Essential Postpartum Support with Dr. Amy Tung | How Humans Heal Podcast

The information provided in this podcast is educational and not intended to diagnose or treat medical conditions. Dr. Donnie Wilson struggled for decades to solve her numerous health issues and heal her body. But with focused determination, she healed herself. And in doing so, she discovered the Dr. Donnie stress recovery Protocol. On this show, you're going to hear from doctors, nutritionists, and Experts along with Dr. Donnie, who will give practical advice and wisdom to help heal your body. This is how humans heal.

Hello, everyone. I'm excited to introduce you to Dr. Amy Tung today. She is a naturopathic physician in Ontario, and she specializes in women's health and hormones. And so today we wanted to talk a lot about the part of pregnancy that happens after the baby's born called postpartum or the fourth trimester. So thank you for joining me. Dr. Amy, I'm so glad you're here.

Thank you for having me. Dr. Donnie. I'm excited to be here.

Yes. And of course, we love talking about hormones as what would be considered naturopathic endocrinologists. We normally think of an endocrinologist as a physician who specializes in helping with hormones and hormone balance.

Actually, in the naturopathic profession, there's a specialty area of naturopathic endocrinologists who specialize in a more naturopathic natural view and approach to balancing hormones. And I know you've played a big role in establishing that specialty and helping people to have more awareness for it. So thank you, first of all, for that.

No problem.

Thank you.

So I am a board member on the EndoANP, which is our Endocrinology association of Naturopathic Physicians. And basically all NDs in North America are open to be members. And we welcome any regulated naturopathic doctor to join and who has an interest in hormones. In Ontario, we actually can't say we specialize, but we definitely have an interest in hormones, and we work hugely with that specific population.

Good. Thank you for clarifying. I know sometimes you do. You have to be careful with the words, but it's really this idea of. And of course, the thing about endocrinology that I love is that it really indicates to us how our bodies are so interconnected. And so I think it really honors. As naturopathic doctors, we're always thinking about how our bodies are interconnected, but with endocrinology, it really points it out, you know, that there's hormones communicating throughout our bodies and with each other. You know, inner hormone communications that really influence the way we feel. And so I think that's, you know, that's really the interest is in how can we understand what's going on by understanding the hormones and how can we help a person feel better by balancing this hormone communication and in particular, what we're talking about here with the postpartum phase, of course, that's a huge shift in hormones because a woman's going from having pregnancy level hormones to. To after pregnancy, where it's just like a huge shift.

And immediate. It's not like a gradual shift. With menopause, usually it's more like a gradual shift, but when you have a baby, it's like an abrupt shift. So tell us that. But also, I really want to also understand you a little bit more and what inspires you to your interest in endocrinology, but also your interest in postpartum for women. Tell us a little bit more about that for you.

Yeah, so I've always been interested in natural medicine when I was younger, so my ethnicity is Chinese, so my mom would bring us to Chinese herbalists or acupuncturist when we were very young. So I had kind of that exposure. And then in university kind of just was always interested in science. But I kind of felt. I think I sort of fell into naturopathic medicine because I was looking for a way to sort of bridge that understanding of traditional science and Eastern medicine. So, like acupuncture and herbs and naturopathic medicine was sort of the perfect fit where it combined all aspects of, like, Eastern medicine. We learn acupuncture in Canada as part of the naturopathic program, herbs, nutrition, as well as lifestyle medicine. So it just seemed kind of the perfect mix. Specifically, my interest in the fourth trimester and postpartum happened after my own pregnancy. So I have three. My youngest, she just turned a year.

So she's been in postpartum recently.

I've been in it and then out very short time and back in it.

Wow, you learned firsthand. Yeah.

And it's interesting because, I mean, when you look at different cultures throughout the world, every culture has sort of different traditions when it comes to the. The postpartum period. In a lot of different Asian cultures, like specifically in the Chinese culture, there's what they call a confinement period where the woman is allowed to rest and she is encouraged to honestly just relax, take care of the baby nurse. She is not expected to cook, clean, organize, go back to work, do anything like that for at least up to like, three months. Up to three months. So most people, it's a month. And this was more like historically. Right. So nowadays most people can't really, literally sit at home for that amount of time. But back, you know, back in the day when you lived with your entire village, your village of women would take care of you. And so that kind of tradition has sort of carried on. So when I was in my postpartum, my mom would be, you know, cooking up different herbs and, like, specific soups and broths and putting different herbs that, like, ginger is a really big one in traditional Chinese medicine that you're supposed to have lots of. And so anyways, I got to experience that firsthand. So that was really great.

So awesome. And I love, like, how you're pointing out that, I mean, even in English we have this word confinement, which sounds a little strict, you know, because we don't usually, you know, usually we use the word confinement. It's like, you know, you're confined. But in some ways, there's a lot to be said for having a word and a cultural sort of like, just established understanding that this is what women are going to need postpartum. And I think, you know, when we aren't using that terminology or we're not, we don't have that as a norm, then it means that women might not, you know, they might be thinking that they're expected to go back to their usual activities or, you know, or for their community to not understand that women need support during that time period. And so, you know, it's just. You're reminding me that even when I studied midwifery.

And was helping women with births, that's part of the training is this thinking of confinement. And you're. I helped with some births with some Asian families, and you're right, they still have that as a tradition. Like, you know, after the baby's born, it's just an understanding. Everybody's going to bring food over and the mom is going to be not expected to be performing usual tasks for a certain period of time. So, I mean, there's a lot we can learn from traditional birth experiences in terms of what women. It's not like, I mean, we're still human. Women still need that recovery time.

So when I was. I presented to the endocrinology members a few months ago on the fourth trimester. So as I was researching it, I came across a reproductive psychologist who had termed in the 1970s, Matrescence was the word that described it.

