The science behind breast milk and why it's amazing for gut health — Dr. Kavita

[00:00:00] So what the formula doesn't do is it doesn't give you immune complexes.

[00:00:04] So it can't do that.

[00:00:05] So cretory, IGA, which is so important for gut health and it can't give you a microbiome.

[00:00:09] That's actually the problem.

[00:00:11] And that puts you at risk of ATP.

[00:00:13] It puts you at risk of allergy.

[00:00:15] It puts you at risk of autoimmune diseases, metabolic diseases, diabetes,

[00:00:19] rheumatoid arthritis, heart disease, asthma, all of that kind of stuff.

[00:00:24] It provides nutrition and it provides fat and you're going to grow,

[00:00:27] but it doesn't give you that extra immunity,

[00:00:31] which is so important for the growing individual.

[00:00:34] I say that with a lot of sensitivity because the one thing I can tell you for my

[00:00:38] years in this field is that no mother wants to do less than for their baby.

[00:00:42] It's the role of everybody now to help the mother learn what is best,

[00:00:46] what is truly best and then to work out how we can get back that knowledge

[00:00:51] so that they can do the best.

[00:00:53] I'm Jane Z. And this is Farm to Future.

[00:00:56] The podcast all about eating better for the planet.

[00:01:00] So I recently saw my mom for her 60th birthday, happy birthday, mom.

[00:01:05] And I got the chance to ask her whether I was breastfed as a baby.

[00:01:10] I wanted to know because we've had several experts on the show now talk about how

[00:01:14] important breast milk is for a baby's gut health and microbiome and immune

[00:01:19] system development.

[00:01:20] And I know that I was born by C-section,

[00:01:23] which is also not as good for your gut health as a vaginal birth.

[00:01:27] And as you'll know, I have had plenty of gut issues in my adulthood.

[00:01:32] So I wanted to know if formula had anything to do with that.

[00:01:36] Lo and behold, the answer was yes,

[00:01:38] I was indeed fed formula as a baby because that was the gold standard back

[00:01:43] in the day in China.

[00:01:44] This was a bit of an epiphany where I was like, oh my gosh,

[00:01:48] the puzzle pieces fit together.

[00:01:50] C-section birth, fed formula.

[00:01:53] And now I have a super sensitive gut.

[00:01:55] And of course, of course, this is not a knock on my mother,

[00:02:00] who is the best mom in the world.

[00:02:02] She did exactly what she thought was best for me.

[00:02:05] And it just so happened that the information she was given was not the best.

[00:02:09] And that's why I wanted to bring on Dr. Kavita today.

[00:02:11] She is a Melbourne based family doctor who is trained as a lactation consultant.

[00:02:17] And she's now helped thousands of families navigate breastfeeding

[00:02:21] in the first few critical months of parenthood.

[00:02:24] Today, we talk about that fascinating

[00:02:26] connection between breast milk and the infant gut going deep on the science.

[00:02:31] And we also discussed some of the most common reasons moms give up on breastfeeding

[00:02:36] and some solutions.

[00:02:38] Dr. Kavita runs an active Instagram page at breastfeeding with Dr.

[00:02:42] Kavita and she has a ton of resources on her website too.

[00:02:46] At Let's Talk Breastfeeding.com.

[00:02:48] If you are a new or expecting mom or dad,

[00:02:52] I highly encourage you to give her a follow.

[00:02:54] Dr. Kavita, welcome to Farm to Future.

[00:02:59] Welcome to the podcast, Dr. Kavita.

[00:03:02] Hi, hi, Zane.

[00:03:03] So you and I met because of an Instagram

[00:03:07] contra... oh, should I call it controversy?

[00:03:09] A real that went viral.

[00:03:12] So a couple months ago, I had chef Dr.

[00:03:15] Mike on who's one of our regulars and we were talking about how breastfeeding

[00:03:19] your baby up to two years is cardio protective for them,

[00:03:23] even up until the baby becomes an adult into their 50s and 60s.

[00:03:27] And so it was all like well intentioned advice, but people went off in the comments.

[00:03:34] And I learned very quickly that breastfeeding is very touchy topic,

[00:03:39] largely because a lot of women may want to breastfeed,

[00:03:42] but aren't able to or don't understand the benefits.

[00:03:46] And you jumped in and you reached out and we're like, hey,

[00:03:49] you know, we should do a full deep dive on breastfeeding.

[00:03:52] And I'm so happy you reached out and so excited for this chat.

[00:03:56] I'm so happy that you are responsive to it because it is such a controversial

[00:04:00] topic and it's not really understood and out there, the data is there,

[00:04:04] but it's not really talked about a lot of the problems and how they connect.

[00:04:09] So thanks for having me on to kind of disseminate this information,

[00:04:13] because like we mentioned, I'm in my 40s, so I'm not as up to date and versatile

[00:04:19] with all of the ways of spreading information, but we need to as doctors do

[00:04:22] that a bit more because there's a big disconnect between our little world

[00:04:27] and where people are and we're not traversing that very well at the moment.

[00:04:31] So that's why people are so overwhelmed with all this information too.

[00:04:35] So thank you for your role in sharing that and and helping us translate that

[00:04:40] information every day, patients help me to kind of understand it.

[00:04:44] They'll say something else.

[00:04:44] Say something to them and they'll be like, oh, what do you mean?

[00:04:46] I'm like, oh, I'm saying this every day to people.

[00:04:50] Oh, I need to explain it better.

[00:04:51] So it's such a crucial and important role what you're doing.

[00:04:54] Before we started recording, I was just mentioning how when I was born in

[00:04:59] China in the 90s, I was born by C-section mostly because I was very, very late.

[00:05:05] I was like a month late by poor mom.

[00:05:07] That's right though.

[00:05:09] Yeah, so born by C-section and then I need to double check with my mom,

[00:05:13] but I'm pretty sure I was either supplemented with formula or fully fed

[00:05:16] formula because in the 90s at the time it was sort of thought

[00:05:22] that formula is better than breast milk.

[00:05:25] And you kind of mentioned,

[00:05:26] you know, that's a big pattern you see among your patients.

[00:05:30] Yeah, I still had even, you know,

[00:05:33] every time I get this question, I still feel down because I'm in a bubble

[00:05:36] where we know what's really helpful.

[00:05:39] But again, we're not crossing that social idea.

[00:05:42] So even when you mentioned about C-section,

[00:05:44] there's so much saying and emotion around it now.

[00:05:47] What people need to know actually is the C-section,

[00:05:50] maternal mortality rates are huge.

[00:05:53] You know, we used to lose mums and babies.

[00:05:56] So much more commonly than we do now.

[00:05:59] And I think the obstetric world is still trying to catch up from that

[00:06:01] because their fields developed from trying to prevent maternal death.

[00:06:06] You know, having a baby was a bit of a Russian roulette or, you know,

[00:06:11] throw of the dice, right?

[00:06:12] It was a real gamble on how you would be alive.

[00:06:16] And even with my second baby, my second baby was very big and my health

[00:06:20] was very tall and got spiky blood.

[00:06:22] So, you know, you can cut this bit out of the podcast.

[00:06:25] That's why we're not supposed to cross breed, right?

[00:06:27] Racially.

[00:06:29] Because, yeah, because I'm an Indian, I'm supposed to have a small,

[00:06:33] you know, nice 2.5 kilo baby and she was 4.2 kilos.

[00:06:37] So we, yeah, I would have died in that delivery had we not had instrumentation.

[00:06:41] And I tried to do that one vaginally and I was a bit crazy about it.

[00:06:44] But I'm still pushing on the table when they had me ready and draped up.

[00:06:48] And my friend who was in the obstetrician was like,

[00:06:49] we're not going to get this baby out that way.

[00:06:51] Like lay back.

[00:06:53] Oh no.

[00:06:53] Yeah.

[00:06:54] Yeah. But again, it's that no form.

[00:06:56] Anyway, that's your point about these sections.

