episode 14
eat, sleep, play, love

Practicing GP, mother-of-two and author of new parenting book Eat, Sleep, Play, Love, Dr Preeya Alexander, is a wise new voice in the parenting space. Preeya has written a practical, inclusive and down-to-earth guide, combined with a big dose of fun, to create the most helpful survival guide for the first few years of parenting.

You can listen to this conversation with Preeya and Lou via our podcast or read it below.

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Tell us a little about yourself and your work.

I'm a mum to two—I've got a daughter (7) and a son who's a three-year-old terror. He's delicious, but he can push me to the edge pretty quickly. I'm also a practising GP in Melbourne, the co-host of the Channel 10 cooking show: Good Chef, Bad Chef, and I'm now an author. I've written Rainbow Plate, which is a kids' book, and I've also written Eat, Sleep, Play, Love.

What inspired you to write your newest book, Eat, Sleep, Play, Love.

I read a lot of parenting books when my kids were born, and some had quite a bit of judgement in them: this is the single right way to do things. And despite being sleep-deprived, my GP brain knew there wasn't one right way. Not every baby has to be swaddled or likes patting, and not every parent wants to do things this way.

So, I wrote the book I wish I'd had and the book I wanted to give my patients. My book says to the reader: we're all on different spectrums when it comes to parenting. Some of us sit on the intuitive side and are happy to go with the baby, rock them to sleep at 11 months, and go to them 15 times at night.

Some of us, like me, are happier implementing an intervention.

This is a platter book. It gives you the evidence, the pros and the cons, and you can choose what works for you. There are lots of expert voices in there too. I didn't want it just to be me.

I really loved the conversation you had with your mum and shared at the beginning of the book. What did she say to you?

I remember when I was in the depth of the postpartum phase and I said to my mum, "Mum, you never told me it was going to be like this. No one's ever told me." And she said, "Oh, darling. If I told you, I wouldn't ever have grandchildren. And she's right.

But that comment really resonated with me and fascinated me. We don't talk about the realities and the fact that even beyond the two years this book covers, it's a juggle: an exhausting and chaotic juggle. It's quite the journey.

Despite having older kids, I felt so seen in this book. Can you talk to me a little bit about prenatal depression—depression before you even have the baby—which is something I think I had, but you don't mention in the book? You do talk about how common postnatal depression is, though.

Postpartum mood disorders are very common, and there's still a lot of stigma in this space. I think many mothers feel they're being undeserving or ungrateful and fear someone will take their baby away. These are the things I've heard in my treatment room. 

So, what I try and do in that chapter is say: this is really common, and there are things you can do. There's exercise, meditation, and medication if needed—there are so many management options, including just seeing your GP.

But you're right. In the book, I don't talk about prenatal. I had written a chapter, and we decided it was a different book. But, prenatal depression is also very common. I see plenty of patients preconception, who have depression or anxiety. The key here is to ask: how can we optimise the management of these conditions to improve pregnancy outcomes for you and the baby? And this is a topic I get very passionate about because many people don't realise maternal mental health can significantly impact pregnancy outcomes. So, looking at how else we can optimise your mood is important. 

Do we need to involve a psychologist preconception to boost the brain before we even get pregnant? Do we need medication or to change the medication to something safer when pregnant? It's all about physical and mental optimisation, and there's a lot more conversation and awareness about these things now.

Tell me a little about your birth experience because in the book, you're so vulnerable and generous in your sharing. I'd love to hear your thoughts on whether you've healed from your traumatic births and how common you think it is.

I think it's so common. 

We thought very hard about including that much detail in Eat, Sleep, Play, Love. I was worried I would scare people. We tried toning it back, but in the end, I knew we had to keep it. And now that I have shared my story, so many people have related to the experience.

I think a lot of people underestimate the traumatic birth can have on so many things: your postpartum physical recovery, your mental recovery, your emotional bonding with the child, and your perception of parenthood. It really shifts things, and it took me a very long time to heal from that birth.

I felt angry. I felt guilty. I felt like I wasn't good enough and that my body had failed me. I was really angry at the obstetrician. And so, how did I heal? 

We spoke to the obstetrician who didn't deliver my daughter for an hour—the one who had been on leave. And he actually offered to get the hospital involved, and I declined because I felt the debrief with him was enough. I saw a perinatal psychiatrist, who was phenomenal—I had about 12 sessions with her. 

Wow, I didn't know perinatal psychiatry was a thing.

Yes, it's hard to get into and very expensive. Please know that I had the privilege of being a GP and had a network in the health system. There are also psychologists in this space and the Birth Trauma Association—there are excellent resources you can turn to.