That's nice.

That's really cool. Like, I really like that. And she said, it's essentially this. The evolution of a mom. So that confinement or that sitting in period essentially allows moms to kind of recognize that it's that time of shift for a woman, especially if it's her first pregnancy. Right.

Becoming a mom.

Yeah. Growing into a mom. And it also. Her definition also included moms who adopted or were surrogate.

That's a really good point because of course, there is this transition of just mom and baby getting to know each other. And, you know, it takes. There's a lot of time involved in energy with just. I mean, we joke, like the babies are just, you know, basically eating, sleeping, or, you know, they have very few activities, but it cycles over and over. So it's. It takes a lot of time. It's amazing how much you really have to be. You want moms and babies to be able to have that time to create that bond, no matter how that relationship came about. You want the mom and baby to be able to focus on the feeding of the baby, but also feeding of the mom and rest for baby, but also rest for the mom. And it takes time. All of that.

Definitely. And I think that's part of the matrescence is that in North America, we tend to focus a lot on the baby, and that's kind of the focus of the attention. And we don't always address the mom's care and needs. And that's so critical because the baby is going to do better and feel better if the mom feels better. That's why it's so critical that we identify that. And like the term matrescence. Think of it. She likened it to the word adolescence. So if you think of a person, a teen, going through puberty, you're going through all these hormonal shifts, which is exactly what happens to a new mom. And you're also forming a new identity as you grow into this post puberty phase in your life.

Wow. I love that it honors the spiritual and the psychological aspect of it in addition to just the physical part about the hormones. I love that matrescence. How do you spell it?

M A T R E S C, E, N, C. I think I feel like I'm in a spelling bee. Yeah.

No, I'm just trying to get a sense of it. Like, how many S's are in there? Because it's a little bit of a mouthful, but once we get used to it, like, I'm gonna. I'm gonna share that more because I can't see.

I have it here. M A T R E S E.

N, C E. Okay, so no double S's. Okay.

Okay.

Dr. Arelli Athen is the PhD who kind of reintroduced the term. But the original doctor was Dr. Raphael in 1970.

Wow, that's beautiful. And I think, you know, that's exactly, you know, and your point about being able to also bring the focus to the mom, because, of course, especially in.

Western culture there, you know, self care is thought to be so indulgent.

But for a new mom, I mean, for anyone, I think self care is not indulgent. It's necessary. But especially for a new mom, right?

Yeah. And moms go through the mom guilt all the time, Right. You feel like you have to do everything and be everything to everyone. And especially in this time period, you really don't want to do that. You really need to just focus on rest and recovery, and that's so critical.

And then right away, it points to the need for support and resources to make that possible. But let's talk through, like, the hormone shift that happens there. Like, what are the hormones that are shifting? Why is it, what are women experiencing in their bodies at that?

It's such an amazing step. Like we always say, like, hormones are a symphony, right. Because there's so many parts, like, just like in a. In a symphony, there's all the different instruments. Your body and hormones are essentially all working together to make all these different functions happen. It's pretty miraculous, right? So in order for the fetus to grow, you have what we call like preconception or trimester 0, some people call it. And then you've got your first, second, third trimester. And as your body progresses through, through pregnancy, there's a huge shift in hormones. First of all, the two really big ones that shift are the estrogen and your progesterone. Right. And as a woman goes through the first, second and third trimester, her levels skyrocket to in the thousands, essentially, like three to six thousand in her levels. And just to give you a sense, like woman in menopause, her levels immediately as she enters menopause is about less than 18, right. For. For estrogen. And so women, immediately after birth, their levels go from these super physiological levels and they literally crash to postmenopausal values.

Wow. So it's like a cliff. Yeah, there's just like huge cliff.

Yeah. And I mean, I'm sure you know this, like, as a midwife, you've. You've seen it the moment a child is born, you know, that baby, it's like a miracle. But in for that mom, there's so many, like, things that are going on physiologically and hormonally. And so the reason the hormones shift, though, is it is for survival. Reasons. Right. So drop in estrogen and progesterone immediately after birth, and then prolactin, which is our hormone that allows us to nurse or to lactate, will start to increase. And it actually. If you look at a graph, it actually pulsates. So it does kind of go up and down throughout the time a mother is nursing. And the levels of estrogen will be suppressed as well as progesterone because prolactin is elevated. Right. So there is reason for that to happen. It doesn't always feel good for the mom, but it's for survival, because in those specific weeks, especially, we're concerned with nursing and feeding that infant. But the mom can sometimes feel obviously quite depressed or feel sad. And there's different symptoms that I talked about as well in the presentation, but estrogen, progesterone are the two big ones. And then you also get oxytocin, which is our bonding hormone. Oxytocin also will rapidly rise just before labor and delivery, and then it allows for the mom to bond with the baby. So it's kind of what we call our cuddling hormone. So it allows us to bond. And for nursing, there's also studies that looked at testosterone. So, interestingly, if we look at postpartum depression, women who had a history of postpartum depression, their testosterone levels were actually increased for the first 24 to 40 hours after delivery.

It may be something like for NDs or medical doctors or midwives who are listening, if you aren't looking at that specific hormone in women who have a history of postpartum depression, that was an interesting study where they looked at that.

And the influence of testosterone. Wow.

Yeah. And then thyroid hormones are shifting. Like, there's shift in thyroid hormone.

Your body, for the mom, specifically, her thyroid throughout pregnancy is responsible for thyroid production and metabolism, not only for her, but also for the baby. And so immediately after birth, her thyroid levels are usually upregulated. Right. So because she's still kind of working to metabolize, and her levels. Yeah. Are helping to maintain her and the infants. But in some women who have postpartum depression, their levels actually don't go back down. So usually within four weeks, the levels will start to regulate.

