The Science Is Clear: Mothers Don't “Bounce Back” After Birth | Dr Federica Amarti

0:00Why is it those thousand days for the mother and parents? There's no other time in life that has quite the same impact. During this time, all of your cells are built, all of your organs built. Father's health is just as important. Just as important. Fertility is probably the only time in pregnancy where paternal health has as big an impact on whether a pregnancy will happen as maternal health. Why do cravings come from? So why do we get the morning sickness in pregnancy? our bodies will take from us. Can you bust a myth for me? I heard that. No. Postpartum. Birth is mad and I actually ended up back in hospital.

0:39I also just wasn't eating enough at all. I've also got psychological. Mothers don't ask for help. If someone asks to come over, unless they're coming over to cook or clean for you, it's a no. Hey, welcome to Motherkind. We are proudly sponsored by Wild Nutrition's Women's Supplements. It is me, your host Zoe, and this is the show for you, the woman behind the mother. During August the Motherkind team and I try and practice a little bit of what we teach by slowing down, we take some time off and try to make the juggle of the summer holidays a little bit easier. So throughout the month we're bringing you some of our most loved and listened to episodes of the year so far.

1:19Today's episode has been one of our biggest of 2026 and I cannot wait for you to hear it. Here it is, enjoy.

1:30Federica, I'm so excited to have you here. Thanks for being here. Thank you for having me. One of my favourite topics. So there's just so much chat, isn't there, about the first 1 ,000 days for our children and how important that is. Well, I want to slightly take the spotlight off our little darlings and put them onto ourselves. That's what this whole podcast is about. So I want to talk about the first 1 ,000 days from preconception all the way through to the end of that sort of first couple of years from a mother's nutritional perspective. And you talk about these life stages of nutrition. Tell me, why is it those thousand days for the mother and parents so important?

2:09So the first thousand days, we refer to it as the golden window of opportunity. And actually, what you said there is really important because the mother is the system. So we can't sort of think about this as just the children or just the babies, because without the maternal feeding and the maternal growing in the womb, there would be no first thousand days. So they're completely interlinked. So we often refer to this as the mother-baby dyad. So we don't separate the two. And this goes on until, certainly until the fourth trimester. So baby until baby's three months old. The full thousand days refers to up to second birthday.

2:44And so after the sort of fourth trimester, the baby does gain some forms of independence from the mother. And then of course, you start to introduce solids so there's less of a biological dependence but the full thousand days is extremely linked to maternal health and then you know parental health if the mother is not there after birth so why is it so important well in sort of life course research which is this way of looking at health outcomes in a cumulative way so we know that health and disease and risk is not a sort of instant effect. It's cumulative over time. So whenever we say, talk about what are the risks of developing X disease or what is the likelihood of living to 120, we look at the cumulative risk or benefit that happens throughout the life course for majority of things.

3:38There are obviously some exceptions where illness can strike very early or there are genetic conditions that strike from conception essentially. But really most of the health outcomes we look at have this cumulative way of showing up. And the first thousand days have a potentiating effect. So in the first thousand days, we see that exposures at this time, whether that's feeding, stress, sleep, infection, they actually have effects that last really far into adulthood. And so it's called the golden window of opportunity because if you can intervene at this time, if you're public health, so my background is in public health, or if you're a doctor or someone who's interested in health, you can have a really multiplicative effect on that cumulative risk or benefit.

4:23So it's this really unique moment in time in life where we can affect the mother's health, which then affects the baby's health for the pregnancy, but also for long-term health outcomes. So some of the best studies we have on this have followed up babies from conception, actually from the mothers from preconception to the baby being 65 years old and you can see how maternal exposures specifically dietary exposures is the research i'm thinking of actually have an effect on the baby's adult life so it's and you can literally see that it was that preconception exposure that made the difference in those outcomes now that's not to say that i don't want to scare people and be like oh my god we're all doomed you know there's just singing that i was like we need to talk about the pressure that that hearing them right yeah and i think you know when i wrote my book everybody should know this where i really talk through live course nutrition because it's something i'm passionate about i've done research on and i teach to medical students a lot i always think of this as like this is an opportunity to empower women empower parents it's also an opportunity to understand yourself because you might think, oh, well, that explains why X, Y, Z.

5:36So sometimes understanding your early life exposures or the exposures in your mother's womb can actually help you to understand where your health is at today. In part, of course, it's not everything, but it does help. So it's about empowering individuals and couples to understand this sort of really special quality that this time has so that then you can make the appropriate choices, decisions, you can inform yourself however you want, then go from there. But it's not intended to scare people. It's more that having this knowledge then gives us the power to say, right, well, then it's really worth investing in X, Y, Z, or it's, you know, that time has passed for me.

6:17What can I do now to support my health or my child's health? So there's lots of strategies. It's not all decided in that first thousand days, in the same way that your genes don't actually decide how your health is going to pan out. but it's just a time a period of time where there is an unusually unusual contribution to long-term health there's no other time in life that has quite the same impact and that's because during this time all of your cells are built all of your organs built so all of your systems are built and then throughout life we evolve and things change we can make new neurons and obviously tissues change all the time but the kind of blueprint the primordial structure is set in the womb which makes sense right because that's where the baby is built and so when we think about really extreme cases you see and this you see unfortunately in countries where there is maternal undernutrition like chronic undernutrition you actually see that for example baby's kidney structures are different because they didn't have enough nutrition to build as many parts to the kidney as someone who has enough so that we have a lot of this understanding from very extreme circumstances and so that's to say that for people listening to this podcast we're talking about long-term effects but often quite small shifts unless you fall into a category where there's quite a big exposure or a big sort of lack of nutrients one thing that you've already fired off in my mind is yes thinking about the first a thousand days for the child but also how we nourish ourselves as a mother.

