What Is Postnatal Depletion? An Interview With Dr. Oscar Serrallach
By Nicole Gusé
Pregnancy is a transformative experience. First, there’s the nine months of pregnancy itself, followed by the birth, and finally – ending with an actual baby completely dependent on you. If you’ve given birth, even within the last decade, there’s a chance you’re still recovering. Dr. Oscar Serrallach refers to this state of ongoing depletion as “postnatal depletion” and addresses this issue in his latest book, The Postnatal Depletion Cure: A Complete Guide to Rebuilding Your Health and Reclaiming Your Energy for Mothers of Newborns, Toddlers, and Young Children. The question is, how can we set ourselves up to mitigate the physical and emotional load of new mothers and help women regain a sense of health and vibrancy in new motherhood? The answer lies in a deeper understanding of the numerous processes women undergo during pregnancy, and beyond.
Below, Dr. Serrallach offers a more realistic approach to recovery.
Can you provide us some insight into what a woman undergoes, physiologically and emotionally during pregnancy? Pregnancy, and beyond, is a massive transformational experience for any woman. I like this idea around matrescence which describes both the biological and the emotional aspects of becoming a mother. It is a process like adolescence which is the transformation of becoming an adult which, takes several years, is hormonally mediated, involves some turbulence as the adolescence gets used to their new body and way of looking at the world. I believe matrescence is more biologically significant than adolescence and involves a more profound upgrade of the brain and hormonal system than occurs in adolescents. The reason why this is important is that if a mother and her support group and society in general understand this massive upgrade that a mother receives, then we would be better placed to support her during her transition, just as we are supportive and understanding of adolescents going through their transition.
In fact, the time of greatest neurogenesis for a human (that is, the brain making new neurons) outside of being a fetus is for a mother during a pregnancy. The brain makes all these extra neurons to enhance and augment parts of her brain like, taste, smell, facial recognition, and emotional reasoning, just to name a few. Studies show that a mother’s EQ increases during pregnancy, whilst her IQ stays stable or gets only a slight increase. Essentially, this means that a mother “feels” more than she used to. If mothers aren’t aware of this, then it can lead to a sense of confusion and be very destabilizing for a mother at this crucial time when she is trying to make sense of it all. She may be totally unaware of this increased need for connection and harmony for her to feel at ease.
You’ve stated that the syndrome – which you call “postnatal depletion” – can show signs for up to 7 years. What are the symptoms of postnatal depletion, and which do you see most often with your patients?The main symptoms of postnatal depletion include deep fatigue that is not relieved by a night or two of good sleep, and a sense of vulnerability and overwhelm that can be easily triggered and is associated with anxiety, worry, overthinking, and poor concentration. Difficulty remembering names of objects and people is a classic postnatal depletion symptom. Mothers can often experience food sensitivities and physical reactions to things that they were tolerant to before the pregnancy, such as chemicals, dust mites, fabrics and the like. The main drivers of postnatal depletion include a low hormonal state where a mother hasn’t been able to hormonally recover during the first six weeks post-birth. Sleep deprivation, a low nutrient status, and the stress, confusion, and overwhelm that can occur in the first months after the birth are also drivers.
Does postnatal depletion affect all women? Are there any preventative measures for postnatal depletion – either during pregnancy, or possibly before? I don’t think it affects all women, but it is certainly very common and probably affects around half of mothers – especially the more kids you have and the older you are becoming a mother. I also think that many mothers are already depleted, stressed out, and overwhelmed going into pregnancy.
It is definitely preventable, with the main focus being on managing stress both biological and emotional during the conception time and during the pregnancy. Most of us don’t really know how to deeply relax, and part of the care and coaching I like to see pregnant mothers receive is around “learning to relax.” It is called the Relaxation Response and is essentially the way to manage stress. I use the metaphor of “hammock time” which is basically the designated time we set aside for ourselves to relax. Many of us don’t have this time set aside, and when we’re doing our “hammock time” we are preoccupied, distracted, and staying in a state of distress to some degree.
Our modern 24/7 lifestyle and social media have a big part to play in this dynamic. So, we teach mothers tools to relax such as guided meditation, such as iRest Yoga Nidra (an 18 minute guided meditation which uses body awareness) and biofeedback techniques such as HeartMath. Making sleep a priority during pregnancy and in the first year after the birth a baby is paramount. The other side of preventing postnatal depletion is making sure nutrients like iron, zinc, magnesium are optimised and that mothers remain active and reduce sugar intake.
