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Supporting Mothers in Their Postpartum Journey with Dr. Oscar Serrallach · Wellness by Designs - Practitioner Podcast

• 0:21
  Speaker 1: This is Wellness By Designs, and I'm your host, andrew Whitfield Cook.
• 0:24
  Speaker 1: Joining us today is Dr Oscar Serolak, the GP who specialises in postpartum care of women and couples, and we'll be discussing just that today.
• 0:35
  Speaker 1: Welcome to Wellness By Designs, oscar.
• 0:37
  Speaker 1: How are you?
• 0:38
  Speaker 2: I'm well, thank you, and thank you for the invitation, andrew, always enjoy talking with you.
• 0:42
  Speaker 1: Thank you, i've got to say our pre-recording chat.
• 0:46
  Speaker 1: I was blown away on several occasions.
• 0:49
  Speaker 1: So, everybody, you are going to learn some really important and new things today.
• 0:54
  Speaker 1: But before we get into the topic, oscar, could you just take us through a little bit of your career?
• 0:59
  Speaker 1: What led you to, firstly, integrative medicine rather than orthodox medicine, integrating both of those but also what caused you to specialise in postpartum care?
• 1:12
  Speaker 2: Yeah, i would have started life like many doctors had done.
• 1:17
  Speaker 2: My specialty in GP was working in the emergency department and running our local hospital in a small town, and I had a natural interest in functional medicine anyway, because I had grown up with homeopathy and acupuncture in my household wasn't an unusual concept, for example.
• 1:36
  Speaker 2: So it wasn't something that was too foreign to me.
• 1:39
  Speaker 2: And with the work that I was doing because I was the only doctor in the small town I was seeing everything And I saw a lot of people who had had tic and people who were sick after tic bites and living in moldy houses, and I was really finding that my toolbox GP toolbox wasn't really able to do much of these people.
• 2:03
  Speaker 2: So I started doing my functional medical training but at the same time that I was starting a family And, as I was learning about the properties of zinc or magnesium or the importance of having good cortisol levels, i was looking at recovering mothers and seeing that they were quite a separate group And there's a lot of things going on for them that were either unique or quite exaggerated in terms of a lot of the functional themes that I was learning about, and so I just decided to do a deep dive essentially into all things mother in terms of the physiology, hormones, what might be going on from a nutrient point of view, and obviously it's a massive transition for a woman psychologically, socially and spiritually.
• 2:57
  Speaker 2: But I was not aware of how profound it was biologically, and so that's sort of started my journey.
• 3:07
  Speaker 2: I wrote a book, i sort of toured with that book And now I've just been just talking to audiences and just seeing mothers in my GP clinic in Byron Bay And it's a fascinating topic.
• 3:22
  Speaker 2: The research is really increasing.
• 3:25
  Speaker 2: So the last five years there's probably been more research in the maternal brain, the maternal immune system, and there has been leading up to that point.
• 3:33
  Speaker 2: So it's a very exciting time to be tuning in.
• 3:37
  Speaker 2: But it's also a very new field.
• 3:40
  Speaker 2: There's a lot that's not known And so but this is why you're sort of mentioning about buckle up, because what is known out there is quite profound and really talks to the fact that mothers should probably be in their own separate group within medicine, because there's so much going on that's unique and different and seems to be permanent.
• 4:05
  Speaker 1: So It's amazing, though, how, as you say, how little was taught previously that it was almost glossed over as, oh yeah, it's just like having breakfast or doing a bowel movement, You know it's like, oh yeah, it's just part of life.
• 4:22
  Speaker 1: No, it's not.
• 4:23
  Speaker 1: Look, there's profound changes, And but also even the hormonal actions and interactions that we see, like our conversation.
• 4:35
  Speaker 1: You were blowing my mind on several occasions, and I've since read up and watched a couple of talks that you did, And it's fascinating.
• 4:43
  Speaker 1: So I have to warn everybody we cannot by any means cover in depth what we're going to be discussing today.
• 4:52
  Speaker 1: This is going to be a little wet your appetite piece, And then, hopefully, that will lead you to learn further on from Oscar's other talks and from other people, obviously.
• 5:02
  Speaker 1: So take us now through the changes that take place in the woman's body.
• 5:09
  Speaker 1: I mean, we're talking about, we think about, during pregnancy and maybe just after pregnancy, the postpartum period, but obviously this starts way before, doesn't it?
• 5:24
  Speaker 2: And then your comment before about after an event.
• 5:28
  Speaker 2: Postpartum just means after the birth, and I was just talking about after an event.
• 5:31
  Speaker 2: We're not really talking about the transformation.
• 5:34
  Speaker 2: So I think we're hearing more and more people use the term matrescence, which is the becoming of a mother, and it purposely rhymes with adolescence, which is the becoming of an adult, which is also a massive transformational time, and everything that happens in adolescence happens in matrescence with a factor of two or three, sometime, when you think, the brain changes or monal shifts, and so let's just start talking about sort of some of them.
• 6:08
  Speaker 2: So, obviously, when the pregnancy starts, the placenta is the first and it really starts to grow And people, we have to understand that the woman is growing another organ So that in itself is just a profound thought And that organ.
• 6:28
  Speaker 2: Most people think the placenta is a fancy filter, and yes, it is a filter, but it does so much more than that And possibly its primary job is as a hormone factory, and so the placenta is churning out hormones of a degree that the mother's body and brain have never experienced before.
• 6:51
  Speaker 2: A mother's brain is exposed to more estrogen in a single pregnancy than for her entire non-pregnant life, just to give it some context, and the levels of the 200 plus hormones that the placenta produces goes from a lot to more And it keeps increasing during the pregnancy.
• 7:14
  Speaker 2: Researchers actually call it an endocrine tsunami And I think that probably sums up what is happening.