7:56Yeah. And the long term impact that that then has on our stress, because we know, you know, we know the stats around maternal burnout and maternal stress. And I'm thinking, my gosh, I did not understand postpartum through my matrescence, the importance of keeping myself nourished. I think I knew it intellectually, right? I'd read the books, but I actually didn't implement it very well. And I am sure that that had an impact then on, you know, the levels of exhaustion. Of course it did. The level of exhaustion I was feeling, but it's so difficult so I want to dive into that but I want to do this chronologically okay let's type A in me it's like right we have to start I can't jump straight to postpartum yeah so let's start at preconception yeah so we talk a lot about mother's health but actually it's very 50 50 here isn't it father's health is just as important just as important and I can't stress this enough because I think with fertility especially if a couple enters fertility fertility struggles it's often like looking straight at the woman well what's wrong why not you know what's happening with you and actually it's it truly is 50 50 it takes two to tango fertility is probably the only time in pregnancy where paternal health has such a big it has as big an impact on whether a pregnancy will happen as maternal health right so and when we think about this it's actually interesting because we are born with all of our eggs actually our eggs were all in our ovaries when we were still in our mother's womb I know that blows my mind I tell that to my kids all the time I carried your my grand potential grandchildren yes in my womb yes and and your children were in your ovary when you were in your mother's womb right so she already had your children in her it's really lovely yeah it's lovely but it's it's also like it it's essentially our eggs are exposed to a variety of things way before we were even thinking about having children and there is a cumulative effect on our eggs and their health over our lifetime which as well as genetic factors actually so for example if your mother or your grandmother entered menopause early uh you're more likely to enter menopause early so there's lots of factors that sort of play out on egg quality and egg number availability, essentially, for fertility in women.

10:24So those are longer-term effects, which a lot of us won't have thought, you know, when we were, I don't know, when you went to, did you go to uni? I did. And, you know, Freshers' Week, when we were all drinking. I can't think about it, to be honest. Vodka reusable pictures for£5, right? so those exposures they happen but it's all a balance so it's like yes we were drinking the pitchers for five pounds but also were we exercising were we eating like a fairly good diet there's lots of things now right before conception so three months about 90 days preconception is when a chosen follicle will be selected for maturation and the egg will be so that egg is going to be one of the selected ones to rupture and be released and it takes about 90 days for that process and so what you eat and what you do in that 90 days can actually have an effect on that egg's potential and like how it then is released into your fallopian tubes to hopefully become you know if you want to become pregnant to be fertilized so there is this effect in those 90 days on how your egg is selected how efficiently your body selects the best egg and how it's nourished into like does the body select the best egg yeah yeah so there's several of them will go into sort of the maturation process and then only usually only one or two will be selected for actual rupture maturation and then release um and so if you think about that if you're giving your body the best possible tools at that time to have all the nutrients necessary for that it's actually a form of micro inflammation that causes that rupture so is your immune system functioning well do you have enough nutrition to support that little that little sort of inflammation in the release loads of factors like that are there specific things in those 90 days preconception to be looking for eating not eating yes so there's what you'd consider sort of a fertility supportive diet and when we think about what that means it's sometimes a lot of people will talk about specific nutrients in this time so folate iodine you know zinc those are all important things to consider but when you translate that to a dietary pattern the best understood dietary what foods am I actually eating is the Mediterranean diet.

12:35So you have some seafood in there, you've got loads of vegetables, loads of fruit, whole grains, nuts and seeds, critical, critical foods for good fertility and pregnancy, right? I can't stress that enough. And so this is also the time when if you're thinking of getting pregnant, you're planning, you might be taking a folate supplement is a good idea. The UK has recently changed their fortification laws so actually we will have fortified flour in the uk after decades of being one of the only countries that doesn't have it um we so actually your bread and bread products like pita breads and stuff will have some folic acid um supplementation in the breads but up until very recently we had none of that so we actually had quite higher higher rates of things like spinobifida in the uk because of the lack of public health supplementation of fortification it's called so take one if you're thinking of getting pregnant um if you're worried about you know online there's quite a lot of noise about the mthfr gene and should you take folate or folic acid folic acid is well understood to be effective but so is methylfolate so if you could afford the methylfolate like natural option great so supplement but and that's useful as a safety net but what you eat the foods you eat are more important than getting the micronutrients right and so if you have a diet that has those elements the oily fish the whole grains nuts and seeds fruits and veg then the pulses are really good for b vitamins as well then you'll be getting the nutrients you need to support good fertility now 90 days is quite short for for a woman so if you're really trying to optimize your nutritional status going back to what you said earlier like you need to have really good nutritional status to cover you for most women for like the first trimester because your appetite and your nausea are going to be impacted.

14:26And so you might not be able to eat as well as you'd like to in the first trimester. So having good nutritional status before you get pregnant really helps with that. It gives you way more buffer. It gives you much more resilience in the face of like nausea all day long. So I would say like in an ideal world, could you start planning like a year or six months before you try to conceive? But most women, we know the majority of pregnancies are still not planned. So 90 days is great. Now, if you're the partner, if you're a man or you're trying to conceive, 90 days is fine. Why do they always get it easier?