Why do you believe these symptoms tend to go untreated, or unrecognized? Do you believe we need an overhaul of the kinds of care provided to new mothers? As a culture, we have certainly normalized the struggles of motherhood and have normalized issues such as fatigue, baby brain, and the distress that so many mothers deeply feel. The amount of times I hear mothers tell me that they have been told, “you are a mother, you are meant to be tired. It’s normal, so don’t worry about it.” This infuriates me as it is not a normal part of motherhood and for me, when a mother is tired, struggling, or overwhelmed, it means that she is under-supported. This may be unfortunately common, but it is not normal and we run a big risk when we normalize what is common. 1 in 2 adults will get cancer in their lifetime, so getting cancer is common, but is it normal?
In terms of care provided to mothers, I think the first step is to collectively acknowledge the maternal transformation and its unique biology, and then to redefine what we consider postnatal. At the moment, the medical definitions extend to six weeks and six months for physical and psychological issues, respectively. I believe the term postnatal, as I mentioned earlier, should extend to seven years beyond the birth of the baby and have its own speciality around this including, research journals, textbooks and the like.
This might be the first time in history in which we are parenting without a ‘village’ of generational support. Does this have lasting effects on motherhood – not just physically, but mentally and emotionally as well? Yes, as a species this is relatively new territory. We are “social apes” and mothers especially were never intended to be alone and isolated. I love the quote, “it takes a village to raise a mother” and being a mother is a learned skill and it doesn’t necessarily come naturally for many mothers. They need that deep support of other mothers and need to be sheltered from the harsh judgement of our emotionally detached 21st century culture.
It also brings on some very deep issues, including the health of the mother during pregnancy which has a direct correlation to many longer term outcomes for her offspring that may even be passed on to further generations. It also contributes to this idea of the “mother wound” or the term I prefer, “the matrilineal wound,” where the trauma of being unsupported as a female and as a mother gets unconsciously passed onto the next generation in various guises.
Talk to us about the push to “get back” to it all – body, career, feeling like yourself again. Is there a more realistic approach to recovery? I feel this is a harmful narrative for many mothers as they go through the transformation from maiden to mother, and then feel this cultural pull to try to go back to being a maiden. This makes no biological or social sense to me and is akin to and adult trying to go back and being a child after they have been through adolescence.
We don’t embrace aging in a healthy way in our society, and place much fear around “not being young.” A lot of this cultural energy goes into motherhood. A more realistic approach would be to embrace motherhood in all its facets, and celebrate the beauty of aging and the acquisition of the skills and knowledge of motherhood. As a society, we need mothers in our communities and in our workplaces to bring this family wisdom and mother energy to help us get out of this “factory worker mindset” we have been indoctrinated with, and bring in the core values of family well-being into every aspect of our society. I don’t know how we are going to look after mother earth when we can’t really support and look after “mothers.” Mothercare is certainly, for me, the starting point for societal repair!
What is a general prescription you would provide to a new mother to begin feeling her best self again? I encourage all pregnant mothers to not only have a birth plan, but also a great postnatal plan which allows for the deep hormonal recovery of the mother. It can also be empowering for the father and other caregivers to have plan to minimize needless stress and socializing in the first few months. Our saying in the clinic is in the first 2-3 months, no visitors only staff. If people are coming over, give them jobs to do – bringing meals, preparing food in the kitchen, helping with chores, and ideally it is not the mother having to organize this.
After the birth of baby I recommend:
– One month deep rest
– 100 days deep support
– One year priority on sleep
Practicing relaxation and self kindness goes a long way, and supplements can make a big difference in helping course-correct a mother back onto the path of wellness.
In terms of supplements, I tend to prescribe a six week course of a supplement with re-evaluation either with symptoms or testing.
Iron Bisglycinate 15-24 mg daily (elemental dose) for 6 weeks can be very useful to help with low iron levels and has a very low rate of digestive upset.
DHA Fish Oil or Algal Oil is a great starting point, and I recommend 1gm DHA for mothers for six weeks or 1.5gm daily if you are breastfeeding.
Choline at 175mg daily for six weeks can be really useful for concentration.
Zinc Picolinate or Citrate at 25mg daily with food for six weeks can help mental function and immune function.
Magnesium (the mother of minerals) or ‘Mum-nesium’ can be great for sleep and relaxing muscles. I usually use simple forms of Magnesium like Magnesium Citrate or Glycinate at 150mg once or twice per day. It’s great before bed.
Herbs for mothers are fantastic and I like to use Ashwaganda, Shatavari, and Tulsi as a triad of support. If breastfeeding, I tend to leave out Shatavari, not because it might be harmful but I haven’t seen good safety data yet.
Other supplements I tend to do testing before recommending.
Other useful interventions are essential oils, such as lavender in an oil diffuser and epsom salt foot baths before bed. Both are relaxing and centering.