[00:06:58] It was the common way of doing things and a lot of countries are still struggling

[00:07:02] to kind of understand that we have different hygiene methods.

[00:07:06] We've got so much more information for the anti-natal period.

[00:07:11] So mothers are a lot more there in better health.

[00:07:13] That's why these sections were so common.

[00:07:16] I digress from what you were saying, which was about the formula.

[00:07:19] So, yeah, what I mentioned to you briefly was that

[00:07:22] I have had patients come and ask me this, this concept that because it's made in the

[00:07:27] lab that formula is superior to breast milk.

[00:07:31] There's this idea that women have about their bodies, which it's not going to be

[00:07:35] the best thing. It's what they're making is not going to be as good as something

[00:07:39] that can be manufactured.

[00:07:40] I had patients from China actually who asked me there was two that were

[00:07:44] first generation from China and that that attitude was still pervasive

[00:07:47] in the 2010s, that the formula is better for babies because it's scientifically

[00:07:53] formulated for them.

[00:07:54] Even the other day I had a patient ask me if the stuff they put in the formula,

[00:07:59] the DHA and the ARA, which is the fat, which helps brain development.

[00:08:03] They were like, isn't that better for them than what's in breast milk?

[00:08:06] And I had to explain that no, actually you get 19 fat in breast milk.

[00:08:10] The former companies, I have to look up just to make sure it's correct.

[00:08:14] The former companies only really have the capacity to add DHA and ARA,

[00:08:18] which are the two fat of the 19 that are in breast milk.

[00:08:21] So yeah.

[00:08:23] Yeah, that's wild.

[00:08:24] And I definitely want to have you dive deeper into the differences between breast

[00:08:29] milk and formula and also cow's milk.

[00:08:31] But I wanted to take a step back a little bit and get your backstory as a doctor.

[00:08:36] Also as a mother of three is it?

[00:08:38] And how you became so passionate about breastfeeding.

[00:08:42] Yeah. OK, so my best story was I started, yeah,

[00:08:46] I've been a doctor for 17 years now.

[00:08:48] I wasn't sure which area I wanted to go into.

[00:08:51] I wasn't interested in having children either, actually.

[00:08:53] I was all about travel and adventure and that kind of way.

[00:08:56] And once I started, then it's like fine, OK, we'll do it.

[00:08:59] But you're also a bit ruled by hormones on stuff.

[00:09:02] So when my patients say to me, do you enjoy it?

[00:09:04] And they have to ask me in 20 years when I've had the withdrawal of the

[00:09:07] hormonal influence, like because right now I think I do.

[00:09:10] But the hormones are so strong.

[00:09:12] So I started off in pediatrics and I was doing

[00:09:14] pediatrics for about six years and that's hospital pediatrics.

[00:09:18] But when I had a community medicine rotation and I started to see the distress

[00:09:24] and I actually think it's academic proportions, the postpartum

[00:09:27] depression, the postpartum anxiety faced by mothers because they're just not

[00:09:31] supportive and pediatrics is the place where you go to sick children.

[00:09:36] But there's a bit of a gap of where you go for help with well children.

[00:09:40] You know, so that was traditionally the role of the midwife or the matriarch

[00:09:44] of the family. You know, they would give you advice and that you'd have aunties

[00:09:48] and friends and things like that to kind of say, no, why don't you try this?

[00:09:51] Your baby's not sleeping. Do this.

[00:09:53] But people started to go to medical people for that advice.

[00:09:57] And we're not necessarily trained in that.

[00:09:59] You know, there's all sorts of things with sleep training and all

[00:10:02] the kind of stuff that we won't go into that.

[00:10:04] If you really want things to blow up, that's where you need to go into sleep training.

[00:10:08] But despite my kind of experience in hospital medicine, I found that

[00:10:13] I had no idea about the problems that people were facing in those first three

[00:10:18] to six months with their well babies.

[00:10:21] I ended up going into general practice or family medicine, I think it's called

[00:10:25] over there and from there, I've been able to see mum and treat both mum

[00:10:30] and baby, because it's the only time in medicine where you actually need to treat

[00:10:34] both people. You can't leave a mum with mastitis and think the baby is going to be

[00:10:40] OK or you can't leave a mum with vasosalamic or nipple pain and you can't

[00:10:44] leave a baby with any kind of infant problem and think the mum is going to be OK.

[00:10:49] So that's kind of how I've ended up around.

[00:10:51] And then I realised as well with breastfeeding

[00:10:54] that it was something that they really wanted to do.

[00:10:57] You know, the rates in Australia, 96% of women start breastfeeding and 83% quit

[00:11:02] before they want to.

[00:11:03] And the reasons why they're quitting are actually preventable if we change that

[00:11:07] generational knowledge.

[00:11:08] So it was really seeing the maternal distress and having mums cry to me every

[00:11:14] single day, I will have at least two or three mums in my room crying

[00:11:19] because it's so overwhelming and they're so unsupported.

[00:11:23] And this is the most important thing at that time for them.

[00:11:26] And they feel like I don't know what I'm doing and I don't know where to go

[00:11:30] for support and I don't know what's right because I'm getting this information

[00:11:34] from this side, I'm getting this information from this side.

[00:11:36] So that's what really got me into breastfeeding medicine.

[00:11:38] And so then after that, I tried to find places to study and find that.

[00:11:43] And I did different training and lactation training and things like that.

[00:11:47] And that's how I've ended up here.

[00:11:48] And I'm working with the Academy of Breastfeeding Medicine over there

[00:11:51] who are fantastic in America and they've got these very rigorous protocols.

[00:11:55] And they actually got a board certifiable exam now, which I'm not eligible to do.

[00:11:59] I did think about doing my USMLE so I could get the qualification.

[00:12:04] But I couldn't go back and I couldn't go back and get my USMLE just to be able

[00:12:09] to sit for the board exam.

[00:12:10] But in Canada and America, if you have an interest in this space,

[00:12:13] you can actually do a board exam now about it.

[00:12:17] And it's quite rigorous.

[00:12:18] Yeah.

[00:12:19] That's so interesting that you mentioned around the intergenerational knowledge

[00:12:24] and how, you know, when my mom had me and my siblings, she had my grandma,

[00:12:29] you know, with her the whole time teaching her about all these things.

[00:12:33] You know, try this and try that.

[00:12:35] And it's interesting now that as a culture,

[00:12:38] a lot of us have moved away from home and we don't necessarily have,

[00:12:42] you know, parents or family nearby at the time of giving birth.

[00:12:46] And so it makes it a lot harder to find that information.

[00:12:50] It's part of the problem.

[00:12:52] Yeah.

[00:12:53] And I wonder the stats around like how breastfeeding has declined over generations.

[00:12:58] I don't know if you've seen numbers like that.

[00:13:00] There is.

[00:13:01] There's actually a great graph remind me in our sender tube.

[00:13:03] It literally goes like this plummets in the 1960s and 1970s.

[00:13:08] And that's the gap that we are trying to still recover from.

[00:13:12] So it goes from the normal rate up here

[00:13:14] because there wasn't a reliable source of nutrition for babies at that point.

[00:13:19] And that's a whole lot of episode how we got to this position.

[00:13:22] And when you look at it, because you needed quite a few different things

[00:13:25] to come together at the right time, you needed safe sterile powdered milk.

[00:13:29] And then from there, you know, that's how you ended up with that.

[00:13:33] And if you look at how formula came about,

[00:13:35] it was they needed condensed milk for wartime rations in the 1800s.

[00:13:41] When that's exactly how it developed.

[00:13:43] And then from there it got adapted to try and it has at times.

[00:13:48] It is life saving and life giving.

[00:13:50] So I definitely don't want to come across as being anti formula.

[00:13:55] There are times where we need it and it has saved lives.

[00:13:58] But for the majority of people, there are other ways to optimize health.