15:04Well, so sperm are produced all the time. So they're not like our precious eggs that have been with us forever. They sort of make new ones every day. And the process that it takes to create a brand new sperm takes 90 days. on average, so between 70 and 110 or something. But so you can put as much potential into that sperm as possible within about 90 days. That's for sperm health. However, when we think about paternal health in general, so the father's health in general, metabolic health, so how well his metabolism is functioning impacts fertility and the child's health. So we can try and get your sperm to be as optimal as possible in that 90 day frame.

15:47But if you're somebody who has smoked and maybe drink a lot of alcohol, and you know, your metabolic function isn't great, so maybe your blood, your, you know, blood fats and your blood sugars are high, blood pressure is a bit high. That's all not helpful for really trying to optimize your child's health. And I think this is a really important factor is that sort of paternal health impacts the child's outcomes differently to maternal health. So a father who has a very high BMI for it perhaps is living with obesity actually impacts child health outcomes differently to maternal obesity. So we do have to actually think about, sure, optimizing the sperm in that 90 days.

16:28But if you're hoping to have a baby or planning to have a baby, try and really get yourself into good shape, like into a really nice metabolic state before you have, before you start. saying metabolic state yeah right break that so try so essentially if you're thinking about blood markers you want your hba1c which is a measure of measure of blood glucose to be healthy you want to try if you're in the pre-diabetic range you want to try and bring that down um if your blood your cholesterol levels are high try and get those to like a healthier level if your triglycerides which are another type of blood fat high try and get those down and the good news is that how we do that how do we get those to improve that the advice is the same so a mediterranean diet is proven to help it's definitely a pattern there is a pattern and you know it's funny i had um i don't know i don't people always tell me that not to read like all the reviews from my book but there was one review who was a very angry person who was like yeah the science was interesting and like the mechanisms are cool but but you know the mediterranean diet can't be the only solution I'm like, well, it truly is the best research solution.

17:34And it's the one when you're writing a book or when we're doing a podcast like this, which needs to be applicable for the majority of the population. You have to choose the thing that's going to deliver benefit to most and won't cause harm. Right. Mediterranean diet is that. And it's accessible, which is really important. Right. We can't be talking about weighing out protein. It's just not accessible for most people. It's not. And it's also not helpful. So like we have, the data is overwhelming on the Mediterranean diet and its benefits. I've written one of the reviews that looks at this for pregnancy outcomes.

18:07So when something is so strong and it's so easy to Google a Mediterranean dietary pyramid. You almost, you're at your duty to share it with us, right? Exactly. Then it's important to reinforce the message. And what I've done to try and simplify it is to think about the new five a day. So like what are the five food groups that most of us are lacking that are key to the Mediterranean diet? And it's what we touched on. It's oily fish, whole grains, nuts and seeds, fruits and vegetables and legumes. So if you can get those five in your day every day, even if it's a handful of nuts and a spoonful of beans to start with, it doesn't have to be that the whole meal is revolving around these ingredients.

18:45But get those in every day. You'll be on your way to a more Mediterranean like pattern. so it's so thinking about how you can change your diet is really important lifestyle is also super important so i can't stress enough that you know i i work with couples trying to conceive and i'm always quite surprised by quite how many of them will say you know i'm eating really well i'm going to the gym i still smoke or i do drink like five times a week and i'm like okay you can't do that if you're trying to consume so it's like there are some and i'm quite strict on it it's not i'm not trying to be nice here i'm trying to help you to get to an end point and it massively decreases your chances so please don't do it um and i think it's it's one of those things which is often overlooked there's some brilliant um research that was done by hertility i don't know if you know their company but they did a big survey of the their population so they've tested over a million women and they give women an understanding of their fertility status and in their testing in their survey they found that like it was something near to 10 percent of women who were trying to conceive were taking illegal drugs and and smoking and and so i think it's a lack of understanding so often we don't get much education around how to get because i think if people understood that yeah you know apart from the extremes whether it be an addiction or you know that's different that's not all we're talking about I think if people understood that I'd be like hey but I think it is really easy to think well you know I'm not pregnant yet so what impact is it going to have of course when I get pregnant then I will stop

20:27education is so focused on how to not get pregnant yes well that's the old adage isn't it you spend 30 however many years or 20 however many years desperate not to get pregnant and then the next five desperate to get pregnant. And so we don't equip young women with the knowledge of what things are going to actually impact their fertility and impact their child's health. So lifestyle is important, not drinking alcohol in excess or at all, if you can just not. To be honest, there's no benefit to drinking alcohol. Some people will then say, oh my gosh, but I drank alcohol when I got pregnant because it was a night out, it was New Year's Eve.

21:02It's interesting because Christmas and New Year's Eve is actually a period where there's a lot of pregnancies. Yeah, because September's the biggest birth month. It is. Yeah. So it's okay. Like if you had a drink, it's more about, again, it's more about what are you doing consistently? Yeah. Like what are the things that are your, what are your daily foods? I say that there's everyday foods and there's sometimes foods. I'm not that interested in your sometimes foods. I'm interested in what your everyday foods are. Yeah. And that's why I focus on the five. And that's why I say like, if you're having a cocktail at a dinner or if you had a glass of wine, that's okay.

21:33But if you're drinking two to three glasses a night every day or four times a week that's more of a regular occurrence in your diet and that will have a negative impact not smoking and then actually keeping active is really important so making sure that you have good and it sounds really old school but good circulation is very helpful well it makes for reproduction because the whole thing is blood growing a placenta that grows a new organ right at the start exactly so you know there's some really interesting small studies that have been done that look at how simply drinking a combination of like watermelon beetroot and ginger juice which has a lot of nutrients like nitrates that help the blood vessels yeah can actually increase the chances of implantation i know that's because my husband is a triathlete and he always takes these beetroot shots there you go i'm like what are you doing so i know that's why because it helps the blood flow oxygenates the blood better right it So it helps vasodilation.