I actually don't think I healed until I had my son, who was born via semi-elective C-section, where I had some control and changed the story completely with the help of the obstetrician and the anaesthetist. 

I think that leads to my next question about the disempowerment so many women feel in birth. Even as a doctor, you felt disempowered. How can women best prepare themselves for something that is already so uncontrollable? 

It sounds bizarre, but I think not having a fixed plan can help. Not that mindset of: as long as the mum and the baby are safe. Instead, it's more: I will have to be slightly adaptable and flexible here and read the room and see what happens, because while I might want a vaginal birth, it might not be the case.

I think preparing for all circumstances can help. Pack things in case you end up having a C-section—what will help you in the recovery? Just go in with all contingencies.

Thank you for sharing your story. I think a lot of women will appreciate it. Let's move on to the first six weeks. What do you think is important to realise in that timeframe?

I think it's important to realise both mum and baby need a six‑week check, which I explained in the book. They've both got their own chapter, and I explained why they both need to be seen: from the mental health of mum, contraception, and checking the nipples. And then there's the baby, you know: hips, eyes, stalk marks—holy mama; there's a lot. 

It's important to know that it's chaotic, and that's okay. I wrote a whole chapter on sleep, including when you can potentially start facilitating sleep intervention. Spoiler, it comes later, and if people are telling you it’s possible to achieve miracles in the first six weeks, they're probably fabricating that.  

You've got to go with the flow in that first six weeks. You've got to say yes to practical love and help. Don't be a hero. If someone says, "I'm going to do your washing for you and fold it," you say yes. If someone says, "I am going to cook you six lasagnes," and you think: I don't want six lasagnes, that's so boring. Just say yes instead. Take the love and just survive. 

That sleep stuff is so interesting because there's a lot of different pressures and advice. What about exercise and meditation? How important do you think it is?

I'm going to get very passionate about this. I think we sometimes underestimate lifestyle interventions because we're looking for a quick fix. But there's so much evidence for exercise, so let's start with that topic.

If we remove the postpartum patch entirely, physical activity is good for our brains. Even an hour a week can reduce the risk of depression. There's research showing exercise can help manage symptoms of stress, improve symptoms of depression in a mood disorder, help symptoms of anxiety, and improve night-time sleep quality. Exercise reduces your risk of chronic diseases, type 2 diabetes and fatty liver. If you're aiming for 30 minutes most days, it hugely reduces the risk of cancers, like bowel and breast. If you're doing weight-bearing exercise, you're reducing osteoporosis risks. So, the benefits are vast. 

And in the postpartum patch, exercise is crucial. I prescribe it at the six-week check because I know that getting mums out of the house and exercising in any capacity is good for them. And it's going to look different for everybody depending on your level of exercise before, the type of birth you've had, any complications you might have suffered. But it's good for the brain, the body and lots of things. 

And you're right; meditation is good postpartum if you're feeling anxious or at any time. There's a lot of evidence that meditation improves symptoms of stress or anxiety, and helps with night-time sleep quality. 

Simple lifestyle interventions can yield a lot of benefits, especially postpartum.

Are there any meditation apps you can recommend?

My favourite is Smiling Mind because it's suitable for the whole family. My daughter does the kids' version, and my son does the teddy bear and starfish breathing. My husband is really good at meditation, so we do the adult ones. Sometimes we do it as a family when we're all feeling a bit wound up. A lot of my patients love Headspace, but you have to pay for it. And a lot of them love the Calm app too.

What are your thoughts about self-compassion? I feel like, as women, we don't practice it enough because we haven't been taught to practice it. I'm getting into it a lot now I'm over 40.

I think self-compassion can look different for everyone. I often talk about negative self-talk with my patients and encourage them to be kinder to themselves. Instead of saying, "I'm not a good enough mother," what if we flip that? Because I can see that the baby is gaining weight, meeting milestones, and the mum and child are attached. So, I try to change that inner dialogue a little bit. Now, obviously, this is psychology, and psychologists are phenomenal in this space, but not all my patients can see a psychologist because it's often very expensive and hard to get into.

What does self-compassion look like for you?

On a really basic level, treating yourself kindly. I've been meditating since I had prenatal depression—so, about eight years. I practice a lot of loving kindness, and I've learned most of us are extremely critical of ourselves.

We can be very criticial.

I look back on myself when I was in that first six weeks and how I tried to do everything. I was back at work after three months, pumping milk in the car, driving an hour to work. I look back and give that person compassion because I thought I had to do it all, but I didn't.

But you nailed it, and sometimes you've got to do what you've got to do at that moment. I feel terrible at times. I've been very busy lately with commitments to launch Eat, Sleep, Play, Love. I rang my mum today and told her how guilty I felt that I couldn't read the kids a book before bed. She had to say, "Darling, it's okay. You're doing amazing things. The children are settled. They're happy as bloody Larry. Go easy." It can be hard to pull back and think: it's okay.

