Cycle Charting as Primary Care: A Midwife’s Perspective | FAMM Practitioner Series | Harriet Thorn (Episode 623)

Full Transcript: Episode 623

Lisa: This is the Fertility Friday Podcast, episode number 623. In today’s episode, I am sharing my interview with Harriet Thorn. She is one of our recent FAMM participants. At the time that we recorded this episode, she was just a couple of months out from finishing our nine-month program.

This conversation was super interesting. One of the things that is kind of fun to know about our FAMM practitioner series is that we don’t really plan ahead what we’re going to talk about. It’s definitely just a conversation. And so I don’t always know — actually, most of the time, I don’t know exactly what direction it’s going to take. So I always find these conversations to be super fun and interesting.

There are a few things that we talked about that I think you’ll really appreciate. Harriet is a midwife, as I’ll get more into when I actually read her bio. We do talk a little bit about the role of midwifery and the interesting nature of it — the fact that you’re working so closely with women, but you’re not necessarily trained in the fertility awareness aspect, even though that’s exactly what a lot of your clients are going to be wanting to know. You would almost assume that midwives have this deeper level of knowledge, but you would be incorrect, because it’s certainly not something that’s covered as a standard part of midwifery school.

In addition to that, we took an interesting turn and talked a lot about research, the role of research literacy in clinical practice, and some of the challenges around it. Obviously here at Fertility Friday headquarters, I incorporate research into everything that we do. If you’ve been a listener to the podcast, you know that we often share research in our FAMM research series and go through these detailed papers. And of course, in FAMM, we spend a lot of time going through the research as well. But the research itself is done by human beings that have different biases, so that was a really interesting topic that we dove into.

Another interesting piece, especially with this particular group of FAMM — our 2025 groups of FAMM — we always have participants from all over the world, but I feel like in our last couple of groups, we definitely had a really good mix. We have practitioners from Spanish-speaking countries, we have practitioners from Hebrew-speaking countries, and Harriet herself is French-speaking. We got into some of the challenges around that.

When we are living in an English-speaking world, we take for granted having access to this material. We talk so much about how it’s hard for women to find information about fertility awareness and how practitioners aren’t trained. But when you’re in an English-speaking country, all of the resources are primarily in your language for the most part. When we’re going out of the country and trying to provide support to women all over the world, one of the biggest challenges is the lack of resources available in their languages.

What was really fun that happened over the course of our 2025 year, given the number of practitioners that we had all across the world, was that we actually started independently creating a bit of a translation team within the program, so that our handouts and resources are slowly being translated into other languages so that our practitioners can present this information to their clients in their primary language.

Without further ado, let me just jump into Harriet’s bio real quick, and then we can jump into today’s episode.

Harriet Thorn is a midwife based in Switzerland. She first completed a Bachelor of Science in Life Technologies, majoring in biotechnology, before going on to complete her PhD in Ireland, where she realized that she was drawn to a vocation with a stronger human and social dimension, which ultimately led her to midwifery. She later trained in the United Kingdom, where the NHS model allowed her to develop strong clinical skills and autonomy while providing continuous care to women and families from early pregnancy through the postpartum period.

Today, Harriet provides holistic women-centered care through pregnancy and the postpartum period, supporting breastfeeding and helping women better understand their menstrual cycles through fertility awareness charting. She is passionate about using the menstrual cycle as a window into overall health, helping women recognize hormonal imbalances that are often overlooked in conventional care or simply accepted as normal. As she puts it, midwifery is more than just pregnancy and birth — midwives are primary caregivers for all women who are menstruating, from the first period all the way to menopause. And that is exactly the vision she brings to her practice every day.

Without further ado, let’s go ahead and jump into today’s episode with Harriet.

Lisa: I’m excited to be here today with Harriet. Welcome to the show.

Harriet: Thanks, Lisa. Excited to be here too.

Lisa: Yeah, excited to have you. I’ve shared a little bit in your bio, but I would love to ask my very favorite question, which is — let us know a little bit about when you had your first period and how those early menstrual years were for you, and ultimately what led you into your profession. And also what led you to jump into the world of fertility awareness and charting and all those good things.

Harriet: So I had my first period when I was 15. I was quite isolated at the time because my parents moved, and it’s always hard — of course I had friends, but not very close friends where you can just say, what’s happening to me? So it was a bit of a surprise, even though I was 15. I was like, what’s happening? And my mom just sat me down and said, okay, this is how you do it, here’s a tampon, just get on with it.