• 7:21
  Speaker 2: But it's balanced, so there's not even though cortisol goes three times above what a mother's body would usually make.
• 7:29
  Speaker 2: It's balanced with all the other hormones progesterone and estrogen and a lot of these other hormones that become brain hormones, neuroactive steroids.
• 7:42
  Speaker 2: So it's those neuroactive steroids that go on and start sculpting and modifying the mother's brain, starting with the paraventricular nucleus, which is the anxiety center of the brain, if you like, but it's also in the middle of the hypothalamus, which is the hormonal response center of the brain, and it kind of remote desktops into the mother's brain, puts a pause on her stress response system to enable these modifications to occur, because otherwise, if that didn't happen, the mother's brain wouldn't have a bar of this in terms of the changes.
• 8:25
  Speaker 2: So you get this immune adaptation and you get this kind of overriding And then the brain changes are massive And we're still working out a lot of those brain changes because they occur mainly in structures that are deep inside the brain.
• 8:41
  Speaker 2: So not easy to look at in terms of even the latest MRIs, those kinds of things.
• 8:50
  Speaker 2: But what it is known, the biggest part of the brain that gets upgraded, and pretty quickly, is the olfactory bulb, the taste and smell.
• 8:59
  Speaker 2: Oh yes, mothers in first trimester often have a lot of nausea.
• 9:04
  Speaker 2: They have a whole change in the sense of smell, the bionic nose that I frequently hear mothers talking about, and then taste diversions and taste cravings.
• 9:20
  Speaker 2: That's not by accident.
• 9:21
  Speaker 2: That's all due to the roadworks that are going on And there's lots of synaptic pruning that goes on, lots of new neurons that are getting grown.
• 9:30
  Speaker 2: The average mother's brain shrinks between five to 8% during pregnancy And it usually reforms by six months postpartum.
• 9:39
  Speaker 2: But it just gives you an idea of the amount of sculpting that's going on And other parts of the brain that get upgraded, if you like.
• 9:49
  Speaker 2: So we talked about smell and taste.
• 9:52
  Speaker 2: Emotional quotient goes up quite a bit, iq goes up slightly, visual security, facial recognition, social reasoning and a lot of the parental circuitry.
• 10:06
  Speaker 2: I mean, the part of the brain that gets the biggest upgrade and they've only just found this out in the last six months is the default mode network.
• 10:13
  Speaker 2: So the default mode network has different structures in the brain and they get heavily modified.
• 10:19
  Speaker 2: So what does that mean?
• 10:20
  Speaker 2: The default mode network is your self representation, your sense of self.
• 10:27
  Speaker 2: When you're not thinking about yourself, who do you think you are?
• 10:30
  Speaker 2: The default mode network is responsible for that Our daydreaming.
• 10:37
  Speaker 2: Are we a good person?
• 10:39
  Speaker 2: Are we, do we have courage?
• 10:41
  Speaker 2: Do we not have courage?
• 10:42
  Speaker 2: A lot of that is in the default mode network.
• 10:46
  Speaker 2: And if that's getting the biggest upgrade, what's going on there?
• 10:49
  Speaker 2: The mother is basically been profoundly changing her sense of who she is Adaptive maternal behavior.
• 11:01
  Speaker 2: She is getting changed, getting the software and hardware upgrade, if you like, to enable her to become a mother.
• 11:09
  Speaker 2: This happens with every pregnancy, so it's not done and dusted like in adolescence.
• 11:13
  Speaker 2: You know you go through adolescence once you go through matresons with each pregnancy And it's not a free lunch And what I mean by that.
• 11:24
  Speaker 2: It's a time of vulnerability as these brain changes try to recalibrate these brain hormones to come back online in the postpartum, and we know that adolescent goats are a bit of a wobble in terms with their adult brain.
• 11:41
  Speaker 1: They don't know.
• 11:43
  Speaker 2: And that can take a year or two before they're.
• 11:46
  Speaker 2: But we understand that.
• 11:48
  Speaker 2: We give adolescents the grace, the time, the support to work through things And we know, once they come good, they are good.
• 11:58
  Speaker 2: You don't go back to the wobble, and during matresons I think it's very similar but probably more profound, and she has a change of who she thinks she is, without her even knowing or consenting to that.
• 12:12
  Speaker 2: And so the placenta is there doing all this stuff, getting the mother ready for her new job, if you like.
• 12:20
  Speaker 2: But just as you don't become an adult at your 18th birthday it's just an important event You don't become a mother at the birth of your child.
• 12:31
  Speaker 2: It's just obviously a very important event.
• 12:33
  Speaker 2: But you have to learn motherhood And so this is a time of vulnerability.
• 12:40
  Speaker 2: And again, what happens when the baby is born is that you birth a placenta, so you lose your hormone factories.
• 12:46
  Speaker 2: This is very different to adolescents, because adolescents often stay in a very high hormonal state And then they just kind of trickle down to a baseline, whereas a mother goes from extremely high to zero in some cases for things like cortisol, progesterone, estradiol, just to name a few, and those hormones not only have body effects but they also have really important aspects in terms of maintaining healthy brain function.
• 13:21
  Speaker 2: And when these brain hormones neuroactive steroids can't do that, so they're deficient or out of ratio, they contribute to all the known issues of postpartum, which includes fatigue, depression, anxiety, obsessive compulsive disorder and possibly they're not too sure yet about bipolar and psychosis in the postpartum.
• 13:46
  Speaker 2: They still have to do the research in that.
• 13:49
  Speaker 2: So I basically came up with a word postnatal depletion, to describe all the things on a spectrum, because it's a neuroinflammatory spectrum that we're talking about in terms of mild, moderate to severe, where the depression, ocd, anxiety, more on the severe end.
