Medicine That Respects How You Birth, Live, and Heal

You chose a midwife because you believe birth is physiological, not pathological. You chose providers who listen. You chose a community that honors the wisdom of your body. Your primary care physician should share those values. I'm Dr. Ash, a board-certified internist, the founder of Fishtown Medicine, and a proud partner of the Magpie Midwifery community. I practice a model of medicine built on long appointments, genuine relationships, and the belief that you are the expert on your own body. I'm here to be your teammate, not your authority.

What I do: Integrative primary care, hormone optimization, pre-conception and postpartum support, metabolic health, and longevity medicine. What I don't do: Pregnancy, obstetrics, or delivery. That is your midwife's lane, and she is extraordinary at it. I am here for everything around it.

Why do Magpie families choose Fishtown Medicine?

Magpie families choose Fishtown Medicine because we share the same care philosophy: unhurried visits, shared decision-making, and seeing you as a whole person. The difference is scope. Where your midwife guides you through pregnancy and birth, I handle the medical landscape that surrounds it. If you have experienced Samm's care at Magpie, you know what it feels like to be truly heard. That is exactly how we practice medicine, too.

• Before conception: Optimizing your hormones, thyroid, nutrient stores, and metabolic health so your body is genuinely ready, not just "not preventing."
• Between pregnancies: Managing the metabolic shifts, nutrient depletion, sleep disruption, and hormonal recalibration that postpartum life brings.
• Beyond the childbearing years: Navigating perimenopause, cardiovascular risk, and the long arc of your health with the same intention you brought to birth.

What does Fishtown Medicine offer the Magpie community?

Fishtown Medicine offers the Magpie community a full range of integrative primary care services that complement midwifery, not replace it.

Pre-Conception Optimization

We call it soil before seed. Most doctors tell you to "try for 12 months" before investigating. We think that is backwards. We run a full diagnostic, including thyroid function, iron and ferritin (a measure of stored iron), vitamin D, metabolic markers, and hormone levels, then we optimize before you start trying. Your midwife manages the pregnancy. We help you build the foundation. Relevant reading: Fertility Optimization | The Prenatal Supplement Trap

Postpartum Recovery and Nutrient Repletion

Growing a human is metabolically expensive. We see new parents months or years after birth still running on empty: depleted iron, crashed vitamin D, low thyroid function, hormones in disarray. We test, we identify the gaps, and we replete strategically.

Hormone Health Across Your Life

From PCOS to perimenopause to full menopause, hormones shape how you feel, think, sleep, and heal. We prescribe bioidentical hormone therapy (BHRT, hormones molecularly identical to what your body makes) when the data supports it. We push back on the "your labs are normal" dismissal that so many women hear. If you do not feel right, your labs may not be optimal. We dig deeper. Relevant reading: Women's Hormone Health | Perimenopause | PCOS | Menopause 3.0

Metabolic and Longevity Medicine

We track what most doctors do not: insulin resistance years before diabetes shows up, ApoB and Lp(a) for true cardiovascular risk, inflammatory markers, and the metabolic shifts that accelerate aging. Prevention that is proactive, not reactive.

Nervous System Support

Dysregulation is real. Whether it is postpartum anxiety, chronic stress, or trauma stored in the body, we integrate somatic tools (physiological sighs, vagal toning, co-regulation strategies) alongside medical care when needed. We believe healing happens in connection, not in isolation. Relevant reading: Nervous System Regulation

Affirming, Trauma-Informed Care

Every body is welcome here. We use chosen names and pronouns, we practice proportional inquiry (asking only what we need), and we create a clinical environment where you never have to brace yourself. Care should feel safe. Relevant reading: Affirming Care Standards | Trauma-Informed Care

How is this different from typical primary care?

This is different from typical primary care because the structure of the visit, the lab targets, and the access are all built around partnership instead of throughput.

Traditional Primary Care	Fishtown Medicine
8-minute appointments	90-minute initial intake, 30 to 60 minute follow-ups
"Your labs are normal"	Optimal ranges, not just reference ranges
Wait weeks for an appointment	Text or call your doctor directly
See a different provider each time	Always Dr. Ash
Reactive: treat when sick	Proactive: optimize before problems emerge
Dismissive of integrative approaches	Functional medicine lens with prescriptive authority

How do we complement your existing team?

We complement your existing team by adding the medical bridge between holistic providers and the prescription pad. You probably already work with providers from the Magpie community: a chiropractor, an acupuncturist, a pelvic floor therapist, a naturopath. That is wonderful. We do not replace any of them. What we add is the medical bridge: ordering imaging, prescribing bioidentical hormones, interpreting complex bloodwork, and catching the things that need an MD's scope, while speaking the same language your holistic team speaks. Think of it as having a doctor who can write the prescription and understand why you would rather not take it unless it is truly necessary.

The Membership

Fishtown Medicine is a Direct Primary Care (DPC) practice, a membership model not based on insurance billing. That means:

• No copays, no surprise bills, no insurance middleman.
• Unlimited visits, in person, video, or text.
• Same-day or next-day access when you need it.
• Home visits available in Philadelphia.
• Telehealth in 41 states for when life takes you beyond Philly.

We offer accessible pricing tiers because this model should be available to everyone, not only the wealthy.

A Note From Dr. Ash

I spent years in hospitals watching what happens when prevention fails: when the heart attack arrives, when the cancer is stage IV, when the autoimmune disease has been quietly building for a decade without anyone looking. That experience did not make me cynical. It made me focused on intervening earlier. I founded Fishtown Medicine to practice the kind of medicine I would want for my own family: unhurried, thorough, grounded in evidence, and deeply respectful of the person across from me. The Magpie community represents what I admire in healthcare: autonomy, trust, presence, and the belief that the person receiving care should be an active participant in it. I am honored to be part of your village. Dr. Ash

Scientific References

1. ACOG Committee Opinion No. 762: Prepregnancy Counseling. Obstetrics and Gynecology. 2019.
2. Bodnar LM, et al. "Maternal Vitamin D Status and the Risk of Mild and Severe Preeclampsia." Epidemiology. 2014.
3. Alexander EK, et al. "2017 Guidelines of the American Thyroid Association for the Diagnosis and Management of Thyroid Disease During Pregnancy and the Postpartum." Thyroid. 2017.
4. The 2022 Hormone Therapy Position Statement of The North American Menopause Society. Menopause. 2022.