Postnatal Care and Wellness with Julie Cottle

How do you support a new mother following the birth of a baby?

The postnatal period can be a mentally, physically and emotionally overwhelming time in the lives of new parents, especially for new mothers.

In this episode, Naturopath and Certified Lactation Consultant Julie Cottle shares how best to support health and wellbeing through this transition.

Covered in this episode

[00:54] Welcoming Julie Cottle
[03:45] Defining postnatal wellness
[07:36] The postnatal hospital experience
[11:50] Breast augmentation and breast feeding
[15:24] Breast feeding issues
[18:41] Supporting the physical and emotional trauma of birth
[20:51] Red flags for postnatal depression
[23:43] Social and functional health post-baby
[32:35] Clinical tips for improving postnatal wellness
[37:26] Breast feeding and expressing
[40:41] Diets and atopic infants
[45:41] Mindfulness for expectant and new parents
[48:25] Postnatal red flags

   

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Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook. Joining us on the line today is Julie Cottle, who works in the Blackmores advisory team with a special focus on infant nutrition and maternal and infant healthcare. Julie is an International Board Certified Lactation Consultant and a naturopath who has been supporting new mothers and their babies since 1998. Welcome to FX Medicine. Julie, how are you going?

Julie: I'm going really well. Thank you, Andrew. Thank you for having me on the show today.

Andrew: Now first, can you tell us a little bit about your history? Which did you do first? Naturopathy or lactation consultant?

Julie: I did naturopathy first. So I was straight out of high school and straight into naturopathy. I found in my final year of studying naturopathy that I became really, really interested in preconception pregnancy and postnatal aspects of naturopathic care. I sort of really came to see that as the beginnings and where there is the most potential to make a big difference in a person's life and their health throughout their life. So I finished naturopathy in 1998 and worked for about a year before I decided to have my own family. And that's, I guess, where a lot of my learning really began by applying this stuff that really fascinated me while I was at college to my own life. And I remember when I was pregnant, I went to visit a friend who had a baby, and it was probably really the first exposure that I had to actually caring for a baby. And she told me all the things that I should learn about before the baby comes along, and one of those things was breastfeeding. And I hadn't really given it a lot of thought up to that point, but I thought, "Oh, yep, she's right. I really do need to learn about this." I became a member of the Australian Breastfeeding Association so that I was all set up and ready to go when I had my baby. And I found that that knowledge and support was totally invaluable to me in the first year or so of my older baby's life, and I then went on to become a breastfeeding counsellor, and saw how many moms out there really, really need the help during the postnatal period.

Andrew: Absolutely, absolutely.

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Physical comfort has epigenetic effects on infants by Laura Miller - Read Article

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Julie: Yeah.

Andrew: Any future parents in Australia at least are bombarded with antenatal education and care, but the aspects of postnatal care and wellness are mostly ignored. So what do you mean by postnatal wellness?

Julie: Well, I guess I mean that it's the feeling of being ready to take on the new role and capable of taking on that new role and doing it in a way that doesn't have you spiralling into overwhelm and, you know, things that can end in postnatal depression or anxiety and just real inability to cope.

Andrew: Yeah. It's just, I remember this total period of there is no instruction book for this. That it was just like here you go. It's like being given a car, you have no idea how to, here we go: it’s like turning on a Tesla. It's like there's no instructions. There's no knobs or switches. Everything is done via the pad. And this is what I've been told. I've never driven one, but they just say it's this total new concept of getting into a car and starting it and working it. So it's really alien to somebody that's been using a normal car in, you know, the old way. Similarly with baby, not similarly, anyway, similarly with babies, there is just this period of overwhelm.

Julie: Yes, even when things go perfectly and by the textbook, which doesn't exist.

Andrew: Yeah, I was just... Which textbook?

Julie: But, you know, even when everything is perfect, it's such a major transition and an incredibly steep learning curve and a time when mum's trying to learn all of these new skills and master this skills under intense pressure.

Andrew: Yeah. And the pressure's both internal and external.

Julie: Yeah, that's right.

Andrew: Yeah.

Julie: Yeah. And the circumstances that moms having to do this under are incredible, lack of sleep and recovering from an incredibly gruelling physical time. It's definitely not an easy task.