22:33So like you get your blood vessels work better, essentially. And so it's the same in like if you're trying to conceive, all these factors help. You want to make sure you have really good blood flow to the womb. If you're, you know, the man, you want to make sure that you have really good blood flow to your genitals. So another thing that's when you think interesting is like if your husband or your boyfriend or your partner is love cycling and cycles like 50 miles a day, just before conception you kind of need to knock that on the head because you're literally cutting off circulation to that area for for quite a long time so it can decrease spam count same with things like really hot environments anything that disrupts the delicate blood flow can actually have an impact on fertility those are those are the nice ones the nice like the tweaks but you know the diet the lifestyle the smoking the alcohol are major ones and so so many partners won't want to hear that do you hear that with the couples that you're working with it's like well hang on I want to go and have a few pints with my friends I might be like grossly generalizing what no for me it's actually I normally have the female but so the woman will come to me and I'll be like cool where's your partner and they're like oh does he need to be here I'm like yeah he does so often it's like isn't that interesting the entire onus of making this work of figuring it out it's often put on the woman yes and then she'll be like oh but i can just let him know i'm like no no he needs to have a consultation i need to understand you can do it together but he needs to be here and answer my questions because he needs to hear it from me that if he doesn't do this your chances of conception and bear in mind i mean women couples who come to see me have often had failed ivf rounds like they've already spent so much time and money and i'm like let's just make this really efficient just how brutal it is the emotional toil right So I'm like, let's make this efficient.

24:24You both need to be here. Because if I'm optimizing you. That's not a metaphor for modern motherhood. I don't know what is. She shows up on her own carrying her load. Happens quite a lot. And then it's often that, you know, the men are then like, oh, my God, thank you so much. I feel better. Like they're then really proud of like how great their sperm is. I mean, that is a motivator for like, look at my sperm. It's great. but but truly when you when you explain that it takes two to tangle at this phase that the it's so important for both to be optimizing as much as is possible for you yep that it's it makes a big difference and i think you know it's not about taking away all all joy so say for instance if uh if someone's like oh my gosh my social life is really going to suffer if i can't go to the pub with my friends once a week we don't want that either because stress and like you don't want someone's mental health to suffer so it's just about finding strategies that can fit into the priorities they have and then if it's something that needs more help than that so if it needs an intervention because there's clearly a problem like you know then that's a different conversation altogether okay let's move on to we've got pregnant we've had a positive test the thing that i really want to talk to you about because i just think it's just so difficult emotionally is is when you when you're sick I mean why it's called morning sickness let's just bin that bad name just sickness just sickness yeah um and you know craving plain foods I craved beans on toast that's quite good which is you know to me the lunch of champions we've created cheese on top but I had that every single day for about six months like that's not bad is it that's I don't know I felt like this is not it's not your five right I'm not ticking off many so can you talk to us about firstly what are what causes that sickness do we know yeah why do cravings come from yeah and how can we work around those two difficult things to get the nutrition we need as we're building the percenter yeah and then the baby yeah so i think what you've just said is so important i think i just want to frame this really carefully the first trimester is important i've seen some dubious claims online being like oh don't worry about it first trimester doesn't matter because the percent the baby's blood supply is not connected no first trimester is when all of the organ systems are built so it is important right having said that we talked about your preconception nutritional status so like ideally your diet before falling pregnant was pretty good so you have some good reservoirs what we have to realize is that in the first trimester the our biology is really smart so it's all about adequacy if you've got enough of something your body will make sure to use it to make the healthiest baby it will take it from you right which is why we get free dental care yes because it's going to take the calcium from you yeah yeah so so i want women to feel like you know you hear from women who have like hyperemesis, like really severe morning sickness, they still go on to have beautiful, healthy babies, right?

27:27So it's not even if you cannot keep anything down, there are ways and strategies obviously get help if that is you. But there are ways of strategies through supplementation through like timed eating that can help to make sure that baby gets what it needs. It needs to be adequate. You can't most women, some women can, but it's hard to get like the really lovely perfect Mediterranean diet in the first trimester. Yeah, there's no way I could have done that. And also the exhaustion. Oh, yeah. You know, most women are still working. I remember I was on the northern line, still commuting into the city.

28:01It was hell. Nobody knew. Nobody knew. Feeling sick. I would get home and just need to lie down. There's no way. I used to have to jump off the tube because I'd get really nauseous. And I'd just have to breathe and get back on the next one and then do a couple of stops. What we go through, honestly. So I think it's important. So why do we get the morning sickness? It's a reaction to the HCG. So like one of the hormones that's involved in like making sure the pregnancy sort of stays and sticks can cause nausea. It's not actually for everybody. So varying levels of HCG impact women differently. So we could have the same level of HCG, but it might make you feel really terrible and we feel just a little bit picky.

