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Oscar Serrallach

What happens to a woman’s body as she transforms into a mother, and how can we better support her during this critical life stage? Join us in a thought-provoking conversation with Dr Oscar Serrallach, a GP specializing in postpartum care for women and couples.

In this episode, we explore the profound physiological, hormonal, and psychological changes during matrescence, the significance of the placenta, and the importance of understanding the unique needs of mothers before, during, and after pregnancy.

We discuss the intricate dynamic between a mother and her baby, the ancient mammalian pathways enhanced for humans, and how traditional cultures had their own language for the postpartum period. Learn how to differentiate between normal fatigue and postpartum depletion, and discover the best ways to provide mothers with the support they need during this transformational time.

Lastly, let’s dive into the unique landscape of postpartum neuroinflammation and how to identify and support mothers experiencing it. Hear about the power of relaxation practices, the role of supplements in reducing neuroinflammation, and the first-ever approved drug for postpartum depression.

This insightful conversation with Dr Oscar Serrallach is a must-listen for anyone wanting to better understand and support mothers during this critical time in their lives. Don’t miss it!

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About Dr Serrallach:
Dr Oscar Serrallach is a Doctor of Functional Medicine with a special interest in Post-Natal Wellbeing. After completing his Fellowship in General Practice and Family Medicine (Board Certification), in 2009, he has dedicated himself to the study of maternal wellbeing .

His initial studies in Functional Medicine coincided with starting a family and through observation of  his own partner and many mothers through his clinical work, he soon realized the unique challenges and issues that mothers face. Combining the growing research on maternal neurobiology with the principles of functional medicine Dr Serrallach, through using a maternal framework and specific postpartum protocols, has been supporting many hundreds of mothers back to wellness.

Dr Serrallach coined the term Post-Natal Depletion to acknowledge and describe the many mothers suffering from a post-natal neuroinflammatory disorder that could not be classified as having a perinatal mood disorder.

He founded the Mother Care Project in 2022 to provide information, inspiration and education to both mothers and mother care workers.

He currently lives near Byron Bay, Australia, with his partner and their three children.  The Post-Natal Depletion Cure is his first book.

Connect with Dr Serrallach: The Health Lodge 



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Andrew: This is “Wellness By Designs,” and I’m your host, Andrew Whitfield-Cook. Joining us today is Dr. Oscar Serrallach, a GP who specializes in postpartum care of women and couples. And we’ll be discussing just that today. Welcome to “Wellness by Designs,” Oscar. How are you?

Oscar: I’m well, thank you. And thank you for the invitation, Andrew. Always enjoy talking with you.

Andrew: Thank you. I’ve gotta say, our pre-recording chat, I was, like, blown away on several occasions. So, everybody, you are going to learn some really important and new things today. But before we get into the topic, Oscar, could you just take us through a little bit of your career? What led you to, firstly, integrative medicine rather than orthodox medicine? Integrating both of those, but also, what caused you to specialize in postpartum care?

Oscar: Yeah. Well, I like many doctors, had done my specialty in GP, was working in emergency department, and running in 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, so it wasn’t something that was too foreign to me. And with the work that I was doing, because I was the only doctor in this small town, I was seeing everything. And I saw a lot of people who had chronic fatigue, and people who were sick after tick bites, and living in mouldy houses. And I was really finding that my toolbox, GP toolbox, wasn’t really able to do much for these people. 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 was 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. But I was not aware of how profound it was biologically. And so, that sort of started my journey. 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. The research is really increasing. So, in the last five years, there’s probably been more research in the maternal brain, the maternal immune system than there has been leading up to that point. So, it’s a very exciting time to be tuning in, but it’s also a very new field. There’s a lot that’s not known. And so, yeah, I’m… 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, so…

Andrew: It’s amazing though, as you say, how little was taught previously, that it was almost glossed over as, yeah, it’s just like having breakfast or doing a bowel movement. You know, it’s like, “Yeah, it’s just part of life.” No, it’s not. Look, there’s profound changes, but also, even the hormonal actions and interactions that we see, like, our conversation, 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. So, I have to warn everybody, we cannot, by any means, cover in depth what we’re going to be discussing today. This is going to be a little whet-your-appetite piece, and then hopefully that will lead you to learn further on, from Oscar’s other talks and from other people, obviously. So, take us now through the changes that take place in the woman’s body. 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?

