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The 4th Trimester with Annalies Corse

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The 4th Trimester with Annalies Corse

As the saying goes, it takes a village to raise a child. However, in modern times, following the birth of her child a women can be left to navigate the new terrain of motherhood with little support. This can come at the cost of her physical and emotional wellbeing, the baby's health and the state of her marriage or relationship.

Today we welcome back Annalies Corse, medical scientist, naturopath and mother who is passionate about developing a better network of integrated health systems to nurture parents through the 4th Trimester. Annalies shares how natural medicine can be a crucial tool in managing post-natal health, including thyroid issues, mastitis, mental wellbeing and more.  

Covered in this episode

[00:43] Welcoming back Annalies Corse
[01:48] What does "the 4th trimester" mean?
[02:41] The state of post-natal care
[06:07] Isolation and family support
[13:38] What can Dads do?
[17:31] Establishing team-work
[22:41] Approaching breastfeeding
[26:08] Herbal Medicine: resources for assessing safety
[27:58] Mastitis support
[34:20] Scope of practice
[37:11] Resources for up-skilling in this area


Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line today is Annalies Corse, who's a medical scientist, lecturer, naturopath, and author based in Sydney. She's worked as a medical scientist at Charles Sturt University, the Australian Institute of Sport, Australian Biologics, and both public and private hospital pathology laboratories. Annalies has been a practicing naturopath and lecturer since 2008. She lectures in human biochemistry and the medical sciences for ACNT and SSNT as well as conference and seminar presenting for fellow health professionals. 
 
Annalies is a past board member of the NHAA and is on the scientific advisory board of the Mind Foundation. Most recently, Annalise has contributed to Leah Hechtman's textbook called "Clinical Naturopathic Medicine" due for publication in 2018. And I warmly welcome you back to FX Medicine, Annalies. How are you? 
 
Annalies: I'm really well, Andrew. How are you? 
 
Andrew: I'm good, thank you. Now, today we're going to be talking about something which I've got to say I went, "eh?" when I first heard it and that is the fourth trimester of pregnancy. What is the fourth trimester? 
 
Annalies: Oh, it's that thing that nobody tells you about when you're pregnant. That's what it is. And it's that trimester that most obstetricians say lasts about six weeks and then you get a checkup, but in reality, it's roughly about 12 months, if not more, after a baby is born. And it also affects people that didn't birth the baby. So it affects fathers, it affects, let's say, a same sex couple and it might be the female that didn't birth the baby, it might be the mother that didn't birth the baby but needed a surrogate, or it might be all the siblings of a new baby. So it's everyone in that immediate family unit. 
 
Andrew: You know, I've been to antenatal classes, the mother's had a baby, "Congratulations on your new born baby… Now see you later." Why is there no postnatal care? And I should qualify this, I have actually met a couple of people that said in their area there was postnatal care, but it certainly isn't mainstream. 
 
Annalies: It is not mainstream, and if you are lucky enough to have, say, a GP Clinic, or a naturopathy practice, or a natural healthcare practitioner, even a doula or a midwife that focuses on this, you are in a rare segment of the population. 

I'm lucky that I'm married to a very orthodox doctor and I've got a lot of very orthodox doctor friends. And when I asked them about this after I had a child and said, "Why, why, why?", their main reason was...well, there were two. They said there's a limited healthcare dollar. 
 
Andrew: Cost, yeah. 
 
Annalies: And the main other reason for this is that there’s that attitude that people should be able to look after themselves with regard to their own nutrition, getting family support after a baby is born. 
 
And for them clinically, in primary medical care, there are competing clinical priorities. So obviously the baby is incredibly vulnerable so that's a clinical priority. If the mother has postnatal depression, that's a clinical priority. But this whole idea of other things maybe not going quite so right in that 12 months after a baby is born, it's probably not thought of as a huge clinical problem. I've also found out that it's not really considered as part of medical education. Unless you go off and do obstetrics or GP training, it's really not brought up in many other specializations. 
 
Andrew: That seems a little bit like robbing Peter to pay Paul, to me? 
 
Annalies: Yeah. Look it's a spectrum, that's the thing. And there's a spectrum of issues that people face when they have a child. And I guess modern medicine is still treating the very endpoint of that spectrum which is things like postnatal depression. But there's a huge amount of gray in here and really the only people that are going to do something about it are those couples or parents that are proactive, or particularly if a GP finds that there's something going on. It will be a referral to maybe an allied health professional. 
 