Andrew: No.

Julie: And we need to be supporting moms in this time if we expect them to be able to come through those demands without suffering for it.

Andrew: They can be this enormous pressure placed on women, especially these days, about what is the perfect birth.

Julie: Sometimes I look it and think it's how we respond to the situation as individuals and that sometimes I feel that people feel a lot of that pressure and I wonder how much of it is coming from other people and how much of it is coming from ourselves. But then, you know, I do spend too much time reading the comments on social media at times, and you do see that there is a lot of people projecting their own expectations onto other women, and the solidarity and the sisterhood can be really helpful in this time, can really help to to lift each other up and support each other, and I don't feel that it's helpful for us to be questioning other peoples' decisions when we don't have the knowledge on why they have made those decisions.

Andrew: Yes. So what sort of aspects does postnatal wellness include? We've obviously got the physical aspects from recovering from the gruelling marathon of the birth which, like this is the, talk about normality. You know, you can get anything from two, three hours to more than a day. 

Julie: Yes.

 

 

Andrew: And, I mean, it can be a marathon for the woman. So how do you care for somebody? How do you prepare them for that journey to then look after themselves postnatally?

Julie: It's such an incredibly difficult thing to prepare for, I think, because it's such an unknown. You can go into birth with a lot of knowledge and a lot of understanding of what it is that you may face and going with a great birth plan and have a good understanding of how you want things to go, and how you are going to be able to cope with all of those things. But that's not necessarily how it will work out. 

Andrew: Yeah.

Julie: And I think a good postnatal care plan needs to be able to take into account all eventualities that happen before a birth, and I think it's important to think beforehand and to have even a written plan just like a birth plan to have a postnatal care plan that allows time for physical rest and recovery as you say, but also that takes into account the emotional and the social aspects that change in a woman's life once she has a baby as well.

Andrew: Yeah. So immediately postnatally, you know, obviously, the hospital staff are going to care for that woman, depending on how much time she spends in hospital. I think it was interesting from the birth of our two kids. The nurses were incredible. Actually, I'm going to qualify that. The full-time staff of the hospital were incredibly compassionate, organised and caring. I did find there was a discrepancy between the agency nurses, and I get that there's a reality there, and that there's maybe that's a continuity of care issue. But I did find a difference. But I was so thankful for how they cared for my wife's needs with the knowledge of, you know, that she's going to need some time, that you get the, you know, the three day blues, that she's going to need some physical recovery, so to limit the well wishers to allow my wife to get a good amount of rest and bonding with our sons…

Julie: Yes.

Andrew: …now, which was just beautiful, I've got to say.

Julie: Yeah, yeah. Yes. I think that that time can be either completely overwhelming with visitors, or it can be this lovely, lovely process…

Andrew: Yeah.

Julie: …family coming together with a new family member and getting to know each other and bonding, and it's really really important in those first few days. If you can do it in hospital, great. If you can do it at home, then fantastic. But it's really important to just spend time snuggling with baby and smelling baby and...

Andrew: Yes. Isn't that interesting? We like to think of ourselves as humans rather than animals.

Julie: Yes.

Andrew: We still want to sniff a baby's head.

Julie: That's right. It's such an instinctual time, and all of those instinctual things that we don't even know that we're doing, like getting a good sniff of a baby's head. Those things are also important for our hormone production and that can change the way that a mother's milk comes in. The opportunities for snuggling and bonding for both mum and dad in those very early days and especially the very early hours should not be underestimated.

Andrew: Oh, absolutely critical. But of course, there can be issues with milk letdown process, whether that be emotionally connected or whether that indeed be physically connected. Like for instance, breast augmentation these days is so common. What do you find the issues are there with regards to breast augmentation? More of an issue, no issue? Lead us through that.

Julie: It can certainly be challenging for women that have had breast surgery. Some, it's very individual. Some people will have no problems whatsoever and will be able to breastfeed. Others will have significant problems breastfeeding. If, it depends on how well the surgeon's done the job and whether they've given consideration to whether a woman may or may not want to breastfeed in the future. So, as with most things in health, it's a very individual thing. But, if a woman has had breast augmentation and is planning to breastfeed, then it really is something that she should think about during pregnancy, and be aware of the signs that things are not going well. And part of her postnatal care plan needs to be, "Who am I going to talk to about how to deal with things when they do go pear shaped?"

