Episode 65: Dr. Nithya Natrajan (She/Her) of Blossoming Mamas - West Columbia, SC

Direct Primary Care Doctor

Her direct care practice is Blossoming Mamas
Dr. Nithya Natrajan

Dr. Nithya Natrajan is a proud a mother of 3, a board certified Family Medicine physician, and Certified Lactation Counselor (CLC) with additional clinical experience and training in infertility, gynecologic care, lactation counseling, and breastfeeding medicine.

Her direct care practice, Blossoming Mamas, was born out of a passion for helping others transition to parenthood with personalized support using evidence-based medicine grounded in lived experience.

After dealing with infertility, pregnancy complications, birth trauma, and postpartum complications (including difficulty with lactation) herself, she shifted her focus to help others as they grow their families.

Her goal with Blossoming Mamas is to work with families to create positive pregnancy and postpartum experiences as her patient’s families grow with a special focus on the 4th trimester. To address this transitional time whilst families are adjusting, Dr. Natrajan eases the transition by offering telemedicine visits to assess lactation and coordinate care – physician to physician – with her patient’s personal OB and pediatrician and will also connect her patients with community resources as needed to ensure they get all the support and assistance they need.

She is proud to be caring for families in South Carolina and Georgia!

Dr. Nithya Natrajan joins us today to share about her practice where she pulls from her own experience as a Mama to help her patients in their fourth trimester journeys. Dr. Natrajan grew up watching her father practice medicine and deciding early on she was going to be accessible to her patients on her terms; in her all virtual practice, she is able to achieve just that.

Resources mentioned by Dr. Natrajan:

IABLE - Primary Care course and Certificate in Lactation Counselling - Jan 8 and 15, 2022

Academy of Breastfeeding Medicine

Lactation Education Resource

Doctors Practicing Breastfeeding Medicne, a FB Group




IG: blossoming_mamas

Website: Blossomingmamas.com


Direct care means that I'm able to take care of my patients the way that I want to. What that means is I'm able to listen to their stories, give them the evidence and help them make a personalized care plan that works for them. You know, in traditional medicine, so much of your time is spent doing administrative tasks by going to a direct care model, I'm able to refocus the relationship on myself and the patient so we can really make a plan that works for them. I'm Dr. Nithya Natrajan with Blossoming Mamas and this is my direct care story.

Welcome to the podcast. Dr. Natrajan thank you for having

me. You are, uh, another mama who has. Little ones under the age of five. And your youngest is now four months old, which is just crazy.

And you are also a direct care doctor. So it is, it's such an honor to talk with you. And I wanted to start with the fact that you are the daughter of a physician and you had been able to see. The world of medicine with the influence of insurance prior to opening your practice. So can you share what was your experience like at your dad's practice and what kind of doctor is.

So my,

my dad is, uh, he's trained in reproductive endocrinology and OB GYN. Currently he'd known her does surgery, so it's all office based practice and he focuses on non IVF, infertility hormone therapy. And then he does a lot of general GYN care because his patients just kind of keep coming back to him.

And so after I finished the fellowship, we had our first baby and I was not sure if I wanted to go back to clinical medicine. So I ended up going back to my dad's office and I practiced with him as a locums for about two years before our second child was born. And it just, it was just an amazing experience to see how he practices and how his office works.

So he does still take private insurance, but he does not take Medicare anymore. And he has a good bit of cash pay because of that. And so much of his time. I spent on that doctor patient relationship because he has a small enough practice that he can do that. And because it's a private practice, he kind of has control over how his schedule work and who stays work.

And so just, just seeing that, that still exists, I think made an, a really big impact on me to say, Yeah, I can still do this. I can still do patient care, but maybe do it in a way that works better because you know, and I think in most residencies and fellowships, it's all insurance based care. You have very short visits, you can't get to know your patients very well.

And all of that kind of made me feel like maybe I don't want to do medicine anymore. Where as looking at my dad's practice and seeing the type of relationships and practice he's built, I was able to see that there are other ways to do this.

It's so lovely to hear that you had that experience of training and also the other side of the fence. So to speak in that you're you saw your dad's practice.

What types of conversations did you guys have when you were mentally exploring the space of, I love what you're doing. I'm realizing that I can do this in my own way. I'm actually thinking about opening up my own practice. What were those conversations like in that transition period for you and your.

Well, so it was it's interesting because when we had our second child, I had actually decided to leave clinical medicine and I was planning to just do a non-clinical position that I've had at Medicaid. And just focus on that. And I did that for about six months to a year. Before I realized, you know, I, I really miss the patient care part of it.

And when I talked to my dad about it, he was like, I don't know, you know, in India, it's really hard to survive in this world if you don't take insurance, because that's kind of what a lot of patients want. And you know, the reason that I can do it is because I've built these relationships over 30 or 40 years.