Ppd, we call it. Their levels can sometimes stay up.

Okay, so this. And you're. Yes. I want to point out you're starting to. Well, first of all, you've identified that certain hormones like estrogen, progesterone, drop. And meanwhile, other hormones go up, like prolactin, for breastfeeding and producing milk. And Oxytocin for bonding. And then you also have this shift in the thyroid. I guess it goes from high to low is what optimally we observe would happen. But if any of those hormones are not quite doing the right thing, shift that can influence the way a woman feels. So if say, her save her oxytocin doesn't go up or her testosterone or her thyroid doesn't come down, that, that could cause symptoms that we. Because postpartum depression is I suppose, one of the main terms to identify when a woman is feeling worse during, during this time period. Right. Like if you, if a woman's experiencing, say, low mood. But it, I think it could also be like to some degree it would be considered normal or common to feel some fatigue, especially because you're probably not getting good sleep. Some hair loss definitely is going to be expected.

Maybe some night sweats. I'm thinking back to myself, my daughter's 18.

Night sweats. There's a lot of other sort of symptoms and I think this is why sometimes it's when women are feeling not good, it gets missed because there's a certain, you know, there's some symptoms that we think of as. It makes sense, right? These hormones are shifting. It makes sense that you're going to feel, you know, you might feel sad, you might feel anxious, you might feel tired, you might have hair loss, you might have weight changes. And all of that's kind of expected. But how do we know when it crosses the line to this is more than expected?

What do you think about that?

It's interesting because a lot of times we associate kind of what is often termed baby blues with postpartum depression. Right. But they're actually, they are similar in that the mom can obviously feel down and postpartum depression is actual depression. So think of major depression, but with specific perinatal criteria. Whereas baby blues is very common. So they say up to 85% of new moms can have baby blues.

Sort of like low mood and fearfulness.

Worried, sometimes even anxiety, confusion. But it's more mild and the onset is usually within two to three days of birth.

Okay.

And it doesn't last more than two weeks is usually the criteria they use for baby blues.

So, okay, so if it's like, if it's within the first two weeks and it's like it's, you know, just know that you're going through a transition and you just more indication that you need more support. And. But if, at what point, what are the. Some of the symptoms that a person could look for that tell Them. Oh, this is. So if it goes more than two weeks.

Yep, if it's more than two weeks. So usually postpartum depression is diagnosed, they say up to six. Like, the DSM criteria is actually within four weeks. The concern, though, is a lot of psychologists and psychiatrists that I've read, they don't agree with that DSM 5 definition. They say that a lot of women can get postpartum depression within a year of baby, right? So if you're getting symptoms, say, for example, four months after baby is born, and that's more feeling of, like, hopelessness, I would say, is kind of the term that is often used. More serious anxiety. But also maybe you're withdrawing more from your friends and family. You know, it's a little bit hard right now. I think during this whole Covid thing, a lot of new moms, right, have gone through a lot harder time in the postpartum period. But those are typical. Those are typical feelings, I would say. And usually. But usually within the first six weeks is kind of the definition, is the most common.

But I think you're making a good point that if you're experiencing these symptoms at any time, that it's important to get more help because. And sometimes it kind of sneaks up on you. Is what I've found with patients over the years is like, you know, because what happens is we start to adapt and kind of like, modify our day and our schedule little by little. And then next thing you know, you feel like you're in a deep, dark hole and you can't find your way out of it. And so sometimes it's sneaky, a lot.

Of support, and there is a lot of help out there. I mean, one thing that I can do, Dr. Donney, is I can send you a list of, like, different resources that I found within Canada and the U.S. that are really great. And I think that a lot of organizations have become more receptive to women because a lot of women are home now and they're not able to go to work or they're working from home. So they have, like, a lot of different things that you can get support and reach out. So I definitely encourage moms. If you feel that you're in a place where you're not feeling like yourself, you definitely need to reach out for help, whether it's through your partner, your spouse, your primary healthcare provider, your midwife, your ob, anyone, you're a naturopathic doctor. Like, we're all here to help, right? And help you. Then we can look for the resources.

To help you yeah, it's never too late, you know, like to just. Even if you're like, oh my gosh, I have been feeling that, or I haven't known what, who, who to even ask or reach out to, then that's. And to realize that there's resources you can access from home is what you're saying. Like, you don't have to be necessarily going into a clinic. There's a lot of ways to get help even from wherever you are by phone or computer.

It's interesting because when I was researching for my seminar, the Canadian statistics from Health Canada was anywhere from one in six pregnancies. The outcome is postpartum depression. And they said that's about 40,000 women pregnancies in Canada. And then the CDC, this was obviously before COVID but it was one. Depending on the state, it was anywhere from 1 in 8 to 1 in 5 pregnancies was affected. So huge.

That's a lot because a lot of times you would think, oh, it's not me, it's not gonna happen to me. But that's way more common. That's not like 1 in 100 people.

No.

That's not even 1 in 10 people. No, that's like 1 in 5 people are gonna have a really hard, you know, because again, it's, it's, you know, to not feel judged either. Because I think a lot of women may feel shame if they don't feel good. Like, what's wrong with my body? Or what did I do wrong or right? Like, I think that's so important.

Like when we look at the hormones and when we understand, okay, these are huge shifts that are happening in a woman's body. Like, that is. It's not a huge surprise that women are not going to feel like themselves because you are dealing with your own physical changes. Plus you have a crying infant to take care of as well. Right. So it's a lot, it's a lot for new moms, especially like first time moms. But even subsequent pregnancies, it's just as hard because you got to worry about another toddler as well as an infant. Right. So it's just, it can get harder as you have multiples, especially if you're not getting, you don't have support and it's just you or like you're a single mom or it's just you and your partner, you know, back, like kind of back in the day, it was like your village, your moms, your aunts, your sisters, all your friends, like they would all be there to help you and they would essentially take care of all the older kids and you could just rest now.

