Postnatal Depletion and the Path to Recovery

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Featuring An Interview with Dr Oscar Serrallach MBChB, FRACGP

By Emily Holler, Mother and Wellness Blogger

Having a baby is widely celebrated as one of the most magical times in a woman’s life. And indeed it can be. But as many of us know all too well, new motherhood is often far from idyllic. 

Pregnancy and the postpartum period can invoke a whole range of mental and physiological challenges, not least the exhaustion of keeping up with the demands of a newborn. Nutritionally devoid foods, a host of environmental pollutants and the hectic pace of our modern lifestyle often finds women in a less-than-optimal state before even falling pregnant, and by the time our babies are born we find ourselves wondering if it’s normal to feel so utterly exhausted all the time.

And the answer is no, it’s not normal. But sadly it appears to be affecting a growing number of women in our community.

Many new mothers will lack energy, be less interested in sex, experience an intensification of existing medical conditions, find it difficult to cope or just generally feel kind of ‘meh’. These are some of the classic warning signs that you could be in a state of postnatal depletion.

Although giddy with happiness after the birth of my baby boy, my own postnatal experience was fraught with numerous unwelcome challenges. A whole range of unusual symptoms from migraines with aura (hello fuzzy patterns in the sky) to Carpal Tunnel Syndrome, and a pesky bulging disc in my lower back, seemed to steal away a little of the precious joy that accompanied my new role. If only I had known then what I know now…

So here’s the silver lining… the condition can be reversed with the appropriate treatment, and armed with the right information it’s likely we can avoid it altogether. Our very own esteemed (and frankly a little bit famous) Dr Oscar Serrallach has devoted much of his professional life to researching postnatal depletion, and will release his first book on the topic—Mothermorphosis: Your Revolutionary Guide to Postnatal Transformation—in June 2018. He has supported countless women on their path to recovery, so I probed his brilliant mind for some deeper insights…

What led you to become such a pioneer in this field? Is postnatal depletion a phrase you conceived? 

As a doctor who was a bit disillusioned with the medical system, I become interested in functional medicine, which is looking at nutrition, lifestyle and environmental factors. After having my own family I realised what a huge impact these things have on the postnatal period. I found a pattern with postnatal mothers who were really fatigued and struggling to regain their centre. The term postnatal depletion is a phrase I have become known for after I misheard a client saying depression during a consultation. It just made perfect sense and it got me thinking. I’ve devoted my practice and my life to learning about this.

How do I know if I’m suffering from postnatal depletion? What symptoms should I look out for?

I have developed a screening questionnaire as a starting point, which basically looks at things like fatigue, problems with concentration, loss of libido, worsening of pre-existing medical conditions, anxiety, poor memory, feelings of wear and tear, finding it hard to lose weight, and accelerated ageing such as loss of hair and skin becoming more wrinkled. We examine all aspects of the mothers wellbeing, but these are the key aspects that we look at.

Why does this condition occur? Is postnatal depletion purely a physiological condition or are their emotional, or even spiritual components as well?

In traditional society there are very complex postpartum practices where a mother is encouraged to rest for 30-42 days. This is a restorative period, when the mothers body repairs from a hormonal point of view. Our culture doesn’t have these postpartum practices and the average age for childbirth is now 30.9 which is quite different from a generation ago. Sleep deprivation is also a big factor—the average mother loses 700 hours of sleep in the first year.

Another factor is the change of direction and purpose instigating confusion around the women’s role, and an expectation to be the perfect mother who does everything. This is the perfect recipe for depletion. Postnatal depletion occurs on an emotional and psychological level, and on a social and a spiritual level. It’s not as simple as lacking a single nutrient, or having a hormonal imbalance, it’s a multi-factorial condition.

What kind of treatment plan would you recommend if I am diagnosed with postnatal depletion?

I will always do testing to confirm the suspicion that the condition is present. I start assessing micro-nutrients, which are things that mothers need in small amounts but can be very key to how the body functions. These are typically vitamins, minerals and metals. Key to the postnatal period are iron, zinc and managing copper which is often too high while zinc is too low. Vitamin D, B12 and some of the trace elements such as selenium, manganese, magnesium can also be important. Then I look at macronutrients such as protein, fats and carbohydrates. One of these which is almost universally deficient in mothers is an Omega 3 fatty acid called DHA. We look at organ function—typically brain, gut, and liver and sometimes the immune system. The fourth aspect in a womens physiology is hormones. We’ll do blood tests, saliva tests or urine tests to investigate. Hormones are often driving symptoms such as lethargy, brain fog, difficulty concentrating, poor libido and hyper-vigilance but it’s hard to balance the hormones if the former aspects haven’t been addressed. We may give hormones or herbs and suggest restorative practices such as acupuncture, tai chi or yoga.