But it's really...I think that there's a huge amount of investment, not just in the healthcare dollar, but just in terms of from an ethical point of view, a compassionate point of view, that there is a lot going on in this fourth trimester, that has huge effects and huge sequellae for that family and potential health consequences later on in life. If it's not dealt with at this particular time. It's such a vulnerable time. There's a huge amount of physiological vulnerability. Your health deteriorates in a lot of cases. And if you're not on top of it and you're not able to be on top of it and the resources aren't there to keep you on top of it, things can go really, really badly for people in this phase. 
 
Andrew: I've got to just talk about my own experiences with my wife and, you know, even Lea, when I remember we came home with Aiden and Aiden was fussing at the breast when he was feeding and things like that. Lea had a cracked nipple. And so there's this added stress, this concern about, "Am I doing something wrong or am I not doing something right, have I not gotten the hang of something?" 

Because everything was rosy in the hospital. There was the support around you and everybody went, "No, this is how do you it." But there was no demonstration of competency, if you like, from the early days to the later days of feeding and routine and all of that sort of thing. And I can still remember Lea being at the end of her tether, in tears. We had to get a lactation consultant to come around and I vaguely remember Lea having a night off. You know, she just had a couple of nights in a place where there was care for her. Now we were very lucky to access that. 
 
Annalise: I know. And I guess in the ‘old days’ we probably had people around us, you know, particularly for the females, maybe not so much for the males. But females had so much more support and not necessarily from the medical profession. But they would've had aunts, mothers, grandmothers, sisters, and they would have had a village around them. 
 
Andrew: And we’ve lost this. 
 
Annalies: We've lost it. We've lost it. And I saw this most beautiful artwork recently and it was the drawing of a woman in her bed with her newborn. And there were a lot of maybe five different pairs, sets of women's hands and one was covering her with a blanket, one was providing her with food, one was bringing her a drink. And I looked at it and I thought, "No… what? What is this? This is not... Nobody has this, really." Maybe in hospitals, because you've got midwives around you, but certainly not when you get home. 

You'll be lucky to have your mother visit in most cases. You'd be lucky to have a friend pop by in some instances. I mean, everybody's situation is different. But I guess what I'm talking about is for those people that don't have the support. That's when this fourth trimester, this vulnerable phase can really create a lot of havoc. 
 
Andrew: Are there any stats on how many mothers’ feel isolated in the early fourth trimester? 
 
Annalies: Well, look, I don't know a quantifiable stat, but I know from a lot of the qualitative research out there, when they survey, when qualitative researchers research and look into surveys with mothers and questionnaires. The majority are dissatisfied with postnatal services and in particular with regard to nutrition, in particular with regard to breastfeeding, and in particular with regard to regaining health, if you like, regaining, you know, what's normal. "What's the normal path for getting back to where I was? And if I'm not getting back to where I was, does that mean that there's a problem?" 

And I think the other big problem is there's so much focus particularly for her on the baby and wanting to know, "Is what my baby is doing normal?" And these days we have the internet to turn to which our fore mothers wouldn't have had. And that opens a whole kind of worms as well because you start reading forums and you start reading opinion pieces from everybody. And in the end, it's probably just best to not look at anything and just get back in tune with your own self, your own intuition. Getting rid of all that distraction that's there and just focusing back in on what's in front of you. The baby, trying to read its cues. 

And there's a whole lot of intuition that comes into this. And sometimes the best advice people give you is not, "Well, here's a routine that I did. Try this." It's more of a, "Well, maybe you just need to...you'll find your own way. You will find your own way. Listen to what you think is best." And this is starting to happen a little bit more, I think, than say in the decades earlier where it was all about, "Well, this way is the best method." It's the baby wearing method. "This method is the best method." I think we're getting away from that a bit more now. Yeah, yeah. 
 
Andrew: What about things like the ease of travel and so therefore the distance of the new parents from their parents? That, you know, kids move away from home and they go and start a life somewhere else. 
 
Annalies: That's right. 
 
Andrew: Not the least of which is, you know, because of access to work and finance and things like that. But what about our expectations about the extended family? Have they majorly changed? 
 
