Microbiome Medics

MicroBirth: Toni Harman on Birthing Choices and the Infant Microbiome

• Season 1 • Episode 22

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In this episode of Microbiome Medics, we sit down with Toni Harman, the filmmaker behind the award-winning documentary Microbirth and co-author of The Microbiome Effect. Toni shares how her personal childbirth experience, including an emergency cesarean and challenges with breastfeeding, sparked her mission to explore the critical role of the infant microbiome. We discuss the insights from Microbirth, which features leading scientists on how birthing methods and infant nutrition shape a child’s microbiome and immune system. Toni also highlights her vision for empowering expectant parents through an antenatal class focused on microbiome science, advocating for informed, compassionate birthing practices to support long-term health.

This podcast is brought to you in collaboration with the British Society of Lifestyle Medicine.

Disclaimer:
The content in this podcast is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your doctor or qualified healthcare provider. Never disregard professional medical advice or delay in seeking it because of something you have heard on this podcast.

Sheena:

Hello and welcome to another Microbiomedics podcast. Today I'm going to be interviewing a really interesting filmmaker called Toni Harman. She's a producer of an award-winning documentary called Microbirth and she's really interested in the origins of the human microbiome. Microbirth has won a top prize at several science film festivals and it's had over a thousand public screenings and been broadcast internationally. She's also the co-author of books The Microbiome effect and your baby's microbiome so but i'm not gonna say much more i'm gonna let tony give you her history and where she's come from and where she's going to with all of this um so tony hi uh.

Guest:

Hello and thank you for so much for having me as a guest and um i think what you're doing is fantastic and i love sharing the uh my knowledge of the microbiome um with uh as many people as possible because once you get it, it kind of unleashes this powerful wave of knowledge that kind of changes how you see everything in the world.

Sheena:

It does, doesn't it? It's really interesting. And I love just being with fellow microbiome nerds on this podcast because I could just chat to people like you, Tony, for hours. So I think let's give the listeners a little bit of your history um let's go back in time and tell me when you first got an interest in microbiomes and why.

Guest:

Okay so there's a um we'd uh it started as many people uh is interested in microbiome so um uh i i was a filmmaker and we just finished our um our first uh feature film a thriller and we just got a um uh got a deal with a hollywood studio and we thought we're on our way to hollywood and then when i say we it's myself and my partner alex and uh so uh and then i discovered i was pregnant which was fantastic and wonderful and brilliant but kind of take us took us on a different journey and uh as a filmmaker um one of the things that you you do is to really really prepare yourself you prepare yourself for every eventuality and that's the approach i took to uh this pregnancy I read every book, saw every film, every video, and I took two different antenatal classes and a separate breastfeeding class to fully prepare myself for the birth. And I wrote a really simple birth plan. I wanted to, if possible, to have a home birth supported by a midwife and to exclusively breastfeed. So it wasn't really complex. I just wanted to have a vaginal birth and breastfeed and as sometimes happens as often happens I ended up with emergency c-section. And then within about an hour of my baby being born, she was presented to me wrapped up tightly in a towel, a white fluffy towel. So I couldn't actually get to her. And then so there was no support for skin to skin, no support for breastfeeding. And then within an hour of my baby being born, someone came into the room. I don't know who it was. They didn't introduce themselves and said, your baby needs to feed. Here's a cup of infant formula and uh so even though i wanted to exclusively breastfeed there was no support so i ended up um mixed feeding so uh breastfeeding but then topping up in the formula and it just i never my milk supply never really got established and it just i just had problems breastfeeding from that point on and it's a very very common story um but that whole experience from kind of preparing for a vaginal birth and ending up having an emergency c-section and then not having support support for breastfeeding it kind of it kind of triggered something in my brain and I kind of started thinking kind of what um what happened there then and what the what are the consequences and what does it actually matter how a baby's born and how a baby's fed um so we started myself myself my partner alex we started thinking about and uh thinking about childbirth and thinking about documentary that we thought there must must be a documentary in here somewhere about childbirth so then we made um a couple of documentaries about uh childbirth about doulas and about kind of um uh human rights in childbirth and we ended up with the film about human rights and childbirth. Which is a fantastic story about a midwife in Hungary who was prosecuted for supporting home births in Hungary and someone she supported to have a home birth, was denied the right to have a home birth. So she took her country to the European Court of Human Rights and won this kind of big, big appeal. Anyway, the screenings, with that, we set up screenings around the world. So we had over a thousand screenings, all happening on the same day of this film, Freedom for Birth. And it was great. We had newspaper headlines. We gave everybody holding a screening. So community screenings held by midwives, doulas, childbirth educators. We gave everybody a screening pack and told them how to contact their local media. And so it ended up we made worldwide headlines all in one day, all across the world. We had people marching in the streets of Buenos Aires. We had this fantastic reaction to this film. And I couldn't actually see that there being another side to it I thought every person every woman every expectant parent has the right to decide how and where and with whom she gives birth that's a fundamental human right and it turns out and I couldn't see the other side to the story, turns out other people did see that there was another side of the story and we just got this like a torrent of um abuse saying why are you telling uh women to uh choose how and how and where to give birth anyway so because it kind of kicked up this storm it's like uh okay what's the science behind childbirth then if if this is the kind of politics what's the science and uh about that time we started hearing about epigenetics actually so we did a started exploring just doing some sort of preparation interviews with scientists about epigenetics and the first couple of scientists we interviewed, they said the most important thing, most exciting thing about epigenetics is we just don't know. Um so uh so to scientists we don't we just don't know it's brilliant because that's opportunities for research but uh for us as filmmakers you can't make a film and we just don't know doesn't really make a great film so then uh a scientist actually emailed me and said one of scientists we'd interviewed about epigenetics said there's some really interesting research about uh the microbiome you should look into it anyway so we started looking into the research in the microbiome and we filmed um so martin blazer from um who was the director of at the time the director of the human microbiome project um and uh he was he told us all about his missing microbes theory and then. We came across a paper in an obscure physics journal by a professor called rodney did it and he had a theory about completed self that um babies born by c-section who are formula fed or receive antibiotics their um their immune system and and so those babies have a an issue with with their immune system and it because their microbiome doesn't complete so um and it just sort of sparked something in our mind so it's like there is a film in this it feels like there's there's evidence for what could be a really important subject so um and that's how we got made microbirth and uh lots has happened since and so it's yeah it's kind of this is kind of by accident we're on a path to epigenetics yeah and then realize that's actually that much more evidence and when we made microbirth that was 10 years ago and there's you know so there was, a bit of evidence then now there's bucket loads you know there's thousands of papers all.

