“Mother whisperer” Dr Amber Hart wants new mums to give themselves a break
She’s known as “the mother whisperer” and now Dr Amber Hart has established a maternal wellbeing centre that allows new mums to forget about being “Instaperfect”.
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Maternal and infant wellbeing specialist Dr Amber Hart wants new mums to give themselves a break.
“The expectations on us are just really unrealistic and ridiculous,” she says.
“It’s not humanly possible to be ‘Instaperfect’, a week after having a baby.”
Hart, described by some former clients as a “mother whisperer”, says society has changed in recent decades to remove many of the support structures women used to rely upon – the so-called village that was used to help raise a child.
At the same time, the country’s health and support system hasn’t evolved to reflect the change.
“Women need time. Historically, and when you think about Southeast Asian cultures and African cultures and South American cultures, women are looked after for a month,” she says.
“Their family cooks for them and cleans for them, they get support and help and recovery and rest.
“We’re just expected to bounce back.”
Hart is pushing to bring the village vibe back through her own practice, which is aimed at wrapping multiple health services into a one-stop-shop.
The decision to establish the Maternal and Infant Wellbeing Melbourne was driven by seeing countless families effectively left to fend for themselves following sometimes traumatic birth experiences.
But she says the dream would be for post-partum multidisciplinary services to be opened up to more women and made a standard of care through Medicare and government policy.
In an ideal world, afterbirth care would be elevated above an afterthought, preventing mental health issues or harm among parents and babies.
“I think in Australia, we do obstetric care exceptionally well,” she says.
“We fall down as soon as that baby is delivered. And our priorities need to shift.”
New mums are considered obstetric patients for six weeks post-partum, but Hart says there is a lack of co-ordinated care during that fourth trimester.
“It stops once the baby is born, and then you get a six-week check and there’s not much in between, other than maternal child health nurse visits,” she says.
As a consequence, new parents are reaching for their phones at 3am and searching Google for advice on how to feed their baby and get them to sleep.
The haphazard nature of post-natal care, which Hart believes contributes to growing rates of depression and anxiety among young mums, was exposed when Covid-19 hit.
As a lactation consultant, she was allowed to see people face-to-face during the pandemic, and had a close-up view of motherhood in crisis.
“Nobody had any support, nobody would leave my room. Time was up but they were like, ‘Please don’t make me go home’,” she says.
“There’s never been amazing post-natal support for people but for some reason, covid really highlighted the lack of post-natal care.
“I would have people come to me, some of them only a week or two post-partum, they’d already seen five different people, spent thousands of dollars and were no better off than when they started. “It’s really sad and it’s not meant to be this hard, it’s meant to be so much more fun.
“I was like, ‘No, this is ridiculous, we need to be able to do better than this’.”
Medicine and patient care has been a lifelong pursuit for Hart, as her childhood dolls would attest.
“They’ve all got puncture marks in their elbows from where I used to give them injections, and they’ve got bandages all around them,” she says with a laugh.
“From when I was old enough to walk and talk, I’d say I was going to be a doctor.”
She was avidly supported by her parents, whose three older children – all boys – had shown less enthusiasm for academic pursuits.
“I’ve got three big brothers, so I had to learn very quickly to use my brain and wit instead of my muscles, because they were so much bigger and stronger than I was,” she says.
“I think that set me up well.
“And because it was a house full of guys, particularly my mum – but also my dad – would say: ‘Don’t ever let your gender get in the way. If you work hard, if you put your mind to it, nothing is ever too big, just go for it.’”
After graduating from an all-girls school in Brisbane, she enrolled in a science course which was required to do a postgraduate medical degree.
She moved to Melbourne, where her parents were from, part-way through the course and settled into life at the University of Melbourne’s Newman College where she “probably had a bit too much fun”.
Following her medical degree, Hart pursued an interest in women’s and children’s health, and was accepted into obstetrics and gynaecology training.