• 14:08
  Speaker 2: There was nothing really conceptually to talk about the mild to moderate end of that spectrum, though the symptoms have a lot of overlap, so there wasn't a word there.
• 14:19
  Speaker 2: So I came up with the word postnatal depletion to at least give it a name going.
• 14:23
  Speaker 2: Okay, well, there's something still neuroinflammatory going on in any mother who has fatigue, brain fog, hypervigilance, difficulty sleeping, though, despite the fact that she's probably very tired, and so and this is a amazing orchestration of things that is very prone to going wrong, especially in our 21st century.
• 14:51
  Speaker 2: We don't think in very maternal ways as a society and we don't really support mothers in a way that is very conducive to good recovery in that first year postpartum, and I'm just talking about a few days or a few weeks.
• 15:08
  Speaker 2: I'm saying that first year is crucial because of that high degree of neuroplasticity that's still present, at least up until that first year.
• 15:22
  Speaker 1: I was just, i was thinking when I was learning more about these.
• 15:26
  Speaker 1: You know the fear, the anxiety centers being initiated.
• 15:29
  Speaker 1: It reminded me of an evolutionary perspective And I was thinking about kangaroos and elephants and mammals that can keep a pregnancy on hold, that can cast out a fetus if the threat to the parent, if you like, is too great.
• 15:52
  Speaker 1: So you know whether that be environmental or predator.
• 15:57
  Speaker 1: I was just.
• 15:59
  Speaker 1: I was really interested about these parallels that you were discussing and I was going, oh yeah, that makes so much sense when you're thinking about protection of the species.
• 16:09
  Speaker 1: Mother, first, carry the fetus when you can.
• 16:12
  Speaker 1: But what I feel is going on is that, just like our, you know, stressors of everyday life, if you see elephants, they'll look after the mother and the newborn.
• 16:25
  Speaker 1: That doesn't tend to happen in the 21st century with humans, you know, with isolation and lack of family ties and lack of social connections and things like that.
• 16:38
  Speaker 1: So I was sort of trying to bring all of this community and sociability sort of aspects into how they affect the physiological and how they cause a dysfunction rather than a natural progression of this.
• 16:58
  Speaker 1: You know, normal fear, hypervigilance, sleeplessness, to excessive hypervigilance, sleeplessness, da da da.
• 17:07
  Speaker 1: It was really interesting to me.
• 17:09
  Speaker 1: One of the things that I have to ask you, though, to comment on was the genetics of the placenta Cause this blew my mind.
• 17:19
  Speaker 2: Well, one of the fascinating things about the placenta is genetically it's almost all the male, the father, and even though baby makes a placenta, it belongs to the baby.
• 17:32
  Speaker 2: The interface is a crucial part of what enables the pregnancy to move forward in a healthy way or not, and there's a lot of action that has to occur at that interface.
• 17:47
  Speaker 2: The placenta is serving two masters, obviously from a resource point of view, the mother and the child.
• 17:53
  Speaker 2: And if the placenta invades too much into the mother, you start to get all the issues of preeclampsia, gestational hypertension and gestational diabetes, just a name of few, and if it doesn't invade far enough, then you can start to have growth restriction and other issues in terms of the things.
• 18:15
  Speaker 2: So it's a very delicate dynamic that's going on, and when we look at nature, there's often some understanding from other animals about care of the mother.
• 18:30
  Speaker 2: We also know that mothers can be unusually aggressive in the postpartum in terms of the mother bear phenomena, and this is again to do with brain modifications, because the mother has a bigger sense of self and her and the baby are basically part of her.
• 18:51
  Speaker 2: And then we have something very interesting called exogestation, which, because human babies are born so helpless if we were to birth similar to other mammals, we'd probably be birthing between 20 to 22 months.
• 19:07
  Speaker 2: We couldn't hold a pregnancy that long, so birthing even on the due date at nine months, the baby is born premature, so to speak.
• 19:18
  Speaker 2: It can't really do anything.
• 19:19
  Speaker 2: It can't hold onto the mother's fur, it can't stand up and run away from her predator.
• 19:27
  Speaker 2: It is really helpless.
• 19:28
  Speaker 2: And so mother natures worked out some extra things to get the human mother involved with the human baby, and they are the addiction pathways.
• 19:40
  Speaker 2: And so it's quite possible it was actually quite probable that the addiction pathways are an ancient maternal mammalian pathway that have been really enhanced for humans.
• 19:52
  Speaker 2: So the mother becomes addicted to her baby, and this is part of the hypervigilance of the babies.
• 19:59
  Speaker 2: Away too long from the mother, she can get quite anxious, and it really explains a lot of what's going on with the stillbirth, where the mother doesn't have the baby to give her that drug like effect through oxytocin and prolactin.
• 20:16
  Speaker 2: So she's literally going through like a drug withdrawal on top of the social and spiritual grieving that she's going through.
• 20:23
  Speaker 2: So, yeah, so this is a very elaborate orchestration that's very prone to disruptions, especially in the 21st century, because we don't honor that first year postpartum.
• 20:39
  Speaker 2: We don't understand that mothers need to rest like they've never rested before.
• 20:44
  Speaker 2: We don't understand that they need to be socially connected, but not socially pressured more than they ever have before.
• 20:52
  Speaker 2: So they really need to feel part of their community or their tribe, but they shouldn't have to have the responsibilities of socializing whereas the focus is just looking after the baby.
• 21:13
  Speaker 2: And so, and especially Australian culture, we have a very she'll be right We've masculized a lot of motherhood really, and just left, have left the mother to her own devices, and we have this myth of the super mother or the super mother who can do it all with no help.