Is there an element of relearning self-care also?

That’s a big part of it. Often mothers are trying to do everything correctly and will drop all their own needs to look after their children even to the point where they don’t prepare meals for themselves, get enough sleep or wash. This self sacrifice sometimes needs reframing. We look at the woman's relationship with her partner. Often they don’t have an active relationship as it has broken up in the storm of having kids, which is an unfortunate pattern that we see. Women are striving for a healthy home and a healthy family but they often don’t have the mental concentration to achieve it. Mothers have very high expectations of themselves and can really beat themselves up sometimes. The default setting is usually that children come first. No mother becomes a martyr willingly but it’s the end product of not having good role models and trying to adhere to unrealistic norms portrayed on social media.

How long does it generally take to recover from this condition? Do our bodies naturally rebalance over time or is this something we need to actively address to reclaim our health?

The body is very smart and to a degree has self-healing mechanisms. There is a reasonable chance that the body may return to health at some stage but that can take years and sometimes doesn’t happen. I had an 80 year old patient in my clinic last year whose issues had all started after the birth of her second child when she was 33. A great example of a body that wasn’t able to self correct. Some people have internal resilience others don’t; some have great support and others have nobody. For a lot of people the dice is really loaded. In terms of recovery we talk about 100 days. We have the 3 trimesters of pregnancy then there’s a ‘4th trimester’, the postpartum period. After that many are on their way to being well but some mothers will take longer depending on the level of depletion.

How many women do you estimate are suffering from this condition? Is it a global phenomenon or more prevalent in the Western culture?

It is a global phenomenon however it’s more prevalent in the Western cultures because mothers are having babies later. There are very few studies on postnatal health or wellbeing. I’m very keen to do more research as I can’t give an exact number of how many women might be affected, I can only offer my observations from talking to professionals and treating mothers. Many women don’t have the time or resources to seek help.

How can we prevent postnatal depletion? Are there any consistent markers you see in women who are most vulnerable to this condition?

The older a woman is and the more issues she has before pregnancy such as medical conditions, chronic pain or joint issues, the more likely she is to struggle postnatally. Having less support is a big factor. And it exists around a sense of control as well. Mothers who have a strong need to have a sense of control over things are more likely to suffer because their hyper-vigilance and anxiety. A question I like to ask is ‘How much control do you feel you need to have about what’s going on?’ Needing to have control is a risk factor. Whatever a woman can do to recover in that first month after giving birth is so crucial. 

Could postnatal depletion make us vulnerable to other more serious health concerns?

It’s possible but it hasn’t been properly researched. My experience is that mothers who are postnatally depleted seem to have a higher rate of autoimmune disease, more issues with inflammatory disorders such as cancer and heart disease and more metabolic issues like diabetes.

Are postnatal depletion and postnatal depression linked? Do they frequently co-exist with the depletion underpinning the depression?

Yes, it can definitely happen but one does not beget the other. There is certainly a lot of overlap. It’s often about the sense of overwhelm, anxiety, of not being supported; the sleep disturbance, low energy, low mood, low self esteem. There are a couple of key differences and I don’t want the two to be used interchangeably because depression is a quite serious and very separate issue. I can help mothers who have pre-depression and may be starting to slide down that slippery slope using the depletion protocol. I can do a lot to prevent depression from manifesting, but once they are depressed they may need pharmaceuticals and a different level of intervention.

Have women throughout history always suffered from this or is it a relatively new condition that we’ve only just become aware of?

I have spent time lots of time researching this and I conclude that it is a relatively new phenomenon. If you look at the ancient medicine of India—Ayurveda and the ancient medicine of China—Traditional Chinese Medicine, both are very aware that this can happen to mothers. There are beautiful descriptions of what happens to a mother if she’s not cared for, and they have practices set up to prevent it from happening. The potential for it to happen has always been there as it’s part of our physiology but it would have been less common. Now we have older mums, a more toxic world, a less supported world, nutritionally devoid foods, pesticides, chemically based personal care products and chlorinated water. These things on their own may not pose a major threat but together it’s a big load for a mothers body to deal with.

Postnatal Depletion can be potentially devastating for relationships and for families. It impacts the entire community if our mothers aren’t well and therefore not fully engaged in their purpose. Everyone loses in that circumstance.

When is your book due for release and how can we obtain a copy of it?

My book, Mothermorphosis: Your Revolutionary Guide to Post-Natal Transformation (Grand Central Publishing) will be available in June 2018 and can be obtained via my website oscarserrallach.com or from The Health Lodge website.

If you're interested in learning more about postnatal depletion and how to recover from it, please join us for our free wellness event 'Overcome Postnatal Depletion' on Wednesday 4th October 2017. Register here for tickets.