Husband Chris is also a medical professional and, fearing the gruelling schedule would limit time available with her own children, she switched to general practice while maintaining obstetrics skills in Castlemaine.
It was then that she first saw “Medicare is not set up for women’s health”.
“Women go to female practitioners with problems that take longer than 10 minutes,” she says.
“I’d try to have long consultations and they’d get triple booked and nothing was getting sorted and I was so frustrated.”
During Chris’s two-year fellowship in Italy, Hart studied to be a lactation consultant, and when back in Australia started helping mums with breastfeeding.
Once again she felt limited in the time she had as a GP, so decided to set up phase one of the MIWM at an obstetrics consulting group in 2019.
“That was after my third baby. I was just a one-woman band, it was awesome,” she says.
“I had the time, I had the space, the room was set up properly. And then covid hit and everything fell apart.”
There are almost 300,000 births in this country every year.
But across Australia’s wide expanse, there are only 83 specialist mental health beds for parents and newborns – known as mother baby units.
“Only the most unwell mums get those beds,” Hart says. “And one in five women has post-natal anxiety or depression. So, there are just not enough options, and with the mental health crisis since Covid, people can’t get in to see psychologists and psychiatrists.”
Earlier this year, leading obstetrician and gynaecologist, Professor Steve Robson, launched an impassioned plea to raise the number of mother baby units to the recommended minimum – 160 across Australia.
Writing in The Australian, Robson said the fact that suicide is the cause of more than 10 per cent of all pregnancy-related deaths in this country “should shock our community”, and the under-resourcing of psychiatric care for mothers and babies “should already be considered a national scandal”.
Hart believes women should be allocated a mental health practitioner – whether that’s a nurse practitioner, a psychologist, or a psychiatrist – “the second you find out you’re pregnant”.
“Regardless of your mental health history, you have that consultation in pregnancy so that we can screen and give you all the tools that you need to manage all of the changes, the uncertainty, the hormonal shifts, the sleep deprivation, the identity crisis that happens,” she says. “People are prepared for that, and then if they do tip over into anxiety, depression, OCD, those kinds of things, well, we’ve already got a referral pathway.”
The MIWM is designed to address or prevent mental health problems mums commonly experience, even if they don’t seem to be struggling at that time.
Experts at the clinic assess all women for signs of anxiety and depression, which Hart says can reduce pressure on other parts of the health system.
Its “day stay” private program is for two consecutive eight-hour stays in a “luxurious, purpose-built space” and has sessions with specialist women’s and children’s GPs.
There are physical and mental health check-ups and assessments as well as breastfeeding and sleep and settling support.
Massages and group therapy sessions are also included in what is described as a “circle of security parenting”.
“We sit and we chat and we debrief and we will sometimes cry together and we’ll laugh together, and it normalises everything for people,” Hart says.
“Some mums say, ‘Oh, I thought my baby was unsettled, but actually, theirs is way more unsettled than mine’, and they’re really validated.
“Others are like, ‘My baby is definitely the most unsettled baby in the room.’
“And you see these women just melt.
“You just see their guards come down, then you see their confidence build, you see that kind of hope that, ‘this can feel better, this can be different. I’ve now got a village of people to support me.’
“Often people exchange phone numbers at the end of the day and they create their own little village because we just don’t have that village anymore.”
At $3330, the two-day program won’t be accessible to everyone, but Hart says for women who have hit the extended Medicare safety net – which most using the private system will do by the time they give birth – the total out-of-pocket costs for two full days is about $960.
It is designed to be a service that is used by parents who have discharged from hospital and need wraparound support; something that “should be standard of care”.
“It’s lovely to go to a hotel (following birth) and spend a couple of nights there, but imagine if you were discharged to a place where you got sleep and settling education, breastfeeding support, mental health support, and you got that dedicated time,” she says.
Early last decade the average number of days women spent in hospital following childbirth was three.
In 2022, the latest available figures from the federal government’s Australian Institute of Health and Welfare, the average had fallen to 2.5 days.
