[00:00:00] Dr Renee White: Knowledge is power, and we are all about empowering the mamas of the world. In each episode, we will unravel and interpret the latest research and evidence-based practices for pregnancy, postpartum, and motherhood. As mums and researchers ourselves, we have experienced firsthand the overwhelming complexity of information myths and those classic old wives tales.

[00:00:27] Dr Renee White: I'm Dr. Renee White, and this is the [00:00:30] Science of Motherhood. Hello and welcome to episode 177 of The Science of Motherhood. I am your host, Dr. Renee White, and this episode is proudly supported by Panda. Now, are you pregnant or have a new bub? Sometimes you might feel sad, worry too much, feel scared or shaky. Find it hard to sleep or stop being able to have a good laugh.

[00:00:57] Dr Renee White: Now, all of these can make it really [00:01:00] hard to care for a baby. Anytime you don't feel like yourself or you're finding it hard to get through the day, remember that there is absolutely someone you can talk to. Now, Panda has a free national helpline for all expecting and new parents, so that includes mums, dads, partners, and they offer counseling and support to get you all the resources and support [00:01:30] that you need.

[00:01:31] Dr Renee White: You can call them for any reason. Doesn't matter how big or small it is, and trust me there are a lot of people I speak to who think, oh, you know, that's not for me. I don't, I don't think I have postnatal depression or anxiety, and I just need to, I need to reiterate, as someone who has experienced postnatal anxiety, you don't need to be halfway off the cliff and you know, at the bottom of the [00:02:00] hole in order to reach out to organisations like this. It can just be that feeling and they absolutely would much rather you call, at the beginning of those feelings rather than, you know, six, 12 months down the track when things are feeling really, really dark.

[00:02:18] Dr Renee White: Because you know, maybe prevention is better than treatment here. So do not feel like you are a burden, okay? They're absolutely there for you. It's good for you [00:02:30] and for your bub when you feel strong and supported and heard, and remember the earlier you get help, the sooner you can be the parent you want to be.

[00:02:40] Dr Renee White: So you can call Panda for free on one three hundred seven two six three zero six. That's 1 307 2 6 3 0 6 from Monday to Friday, 9:00 AM till 7:30 PM or you can visit their website, Panda. [00:03:00] PAND a.org. Org au for online checklists, some information and stories from other parents. Okay, let's dive into today's episode.

[00:03:16] Dr Renee White: Hello and welcome. I'm your host, Dr. Renee White. I am a biochemist and founder of Fill Your Cup, Australia's first doula village and in today's episode, I wanted to explore with you how [00:03:30] doulas can bridge critical gaps in Australian maternal care. So let's dive in. We have to set the scene. Australia has a maternal care crisis that we really need to talk about.

[00:03:47] Dr Renee White: The statistics are quite alarming. One in three Australian women describe their birth as traumatic, and over 60,000 mothers annually experience perinatal depression or [00:04:00] anxiety. Only 10% receive adequate treatment. So this isn't just a health crisis, it's an economic one too. Looking at the figures, the mental health burden of inadequate maternal support costs Australia's economy over $870 million in the first year alone with lifetime costs exceeding $7 [00:04:30] billion per birth cohort. Now, if we look at that as an individual case of perinatal depression, it carries a lifetime cost of approximately $122,000 when we consider, you know, things like healthcare utilisation, productivity loss, and quality of life impacts.

[00:04:52] Dr Renee White: So what is going on here and why are we continuing to fail mothers so dramatically? [00:05:00] To understand this, we need to look at the biochemistry of birth itself, and as a biochemist, it would be remiss of me not to talk about this. So let's just set the foundations here, birth is fundamentally a hormonal process. We have things like oxytocin, which drives contractions and facilitates bonding and research demonstrates how oxytocin requires women to feel [00:05:30] safe during birth and in return, provides natural pain relief and labor efficiency. Now, this is very important because this hormone activates the brain's pleasure and reward centers creating that natural euphoria when meeting our babies. In contrast, when a woman feels threatened or unsupported, we have hormones like adrenaline and [00:06:00] cortisol. These are our stress hormones, and they override this process. It subsequently slows down contractions. Reduces the oxytocin flow and creates this negative feedback loop that can actually stall labor and lead to unnecessary interventions.

[00:06:20] Dr Renee White: Now, the physiological impact of birth experiences extends far beyond the delivery room, and we know from the [00:06:30] research that it shows that women who experience birth trauma can have disruptions in hormonal systems that affect bonding, breastfeeding success and their postpartum recovery and the stress response systems activated during difficult births create biological pathways that increase vulnerability to postpartum depression and anxiety. And this is why birth matters [00:07:00] deeply for long-term maternal infant health. So, what is the solution Australia has recognised time and time again? Midwifery continuity of care is the gold standard in maternity services, and for good reason. This model reduces preterm birth by 24% and decreases fetal loss and neonatal death by [00:07:30] 16%.

