Transcriber: Rowan McClain
Reviewer: Ines Dif Hi, everybody. Who’s ready to talk science? (audience cheering) Awesome. Awesome. Okay, so I’m going to start
with a few questions. Who here has had a baby? Okay. Who maybe was a baby? (audience laughing) Okay, great. Who has heard the term, Mom Brain, Baby Brain,
Placenta Brain? Raise your hand if that
was a positive connotation. Interesting. Raise your hand if that was
a negative connotation. Wow. Okay. So, I’ll tell you a story. I’m a doctor.
You just heard. I went to medical school. I learned all about the
brain and the body. I memorized a ridiculous
amount of information. I decided I wanted to study obstetrics
and gynecology because I think women's health is amazing. The first delivery I was part
of as a medical student, I cried more than the baby. (audience laughing) So embarrassing. I matched for residency at a hospital in
Boston and headed up to start my career. As part of my training, I learned all
about postpartum mood disorders. I was taught that 50 to 85% of women
have the “baby blues” after delivery. This is sadness, tearfulness,
irritability, poor sleep. I mean, come on. It starts a few days after delivery
and can last for up to a few weeks. I was taught that it’s the result of a
steep drop in estrogen and progesterone that happens after delivery; one of the sharpest changes
in hormones in human life. All in all, a bad but
nearly inevitable thing. A smaller percentage of women will develop
postpartum depression, anxiety, or OCD. About 10 to 15% of women
develop postpartum depression, interestingly, pretty
consistently across the globe. Less than 1% will develop
postpartum psychosis. Now, I saw this in residency. The real deal. And it is very scary. It can end in suicide,
infanticide or homicide. But we’re taught these
things exist on a spectrum, That they’re just different
degrees of the same phenomenon, which sort of makes baby
blues psychosis light. You can imagine framed in that way, you might be reluctant to tell
your doctor what's going on. Armed with this information, I saw my postpartum patients
at their six week visit. I administered the Edinburgh
Depression Scale. I consoled them that the baby blues
is just a bad thing you get because of your hormones. And I moved on. Job done. And then I had my own children. That never changes things, does it? (audience laughing) My husband, Kevin and I decided
to start our family in residency. At my first ultrasound at nine weeks, the
tech turned the screen around and said, “what do you know about this pregnancy?” I sat straight up. Recognizing the coded language
for something here is unusual, and I don’t know how
much you know about it. What do you mean, “what do I know
about this pregnancy?” I know I had a positive test. That’s it. She turned the screen back around. “well, you’re positive...for two.” I looked at the dual heart rates of
the two tiny bean shaped embryos, and all of our plans went out the window. It hit me all at once. Our one room condo, our inability to
afford daycare for two infants in Boston, the twin mom I had just seen in the
ICU who needed a liver transplant, potentially needing to extend residency
or missing the application window for fellowship. The world grew gray around the
edges and I had to lay back down. Luckily, things went smoothly. I ended up getting induced at 36 weeks due to a growth disparity
between the twins. They were a monochorionic
diamniotic pregnancy. This means that they had two
amniotic sacs or bags of water, but shared one placenta. In this type of pregnancy, there is
concern about how long one placenta can support two babies, so
their growth is measured carefully. The boys had grown well, but towards the
end baby B fell off his curve a little, so we moved forward. The induction was long but
essentially uneventful. My husband and I took home two tiny,
skinny babies with enormous eyes and baggy skin around their knees
like French bulldogs. (audience laughing) With normal neonatal weight loss, we took on one baby in the 4lbs
range and one just over 5lbs. It was terrifying. My husband could hold one in each hand. But we adapted and I thought
the surprises were over. Shortly after, on a beautiful fall day, I was pushing a stroller down the
sidewalk of our neighborhood, admiring the fall foliage, and my vision landed on the cars
moving in the street beside us. My mood turned anxious and I had
a sudden specific vision of the car jumping the curb and hitting
the stroller in my tiny baby's. It was so horrifying and abrupt that
I had to stop what I was doing. My heart was racing,
my breathing sped up. What had just happened? I was surely in a better position than
most to understand what was going on, and I had never heard of
anything like this. So like most people, when the usual