[00:14:04] But yeah, that data would be and with the intergenerational thing,

[00:14:07] it is a massive problem.

[00:14:08] And I always say when people they look a bit sheepish

[00:14:10] and they come with their mothers or other people to help them.

[00:14:13] And I'm like, no, no, more than Mary, I bring I'm happy to have like four people

[00:14:17] in my consulting space because you can't take in, you know, studies have shown

[00:14:21] that you can only take in 30 percent of what is said to you at a consultation.

[00:14:25] So I'm like, yes.

[00:14:26] And I'll actually say now, this is what I want you to remember when she's

[00:14:29] doing this, this is what I want you to remember when she's doing this.

[00:14:32] And I'll give them all a task of what to remember to help.

[00:14:36] But yeah.

[00:14:37] So that loss of generational information is and support is hugely problematic.

[00:14:43] And yeah, I mean, it's so deep the problems that moms are facing.

[00:14:48] And we keep on bandating it with a solution.

[00:14:51] But we really have to explore why we've isolated moms at this time.

[00:14:56] So much of our food system was transformed by the war time.

[00:15:00] I mean, even if you look at the chemical fertilizers that are so probably a lot

[00:15:05] of it came about because of the war and because these chemicals were being

[00:15:09] produced for ammunition and things.

[00:15:11] So that's such an interesting kind of pattern to call out.

[00:15:15] How much of this pattern do you think is impacted by formula companies themselves

[00:15:20] marketing themselves as a superior option to breast milk?

[00:15:25] So that is a very controversial topic.

[00:15:27] I'm not the best person to speak to that.

[00:15:30] But what I do know, and I know, you know, just in chatting with

[00:15:33] different people that in the 40s and 50s and 60s and everyone seems to know

[00:15:38] that there would be companies, Nestle being one of them and a few other ones

[00:15:43] that really were pushing it on parents and saying that this is better

[00:15:47] and trying to dissuade them from it.

[00:15:48] Now, I haven't seen I'd like to actually see these campaigns,

[00:15:51] see some literature from that time to really kind of form a properly informed

[00:15:55] opinion about it rather than just hearsay because right now I only have

[00:15:58] hearsay about what was being done at the time.

[00:16:00] But there's also the WHO has a code of conduct and a lot of countries,

[00:16:06] secretaries to this about the way formula can be marketed.

[00:16:09] So for example, in baby friendly hospitals, you're not allowed to have

[00:16:13] samples of formula and you're not allowed to offer different things.

[00:16:17] The problem there is that we're saying you must breastfeed.

[00:16:20] No one has the knowledge how to breastfeed.

[00:16:21] And we're not going to give you another option.

[00:16:23] This is where most parents are sitting, you know, and that is why

[00:16:28] this level of distress is so huge in the community.

[00:16:32] And that's what my patients will say to me.

[00:16:34] They'll say, oh, everyone told me I have to breastfeed and they did this and this

[00:16:38] and this to me, but they didn't show me how there's no standard.

[00:16:41] I was way of doing it and they won't help me.

[00:16:43] Am I starving my baby?

[00:16:45] And that's the thing that a mother and myself, I've been among three

[00:16:49] time I'm still a mom, but I am that newborn phase three times.

[00:16:53] You have another drug because you actually have maternal brain changes

[00:16:55] that last for about two years.

[00:16:57] You know, your brain actually changes that drive to feed your baby.

[00:17:01] And you don't trust yourself because of the area, the emotional area where you

[00:17:06] where the changes occur.

[00:17:07] You don't trust that you know what to do for your baby.

[00:17:10] An example I always tell my patients is I was in P.

[00:17:13] I was looking after newborns every day.

[00:17:15] And when I came home, I was like, oh,

[00:17:18] I sent a picture to one of my other friends who's a P.

[00:17:20] And I was like, is this a normal baby?

[00:17:22] And then when the midwife came around, I was like,

[00:17:25] oh, does my baby have a tongue tight?

[00:17:26] I knew he didn't have a tongue tight, but I didn't trust myself.

[00:17:29] And that's part of that brain changes.

[00:17:31] I tell patients about this to explain that it's not their fault if they don't know.

[00:17:35] You know, somebody who is in the field who knew everything and I'm still

[00:17:39] overwhelmed and doctors or the doctors that, you know, all my friends

[00:17:42] who are doctors are also overwhelmed.

[00:17:44] You know, there's not anybody who's like, all right,

[00:17:46] baby's out, here we go, off we go.

[00:17:48] I know exactly what I'm doing.

[00:17:49] I have no concern.

[00:17:50] So I guess for like a new mom, someone who's just given birth at the hospital,

[00:17:56] do they leave the hospital with any consultation from the doctor or nurses

[00:18:01] or maybe they have their doula there?

[00:18:03] Or do they have to go and seek out a lactation consultant themselves?

[00:18:08] So and this is part of the systemic problem.

[00:18:11] And the hospitals are doing their best.

[00:18:13] I really want to say that.

[00:18:14] And the midwives are amazing.

[00:18:15] I learned a lot of my information from midwives.

[00:18:18] They were the ones that taught me all the different things,

[00:18:20] because I didn't get any lectures on breastfeeding and pediatric or in GP.

[00:18:24] Actually, so with the hospitals, what happens is you have the baby

[00:18:27] and everybody has a different training.

[00:18:30] So one of the things that I really want to work towards worldwide

[00:18:33] is probably going to take me 20 years is standardisation of lactation training.

[00:18:37] So a lot of the techniques being taught still add to nipple pain.

[00:18:41] And we know that if you have nipple pain,

[00:18:43] you are very, very likely to quit because it's extremely painful.

[00:18:47] The nipples are one of the most innovative areas of the body.

[00:18:50] And so if you have pain and it will be excruciating,

[00:18:55] you will most likely quit within a certain time frame.

[00:18:57] And we can prevent that.

[00:18:58] We actually have the knowledge we have the science now to prevent it.

[00:19:01] But we haven't got a system of standardised lactation training.

[00:19:05] And that's what has to happen.

[00:19:06] It has to be this is the way we're going to do this training.

[00:19:09] And this is the techniques we're going to use.

[00:19:11] And that's why do you have your water bottle there?

[00:19:14] Should we go to this bit now?

[00:19:15] Yeah, sure.

[00:19:16] I've got a water bottle.

[00:19:18] Does this work?

[00:19:19] It's it's just like a regular seltzer bottle.

[00:19:21] Yeah, yeah. Yeah.

[00:19:22] So what I wanted to show you is the two techniques that I taught,

[00:19:26] which are very harmful to breastfeeding.

[00:19:29] They grab the back of the baby.

[00:19:31] I've got my cancer test.

[00:19:32] I've got my baby here.

[00:19:34] I've got all my lactation tools here.

[00:19:37] Right.

[00:19:38] I love it.

[00:19:39] I was like, I don't know what I might need.

[00:19:41] Right. So I've got like coffee, I've got lip balm and I've got I've got

[00:19:44] two of my two different breasts and my doll, which is a five dollar doll

[00:19:51] from Kmart because the lactation doll is like eight hundred dollars.

[00:19:55] The ones that have an open mouth and things.

[00:19:57] I know. I guess.

[00:19:59] Yeah. Yeah.

[00:20:00] So the way they teach you is that you grab the baby and you shove the baby

[00:20:04] on the breast and you hold them at the back of the neck.

[00:20:08] But what I wanted to demonstrate to you is, OK,

[00:20:11] if I do this with my patients in rooms,

[00:20:13] if I get them when they're pregnant is put one hand on the back of your neck and

[00:20:17] push it down.

[00:20:19] OK, and then now with your water bottle, try and drink your water from the water bottle.

[00:20:25] Like, oh, sorry, you can unscrew it and now actually.

[00:20:27] OK.

[00:20:28] Yeah, sorry.

[00:20:30] I'm like, I'm drinking.

[00:20:32] OK, let's see.

[00:20:33] Yeah, I think this is going to be difficult.