28:39Can you bust a myth for me? Yeah. So I heard, I can't remember where, that morning sickness could be because your body is craving sort of plain, simple foods so as not to put the baby at risk. No. I've heard this. I don't think that's the one. No, I don't think that's right. I think it's just so we have obviously dozens of hormones, right? But we all react differently to the hormones we have. and so in the same way that some women will have really quite bad pms or will suffer quite badly with for example someone will have like terrible breast tenderness in pregnancy where it's almost unbearable um some women will get have you ever seen pregnancy nose yeah yeah with the so difference i have actually different women will we all react differently to our hormones and you can see that throughout your menstrual phases so your menstrual menstrual women experience menstrual struggles very differently and we experience pregnancy very differently depending on how we respond to our hormones how many receptors we express where like and how how efficient we are at clearing hormones i think that is i just want to underscore that because i think that's such an important thing to say because i think so many women get gaslit by not only other women well i never had that is that a thing or really you're experiencing that and i suspect by the medical profession i think it's just so important to know that what you are going through you are going through and yes it might be it might be unique to you and it might be different to everyone and you see this throughout the life course and this is like why i'm so hot on personalization is because you know it's the same with menopause you see women who have such such severe symptoms and then you see others who are like i actually didn't notice yeah and you're like great both valid they're both valid experiences so it just depends on who you are and how you respond to the changes so the first trimester can be very different for it for each woman and very different between pregnancies yes so and then people try and guess the gender based on that experience don't they they're like well well you're carrying low you're carrying high your skin's clear your skin's not clear it's like what are we doing here again that there's not much science so there's actually some studies looking at whether there are ways of telling gender differences with symptoms or cravings there's no real clear science there but it's important to just remember that in the first trimester we have ideally this nutritional status from before supplementing is a good idea and our supplements can sometimes be really hard to stomach so again finding a way that you can get take the supplements you need and do that in a way that doesn't trigger the nausea so i often recommend like actually on an empty stomach they can be much worse so i've worked with women who will wake up first thing in the morning have a glass of water and take their supplements into an empty stomach more likely to cause nausea than if you have them just after your breakfast or even if your breakfast at the moment can only be a smoothie because you don't want to chew anything but it actually helps with the absorption of the nutrients and with tolerating the supplements so there's like things we can do bland food is not a problem bland food can be absolutely nutritious what's important to remember is just to try and incorporate some diversity so now baked beans is interesting on toast because there's no diversity let me tell you but beans are a powerhouse in terms of nutrition yes they pack in sugar though although i was trying to have the sugar-free ones which is great but like you know they have they pack like plant protein fiber b vitamins including folate they have some iron like you it's great you've got quite a lot of it's interesting i was i mean i was craving them like i cannot is there any truth in that that you crave what your body needs no you do so i think there is certainly interestingly more from microbiome science than from really then well then okay so let's separate it there's some types of cravings specifically for non-food items which are really a red flag okay like coal ice coal uh coal ice uh there's another one soil so those kinds of cravings where it's not food items tend to actually signal a deficiency or an insufficiency so like get yourself off to a doctor and have a nutrient panel often iron or calcium so like just make sure because they're both essential nutrients in pregnancy and so women who start displaying these really random cravings for non-food items definitely get it checked out um food cravings there's sort of i i think in terms of ancient wisdom it makes sense that your food your body's like i really crave that okay there There must be something in that that I want to have.

33:14I think that applies well to foods. I don't think you can apply the same logic to like a tub of Pringles. So the problem is that we now live in a food environment that's also filled with just foods that don't actually serve a nutritional purpose, but that are designed to be hyperpalatable. Yes. I mean, it is true. Once you pop, you cannot stop. They have this wagon for a reason. You literally can't stop. So we have to differentiate like, is it just because I know that they're delicious and I want to eat them? Or is there something? So it's a different craving. I think we need to frame that slightly.

33:47Yes. Be mindful of that. And then the craving for foods. So there's some, for example, women who will be, who will have maybe observed a vegan diet for some time. And then they'll get pregnant and they'll say, I can't, I really want to eat meat. I experienced that. and so in those cases i think it could it could signal that there's maybe b12 or iron that your body's just really craving that at that time so what's worth doing is like listening to those don't put too much pressure like also some of them don't really get cravings and so there's also a weird pressure to like expect to have them and so then they just underscores what you're saying earlier that we we all experience this completely differently depending on our individual kind of And it might be that you just, as opposed to cravings, it's flavor combinations that you find more tolerable.