Oscar: Well, your comment before about after an event, postpartum just means after the birth. And I was just talking about after an event, and not really talking about the transformation. So, I think we’re hearing more and more people use the term matrescence, which is the becoming of a mother. And it’s purposely rhymed 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 sometimes, when you think the brain changes, hormonal shifts. And so, let’s just start talking about sort of some of them.

So, obviously, when the pregnancy starts, the placenta is the first thing that really starts to grow. Now, we have to understand that the woman is growing another organ. So, that in itself is just a profound thought. And that organ, 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’s churning out hormones, of a degree that the mother’s body and brain have never experienced before. You know, 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. Researchers actually call it an endocrine tsunami. And I think that probably sums up what is happening, but it’s balanced. So, even though cortisol goes three times above what a mother’s body would usually make, it’s balanced with all the other hormones, progesterone, and estrogen, and a lot of these other hormones that become brain hormones, or neuroactive steroids.

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 centre of the brain, if you like. But it’s also in the middle of the hypothalamus, which is the hormonal response centre 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. So, you get this immune adaptation, and you get this kind of overriding, and then the brain changes are massive, and we are still working out a lot of those brain changes, because they occur mainly in structures that are deep inside the brain, so not easy to look at in terms of even, you know, the latest MRIs, those kind of things.

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. Oh, yes. Mothers in first trimester often have a lot of nausea. They have a whole change in sense of smell, the bionic nose that I frequently hear mothers talking about. And then taste aversions and taste cravings. You know, that’s not by accident. 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 get grown. You know, the average mother’s brain shrinks between 5% to 8% during pregnancy, and it usually reforms by 6 months postpartum. 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.

So, we talked about smell and taste. Emotional quotient goes up quite a bit. IQ goes up slightly, visual acuity, facial recognition, social reasoning, and a lot of the parental circuitry. 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. So, the default mode network are different structures in the brain, and they get heavily modified. So, what does that mean? The default mode network is your self-representation, your sense of self. When you’re not thinking about yourself, who do you think you are? The default mode network is responsible for that. Now, daydreaming, are we a good person? Do we have courage? Do we not have courage? You know, a lot of that is in the default mode network.

And if that’s getting the biggest upgrade, what’s going on there? The mother is basically being profoundly changed in her sense of who she is, adaptive maternal behaviour. She’s getting changed, getting the software and hardware upgrade, if you like, to enable her to become a mother. This happens with every pregnancy. So, it’s not done and dusted like in adolescence. You know, you go through adolescence once. You go through matrescence with each pregnancy, and it’s not a free lunch. And what I mean by that, 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 an adolescent goes through a bit of a wobble with their adult brain. They don’t know…

Andrew: Bit of a wobble.

Oscar: …and that can take a year or two before they’re… But we understand that. We give adolescents the grace, the time, the support to work through things. And we know once they come good, they are good. That you don’t go back to the wobble. And during matrescence, 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. And so, the placenta is there doing all this stuff, getting the mother ready for her new job, if you like. But, just as you don’t become an adult at your 18th birthday, just an important event, you don’t become a mother at the birth of your child. It’s just obviously a very important event, but you have to learn motherhood. And so, this is a time of vulnerability. And again, what happens when the baby’s born is that you birth the placenta, so you lose your hormone factory. So, this is very different to adolescence.

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. 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, a bipolar and psychosis in the postpartum. They still have to do the research in that. 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.

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, so I came up with the word “postnatal depletion,” to at least give it a name, going, 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 this is an amazing orchestration of things that is very prone to going wrong, especially in our 21st century. 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. We’re not just talking about a few days or a few weeks. 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.

Andrew: When I was learning more about these, you know, the fear, the anxiety centres being initiated, it reminded me of an evolutionary perspective. And I was thinking about kangaroos and elephants and things, 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. So, you know, whether that be environmental or predator. 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.” Mother first, carry the fetus when you can. 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.

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. So, I 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, you know, normal fear, hypervigilance, sleeplessness, to excessive hypervigilance, sleeplessness, da, da, da. It was really interesting to me. One of the things that I have to ask you though, to comment on, was the genetics of the placenta, because this blew my mind.

Oscar: Well, one of the fascinating things about the placenta is, genetically, it’s almost all the male, the father. And even though makes a placenta, it belongs to the baby, 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. And the placenta’s serving two masters, obviously, from a resource point of view, the mother and the child. And if the placenta invades too much into the mother, you start to get all the issues of preeclampsia, gestational hypertension, and, you know, gestational diabetes, just to name a few. And if it doesn’t invade far enough, then you can start to have growth restriction and other issues in terms of the 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.