[00:20:36] Yeah.

[00:20:37] Yeah, it's not the right position.

[00:20:40] Yeah. Correct.

[00:20:41] Yeah. And so the biggest thing that we need to change is how we position babies so

[00:20:45] that they have a little bit of neck flexion and in Western Australia,

[00:20:49] there's the Getty Hartman Institute and they get his research and they've

[00:20:53] actually got to study in 2009 showing optimal infant oral cavity function.

[00:21:00] But again, it's a problem translating that research into the common knowledge

[00:21:03] which we're struggling with.

[00:21:05] But what happens is when the baby can't drink and they have a very strong

[00:21:09] suck reflex, they then attach to the nipple and they're not supposed to.

[00:21:14] They're supposed to get a lot of about that much in the mouth so that it doesn't

[00:21:18] cause pain. But what happens is they attach to nipple here and that's how you

[00:21:22] get nipple damage.

[00:21:24] So you want them just for the audio listeners, you want them to attach

[00:21:28] like more of the breast than just the nipple.

[00:21:32] Correct. There's four things that I check and I used to kind of dismiss

[00:21:35] what I did and I call it things for medicine because one of my page friends

[00:21:38] would say that it's not really medicine or it's like I'm taking position.

[00:21:42] But but it makes a huge difference for infant outcomes with the gut and things.

[00:21:46] So the biggest thing is that the baby needs to attach.

[00:21:49] I don't know how to make this there, but it needs to put the tin on the inside

[00:21:52] of the breast. So if your breast is on this side, that's not showing it well.

[00:21:56] They need to attach that way.

[00:21:57] If you're breastfeeding on this side, then the baby needs to attach that way.

[00:22:02] And you put the tin deep in the breast here and then they can extend

[00:22:06] their neck enough to open.

[00:22:08] And that's where I use this bottle.

[00:22:10] I'm like, imagine if you're with a cup, you can see that if you drink that tin,

[00:22:15] this part has to be anchored somewhere.

[00:22:16] It's very hard to drink with no kind of grounding in that area.

[00:22:22] Yeah, but we'll go into that.

[00:22:23] We wanted to talk about the gut.

[00:22:24] So so when people leave hospital, they do have to seek their own lactation care.

[00:22:30] There is a lactation consultant in the hospital in America.

[00:22:33] You're actually quite lucky because there's quite a few hospitals that

[00:22:36] actually have a lactation department with doctors who are trained in breastfeeding

[00:22:41] medicine, but in Australia, we haven't got that yet.

[00:22:43] And I'm kind of banging my head against

[00:22:45] forwards and you're going to make it happen.

[00:22:47] I don't know.

[00:22:48] Some days I feel like giving up the uphill battle, you know, but yeah,

[00:22:53] it's a constant battle.

[00:22:55] Just there's no interest in this area.

[00:22:58] You know, it has such a big impact on maternal health.

[00:23:02] Well, let's dive into the science a little bit because so

[00:23:05] my understanding and I'm going to get the terms wrong, but my understanding is

[00:23:10] that when the baby is born, it essentially has a leaky gut, right?

[00:23:14] Or leaky junctions, as you mentioned.

[00:23:16] And that's where breast milk or colostrum and maybe you can talk about

[00:23:20] the difference between the two, but the substances in breast milk and

[00:23:23] colostrum actually help to seal the baby's gut lining.

[00:23:27] Can you talk about that process?

[00:23:29] Yes, there's a few things there.

[00:23:31] The really important thing is that when infants are born,

[00:23:35] they have what is known as that leaky gut.

[00:23:37] What it actually is, though, is that their intestinal ethereal cells are more

[00:23:42] permeable, which means that more things can get passed into the bloodstream,

[00:23:47] into the body than they can when you get that gut closure.

[00:23:50] That is essentially where the magic of breast milk and the infant gut meet.

[00:23:56] OK, so what happens at birth is that you've got quite a permeable gut

[00:24:01] and colostrum contains a lot of immune complexes and especially a magic ingredient

[00:24:08] called secretory IgA.

[00:24:10] Secretory IgA lines itself to the infant gut and actually prevents

[00:24:16] different insults and bacteria and viruses and what have you going across

[00:24:20] that intestinal woman. So that's what colostrum does.

[00:24:24] But what a lot of people, I'm not sure people know this, breast milk and

[00:24:27] colostrum contains a lot of bacteria and it also contains the food for the bacteria,

[00:24:32] which is the HMO, the oligosaccharide.

[00:24:34] And that's the food for the bacteria to form the gut microbiome,

[00:24:38] which is probably your area of specialty.

[00:24:41] I only know the basics as pertaining to the infant gut and breast milk.

[00:24:45] I haven't had time to really dive into the organisms and that lady,

[00:24:50] Susan V. Lynch, I think, like in that Bernieoff Center,

[00:24:53] they seem to have done amazing research about the microbiome and they

[00:24:56] would be the people to talk about it.

[00:24:58] But what I can tell you is the infant gut, it's very permeable.

[00:25:02] So it's exposed to different things and the breast milk gives it the perfect

[00:25:07] thing to protect the gut and to lead to gut health and general immune health,

[00:25:13] possibly for the rest of their lives.

[00:25:15] And I know I sound a bit extreme when I say that because people must think,

[00:25:20] if that's the case, why doesn't everyone know about this?

[00:25:23] And the reason is because we haven't done much research into breast milk.

[00:25:26] And to the last 15, 20 years.

[00:25:28] So there just wasn't the research into it.

[00:25:30] There's still not the interest.

[00:25:31] I could get five other projects funded.

[00:25:33] Sorry, even when I contact the schools and hospitals, they're like, oh, yeah,

[00:25:37] there's just not that interest in funding this research.

[00:25:39] These are the barriers that we're facing.

[00:25:40] And what colostrum has is it is very, very rich in those immune complexes,

[00:25:47] those immunoglobulins, those proteins.

[00:25:49] It's 90 percent that and then 10 percent the syllabus and things like that.

[00:25:54] So the purpose of this breast milk is to protect the infant gut and the infant

[00:26:01] immune system. That's kind of the magic of colostrum.

[00:26:04] And then it transitions, but that leaky gut is still there until about six months.

[00:26:09] We're an amazing thing happens because the body and I don't even ask me how

[00:26:15] the maternal breast knows how to do it.

[00:26:17] And I do know some of the signs that I'm every time I look at it,

[00:26:20] I'm blown away by how amazing the body is.

[00:26:23] What happens at six months is you get an increase in lysosomes,

[00:26:26] and that continues until whatever duration you want to breastfeed.

[00:26:29] So if you want to breastfeed until therefore

[00:26:31] you will have a lot of lysosomes which are bacteria eating enzymes, essentially.

[00:26:37] And it increases the production of that at six months because

[00:26:41] the gut closure is a lot more pronounced at six months.

[00:26:45] So that means that the baby's gut can't absorb as many immune complexes

[00:26:50] from the mother because that's outlining, which is supposed to happen,

[00:26:54] happens, but it also means that it puts in an extra defense mechanism for the baby,

[00:26:58] which is the lysosomes.

[00:27:00] So, for example, if as a mother you're exposed to a pathogen within six hours,

[00:27:07] your body will start producing antibodies that will then go into the baby,

[00:27:11] the breast milk that the baby will then inject.

[00:27:15] It doesn't mean the baby won't get sick.

[00:27:16] The baby will still get sick, but it may not get as sick as it would have

[00:27:19] got had it not had that breast milk.

[00:27:21] And I see that every day.

[00:27:22] Wow, wow.

[00:27:23] I've heard breast milk and the baby's

[00:27:26] got be described as almost a lock and key mechanism where it just fits like a glove.

[00:27:32] And it is sort of magical the way you describe it, how the mother's

[00:27:36] breast just knows what to do and knows what the baby needs at a given time.

[00:27:40] That's why even, do you know where those bacteria come from?