What’s also surprising is that I was top of my class in biology. That just shows you how women’s health is just ignored, even in schools.

My periods started off quite regular — textbook regular, actually. Every 28 days, they just came. But they were heavy. I had just very heavy bleeding. That’s what I remember the most of my first menses — embarrassingly heavy. And then the pain gradually set in as well.

When I was 17, one of my school teachers actually said to me, I think you should go and see a doctor. I was like, okay, why? And he said, well, every month you look a bit green. And that’s how I actually started my journey with hormonal contraception. That really helped the bleeding situation. In my head, I was still having periods — I couldn’t get pregnant, but I was still having periods — and the pain was gone and my bleeding was manageable.

As time progressed, I noticed that my moods were really getting impacted by my cycles. When I was getting closer and closer to my periods, or withdrawal bleeds, I was just getting more and more anxious, getting quite moody and ratty. In the end, I was like, okay, I need to change pill. So then I changed pill, then it got a bit better, and then we started again. Then I tried the mini pill and I was just spotting constantly. Then I tried the NuvaRing, and that was a bit better, but it just made my life sort of stable — I wasn’t feeling great.

Meanwhile, I actually started studying biotechnology. I did a bachelor’s and then I moved to Dublin where I did a PhD. And when you do a PhD, you actually learn a lot about your science, but you also learn a lot about yourself. I realized — what am I doing in the lab? I actually want to have a vocation. I want to be with people and not with machines.

I completed my PhD and then turned back towards the drawing board of what I was going to do. Women’s health always fascinated me. Pregnancy, birth — I was always passionate about it. So I applied for midwifery schools in Switzerland, in Ireland, and in the UK. I actually got a spot in the UK and did my master’s. And that’s where I discovered that hormonal pills or contraception is not the only way to avoid pregnancy. I learned about the copper coil, and I also learned about charting, because I was on a very tight budget and I just needed to finish my midwifery school with no delays. I could not get pregnant.

I decided to go for the copper coil. And oh my God, my bleeding and the pain was just so bad, but I managed and I pulled through.

When I finished my midwifery, I started charting and said, okay, well, I’m ovulating here, I actually see that it could work for me. And then I went on to charting, removed my coil, did a few months of avoiding pregnancy, and when we decided with my husband to try for a baby — bingo.

Your question about why I’m looking into charting and integrating that into my practice as a midwife — midwives are really well known for prenatal care, birth, postnatal care, breastfeeding. But actually we are the primary caregivers in women’s health. There’s a big portion of my scope of practice where I had very little training. I just find that charting and learning how to read charts, and really understanding that it is the report card — it tells you how healthy you are, and if not, what can you do to improve your health holistically — that is just such a key skill to have as a midwife. And that’s why I’m here.

Lisa: Well, it’s amazing. That’s why it’s my favorite question, because it gives me — in your case — maybe over a decade, maybe two decades of your life summed up in a very short time. You had a lot of different experiences over those years with heavy periods, painful periods, having to figure out how to manage those. I thought it was interesting that it was your teacher that said that to you.

Harriet: It was so awkward.

Lisa: Was it a male teacher?

Harriet: Yeah. I sort of sensed that. He was very intentional — is that the word to say in English? He was very caring. As a teenager, it was horrible. But now as an adult, I’m going, that’s actually really nice and sweet to actually dare to come to me and say, you need to sort yourself out.

Lisa: Well, and there’s so much there. For most women, yourself included — did it occur to you that it shouldn’t be this way? That maybe there was something that you could do about it? It’s kind of like, this is just your lot in life, you just have to deal with this pain. It’s impossible to imagine how many women out there just have to deal with it.

And obviously in your case, it’s kind of the same story as 95% of women on earth, which is that when you do ask for support, you get put on pill. But in your case, it did help. You said that the bleeds were lighter, the pain was less, and so it did allow you to manage for quite some time.

Harriet: Yeah. But then gradually, as we were going into sort of like 10 years of usage, I was finding, okay, this is now impacting my moods and relationships and trust in people. I’m getting anxiety at the end of each pill wrapper. This is not okay. I needed to find a way to actually manage it.

Lisa: You know what’s interesting — I’ve been talking about the pill for years, and you look at the research, and even if you just open the insert, mood changes is what they call it. That’s certainly a euphemism for what’s going on. But it’s right there, front and center. I would say the most common side effects would be the anxiety and depression and low libido. And that kind of what you were talking about — those feelings of anxiety, all that kind of stuff.