It's a lot harder when I, you know, I usually am thinking of things from the perspective of stress, I call it. And like in labor, when, you know, when. When a woman's pregnant and she's going to have a baby, we know that a certain amount of stress is necessary, like a certain amount of cortisol and adrenaline is necessary for labor to happen. But we also know that if there's too much stress, the labor stops. That's why having support during the labor process is so helpful, because we're trying to get right in that area where the body can respond to the stress but also have enough support and recovery time. I'm thinking of that same analogy for postpartum, that there's a certain amount of, you know, yes, we're expecting the body's going to be able to go through this process even though there is a certain amount of stress that's naturally involved. But if we. If a woman has more stress or kind of is overwhelmed with the process and the stress and doesn't have enough support, she's more likely to experience this increase in symptoms. And we call those symptoms postpartum depression. That's what we named it in a medical world. But I think to some degree, just allowing women to know that if you're experiencing where you feel overwhelmed in that process. Even if we don't, we don't, you know, even if you don't identify with the term postpartum depression, if you're feeling like you're not able to keep up and this is overwhelming you, that's enough of a reason to get more help. Because what we can do then is we can look at these hormone levels, we can do testing, we can identify what's out of balance, where for your body did it get overwhelmed, and how can we help you? Yes, certainly, like in terms of help at home and getting food and getting sleep and getting water, some of those basic things. But also in terms of things we can do in terms of nutrients and hormonal support so that it doesn't have to be such a cliff dive. We can actually make it more of a smooth transition. So let's talk about that a little bit. I mean, I know that one of the things I help my patients with, because I do a lot of help with fertility. And inevitably then when, you know, during pregnancy, women have their prenatal provider, but once the baby's born, you're on your own, basically. I mean, the prenatal provider should follow up within six to eight weeks. But you're kind of on your own. And so I like women to know what if you're pregnant or you're postpartum, what should you be making? Sure, like I always say to women, let's make sure you get blood work done within that six to eight week period so that in case your prenatal provider isn't doing it.

Yeah, for sure. So iron is a big one. Most women have. Even if you had just a regular vaginal delivery, you can still have a little bit of blood loss. And if you've had a C section, for sure there's gonna be blood loss. So iron is a big one especially. So we didn't talk about serotonin. Serotonin specifically when it comes to our mood and horm. Serotonin is directly affected by estrogen in our body and in our brain. And so the interesting thing is, so estrogen levels actually help to regulate the production of serotonin. And we already talked about this huge drop in estrogen that's going to impact directly your body's serotonin levels. And like serotonin is, we call it our feel good or happy hormone. But serotonin production is also regulated by specific nutrient CO factors. So when it comes to the conversion of tryptophan, it's like this huge biochemical process that happens. Right? But essentially.

Where it starts is tryptophan. Our amino Acid is converted into 5 HTP and that is regulated through different enzymes. Specifically in the gut as well as the brain, that's directly regulated by estrogen. Then from 5 HTP into serotonin, you get specific cofactors. So like iron, B6, folate, vitamin D, essential fatty acids, like these are specific cofactors, meaning that you need them for your body to actually make the next step. And then from 5 HTP to serotonin you need other cofactors and these are all nutrients. So iron is a really big cofactor for serotonin production. So it's huge.

That's a good point because here, you know, most during pregnancy it's normal to be anemic or you know, very common to be anemic and low iron. And then you go through birth process and lose blood. So then you're more likely to have low iron at that time. And yet you need the iron for like you're saying for serotonin. But you also, we also need iron for thyroid hormone production. So many things. And if you have low iron, you're more likely to feel tired, low mood, have hair loss, you know, so it's like, even sometimes something as simple as iron, and we call it, like, in a prenatal vitamin, which women are usually taking during pregnancy. It usually contains iron, but sometimes women kind of wonder, what am I supposed to take after the birth? And, you know, what I would say is just, you can just keep taking that prenatal vitamin and use it as your post vitamin because you still need the iron. In fact, you probably need more iron postpartum.

Yeah, I usually recommend they take the prenatal vitamin even up to a year postpartum just because it has adequate iron, usually. And if they're able to get more nutrients from their food, that's also obviously a great source of iron. So, like, soups and broths and stews and things like that are great because you can incorporate that into it. If you can. If you aren't vegan or vegetarian, you can look at things like liver or pate. Those are also good iron sources.

Oh, I love it. I love it. And. And like we were talking about in the blood work, so you're gonna want to. I mean, I would. I guess four weeks might. I mean, part of me almost wonders what the blood work would show in four weeks, but I think more common will say more like six weeks. And you're going to want to do not only the CBC to check for anemia, but also I would do a ferritin. Right. The F, E, R, R, I, T, I, N ferritin to check for iron storage. So we could. Sometimes you might not have anemia, but you might still have low iron storage. And then we're gonna still need to boost your iron some more, right?

Definitely. Yeah. Like, I've had patients where we checked their ferritin and hemoglobin during pregnancy, and it was okay, like, not great. But we definitely want to boost levels if they're already kind of creeping down towards the lower end. But if you check postpartum and they're definitely, like, their stores are low, you really want to kind of up the dosage of what you're taking from iron. Obviously, work with your naturopathic doctor or family physician, but it's definitely something that a lot of women do need more of.