Andrew: Yes, cause they will.

Julie: Yeah, they will most certainly.

Andrew: Oh, my goodness. I can still remember, Lee. Lee, my wife, Lee, is the most competent, compassionate lady ever. And yet Lee even had her issues. She was just at wits end with, you know, our firstborn, fussing at the breast. And, you know, oh, gosh, I remember all of this, cracked nipples and all sorts of issues. And Lee, at one stage, we just called the lactation consultants who were just, I've got to say, worth their weight in gold. And they came in, took control, and got Lee some rest. And that's what Lee needed.

Julie: Yes.

Andrew: Some practitioners may have knowledge about the various support, but when should mothers start planning for intervention should any issues arise?

Julie: Yeah, that's such a tricky thing. And I've got four children myself, and I found with each and every one of them I've just been thinking, "Oh, my goodness, I'm so glad that I have the knowledge that I have, because I don't know where I would be without it." As care providers, I think it's really important to screen for all of the issues that may potentially come up and to take the time to really understand what's going on for a mum and whats kinds of issues she may face. So this kind of...I've said before this kind of postnatal care planning really should take place during pregnancy, you need to have an understanding of what can go wrong and how I'm going to fix it, or how I'm going to cope with that when it does, when and if it does come up. But that's the role of the healthcare professionals that are caring for pregnant and postpartum women…

Andrew: Yeah.

Julie: … to educate during pregnancy, and to educate again after pregnancy and don't count on the fact that mom is going to be able to necessarily articulate what's going on for her. They need to be quite preemptive and think about the sorts of things that she may be up against.

Andrew: What are some of the issues facing breastfeeding mothers? And what are some of the red flags that we need to be aware of?

Julie: Okay. Well, I like to cover physical, emotional, social, and functional aspects of life in the postpartum period, and you'll find every woman has got, will probably be coping quite well in one of those areas and really flailing in another aspect. So the physical stuff we've kind of touched on, and generally that the physical things that are going to affect her most are likely to be breastfeeding related or related to recovery from pregnancy. But it is important to ask mum, how is the breastfeeding going, how…like and to really take quite a good detailed history of what's happening with both her and the baby and whether she feels like baby is getting enough? Does she feel that there is anything wrong? And then if she does flag anything, to make sure that you refer her on to appropriate care.

Andrew: Yeah.

Julie: So, I would say, for breastfeeding issues, really an international board certified lactation consultant is the right person to refer to because you need to have really, really strong breastfeeding specific knowledge and a lot of hours of experience under your belt before you can even sit the exam.

Andrew: Yeah.

Julie: So that one. So…and often if baby's fussing at the breast or there's a supply issue, most of the time those things can be resolved with one-on-one support. And the other aspect of that too is if you are providing breastfeeding support, a really simple practice to promote is skin to skin contact for bubs when they're young, but even as they get older if mum feels that she's having any kinds of supply issues or attachment issues or something's just not going right, sometimes the simple intervention of telling mum to snuggle baby without a top on and to have baby with no top on and to be snuggled up skin to skin can make a really big difference very quickly. So, looking at the emotional aspects is also really important for caregivers. And often the emotional components will revolve around perhaps expectations not meeting reality. Mum's feeling just overwhelmed and not able to cope with a new way of being. 

Andrew: Ah.

Julie: So, yeah.

Andrew: That's an interesting one.

Julie: She may be really devastated about what happened maybe in her pregnancy or in her birth. There may be unresolved trauma, and that's such an incredibly important thing to address. Unresolved trauma can cause all sorts of emotional and functional difficulties for moms throughout that first year, or first two years, whatever, I mean, it's something that can have a profound impact.

Andrew: Are you talking about emotional trauma or are you talking about physical trauma having an emotional impact, like for instance episiotomy, you know, an unexpected birthing outcome, unexpected pain, unexpected gelling between the plan and what actually happened, as you said, the expectations versus reality? Is this the trauma that you're talking about or the emotional trauma of change?