• 21:33
  Speaker 2: And it's almost seen as a sign of weakness and some cultural norms that if the mother is needing help where it's, for me it should be turned around the other way, that it's not possible to give that mother too much support and she's going to need everything that people can give her.
• 21:52
  Speaker 2: And if we do that, like the adolescents who's stumbling in the dark with their journey, that matrescent mother will come good and she'll be better than she's ever been in terms of just how she's feeling and her centeredness and her ability to better turn up to her life in a way that she would like to.
• 22:19
  Speaker 1: Yeah.
• 22:21
  Speaker 1: So again, just thinking about the care in the postpartum period, we really need to think about setting up that care way earlier.
• 22:31
  Speaker 1: So again, that connection, that that preparation for not just the pregnancy but also after the pregnancy needs to happen, social connections, things like that, that needs to happen way before.
• 22:43
  Speaker 1: It should be part of preconceptual care.
• 22:47
  Speaker 2: Yeah, ideally the the idea of matrescence is understood before we even get pregnant with a child, because that would be a true enrollment in the journey rather than a workout parenthood once I'm there.
• 23:03
  Speaker 2: And there's a saying in postpartum care that everyone prepares for the marriage.
• 23:10
  Speaker 2: No one prepares for the wedding.
• 23:15
  Speaker 2: No one prepares for the marriage, no one prepares for the birth, no one prepares for the postpartum.
• 23:21
  Speaker 2: And we should really be talking about postpartum care as early as we can, but definitely during the pregnancy and understanding.
• 23:32
  Speaker 2: Okay, you're going to need to have a time of rest and support where we need to give you permission not to go out there and do too much and we need you to recover because if you don't, weird things are going to happen, like depression, anxiety, hypervigilance, fatigue.
• 23:53
  Speaker 2: And what's interesting is that traditional cultures, even though they didn't call it neuroinflammatory problems in the postpartum, they had their own language for this.
• 24:03
  Speaker 2: They knew the potential for mothers to go into this state And so they.
• 24:09
  Speaker 2: This is why traditional cultures often have quite elaborate language, concepts, ceremony and care around the mother, and many cultures the mother is not allowed to do very much for four or six weeks.
• 24:24
  Speaker 2: There is a lot of support that turns up, whether she likes it or not, and once she's good, she's back to a busy life.
• 24:35
  Speaker 2: So it's not like these cultures are being nice, they're just being pragmatic.
• 24:40
  Speaker 1: So we've gone through some of the changes and you know some of the many changes that happen in pregnancy and even leading into the postpartum period.
• 24:51
  Speaker 1: But can we differentiate between a normal fatigue that a pregnant woman, that a new mother, sorry will experience, because that is just part of the recovery process?
• 25:07
  Speaker 1: true, but how do we differentiate between that and postpartum depletion?
• 25:13
  Speaker 1: when does it become a problem that we need to go?
• 25:17
  Speaker 1: you need help.
• 25:19
  Speaker 2: Well, that's a great question yeah, that's a great question and my comment to that really is if your average mother loses 700 hours of sleep in the first year, and so I'm always thinking, okay, if someone's just got sleep loss, if they have a few nights good sleep, they should come good.
• 25:43
  Speaker 2: If someone's just recovering from surgery, it takes them a little while to recover, but those should come good relatively quickly.
• 25:50
  Speaker 2: If someone's anemic or iron deficient, those things can be corrected relatively quickly.
• 25:57
  Speaker 2: And so it's when you recognize, okay, there's something going on here and the thing that would typically help that an adult getting enough sleep, topping up nutrients that are deficient, and things don't turn around relatively quickly, you know you're probably dealing with some sort of neuro inflammatory component, and these neuro inflammatory issues in mother's experience are unique.
• 26:26
  Speaker 2: They don't occur in other adults.
• 26:29
  Speaker 2: The research is quite clear on that.
• 26:31
  Speaker 2: So and so we shouldn't really be calling it depression or anxiety.
• 26:37
  Speaker 2: We should be calling it post-metal neuro inflammation with dot, dot, dot, and you can put the symptoms in there, whether it be fatigue, whether it be hypervigilance, anxiety, depression, because when we talk about depression we we think about all types of depression being very similar, sorry, yeah so when we're talking about neuro inflammation being the antecedent, is that the right word?
• 27:07
  Speaker 1: the core thing at the center of it?
• 27:09
  Speaker 1: We would think about things interceding with things that will dampen neuro inflammation.
• 27:18
  Speaker 1: Things like, as you mentioned, good sleep, some exercise, social connectivity we've discussed but then things like nutrients that we commonly use magnesium, fish oils, perhaps phosphatidylserine, blah, blah, blah.
• 27:35
  Speaker 1: Are these of use?
• 27:36
  Speaker 1: Oh, forgive me, how could I not mention the beautiful herbs we have at our disposal?
• 27:40
  Speaker 1: So is this where we intercede?
• 27:44
  Speaker 1: or do we really need to pull back and look at the support network as the foundation you know, and really make sure that that's being done before any supplements are given?
• 27:55
  Speaker 1: How do you stratify it?
• 28:00
  Speaker 2: Yeah.
• 28:00
  Speaker 2: So support is fundamental, and I don't think you can supplement your way past the lack of support, though sometimes you need to because it supports very hard to get.
• 28:10
  Speaker 2: But on that foundation of support, then, yes, a lot of these herbs, for example, help reduce the heightened stress response And then that helps reduce neuro inflammation.
• 28:25
  Speaker 2: Having enough iron, for example, helps significantly with neuro inflammation because of the parts of the brain that require iron for metabolism.
• 28:33
  Speaker 2: Fatty acids of all types are obviously very useful.
• 28:38
  Speaker 2: B12 as a methylating agent if it's deficient, is going to be problematic.
• 28:44
  Speaker 2: And fish oils DHA, i think, can be quite important.