We also know that mothers can be unusually aggressive in the postpartum, in terms of the mother bear phenomenon. 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. 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. 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. It can’t really do anything. It can’t hold onto the mother’s fur. It can’t, you know, stand up and run away from a predator. It is really helpless. And so, mother nature’s worked out some extra things to get the human mother involved with the human baby, and they are the addiction pathways.

And so it’s quite possible, well, it’s actually quite probable that the addiction pathways are an ancient maternal mammalian pathway that have been really enhanced for humans. So, the mother becomes addicted to her baby. And this is part of the hypervigilance. If the baby’s 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, so she’s literally going through, like, a drug withdrawal, on top of the social and spiritual grieving that she’s going through, so… Yeah, so, this is a very elaborate orchestration, that’s very prone to disruptions, especially in the 21st century, because we don’t honour that first year of postpartum. We don’t understand that mothers need to rest like they’ve never rested before.

We don’t understand that they need to be socially connected, but not socially pressured, more than they ever have before. 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. And especially Australian culture, we have a very, “She’ll be right.” We’ve masculinized a lot of motherhood really, and have left the mother to her own devices. And we have this myth of the super mother, or the super mum, who can do it all with no help. And it’s almost seen as a sign of weakness in some cultural norms that if a 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 gonna need everything that people can give her. And if we do that, like the adolescent 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 be able to turn up to her life in the way that she would like to.

Andrew: Yeah. So, again, just thinking about the care in the postpartum period, we really need to think about setting up that care way earlier. So, again, that connection, 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. It should be part of pre-conceptual care.

Oscar: Yeah. Well, ideally, the idea of matrescence is understood before we even get pregnant, because that would be a true enrollment in the journey, rather than, “Ah, I’ll work out parenthood once I’m there.” And there’s a saying in postpartum care that everyone prepares for the wedding, no one prepares for the marriage. Everyone prepares for the birth, no one prepares for the postpartum. And we should really be talking about postpartum care as early as we can, but definitely during the pregnancy, and understanding, “Okay, you’re gonna 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 gonna happen, like depression, anxiety, hypervigilance, fatigue.”

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. They knew the potential for mothers to go into this state. And so this is why traditional cultures often have quite elaborate language, concepts, ceremony, and care around the mother. In many cultures, the mother’s not allowed to do very much for four, six weeks. 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. So, it’s not like these cultures are being nice. They’re just being pragmatic.

Andrew: 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. 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? True. But how do we differentiate between that and postpartum depletion? When does it become a problem, that we need to go, “You need help?”

Oscar: Well, that’s a…

Andrew: What do we look for?

Oscar: …great question. Yeah, that’s a great question. And my comment to that, really, is, if you’re… The 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.” If someone’s just recovering from surgery, it takes them a little while to recover, but those should come good relatively quickly. If someone’s anemic or iron deficient, those things can be corrected relatively quickly. And so, it’s when you recognize, “Okay, there’s something going on here.” And the thing that would typically help that in 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 neuroinflammatory component. And these neuroinflammatory issues that mothers experience are unique. They don’t occur in other adults. The research is quite clear on that. And so we shouldn’t really be calling it depression or anxiety. We should be calling it postnatal neuroinflammation, 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…

Andrew: So

Oscar: …we think about all types of depression being very similar, so…

Andrew: Yeah. So, when we’re talking about neuroinflammation being the antecedent, is that the right word? The core thing at the centre of it. We would think about things…interceding with things that will dampen neuroinflammation. Things like, as you mentioned, good sleep, some exercise. Social connectivity, we’ve discussed. But then, things, nutrients that we commonly use, magnesium, fish oils, perhaps phosphatidylserine, blah, blah, blah. Are these of use? Forgive me, how could I not mention the beautiful herbs we have at our disposal? So, is this where we intercede, 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? How do you stratify it?