Julie: Look, I'd say, I was talking more about the physical aspects that you just spoke about, but that emotional trauma of change is a big thing as well. But certainly the birth trauma and all of those physical aspects that you spoke about can cause PTSD symptoms and that's something that can really benefit from appropriate referral, the, the emotional aspects of change and that the change…right, let's face it, it's a completely new life. From the time that you go into the hospital to have your baby to the time you come out, you've taken on a completely new role…

Andrew: Yeah.

Julie: ...and almost transformed into a completely different person, a different life.

Andrew: Yeah, you have.

Julie: Yes, that's right. It's a different life and that can be shocking for some people, and sometimes people just need to talk about all of that. And I think that's where mother's groups can be quite helpful when they're supportive, rather than, as you mentioned before, when they're sort of a little bit more competitive.

Andrew: Yeah.

Julie: Yeah.

Andrew: When do you find there's a difference? And how do you tell the difference between, I glibly say, this, forgive me, but normal overwhelm - I know, forgive me - normal overwhelm, versus the beginnings of a stress disorder, a post-traumatic stress disorder or postnatal depression. When do you find... What's the red flag?

Julie: Well, postnatal depression, anxiety, PTSD, all of those things, the symptoms are the same whether it's happening in a person that's recently given birth or not. So the symptoms that you would look at, very similar symptom pattern. But I guess what it comes down to is does mum feel that she's able to cope with this? Is this affecting her life in a way that's just making things unbearable? Is she able to sleep? Is she able to cope and get through? And is she able to do that in a way that improves her life or is it a destructive thing in her life? 

Andrew: Yeah.

Julie: And I think if there's any kind of destructive element there then she really should be properly assessed by, I prefer to refer to a psychologist that has a lot of experience with perinatal mental health and that there are plenty of psychologists around that do specialise in that area…

Andrew: Right.

Julie: …and they can be really helpful.

Andrew: So what about things like an admittance of disconnectedness with your child?

Julie: Yeah. Again, that can be just a normal part of bonding, but not everybody feels that connection immediately. 

Andrew: Sure.

Julie: Like I said before, I've had four children, and that experience of connecting to the child has been different for each one of them.

Andrew: Yep.

Julie: It's not always immediate. But if it's not immediate, and it's not growing, and mum is, mum mentions that and she feels that it's something that's really bothering her, then it's really important to talk to somebody about that. That should be properly addressed.

Andrew: Yeah. And it's a big thing for a woman to admit that because it goes against the social norm, the mores. You know?

Julie: Absolutely. It's often connected to a real feeling of failure.

Andrew: Yeah. It's really interesting how we have this textbook guideline, as you say, and basically I think there's your textbook, it's got 500 pages, rip out to page 1 to 499 and there you go. That's what you're really work with.

Julie: Yeah, that's right. It's such an individual journey.

Andrew: How do we define social and functional health?

Julie: Okay. Well, social aspects refer to your relationships with people, and bringing a new baby into the world can change those relationships quite dramatically. I guess the most significant one is your relationship with your partner. For a new mum, all of a sudden she will go from being a wife or a partner to being a mum, and that's almost all she can cope with at that time, right, and just learning that new role and keeping that connection to the baby and making sure that she's always available to meet the needs of this helpless little human that she's bought into the world. That can be very overwhelming and other relationships often suffer as a result of that. And that can…I have seen that that can cause problems for mum, often leading to feelings of guilt and that she's maybe neglecting other parts of her life. And I think dads in particular feel that disconnect early on in a baby's life. They often wonder what their role is particularly with newborns. I don't know how you found it, but I know my husband was kind of like, “Oh, well, where do I fit in?"

Andrew: What I found really, really useful is actually books, you know the, "How To Be An Expectant Dad." I think it was Steve Biddulph who wrote that.

Julie: Yeah.

Andrew: And then there's, yeah, "The Expectant Father," that was Jennifer Brott.

Julie: Mm-hmm.

Andrew: So, you know, there's some really good books out there for fathers to cope.

Julie: Yeah, they really are. There's another one that I love "Beer and Bubs."