34:35So I'll give you an example. When I was pregnant with my second daughter, I found salt and vinegar, a combination that I could tolerate. I mean, my nausea was like made my nausea better. So I couldn't chomp Walker's salt and vinegar. Well, not given your job. I also didn't want that. So I found ways of like, I found like salt and vinegar chickpeas. I was going to say, what are you doing? chickpeas with salt and ving and like in or on your lentils or something yeah no i did i used that combination across different foods to like help me get more more nutritious foods in so there's also like uh sometimes it's the flavor profile that can really help but you it's definitely the first trimester and pregnancy in general tends to be a time when women are so in touch with their bodies more than they have been before you suddenly notice all these feelings so true all this i i don't like one of the things i always notice in pregnancy is like i get this feeling of like i can feel the blood flowing to my womb and it sounds weird you can hear it i've had that experience and so you have this sudden connection with your body and so i i also think that the cravings and the preferences for foods are also tied to that but the microbiome is interesting so professor john crean at the university of cork has done some research to show that if you have a gut microbiome composition that prefers a certain food so maybe your gut microbes and you have a lot of bean lovers they can actually send signals through the vagus nerve to the brain to to search for more of the food that will keep them alive so you basically your food preferences can be guided by your gut microbiome composition not not entirely we're not completely controlled by them yet but it does have an influence so there's also a gut microbiome plays a really important role in pregnancy and so there's some evidence to show that actually that there's a connection there of is trying to guide you to foods that will help to foster like a gut microbiome population that that is trying to thrive god that's so interesting i want to move on to talk about postpartum okay because there's lots to cover there and i want to make sure that we yeah we have so whistle slots through pregnancy yeah uh first trimester can be tricky but just try and get nutrition in i think timing is important so in the first trimester often there's a time period where women feel a bit less sick usually around 11 a.m in my experience with clinic in clinic um and and also don't be afraid of um smoothies and so cold foods tend to create less aversion because they have less smell as well so if you're having really nutritious smoothies or like cold soups even crack on it's a nice way to try and incorporate uh more foods and then second and third trimester but also first trimester is important so like you know there's a lot going on at a time so do try to um look after yourself second and third trimester is more about growth brain growth and actually the baby putting on weight so that that's when we think about the omega-3 specifically DHA for the brain formation so oily fish or a pregnancy safe supplement is really important here as is iodine which our salt in the UK is not um fortified with you can buy it you can find it but just be mindful that unlike other countries where there it is fortified ours isn't so look out for iodine um and and then in the third trimester it's like there's a slightly increased need for more energy so more food it's not massive you don't have to eat for two and all that stuff it's just your baby needs to put on some weight and build some muscle so making sure that you're having a lot of whole foods introduce maybe a snack in the day if you're not already doing that and focus on really healthy proteins from things like edamame tofu uh quinoa lentils beans some lean meats like meat is fine oily fish is the most important animal protein and then fermented dairy like yogurt kefir really good and cheese um so fair to myself you give birth birth just like that is really it's so there's loads of like cool studies that have looked at birth and it's the equivalent of like 10 marathons or yeah it's insane like it's anyone who's done it it is incredibly hard work i think that's what it's just so it seems it just seems so interesting to me that we go into the most depleting period of our lives completely depleted from sometimes a 30 40 hour marathon labor it seems so unfair that we must have got it wrong somewhere along the way as in when you look at other cultures this the new mothers are so cared for and i'm like that makes sense right because you have gone through the equivalent of 10 marathons and don't forget that in pregnancy mothers do become nutrient deplete because actually as you said earlier our bodies will take from us to make sure the baby's growing so most women get to sort of postpartum they're already lacking nutrition nutrients from the pregnancy yeah plus the marathon yes so it's now you're gonna sleep for a year very intense physiological process birth is mad when you look at it it's crazy and that it's like not it doesn't matter whether you have a vaginal delivery or cesarean delivery they're both really hard physiologically for different reasons but very hard so postpartum which is again is often called the fourth trimester and we call it that also because really human babies come out a bit before they need they should so they're very defenseless and even things like temperature regulation are not quite honed yet so there's this real benefit to essentially not separating mother and baby and just that's why in a lot of cultures um and also in trying to improve survival in neonatal intensive care units skin to skin contact and kangaroo care are critical yep just keep them on and that was my biggest learning on my second daughter i bought one of those tops that you just put the baby in have you seen those yeah and you tie them up she lived in there yeah she was happy and then i could run around off yeah it's good because then you got hands free right so it's so crucial crucial for us to understand that actually postpartum especially for breastfeeding that's when our nutrient requirements actually go up way more than in pregnancy by the way so breastfeeding is incredibly physiologically intense you are creating a lot of breast what is it like thousands of calories a day or something it's about an extra between an extra 600 to 800 calories a day but and calories is a bit of a weird yes but but it's sort of like it's an extra meal a day right uh meal not snack and i remember at that time you know i was i was trying to breastfeed and it was so difficult and i was you know guy my husband he'd gone back to work yeah i was snatching pieces of toast there was no proper meals until he came home and then And he did make sense.