But in your case, you did link it to the pill, but it sounds like it was more because it was cyclical. So you kind of thought, okay, this is related. I feel like that’s a positive, because I’ve spoken to so many women who felt a certain level of anxiety but they’d never put two and two together that it could be the pill.

Harriet: If I’m totally honest, when I was in the full swing of things, I realized that my mood was really bad and my anxiety just made my life so chaotic. I was living a really difficult time because I was completing my PhD with a not very supportive professor, and it just made things like a thousand times worse than it actually was.

I was getting support, and I was thinking, okay, well, the doctor never suggested that it was probably my cycles, but she asked me to write things down. And that’s when I realized — okay, this is coming regularly every 28 days. There’s a new round of anxiety coming. That’s how I realized. And I was like, okay, I need to get off the pill.

Lisa: I know in North America we tend to call it the IUD and in the UK we tend to call it the coil. Did they tell you that when they insert that, if you already had heavy and painful periods, they would be heavier and more painful?

Harriet: They did. I was going in with full informed consent, that’s for sure. But in my mind, I kind of forgotten my teenage years. And I was like, well, my bleeding is probably quite low now, so should be okay. And we’ll just see. And if needs be, I’ll just take it out.

Lisa: And at that point, would you say that you knew that the pill was not a real period, that it was like a withdrawal bleed?

Harriet: No, this is me now talking as a midwife and nearly certified practitioner. But no.

Lisa: The reason I’m asking is because most women don’t necessarily know that unless they have learned it. And it was interesting what you said too, because you were like, I was a big bio major, I was top of my class, I knew everything about biology. And then I got my period and I was like, what’s going on? In biology class, they might teach you the basics, like you have a uterus, but beyond that, you don’t really learn anything about the cycle at all.

Harriet: I think from what I remember, they were saying, okay, men produce sperm, women produce the ovums or eggs. And then that was about it. Not how it actually happened.

Lisa: I really love the medical professionals out there who are actively trying to get this into med schools. That’s not my calling, but I love that there are people out there trying to do that. I know some of our FAMM practitioners are working on programs that can get them into schools so they can educate about the biology and cycle and all of those things.

It’s so ridiculous that you have to kind of stumble across this information. And had you not decided to go into midwifery school, would you have stumbled on it?

Harriet: No. Maybe, but… Even in midwifery school, there’s one whole page on the combined pill, then a whole page on the progesterone pill, then two-thirds on the Depo-Provera, and then half a page on the different coils, and then like just a quick chart — a capture of the chart and a few lines — this is how you can see when the person ovulates and they can then decide.

And that was actually the page — even though it was the smallest — that really captured me. I was like, wow, this is amazing. We don’t need all the other stuff. It’s great for some people, but I need to master this. This is data that we can actually collect about our bodies.

And then the more I learned about charting — well, at first, like I’m sure like many women, I realized, okay, I can use this as a tool to avoid or to conceive when I want. So it actually empowers me. And now, even in my practice, I can decide if I want to conceive or to avoid, but it also gives so much more information than that. And to be able to read that is so valuable. I think women should know these things.

Lisa: When you had the IUD removed and you started charting, what were your periods like at that point?

Harriet: Honestly, now I would say they weren’t very memorable. So probably they weren’t normal. Well, after the copper IUD exacerbated the bleeding and the pain, I was probably like — yay, I’m free. Emancipated.

Lisa: Exactly, right? Literally.

Just for anyone who might not have as much background — I used to do a lot more of what I called my pill reality series back in the day, and I used to interview a lot of women specifically on their symptoms of birth control. Some of my more recent listeners might not have heard the whole story about the copper IUD.

I think it’s interesting when you bring up the copper IUD, depending on how you’re taught and who you’re talking to, because for many women the copper IUD represents emancipation from hormones — this is the non-hormonal solution, it’s highly effective, it works really well. And so it’s interesting that some women are kind of taken off when you suggest there might be problems with it.

For women who have a really good experience on it, they absolutely love it. When you don’t have particularly heavy periods or painful cycles and you don’t really suffer any type of side effects — how could you have a side effect from a non-hormonal method? But it’s great when it works.