Sheena:

About the kind.

Guest:

Of infant microbiome the consequences of cesarean section or formula feeding or antibiotics the three main perturbations to the infant microbiome.

Sheena:

Yeah amazing so so that's really interesting because your initial um drive for this was was feeling like your experience um as a patient had all of your choices taken away from you um and and it wasn't so much that you were absolutely certain at that time that the vaginal birth and the and the the mode of um feeding was going to make a dramatic difference to your child's um health but you instinctively felt that that was the right way to have your birth and introduce your child into the world. And I think a lot of women instinctively feel that way. But it is increasingly hard for your birth to go as you want it to. So see that original documentary that you made with the doulas and the birth attendants. And what were your main messages around that? Because, I mean, this is a subject where a lot of people get very anxious about talking about the mode of deliveries and things because some people feel that we shouldn't be talking about everybody having vaginal deliveries and breastfeeding because that makes people who have C-sections or, you know, or formula feeding feel terrible that they weren't able to have that. And, you know, so what was your, how did you frame that in your original documentary?

Guest:

I think, so up until the time I had my own baby, I'd never actually been to a birth before, never been present at a birth. And it was at the, we actually made a film before that, after we gave birth, we made a film with the other parents in our antenatal group, just about our own experiences of childbirth. And everybody had a different kind of route to childbirth. um and their every you know some had c-sections some had um vaginal birth some formula fed some um breastfed so um and it was the premiere of that of that film um that a doula came up to me and said uh you should make a film about doulas and what they do so um and it was only when i went to film births supported by doulas that I saw the the kind of unmedicalized version of childbirth and um so the so it was a beautiful I filmed a whole series of beautiful calm fantastic home births actually I also filmed some cesareans some sort of empowered cesareans and um And it just really struck me that a birth that is supported by a midwife and a doula, provided it's a low-risk birth, it's not a high risk. I should be clear that obstetricians and clinicians do a brilliant, brilliant job. And thank goodness we have cesareans and thank goodness we have antibiotics and thank goodness we have formula feeding because sometimes all three are needed and brilliant that we have them however there is a another side to physiological birth where a woman just gives birth and you know is supported to have skin to skin and is supported to have breastfeeding which is so beautiful and powerful and it's just it's kind of how we have evolved to give birth so in terms of the messaging i think it's it's like this is not, You know, it's not suitable for everybody because not everybody has a low risk pregnancy. And it's just this vision that this could be possible. Sometimes it's not possible. And sometimes, you know, cesareans can be fantastic and empowering, particularly if you say with a cesarean, you have the baby delivered straight onto the mother's chest inside the operating theatre. So you have skin to see inside the operating theatre within seconds of the baby being born. And so those gentle caesarean techniques of having the cannula put in the non-dominant arm, the drape lowered at the moment of the baby being born. Um the you know so the general chatter of the of the um the operating theater reduces so that the the mum hears the baby and the baby hears the mum's voice for the first time all of those things could be possible so i'm not saying it's um uh that everybody has to have a vaginal birth but just everybody needs to have a respectful birth and whether that is a physiologic completely physiological birth or a caesarean it's just it's just kind of respecting that kind of that sensitive time. Period when the baby is born and then I mean I feel very very very passionate that there should be more support for every single mother to breastfeed and I think it's not enough just to have a tick box exercise where sure a mum has you know 60 minutes of skin to skin well actually we um we've interviewed scientists who say actually for the for the wiring of the mum's brain ideally you'd have 20 hours 20 continuous hours of skin to skin to wire the mum's and the baby's brain wow so um i mean that might not be possible it needs a rethinking of the whole um birth process yeah but i think it's i mean in terms of messaging it's like let's. Let's let's show people what could be possible whether whether it's a vaginal birth or whether it is a cesarean and show actually there are simple things you can do that don't cost anything.