Annalies: Yeah. Well, I think they have changed a lot. The village really doesn't exist as much as it used to, particularly on the family plane, and that's usually because, like you said, we do move away, we are far more globalized than we used to be, our village might be on the other side of the world in a FaceTime call or a Skype session these days. And it's fantastic that we have that technology. 

But I think it gets back to the fact that most of us are having children a little bit older, very much so westernized countries. So therefore that makes the grandparents older. They may have their own health issues or they're just as energetic as they were when they were say, in their 40s or 50s. And they're not able to assume the role that they maybe want to assume. They may want that, but they just can't do that because of their own health issues and their age and their distance away from you. So the grandparents are no longer youngish. 

I think the other thing with the double income, no kids, because that's what the majority of us in Australia were before we became parents. We’re highly independent and there's this huge, I guess, problem in asking for help. It's still seen as a sign of weakness to ask for help. So because you were in this professional background you were highly competent and then all of a sudden, you've given birth to a baby and you have absolutely no idea what's right, what's wrong, and then to actually go and ask for help. You may have never asked for help, ever. Because you're just so used to achieving, producing, and being the fixer at work. Depending on what your role was and the type of profession you were in. I really find that people just don't want to look weak. 

And so the village might be there in some way, but it might not be getting accessed as much as we would like it there for us. 
 
Andrew: Yeah. There are significant stresses on the male. The pressure to be the bread-winner when mum is at home looking after the baby. And there's the expectations of financial and, you know, success. And we don't know what to do. We're looking at this baby going, "Man, you've come in between me and my wife." 
 
Annalies: Well, I think for males, like a lot of those fathers that I've spoken to say things like, "I don't know how I can help. I want to be helpful, but I don't know..." I mean, they can't breastfeed. They can’t.. and there is a lot of things that physically the father just can't do because the physiology of the mother is that the mother feeds the baby. 

So the other thing is, I truly feel very passionate about this, is that the male and the father is just as important in all of this as the mother. So this fourth trimester idea absolutely includes the father and it includes their physical, their nutritional, and their mental health. 
 
There are some studies and reports coming out in the literature about postnatal depression affecting fathers, that it's not just a female thing. And that's obviously not necessarily related to hormone fluctuations and these sort of things, but, you know, the psychological transition to becoming a parent. So, it's something that I think as we go further into the future, I think that mens' health, for new fathers or any father whether it's his second, third, or fourth child, is probably going to become more of a focus and I think that that's really, really important. 
 
Fathers, so many fathers that I know, modern day fathers, are helping out. They're getting up with the feeds in the night, they're giving their wife or their partner a night off and doing the feeds, and then they're showing up at work the next day expected to do a massive presentation, or expected to work, you know, a back-to-back shift, or, you know, they're working really, really hard and they're sleep deprived as well. That puts stress on their immune system. It puts stress on their HPA axis in terms of, you know, physiological stress. They have a lack of recreation time as well because, you know, they really want to give their wife recreation time because she might be at home with the children more so than he is and so he's losing a lot of his hobbies. 
 
And then there's worry there as well. So it's not just the mothers. You know, there's a big area of mens' health that I think opens up when they become fathers. It's interesting because I think because of the way the whole topic about mental health is starting to open up via other avenues, like R U OK? Day and BeyondBlue and mens' health initiatives. I think that the trickle-down effect is probably going to be absorbed by programs that are for new fathers. 

One came up a few years ago, I don't know if it's still running, but it started here in Sydney and it was called Beer + Bubs at the pub. And it was about...a bit like a mother's group but it was for fathers and I don't...they obviously didn't take the children, but it was just about getting together with other fathers at the pub. So, in an environment that they might feel a little bit more comfortable in, something that they might actually go to, and they're starting to connect with other fathers and make new friends and they're getting some recreation time in there, which is good, you know, as long they're not drinking to excess. But all of these things can be really beneficial. 
 
Andrew: So how I can we look after ourselves physically, though, with regards to, you know, you mentioned, you know, the shift work and the helping and things like that. I remember that Lea and I eventually got down to a really good routine. Because Lea is a morning person and I'm a night owl. And so I would do the late-night feeds and things like that. Lea would get some rest there and Lea was quite happy to wake up in the early hours of the morning, when I am dead on my feet. And that worked for us, but it's never a perfect handover. 
 