So when he quit Medicare, he did have patients leave, but he still had a good portion of his patients that said they didn't care. They wanted. I see him. So they, they were willing to pay for it. But, you know, I think when I initially had that conversation with him, he was, he had never really heard of direct primary care.

He he'd heard of like concierge medicine and things like that, but he was kind of like, I don't know if he can really do a specialty, uh, and, and, you know, focus your practice like that. And also say you're not taking insurance. So initially he was kind of, you know, I think he gave me a re he was trying to give me a reality check and I was kind of like, I don't want to reality check, you know, it's either I need to do this my way, or I don't think I can do it at all with the way the insurance systems are set up these days.

And so, you know, I think for him initially, he was a little hesitant. And then as I started building things and talking to more people and learning about their practices, and I explained to him, you know, why I think this could work. He. Come on board. And I think now he's just, he's just excited and thrilled and happy to see that, you know, it is something that can be done and that there is a way to get out of the system that this kind of trapping positions and trapping patients and not really working anymore.

And you're doing it while taking a break for your own maternity leave with your latest little one and who is now four months old. So. That's awesome. And congratulations, you know, for, for doing this and making the jump and educating your dad, and I'm sure he's probably told other physicians about the fact that you're doing your own thing and it's in alignment with the way you want to do medicine.

Now, in addition to the conversations you were having with your dad, what were the mental plans that you were actively making before opening your practice in order to open the practice that you desired to? You know, I think

the first thing was just figuring out what I wanted to do with my practice. And I think in the fourth trimester space, which is what I focus on is, uh, is something that's really developing.

There's just not that many people doing it right now. And so it, it really was about defining what I'm able to do and what I want to do. Now versus what, you know, in five or 10 years where I'm hoping to be. And so I, since we have such little children and since we're in the middle of the pandemic, which is kind of a crazy time to start anything, you know, it just made sense to start it all virtually, both for protecting my family, but also to protect the families.

You know, these new infants, like just to help them get half an option where they can be seen from home. So I decided to really focus on that fourth trimester and then focus in on breastfeeding because we had a lot of difficulty with breastfeeding. I couldn't find any specialists locally. That was a physician that understood breastfeeding enough to help me with the problems that we had with our first child.

So that was why I decided to focus on that. And I knew that was what I wanted to do. And then I. I spoke with, uh, Dr. Rebecca Behrens, who I think you had on a while ago, she was kind enough to talk to me after I asked a question on the physician entrepreneur group and she is kind of the one that really got me started on like, Hey, I can do this.

I can make it a reality. And so that's when I started exploring all the logistics of how do you set up a practice and what are the different pieces that need to be in. To be able to open up. So that's kind of how it evolved is like I had this idea for, this is what I want to practice. This is how I want to practice.

And then I went from there to, this is how I make that happen.

Wonderful. And I love that that tie in it's if we all talk about. The word of mouth is the way to network about our practice. But I love hearing stories about the word of mouth, about DPC as a model is getting out to other physicians and inspiring other physicians to, to learn about the movement and to potentially jump in.

On your website. In addition to talking with your dad, you had also talked about having a conversation with your sister about your practice. And so I want to ask about that conversation because speaking with somebody who is a non-medical professional is sometimes very different than when we talk to a physician, especially who is understanding of the fee for service model.

Right. So with my sister, it's interesting because she was kind of the one that even pushed me to start thinking about, you know, providing the service to people.

She was really struggling with feeding her daughter. And the first time they came to visit her daughter was about two months old. And our second child was also about two months old because. They use within like two weeks of each other. And she came here and she was just always feeding her baby. And so we sat down and I asked her, you know, is it okay if I try to help you?

This was before I had done any training or anything. And it was like, she was uncomfortable. Her baby was uncomfortable and it didn't seem like she was getting any milk. So we talked through it and figured it out together. And you know, it, it was crazy because when she was leaving. My house is when she was like, you should do this for other people.

Like what, you know, you actually understand the medicine and you've breastfed your babies. Your, you know, your first baby, you went through a lot of struggles and it just makes sense for you to provide this as, as a service to other people, because you could really help them with your medical knowledge in addition to the lactation portion.

And I was kind of like, yeah, right. You know, I don't know. That's not, you know, how, how am I going to make that work? I have all these little kids at home and now. The focus on my nonclinical work and all of that. And she was like, I don't know Nythia but you need to figure it out. And so it was maybe like six months later when I talked to her Becca.

So it was like six months of just thinking and trying to figure out, you know, is there even a way that I can make this work that would make me happy. And then after talking to Rebecca, I talked to my sister again. I was like, Hey, I think I'm going to do this. That's awesome. Just let me know what I can do.

And I explained to her, you know, I don't, I don't think I can take insurance. Like I just can't do it and run, uh, you know, have a small practice. And she was like, I mean, I think it makes sense. I think this is a service people need. I think it's a service that very few people offer. And if you put it out there, I feel like moms are going to come to, to get that help because they just can't get it anywhere.