Sheena:

To

Guest:

Make that birth really respectful and really mindful of the baby's microbiome.

Sheena:

Okay so so we'll come on to the baby's microbiome in a wee bit um and and certainly you know i think that the messaging is massively important because because I think women need to to not feel any guilt around the the time of their delivery and um you know when things don't go to plan because you know most women that I know that wrote big birth plans like you did they didn't go to plan and you know I'm one of those um I hadn't actually written mine down per se but I had assumed that I would have you know a natural delivery at the due date you know and that you know I would I would breastfeed and everything and my first baby was born prematurely six weeks early and that was a huge shock to my system because I wasn't quite prepared when when my baby came along and and And then, you know, to confound that, you know, I wasn't really supported to breastfeed either. I was just sort of thrown a breast pump because my baby couldn't breastfeed. She didn't have the strength to breastfeed because she was so premature. So she had a little nasogastric tube and I was thrown a breast pump and just told to pump. And I had no idea what I was doing. I might be a medic, but I was absolutely useless, totally unprepared. And I felt that there certainly could have been somebody sitting down with me and just talking me through it a little bit more kindly than I received at the time. And I'm sure my experience is not dissimilar to other people's. If you're not really desperate to do something like breastfeed, then, you know, with that kind of an experience, it's really going to put you off. So, you know, I persevered and I'm glad I did. But I think it's really hard to plan a birth because so much can go wrong for any woman. Um and and it's really hard and you don't want whatever happens you want to know that it's going to be safe that you're going to have um people available to you to deliver this baby safely um in a in a safe environment and you want your your own health to be protected and you want the health of your baby to be protected and this is why you know modern um birthing in obstetric units has been absolutely life-saving um but but it's really interesting what you're saying about doulas and people may not have heard of doulas so um can you can you just explain the the different systems of childbirth because most people would just sort of register with their maternity unit and uh get their midwife and um and when they when they feel their contractions start they will phone up the hospital and go in and have their baby in a hospital environment. Can you just explain doulas and home births and really just other options that are available to women?

Guest:

Okay so there's great question so uh a doula is a non-medical professional who um provides practical and emotional support to a mother so um but doesn't do anything medical right so um whereas a midwife is responsible for the medical side of things for low-risk birth obviously if there's a high risk um situation then you then you have your uh obgyn involved and they it goes to kind of consultant level and they make in conjunction with the mother and sort of decisions about the best possible care but if you're talking about um i'd say say a low risk birth so a a mother might think okay i've i've i've read all the literature i've been informed um i've been to my antenatal classes i've um they kind of want a a home birth as if that was a supported option in the area and in many cases in in the uk and around the world home birth is not a supported option i mean i'd love to see more because the where it is a supported option a fully supported option in the area it can be as safe as a hospital birth right so a a doula would sit down with the parents beforehand, talk through the different options for birth. And then during, say, if it was a home birth, the births I've filmed. The dooda would say the mum has, the waters might break or she has a first contraction. The dooda goes over, usually in the middle of the night. And if the mum's having a birth pool, the doula would fill the birth pool, would put warm compresses on the mum's back, would relax her, would get the music set up. Would kind of calm the dad down, would then make cups of tea or do snacks. The midwife would come the midwife would would do all the medical stuff and meanwhile the doula is just kind of holding the space of just a a lovely of loveliness and then uh as the baby as the as the birth progresses um the the mum might be holding on to the doula for support or might be holding on to the dad or might be phoning the doula might be taking the the child to the neighbor for um if there's a sort of child care issues all of those kind of things that you kind of want an extra pair of hands to do that's what a doula does and then uh and then after the baby is born the doula again make more cups of tea or um put you know wrap the the mum in a towel or a blanket to keep the mum warm uh and to might the if the dude is trained in breastfeeding um. Will will help initiate breastfeeding or initiate skin to skin and it's just a kind of a a really lovely practical and emotional support so if i was to have another baby i would definitely have a doula because it it's just having somebody who's on your side you can kind of protect protect your bubble of space and obviously if there's an emergency situation you can have a doula for a hospital birth um depending some units are a little bit funny about allowing access only having one parent and not an additional support person but generally the. Doulas are allowed on the um on the uh the birthing suite in the hospital and but um so if a if a baby was being born by cesarean then the doula might be inside the operating operating theater again facilitating skin to skin or just supporting the the dad or the partner just their presence and in the recovery room the the dude will be there making making cups of tea again or just you know making sure that everything is lovely that the mum's informed about her decisions and I think that's the for me one of my touch buttons is um that parents being informed fully informed I think that it's a fundamental human right that every parent should be fully informed about their birth and their infant feeding choices and when you talk about guilt it's a little bit of a trigger for me because um. I don't think that most parents are informed about their birth and feeding choices. And the sense of guilt happens if you know your choices and then you make a choice and then you feel guilty about that choice afterwards. But right now, most parents are not fully informed about their infant feeding choices. The microbiome is not mentioned. Other aspects of their care are not discussed with the mother and the father too, the partner. So the mum's basis for choices is not fully informed so whether that's induction or reasons for a cesarean or epidurals whatever it is that it's not it's not enough just to tick a box and say oh yeah it's fine i've discussed the the inductions and the need for a need or not for inductions or even you know sort of antibiotics the use of antibiotics it's just this you know I would love for parents to be able to ask their health care provider or clinician, what happens if I take those antibiotics? What happens if I don't take the antibiotics? What's the plan if I take the antibiotics? It's kind of the full range of choices. I mean, it seems quite right now, parents are kind of taken down a line and they're not given choices. It's the choice of the healthcare provider. So it's.