Oscar: Yeah. 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 support’s very hard to get. 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 neuroinflammation. Having enough iron, for example, helps significantly with neuroinflammation because of the parts of the brain that require iron for metabolism. Fatty acids of all types are obviously very useful. B12 as a methylating agent, if it’s deficient, is going to be problematic. And, you know, fish oils, DHA, you know, I think can be quite important. Choline can be quite important. There’s so many things that…

And it’s not a matter of going, “Oh, you need to be on the perfect supplement regime.” It’s much more just understanding, okay, when are the supplements useful? Support first, and then I always go to nervous system practices second, which is about modulating the stress response, because that… Stress begets stress, especially in a neuro-inflamed brain, unfortunately. And it’s not about avoiding stress, because mum life is full-on on a good day. It’s about making sure there’s enough relaxation to offset the stress. And so, sleep is obviously the big thing that we do. So, if we’re not getting enough sleep, what else can we be doing? 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 that we’re doing weekly or twice a week, such as a good massage or a restorative yoga session, things that we can go deeper into that relaxation. That can be quite profound in helping with neuroinflammation.

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. And just to give it a case in point, Andrew, some people are aware of this, but the first-ever approved drug for postpartum depression came out in America, 2019. 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 the neuroinflammation within a short time period. And, wow. And so it’s really talking to the fact that you’ve got a unique solution for a unique problem. 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, but to know that there’s been research done 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’ll find. So, yeah, I’ve bated 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, you know, I’m just really hoping that there’ll be much more research coming out in the next decade to help guide treatments and help guide prevention. Because at the moment we’re just having to join dots, and sometimes those dots are quite distant.

Andrew: Yeah, yeah. But, you know, 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, you know, 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. So, there’s so many reasons why looking after the mother is so important. It’s not just for the mother.

Oscar: Yeah. 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. 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, you know, autism is a condition that starts in the womb. Possibly a lot of the ADHD and neurodiverse issues may be related to that as well. And then there’s research showing that if a mum’s significantly iron deficient during pregnancy, her child will have a significantly lower IQ at the age of 10 from that pregnancy.

Andrew: And iodine as well.

Oscar: Research that came out iodine is, I mean, that’s, again, it should be a hot topic. It’s something that we yawn about sometimes when we hear about it. But it’s super important in terms of just an IQ point of view. And then, breastfeeding. So, if the mother’s really anxious and not supported, she’s less likely to breastfeed. And an interesting statistic that I came across recently, if we included breastfeeding onto the Australian GDP as a cost, it would cost $3 billion to the Australian economy. But if we added the yearly cost of reductions in breastfeeding, because of where we could be and where we’re at, that costs the Australian government $6 billion 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.

Andrew: So, not breastfeeding doubles your cost?

Oscar: Well, no. So, the breastfeeding, just as a cost, if you had to replace it with something else, is $3 billion. But then the cost to the economy, if we improved our breastfeeding rate from where it is to where it maximally could be… So, they think about 90% to 95% of mothers could breastfeed given the right supports and education, but only, I think, 47% to 52% of mothers breastfeed beyond a few months. And there’s a lot of social pressures. There can be a lot of stressors. And breastfeeding’s not an easy thing. People make out like it is straightforward and easy. It’s a very challenging task to learn, both for the baby and for the mother. But given the right support… Excuse me. Given the right support, when children are breastfed, their IQ is better. And 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 the neurodevelopmental effect from that child. So, whether it’s iodine, whether it’s breastfeeding, whether it’s having enough iron, whether it’s good, attentive 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.

Andrew: 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, the people from around the northern rivers, they’re going to be already aware of these things, largely. Not totally, obviously. But do you find when you speak to colleagues who embrace what you teach that there really is this…you’ve gotta sell the care. You’ve gotta sell that you need to put in here looking after the mother, so that she can get enough sleep and rest, recuperation, so that she can take care of your baby. And that will have, you know, tenfold payback down the line, when you don’t have a stressed, you know, child or adolescent, when they’re not overcome with anxiety. So, you’ve gotta look in here, you’ve gotta put in the hard work here, to look down there. Is that something that you teach, you know, your colleagues? Is that something that they report?

Oscar: Well, I definitely, am 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 Scandinavic countries, because they invest a lot more into the postpartum. Many of these countries will have up to two years of paid maternal and/or paternal leave, and sometimes at 100%, sometimes at 80%. But they really understand that investing in mothers early on pays off down the track. But these countries are much more socialistic than we are.

Andrew: Yeah, yeah.

Oscar: 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 the… 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 honour and understand. 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, you know, when we’re talking in the billions of dollars in terms of cost savings to society. But they’re long-term, not…they don’t happen in any political cycles that we’re aware of anyway.

