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How the brain changes of motherhood help human survival | Dr. Lara Harvey | TEDxNashvilleWomen
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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)
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