Andrew: "Beer and Bubs," okay.

Julie: Yeah. I can't remember who wrote it but it's a good read really for dads.

Andrew: Self-explanatory title they'll be able to find. And will put up these references on the fxmedicine.com.au websites as well.

Julie: Oh, fantastic right.

Andrew: Right. So forgive me continue.

Julie: Yeah. I guess another really important as a social relationship that changes after a mum has a baby is that with her own mum often. There can be unwanted support...

Andrew: Yeah.

Julie: ...unwanted and overwhelming support from loving family members who just want to help. 

Andrew: Yep.

Julie: There can be a lot of advice that is given and expected to be taken where maybe the new mum doesn't particularly want to be doing things the way that her mum thinks that she should be doing it and that that can cause a lot of problems. She can be perhaps feeling neglectful of other relationships in her life as well. Somebody that might have had a good close knit group of friends may all of a sudden not have time to see them or no desire to go out and socialise anymore. So a lot of just social circle may fall away too.

Andrew: You get the great stories about friends having, you know, birth's that they're having at the same time, and they're sort of you know, comparing and contrasting and enjoying the journey. And then you get people that they're in a circle of nulliparous women, and, you know, one of them becomes pregnant and starts a family. Their whole focus has to change.

Julie: Yeah, it's a very profound change.

Andrew: Yep.

Julie: It took me a long time to even recognise that those relationships had moved in some way.

Andrew: What about functional health? How does that differ from social health?

Julie: Functional health refers to how capable a mum is feeling. So how well she feels she's able to manage the mundane parts of life or things like feeding herself and feeding her baby and keeping her health as functional, whether she's able to get out and get some exercise or take the baby out for a walk, how capable she feeling of managing life, I guess, during that time.

Andrew: Yeah.

Julie: So for some women, it's really really important for them to have a tidy house and to have a nutritious meal on the table every night. And it may not necessarily be an easy thing to maintain during that time after she's had a baby, you know. Some mums will be able to snap back to work even within six weeks. But others are still struggling to get up and have a shower every day six months down the track, and both of those, I think, are normal adaptations during that time. It just depends on what she wants to focus on really.

Andrew: Right. So I guess my question comes in about if they're not showering and just doing the simple daily activities of living, where do you make a judgement, to say this is not "normal," this is actually dysfunctional if you're not coping with these simple daily tasks, and therefore, you're putting yourself and your child at risk? Like, where's that line?

Julie: Again, I would put it back to how she feels it is. Like if she's saying, "Okay. Well, I haven't been able to have a shower today, but that's okay. I'll have one tomorrow and it's fine..."

Andrew: Yeah.

Julie: ...then that's, I think that that's fairly reasonable. But if she's saying, "Look, I can't, I'm just not interested in looking after myself. I can't be bothered." And if that's going on for days or weeks at a time, then that's an important red flag.

Andrew: Yeah. Yeah.

Julie: Yeah.

Andrew: How important do you think the feeling of guilt is with this?

Julie: I think guilt can be overwhelming for a lot of mums and it's just such a common emotion. I think every new mother feels guilt on some level. I haven't spoken to any mum yet that hasn't expressed guilt of some description...

Andrew: Wow.

Julie: ...to me in that first year.

Andrew: Yeah.

Julie: With regards to how she feels that she should be managing things, most women will go into motherhood with some expectation of what it's going to be like for her and what the role of a mother is, and if she is in a situation where she is unable to give what she feels is required at the time then she will feel guilt about it.

Andrew: Wow.

Julie: You know, feeding is probably the biggest, most emotive one that comes out.

Andrew: That's incredible that women feel that way. Has any research being done on why women feel this?

Julie: There has been some really interesting research, some great social research that has been conducted on this. There's a couple of studies that I'll make available for listeners after the show. The Aber, et al., study looked at how a women adapts to motherhood and the types of things that do affect her feeling of functionality in the world. Things like whether her baby is a high needs baby or a lower needs baby…

Andrew: Ah.

Julie: …how attached she feels to the baby, how supported she feels in her relationships and how in control of her day-to-day life she feels, whether she's got a social life and how much time she has for herself. All of those things are going to feed into how well she feels she's adapting and how on top of life she is.