[00:27:43] Right?

[00:27:44] The real bacteria, you know, how you have a thousand to ten thousand units of bacteria

[00:27:49] in like each meal, do you know where they come from?

[00:27:52] They come from the mum's gut.

[00:27:53] So the mum's gut does something where and they don't really understand the mechanism yet.

[00:27:59] But somehow her bacteria goes across the bloodstream.

[00:28:03] This is the current theory.

[00:28:04] And usually it would be killed by the mum's immune system.

[00:28:07] But somehow it gets up to the breast and goes through the leaky.

[00:28:10] There's so many different lock and key mechanisms.

[00:28:13] So in those first three weeks postpartum, so after you've had your baby,

[00:28:19] the lacticide in the mammary glands are more leaky as well.

[00:28:23] So more protein can get through from the maternal bloodstream into the milk.

[00:28:27] That's why that that crucial time so much is transferred between mum and baby.

[00:28:33] And then the lacticides actually become less leaky and they don't let

[00:28:37] the same amount of proteins through once you get past that three to four weeks.

[00:28:42] Try to mark.

[00:28:43] How does breastfeeding affect the mum's gut?

[00:28:46] And we can talk about overall, what are some other benefits of breastfeeding for

[00:28:51] the mother, but do you notice in patients will the moms also have like got issues

[00:28:57] or maybe better digestion while they're breastfeeding?

[00:29:00] Yeah, so this one, I don't actually know what the research is on this.

[00:29:04] I'm not sure if there are studies on how

[00:29:07] mom's gut improve or their digestion digestion at that time.

[00:29:13] But I can tell you that generally, I don't know how to say it, but there's a looser gut.

[00:29:18] So, you know, you've had constipation up to a certain point.

[00:29:21] But that could also be with the withdrawal of progesterone,

[00:29:23] you know, prolactin inhibits progesterone.

[00:29:25] Progesterone is slows down gut motility.

[00:29:27] So maybe the withdrawal of that hormone has a big difference as well on the

[00:29:32] mother's gut, but that's actually a really interesting question.

[00:29:36] Because there is this biofeedback mechanism where from the baby's saliva,

[00:29:42] the mum gets messages of what needs to be made.

[00:29:45] And that's why present changes in composition as the baby gets older.

[00:29:49] That could explain if the mother is getting this

[00:29:53] messaging, this signaling from the baby's saliva, maybe that would change

[00:29:57] the composition of third microbiome.

[00:29:59] I'm not too well versed in this, but I do know that what the mother's gut

[00:30:05] ingest has a big difference on her microbiome, which then can affect the

[00:30:10] microbiome of the baby because there's different bacteria and viruses and fungi

[00:30:15] and all of that kind of stuff there.

[00:30:17] So, you know, when you said you were having kimchi, I was like, yay.

[00:30:20] I know that my understanding is kimchi is a really good probiotic.

[00:30:24] Is that your understanding?

[00:30:25] Yes.

[00:30:26] Yes.

[00:30:27] Yeah.

[00:30:27] Good.

[00:30:28] I always check the digestion kind of the actual practical advice because this

[00:30:32] definitely not my area of specialty, but I know that kimchi, sauerkraut,

[00:30:35] all these kind of things are really good.

[00:30:36] All the fermented foods.

[00:30:38] Yeah.

[00:30:39] Totally.

[00:30:40] So good for the bacteria.

[00:30:42] So if mums are eating that, that actually makes a difference on her gut bacteria.

[00:30:46] But I don't know if it...

[00:30:49] I don't have the answer for you on whether mum's sea improves digestion.

[00:30:53] So I guess your question is if mums have digestive issues,

[00:30:56] do they also improve when their breastfeeding?

[00:30:59] And I don't have the data on that.

[00:31:02] That'd be an interesting question to look into.

[00:31:04] It actually really is.

[00:31:06] Yeah.

[00:31:07] Really fascinating question.

[00:31:08] My brain is turning over like about 50 things going through the head and being like,

[00:31:12] oh yeah, I never thought of it that way.

[00:31:14] Yeah.

[00:31:15] What are the other sort of magical components of breast milk?

[00:31:20] You mentioned HMOs, which are kind of the sugars that oligosaccharides.

[00:31:24] There's the bacteria.

[00:31:25] What are the other components of breast milk?

[00:31:28] So the components are carbohydrates, protein and there's also a lot of water

[00:31:33] and fats and water because of the components, carbohydrates, protein, fat and then 87%

[00:31:40] water. So all that good stuff is in that 13% of the breast milk.

[00:31:46] Isn't that spectacular?

[00:31:48] So what the fat...

[00:31:50] Yeah, I know, right?

[00:31:51] So what the fat is, the fat helps the brain development.

[00:31:54] So the fats are all the amino acids.

[00:31:57] But we know that depending on what the baby and just you get different fats for

[00:32:04] the brain development and things like that.

[00:32:06] Breast milk has 19s and formula as far as I know, and I could be...

[00:32:11] I haven't checked the constitution of the formulas at the moment,

[00:32:14] but they have mainly DHA and ARA.

[00:32:17] And DHA is the omega 3s and omega 6s and all those ones which are so important

[00:32:22] for brain development and ARA.

[00:32:24] And it's so great the formula now as if it didn't for a long time.

[00:32:29] So until they knew about the importance of that, they didn't add that.

[00:32:32] And even that's the great thing.

[00:32:34] Anyone who's giving their baby formula and hasn't been able to meet their goals

[00:32:39] or didn't want to breastfeed, formula is still...

[00:32:42] I'm not supposed to say this as a lactation component.

[00:32:45] I'm not supposed to talk about the benefits.

[00:32:47] But formula, I think it's important that the mothers aren't made to feel

[00:32:50] worse about their decisions.

[00:32:52] That formula still has a lot of nutrition and it's

[00:32:54] so much better than what it was 20 years ago.

[00:32:56] They actually even add some oligosaccharides and they put in...

[00:33:00] I don't think they've got bifidates, but they've got other different strains

[00:33:03] of important bacteria that they're trying to put into the formula.

[00:33:06] They're doing their best.

[00:33:07] So these are small differences.

[00:33:10] But it's important for parents.

[00:33:11] I have some patients who are solely formula feeding.

[00:33:14] And they're some of my most loyal patients.

[00:33:16] I'm always so cautious to make sure that they don't feel judged and

[00:33:20] ashamed because what I always say is, well,

[00:33:21] mom's mental health is the most important thing.

[00:33:24] If you look after mom, maybe you'll be fine.

[00:33:26] And there are some patients who breastfeeding isn't the best option.

[00:33:29] You know, but they...

[00:33:30] The majority of patients, it would actually be the best option if they were supported.

[00:33:34] Yeah. Can you talk about some of the barriers that

[00:33:38] mom's experience where it gets to a point where breastfeeding is not

[00:33:43] the best option for them?

[00:33:45] Yeah, this is that.

[00:33:46] And that's why I've gotten into this.

[00:33:47] That's what's driven my passion here.

[00:33:49] The barriers are so many.

[00:33:51] You've got big problems in America there because basically because the lack of

[00:33:56] parental leave, so from when they have the baby,

[00:34:00] they're working out how do I feed my baby?

[00:34:03] If I'm supposed to breastfeed, how am I supposed to do this and pay my rent?

[00:34:06] There's so many problems there with that.

[00:34:08] There's so many societal factors which lead to the problems.

[00:34:11] In Australia, we have leave for 12 months that you can take.

[00:34:14] Not all of us at this age, but you have access to 12 months.

[00:34:18] But I notice a four month that's when the anxiety starts for parents.

[00:34:23] They come in and they ask me, OK, how am I going to do this?

[00:34:26] How am I going to eat my baby to take a bottle?

[00:34:28] What's my family?

[00:34:29] And what's really hard about that is babies change and grow so much every month.

[00:34:33] You know, what a baby can do at two months is very different to what a baby

[00:34:36] can do at four months.