Sheena:

Yeah. So can I go back a little tiny bit? I agree with you on the consent side, because as you say, there isn't a discussion happening about microbiome. And actually, up until now, we haven't really mentioned microbiome in this podcast. But obviously, we're microbiome medics, and that's our fundamental interest. And the reason why I've invited you on to talk about childbirth and breastfeeding is because it is integral to the development of the microbiome of the infant. And we know that that can affect the infant's health as they progress through their life. You know, children that are born by vaginal delivery and are breastfeed are receiving the right microorganisms into their gut right from the very start. And these microorganisms are massively important to train the body's immune system. So they're less likely to get disease as they age. So it's a really important thing. And actually, any listener listening to this who wants to know a little bit more, please have a listen back because there are a couple of podcasts we have on mode of delivery and the gut microbiome and also on the feeding choice and the gut microbiome. So, we've covered these in previous podcasts in a lot more depth and our listeners can go back and have a wee listen and that will tell you a lot more about why this is so important to the development of the infant gut microbiome, but I think going back to the issue of consent, and that doula being in the room, I remember personally when I was having my premature delivery. I really felt that I wasn't really taking in a lot of the information that I was being given. I think it was all a bit of a blur, to be honest with you. Well, one, you're in pain. And when you're in pain, it's very hard to concentrate on anything else that anybody might be telling you. Two, it can be a frightening situation. You know, it can be quite a shocking situation being in a hospital, you know, being in pain, not really certain what's going to happen next. And I would say, especially for me having a premature birth, you know, I wasn't quite prepared for that. And I suppose emotionally it was stressful. So, of course, you know, somebody talking to me, giving me options at that stage, I'm not really taking it in. And I think, you know, I spoke to a doula recently about this. And that was her point, you know, that, you know, somebody has to be there to be able to translate to the mother and father what is actually happening. And it's not just the mother that is stressed to bits and, you know, pain. The father or the partner of the pregnant lady is also going to be under a great amount of stress as well in this situation. And so, you know, it's lovely to have a person who can be quite objective, who's able to translate what's happening all around. And you may or may not have experience in the medical field and know, have an understanding of what's going on. But if you don't, it must be even more frightening. so so having a doula to explain things and explain what your choices are I think is a really really important part of their work and also they're prioritizing what they think is beneficial to the mom and the baby and to to make sure that you know the mom is given the opportunity to. Birth in in a position that is helpful for her and and I think that's useful because they have a lot of understanding about you know different positions of birthing and you know how that will impact upon your body and your your baby and you know they have a lot of understanding about normal childbirth what is normal how to create normal childbirth and and having that understanding and that experience is very very useful to have in the room um but you're it's important that people understand that these uh doulas aren't medically trained and and so aren't able to to take the role of the midwife if things get complicated or um or take the role of an obstetrician if things were complicated um so so what do you think uh tony uh.