Andrew: So let's talk about some practice tips for improving postnatal wellness. What can you share with us?

Julie: Okay. Well, I think the most important thing is to start thinking about this early on, and so incorporate it into pregnancy care. Help mum to review her support networks. Start a list of people that might be able to help her in that time, and make sure that those people are aware that she would like help during that time as well.

Andrew: Right.

Julie: And there was some research, one of those research papers that I mentioned before actually talks about mothers having this expectation of social support, but not actually communicating that to the people that they expect that from.

Andrew: Yeah. Doh!

Julie: That's a really important part of getting help. You can't necessarily rely on yourself to know what you need during that time. Sometimes just going into it with a good plan is very useful. And the only person that can know is the mother herself.

Andrew: Yeah, and a written plan because you do get pregnancy brain.

Julie: Absolutely. Baby brain. And I think it's worse than pregnancy brain.

Andrew: Yeah, baby brain. Forgive me, sorry. Baby brain.

Julie: Yeah, so help her to identify who can help and what her expectations are to them, and help her to communicate that to the right people.

Andrew: Yep.

Julie: So that can include her social network, but also healthcare professionals that you may be able to refer them to as well. So, you know, if I have breastfeeding problems, this is my local international board certified lactation consultant. Maybe the hospital might have somebody that can see you as an outpatient that maybe you might need to go and see somebody in private practice. So have those options available…

Andrew: Yep.

Julie: …when you leave, before you need them. Make sure that they know that perhaps that their relationship's going to change with their partner and that they should have a conversation about those changes and those expectations that they have and how they might navigate things like increased stress in the household and not enough sleep, and who's going to cook the dinner and who's going to clean the bathroom and all of those sorts of things...

Andrew: Yeah, absolutely.

Julie: ...that might be important to a family.

Andrew: I mean, I can still remember scheduling was the probably the most important thing for allowing my wife to get a dedicated amount of rest. So because I'm a night owl, I took over the evening shift, and then Lee was able to get a good night's rest tonight and she'd wake up earlier because she's a morning person. So it was really, really interesting just how powerful that simple staggering the workload was. Of course, you know, men are typically lazy when it comes to household chores and women, you know, soldier on through and run themselves ragged. So I think this is a call out to all men, all expectant fathers, partners, you know.

Julie: Well, I think sometimes it's both though.

Andrew: Lift your game.

Julie: Yeah. Well, definitely I do see, and I do see quite a lot of those dads in my work. 

Andrew: Yeah. Yep.

Julie: But I also see probably the majority of them that do want to be helpful and that do want to do the right thing, but they're absolutely clueless as to what it is that is needed from them at that time.

Andrew: Okay.

Julie: And that they just need somebody to say "This is what I need you to do right now."

Andrew: The mindless drone, we just need to tell. But that's actually a really important point because as, you know, Steve Biddulph raised, there's often there's real, and it can be a guilt. It can be, "I don't know what you need from me. I want to be useful at the moment I'm not, and this is frustrating the hell out of me."

Julie: There are many, a lot of the time people think, "Oh, I can feed the baby. That will take the pressure off." But a lot of the time, that's the one thing that needs to be left up to the mum, because milk is made by having a baby at the breast. So sometimes, taking the baby and bottle feeding the baby is not necessarily going to be the most helpful thing.

Andrew: Yeah.

Julie: But enabling mum to take the time to sit down and feed without feeling guilty about not doing other things or having to worry about all of the other things, those are the sorts of things that a mother really needs help with generally.

Andrew: Yeah. When you've got, you know, being a lactation consultant, I know, and we all favour breast, you know, breast fed is best, there are some practicalities in here, and, you know, when the mother is simply just worn out and needs a rest. And so what's your opinion? How do you tackle that, that issue of sapping of, you know, like that skin to skin love, right, is the best initiator of a letdown reflex, that feeling of bub. But when you've got a cold hard breast pump sucking at your breast, it doesn't have that same initiation. So what's your thoughts around having bubby near while you're expressing so that you have enough milk both for bub now and later?