[00:34:37] So that's one of the biggest barriers relevant to America and Canada.

[00:34:42] Actually, I think Canada has a pretty good family.

[00:34:45] Yeah, it's also 12 months split between the two parents so you can choose how much

[00:34:50] to take and it's it's not fully paid the whole time.

[00:34:53] But you do legally have access to 12 months.

[00:34:56] So the actual physical barriers that people face for breastfeeding.

[00:35:00] There's a study that was out in the mid 2000s and I'll be 83 percent.

[00:35:05] That quit 46 percent quit before they want to because of nipple pain,

[00:35:10] which we could prevent with the right lactation training.

[00:35:14] So that's half of that 83 percent of moments we would be able to help almost up.

[00:35:20] The other reason the other the other biggest

[00:35:23] sighted reason is perceived low volume.

[00:35:27] We are now at a situation where mothers have a pathological fear of low supply

[00:35:33] and there's a lack of general information about how breast milk is produced.

[00:35:37] And that's pretty much if we could change that knowledge.

[00:35:40] So my kind of misson when I started this was I want to just bust to miss

[00:35:44] that nipple pain, breastfeeding is not supposed to be painful.

[00:35:47] And the second thing is that low supply is not going to be a medical situation for

[00:35:52] most people. It's a lack of again, that generational societal knowledge

[00:35:57] about breastfeeding and newborns, which has led to this idea of a low supply.

[00:36:01] When I had my kids, I didn't know about something called cluster feeding.

[00:36:05] Now everyone knows about cluster feeding, but it wasn't known.

[00:36:09] It was and it was a midwife who told me about cluster feeding,

[00:36:11] which is basically where your baby will sit on you and feed nonstop.

[00:36:15] And they'll do this in the first three days and I'll do it at 10 days.

[00:36:18] And what happens in society is people think I'm not making enough milk,

[00:36:23] going back to that anxiety and that lack of trust that moms have in themselves.

[00:36:26] They're like, oh, my gosh, I don't have enough milk.

[00:36:28] I need to start formula.

[00:36:30] And that's the big problem that starts.

[00:36:33] And then that makes the mother not trust herself.

[00:36:36] When we break that trust that moms in that maternal instinct,

[00:36:41] it's very damaging, very damaging for babies.

[00:36:45] Cluster feeding. So does that mean like the baby feeds a lot the first three days

[00:36:51] and that day 10, but then the days in between you might be producing last milk?

[00:36:56] No, so this is something that's not understood as well.

[00:36:59] So milk volume is a very much a supply and demand.

[00:37:02] If milk is removed from the breast, you will make more milk.

[00:37:06] I have a few reels explaining that on my page to explain the cycle.

[00:37:11] But essentially what happens is we go for making zero breast milk at birth to suddenly

[00:37:16] by three weeks, the average one will be making somewhere in the vicinity of 750

[00:37:20] mills per day, seven zero to 750 mills per day.

[00:37:24] The only way the body gets the message to make that milk is by simulation

[00:37:30] at the breast. There are nerve receptors in the nipples that send messages up to

[00:37:35] your respiratory gland, which then provides prolactin, which signals to the lacticide

[00:37:40] to make the milk.

[00:37:42] So if you don't have that suction at the breast, not suckling, not suction

[00:37:48] at the breast, you will not make enough milk.

[00:37:51] So if you don't feed the baby, if the breast is not stimulated every three

[00:37:55] hours, you will not produce a full supply of breast milk.

[00:37:59] It has to be stimulated at the minimum every three hours and it can be even more

[00:38:04] sometimes. And that's also problematic because a lot of places they're told to

[00:38:08] feed them for very short periods of time.

[00:38:10] And even I have a family member in the Netherlands and she was just told,

[00:38:16] no, only breast feed your baby for 10 minutes at a time in the first three

[00:38:19] days of life and it led to a calf data problem.

[00:38:21] So breast milk will only be produced by that suction there.

[00:38:25] So that's the role of cluster feeding cluster feeding actually has a very

[00:38:28] important role of increasing your body's production of breast milk.

[00:38:32] Does pumping count as stimulating the breast?

[00:38:34] Absolutely, absolutely.

[00:38:36] So in the case of when a baby and mother are separated pumping, so that's still

[00:38:41] stimulation at the breast where the brain is getting that message that

[00:38:45] there is something happening at the breast, it will send the message to make

[00:38:49] more milk. So for example, my third baby was born premature.

[00:38:52] So I was exclusively pumping.

[00:38:54] I was able to produce milk just by that pumping, you know, every three hours.

[00:38:59] And then slowly once that has established after the three weeks,

[00:39:02] I was able to tweak it a bit and change it.

[00:39:03] But it was definitely you can still do that with pumping.

[00:39:08] And pumping is such an unregulated problem in America, but it's so

[00:39:13] important and I could see a whole other thing on cow's milk allergy

[00:39:17] and how that ends up being a problem because of the over supply.

[00:39:22] So what happens is the lactified junctions get leaky because they're letting

[00:39:25] out bigger protein and then that's getting into the baby's gut.

[00:39:28] Wait, I'm curious about that though.

[00:39:30] Yeah, yeah.

[00:39:31] Yeah, you want to say more?

[00:39:33] Yeah, I can totally say more.

[00:39:34] What happens is with pumping, I don't know if you say on social media,

[00:39:37] but people are now producing huge volumes of milk.

[00:39:40] And again, it's that supply that they want to freeze the stuff.

[00:39:43] When they've got these pathological fear of a low supply,

[00:39:46] I then don't want to be like, oh, well, there's also a problem with an

[00:39:48] over supply.

[00:39:49] But what happens is in the lactified, if you're getting that messaging to

[00:39:55] keep making milk and they're pumping too long or with too high a suction or too

[00:39:59] often, what happens then is that the lactified gets very full and then those

[00:40:04] those cell junctions become leaky and that lets out bigger proteins again,

[00:40:09] which aren't supposed to be going out.

[00:40:11] The other problem is that it causes edema in that area.

[00:40:14] And then that causes vasoconstriction to the nipple.

[00:40:18] And then that leads to this mastitis syndrome, which is actually inflamed

[00:40:23] breast tissue. It's a whole other technical thing.

[00:40:25] Interesting. Just to follow up on the first point.

[00:40:28] So letting out these bigger proteins and when the baby, you know,

[00:40:32] eats that or drinks that, that can lead to a milk allergy or issues with

[00:40:38] digesting.

[00:40:39] It can it can lead to and this is still being researched, by the way.

[00:40:43] So this is just a hypothesis, but we know that it will let out bigger

[00:40:46] protein because we're trying to explain why are we seeing a higher incidence

[00:40:51] of cow's milk protein allergy in breastfed babies.

[00:40:54] So do people know that the problem with cow's milk protein in allergy is the

[00:40:58] size of the protein? So a lot of people who have cow's milk

[00:41:02] protein allergy, especially as babies, it's the size of protein,

[00:41:05] which is too hard on the gut.

[00:41:06] And we see this more with formula because the formula doesn't provide that

[00:41:10] lining of the gut, which prevents things going across that gut barrier.

[00:41:13] Right. So which breast milk does.

[00:41:15] So because that lining isn't there, the cow's milk protein then goes across

[00:41:20] the baby's circulation and then the baby's immature immune system will make

[00:41:24] complexes, which recognizes it as an allergen.

[00:41:27] And that's how you actually end up with this cow's milk protein allergy

[00:41:30] that we see specifically in the infant, as opposed to the older children.

[00:41:34] But I couldn't understand why certain proteins were more likely

[00:41:38] because I'm a big, toastery reading person and I like my story,

[00:41:42] you know, with different things.

[00:41:43] And I would be 30 percent of people of infants that have cow's milk protein

[00:41:47] allergy or intolerance also have a reaction to soy.

[00:41:51] And then the next big issues are egg,

[00:41:54] then chicken and corn.