And you know, it just, I think that she was very accepting of it because she had gone through that and knew how. Pain and struggle. She went through and in a place where she couldn't find anyone to help her, like everyone was like, it's going to be fine. Just keep going. It's you know, and I think there's this tendency to do that to new moms, like just push through it.

It's going to be okay. And sometimes, no, it's not okay. You know, someone can help you. And that, that was kind of her whole reasoning. She was. You know, I think you should do this. And I think you can do this because it's a space where people need help and they're not able to find the help they need.

And for you, as you explained earlier, you have skin in the game in terms of you understand that it's not just, Hey, I gave birth to your baby.

And now the baby's eating no problem. As his fellow physicians, we've seen that it is not a hundred percent where a baby will go from being born to breastfeeding successfully. And as you're describing like you and your sister experienced challenges, when it came to.

Successful breastfeeding. And so when I look back into my own training, in terms of working with IBCLCs and the hospital, I loved the IBCLCs that I worked with . There are amazing people, but it's similar to when we choose to not do fee for service medicine. Had expressed the frustration when it comes to , not really having time with their patients and on the receiving end of that.

Having had both of my babies in a hospital, you know, even, even when you're medically trained, when you're flipping exhausted, because you've just delivered a baby and then somebody tells you when you're half awake, How to breastfeed in 20 minutes, maybe for two days in a row, that's a really steep learning curve to be on when you have a new little one to take care of, you're exhausted, possibly in pain.

And then having to remember to breastfeed

yeah. And I think even as positions, you know, I, we don't get any training in breastfeeding, really very minimal training in breastfeeding.

And, you know, I, I think IBCLCs are wonderful if they do a great job at what they do, but they're not, they're not trained to think medically. So then when there's a problem, right, they're not really trained to think through, this is the differential diagnosis. This is how I manage it. This is what could be going on hormonally.

This is what could be going on physically, right? I mean, they, they're wonderful, wonderful, wonderful. What they do, but their role is not to be a physician. And unfortunately, you know, the way that breastfeeding is in medicine and in our culture, a lot of the times it's kind of not really talked about or understood.

And so, you know, I think it's a space that is thankfully growing. I think more people are getting interested in this field. But there's just not that many people doing it right now. So I'm just, I'm glad that I'm able to offer that service and hopefully, you know, able to help, help moms meet their goals and figure out what's going to work best for their families.

Because at the end of the day, that's, what's most important is to find what works for them, not to force an agenda on it on people or make them do something, but figure out a way to. Set up something that makes them happy. Right. And with direct care, I'm able to do that because we actually have time to talk to people and understand what their needs are and then figure out how to meet those needs with evidence-based personalized care

and a relationship that doesn't have to happen in the 20 minutes.

You know, you're allotted in the hospital, but you can have multiple conversations with a family if needed. So I want to ask about your practice specifically. So can you share when a patient finds Boston mamas, what does it look like in terms of the type of services that you provide as a physician?

So I I've got a couple of different options.

So I do have a fourth trimester package, and this is a more comprehensive package. It's a $500 total, but it's like four months of care. And so what I typically recommend is in that last month of pregnancy that people meet with me so we can assess what their goals are, understand what they would like go over kind of, you know, what to expect and how to establish a breastfeeding relationship.

So that way they have that knowledge. Before they're in the hospital postpartum possibly, you know, still with medications on their system. And. Totally the world has totally changed with this event. Right. So it's hard to focus in that situation. So I try to meet with them beforehand so we can go over.

What does breastfeeding look like? What can we do to plan for your fourth trimester in general? What support systems can we set up? So. But what kind of a person has it in the package? And then after delivery, we do two more visits. So one is right after delivery to check in, make sure everything's going okay.

Assess for any problems. And then I have another visit where I kind of leave it up to them, what they want to do with that, if they want to do, how do I do a return to work schedule, or if they have a problem. And then I have reduced rates for any additional visits. And I also offer text messaging support from whenever they start in their pregnancy through that fourth trimester, which is the first three months after they deliver.

And so they they're able to get text messaging support through that, and then they get those three virtual visits with me and then discounts on anything else. Uh, if they don't want to purchase the package, then they can just purchase each of those visits individually. So if someone just wanted a prenatal visit to get an idea of what they needed to do to prepare, they can do that.

If someone just needs to be seen postpartum, because they're having a problem, we can do that. Or if they want to set up a visit to figure out how to return to work, then we can do that as well. But I'll usually set that. More as like that post full postpartum visit. So we have time to discuss everything.

So the, the way that my practice is set up, it's like, I'm trying to give people options because I know that, you know, motherhood is, and parenthood is transformative. And a lot of times people don't know what they need ahead of time. So for those that like to plan or want to plan, I have that option to get that package during pregnancy.

For those that may just need to be seen for an acute visit. I also do offer more of, I guess, like a fee for service, individual visit option as well. Now

you mentioned earlier that you opened as a telemedicine only practice. Are you still offering telemedicine visits exclusively or are you doing in-person?