And then in that blood work, we would also check thyroid, like TSH and free T3 and free T4, and see how are the thigh. And if a lot of women are taking thyroid hormone during pregnancy, maybe you had a little bit low thyroid function and you were taking thyroid hormone during the pregnancy. And then postpartum, your dose could change too. Or you maybe you had normal thyroid function before and all of a sudden you drop into low thyroid function after pregnancy is common too, right?

Yeah. And I always recommend like checking antibodies, thyroid antibodies. So anti TPO is a big one. There were studies that looked at women who had, not necessarily Hashimoto's, but they just were tested and they had elevated anti tpo, which is a thyroid antibody in their blood. And they were actually at increased risk of developing postpartum depression. So you really want to make sure during pregnancy. If you have a healthcare provider who can check that, like your naturopathic doctor, I definitely encourage you to look at that. But if you can't check it during pregnancy, definitely within that six weeks time frame. But postpartum thyroiditis is. They actually say it's like the most common endocrine disorder in the postpartum period.

Right. So it's like you want to have it on your radar and check for the antibodies and for the thyroid function because it. And to know that your dose might change if you're already on thyroid hormone, that your dose might change, your dose can definitely change.

Yeah. So that's why, like you were mentioning Dr. Donnie, like having that proper follow up, because here I had a midwife for my last two pregnancies and an OB for the first. With the midwife, you definitely get more follow up. But after the eight weeks, like you said, you're kind of on your own. And if you don't have a family doctor or a naturopathic doctor who can follow up with you, you sort of have to figure it out on your own. So I do encourage you to see and look for a naturopathic doctor if you don't have one, because they can at least look at the blood work for you. Do the proper follow up. The American College of Obstetrics and Gynecologists, they actually came out during a symposium with an altered form of follow up for healthcare providers which provided more like individualized care. And I thought it was a really great formula in terms of looking at the individual woman. Right. As opposed to, okay, you're just coming in for your two week, four week or whatever follow up. But if a woman needs more follow up, she should be able to get that right. And that's really important. If you can't get that with your OB or your midwife, you gotta look for other options.

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Yeah, because it's not built into the system really. It's not like they don't necessarily say to you, you know, oh you need this, you know, follow up. And like you said before, the attention is so much on the baby and sometimes it's hard for mom. I mean I know for me it was sometimes it's hard enough to get a shower, let alone going for a blood draw or have, you know, you have to have someone to be able to take care of the baby, to help, to even be able to get even if you have a phlebotomist come to the house, I suppose that might be a way to get it where you don't have to leave the house. But you know, to be able to get a blood draw is like, feels like a huge task. So you know, sometimes I know at that time period, but it's worth it especially if you're, you're noticing, you know, that your body is giving you signals that it's not, that it needs more attention then definitely worth it. And really everyone, every woman should get that follow up blood work to just, you know, because then we can, we can do support like you're saying, like even for serotonin in addition to iron. If I see low serotonin, we know we can use 5 HTP for example as an amino acid that's a precursor nutrient to serotonin. So if serotonin is low, we can support it safely even with breastfeeding so that you don't have to go feeling awful just because you're breastfeeding. Like there's ways we can support with nutrients and that's why, you know, I think it's so awesome with what we do as naturopathic doctors, we're essentially also clinical nutritionists and we can use nutrients in this way even to help with mood and the nervous system.

Definitely. Yeah. And I mean, there's great herbs like that we can use as well. So motherwort is a really, probably the most well studied in terms of like historical use. So motherwort or Leonard, they often use it for the postpartum. Yeah.

And it's so great just the name. Right. You realize it's named motherwort for a reason.

Yeah, there's definitely a reason for that. But like, there are so many options. And I think it's important though to be diagnosed properly. So if it is postpartum depression, it's not okay just to kind of figure it out on your own. I do think that women need to reach out to the proper healthcare provider. And there are. There's another clinical tool that I don't know if you've probably seen it as a midwife called Edinburgh Perinatal Scale. So it's called the EPDs, which my midwife gave me only in my third pregnancy. But you can actually measure mom's mood and you can give it around 30, anywhere from 26 to 38 weeks during the pregnancy. And it kind of gives the healthcare provider an idea of where the mom is in terms of mood. But you can also give the study anywhere, like within hours of birth, although I don't know if I would give it to a mom who's just given birth, but within the first day and up to the six week time period. So there are ways that we can kind of diagnose not just based on, you know, are you feeling sad, are you feeling, you know, so it's more specific. And they actually use that a lot in research when they look at postpartum depression.

Oh, interesting. That's great. And I'm wondering, is there an easy way that women could access that themselves?

You can just Google Edinburgh Perinatal Scale for depression episodes.

Okay, great. Because I'm imagining, you know, you could just, it'd be something probably, you know, women should just kind of do for themselves even every week if, especially if your practitioner is not doing it. And then you just have a sense of like, you know, as much as we can kind of be objective. Of course, it's. Of course, when you have a new baby, I don't even think. Sometimes you don't even know that a week has gone by. You're so in. I call it in baby land, you know, and baby land is very hard to know one day, Wednesday, what day it is anyway. But you know, you can kind of try to like, help yourself to.

You know, to check in, in that way so you know, when, when you need more help and because I do think that it's, I mean, sometimes it's, it's, you know, there's a feeling of like you can feel, oh my gosh, I can't believe I'm on my own. I can't believe I'm having to figure this out myself. But at the same time, if we can just look at the other side of the coin and realize, yes, there's a certain point, part of being your own advocate here that's gonna make a difference where you can, you know, if you can be a bit proactive even in terms of creating good self care and support for yourself. Let's talk about that a little bit. What would that look like optimally in terms of like a support team for women during this time period?