Julie: Ideally, if mum feels that she needs to get a stash of milk put away so that she's got some for when she wants to go out or if she needs a good stretch of sleep throughout the night and somebody can take the pressure off by feeding expressed milk, then ideally, it's best to wait until the milk supply is well established. So usually that happens in around six to eight weeks or can take a lot longer than that for some women. So if she can, just for the first six weeks, just focus on establishing a milk supply and that's her only job and she can get to that point, then that's fantastic. If she does need then to express to get a phrase of stash going, then having bub close by while she expresses can be really, really, helpful, because you do, as you said before, you do get that feedback from even just looking at photos of your baby can help to get that down reflex going. 

Andrew: Yeah.

Julie: Things like recording cute noises that your baby makes, you know, when they're lying in bed and make those cute little sucking sounds or crying. Those sound can also help to trigger that down reflex.

Andrew: Yeah. And any woman, any mother will know this when they go to the supermarket, even another baby's cry it's like, "Oh, no."

Julie: Yeah. Soaked my shirt again.

Andrew: Yeah. Good ole flannels.

Julie: Yeah. Yes, having smell reminders, sound reminders, even expressing in the same place every time. So if you need to make friends with the breast pump do it in your favourite rocking chair, do it in the same place.

Andrew: Making friends with the breast pump.

Julie: Yeah. Some women do really need to get very, very intimate with the breast pump.

Andrew: There are some breast pumps that look like more like torture devices.

Julie: Yes, there are.

Andrew: I hope they've improved since our day.

Julie: Some of them are a bit too complicated and fandangled. 

Andrew: Yeah.

Julie: And one of the great skills that you can learn, hand expressing is a really handy skill...

Andrew: Yeah.

Julie: ...for a mum to learn, so add that one to the bag of tricks.

Andrew: Yeah, absolutely. So what about things like, you know, if a mother feels that, dare I say the word doing damage, or, you know, what about infant eczema? How do you help the mother to identify things that might be an issue for her baby?

Julie: If a mum thinks that it's her milk that's maybe making her baby colicky, or have gastrointestinal problems or eczema, I always start with an elimination diet, but trying to keep it fairly basic because you can't overwhelm a new mother with a crazy diet.

Andrew: Yeah. You still got to make it nutritionally complete as well.

Julie: That's right it has to be good nutritious food. So I only try to eliminate foods as necessary. So I would start with the most highly allergenic foods. So, start with removing dairy and wheat to start with, I'd look at also maybe shellfish and tree nuts and peanuts if it was a skin allergy. I'd also look at making, looking for interactions in the microbiome development as well, so perhaps having interventions during the birthing process, or antibiotic treatment during or after birth. In those cases, I would recommend a good probiotic regime for both mum and baby to help microbiome development and to make sure that that's not contributing to any kind of allergic issues.

Andrew: There's a real trick to that isn’t there, like, you know, the research shows positive effects when you started in pregnancy for the last trimester of pregnancy. 

Julie: Yes.

Andrew: So you've got to really be really on your game to identify the potential, the atopic potential before birth. Because, if they started probiotics given to either mother or bub after birth, it just didn't work. So you really need to be on your game.

Julie: You do, and you do need to make sure that you're using the right strains as well.

Andrew: That’s right. Yep. So that's Lactobacillus rhamnosus GG.

Julie: Yes, yeah, because that's true. There is a product that does have a strain that's isolated from breast milk that has very good research as well.

Andrew: Yeah, this is certainly an ongoing area, you know. Now people are looking more at multiple strains, identify the strains and seeing what the effects they are. So we'll put all of this research up on the fxmedicine.com.au website so that people can educate themselves about not just the research that's happened, but also the upcoming research. It's very exciting stuff.

Julie: It's definitely a growing area.

Andrew: Absolutely. And of course, probiotics should always be used in the context of diet. So what about things like, you know, you and I have spoken about this earlier, traditional foods?