The mode of operation is the slight inflammation and then the spermicidal effect of the copper. And so for women like you, Harriet, it can just exacerbate the issues. The inflammation can have an effect on your progesterone, so some women do find that they have some side effects even though it’s non-hormonal. I just wanted to throw that out there for anyone who’s like, why is she knocking the copper IUD? Definitely not.

Harriet: What you’re saying there — I clearly see it in my practice. I see women during pregnancy and then early postpartum, and then when we start finishing midwifery care, I talk about contraception. What I see is that maybe two-thirds of women actually leave the hospital with a prescription for the pill, but they haven’t been counseled about it at all. They say, oh well, I took it before, so I’ll just take it again.

Some women say, oh well, I just want to have the coil, and that’s what I had — that’s great. But then some people say, well, I’ve been prescribed the pill, I’m not sure. It was actually great when I was conceiving, I was feeling so much better. What do I do? Some just turn towards barrier methods. Some are actually quite interested in charting their cycles, but then they go, but I’m postpartum — is this feasible?

And then some people are like, no, this is not for me. I need something that is just there and I don’t need to think about my fertility. And that’s fine too. I think contraception is like a pair of shoes. Not every shoe fits everyone. If I put on a pair of Converse — oh my God. High heels — oh no. A good pair of hiking boots — no problem. That’s my shoe. Women need to choose what is right for them, and what is right for them might not be right for another.

Lisa: Well, I love that. And I feel like that’s at the heart of what we talk about, because obviously I teach fertility awareness and have been doing it for a long time. Do I think every single woman on earth is going to use this as their primary birth control? No.

The difference is that most women, if they’re counseled at all, the counseling is typically just going to pill. For most women, even if they’re counseled at all, they’re just provided a range of hormonal options — probably not even necessarily the copper IUD unless they ask for it or push for it, let alone fertility awareness-based methods.

In my perfect world, it wouldn’t be that everyone is using fertility awareness — although that would be kind of cool. My perfect world would just look like women have actual informed choice about all of the options. Like you said, they can choose the pair of shoes that fits best.

For a lot of women, the birth control pill does check a lot of the boxes they’re trying to check. But then they didn’t sign up for some of the side effects — they unwittingly signed up for some of the other issues that crop up after. They thought the shoe fit really well, but then when the issues start cropping up — the corns and stuff like that — they’re just like, well, I don’t think there’s any other shoes I can try. I feel like this is the only one, because this was all I’ve ever been presented with.

Harriet: Yeah, that unfortunately is something that even in the world of fertility awareness, some people say — well, actually, postpartum charting is not possible. For me, evidence-based practice is the gold standard. But many people aren’t aware of all the studies that are there. Even those that are teaching the method say there are no studies on fertility awareness. I’m like, excuse me? You’ve clearly not done a search, and we all have access to Google, so I don’t know what’s going on.

Now, I might be completely wrong, but in Europe — definitely in the French-speaking countries — mucus-only methods, they don’t exist. It’s always sympto-thermal. And some methods like Sensiplan are well researched, but then it’s one or two studies and after that there’s no more. So they don’t find the evidence that they’re seeking. But then if they go into Creighton, Billings — there’s research there, but people aren’t really aware of these methods. That’s my explanation, especially in Europe anyway.

Lisa: Yeah, I think you bring up a really good point. Being that I’m living in an English-speaking place, fertility awareness-based methods are already quite a niche thing. I can think of being in a business building program or a coaching situation — I’m like the only one. It’s a very niche practice in general, even within the English-speaking world.

When you look at other countries — and this has come up quite a bit in our FAMM program, because we have practitioners from all over the world — when you are out of the English-speaking world, the number of resources is very, very limited. From that perspective, it’s not necessarily a surprise that the knowledge of it is even less in some of these countries. And one of the biggest barriers is having these books and resources translated into these languages.

Harriet: Yes, definitely. And even the research — do you have a comment on that? I think potentially it’s easier now with AI, because theoretically you could more easily translate that information instantly with certain AI tools. But I would be curious as to your experience, because a lot of the research is obviously in English.

Having taught in universities how to do research, I don’t think that it’s too much of a barrier. But the way it’s taught in midwifery schools and other bachelor programs — it’s like, well, it’s the best latest evidence. So people then put a search barrier and say, okay, I’m now searching from 2015 or even 2016 up to now. And they forget all the studies that were done previously. So I think that is also a barrier to accessing research.