So I really encourage moms when they are pregnant to try to start thinking about the postpartum because a lot of times we focus on like the birth, especially for the first pregnancy. It's like, what's my birth plan? Do I want a home birth? Do I want a hospital birth? And we don't really think about beyond that. And that's usually, I know for me personally, like when I had my first, it was huge shift. And you don't really think about what happens after, you know, you bring the baby home from the hospital if you have a hospital birth, or what's going to happen in the weeks and the months after.

Or like I was thinking of moms who maybe have a baby that was born early and the baby's in the NICU and you're going back and forth to the hospital. I mean, there's so many things that it's hard to anticipate. And then you figure, well, I'm going to figure out when I'm going to get there. But it's better if you can, like you're saying, anticipate it and have it a little bit figured out ahead of time.

Yeah. And the thing is too, I mean, you talk a lot about stress and I think women can go through different stress. So you could maybe even have an idea of, you know, you want a home birth, you want a water birth, but then something happens and you know, the midwife sees meconium. You get rushed to the hospital for a C section, for example, like it's not the birth that you envisioned. And this can be really hard for women. Very hard, very stressful. There could also be specific socioeconomic reasons that can increase stress. Maybe you're not working. There are so many factors. But I think what is good is if you can anticipate and plan as much as you can. Obviously we can't predict every possible outcome, but just have the tools available to you. One thing that I always recommend for my patients is to look for a lactation consultant and just have them on hand. So what a lactation consultant does is somebody, if you are thinking to nurse because not every mom wants to or is able to, but if that is something that you would like, have a lactation consultant available. Because what they do is they come to you and they often give you tools and techniques and different ways to kind of help your baby to latch and to nurse. A lot of hospitals actually provide that free of charge as well. You can't pay for one specifically. They do have lactation consultants at the hospital. I would also like talk to your partner or your spouse. Just make sure that you're kind of on the same page as to what you would like. And this time that you're going to need specifically to, you know, I'm not going to be able to really do as much as I would have done maybe prior. And I really want this time to kind of just rest and bond with baby. And I think most partners are pretty understanding of that. But ask for support from your friends and family. Like maybe they can't physically come in to see the baby. Maybe they can just drop food off, for example, and you can have freezer full of different foods that are already prepared and all you have to do is warm them up. That is a huge, huge help, especially the first little bit. I would say the most important thing is really just, just listen to your body and don't feel that you have to be this super mom and be back to your old self and quote, unquote, lose your baby weight. Because that is not an important thing. Especially in that fourth trimester. You really just want to focus on rest, focus on nourishment, focus on bonding as much as possible. The other thing is a lot of moms are in a lot of pain. If you've had a C section, for example, or any type of tear, you could look at preparing perinatal pads right in your freezer. Have that available in case you need it. Just things like that. Look for things that are going to help make you comfortable after baby, not just obviously having a crib and having the baby shower and all that stuff for baby. There's things that you may love. Having a nice cup of tea, for example, every day. And that could be Your form of self care that you have this tea and your favorite mug every day at, you know, this, this time, and you just can read a book and relax and maybe have your partner take over for a few hours or even look at pumping. If you are nursing and have your partner do one of the feeds at night so you can get a little bit longer rest. I find that is so important because moms, moms are not going to get enough sleep, especially the first little bit, until the baby starts to sleep a little bit longer. So whatever you can do to get that rest in whenever possible, even if it's in the middle of the day, try to get that.

Those are great ideas. And sometimes, yeah, just sometimes it may seem as simple as having plenty of your favorite tea around that you can choose that every day. It can be that simple. But it can make a big difference to just have a few minutes, I say have my brain to myself.

When you're taking care of this little one and you've got all these different things going on, it feels like it's hard to find some space to just be you and think about you for a few minutes. And.

So having those, you know, kind of. And even if you're listening to this now and you're, you know, you're in the midst of it, you know, see if you can create even just little pockets of time for you to have a break, a brain break and just be able to, you know, and it. Sometimes it's hard to ask for help, but at this time period is probably when you're most to the point where you're going to, you know, you're going to get some practice asking for help, you know, and finding ways. What are your, what would you suggest? What are ways that, if women are not used to asking for help, what are some ways they can do that that might just help them to get over that hump?

That's a good question. I think it's really just taking that time and looking inside and just taking that breath because sometimes we're just on the go, go, go, go nonstop that you don't even know what you need and you're not thinking about what you need. You have absolutely no idea what it is that could help you. And so I think just take a breath and, you know, maybe even just meditation is great if you can do it. And if you have time, there are some really great apps I think that can help new moms where it's literally one minute a day. If that's all that you can find, you put your Headphones in, plug in the app on your phone or whatever and just kind of close your eyes and just relax, calm your brain and just don't even think or do anything for that one minute. And then if you can do that a few times in a day, I think that's great. Or even just sometimes I'll just lie literally on the carpet or my yoga mat for like a minute in Savasana and I'm just totally relaxed. And it actually does really ground you. I feel like that's.

The baby could be sleeping next to you or something like that. Yeah.

Going for walks if possible, like just getting some fresh air. Like literally if you can only sit on your porch or whatever and you don't want to go out because it's cold or wherever you are, just get some fresh air and get natural sunlight as much as you can. I think that really helps with our mood.

And of course, if you are breastfeeding, then to make breast milk you need fluid. So we need you to be drinking any water or non caffeinated beverage to keep you hydrated. And food, you know, so to remind yourself, like if the baby's eating every few hours, you probably need to eat and drink every couple of hours also.

Definitely. Yeah. And I usually remind moms like if they have a little couch or recliner where they're nursing, just keep a water bottle or, you know, your canteen or whatever next to you and just take sips while you're nursing so that it reminds you and have little like snacks, like healthy snacks next to you, maybe some granola or nuts and seeds or whatever. And just try to like nourish yourself while the baby is feeding.