Andrew: I know I’m jumping around a bit, but I wanna go back to the supplements that you use, and that you find important. So, we’ve covered off magnesium. Do you tend to use faster magnesiums here, like the glycinates, aspartates, orotates? Do you…citrates? 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? How do you wend your way with that? Same with fish oil and choline. Can you cover off a few of those for us?

Oscar: Yeah, yeah. Sure. So, I’m a big fan of fish oil, and because of what we’re doing to the oceans, and microplastics in fish and fishing stocks, those kind of things, we’re going to go to the original factory of DHA, which is algae. So, the algae oil or fish oil. And I’ll do quite high doses in pregnancy and in the postpartum, especially with breastfeeding. And choline, I think, can be quite useful. Choline’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… It’d be interesting 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 things.

But they would need to be started earlier rather than once you’ve got issues. Because once you’ve got issues, it’s, you know, you’re trying to put out a fire with a watering can. It’s just not going to do it. And so, the DHA, choline, I think, are really useful. In terms of the micronutrients, iron’s the most important, by far. And so, 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. Magnesium, I’ll often do a 24-hour urinary magnesium 6 weeks 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.” It’s a mineral that does everything. And so, I’m happy to use mixed magnesiums. I’m happy to use creams. I’m happy to use Epsom salt baths, foot baths. And I do like the glycinates and citrates because they’re well-tolerated. They can be quite relaxing to the nervous system.

So, that’s why I think we’re not just treating a deficiency or a insufficiency. We’re actually really trying to help regulate this jumpy, hyperactive aspect of the polyvagal system, which is, magnesium can be quite useful for that. And then zinc I think is also important. And again, free copper can increase hugely during pregnancy, and sometimes won’t come down. And that will contribute to anxiety and neuroinflammation. So, zinc then becomes even more important, especially if you’ve got a mother who’s anxiety-prone beforehand, in terms of before she was pregnant, zinc can be very useful. And then B12, vitamin D, you know, I think these things can be very important as well, because guess what? Everything is a one-way street to the baby. So, if the baby needs DHA to make its own brain, guess where it’s gonna get it from if mum’s not supplementing? Probably from the mother’s brain, and that seems to be what kinda happens. So, it’s not only is she giving her heart and soul, she’s also giving her brain over to that baby. So we need to be replacing those things.

Now, vitamin D is the only thing that’s an even share between the fetus and the mother. Everything else, it’s preferentially for the baby. And so we need to look at optimal levels, not just, “Ah, you know, we don’t have a vitamin D deficient mother.” It’s like, well, you know, maybe you can tolerate low-ish vitamin Ds outside of pregnancy and postpartum, but we shouldn’t tolerate that when we’re dealing with someone who’s pregnant or in the postpartum.

Andrew: 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. Now, admittedly, this is in a cultural area where they cover up, and so they are at, you know, quite severe risk of deficiency. But there was data that she was using. I think it was 4,000 IU per day, in gestation. And it was safe. And I just don’t understand why this isn’t catching on. We’re speaking about iodine. Creswell Eastman is tearing his hair out that the GPs aren’t getting the message about…

Oscar: No.

Andrew: It’s a recommended thing from the NHMRC that women get 150 micrograms of our supplement, including our fortified bread, of our supplement. It’s the first time, not folate. And then we got folate, which I haven’t covered, which I haven’t asked about. So, do you prefer a certain form of folate? Do you think folic acid will do? What’s your opinion?

Oscar: Well, this is a contentious issue, and only from a TGA point of view. So, to call something an antenatal 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, so a lot of the supplements that I see and that I use will have the folate, and then they’ll have activated folinates, or 5-MHTF in there as well. 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 antenatal supplement, just like you have to have the right amount of iodine in there as well. 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, so… Now, you can get lost into the detail of, you know, 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.

Andrew: Gotcha. Sweet. And also, we covered off a few of the herbs, 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 kava. You know, the effect on the baby if you’re gonna use kava in the mother. Great herb, wonderful herb. But is it appropriate in this period, when hopefully, they’re breastfeeding? Can you take us through some herbs?