Lisa: It’s so interesting. With fertility awareness, there is a lot of foundational research that was done in earlier years — I think this is true for a lot of different fields. And even the new research papers are drawing on those earlier findings, not re-researching the initial results. Those early papers established the basis of mucus or temperature or whatever, so the newer studies aren’t redoing that.

I find with research, you do have to be somewhat patient and somewhat creative in terms of what you’re searching for and what you’re looking for. And one of the things I always think of is — who is doing the research and why? Because often when you’re looking for research, I have to think, well, where’s the money coming from? Who would be researching this and why?

One of the challenges with fertility awareness-based methods is that there’s no $20,000 IVF procedure if you can just get pregnant by tracking your mucus. For example, when I was writing Real Food for Fertility, if I’m looking for research on nutrients that support egg quality, I look at the IVF research often, because that’s where the money is. That’s where you’re going to find a lot of this research, because they’re trying to find out what could be done to improve the effectiveness of IVF.

I think there are a lot of challenges with research. I would argue that there is newer research available about fertility awareness-based methods, but it’s still streamlined. You see a lot of the same researchers who are in that field. The newer studies I’ve seen are often about effectiveness, because within the fertility awareness world, they’re trying to show there are effectiveness studies. But you do have to be a lot more diligent if you’re looking for fertility awareness research, because it’s just not like some of the other fields where there’s just an unparalleled amount of information.

Harriet: I’m going to maybe push things a tiny bit more in saying that people, when they do their research, they type things into Google, PubMed, whichever platform they’re using. But then they’re just looking at screening for titles plus minus abstracts. But sometimes the information — like, for example, liver — you’ve said it yourself in previous episodes. It’s not even mentioned in the abstract, but that’s the key finding for bringing in the vitamin A. So sometimes you have to look deeper.

That’s the thing — I don’t know what the average person is looking for, but I definitely get the sense that people have their preconceived notions about a topic and then they maybe already have their paper written or the paragraph written, and then they look for research to support what they already said. And then they find the research that supports what they already said and plug it in.

I’m the kind of nerdy, irritating human being who does not do that. If I want to write about a topic, what I typically do is pull as many papers as possible. I have a ridiculous folder with who knows 20,000, 30,000 papers in there — not the best organized, but I just stick them in folders. If I’m looking at a topic, I’m going to pull as many papers as I can about the topic first, and then I go through the papers and kind of star the ones that seem to be more relevant or more recent.

I don’t judge only based on the date of the paper. I will pull older studies as well. Maybe in my final writing on this topic, I will source some of the newer, more recent papers, because I know that is what is valued right now. But in terms of informing myself about that topic, I want to read about the topic, and then I write and I cite. Because then I’m not just having my preconceived notion — I’m actually looking at what the research has to say about the topic and then writing more of a summary on it.

And that takes 10 times as long. I can understand why the average person isn’t taking that approach. If you just did a very cursory search on fertility awareness and just found a bunch of medical people saying that it doesn’t work, then that’s going to be what you think about the topic if you don’t really do a thorough search.

Harriet: Yeah. Well, there are also peer-reviewed papers, and then that’s what’s in the news. And sometimes — maybe I’m opening a can of worms here — what’s in the news sometimes doesn’t really reflect what the science is actually saying, because it’s just an interpretation. That could be correct or false, but that’s the message being brought to the greater public.

Lisa: And I feel like you bring a really good point too, because what some people call research would be reading an article that mentions a study and assuming that that article is correct in whatever it’s saying about the study — and they never go and find the study. And like you said, maybe they just read the abstract if they read anything, and they don’t necessarily read the whole study.

This is a big topic. I know this was something that Lily and I talked a ton about when we wrote Real Food for Fertility. Research articles are written by human beings that have preconceived notions. You can quite literally have an article that looks at a data set, and whatever this researcher focuses on and what their conclusion is could be very different from your conclusion, literally looking at the same data.

You brought up the example of that paper about the liver. In Real Food for Fertility, I found this really great article — I was pulling up the whole article, reading it through. It was an article about different foods and nutrition and how these different foods were affecting sperm quality. The title and the abstract was kind of Mediterranean diet-esque. And I don’t remember if it was saying specifically that meat was bad or whatever, but you read the abstract — the male participants who had regularly consumed liver specifically had pretty significant improvements in their sperm quality compared to the other population.

It was significant enough that they literally could have titled the paper, “Liver Improved Sperm Parameters in Men.” It was that significant compared to all of the other groups, but it didn’t even make it into the abstract. And the researchers kind of came to the conclusion of, we’re unsure why this happened.