sources of information are insufficient, I turn to the internet. (audience laughing) I learned fun names for these things intrusive images that moms
were calling, “daymares,” or the night time scaries. A great name for worsening
postpartum anxiety at night. I learned how incredibly common this is. One study found that close to 100% of new
moms have some form of harming intrusions. Here’s the thing. If something
happens to nearly 100% of a group, it’s pretty hard to call that a pathology. (audience laughing) It might be more accurately
described as, “the way things are.” (audience laughing) Over time, I began to think of these
as warnings from my lizard brain. Okay. So the brain as an organ has developed
different parts over eons of time. The brain stem, in the yellow
here, is an old part of the brain. It houses functions like
heart rate, respiration. Lower order animals like
lizards have these parts. The cerebral cortex in pink here, in particularly the prefrontal
cortex in humans, is a site of more complex actions
like executive function. This is a newer part of the brain. I imagine these visions as being from
a deep and old part of my brain, something that, instead of
trying to terrorize me, was actually trying to help me. It sounds crazy, but I began
to cope with them by saying an internal thank you to Lizard Mother,
as I dubbed her, (audience laughing) and saying that I would be careful
about that specific danger. It sounds strange, but it worked for me. Once lizard mom was an ally, a teammate, a voice of ancient mothers past
and not a terrifying intruder, I could heed her warnings in peace. But in my mind, questions
began to percolate. If something happens so frequently. Why is it only described negatively? Surely there must be some sort of
positive aspect to it or purpose. Medicine is very ingrained
in the biological locus. Its perspective is trained
towards pathology. And that makes sense.
Pathology is what we’re trying to fix, but less effort is spent on
health and normal states, particularly for women, although
that's starting to change. I wanted to know, who is lizard mom? Why has she been ignored? And what else could she teach me? And my search for answers
went back to my college days when I majored in anthropology
or the study of people. Doctor Wenda Trevathan wrote a great book
called “Ancient Bodies, Modern Lives.” In it, she describes the concept
of evolutionary medicine. This is a study of a species in the
context of its evolutionary history. Now to talk about human
evolutionary history. It's going to get real sciency
here for a second. We have to talk about primates. So primates are an order. Do you remember this from science class? Kingdom, Phylum, Class,
Order, Family, Genus, Species. This is the Linnaean taxonomy. Primates are an order that contains
monkeys, apes, humans, and prosimians, which are things like lemurs. Okay, we also have to talk
about ancient hominy, or more commonly, but less
accurately named hominids. Okay, so that’s modern people and our
ancient ancestors, australopithecines, Homo habilis, Homo erectus,
and Neanderthals. So primates have helpless babies. Ancient hominids had even
more helpless babies, and modern humans have
completely useless babies. (audience laughing) We don't often stop to think about it, but the degree of helplessness is pretty
profound compared to other animals. They can't even lift their head for weeks. Some scientists have theorized
that humans are born very early in our gestational development, and that if we were born at comparable
stages to other primates, human gestation or pregnancy
would last 18 to 21 months. (audience laughing) Being pregnant with a toddler. (audience laughing) Yeah. So people have suggested that the
more helpless human babies became, the more complex the human brain had to
become in order to help them survive. In fact, the helpless human infant is
thought to be behind human pair bonding, father provisioning, low reproductive
output, late reproductive onset, and even menopause, which is
almost unique to humans. Did you know that? Also killer whales for some reason. (audience laughing) In most species, reproductive
function ceases near death, but in humans we have something
called the grandmother effect, which is that if there's
a grandmother around, grandchildren are more likely to survive,
and there may be even more born. Now let's talk about a species of monkey
called the Japanese macaque. Harriet Smith describes them in a book
called, “Parenting for Primates.” There’s a group that lives in a park with
hot springs, and they love to dive in. What park staff noticed
was that primiparous, or monkeys who had their first baby, would often jump into the hot springs
with their infant on their back, and the babies would drown. Which is really sad, but that almost never happened
to the more experienced moms. Maternal experience led to