That's such a good idea. Because of course once you sit down to nurse, then you're like, oh shoot, I forgot to get my water. And you don't want to have to get up and go get it. So you need it kind of sitting there where. So you just land there with the baby and then you have at your in arm's reach, you have what you need to feed and hydrate yourself while the baby's nursing.

And if the mom is well nourished and fed, the baby is going to be well nourished and fed. Right. So again, it goes back to the whole mom guilt. Like don't feel guilty. You need to nourish yourself if you're going to be able to nurse and feed and provide for that baby.

And even if you're not nursing when you can do the same.

You still need hydration and nourishment in order to, like you're saying, take care of the baby. So if it kind of helps your mind, think about it as you know, we need you at your best because you're the one taking care of the baby.

Soups and broths and things like that. Especially because when you make like things like bone broth and things like that, there's natural collagen, which is great for a mom, right. To kind of rebuild and heal. But you can also add like vegetables and things like that to get like your vitamin C. And you know, like there's different ways to get fluid. So it doesn't just have to be water. Like if you are adverse to maybe the taste of water, you could put a bit of lemon, right? Or you could have a sip of chicken soup. You can have herbal teas. Like there's different options. But I think it's really important to nourish ourselves and our body and protein is really important. I find a lot of moms, we kind of reach for the carbs, right, which are easier and faster, but really try to get a little bit more protein in our diet as much as possible.

Those amino acids. And I like that idea of soup because you can say you make a larger quantity of soup now, you could eat that over a couple days or you could freeze it and have it later. So it means you don't have to keep on making more meals. You just have something you can keep going back to that has a lot of nutrition in serving. Oh, that's, that's a great idea. And it made me think too that one of my office assistants recently had a baby about a year, maybe about the same age as your baby. And she was telling me that she found this app where she could enter her due date and it matched her up with other women who were having a baby at that same time period.

Yeah, I've heard about that. Yes, Yes.

I gotta ask her the name of it. I don't know if you know, but she, she really liked it because it meant that she had kind of a community of people who had a similar age baby and could, you know, connect with each other and talk to each other about that.

Yeah, I think it's good. Like, because that, that is the other aspect that is really hard for new moms, especially for first time moms during this whole pandemic, is that you really feel isolated. And I know when I had my first I really was like, well, a lot of my friends had babies, but they live not within like my like city. So it would be really hard to, you know, we call and video chat and things like that. But I really wanted that kind of one on one. So I think that's a great idea to get that support and community.

Yeah. And to feel like you're not alone and there's other people in a similar circumstances. Because sometimes you only think of certain things that you need help with when you're in that situation. And then, you know, other people are dealing with the same thing and they might be like, oh, I found this or you know, and certainly with food as well, you can, you can have food delivered, whether it's having groceries delivered or having pre made meals delivered so that you're not having, you know what I mean? Just trying to cut out some of the steps because we're so used to, you know, just being able to go to the store and come home and cook and have the food right there. But in this situation it's not so easy to just jump in the car and go get some food. You're able to either have someone bring it to you or if you are in a situation where you could have it, you know, instead maybe order from your phone and have it delivered. And I was recently researching companies that deliver pre made meals. Like there's one called Trifecta Nutrition that, you know, you can sign up and they'll deliver like, you know, clean meals, you know, like gluten free, dairy free if you know, if you're one or you know, so they can actually deliver healthy meals that are already prepared. You know what I mean? So those are also possible resources, right?

Yeah. If you can't like say you don't have family that can make food or you don't have the time to prepare beforehand. Yeah, definitely look for those resources. I was thinking when you mentioned app, this is the one I was thinking of. There's actually one where you can have friends that basically they plan out the meals that you need and they deliver on certain days depending. It's like a food train app, I guess. Yeah, it's kind of, I don't know, I mean people still use it now with this pandemic's kind of changed a lot of things. But definitely like your friends or neighbors who you're close with. That is definitely a good option.

Yeah. So so many resources. And before we wrap up, I wanted to just touch base on a couple things that came to mind as we've been talking. One is that I help a lot of women who know they have an MTHFR gene mutation and mthfr. For those of you who May not be familiar with. It is a. It's a gene variation that affects the ability to activate folate into act in an active folate, which is vitamin B9. And so times mthfr come women become aware of it because it can increase risk of miscarriage.

And so usually we're working with it to help them to get pregnant. And then I continue to monitor during the pregnancy. But that would also be an important thing to measure. Again, in that postpartum blood work.

I check the homocysteine and methylmalonic acid because, I mean, a lot of times doctors will measure, say, just your folate level or your B12 level, but those levels are not going to be very helpful or accurate when you're currently taking those nutrients. So really, the test that we should be doing is homocysteine and methylmalonic acid, because then we're actually going to see how well your body's using the amount of B vitamins that you're currently taking. And that could shift postpartum also. And so you may have a different nutrient requirement for folate and B12 as well. And that could affect, of course, those B vitamins affect energy level, mood, neurotransmitters. Right?

Yep. And I always. Any. Any type of prenatal for moms, I always get them on the 5mthf.

Methyl folate.

Yeah. The methylfolate is the better form. So if you're using a generic prenatal that, say you get at the drugstore, it's not going to have the activated form of folate. It's going to have folic acid, which is synthetic. Right. It's not the same thing. The other test that you. I know you do the Dutch test as well. I think the Dutch is a great adjunct as well, if you can do the blood work to look at your iron and things like that. But when it comes to, like when we were talking about serotonin, so it actually measures serotonin and melatonin. Right. So the. What we call the kynurenine pathway, it can measure cortisol, all the sex hormones. Like, it's a great. It measures methylmalonic acid. Like, it's a great adjunct if you want a kind of a clearer picture of where you're at.