• 28:51
  Speaker 2: Coalene can be quite important.
• 28:52
  Speaker 2: There's so many things that, and it's not a matter of going, oh, you need to be on the perfect supplement regime.
• 29:00
  Speaker 2: It's much more just understanding.
• 29:02
  Speaker 2: Okay, when are the supplements useful?
• 29:05
  Speaker 2: Support first, and then I always go.
• 29:09
  Speaker 2: Nervous system practices second, which is about modulating the stress response, because that stress begets stress, especially in a neuro inflamed brain, unfortunately.
• 29:19
  Speaker 2: And it's not about avoiding stress because, mom, life is full on on a good day.
• 29:29
  Speaker 2: It's about making sure there's enough relaxation to offset the stress, and so sleep is obviously the big thing that we do.
• 29:37
  Speaker 2: So we're not getting enough sleep.
• 29:38
  Speaker 2: What else can we be doing?
• 29:39
  Speaker 2: And so I'm coaching a lot of my mothers about trying to get very small chunks of rest, which may just be some breath work, some larger chunks of rest, which might just be a micro nap or a guided meditation or a gratitude practice, and then we're moving into things longest, things that we're doing weekly or twice a week, such as a good massage or restorative yoga session, things that we can go deeper into, that relaxation That can imply profoundly on helping with neuro inflammation.
• 30:12
  Speaker 2: And so I think it's a multifaceted approach in terms, but as a practitioner, you need to then have some understanding of all those facets about sleep, about regulating stress, about nutrients, about diet, about social wellbeing, and then about some of the neurobiology of what's going on as well.
• 30:39
  Speaker 2: And just to give it a case and point, andrew, some people are aware of this, but the first ever approved drug for postpartum depression came out in America 2019.
• 30:51
  Speaker 2: It's not available in Australia yet, and it's essentially a synthetic placental hormone that they infuse into the mother, which many times will switch off in your inflammation within a short time period And wow.
• 31:08
  Speaker 2: And so it's really talking to the fact that you've got a unique solution for a unique problem.
• 31:15
  Speaker 2: It's a very expensive solution if you're looking at the American costs, and ideally we're trying to help support mothers so they never need to use the big guns, so to speak.
• 31:31
  Speaker 2: But to know that there's been research down on that And they're going to phase three trials for the second time now to figure out why their wonder drug isn't working in men or women who haven't had children, and so it's because they haven't been placentally modified, i think they're all fine.
• 31:50
  Speaker 2: So I'm baited breath with that research because it talks to the unique landscape of motherhood and also talks to the maternal brain and why we should be more aware of that And just really hoping that there'll be much more research coming out in the next decade to help guide treatments and help guide prevention That the moment we just have to join dots and sometimes those dots are quite distant.
• 32:27
  Speaker 1: Yeah, yeah.
• 32:28
  Speaker 1: But given that there's a lot of not just physical but also social implications of postpartum depletion, even if you want to take away from the mother and you want to think about the offspring, that lack of connectivity, that lack of, as you say, addiction to the newborn, the imprinting of stresses from the mother, biologically but also emotionally, onto that newborn will follow through and have consequences for that offspring growing up but later in life.
• 33:05
  Speaker 1: So there's so many reasons why looking after the mother is so important.
• 33:10
  Speaker 1: It's not just for the mother.
• 33:14
  Speaker 2: Yeah.
• 33:15
  Speaker 2: so the human cost of not looking after the mother is not only to her but also to that family and then to the trajectory of that child.
• 33:24
  Speaker 2: And there's significant research showing that if the mother has too much inflammation during pregnancy, her offspring will be neurobiologically disadvantaged And they're realizing now that autism is a condition that starts in the womb.
• 33:45
  Speaker 2: Possibly a lot of the ADHD and neurodiverse issues may be related to that as well.
• 33:54
  Speaker 2: And there's research showing that if a mom's iron deficient significantly iron deficient during pregnancy, her child will have a significantly lower IQ at the age of 10 from that pregnancy.
• 34:08
  Speaker 1: Thank you very much.
• 34:10
  Speaker 2: I think, is.
• 34:11
  Speaker 2: I mean, that's again.
• 34:12
  Speaker 2: It should be a hot topic.
• 34:13
  Speaker 2: It's something that we yawn about sometimes when we hear it, but it's super important in terms of just an IQ point of view.
• 34:20
  Speaker 2: And then breastfeeding so the mother's really anxious and not supported.
• 34:25
  Speaker 2: She's less likely to breastfeed.
• 34:26
  Speaker 2: And interesting statistic that I came across recently if if we included breastfeeding on to the Australian GDP as a cost, it would cost three billion dollars to the Australian economy.
• 34:41
  Speaker 2: But if we added the yearly cost of of reductions in breastfeeding because of where we could be and where we're at, that cost the Australian government six billion dollars in terms of lost work productivity because of reduced cognitive capacity in children as they grow up to be adults and then they're in the workplace.
• 35:06
  Speaker 2: So not breastfeeding doubles your cost.
• 35:10
  Speaker 2: Well, no.
• 35:10
  Speaker 2: So the breastfeeding, just as a cost, if you had to replace it with something else is three billion dollars.
• 35:16
  Speaker 2: But then the cost to the economy if we improved our breastfeeding rate from where it is to where it maximally could be.
• 35:25
  Speaker 2: So they think about 90 to 95% of mothers could breastfeed, given the right supports and and education, but only 47 to 52% of mothers breastfeed beyond a few months.
• 35:45
  Speaker 2: There's a lot of social pressures, there can be a lot of stressors and breastfeeding is not an easy thing.
• 35:51
  Speaker 2: People make out like it is straightforward and easy.
• 35:56
  Speaker 2: It's a very challenging task to learn, both the baby and for the mother.