awareness of danger, which led to increased
survival of offspring. Nancy Nicholson studied
all of bamboo mothers, and what she found was that 43% 43% of infants of first time moms
died in the first six months of life. It’s almost half. This is compared to 6% of
more experienced mothers. You can find similar studies for rhesus,
howler and squirrel monkeys. Now it's hard to get definitive evidence
on evolutionary medicine. For obvious reasons. Ancient hominids
are no longer around. And they didn’t leave much
material culture for us to study. But I'd like you to picture, if you will,
a Homo erectus mother. She lived about a million years
ago in Africa or West Asia. She stood about five feet tall. She had a heavy brow ridge. She could make fire and art. Unclear
how much she could speak. Let's picture this mom
has just had a baby. She needs to accomplish a task in a river. She wades in, but because
she needs her hands, she goes to sit the baby on a
rock in the middle of the river. But as she does so, unlike the Japanese
macaque, she is a sudden, intrusive image of the baby being swept off
the rock down stream. She pauses, eyes widened, pupils dilated and goes to take the baby
to a safer place ashore. Whose children are going to survive,
more commonly to pass on genes. Those whose mothers had intrusive
images of danger, or those like the Japanese macaque
who had to learn from experience. What I can say for certain is that humans
have really complex brains, and that something really complex happens
to your brain when you have a baby. After practicing medicine for a few years, I can also tell you there's
a lot we still don't know. We don't understand exactly
why pre-eclampsia happens. We don't really know what an instinct is. And there is a vast black hole of
information around pregnancy, delivery and the postpartum period. Let’s talk about postpartum depression. No primate in the history of time
has ever parented as alone as the modern human woman. Primates, ancient hominids,
modern hunter gatherers, all parent very much in groups
with lots of social support built in. We don’t know why exactly
postpartum depression happens, but some scientists have theorized
it may serve as a rallying cry, a way to build support around a
mother baby dyad from the community. Others have suggested it may be a way
to decrease energy expenditure in a time when caloric needs are high. Regardless, I think it's time we reframe
the brain changes of motherhood. Is it possible that instead
of being pathologic? They may have been the very
key to human survival. In which case they should be celebrated. When you have a baby, you get superpowers. Here's another fun example. The reticular activating system
is a collection of neurons in the brainstem about the size of a pencil. It’s a very old part of the brain. One of the things it does
is direct your attention. It decides what is important
enough to rise to the level of your conscious attention. This is why some people can
live next to a train track, and eventually won’t hear
the train go by anymore. It’s because the reticular
activating system decides, oh, that’s not important. Let her sleep. The reticular activating system in moms
is acutely attuned from birth. to any sound their baby makes or the absence of sound. Have you ever woken up
because it was too quiet? In a room full of mothers and
sleeping babies, if you can imagine, eventually, a mom will wake
only to her own baby’s cry. There are likely many other
examples we can find when we look at these things from
a multidisciplinary perspective. So how can we change? Number one. What if we educated pregnant
moms all about the ways their bodies and brains will
change to protect their child? There is evidence that the context in
which harming intrusions occurs makes a difference to the level
of distress that they cause. So if you think you’re on the
way to postpartum psychosis, it’s pretty distressing. If you think of them as a gift from
lizard mom, it’s less upsetting. We can make this experience
ess distressing with education. Number two. If postpartum
depression is a call to the community, then let's find ways to bring
the community back in. This may mean we have to
radically change the way we think and our habits and structures around
delivery in the postpartum period. Number three, we need to demand and
fund more research on women’s health. (audience applauding) Call your legislator. Ask them to direct
the NIH to put more money that way. But lastly, and most
importantly, in my opinion, we need to change the way we
think and talk about these things. Thanks (presenter and audience laughing) Mom brain is not something bad. It may be the very reason you
and I are sitting here today. Lizard mom deserves some respect. Thanks. (audience cheering and applauding)