Guest:

I think you've summed up the role of a doula is fantastic i think that um, I mean, obviously, the best person, if you've got a high risk or a situation or any kind of pregnancy, the best person to talk to is your midwife or your OBGYN. But it is having this kind of another person listening and able to kind of pick out points and advocate for you if necessary. But actually i mean i just believe that it's parents themselves who need to be given an understanding of of their choices and uh it's like sometimes when you i understand what you're saying about kind of when you're in pain you can't you can't really take people in i've had a couple of operations and you know kind of when you come around from an operation um and the doctor is explain to you kind of okay the the follow-up strategies literally five minutes later you've got no idea what they said to you yeah and and it's and it's not you know it's just that they've they've done a brilliant job and it's fantastic but it's that. Kind of um I mean ideally all those conversations and those options should be discussed way earlier in pregnancy and just you know to have an informed discussion about um I mean I know there's kind of there's pressures on the health care system and you know midwives are brilliant and obstetricians are fantastic I mean everyone works really really hard um and I just would love for just for more time and more resources to go into this this period yeah so to support choice just absolutely make those choices meaningful and so that people understand what what the choices mean yeah and uh and I mean I would just love more support for I mean however you never know how a birth is going to go right so you're never going to know if a birth is going to go smoothly in a vaginal birth or whether it's going to be a c-section you just don't know the consequences but if there was just more support for skin to skin and more support for breastfeeding however a baby is born that's the best possible thing for the infant microbiome and um so that's kind of where my passion is so doulas are fantastic midwives are fantastic obstetricians are fantastic um but it's just that kind of initial thing yeah.

Sheena:

So let's move on then because then your interest was focused on the microbiome and and the infant microbiome and you know the importance of that and this moves on to your documentary microbirth so So talk me through what happened with that documentary. Who did you interview? What did you say? What were the main messages of your microbirth documentary? And what were you trying to change at that time?

Guest:

So microbirth featured 11 different professors across different fields. So we had obstetricians, we had microbiologists, we had immunologists. And the key messages were that this really sensitive time period surrounding pregnancy, birth, and those first few weeks and first few months is a really critical time period for establishing the infant gut microbiome and perturbations like c-section or antibiotics or formula feeding they as you said yourself they they they disrupt the optimal training of the infant immune system which can lead to increased risk for allergies asthma obesity diabetes all those um um lots of immune related conditions so that's that's the key message really that we need to pay attention to this sensitive time period and to really look at what we're doing within that time period and um and look at look at the practices these common practices that up until that point hadn't been looked at through the lens of the microbiome. So we made the film and we used the same distribution model as we had for Freedom for Birth. So our previous film about the human rights and childbirth. So we set up screenings with, we had a thousand different screenings across the world happening on the same day. And each of those screenings was held by our network of midwives, dooders, childbirth educators, um that Haitian consultants and they held these community screenings and um it was great we had this fantastic wave of screenings and again we um uh the film was featured on different tv stations and we made newspaper headlines everywhere and uh in fact I was um uh in Holland a couple of years ago and uh i was talking to a i was interviewing a professor and he said your film um it prompted a two-hour debate on dutch tv about microbirth and what we should do about microbirth.

Sheena:

Brilliant what year was this.

Guest:

Oh it was released in 2014 so that was quite a while 10.

Sheena:

Years ago wow.

Guest:

When we had um so it's one very science film festivals and one of the film festivals was in Prague and so we screened the film and one of the obstetricians the big the biggest obstetrician in the Czech Republic stood up and said this this film shows we have to change we have to change our protocols we have to change our procedures and and he asked the medical community that were present what are we going to do, And 10 years later.

Sheena:

Nothing just changed. Yeah, and so, I mean, that's incredible. You got a lot of attention from the media. You were out there in the newspapers. You were screening all over the place. And yet, people were obviously interested. But what do you think were the stumbling blocks for people to take this on board in 2014?

Guest:

I think at the um so at the time there was there was research published and um but there wasn't a body of research now there's a body of research and i think that there's a there's this off-sited statistic that it takes it can take up to 17 years from um a paper being published from for that information to be uh adopted into clinical practice so i think there is a kind of a delay between research being published and clinical practice. But I also think that, I mean, thinking about the microbiome, and you know this, that thinking about the microbiome does mean a whole new way of thinking. And it involves putting the microbiome first, so to speak. And that takes a whole, that's going to take a while for everybody to get their heads around this, for us to rethink obstetric procedures or or breastfeeding support procedures yeah because people just even now i mean you know we've been banging on about this for for 10 years we've set up we've got 43 000 people in our online school we've we've done conferences we've written books we've been i've done those immediate interviews yeah and still um a percentage of the population haven't heard of the microbiome. A percentage of doctors might have heard about the microbiome but might not know what to do with this information. So I think there's just this. Between kind of what the scientists know and what the clinicians do and my my hope is that that that gap closes and that we can um you know for the microbiome to be taught in medical schools for there to be clinical protocols that support the microbiome particularly over this kind of this sensitive time period around birth in the first few weeks yeah and and and it's not it's not rocket sides and it's not expensive things so however birth goes it's being respectful of the microbiome so that that skin to skin and exclusive breastfeeding number one and number two for every single birth.