Yeah, I think we've been told we have to be everything to everyone. Another really important thing for mums is time to themselves. How do you get time to yourself? What gives you joy?

I either go for a walk on my own with headphones in listening to sweary music that I can't listen to with the kids around. Or, I do a Pilates class. That's my self-care. I've got it in the diary for today, and I tell patients it should be guiltless self-care. You are allowed to put yourself first. I won't feel guilty about it because I know it helps my brain. It makes me more tolerant, reduces my risk of cancer and chronic disease, and I need it. 

Did your mum look after herself that way?

My mum had a different journey. She was a single mum and a barrister—she's a King's Council. She raised me singlehandedly with the support of my grandma and my aunt.

Mum was always practical love. She did things, and I have a happiness list from my mum in the book, and every time I read them, I bawl my eyes out because that is how she lives her life. I remember she would be cutting blunt beans on the kitchen bench with me, and she might not have seen her all week because she'd been in court. But those hours in the kitchen, talking, cooking, laughing, made me feel like the centre of the universe.

So, her self-care was definitely physical activity. We would walk and talk together. And that's what I do with my kids now. And cooking and veggie gardening. It's so crazy how I've turned to all the same things. I've basically turned into my mum, which is a great thing.

That's beautiful. Now, let’s talk about something that’s relevant forever: your piece on pelvic floor.

This is a huge part of Eat, Sleep, Play, Love, and I involved a pelvic floor physio to write it. And I agree—it's not a glamorous topic. But gosh, it's so important. So many people struggle postpartum regardless of what kind of pregnancy or birth they've had.

The most common thing I see is urinary incontinence: the involuntary leakage of urine. You can also get bowel changes or bowel leakage, and people can develop a pelvic dragging sensation.  

I think we tolerate or accept things as normal that shouldn't be. It's really important we change the narrative. It doesn't matter where you are on your postpartum journey, women will say, "I can't jump on the trampoline because, you know, I'll get wet undies or I can't sneeze." We've almost normalised it. 

It doesn't have to be normal. You can do things to support your pelvic floor. You don't have to tolerate urinary incontinence. I would chat with your GP, a pelvic floor physio, or a women's health physio. Some people find it hard to do the exercises. I've had to tell some patients that I just can't help them; they need to see a pelvic floor physio if they can't quite localise the exercise. But there's stuff you can do, friends. 

Another topic I thought was fascinating was dental care from zero to two. Tell us a little about that.

People often don't realise that stuff needs to happen with the teeth early on. I involved a dentist to help me write it. But, I recall having a patient who came to see me, and their child had a tooth coming through. I asked if they were wiping the gums with a cool flannel. She didn't know she was supposed to. 

But dental care starts really early. The minute teeth begin to appear, you want to start looking after them. You don't need toothpaste, but you should be using a soft little toothbrush. And by about 12 months, you want to be seeing a dentist. And once they have a few teeth, you want to start flossing and cleaning inbetween them. It can be tricky, but we give tips on how to do it with kids lying in your lap and making it fun.

You bring up a lot of research in the section on screen time. Can you give us some comments on it?

Overall, the consensus is that screen time for kids under two isn't good. FaceTime doesn't count, thank goodness, but ideally, it's no screens under two. And the reason is that it promotes sedentary time, and obesity and obesity-related diseases in children are increasing worldwide.

Also, we know screens have a negative impact on concentration, language development and sleep quality because of blue light. Blue light blocks the production of melatonin—the sleeping hormone. 

The reality is, not everyone is doing no screen time under two. So, I give some tips on reducing those risks when using screens under two. Like, having things that get them up and moving, singing or dancing. Reducing screen time in the hour before bed and choosing age-appropriate content.

Plenty of parents will say something like, "I've got three kids at home, and I have to work – I have to use a screen." And I tell them, "It's okay; you're not failing; you're still amazing. Here are some tips on how we can use screens more safely." 

There is no judgement in this book, though, particularly for things like screentime or feeding. Judgement doesn't help.

What did you learn about yourself when writing this book?

That I missed out on a lot of being present in those initial months with my daughter. I really did have a pretty crap time in those postpartum months.

Writing this book was actually quite healing. That birth completely threw me, and I've had anxiety for probably 17 years now, but I've not had a flare since then.

But, writing Eat, Sleep, Play, Love made me realise I missed a lot of stuff with her. Luckily my son was a very healing experience.

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Eat, Sleep, Play, Love is written by Dr Preeya Alexander. For more inspiring conversations, check out other episodes of the Lunch Lady podcast.