Annalies: No. No. Of course not. It's never perfect. 

And the other thing is you can talk about this before the baby comes along, but that whole idea of what you're going to do can be completely changed and turned on its head when the baby is born. So it's a matter of working out...and you may not get into a routine for many months. Those first few months are beautiful, but they're also horrendous, let's be honest. 

Because you're...yeah, because you're... For the first few weeks, if the mother's breastfeeding, it takes a long time to establish breastfeeding. And I have always… this is what...from my own experience having...I've got one little boy. I just found that it took a long time to establish a routine and the routines that were sort of being ‘prescribed’ by say midwives or whatever, I just, I couldn't...the more I tried to force our life into that routine, the more upset I became, and the more stressed I became. 
 
So when I decided that I was just going to let our family situation dictate our own routine, things got better. So I think that's really important advice for any new family, whether they've only got one baby or it's a new baby, a sibling or whatever. Really sitting down and looking at where, like you did, the areas that you find are easier to cope with, you absorb that. It might be different for your partner. 

I was… I'm not a morning person but my husband is. So he sort of did more of the work in the morning and I had a sleep in, whereas I sort of did more at night. I also demand-fed my son for the first 12 months. So I'd get up a lot during the night because I could cope with that. My husband was off at work the whole time. So I felt better that he wasn't waking up during the night, but he could go off to work and I sort of felt better about him being off at work and coping that way. Because I knew he'd got some sleep, whereas the next day I could sort of take it easy a little bit more and just not do too much or not expend too much energy the next if I'd had a big night with my son the night before. 

So communication's really important between the couple, working out what are your areas that you think you can cope with? Teamwork is so important. But then outside of that it's working on...well, we can't do everything on our own. Most of the time you are, 90% of the time, you're really just you and your partner. Sometimes it's a single parent situation and you're really just you, and that's it, and that's very, very hard. 
 
Andrew: Very hard. 
 
Annalies: But it...yeah. It's just a matter of realising what the priorities are. Your health is a priority. I mean, I'm talking from the perspective of being a naturopath so, but not everyone that's in this situation is going to be thinking about their health, let's be honest. They're just going to be putting their head down and, you know, getting on with it. 

But you can't get on with it if you're not healthy. So I guess the whole reason that I'm talking about this is because I think there's a need, there's a need to help people with their health in this phase. And whether it's nutritional intervention, whether it's lifestyle intervention, whether it's mental health, psychological, emotional intervention, all of these things can help. 
 
And if things are going badly for you, whether you're the father, or the mother, or whatever it is. If things are going badly for you and you're finding it hard to cope, you tell your partner, you basically say, "Look, we..." It's almost like you need to treat it like you would an employment situation. Takes all the romance out of it, but you sort of need to sit down and communicate and say, "Well, here's the problem, how do we rectify this? What things can we put in place for this to change?" And you might identify that your diet is crazy and going out the window or, "I just need an hour twice a week to get out for a run. That would really help me." And just telling your partner the things that you need in order to maintain some semblance of... 
 
Andrew: Sanity. 
 
Annalies: Health and sanity. Exactly, exactly. 
 
Andrew: So when we're talking about looking after ourselves physically, I've got to ask you, you mentioned demand-feeding? How did you find you got enough rest with that? You know, were you able to have the feed and then drift back to sleep or did you find that you're wired after that feed for a little while? Did you find that you'd wake up and do other housework? How did you get enough rest to actually to look after yourself physically? 
 
Annalies: Yeah. Look, for me, my situation… and it might be different for other people that demand feed. But my situation was that it was easier for me to get up and demand feed than try to do it to a routine. And I sort of found that I was tired enough and exhausted enough that I'd probably get back to sleep within 20 minutes after feeding, and usually it was a fairly...the older he got, the shorter the feeds became and that's generally what happens as we all know, with babies, anyway. 

I guess what if found was it was the next day, having a rough a night with demand feeding wouldn't sort of affect me too much at night, I could get back to sleep. But if I'd spent a lot of time awake, the next day I really didn't have a lot energy. So I may not have the energy to say go and meet up with another mother that I'd met through mother's group or I might have just been too tired to do something. And where I found it hard was in that, what happens the next day, or that week during the day, because I didn't have the energy. 