• 36:00
  Speaker 2: But given the right support excuse me, given the right support, when children breastfeed, their IQ is better.
• 36:11
  Speaker 2: So this is something that we don't talk about enough in terms of being truly informed and truly enrolled into the journey because of those that the neurodevelopmental effect of from that chart.
• 36:29
  Speaker 2: So, whether it's iodine, whether it's breastfeeding, whether it's having enough iron, whether it's good attempt of social interaction with the mother because she's feeling good about herself and her life and she's not depressed and she's got reasonable energy, that's going to significantly change her interactions with that child, especially very early on.
• 36:57
  Speaker 1: So just looking at the patients that come and see you, that seek you out, i'm going to guess that because of the demographic that you're going to be attracting, that the people from around the northern rivers they're going to be all over the place, the northern rivers they're going to be already aware of these things largely not totally, obviously.
• 37:18
  Speaker 1: But do you find, when you speak to colleagues who embrace what you teach, that there really is this you've got to sell the care.
• 37:31
  Speaker 1: You've got to sell that you need to put in here looking after the mother so that she can get enough sleep and rest, rest, recuperation, so that she can take care of your baby, and that will have tenfold payback down the line when you don't have a stressed child or adolescent, when they're not overcome with anxiety.
• 37:57
  Speaker 1: So you've got to look in here, you've got to put in the the hard work here to look down there.
• 38:02
  Speaker 1: Is that something that you teach your colleagues?
• 38:06
  Speaker 1: is that something that they report?
• 38:09
  Speaker 2: Well, i definitely are blowing that trumpet, so to speak, but we live in a society that thinks very short term, especially politically, and I'm always looking to the Baltic countries and the Scandinavian countries, because they invest a lot more into the postpartum.
• 38:36
  Speaker 2: Many of these countries will have one to two, up to two years of paid paternal leave, and sometimes at 100%, sometimes at 80%, but they really understand that investing in mothers early on pays off down the track.
• 38:58
  Speaker 2: But these countries are much more socialistic than we are.
• 39:01
  Speaker 2: Yeah, yeah, and even though we are in the process of increasing our paid maternity leave, we're still way down the list of countries when you compare it to the world, and it's at a 42%, i think we're currently at in terms of.
• 39:17
  Speaker 2: So there's a big gap between what the mother was earning and then what maternity leave will pay her, and so I think on that level, it's really important to honor and understand.
• 39:26
  Speaker 2: It has to be with education as well, and it shouldn't be a difficult sell when you can pull out numbers that are as significant as when we're talking in the billions of dollars in terms of cost savings to society.
• 39:44
  Speaker 2: But they're long term.
• 39:44
  Speaker 2: They don't happen in any political cycles that we're aware of.
• 39:50
  Speaker 1: Anyway, i know I'm jumping around a bit, but I want to go back to the supplements that you use and that you find important.
• 39:56
  Speaker 1: So we've covered off magnesium.
• 40:02
  Speaker 1: Do you tend to use faster magnesiums here, like the glycinate, aspartate or acetrates, Or do you tend to just go low dose trickle in magnesium, even the oxides, if it's less than like 100 milligrams per dose.
• 40:21
  Speaker 1: How do you wend your way with that?
• 40:25
  Speaker 1: Same with fish oil and coalene.
• 40:26
  Speaker 1: Can you cover off a few of those for us?
• 40:29
  Speaker 2: Yeah, sure, because of what we do into the oceans, microplastics and fish and fishing stocks, we're going to go to the original factory of DHA, which is algae.
• 40:48
  Speaker 2: So algae oil or fish oil And I'll do quite high doses in pregnancy and in the postpartum.
• 40:54
  Speaker 2: Fish with breastfeeding And coalene I think can be quite useful.
• 40:59
  Speaker 2: Coalene's been shown to be very useful to help with vascularization of the placenta, so it may be a treatment or a support for some of the.
• 41:10
  Speaker 2: Now I've even seen to see where the research goes with it but to maybe reduce the severity or the rates of things like preeclampsia or gestational hypertension, those kind of thing.
• 41:23
  Speaker 2: So it's used out earlier rather than once you've got issues.
• 41:27
  Speaker 2: Once you've got issues you try to put out a fire with a watering can.
• 41:32
  Speaker 2: It's not going to do it And so the DHA and coalene I think are really useful.
• 41:40
  Speaker 2: In terms of the micronutrients, ions are most important by far.
• 41:44
  Speaker 2: It's always testing, wanting to get the iron up to a good level And the ferritin needs to be at least 50, if not 70, ideally during pregnancy and in the postpartum.
• 41:58
  Speaker 2: Magnesium I'll often do a 24-hour urinary magnesium six-week postpartum to see where I'm at with that mother, because that gives me, i think the best indication of true magnesium stores I call magnesium mumnesium.
• 42:13
  Speaker 2: It's minerals, that does everything.
• 42:14
  Speaker 2: And so I'm happy to use mixed magnesiums, i'm happy to use creams, i'm happy to use its insults foot baths, and I do like the glycinate and citrate because they're well tolerated.
• 42:30
  Speaker 2: It can be quite relaxing to the nervous system.
• 42:34
  Speaker 2: So that's why I think we're not just treating it deficiency or insufficiency, we're actually really trying to help regulate this jumpy, hyperactive aspect of the polyvinyl system, which is magnesium can be quite useful for that.
• 42:54
  Speaker 2: And then zinc, i think it's also important.
• 42:56
  Speaker 2: And again, free copper can increase hugely during pregnancy and sometimes won't come down, and that will contribute to anxiety and your inflammation.
• 43:07
  Speaker 2: So zinc then becomes even more important, especially if you've got a mother whose anxiety prone beforehand in terms of before she was pregnant.