And you see that a lot in research. The researchers are people and they’re coming into this study with their preconceived notions. If anyone’s ever written a paper, you make your hypothesis — you have your expectation of what you think is going to happen. You see this a lot, especially in fertility research, where they’ll see something that doesn’t fit their specific expectation. You can tell the researchers thought meat would be bad, or they thought higher fat diets would be bad, or they thought the liver wouldn’t have any effect. And then they get this result and you see in their discussion and conclusion that they kind of just explain it away. They’ll be like, oh, well, this was kind of weird, we didn’t expect it, it’s probably nothing.

If you want to be honest and you want to try to get a good idea of a topic, you want to read the whole paper. You want to read multiple papers on the same topic. And you want to understand why certain papers are saying this thing is not helpful and why others are saying it is. You want to look at even the design of the study and say, well, what would account for these differences?

In every area — Harriet, you have your PhD, you know — every area you research, there’s always some papers that say this supports this and always some papers that say it doesn’t. If you’re being honest, even if you have a preconceived notion, you should be able to understand why some papers are finding a positive result and some papers are finding a negative result. And if you haven’t researched to the level to be able to do that, then maybe you shouldn’t be going out there making definitive claims.

Harriet: I think to defend researchers — especially because I was one — I think it’s just how you’re taught. You’re taught, okay, I’ve got my research question, I do a quick search of the literature, then I make my research question and formulate a hypothesis. After that, I’m going to do my research, and once I’ve done my research I’m going to look at the results, and oh bingo — I actually validated my hypothesis. Or oh dear, I haven’t. And then you write your discussion based on that.

All the details that are on the side — they’re not really ignored, but you’re also very time-limited. You can’t then go and research another thing and another thing, because otherwise you just don’t stop. And as you said, research is driven by money, or time — this is a PhD student or a master’s student, and they’ve got so many months or years to complete their thesis. They can’t go and research every detail. So these things get ignored. But then when you’re doing your own reading, you still have those details, which can bring a lot of information. And maybe those details that were details for the researcher are then something fundamental for you. And that’s why sometimes reading the full text is crucial.

Lisa: Well, and when you read enough research, you start to see — I’m not a fan of the word scientific consensus, because I feel like it’s dishonest to say that there’s like a consensus. Even vitamin D and its effect on fertility — there are some papers that will do a study and say this didn’t really have an effect. But I find that when you’re researching certain topics, you start to see certain things seem… I mean, you read enough papers and there are certain things that seem to have to be written. There are certain phrases that are repeated. There is this kind of consensus thing. And when you have research that kind of shows results outside of that perspective, you do see researchers trying to fit it back in the box and explain away some of this stuff.

But this is not me saying that there’s something wrong with research. I love research and I’m so thankful that we have access to it. And I’m so thankful when you can review the full text, and when you have a topic where you can find dozens of papers that you can delve into and really look at those nuances and get a better understanding of the topic.

There have been many times where I had a certain bias about something and the research showed — okay, what I thought isn’t entirely correct. I think that’s important. If you call yourself a researcher — whether you’re doing the research or not — if you actually think you have everything figured out, you’re not on the right side of research and how it works.

I mean, I love getting into the weeds about these topics. And I think over the years, I’ve been critical about it because I am not required to say XYZ to get my funding or whatever. I’m in a position where I can look into things and I can say certain things and I can write about certain things and I don’t really have to worry about whether the funder is going to say anything or whether my paper is going to be published in a certain journal.

I did an interview with Marguerite Duane — might have been a year ago — and it was such an interesting conversation. I had just said to her, oh, congratulations, I’ve seen so many new papers come out, because she’s publishing research pretty consistently. And she was like, actually, I have a whole stack on my desk that is not published and I’m having a really hard time getting them published because they’re being rejected by these big publishing houses because it’s not part of whatever they are wanting to publish.

I do think that we need research. In FAMM, we base everything on research. That was probably one of the things that drew you to FAMM, given the fact that we’re having this discussion. It’s the foundation of what we do. And I’m all about research. But at the same time, if we put it on a pedestal and pretend like it’s not a human-directed thing — where you have people who have biases and you have money involved and you have all of these other things — then you wouldn’t be correct. And also, if you think that just because we don’t have a paper on X it means that thing is necessarily false — we don’t know about the gray literature.