Sheena:

Okay and i should probably let people know how we met because um we were at a recent meeting um put on by the royal society um a small sort of think tank type meeting um whereby um some really prominent microbiome scientists and people like Tony and me and some really interesting people who are also involved in politics and just really interested parties in microbiome science gathered together, really just to think around how we get microbiome science out into the mainstream now because we, you know, it has, the science has built so much. There is so much evidence now for the importance of human microbiomes and that you know, we should be considering this in our sort of mainstream medicine and our mainstream surgery and just day-to-day healthy living, we should be considering our microbiome. So, so there's definitely a lot of interest at the moment in trying to get this into curriculums, into mainstream medicine practice. But like you say, Tony, my experience so far is that the vast majority of my colleagues don't have the knowledge, don't have the interest in microbiome science. And I know for a fact that my patients who are having babies and going into my local obstetric unit are not being counseled on the importance of their gut microbiome and having a healthy gut microbiome throughout their pregnancy and also the importance to their infant of developing a healthy microbiome through their mode of delivery and their feeding choice. And so that's not something that is part of the narrative at the moment. And I've given talks to my local obstetrics uh obstetric unit and i've even met with my local feeding coordinators as well on this subject but we we seem to have a long way to go in certainly in scotland um so, i i feel for you 10 10 years you've been on at this and and you know we're still not there yet tony um this is a bit hard to hear really for me as well just starting this journey.

Guest:

You know there's hope okay um and the fact that more people know about the microbiome so there's there's more interest in the microbiome um so when we started people literally my family members thought i was i was nuts i had no idea what i was why i was talking about bacteria. While i was interested in it and um no one had really heard of the microbiome back then in 2014 now people are have heard of the microbiome and i think that i think um there's there's things which have kind of tripped us up in a way where um things like um people here associate the microbiome with gut health and that's fantastic and yes you know it's um uh those those messages about eating healthily fantastic brilliant wonderful but there does seem to be a um some some messages are have been co-opted by commercial companies where it's like it's okay you just need a probiotic to fix it and um and i think it's it's i mean i'd love to just see this message of okay let's just get it right at the beginning with birth and let's let's all be aware of the microbiome and make choices that are microbiome mindful and um you know so whether that's eating more fiber or eating a rainbow vegetables or doing more exercise or just just being aware that it's not just you it's your trillions of microbes living on on and in you and being mindful of that and uh so that's kind of with the the kind of the curtain starting to to lift up but i think we've and and there's hope and there's a rainbow through the curtain that we can see but. Not but there's a maybe a glass between us and the rainbow still.

Sheena:

A little barrier there um yeah okay great so with that in mind though tony how do you see us being able to integrate microbiome science into the um the journey of the the patient woman the the patient who's going to go through obstetrics now you know the they are uh they get pregnant they phone up their local birthing unit, they book their first appointment. How do you see an education into microbiome science being delivered to that patient from the start and all the way through?

Guest:

I would love it. So there is a gap right now between all the research on the microbiome and that information reaching parents. So we've created an antenatal class that's microbiome focused. So we're beating tests, testing that at the moment. We've got 109 people around the world kind of holding our classes to introduce expectant parents to the idea of the microbiome early in pregnancy so they can be informed about their choices um and i think so that's part one part two is uh educating the health professionals so um we've got our school which we've got you know 43 000 health professionals being being educated about the the microbiome same as same as you you're educating the health professionals about the microbiome so that there's a kind of a knowledge and an awareness of the microbiome uh so but my uh we've got a new film coming out uh next year so 2025 which is um aimed at expectant parents so to bring the knowledge of the microbiome to expectant parents not not in a judgmental way but just in a this is really exciting and this is what you can do to optimize your own gut health but also to optimize your baby's trajectory of health um and it's really really simple it's just like you know just be aware and uh this is so it's kind of um. But with jeopardy that if you there is this narrow window to optimize optimize your baby's gut and if and there's only one chance to do it so uh it's just the awareness of that um and then our idea is that if we can um so 10 years ago we had a thousand screenings of microbirth we'd love to have 10 000 screenings of microbirth happening all around the world um over the next year and to So really, so for those screenings to be held in communities by, say, midwives, dooders, childbirth educators or doctors or anybody kind of microbiome geeks like me who are kind of really into the science, you can hold a screen. Um uh and and for for those screenings to invite expectant parents to go along to the screening to start engaging so um expectant or new parents and to learn about this amazing science and to think about you know what we can do and to maybe bring in experts like local microbiologists talking about the science and talking about kind of what you can do in your day-to-day life and if we can have you know 10 000 screenings um supported by we've got a directory of of health professionals who are microbiome aware that's part of our the microbirth plan and it's just this kind of okay let's let's start get bringing this information out there and bringing this to parents and at some point these uh these parents will ask their health professional about the microbiome and hopefully that that health professional should be aware of the microbiome and should be aware of of the latest research about you know support for skin skin support for breastfeeding and so we just you know change happens at the top and there's people working at the top um working at. With politicians and hospital managers and insurance companies so um those conversations are happening at the top but also we we kind of um we're empowering parents with fully informed choice about the microbiome um and it's just it's not telling anyone what to do it's just like this is what this amazing science is saying and these are the things you can do but what you do is up to you yeah so and it's all based on on research evidence-based research and for me it's just about empowering choice and to empower those those conversations with health health professionals whether that's your midwife when you first book in or with a with a an obstetrician later on in the journey it's just to for parents to to understand that they need to factor in the microbiome in their choices and those discussions need to incorporate the microbiome yeah so it's kind of a i'm seeing a 10-year trajectory where we can start doing this and start making change happen so it's not going to happen overnight as much as i want to reach a tipping point where everyone's talking about this and change happens really quickly i think uh realistically it's going to take a while to to set you know clinical protocols it's going to take a while for um the medical curriculum to change it's going to take a while for hospital policies to change but i think. It's it i think there's such overwhelming evidence for incorporating the microbiome into clinical practice that the world will change great.