• 43:16
  Speaker 2: So zinc can be very useful.
• 43:18
  Speaker 2: And then B12, vitamin D I think these things can be very important as well because guess what?
• 43:28
  Speaker 2: Everything is a one way street to the baby.
• 43:30
  Speaker 2: So if the baby needs DHA to make its own brain, guess where it's going to get it from if mum's not supplementing?
• 43:39
  Speaker 2: Probably from the mother's brain, and it seems to be what kind of happens?
• 43:45
  Speaker 2: So it's not only is she giving her heart and soul, she's also giving her brain over to that baby.
• 43:52
  Speaker 2: So we need to be replacing those things Now.
• 43:57
  Speaker 2: Vitamin D is the only thing.
• 43:59
  Speaker 2: That's an even share between the fetus and the mother.
• 44:02
  Speaker 2: Everything else it's preferentially for the baby, and so we need to look at optimal levels, not just.
• 44:10
  Speaker 2: We don't have a vitamin D deficient mother, So maybe you can tolerate lowage vitamin D outside of pregnancy and postpartum, but we shouldn't tolerate that when we're dealing with someone who is pregnant or in the postpartum.
• 44:30
  Speaker 1: It absolutely stuns me that I still see many most scripts in a pharmacy arena being 1000 IU for pregnant women, for everybody 1000 IU, and yet the work has been done by Jenny Gunton at Westmead Hospital.
• 44:48
  Speaker 1: Now, admittedly, this is in a cultural area where they cover up and so they are at quite severe risk of deficiency, but there was data that she was using.
• 44:58
  Speaker 1: I think it was 4000 IU per day ingestation and it was safe, and I just don't understand why this isn't catching on.
• 45:08
  Speaker 1: We're speaking about iodine.
• 45:10
  Speaker 1: Creswell Eastman is tearing his hair out that the GPs aren't getting the message about.
• 45:14
  Speaker 1: It's a recommended thing from the NHMRC that women get 150 micrograms of our supplement, including our fortified bread of our supplement.
• 45:26
  Speaker 1: It's the first time, not folate, and then we've got folate, which I haven't covered, which I haven't asked about.
• 45:31
  Speaker 1: So do you prefer a certain form of folate?
• 45:34
  Speaker 1: Do you think folic acid will do?
• 45:36
  Speaker 1: What's your opinion?
• 45:39
  Speaker 2: Well, this is a contentious issue, and only from a TGA point of view.
• 45:45
  Speaker 2: So to call something an antinatal supplement, you need to have folic acid or folate, And, as we know, that doesn't occur in nature but the research has been done with that.
• 45:56
  Speaker 2: So a lot of the supplements that I see and that I use will have the folate and then they'll have activated folanates or 5MTHF in there as well.
• 46:08
  Speaker 2: And I think that that's just where we're at in the 21st century at the moment is we just have to have mixed folates one to be able to get the tick for it to be an antinatal supplement, just like you have to have the right amount of iodine and in there as well.
• 46:23
  Speaker 2: But then we want some activated forms just to help support those mothers who have genetic variants that may not be great at activating B9 or transporting B9 into the cell.
• 46:36
  Speaker 2: So we just now you can get lots into the detail of methylation genes and types of B9, but as long as we're getting sufficient amounts of different types, I don't see that being problematic.
• 46:54
  Speaker 1: Gotcha Sweet And also we covered off a few of the herbs.
• 46:59
  Speaker 1: But can we just delve into the herbs a little bit more, and maybe even some herbs that you might be cautious about, like, for instance, carver the effect on the baby.
• 47:09
  Speaker 1: If you're going to use carver in the mother, great herb, wonderful herb, but is it appropriate in this period when, hopefully, they're breastfeeding?
• 47:19
  Speaker 1: Can you take a switch now?
• 47:22
  Speaker 2: Yeah, definitely.
• 47:23
  Speaker 2: So that's something I've thought a lot about, obviously because I just want to find things that are going to be useful and that have to be safe.
• 47:31
  Speaker 2: And in where I work in Byron Bay, there is an assumption among some of my clients that cannabis is natural and therefore it's safe.
• 47:44
  Speaker 2: And obviously cannabis is not okay for a developing brain, especially the baby's brain, and it's probably not very good for the mother's brain, even though it may be very good for relieving symptoms of hyperemesis.
• 48:01
  Speaker 2: So, and the research is pretty black and white on that.
• 48:05
  Speaker 2: So this is why I tread very carefully with herbs.
• 48:09
  Speaker 2: So I look for safety and then I look for cultural use as well.
• 48:14
  Speaker 2: So my preferred herb is ashwagandha, because I'm happy to use that in second and third trimester, unless something's 100% first trimester we have to just be obviously cautious.
• 48:30
  Speaker 2: And then postpartum, there's good safety data with that.
• 48:36
  Speaker 2: There's a lot of hesitancy out there using herbs Carver I do like carver, but I just don't find myself using it because I can't be reassured that a breast-seeming mother the carver is okay.
• 48:50
  Speaker 2: I do like a lot of the mushroom herbs as well.
• 48:55
  Speaker 2: So Yukomia, those kind of things, because they've got good data about safety in pregnancy and in the postpartum, and I'm not a trained herbalist but I do like using herbs.
• 49:09
  Speaker 2: I'm always trying to bring in my naturopath or my herbicide dispensary to sometimes have a look at the art of herbalism as well, because when researchers look at herbs they're always wondering which herb is doing has having the most benefit when they do blends And the reason why they can't often figure it out.
• 49:31
  Speaker 2: Now, menopause is a good example.
• 49:33
  Speaker 2: Which herb helps with menopause?
• 49:34
  Speaker 2: None of them do.
• 49:35
  Speaker 2: They use it as a group.