Yes, thank you. And that's exactly. I was going to come back to talking about cortisol, too, because it. And that test is so like. And it's not considered a standard. Like, normally it's not standard that practitioners would test cortisol levels or. And certainly not, you know, looking at your cortisol throughout the day, let alone like you're mentioning the, the metabolism of the neurotransmitters and the nutrients and then, and then also other hormones like melatonin. Like, that's, those are not part of standard care, which also means they're probably not going to get covered by your insurance. But like you're saying if you're, if you're a person who's really like, already an advocate for your health and you're wanting to. Or maybe you have a history of a prior pregnancy, not feeling good postpartum, and you're like, I'm not going to do that again. What can I do to prevent that? Then these are steps you can take that. Yes. Could be, you know, this, this could be like a, you know, maybe it's a. Depending on where you're located in the prices, it's probably 2, $300 test. But it's worth it if it can help you really understand better what's going on in your body. Then you have a naturopathic doctor like us to help guide you and say, okay, if this is out of balance, here's what we can do. Because there's, that's the thing. I always think, let's do tests for things that we can do something about. And that's exactly what this is. We can do a test and see where the imbalance is. We can actually do something about it to help your body out.

Yes. So for the Dutch, I think because of the conversion and in Ontario, we're not able to order directly from the Dutch lab. So we have a kind of middle lab that we Ontario naturopathic doctors we order from. So it is a little bit more expensive. It's about almost 500 in Canada.

Okay.

Yes.

But it's still, it's like worth it.

If you really want to see what's going on in the body in the whole picture. I do have a lot of my women patients do it and they find the results really helpful.

And it's like, it's again that taking your health into your own hands, because we don't want you to get to feeling terrible and then have to recover from that. We want to try to be proactive and go, hey, let's, let's check your levels. You know, even, you can just plan on it even ahead of time or certainly if you start to have symptoms, then definitely it's like, okay, let's check these levels so we can see what's going on. Because there's, there's general things like we've talked about that you can do self care and you can be taking your prenatal vitamin. But if you're still finding that that's not enough, then a test like this can really help us figure out, like, okay, what are we missing? Do you need, you know, do we need more of certain B vitamins or do we need more, certain support even for the adrenals? Right. So the adrenal glands make cortisol and adrenaline. And tell me more about the research. I haven't looked specifically recently at the research on cortisol postpartum. What do they find that cortisol does?

You were saying in midwifery. Right. You've seen we definitely. It's like that, Goldilocks. You need enough cortisol and adrenaline to kind of initiate labor and partition. So what happens is cortisol. So our stress hormone actually steadily increases until about, usually about four weeks. Your levels of cortisol will start to kind of re regulate. In women who are postpartum, who have postpartum depression, they actually, their cortisol levels do not go back down. They kind of stay elevated. And we know that in just regular major depression, a lot of people have elevated cortisol right in their brain. So you can test cortisol. And the way we test cortisol is either through urine or saliva. You can't test cortisol through serum. So a lot of the research where they looked at.

Urine tests for cortisol, their levels were actually increased six weeks. And on postpartum in women who had postpartum depression.

Wow. I mean, that just says to me that it should be common practice to check.

Yeah, along with thyroid. I think it's one of those things for women who have any type of history of postpartum depression or anxiety, they definitely need to get their thyroid and adrenal function looked at and in check.

Well, again, it makes sense. I mean, this is a. Yes, it's a natural thing that human bodies do to have a baby, but it's also, there's a lot of stress involved, not just from the birth, but all the other things that are going on in that time period. And so it makes sense that the adrenal glands that are making all the cortisol and adrenaline, we're demanding more from them. And depending on your past history of stress and your genetics related to cortisol and stress, that can play a role in how your body kind of bounces back from any stress you go through, let alone a birth experience or a new baby experience. And so being able to Go, hey, what are my adrenal, how are my adrenals holding up under this stressful time then like you're saying, I mean, if we do cortisol in the blood, we only get a single whatever time you had your blood drawn. But what we really want is we want to see your cortisol, like morning, midday, evening, bedtime, so we can see, hey, is it, is it just high or too low at certain times a day or all day. And as you mentioned, high cortisol can be associated with depression, but low cortisol can too. So we want to see, is it too high, is it too low? We don't want to, because women might say, well, if it might be high cortisol, let's just treat it that way. But I would end up thinking, well, but what if it's too low? And that's a totally different treatment.

Yeah. And it's like, I know Dr. Carrie Jones, she says cortisol and melatonin are like the sun and the moon, so they oppose each other. Right. So cortisol typically is higher in the morning when we wake up, and then it goes down and then melatonin is more dominant when we're sleeping. So there's definitely an interplay there that goes on that we need to look at. That's why I like the Dutch, because it does give us a good sense of where you're at and it gives you the different times that you can test for cortisol, which is really helpful.

Yeah. So good. But wow. Thank you. It's a lot of information we've covered, but I think all so essential and I really glad that the women are going to be able to listen to this as a resource if they want to get in touch with you or learn more from you. Where, where can they find you?

So I practice in Mississauga, Ontario, Canada and I do virtual and in person visits and my website is dramytung.com and you can also find me on Instagram at dramytung. And that's probably the best way to find me.

And Amy is Amy and Tung is T u n G. So it's just the way it sounds, right?

Yeah.

Oh my gosh. I mean, thank you so much. And this is, it's amazing that you've really, you know, been able to dive into this research and to be able to share it and be a resource for women. I mean, thank you. I want to say thank you. Thank you for all the work you're.

Doing with women and stress. I think it's so wonderful. I love seeing all the great content that you're putting out there.

Thanks for listening to how Humans Heal.

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