[00:41:57] And I haven't seen the data because we're not a big corn eating country here.

[00:42:01] But I know that it's a very dominant protein over there.

[00:42:04] And, you know, again, the size of these proteins are what's huge.

[00:42:09] So it's known that if babies have something, they're called the lamp here

[00:42:14] and rice diet, that they know that these are smaller proteins

[00:42:18] and it won't affect the baby in the same way.

[00:42:20] I want to touch on the piece on formula.

[00:42:24] And maybe you can talk about the damage that formula can do to a baby's gut.

[00:42:29] But you had mentioned, you know, because the baby's gut is not fully sealed,

[00:42:33] you know, there's leaky junctions that can allow the milk proteins to then

[00:42:38] see in between the lining and go into the bloodstream.

[00:42:42] Is that sort of the main problem?

[00:42:44] Well, other than missing out on all of the wonderful benefits of breast milk,

[00:42:49] like all the fats and, you know, all the other nutrients,

[00:42:52] what about formula can be actively harmful to a baby's development?

[00:42:57] No, I think the way I'd phrase it is it lacks the protective mechanism for the gut.

[00:43:02] What happens with the formula is that say we've got a leaky gut

[00:43:06] and now we've got one liquid that goes across and actually

[00:43:12] provides certain immune complexes and also starts giving you a microbiome

[00:43:17] to help you handle any insults.

[00:43:21] Then we've got the other liquid, which has really good composition,

[00:43:26] but it doesn't have those abilities.

[00:43:28] So what the formula doesn't do is it doesn't give you immune complexes.

[00:43:33] It can't give you any immune complexes.

[00:43:35] So it can't give you that secretory IGA, which is so important for gut health.

[00:43:39] And it can't give you a microbiome.

[00:43:41] That's actually the problem.

[00:43:43] And that puts you at risk of ATP, it puts you at risk of allergy,

[00:43:47] it puts you at risk of autoimmune diseases.

[00:43:50] It puts you at risk of a whole bunch of other metabolic diseases, diabetes,

[00:43:54] rheumatoid arthritis, heart disease, asthma, other respiratory illnesses

[00:43:59] general like allergic rhinitis, all of that kind of stuff.

[00:44:02] It puts you at risk of that.

[00:44:04] It provides nutrition and it provides fat and you're going to grow,

[00:44:08] but it doesn't give you that extra immunity, which is so important

[00:44:15] for the growing individual.

[00:44:16] And I say that with a lot of sensitivity because the one thing I can tell you

[00:44:21] from my years in this field is that no mother wants to do less than for their

[00:44:27] baby and I don't care what situation you have for the baby.

[00:44:30] You could be in a drug then you can have someone, you know,

[00:44:33] who is the most well-meaning and disconnected mother,

[00:44:37] but they still want to do the best for their baby.

[00:44:40] And that is a universal that we have to understand.

[00:44:42] It's the role of everybody now to help the mothers learn what is best,

[00:44:47] what is truly best and then to work out how we can get back that knowledge

[00:44:52] so that they can do the best.

[00:44:54] Yeah, so that's really the problem between formula and breast milk.

[00:44:59] Yes, there's all the other fats and all of that for brain development,

[00:45:03] but it's actually about the health later on.

[00:45:06] And that Bernie off Institute, you know, the other reason I contacted you

[00:45:10] was about autism in C-section and I think it was your figures, 23 percent.

[00:45:16] Yeah, it was something in that range.

[00:45:18] I mean, something like that.

[00:45:19] And it increases the risk to 23 percent or something, some figure like that.

[00:45:25] But what they don't look at is when you have a C-section, it's quite traumatic.

[00:45:29] You know, a C-section isn't just, oh, I'm just going to take the easy way out

[00:45:34] and do it.

[00:45:35] C-section is the last major abdominal surgery that we have left.

[00:45:38] Everything else is robotic and tiny little holes other than open heart surgery.

[00:45:43] But major abdominal surgery is one of the biggest surgeries that a mother undergoes.

[00:45:47] And there's also a lot of trauma coming up to that.

[00:45:50] You know, if they've been told they need it for health reasons,

[00:45:53] the mother already feels like, OK, my body's failing me.

[00:45:57] And then they have the C-section and emotionally,

[00:46:00] they're already coming from a down place, a place of just insecurity.

[00:46:05] And then you add breastfeeding on top of it and the normal breastfeeding challenges.

[00:46:10] It's a lot.

[00:46:11] So what we see is that the rates of breastfeeding after a C-section are a lot

[00:46:15] lower. And yes, we know that with a C-section,

[00:46:18] you don't get the same vaginal microbiome at all.

[00:46:21] But you could still improve that.

[00:46:23] You know, most mothers don't have a choice on C-section or not.

[00:46:27] In Australia, definitely.

[00:46:28] In the public system, we're very provagional, you know,

[00:46:30] so they get all of those kind of things.

[00:46:32] So mothers don't really have a choice on that.

[00:46:34] And I get nervous that poor mothers will go from a place of,

[00:46:37] oh, OK, I had a C-section, wasn't my choice.

[00:46:40] And now my baby's at an increased risk.

[00:46:42] You can undo that risk by breastfeeding.

[00:46:45] So actually breastfeeding would be empowering if we taught them you've got to feed

[00:46:49] every three hours or stimulate the breast every three hours for three weeks.

[00:46:53] That's it. There's no way around that.

[00:46:54] You're not going to have full milk volume if you don't do that.

[00:46:57] There is literally no physiological way.

[00:46:59] The second thing is that breastfeeding is supposed to be painless.

[00:47:02] So if we get you to understand that and the mechanism,

[00:47:05] you know, the drinking the water, you know, the way you attach to babies,

[00:47:09] yet all of those kind of things, then there's something you can do

[00:47:13] to reduce the incident where you feel this problem.

[00:47:17] And that's what I see.

[00:47:18] The mothers that I get breastfeeding and most of my moms will actually get

[00:47:21] there, there's a confidence, there's a protection to that maternal mental health.

[00:47:25] There's a trust in themselves.

[00:47:26] There's a trust in their maternal instinct that lasts for a long time.

[00:47:29] That ability to provide for your child.

[00:47:32] Yeah, yeah.

[00:47:34] And the other moms are providing too, you know, looking at.

[00:47:38] Yeah, I know, I know.

[00:47:39] I'm always just like, you know, when people come in and say,

[00:47:41] I'm returning back to work, I might throw up.

[00:47:44] Do you mean paid work?

[00:47:45] Because being a mom is actually harder.

[00:47:47] You know, being a doctor was way easier than being a stay at home mom.

[00:47:50] I can say that.

[00:47:52] That's saying something.

[00:47:54] OK, a very silly question came to mind and I want to get your thoughts

[00:47:59] as a doctor and as someone who's probably been, you know, in a lot of births.

[00:48:04] But the whole thing about vaginal birth versus C-section,

[00:48:08] the idea is that when the baby's birth naturally or through the vaginal canal,

[00:48:13] they get covered in these vaginal fluids that can help with the baby's gut.

[00:48:19] Is this a thing like, can you like scoop?

[00:48:22] If you were to do a C-section, could you scoop out the vaginal fluids and like

[00:48:26] smear that on the baby?

[00:48:28] It is. It is a thing.

[00:48:29] It is a thing.

[00:48:30] OK, I'm probably older, so I haven't seen it done much.

[00:48:34] But it's probably being done in a lot more new age kind of.

[00:48:38] I don't know any obstetricians that do that, but I can totally see the value

[00:48:42] for it, you know, but it's well known that that's something that can be done.

[00:48:45] And it can help with the microbiome.

[00:48:47] But again, it's in the secretion, you know, like amniotic fluid has its own

[00:48:52] microbiome, too. There's all of these things.

[00:48:54] So I would say to people that while, yes, that's important,

[00:48:59] we spend so much time and energy focusing on the birth,

[00:49:03] which most people, it's going to last less than three days.