41:24And I had this very exactly the same experience. And I actually ended up back in hospital. Did you? Because I basically got dehydrated. But I just, first time around, I was just like so preoccupied with keeping her alive and just making sure she was okay. That I wasn't resting. I wasn't really drinking enough. Because also water, you need a lot more fluids because you're literally... And also it's so easy to turn to coffee because you're so tired. And that dehydrates you more. And it doesn't really... So coffee doesn't necessarily dehydrate you actually. but it's it does if you drink enough of it it increases your urine output so it can have that but it's just i also just wasn't eating enough at all like but i wasn't hungry because i was so tired so you do have to have some level of planning and go into it knowing like okay what i'm going to do is make sure that i have easy to grab snacks ready to go like have things in the freezer but i said you've got to do that before yeah like you're not you're not prepping healthy snacks with a newborn no no so this is this is all ready to go before you give birth yeah right some people have these parties have you seen this it's a really good idea i love it idea don't have a baby shower or do but everyone comes and batch cooks for you i wish i'd have done what a great i mean actually things have moved forward so my eldest is eight now things have progressed so much even in just like how much more of those ideas are mainstream yeah talking about i'm so pleased because i was one of the first to have a baby in my friendship group so i was also like just navigating i was like what is happening and and even though i was already publishing i was a researcher in this space but the practicalities but i think that gives people a lot of a lot of self-compassion because it's like well you're you live in this world and you still like that gives me a lot of compassion for myself yes when i was just because the social construct issue it's not like an education issue yeah you need that support network you need that help from someone who's been there to be like oh by the way this really helps so like whenever i speak to a patient or someone just asked me i say okay here are my top tips like prepare get help if you can just and have things in place so that at least the first few weeks your only preoccupation is getting used to having a newborn and just spending time with them and making sure that you're eating you're drinking and you're resting i'm trying to get over the 10 marathons and then we're recovering it's not just the physical you know we also know the stats on birth trauma which is it just you know 40 percent reported i think it's much much higher so you've also got psychological huge challenges going on an adjustment adjusting to having you know it's so much going on yeah so i think having that awareness ahead of time it's not something that you just like you know you hear the stories oh yeah my mom you know she popped a baby out and then she just went back to about three days later not helpful narratives but i think we had a lot of that growing up where it's like oh you just give birth and it's fine so it was the 80s i mean it was for me i'm 42 so it was the 80s there's a lot of that right like a lot of like oh it's no big deal you just get on with it you just get on with it he's like just get on with it it's like guys this is actually a big deal it's not just and so i love your reference to other cultures where women are like basically kept in like pampered status for 70 days where they're like not allowed to do anything but rest and be fed nutritious foods oh my god and you know there's actually in the in london now they've opened this really expensive one it's so expensive but like the idea is good it's it's basically i don't know what we're talking about it's called the 10th i think yeah and it's um a postpartum hotel i mean great idea great idea but in other cultures it's everyone that's doing it at home so your aunties and your grandma and your mom all come around and they cook for you they feed you they give you like delicious nourishing drinks and then they look after you and like hold the baby if you need a shower you shouldn't have to pay like i mean the tent sounds lovely but you shouldn't have to pay that to have that support but the way that our society is structured now you don't have availability so if you can build that for yourself with friends or with family ahead of time and ask for that help i think also we have a culture where mothers don't ask for help they're like i'll just figure it out myself i'll do it and actually you often see you know mothers you know bleeding from birth stitched up yeah you know having people around to visit the baby saying can i make you some lunch i mean that is just all levels no wrong right we shouldn't be hosting no we should not be that's really common i don't even first babies i think it is and i always say to people now i'm like you know if someone asked to come over unless they're coming over to cook or clean for you it's a no like what are you coming here to do because you know what always happens if someone comes over to visit baby falls asleep and then now you have to be awake because someone's the and all you really want to do is have a nap so i think i think it's just having that it's also having that giving yourself permission to ask for help and to say actually if you want to come over that's great but what i really need is help with xyz can you help me with that if not i'd rather rest i'd rather be you know stay home so giving yourself that agency to speak for yourself is super important postpartum in terms of nutrition it's really focusing so every pregnancy every type of delivery has blood loss right now one of the reasons why iron deficiency or anemia in pregnancy is so dangerous is because if you don't have enough iron in pregnancy there will be blood loss in in at birth and that really puts the risk of maternal death up so it's really sad when you see the statistics on maternal death and how much it's linked to to basically blood loss and so going into making sure you're aware of your iron status ideally before you get pregnant and then And most doctors, like most antenatal care, will always keep an eye on your iron so to start pregnancy.

47:03And as soon as you've given birth, be aware that your body is really kind of working hard to make up that lost blood. So add that to the marathon and to the extra production of breast milk means that nutrient density of food is really important. So making sure that everything you're eating is helping you to replenish, recover and build. so this is why like what we were saying earlier about pre-making really nutritious snacks and meals that are ready to go can be really helpful for this because otherwise what happens is the easiest things to grab and go in our food environment are biscuits cakes pastries one hand a lot of those um a lot of i mean i'll never forget like uh when i was struggling i when i was struggling to make milk in with my first daughter and i'd lost a lot of weight from that week when i didn't eat one of my friends was like just have a pan of chocolate a day and i was like it doesn't counterintuitive but it was just funny how like that's what you end up resorting to often say well you just do that because yeah it'll help with like just but actually better to have access to really healthy nutritious nutritious foods that yes will help you to kind of get that energy but also offer iron offer folate offer again iodine you still need omega-3 fatty acids they are going to be transferred from your milk to your baby making sure that if it's winter time vitamin d which is important for sort of especially repairing after inflammation or if you already if you have ongoing inflammation vitamin d is going to be depleted especially as you don't go out as much especially yeah and especially if it's winter right yeah um so it's kind of all those things play a part so it's some it's like minor minority supplementation majority is like try to make sure you have whole foods ready to eat so i remember one of my good friends she made me these amazing frozen burritos so she's american and she just like she made these gorgeous with like loads of beans and vegetables and like this like she made the actual tortilla wraps herself with like oh yeah next level she's so kind she'd had yeah so she was like put these in the freezer and then you can just take them out microwave them one hand what you need that is the kind of that is what helps right so having that ready to go is important and then if you're if you have a partner who's there so you know partners have to go back to work so early now two weeks is ridiculous behavior so if you do have a partner that can help then help you know giving them advice on like here's the kinds of foods i mean rianne and lambert wrote a really good book on pregnancy nutrition and it's got loads of recipes in there so there are recipe books specific for this time of time of life as well but again Mediterranean diet nutrient dense foods and remember that you are recovering from a nutrient depletion and 10 marathons and blood loss and that will help you reframe how postpartum is supposed to be a healing time Yes, because you hear people say my house is a mess.

50:05It's just like, I get it that it's hard for particularly those of us, me included, who has been type A, right, on top of stuff, tidy house, dun, dun, dun, dun. Suddenly, to have to lie horizontal for a bit with a baby, you know, skin to skin and everything just go to chaos around us is, again, another thing to add into the massive shift. It's that you start to have that mental load, right? It starts then. Well, you're suddenly like... It starts before then, isn't it? It starts when your client comes in on her own and she's taken away. So like that mental... And it's like, I always say, so that's why I say like, forget spending money on like a super expensive crib.

50:50They're going to be sleeping on your chest most of the time. Pay a cleaner to come and clean your house. like if you have that freedom if you have that choice pay someone to come and do the stuff that you shouldn't really be worried about right now because at the end of the day like as i said especially the first the fourth trimester the baby really really wants to be with the mother and like the smell the temperature everything is perfectly attuned and if you're trying to breastfeed and establish breastfeeding that skin-to-skin contact is super helpful and the frequency of breastfeeding and allowing like basically responsive feeding, which is, by the way, a full-time job.