Oscar: Yeah, definitely. And this is something that I’ve thought a lot about, obviously, because I just wanna find things that are gonna be useful, and that have to be safe. And in, where I work in Byron Bay, there is an assumption amongst some of my clients that cannabis is natural, and therefore it’s safe. 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. So, and the research is pretty black and white on that. So, this is, you know, why I tread very carefully with herbs. So, I look for safety, and then I look for cultural use as well. So, my preferred herb is ashwagandha, because we can… I’m happy to use that in second and third trimester. Unless something’s 100%…you know, first trimester, we have to just be, obviously, cautious. And then postpartum, you know, there’s good safety data with that.

There’s a lot of hesitancy out there to using herbs. Kava, you know, I do like kava, but I just don’t find myself using it, because I can’t be reassured that, a breastfeeding mother, that the kava is okay. I do like a lot of the mushroom herbs as well. So, Eucommia, those kind of things, because they’ve got good data about safety in pregnancy and in the postpartum. And, you know, I’m not a trained herbalist, but I do like using herbs. I’m always trying to bring in my naturopath or my herbalist 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 having the most benefit when they do blends.

And the reason why they can’t often figure it out, you know, menopause is a good example, which herb helps with menopause. None of them do, but when they use it as a group, they have, you know, quite a useful benefit. And so, I think sometimes that blending can be sort of really useful, and there are lots of options out there. The ashwagandha, I do like, Eucommia I do like, and then also just trying to find which adaptogen works for that mother, because we’re all different. It’s not that one herb is going to work well for everyone. We’ve all got slightly different nervous systems, and had mothers who have had different brain modifications, and their liver will process things differently. So, and there can be a few unknowns in that world, but they seem to be very effective, and you don’t need to use them for a long time, either.

Andrew: Oscar, what’s your call-out for both and also patients, obviously, to learn more about this topic? Now, you’ve said, at the beginning, you’ve written a book. You’ve also done some talks with ACNEM, teaching practitioners. What are the resources? In fact, firstly, take us through your book, because I think that’s gonna be a really important one to learn all about it. So, is that “Mother Brain” that I see behind you?

Oscar: No, it’s called “The Postnatal Depletion Cure.” And it’s more a self-help book for mothers. I mean, there is things in there for practitioners, but it was really designed for mothers. Now, unfortunately, there isn’t an organization or a gathering point for this topic yet, but it is happening. I mean, this book, “Mother Brain,” I would recommend because this, Chelsea Conaboy, she, this just came out recently, and it’s a great summary of a lot of the neuroscientists and the research that’s been done. 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. 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 an interest. This is a rapidly evolving field. And some of the women’s health magazines, women’s health journals are really starting to have more articles on these topics.

Andrew: Like “Maturitas?” That sort of thing?

Oscar: Yeah, “Maturitas.”

Andrew: Excellent. Yeah.

Oscar: I don’t know what your keywords are, and so if you understand that postpartum always has search words for partum depression and neuroinflammation and stress modulation, those kind of things, and I get, you know, through my different apps, I get fed a lot of articles about these kind of topics.

Andrew: And also, you do a podcast as well. So, that will be, they’re available on your website?

Oscar: The podcast hasn’t come out yet, but that will be coming out this year. So, “The Science of Motherhood.” There’s another great podcast out there, Dr. Jodi Pawluski, who’s an American neuroscientist who’s living in France, “The Mummy Brain.” And she’s 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, you know, the papers of significance, you know, there were less than 100 papers on the human maternal brain that had been published at that time. So, the number is increasing rapidly.

Andrew: Yeah. What a shame it wasn’t cottoned onto earlier. It’s strange, isn’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. It’s just stunning that it hasn’t been looked into earlier.

Oscar: 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. Certainly, that’s the data in America. And Australia’s probably similar. So that’s a pretty significant part of the population. But as we know, medicine is very generic, has a generic masculine which, as pointed out in a key paper a couple of years ago, that most research and 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, and 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 and…

Andrew: Hmm. 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, you know, social, dietary, toxic, we didn’t go into this, factors that affect a mother, and therefore the baby. It’s such an important topic that we can learn more about. And obviously, we’re gonna be looking for, bated breath, for your podcast. But thanks so much for taking us through postpartum depletion and what we can do about it today, on “Wellness by Designs.”

Oscar: Okay, well 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. That’s kind of the law of the jungle, I believe.

Andrew: It’s so obvious that you care. It’s not just a business, a job for you, but there’s so much care that you give to your patients. I honour you, sir. And thank you, everyone, for joining us today. Now, remember that you can catch up on all the show notes. 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. I’m Andrew Whitfield-Cook. This is “Wellness by Designs.”

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