[00:49:06] You know, that's the worst case scenario, three days.

[00:49:08] I've heard one last bit longer.

[00:49:11] Yeah, usually it's less than that.

[00:49:12] Usually it's 24 to 48 hours somewhere in that facility and even less

[00:49:15] than the 24 hours of the most people.

[00:49:17] I had a few nightmare ones.

[00:49:18] All of the pregnancy stuff is geared towards birth and none of it is geared

[00:49:24] towards how are you going to cope once you have the baby?

[00:49:27] How are you going to actually care for your baby?

[00:49:29] So while I think that, you know, getting the vaginal flora and all of that,

[00:49:33] I think I think everything would be fantastic.

[00:49:36] But I'm like if I had to pick one,

[00:49:39] let them think that even if I don't get the birth I want,

[00:49:43] you can still really, really, really help that microbiome,

[00:49:47] which they would get anyway from your own body because it's going across

[00:49:52] through your own intestinal barrier into your bloodstream,

[00:49:54] then into the lacticide and then into that breast milk.

[00:49:57] So there's still a way for the body to give your baby that.

[00:50:02] And I say that as a mum who had one vaginal and two caesareans

[00:50:07] and both of the caesareans were emergency ones.

[00:50:09] And it's very different to what I actually wanted.

[00:50:10] You know, before I had babies,

[00:50:11] because I'd been in so many of these labors,

[00:50:14] I was like, oh, I'm never going to have a vaginal delivery.

[00:50:17] I'm going to go have it nicely out.

[00:50:19] Oh, really?

[00:50:20] Thank you very much.

[00:50:21] Yeah, I was like, no, thank you.

[00:50:24] From the PEDE side, we used to get called in for any instrumental delivery.

[00:50:27] So they'll always be at PEDE for any kind of complicated delivery.

[00:50:30] And so I'd be standing there and my role is just for the baby.

[00:50:33] Nothing to do with the mother.

[00:50:35] And we're all sitting there pushing and figuring it out as the mum is doing it.

[00:50:38] And you see so many things.

[00:50:39] I was like, no, no, I'm just having a caesarean.

[00:50:41] But once the hormones kicked in and I was pregnant,

[00:50:44] I was like, this is what I meant about not being in control.

[00:50:47] Like it's a different thing.

[00:50:49] I'm a different person because I was like, no, I actually want a vaginal delivery.

[00:50:53] Oh, but I'm trying to stop using the word delivery because that's very medical term.

[00:50:56] And I actually had a reason to go for a caesarean

[00:50:59] because the placenta was over there opening my cervix.

[00:51:01] And I was still like, please, please, please let it go up so that I could have

[00:51:05] a vaginal birth. So it's a very funny thing.

[00:51:09] I guess off to the top of your head.

[00:51:10] Like, is there anything else you want to leave with listeners?

[00:51:14] Maybe that we haven't covered yet.

[00:51:15] The thing I would really say to people who are

[00:51:18] pregnant and people who are in that kind of phase, what I get my patients to do

[00:51:23] is when they ask me a question, I say, what do you think your instinct is?

[00:51:26] Sometimes it annoys them.

[00:51:27] They're like, I'm coming to see you because I want the answer.

[00:51:29] But I really encourage mothers learning to listen to that instinct.

[00:51:33] That instinct is almost always right.

[00:51:36] And when it's not right because there's mental health issues.

[00:51:39] So the mum just can't work out what's the instinctively field.

[00:51:43] Learn to trust your instincts and get the information from a reliable source.

[00:51:47] Find somebody who is trained properly in lactation and start focusing on new

[00:51:53] born care, you put that hard work in for those first three months and the rest

[00:51:59] of it becomes manageable. There's so much misinformation out there.

[00:52:03] And some of it is from doctors.

[00:52:04] I definitely know I was giving wrong advice before I started doing my

[00:52:08] lactation training. I was doing the pushing the baby on.

[00:52:11] I was saying nipple to nose.

[00:52:13] I was doing all of those things.

[00:52:14] So finding the most up to date information is super important.

[00:52:19] And I can send you some of those links and stuff so that people can have access

[00:52:23] to it and also just trust that you'll do the right thing for your baby.

[00:52:27] And this is a bit of a hard one to say, but try and take that emotion

[00:52:31] with your decision out of it because guilt is a waste of it's a waste of energy.

[00:52:35] You know, I mean, everyone's got to feel whatever they need to feel.

[00:52:39] But I feel it's so polarized because people feel so traumatized by the pressure

[00:52:43] they were under and that they were made to make a decision.

[00:52:46] And then they feel like other people say they've made an inferior decision.

[00:52:50] I see what you're saying because your emotions are temporary and your decision.

[00:52:56] Like ideally, you make it when you're in the best state of mind,

[00:52:58] but sometimes you just can't because of hormones, whatever.

[00:53:01] If you've just given birth, there's a lot going on.

[00:53:04] And one advice I've heard not that I've been a mom yet, but working on it is to try

[00:53:09] and do as much prep and planning of some of these questions before you go into it

[00:53:14] so that you're not having to make game time decisions.

[00:53:18] It's also being prepared for what it is, knowing every three hours for three weeks.

[00:53:24] That's what I keep saying.

[00:53:25] You know, knowing that changes the mental state because otherwise you go in thinking

[00:53:29] there's something wrong with you and you're not a good mom because you're

[00:53:32] not getting sleep. You're not supposed to get sleep.

[00:53:34] You were supposed to do it with other people so you would get some rest.

[00:53:37] But the way that most of us are doing it is we're on our own and every three

[00:53:42] hours to three weeks, knowing that going into it is the best thing.

[00:53:47] And if you have nipple pain, seek out a source.

[00:53:49] You will get misinformation somewhere along that.

[00:53:52] You know, I had a patient who came in yesterday who has been five

[00:53:56] other different lactation people before seeing me.

[00:53:58] And they're all giving information that is somewhat correct, but it's incorrect

[00:54:03] for the situation. So bear with that wrong information.

[00:54:06] And if it doesn't feel right to you, then go and find more information.

[00:54:10] You know, she was using the silver X and I said that actually causing

[00:54:13] some nipple edema and she's like, oh, but I feel like it helped.

[00:54:17] And I said, OK, I'll leave it to you to make your decision.

[00:54:19] But I can definitely tell you that most of the time it causes

[00:54:22] edema and during the course of the of the consult when she took it off,

[00:54:25] it had an indentation over the nipple.

[00:54:29] And I was like, see that's compressing your milk.

[00:54:31] That and that's leading to more milk staying back there.

[00:54:35] Given time, most people will be through all of those kind of things.

[00:54:39] Yeah, I feel like you have so much more to teach us and you put out some great

[00:54:43] content. I was looking through your website to prep for this and you have

[00:54:47] amazing guides and PDFs with diagrams that you put together.

[00:54:50] So if folks want to learn more, where can they find you?

[00:54:54] Oh, yeah. So on the website, I have free downloadable information that my

[00:54:58] patients told me they preferred real.

[00:54:59] So with the help of a few friends and nurses and things,

[00:55:02] we put together these reels.

[00:55:03] But it's been so interesting to find out what people actually want.

[00:55:06] You know, so some people seem as a patient, very different to when you're

[00:55:10] not in that urgent situation, you actually have a different need.

[00:55:13] So yeah, reach out to me on Instagram at breastfeeding with Dr.

[00:55:16] Kavita or through the website.

[00:55:18] And I will endeavor to kind of answer your questions and things.

[00:55:22] Yeah. Awesome.

[00:55:23] And the website is letstalkbreastfeeding.com.

[00:55:26] Yeah. Oh, yes. Yes. Thank you so much.

[00:55:28] Yeah. Thank you.

[00:55:31] And that's a wrap.

[00:55:32] Thank you so much for tuning in.

[00:55:34] Remember to nourish your body and I'll talk to you next time.