I didn't have the energy for social interactions and I found that whole year quite socially isolating because for me in my head I thought, "Well, I need to conserve energy. I need to eat properly. I don't have a lot of time. In order to eat properly I'm going to spend most of my time making sure I eat properly." And that may have meant foregoing social interaction which for me, I found the hardest, to be honest. After becoming a parent, the social isolation for me...because a lot of my friends don't have children, they're still working, and they haven't had kids yet. 

So the next day I always found that harder than the night time stuff. But the only way that I could deal with it was buffering that with a sound basis of nutrition. And, like I said, everyone's situation is so different. So, you know, I can be talking about what I did and there might some similarities out there, and not everyone has the same experience. So, you know, it's always hard to give out this advice for new parents when they're going to forge their own way. 

But nutrition is a big one and definitely herbal medicines can make a difference as well. A big difference for the male and also...well, for the father, for the mother in the relationship because as we know herbal medicines have a great influence on stress, the immune system and they are medicines. So if something is coming up we can use herbs. I guess the only thing is for the female, if you're breastfeeding, you have to be careful about alcoholic extracts and just focus on other ways like recipes and teas, and not going down that path of alcohol tinctures or decoctions. 
 
Andrew: One of the things that I think surprises a lot of practitioners is there's a lot more safety data on herbs in pregnancy than there is for herbs in breastfeeding. And it's a real conundrum here. It doesn't matter about the tradition, it matters also about the medico-legal aspects of treatment. So it's kind of like, "Well, where do you lean here?" I've got say, I lean very heavily on Kerry Bone's herbal safety book and I do believe it's very comprehensive. I think it's one of the masterpieces of practice. I think every practitioner who wants to practice herbal medicine should get that book, at the very least. 
 
Annalies: Absolutely. Absolutely. And always erring on the side of caution and always safety first. So if you're not sure about alcohol and ethanol, or a particular type of herb for whatever reason, don't do it. There are other ways of doing it. 
 
Andrew: Or use teas.  
 
Annalies: Yes. Exactly. Use a tea. Use that food if it's a more of a culinary type...we're lucky with the pregnancy stuff in that so many of the galactagogues are culinary. So you can come up with recipes. They may not be the nicest thing out there, you might be, you know, making some kind of an ‘edible poultice’. I call them edible poultices because they're like a bit of a paste. 

Andrew: Fenugreek.

Annalies: Yeah, and you're just sort of putting it into your mouth like a paste. But it's a way of getting it in, but you don't have to worry about ethanol content. So your prescription is often a bit of a potion/recipe that they can make up in their kitchen within five minutes. It's not something that, you know, you're asking them to make almond milk over a week, and they say, "I can't do that. I'm too busy looking after my baby." You can say, "But this takes five minutes. You can make it, keep it in the fridge, and have teaspoon twice a day.  
 
Andrew: What about things like, for instance, with mastitis, there's the good old, you know, cold, white cabbage leaves. There's, you know, various probiotics now for mastitis indeed. What about things like, you know, dysphoric milk ejection reflex? What about certain, let's call them functional foods, to aid in lactation? What sort of things do you employ?  
 
Annalies: Okay. Well, first of all, with mastitis, I think frequent feeding helps, but complete emptying of the breast, the correct technique, the attachment of the baby, that is all crucial. 

On top of that, things that lead to mastitis include things like the unique anatomy of that woman's breast, sometimes physiological or pathophysiological determinants. She might have had a really poor immune system before she became pregnant. And I find that women who have a history of immunocompromise are far more likely to develop mastitis, chronic mastitis. It may even lead to things like antibiotic use or stopping breastfeeding for that reason. 
 
So if there's anyone with mastitis, you might be experiencing a little bit of it in those early days as you establish breastfeeding and if that's the case, definitely you should get a lactation consultant appointment and go and see one. Because if you get a good lactation consultant, the advice they give you is invaluable. And you'll probably find that you're breastfeeding for two years, if you want to, after establishing a good breastfeeding regime with a lactation consultant. The cabbage leaves and some of the more traditional methods are for, you know, topical relief, they're for pain relief. They help, but they're not going to be treating the underlying cause, as we know. 
 