• 49:36
  Speaker 2: They have quite a useful benefit And so I think sometimes the blending can be really useful And there are lots of options out there The ashwakandra I do like, yukomia I do like, and then also just trying to find which adaptogen works for that mother, because we're all different.
• 50:00
  Speaker 2: It's not that one herb is going to work well for everyone, So that's totally different.
• 50:08
  Speaker 2: You know the systems have had others have had different brain modifications and they're livable processings differently So and there can be a few unknowns in that world, but it's.
• 50:22
  Speaker 2: They seem to be very effective and you don't need to use them for a long time either.
• 50:27
  Speaker 1: Oscar, what's your call out for both Prachies and also patients?
• 50:32
  Speaker 1: obviously to learn more about this topic.
• 50:35
  Speaker 1: Now, you said at the beginning you've written a book.
• 50:38
  Speaker 1: You've also done some talks with ACNEM, teaching practitioners.
• 50:44
  Speaker 1: What other resources in fact?
• 50:49
  Speaker 1: firstly, take us through your book, because I think that's going to be a really important one to learn all about it.
• 50:54
  Speaker 1: So is that Mother Brain that I see behind you?
• 50:58
  Speaker 2: No, it's called the Postnatal Depletion Cure And it's a more self-help book for mothers.
• 51:05
  Speaker 2: I mean, there is things in there for practitioners, but it was redesigned for mothers.
• 51:10
  Speaker 2: Now, unfortunately, there isn't an organization or a gathering point for this topic yet, but it is happening.
• 51:23
  Speaker 2: I mean this book Mother Brain.
• 51:25
  Speaker 2: I would recommend it is this Chelsea Conor Boy She's.
• 51:31
  Speaker 2: This just came out recently and it's a great summary of a lot of the neuroscientists and the research that's been done.
• 51:39
  Speaker 2: It's written with quite easy to follow language, and so that is probably the most pearls per minute, so to speak, in terms of wanting to find out more about that.
• 51:50
  Speaker 2: I'd invite people just to have a look at my website, the Mother Care Project, because I'll be having more and more resources and courses out there, and just to have interest.
• 52:02
  Speaker 2: This is a rapidly evolving field And some of the Woman's Health magazines Woman's Health journals are really starting to have more articles on these topics.
• 52:23
  Speaker 1: Like Maturitas, that sort of thing.
• 52:26
  Speaker 2: Yeah, maturitas, and just to know what your keywords are.
• 52:32
  Speaker 2: And so if you understand that postpartum always has to do with the part of depression and neuroinflammation and stress modulation, those kind of things, and I get through my different apps, i get fed a lot of articles about these kind of topics.
• 52:50
  Speaker 1: And also you do a podcast as well, so that will be there there available on your website.
• 52:57
  Speaker 2: The podcast hasn't come out yet, but that will be coming out this year.
• 53:00
  Speaker 2: To the science of motherhood, there's another great podcast out there Dr Jodi Polowsky, who's an American neuroscientist who's living in France The Mummy Brain, and she just had a book published, but it's in French, so it will be coming out in English, but that would also be an amazing book, i suspect, knowing her work And yeah, so this is a great time to be interested in, and certainly when my book came out in 2018, there was the papers of significance were there were less than 100 papers on the human maternal brain that had been published at that time, so the number is increasing rapidly.
• 53:45
  Speaker 1: Yeah, what a shame it wasn't cottoned on too earlier.
• 53:48
  Speaker 1: It's strange, doesn't it, When it's a part of every theme, or I should say every mother, And it's so important for the progression of our species.
• 54:03
  Speaker 1: It's just stunning that it hasn't been looked into earlier.
• 54:09
  Speaker 2: Well, it's a fundamentally human thing And it's hard to know the numbers exactly, but probably about 85% of women go on to having a full term birth.
• 54:19
  Speaker 2: So that's about it in America And Australia is probably similar, so it's a pretty significant part of the population.
• 54:28
  Speaker 2: But, as we know, medicine is very generic, has a generic masculine hat which, as the Lancet pointed out in a key paper a couple of years ago, that most research in medicine has been done in male mice, male cells and men, and so trying to extrapolate that into the rest of the 50% of the population, then into the placentally modified mothers, it's very frustrating for me to run aground very quickly sometimes when I'm trying to look at research topics.
• 55:11
  Speaker 1: Oscar, as I said at the beginning, this is way too big of a topic to cover in one podcast, But I thank you so much for exploding our minds to not just the physiological changes that happen to a placentally modified woman, but also the effects of certain social, dietary toxic factors that affect a mother and therefore the baby.
• 55:44
  Speaker 1: It's such an important topic that we can learn more about And obviously we're going to be looking for baited breath for your podcast.
• 55:52
  Speaker 1: But thanks so much for taking us through postpartum depletion and what we can do about it today.
• 55:56
  Speaker 1: On Wellness by Designs Okay well.
• 55:59
  Speaker 2: Thank you, andrew, and thank you for talking with me today and giving me the opportunity to talk about mothers, and if mothers aren't good, no one's good.
• 56:08
  Speaker 2: That's kind of the law of the jungle, i believe.
• 56:12
  Speaker 1: It's so obvious that you care.
• 56:14
  Speaker 1: It's not just a business, a job for you, but there's so much care that you give to your patients.
• 56:21
  Speaker 1: I honor you, sir, and thank you everyone for joining us today.
• 56:26
  Speaker 1: Now remember that you can catch up on all the show notes.
• 56:28
  Speaker 1: There will be heaps of references for this podcast, so look at those and also, obviously, the other podcasts on the Designs for Health website.
• 56:38
  Speaker 1: I'm Andrew Whitfield Cook.
• 56:39
  Speaker 1: This is Wellness by Designs.