51:28It's eight hours a day on average. So if you know that you're going to be spending eight hours a day establishing breastfeeding and spending that time with your baby, you're going to have to outsource some of the stuff. So if you have the freedom, if you're lucky enough to have some financial freedom, forget the expensive, babies need like nothing until they're out five months, truly. Like maybe a pram and a carrier, but that's it. If you have that, you know, or if your friends say, what can I buy you? actually can you buy me a cleaner yeah come next week or pay for one week can you pay yeah because those are the things that reduce mental load and help you to actually at least try and enjoy the time it's hard work you're beaten up it's a massive psychological shift especially with the first baby it truly is like a a real shifting moment but at least if other things are being taken care of you give yourself a bit of mental space to be like actually okay i'm gonna try and And I do this in a way that I can...

52:24Just talking through it now. It's just bringing it all back. And I just think, isn't it wild that we just say to mothers, enjoy every moment. It's a magical time. And I remember thinking, this feels nothing. I was going to say, hell, that's a bit strong. I mean, not far off some days. I'm not enjoying every moment. I'm not enjoying five minutes of every... Like what? It's just such a... It's so gaslighting, isn't it? It is. And I think that's it. I think it's like less about enjoying every moment and more about give yourself the space to just, you have to be in that moment because you're going to go through it.

52:57So give yourself the grace and the space to do it in the least stressful way. It's way better advice. I think, so that's why I'm like, people say often, they'll ask me like, do you think I should pay for a night nurse? Do you think I should pay for a nanny? And I like, listen, if you've got that, great. But actually, I think it's more about the other stuff that we have, we carry. the cleaning the house the like preparing meals for the rest of your family those are actually the things and if you have other children yeah for the rest of the family exactly those are the things that actually then take away any kind of peace so if you can outsource that and then you know people always say to me nap in the baby naps and I used to be like how do you do that and with my second daughter I was like you know what I'm going to do it and god that was good I got an eye mask and even if I didn't sleep when she fell asleep I would just lie down with an eye mask on in the dark because the first time round I would spend every nap time tidying cooking putting the laundry on like whatever-ing and it's like I just why did I do that to myself it was such such a unhelpful way to be so with the second I was like I'm not doing that again I think that's right you get wiser don't you I want to make sure that we've got time we've got a couple minutes left to talk about you know talked about that postpartum yeah first a thousand days was the promise so we've got sort of 18 months ish to cover is there anything kind of key from the from the mother's perspective yes nutritionally yeah and broader that you that we have to touch on so just bear in mind that in terms of how long it takes your body to recover you know nine months in nine months out is quite a good guide so it takes you know nine months postpartum is when you'll start to feel like your body is returning slightly to baseline but if you're breastfeeding so recommendations to breastfeed to two years um if you're breastfeeding your hormones will still be affected by the breastfeeding the the more the less frequent the feeds the more your hormones sort of start returning back to normal for some women you may return full back to full ovulatory cycles um as early as sort of nine months or even before depending on how frequently the baby's feeling basically and how responsive you are to the hormones so to give yourself that nine months grace time i think it's really important to note here that for like there is a recommendation for spacing pregnancies for women's health for maternal health so often people think about oh i want my children to be friends and to be close and think about the child's benefit although actually we'll go on to that but it's it's there's some interesting psychological evidence on that.

55:34But for maternal health, to reduce the risk of complications of pregnancy and to reduce the risk of nutrient depletion, you want at least 18 months between the birth of your last baby and the conception of your next baby. So actually the recommended minimum gap is two and a half years, which is not like often women don't really know that. They're not told that. So you're putting yourself and women do it all the time and it's fine, but you are putting your body through quite a pace and quite a stress if they're quite close close together um not to mention like having two under two is not a holiday quite a lot of work so that's one thing and from the child's point of view actually the the longer the age gap the better it is for the psychological safety of the child so they can they basically get more of a sense of self before their sibling is born which is better for their long term yeah which is quite interesting is there an optimal gap so there were studies so it's so for maternal health you want to have a two and a half year gap between births um up to five years so when you then push to like past five years from your last pregnancy you start to increase risks from from the increase in maternal age as well but increases for things like um hypertension and pregnancy so high blood pressure and pregnancy and uh gestational diabetes so there's this like sweet spot between two and a half and five year age gap and for child's health it's like minimum psychological minimum three years they say is like optimal and then sort of the more gap that there's not an upper limit for gap uh as such so it's kind of it's i think it's i always do advise especially my patients who are doing fertility treatments So there is always an element of time.

57:16I do recommend to them, and their obstetricians do as well, like do try and give it at least 18 months after birth before you get pregnant again or do an embryo transfer because it's a massive toll on the body. So we have to remember that we don't bounce back and that there is this like minimum time window where we need to let our bodies repair, return to baseline, replenish. Like all these things need to happen. It takes time. um and also you know from uh we have to remember that a lot of us are having children later now so oftentimes you'll have your first child or your second child you might be in your late 30s and then you'll be soon hitting your 40s and so there's also the transition to perimenopause which affects your how your body changes again not fun with a toddler those two probably not fun with any you know any any age yeah but it's so it's important to say it's in the book i actually talk about this postnatal perimenopause because some of them they'll expect to go back to how they felt pre-children i'm like well we'll know because now you're entering a completely new phase of life so we won't return to so listen unless you're somebody who started having children very young so of course there are women who will have their first at 21 and great and they have By the time they're 31, they've got like four kids.