That was something that Marguerite Duane talked about too. She defined the gray literature as, for example, all these things that doctors are finding and presenting at conferences and things, but that haven’t been formally published as research. And then there are also the papers that have been written but no one will publish them.

Harriet: And also, we are not researchers. We’re either healthcare providers or practitioners. What is the latest best evidence care? There are three arms to it. There is the research — and that takes a big chunk of the practice. But then there’s also the practitioner’s or the healthcare provider’s experience. And then there’s also the third party, which is non-negligible, which is the patient or the client and her experience, her life, her situation, because research is not black or white. Having all three things knit together — then we can give proper high quality care.

Lisa: Oh, I love that. What I found is that if you’re wanting to work with clients in a professional setting, being able to stand on the research that we do have really helps. When you have strong research on a topic and you have multiple peer-reviewed studies showing a similar trend, you can feel a lot more confident making certain recommendations and creating certain protocols, because you can actually show a consistent trend of results — not one random paper because of your bias.

But you definitely have to add in your experience. As a podcaster over the years, I find my most interesting interviews are when people share their stories — which is why I love doing the FAMM Practitioner Series. I love interviewing people who have a lot of experience in a specialized area where they have the patient experience as well as the research, because then you really get this level of expertise and deeper understanding about a topic that you wouldn’t necessarily get only by reading the research.

You have the research and then you apply it and see what happens in your patients, and that should lead to further research. But then you also have the individual differences. All of that is necessary.

I love obviously talking about research since I’m a huge research nerd. And I think my thing about it is always — we have to be nuanced. Because what I see is that a lot of people either scrape the surface and just try to find things to fulfill their bias, or there’s a lot of misunderstanding in the overall world, especially within the field of fertility awareness. I’m typically searching for fertility awareness research a lot, and what I find are interesting things I love to share with the audience to kind of fight that idea that there is no research on this topic and that it is just the rhythm method.

Well, Harriet — I would love to continue, but let me switch the topic a little bit. I want to ask you — obviously as a midwife with significant educational background — share with us what your experience has been like now that you have gone through the whole FAMM rabbit hole with us and you’ve started to put this work into your practice. Maybe share with us what has changed, if anything, with your perspective, and how have you been integrating this into your client work?

Harriet: That’s a very good question. I think what FAMM has really brought to me, to my practice, is really the structure. I love how you do the intake and just filling everything in and making sure we’re step by step. Because we’re seeing clients maybe for about seven or eight sessions sometimes — you’re at session five, where are we going? Being able to go back to your notes and your intake and then the actions and problems — where do I go? Sometimes it gets you out of that rabbit hole and maybe takes you either in a new direction or confirms, okay, this is the right thing, let’s carry on. That is something that has enriched my practice.

I’ve learned so much about women’s health as well. Nutrition — for me, nutrition has always been a bit of a pushback. I really needed to get into it. But it’s fascinating. And what is discussed culturally and socially about foods is not necessarily what is healthy. There’s, again, the research that backs it up.

And also opening up to different types of clients — online care. This is totally new for me. I’m more of a one-on-one in-person kind of person. My standard midwifery practice is covered by health insurance, so I just send my bills to the health insurance and I have no say on how much I charge, because it’s just standardized. But now I have to decide — how much am I charging my clients? Is this really representing my worth, my time?

And what you always say — I need to be paid so that somebody looks after my children. Well, that’s my big problem. These are new things that I really need to put in my head. Okay, this is what you’re worth. This is what you’re providing your clients. So that’s also a new pillar to my practice — putting myself out there.

Lisa: And it’s especially hard when you are coming from a background where you are billing and it’s standard — it can be really hard to figure out where you’re standing. While it’s definitely not the bulk of our training, we do have a business billing module and we do have calls where we talk about it. We’ve even had some guest speakers that specifically go into some of the business aspects of things.

Obviously in a program like FAMM, where a lot of our practitioners are looking to either add to what they’re already doing or potentially have a new thing that they can do — a lot of our practitioners say a similar thing to what you said, which is that before, they weren’t able to do any remote work, they weren’t able to necessarily see clients online. Now they can move into that. And that does come with some conversations around marketing and pricing and things like that.

For someone who is tuning into this episode and maybe listening to some of the practitioner series to get a sense of what are they doing in here and would it be valuable for me — what would you want someone to know? Maybe if they were in a similar situation to you, being a midwife or another healthcare provider?