For women in the public health system it’s lower, and for many mums who have vaginal births it can be a matter of hours, not days.
The Institute says it is a clear “trend toward shorter post-natal stays”.
“That’s fine if you’re going home to mum, grandma, aunty, neighbour, sister,” Hart says.
“It’s not OK if you’ve got nobody, and you’ve never done this before.”
Hart returns to the concept of “post-natal school”.
“We need to go back to school, but for babies. The biggest criticism that I hear from patients in those first two days post-partum is: ‘I was so confused’,” she says. “They say: ‘I didn’t know who I was supposed to listen to. Everybody told me I was doing the wrong thing. Everybody told me something different.’
“So we need that consistency.”
The key is education, which should be consistent across the healthcare network in the days post-partum in hospital.
“That’s where it all falls apart, where people are not getting the same advice, they’re not getting the right advice. It’s really inconsistent,” she says.
“If we had that really good antenatal mental health, breastfeeding, sleep education, when everybody has the mental capacity to actually take it in, and then the practical help in those first couple of days to consolidate those skills that they’ve learnt during pregnancy, I think that this would be so much more enjoyable and we would have lower rates of formula feeding and mastitis and slow growth and anxiety and depression.”
When Hart asked her own children what she did for a job, one response was “hilarious”.
“My kids call me the magical boob doctor,” she laughs.
“I’ve got this hilarious video of my six-year-old and I say, ‘What do I do for work?’ And she says ‘You help the mummies and babies’, and I asked her something else and she says, ‘because you’re the magical boob doctor’.”
Despite years of medical training, Hart says the experience of having three girls and being a new parent was never a textbook exercise.
“I don’t think my husband and I had ever had a proper fight until we had a baby,” she says.
“And then everybody’s trying to do their best and everybody’s tired and stressed.
“I’ve walked this path, I’ve lived this.
“I was really lucky with my breastfeeding for the most part, I didn’t have terribly many problems.
“But I just remember thinking, ‘I am supposedly an expert in this, I have all the health literacy under the sun, know how to speak to doctors and midwives, and I’m floundering’.”
Breastfeeding struggles faced by many women – and which studies show has an impact on mental health – are exacerbated by the village problem.
“Everybody just assumes that it’s going to happen … ‘Oh it’s the most natural thing in the world’,” Hart says.
“It’s actually a really complex skill.
“And we’re supposed to be surrounded by the village – our grandparents, they grew up watching their mums, their sisters, their aunts, their neighbours, breastfeed babies.
“Now, often the first time you experience breastfeeding is when you have a baby put on you and you’re expected to do it.
“I say to people, imagine if you’d never seen a bicycle before in your life and you were put in a room with a complete stranger and a tandem bicycle and told to go, ‘OK, ride it.’
“People need support, they need help.”
The same goes for sleep, and Hart takes aim at misinformation about the myth of babies “sleeping through the night”.
She says many studies that led to claims babies sleep “through the night” at three months were done in the 1950s, when babies were shut in their own room with the door closed.
Even a gentle interrogation of those studies shows that sleeping through the night was actually defined as five hours.
“It was also five hours of parents’ sleep not being interrupted, so these babies could have woken up five times but all the doors are closed, and you can’t hear them,” she says.
“We’re just setting parents up to fail because you think, ‘Oh my gosh, why is everybody else’s baby doing this?’”
Sleep schools, which provide a one-size-fits-all approach to settling, are also often unhelpful.
“Why do you need to sleep train your baby? You don’t need to teach them to sleep, just like you don’t need to teach them to breathe,” she says.
“What I say to my clients here is there is no one approach that works for every family, every time.”
Changing perceptions is also part of the MIWM mission, to try to flip the dread of night time feeding as one of the best times of the day.
“Nobody else is around, it’s this private time you get to have with this gorgeous little baby,” she says.
“They’re really calm, you’re nice and calm. You just get to snuggle up with them.
“It’s all about just shifting people’s perceptions, taking away that feeling that everything has to be perfect all the time.”
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