There's also, with mastitis, there are deficiencies associated with this. So vitamin A, vitamin D, vitamin E, selenium and zinc, these are all linked to...or they renowned for causing mastitis. And this might sound a bit funny, but in the dairy industry, mastitis is a huge problem and they actually supplement the feed of lactating cows with these supplements because they know what a huge problem mastitis is. And I know we're talking about cows here, but... 
 
Andrew: It doesn't matter. 
 
Annalies:...sometimes we need to look at other species of mammals and think, "Well, what are they doing in the veterinary world? What are they doing in the farming world in terms of nutrition and how can we apply that to say human mammals?" So yeah, A, E, selenium and zinc deficiencies, and D is a big one. 
 
Andrew: Yeah. And if you're talking about dairy production, you're talking about, you know, the massive dairy production of Illawarra reds or Friesians or something like that. 
 
Annalies: Yeah, they're all being supplemented. 

So the other thing is, I also think demand-feeding. I am a huge proponent of demand-feeding but I also completely appreciate that not every woman can do this because she might go back to work soon or for whatever reason. But there is so much evidence that as we are human mammals and mammals are either spaced feeders or continual feeders. 

So space feeders are the mammals that they cachet their young away in a nest, like rabbits and burrow...animals who have their young in burrows. And they go off and forrage for the whole day, and their breast milk is really, really high in fat. And they're evolved in that way because they're away from their young for such a long time, whereas human mammals are continual feeders. So we're apes, and we only have to look other apes to see where we've come from. The baby is pretty much hanging onto mum constantly. 

Andrew: Constantly, yeah. 

Annalies: And they'll just access the breast whenever they feel like it. And continual feeders, like humans, have more dilute, less calorie-rich, just 3% to 4% fat milk. Because we are supposed to be feeding them continually. So for me, when I read about demand-feeding and I sort of threw the whole "feed at 1:00 a.m., 5:00 a.m., 9:00 a.m.", threw that routine out the window...I'm sorry to the beautiful midwife who suggested that to me, she was lovely, but I just couldn't do it. For me, the evidence is in our milk. And we are continually feeding mammals. 
 
And if we can adopt that, if we are willing to do it, it's not easy. I absolutely empathise with women who don't...maybe don't like breastfeeding, can't breastfeed, need to go back to work. But if you're in the position to demand-feed it helps immeasurably with preventing mastitis. So it's good for the mother, but it's also very, very good for the baby as well. And it helps with all things like colic and diarrhea and flatulence and settling and bonding and keeping your oxytocin levels high, etc. 
 
Andrew: Yep. Any work being done on microbiota with, you know, demand-feeding versus formula feeding over a longer time rather than shorter time? 
 
Annalies: Well, most of the data really hasn't looked at demand-feeding versus timed-routine feeding. Most of the data around microbiota is still around C-section babies versus naturally birthed babies, which everyone sort of knows about that. 

But yeah, not a lot of studies on demand versus routine. And that would be definitely an interesting PhD for someone if they're interested in breastfeeding, and interested in the microbiome. Because that's our natural evolutionary practice. It'd be interesting to see what the microbiome of babies fed that way is, at certain time points, over a lifetime. Absolutely. 
 
Andrew: There we go. Martin Blaser, if you wouldn't mind being the professor on this one, that would be lovely. 
 
Annalies: We need some supervisors and some students getting onto this. 
 
Andrew: Yeah. Annalies, what about scope of practice here? How are naturopaths placed for looking after couples, indeed, I would say now, family units, in the fourth trimester? 
 
Annalies: Perfectly placed. And this is something that I believe in and this is why I talk about this topic a lot since having a little boy. Because naturopaths and nutritionists, holistically trained professionals who use herbal medicine, nutritional medicine, are perfectly placed to fill this hole. 

There is a gap in the...I don't want to say the market because it's not a market. There's a gap in humanity, there's a gap in medical practice, there is a need, and it's not being filled by the medical profession for many reasons, and it's not intentional. They're busy doing other things or for whatever reason. 
 
They also don't have the training that we have. They don't have the training in nutrition and herbal medicine. We are the perfect profession to be filling this need. And you don't need extra training in postnatal health protocols per se. It's obviously good to do your reading and attend seminars. But really, it's just about looking at the couple in front of you and think, "Well, okay, here's a mum, here's a dad. Tell me what your issues are." And just start supporting them. 