[00:07:31] Dr Renee White: But here is the problem. Only about 14% of Australian women can access full midwifery continuity models. And when we look at the reality of maternal care access in Australia, the most dominant model covering around 40% of all maternity care is standard public maternity care that is [00:08:00] fragmented in nature with women seeing different providers at each visit, and only 14% of care models offer true midwifery continuity through things like group practices or caseload care. While we have private midwife practices representing only about 2% of models here in Australia and this is where doulas become essential as the missing [00:08:30] piece in our maternal care puzzle. Now, research shows that doula support significantly reduces cesarean rates by 39%, decreases negative birth experiences by 34%, and reduces requests for pain medication by 10%.

[00:08:48] Dr Renee White: Even the ability to shorten labor by around 41 minutes. Now, this is not theoretical at all in terms of the impact that [00:09:00] doulas can make, and we have practical evidence of this impact. Now a recent 2025 audit in May of the New York City, citywide doula Initiative showed significantly improved outcomes for black and Hispanic mothers who typically experienced the highest rates of maternal mortality. Now, participants had lower rates of cesarean sections, preterm birth, and low [00:09:30] birth weights compared to citywide averages and most amazing result was no pregnancy associated deaths were reported among participants in stark contrast to the alarming statistics that are currently happening in and around those areas.

[00:09:48] Dr Renee White: So you ask what makes doula support so effective? Now, the research consistently identifies four essential factors mothers need [00:10:00] to thrive. The first is evidence-based information enabling informed decision making. Second is psychological support, which creates that emotional safety. Number three is normalised share experience, so women understand that they are not failing. And the fourth is practical assistance with recovery and newborn care. And while our fragmented healthcare system struggles to [00:10:30] provide all four consistently. The doula model naturally incorporates each of these elements. Now, let's consider the continuity gap in standard care. The 86% of Australian women who cannot access midwifery continuity typically receive only about six to 10 brief prenatal visits lasting about 10 to 15 minutes each with different [00:11:00] providers. Labor is often attended by staff, unknown to mum, and then after birth, most women receive only one to two brief midwife visits before entering what I like to call the six week void or gap. And this gap is between hospital discharge and then medical follow up, or that six week checkup as we like to call it.

[00:11:26] Dr Renee White: And this is precisely when [00:11:30] hormonal fluctuations are most significant and when psychiatric symptoms commonly emerge for mothers. Now, I would argue that the Doula Village model reimagines continuous care by combining birth advocacy with extensive postpartum support. Now, our approach utilised a team of specialised doulas who provide seamless support from pregnancy [00:12:00] through to the fourth trimester, and birth doulas provide this beautiful evidence-based, physical and emotional support during labor, while postpartum doulas deliver in-home care for at least three hours per week now, this creates the consistency that optimises the neurohormonal environment for both mother and baby. So what can birth workers [00:12:30] do today? Well, we create this psychological safety through specific communication techniques.

[00:12:37] Dr Renee White: We know from the research that simply having a known, trusted support person present reduces cortisol levels by up to 25% during labor. You can use environmental modifications like dimmed lighting and reduce noise to optimise hormonal flow. And when doulas advocate for clients, they frame [00:13:00] requests in ways that highlight mutual goals rather than creating this adversarial dynamics with medical staff. So the future of Australian maternal care requires a dual approach. I believe that we need to expand midwifery continuity, belo beyond the current 14% where possible, while simultaneously integrating doulas into standard care pathways for the remaining [00:13:30] 86% of Australian women, and by expanding access to continuous care models through doulas, we can significantly reduce Australia's economic and human cost of birth trauma.

[00:13:44] Dr Renee White: And that's exactly what we're trying to do here at Fill Your Cup. We are creating change through our doula network model. We have built Australia's first coordinated network of 18 professionally trained doulas working across seven [00:14:00] major cities. We're providing evidence-based support that improves outcomes, and by next year we expand or plan to expand by 20 to 30%. So, I would really invite you to join us on this mission. Whether you are a birth worker or a healthcare provider or a parent to be, we can transform the maternal care system here in Australia by recognising that doulas are not [00:14:30] a luxury, they're the missing piece in our continuity of care puzzle. I'm gonna leave you with those thoughts.

[00:14:37] Dr Renee White: Thanks again for listening to the Science of Motherhood. I'm Dr. Renee White, and until next time, remember that every mother deserves to have her cup filled. If you loved this episode, please hit the subscribe button and leave a review. If you know someone out there who would also love to listen to this episode, please hit the share button so they [00:15:00] can benefit from it as well.

[00:15:01] Dr Renee White: You've just listened to another episode of The Science of Motherhood proudly presented by Fill Your Cup, Australia's first doula village. Head to our website I fill your cup.com to learn more about our birth and postpartum doula offerings where every mother we pledge to be the steady hand that guides you back to yourself. Ensuring you feel nurtured, informed, and empowered so you can fully embrace the joy of motherhood with [00:15:30] confidence. Until next time, bye.