Harriet: I could say so many things. I’d say just do it. It’s really enriched my practice, and my vision of my job is really to empower women. I empower women in the prenatal and I empower women in the postnatal. When I was working in hospital, I was also empowering them to make choices, informed consent, and having the birth that they want.

But midwifery is more than just pregnancy and birth. We are the primary caregivers for all women that are menstruating — from the first period all the way to menopause. And this program really gives me the pillars, the foundations to be able to support women year after year, cycle after cycle.

Lisa: Well, thank you for that. There’s one question that came to mind because when we have conversations with midwives, of course, they’re wanting to know about postpartum charting. That’s a whole topic — obviously we don’t have another three hours for a presentation. But that question comes up a lot — do you teach the charting postpartum and charting strategies, and will I be able to support women?

Now having kind of gone through most of the program, how do you feel about women who are wanting to maybe look into charting postpartum?

Harriet: Well, it’s definitely a possibility. It depends where in the postpartum they are. There are adaptations that need to be made. And why not? Obviously it’s not a method for all women out there. But if it’s something that speaks to them and they want to investigate, I think it’s definitely a method that can be looked into, no matter if you’re breastfeeding or not.

Lisa: I agree. It’s a whole interesting conversation. But what we do is we help practitioners to feel confident in supporting their clients if they’re wanting to chart at that time. And we also help our practitioners to be able to identify if they ever have a client who may not be an ideal candidate. Not everyone necessarily is going to make that choice, and we equip you to navigate that.

You shared a little bit about what you do and you alluded to where you are in the world, but share a little bit more about what you do in case anyone is listening who happens to be in your area — and also let our listeners know where they can learn more about you and what you do.

Harriet: So if you’re in my area, I am practicing primarily as a midwife. I do home visits prenatally and postnatally, I support with breastfeeding, and I’m now also extending my practice, as I alluded to, to menstrual health. If you’re having trouble conceiving, or you have menstrual pain, or you’re not sure if your cycles are normal, you can always check me out on my website, which is harrietsagefemme.com — sagefemme is midwife in French.

Lisa: And where are you in the world, in case anyone wants to know?

Harriet: Sorry, I should have mentioned — I’m actually in the canton of Fribourg in Switzerland.

Lisa: Amazing. Well, Harriet, this has been such a fun conversation. I love that we dove into the research questions. I feel like this is going to be particularly interesting for a lot of our listeners. Thank you for joining us today.

Harriet: You’re so welcome. Thank you for having me.

Lisa: I hope that you enjoyed today’s episode with Harriet. As I mentioned at the top of the episode, I had such a great time having this conversation and I love the different directions that we went into. It kind of gives you a taste of our FAMM program, because of course these are the topics that come up and these are the issues that our practitioners are struggling with.

Working with practitioners all over the world really opens your eyes to the question of how do we ensure that our clients have access to all of these resources. I’ve certainly been plugging away in my lane here for many years. But over the past few years, it has come to my attention time and time again. I presented last year virtually to a group of medical doctors in a Spanish-speaking country, and all of them were just like, you need to publish your book in Spanish. There are certain challenges related to publishing in different languages, of course. But it just speaks to the need to have resources available worldwide.

No matter how difficult we think it is for women to access this information in English-speaking countries, we have to remember that we actually have the most access in terms of having resources in our actual languages.

I hope that you enjoyed our conversation — how we touched on research and some of the challenges there, but also some of the challenges for practitioners. And of course, this is what we focus on — equipping practitioners to be able to expand their repertoire so that they can support fertility awareness clients alongside their regular clients, or provide those fertility awareness services to their existing clients. We’ve certainly had many midwives come to our program just for that reason, as well as other birth workers, nutritionists, chiropractors, acupuncturists — the list really does go on and on.

If you are listening to this in April or May of 2026, we are currently accepting applications for our May 2026 group of FAMM. We are so excited to welcome this new group to our program. We’ve just launched our brand new Fertility Awareness Institute. For those of you who haven’t seen it yet, you can head over to fertilityawarenessinstitute.com and you’ll find information about our FAMM program, our certification program, and our curriculum is listed there. You’ll find a ton of information, and of course, you’ll have the opportunity to apply if you want to join us. You can also head over to fertilityfriday.com/FAMMlive and you will be redirected to our new Fertility Awareness Institute site.

With that said, I hope you have a wonderful week, weekend, whenever you’re tuning into the show. And of course, as always, until next time — be well and happy charting.