Sheena:

Um so that's really exciting about your forthcoming documentary um and if somebody wanted to hold a screening how would they go about doing that.

Guest:

Uh we haven't announced the um how they're going to hold a screening but um we've got either go to uh microbirth um dot com or uh the microbirth plan dot com um so the microbirth plan is our uh directory of kind of health care professions which we're just setting up, and just email us and be on our list and as soon as we announce the film and how to set up a screening. So it's quite a... It kind of now now we've done it twice we've done this kind of global premiere screening protocol twice and it's been fantastic but now our reach is bigger and it's going to take a bit more thought and kind of mindfulness and of how to to get people setting up screenings and the questions they're going to be asked at the screenings because we'd love to have panels at each of the screenings but i'd love everybody everybody listening to hold a screening and just.

Sheena:

Like kind.

Guest:

Of come on board and like let's just do this together i think it's just this powerful once you get the mic button once you kind of understand the power it's like yeah.

Sheena:

We can.

Guest:

We can transform potentially the trajectory of health for the next generation and it's and it's just simple things.

Sheena:

And and actually i'm i'm well situated to hold a screening being a gp i have you know I have patients who are going through maternity care at the moment so you know it wouldn't be so difficult for me to hold a screening in my surgery for anybody who was really interested to find out about this so I think I will be contacting you to get on board with that Tony it's right up my street and it's you know it's a big passion of mine as well sadly at the moment when patients are discovering they're pregnant and booking in with their maternity care I don't normally see them you know if you have a normal pregnancy you don't really have to encounter your GP in that process because people can self-refer now to the maternity hospital so although I have an interest in microbiome science and I have the knowledge to pass on to patients, I rarely have the opportunity to do that because patients bypass me. And the first time I see them is when they come in for their six-week check. And by this stage, you know, the baby's six weeks old, they may have even stopped breastfeeding by the time they see me or if they'd have done it at all. And I'm seeing more children these days being discharged from hospital on dual feeding regimes, which seem to be very popular in my maternity unit. And unfortunately, that tends to really introduce a decline in maternal breast milk production and a decline in breastfeeding. So I see breastfeeding not being as successful with dual feeding um which you know i i've been concerned about just that's just purely an observation from from my own patients um so so yeah i mean i i think that would be really interesting to to have a screening and and to to think about how we can um you know empower women to make, the choices that suit them but also um have the confidence to be able to um you know say how they feel about you know birthing choices and also to understand the impact of that these birthing choices make um going forward um so so that's going to be 2025 have you got a sort of date for 2025 when you think that's going to be spring 2025 so okay um.

Guest:

Not until we announce it so we haven't told anyone the title we haven't told anybody that so it's kind of uh yeah so once we once we announce it then we're a countdown to launch so.

Sheena:

Watch this space at the moment but get ready for it and what can people do in in the meantime if if you're empowered by this conversation and you want to um get involved um or learn more um if you're a health professional even a non-health professional or somebody who is uh you know considering a pregnancy even you know what what can you do to to get more information and and help um in this process uh.

Guest:

So uh we've set up our directory of um the um the microbirthplan.com so it's our global global directory of of um healthcare professionals who are microbiome mindful you can um so join the directory you can take our um our courses we've got kind of online courses we've got free offerings we've got um loads of information out there you can go to uh if you want to contact me um either go via our social media which are microbirth movie or microbiome courses um and just to just start a conversation and just to kind of get involved really and um i mean i love the idea i mean wouldn't it be fantastic if every gp surgery held a screening of of our film or just or had a little clinic ran a little clinic about the microbiome early in pregnancy early enough or even pre-conception so that people can start eating and eating kind of, more fiber and more diverse range of fruit and vegetables in order to optimize their gut microbiome before they they give birth I mean so I mean I can imagine like a like a little clinic a little fun kind of get-together in every gp surgery of kind of expectant parents like early in pregnancy where they talk about what they can do for their microbiome that's where I'm seeing Yeah.