In an ideal world, I would love to see someday, in every GP practice, a naturopath and a nutritionist focusing on fourth trimester services for new parents. That's what… if I could get that happening, that would be the perfect thing and make it part of primary care. And the thing is, even though I'm saying there's a need, there are naturopaths who are already doing this already. You know, they've geared their practice towards this. 

There's a lovely colleague of mine here in Sydney who's doing this. Two of them actually. One is a naturopath, one is a naturopath-doula, they're doing amazing things with this. But, you know, they can't help everybody there's only one of them and they’re… 
 
Andrew: There are geographic limitations, yeah. 
 
Annalies: Exactly. So it is a need and I think we are the profession to go out and do it. But it's a matter of communicating with the medical profession and them getting to know us personally, not just necessarily as a professional in the industry. But personally, getting to know the local naturopath, meeting them, having a coffee with them, explaining what you do, showing them that you are safe. Okay, that I think that's the thing. We need to start building some bridges. 
 
Andrew: Where can naturopaths go for further resources to become educated, proficient, and as you say, safe, in the fourth trimester? 
 
Annalies: I think there's a number of different things that naturopaths and nutritionists can be doing. The first thing is having the confidence to...almost to ‘just do it’. If you're not confident in this, I would start looking at resources that speak about how to treat thyroid function… because thyroid function is something that is a little bit problematic for women after they have a child. 

So I'm just sort of thinking about clinical scenarios that might require a little bit of extra study. So if you feel you need to do more work around the thyroid imbalance before you start offering services in this area, go and do a bit more training in seminars in that particular area. 
 
Go and do more training in...if you feel that your practice is particularly strong in a nutritional realm and you can know what to go give nutritionally and with herbs, go and do some more work around possibly emotional issues, mental health issues, because that's a lot of what you're going to be treating. 

If you think your practice needs a little bit more of a scope around people that work in this area a lot, try and meet with midwives or doulas or any other naturopaths that you know that are working in this area already, and see if you can get some kind of mentorship happening with them. Because they're the people that can help you with things like coming up with a clinical questionnaire that you can use in your clinic for how to identify clinical issues that are coming up in the practice. 

Unfortunately, there's not really a lot of books that I can recommend for people on this particular issue. There are seminars out there on, you know, what to eat for breastfeeding. They're fantastic, anything you can find in terms of seminars, CPE articles about, you know, galactagogues and what to eat for enhancing breast milk production. That's all fantastic. But actual books, they really aren't in...there's no sort of textbook on this. There are textbooks out there that are more midwifery type basis and I think they're good. They're good because you can get some good insights into how the medical profession deal with this and some of the more, I guess, critical issues that can come up in the fourth trimester. So, how to screen for postnatal depression, how to screen for thyroid issues, the types of blood test that you might want to order. So I wouldn't discount even just going and buying or borrowing a midwifery textbook that deals with the first six weeks postpartum. They can be very, very useful as well. 

The other thing that I would suggest is if you are a parent and you've been through this yourself. You have expertise because you've been through it. If you're a naturopath or a nutritionist and you're not a parent yet, or you may not want to be a parent and...but you'd really like to work in this area, don't let that stop you. Because you can still work in this area. I've got quite a number of young female students who want to work in this area, but they haven't had their kids yet and I say to them, "Don't let that stop you. Don't let that stop you. You just need to get educated and make sure that you've got the right tools in your clinic." 
 
So I think top three would be, trying to get a mentor, if you can. Try and do a bit of extra reading and extra seminars about breastfeeding and some of those more medical midwifery concepts that are useful in that period of time, and then just have the confidence to start somewhere. And have a referral group around you. Get to know the local GP, get to know doulas, get to know midwives because it's definitely a team effort and it's about getting people with clinical experience and absorbing that into something that you can offer. 
 
Andrew: Annalies, thank you so much for taking us through that. It's obvious that you've come from a point of expertise, from your own experiences, and you're now sharing this too, or for the betterment of the patients that you see. So I truly thank you for taking us through the fourth trimester today on FX Medicine. Thanks. 
 
Annalies: Thank you, Andrew. Thanks again. 
 
Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook.

Additional Resources

Annalies Corse
R U OK?
beyondblue
Beer and Bubs
The Essential Guide to Herbal Safety by Kerry Bone and Simon Mills
Prof Martin Blaser

Other podcasts with Annalies include:


DISCLAIMER: 

The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.

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