birth is normal, and about the fact that mamas need support. That’s what West End Mamas was built for, so that we could collaborate together beautifully to provide the best possible care for women, and my team does that so well.
Can you share any personal stories that demonstrate how much of an impact West End Mamas has had on women’s lives?
I hear so often the words “I wish you had been here when my first baby was born,” and “West End Mamas is the best part about being pregnant.” We are really impacting the lives of women.
We had one patient recently who had a fifty-seven-hour first labour that ended up in cesarean section. She didn’t want to repeat this with her second baby and she really wanted to have a vaginal birth the second time around if she could. After hearing that we have an almost 100% VBAC (vaginal birth after cesarean) rate at West End Mamas, she came over and got on the plan. We usually recommend regular chiropractic, pelvic physio and acupuncture for these patients to make sure that we’re setting them up for success with a VBAC. She was completely on board with the treatment plan, and went on to have a relatively easy (well, if you can call any labour “easy”) seven-hour second labour and successful VBAC, with ten minutes of pushing, no tearing, and a perfectly healthy baby. She felt so empowered because she knew what her options were, she knew what to expect, including where things could go sideways and how to manage that, and she got the birth she wanted. Birth experiences stay with us for a lifetime. We have a responsibility to empower women to have the best experience that they can during birth, whenever possible.