Julie: Yeah. Obviously with our cultural diversity in Australia, our practitioners are going to kind of come across new mums that are embracing their cultural practices and their traditional foods. And I find when I go out and visit a new mum, that typically the Chinese mums and the Indian mums, they're being nurtured with traditional foods, which are designed to be very nurturing and warming and building of health and very easy to digest. And that can really help women that are living outside of their country of birth to feel more connected and it also helps to build their health, and I feel that those practices and those foods should really be encouraged and that's another thing that women can build into their care plan. They can look at what kinds of foods are traditionally used during the postpartum recovery period. In my culture or in my family, is there anything special there that I can bring through and incorporate that into my care plan?

Andrew: Yeah. And this could also help with the inclusion of family and things like that as well, couldn't it?

Julie: Yeah, absolutely. That's such a good job to give to your family. "Please make me some nice nourishing meals so that I don't have to worry about it."

Andrew: Yeah.

Julie: "And so that I can nurture myself easily."

Andrew: What about things like mindfulness? When should this be taught to expectant mothers and indeed, fathers?

Julie: Mindfulness is an incredibly useful tool to teach throughout pregnancy. And because it's a skill and it requires practice, I think it needs to be taught during pregnancy. It's a skill that's helpful for anybody that's undergoing a stressful situation. So for expectant mums and dads, it's going to come in handy to deal with the anxiety of pregnancy and the upcoming birth. Even if things are going wonderfully there's always going to be this background niggle there about what's to come. And mindfulness can be very helpful to help keep you in the present moment and not to let those anxieties and fears overtake. So, yeah, good, good one to practice during pregnancy. Good one to teach during pregnancy.

Andrew: And there's even some awesome apps nowadays on smartphones. 

Julie: Yeah.

Andrew: It’s just amazing what's out there that's, you know, really quite useful to help in getting into the moment if you like.

Julie: Yeah, absolutely. So there's one called "Mind The Bump," which I find, fantastic. And it has just short little exercises that you can do.

Andrew: Yeah.

Julie: There's also another app put out by ACT, where that's based on the acceptance and commitment therapy principles of helping families to identify their values and just finding moments in the day to check back in that you're acting in accordance with those values.

Andrew: That's really cool. ACT, A-C-T?

Julie: Yeah, acceptance and commitment therapy. It's a free little app that just sends you little reminders during the day, and things like, pay attention to the most distant sounds that you can hear right now.

Andrew: Right.

Julie: So just things that take a few seconds, and just remind you to stay in the present and to act in accordance to your values and your principles.

Andrew: Yeah I can just imagine, you're a mother's most distant sound, baby crying. Most distant sound, baby crying. That's sort of like...

Julie: It's interesting because you've got to listen beyond the most overwhelming sound in the environment.

Andrew: Husband, take baby away.

Julie: Yeah. You find birds chirping, "Oh, yeah, it's still there." Yeah.

Andrew: Julie, I have to covers just some things. What shouldn't we do? What do we need to be mindful of, to raise a red flag? You know, we've raised one before regarding PTSD. 

Julie: Yes.

Andrew: It often goes undiagnosed, unrecognised. 

Julie: Yes.

Andrew: What do we need to be aware of to recognise it?

Julie: We need to not let it get lost in the overwhelm of the postpartum period. So we can't just keep saying to mums, "It's normal. It's normal. It's normal. It's just, you know, it's just adjustment." If a mum is sitting in front of you and indicates that she's struggling or you feel that she's struggling and she's not able to verbalise that she's struggling, then it's important to investigate that fully and to refer on as required.

Andrew: I think refer early as well.

Julie: Absolutely, refer quickly. It's very, very common in the postpartum period to suffer from depression, anxiety, or even PTSD, and the earlier these things are picked up on, the better. So any red flag, anytime a mum says, "Look, I'm really not sure that this is normal," just have it investigated.

Andrew: Yeah.

Julie: And there are loads of things that we can do as integrative professionals to be able to assist in that time. But I do feel that it's very appropriate to refer to a wider network for investigation and interdisciplinary collaboration.

Andrew: Responsible and expert care, and so well said. Julie, thank you so much for taking us through. This is a real complex issue, it’s not a light sort of podcast. You know, I think there's a lot more education that needs to be undertaken before you'd feel anywhere near competent in helping women through this. But I thank you so much for taking us through the tip of the iceberg today on FX Medicine. Thanks so much.

Julie: Thank you for having me, Andrew. It's been a pleasure.

Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.

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