Sheena:

Absolutely. Absolutely. And I think you're absolutely spot on. You know, if you are pregnant, the state of your microbiome really matters because one, that's going to be the microbiome you pass on to your infant when you have your vaginal delivery, if you have one. But secondly, in order to be healthy and fit throughout your pregnancy and to reduce your chances of disease, infections, complications, looking after your own gut microbiome can be so, so important. And yet, I don't think a lot of mothers are at all aware that that can make a difference to them. I spoke to a pregnant patient of mine once who had just been diagnosed with gestational diabetes, and that's diabetes in pregnancy. And diabetes in pregnancy puts you at more risk because your infant can grow larger, and then you can have more difficulties during the birthing process just because of the size of the infant. And so that might cause you problems with the vaginal delivery but you're also more prone to other complications like preeclampsia which is a high blood pressure in pregnancy and infections and you know a whole host of different things and the infant is more likely to develop diabetes as they grow older and have obesity issues and various things because they inherit that microbiome of the mother which is an altered microbiome because of the gestational diabetes. And actually, I explained all of this to my patient with gestational diabetes, and it was news to her. She thought, oh, I've just got a bit of gestational diabetes. I just need to take my medication and then I'll be fine. But it wasn't really explained to her that taking the medication didn't actually reverse the diabetes. It treated the sugar levels and brought them down a little, but it didn't reverse the process that caused the diabetes and it certainly didn't eradicate the diabetes and it didn't eradicate the issues in the gut. So I explained this to her and I explained that a diet, would enhance her gut microbiome would also help her to reverse this diabetes so that we could put her in a better state at the end of her pregnancy to pass a better gut microbiome onto her infant. And I saw her for her six-week check, which was about three months down the line, and she had reversed her diabetes with diet, so much so that she brought her weight down radically as well um she had an uncomplicated birth um and she um was breastfeeding um and she um she thanked me for the knowledge because she was then able to educate her family as well and she managed to change the diets of everybody in her family and she was super healthy super fit and she looked amazing and i was absolutely delighted but um that's just one example of somebody who you know hadn't been given any sort of education so wasn't able to make a an informed decision um and and i think you know we could all impact even individual patients in that way um or you know we can do it on a hopefully a grander scale with your documentary.

Guest:

I love that i love that that that you've kind of empowered someone just with their knowledge about uh their diet and it's a it's kind of i feel i feel for someone who's who are um who's pregnant right now because the the advice for for kind of how to eat healthy or be healthy is pretty slim on the ground it's just kind of like okay avoid these types of foods avoid caffeine avoid alcohol and and it's kind of yeah it just it just needs to be well a whole different conversation but uh just nutritional, nutritional benefits. Um training or resources just to help support parents i mean that's what i'd love is just more support for parents.

Sheena:

Yeah and.

Guest:

Their choices and and i think that's brilliant i think that's such a powerful thing to reverse diabetes and to to optimize their gut microbiome before the birth i think wow.

Sheena:

Whatever you do.

Guest:

That should be kind of put out to every pregnant person.

Sheena:

Yeah i think so i think so i think it needs to be um there just needs to be more education there just needs to be more awareness and and we should be trying to reverse gestational diabetes when somebody develops it not just treat it um and yeah i mean these are the sort of conversations that i'm hoping will happen more um so um yeah i think we've still got a wee way to go with this But I'm, you know, I'm delighted that you're making headway with this because as a lone GP trying to send the message, I find it's really exciting for me that you're out there and you're doing something on a much grander scale than I could ever achieve. And you're going to reach so many people. And that's exciting for me, Tony.

Guest:

Well, thank you. I think it's a case of we're all holding hands together. So we've filmed maybe about a hundred different scientists in different fields in the last 10 years and uh but it is kind of we're holding hands with the scientists we're holding hands with uh with the health professionals um with the doulas the midwives lactation consultants um with medics those kind of aware medics with you with your kind of listeners i think we're all holding hands together and together we can make a difference and i think yeah i feel real hope for the future.

Sheena:

Great, great, fantastic. Well, I think on that, Tony, I'm really excited about what you're doing. I'm delighted you came on the podcast to tell everybody about it. I think this is really, really important. It's important messaging. There's so much we can do to really enhance the microbiome of our next generation that are coming down the line. And I think, you know, we've got this opportunity now with your resources and with your help to get this education out to more people. So thanks again. Thanks for coming on. And I really look forward to seeing this documentary. Thanks. Thanks, Tony.

Guest:

Thank you.