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The Postnatal Depletion Cure
A Complete Guide to Rebuilding Your Health and Reclaiming Your Energy for Mothers of Newborns, Toddlers, and Young Children
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Any woman who has read What to Expect When You’re Expecting needs a copy of The Postnatal Depletion Cure. Filled with trustworthy advice, protocols for successful recovery, and written by a compassionate expert in women’s health, this book is a guide to help any mother restore her energy, replenish her body, and reclaim her sense of self.
Most mothers have experienced pain, forgetfulness, indecision, low energy levels, moodiness, or some form of baby brain. And it’s no wonder: The process of growing a baby depletes a mother’s body in substantial ways–on average, a mother’s brain shrinks 5% during pregnancy, and the placenta saps her of essential nutrients that she needs to be healthy and contented. But with postnatal care ending after 6 weeks, most women never learn how to rebuild their strength and care for their bodies after childbirth. As a result, they can suffer from the effects of depletion for many years, without knowing what’s wrong as well as getting the support and treatments that they need.
I have written this book to answer a question many women ask: “How do I get my life and myself back after becoming a mother?” How do you find the strength to deal with your needs when our society tells us to focus entirely on the needs of the baby, causing you to disappear into the shadows of your predestined role? This infant-centered focus is something I witnessed in my practice as a doctor and as a father watching my extraordinary partner, Caroline, struggle after the birth of our children. It has been consistently mentioned by almost every mom I’ve spoken to, in contexts that vary from energy to illness to time management to self-confidence.
This is a huge hole in our thinking and treatment of new mothers. Worse, it’s a hole that gets bigger and bigger because it’s not discussed from a medical point of view. Postpartum depression, yes. Postnatal depletion? Say what? There’s not even healthy dialogue around this concept, let alone healthy societal awareness and information.
What’s just as, if not more, important to note is that postnatal depletion doesn’t just affect new mothers—it affects all mothers. If a new mom isn’t allowed to fully recover from the demanding requirements of pregnancy and birth, the aftereffects can last for years. I’ve treated women who were still depleted ten years after their babies were born. And if you then take into account the stress and sleeplessness associated with raising tweens and teenagers, coupled with the hormonal effects of perimenopause and menopause, it can become a pretty grim journey if mothers aren’t truly supported and allowed to recover.
I know that this condition is real, and I know there is no need for you to suffer. There is almost a subconscious badge of honor associated with a mom’s ability to juggle motherhood and child care with returning to work as soon as possible. Our Western culture has done mothers a great disservice by not honoring them on their road to recovery and giving them the time they need to adjust to the monumental changes in their lives. This needs to change! It is my hope that I can play a role in helping change the narrative of how we think about postpartum care, and it is urgent that we do. It was out of necessity that I went on a quest to help my darling partner, Caroline, back to health. But she helped me discover the reasons why mothers get so depleted, and what can be done to help them back to full functioning.
Nimbin is a small, quaint town about an hour’s drive inland from Byron Bay, which is Australia’s most eastern point in the state of New South Wales. I moved there in 2003, feeling unfulfilled as a doctor and needing a change to jolt me out of my career rut. I’d been a medical mercenary up until then, chasing jobs from city to city, working on everything from drug addiction to indigenous health to psychiatry to being part of the Emergency Department team in the coastal town of Ballina.
Unlike most other areas of medicine, emergency medicine is uncompromisingly simple: patients have specific needs that we can treat on the spot. I really enjoyed the camaraderie, and my schedule left me time to learn how to surf, practice my guitar, and be a player-coach for my local soccer club. But a deep restlessness and frustration led me to Nimbin, a town renowned for being a center of counterculture in my country; even though I didn’t buy into the town’s somewhat notorious hippie ethos of “free love and drugs,” I dove into the deep ecological consciousness that was also an integral part of living in this area. I met many inspiring people with thought-provoking ideas. This is where my evolution as a doctor began.
At a music festival in 2003, I met Caroline Cowley, who soon became my life partner. Although she was a high-flying professional, born and bred in the metropolitan city of Melbourne, I was able to convince her to come live in the sleepy countryside surrounding Nimbin. We fell deeply in love and got very caught up in the romantic idealism of self-sufficiency. We created a thriving garden and spent many hours working on the land. It became quickly apparent to us that in this idyllic scenario we wanted to start a family, which led us to become involved in the thriving local home-birth community.
Having been trained in orthodox medicine, it was not an easy thing for me to embrace the idea of our first child being born outside a hospital setting. It took many meetings with home-birthing moms, experienced midwives, and doctors who’d had home births with their own children to finally warm me up to the idea. I tapped into an incredible amount of support and information about prenatal and postpartum care, from books, workshops, and mothers we met. One of the most wonderful experiences was when Caroline had a “blessingway ceremony”—a tradition in the Native American culture in which the mothers sit in a circle and share stories in support of the mother-to-be. As the father-to-be, I was taken on a ceremonial walk by an aboriginal friend of mine to a sacred area to celebrate my up-and-coming role. It was a beautiful experience and made me feel part of the long, ancient history of generations birthing generations. Still, I couldn’t help myself: I wrote a very detailed birth plan in case we did need to make the transfer to hospital!
Caroline and I were very fortunate to have a beautiful and totally routine home birth with our first child, Felix, surrounded by family and loved ones. Our local community even organized a meal-delivery roster for a full two weeks, so we didn’t have to think about what to cook when we were sleep deprived and adjusting to our amazing little baby. The instant quagmire of parenting left us overwhelmed with decisions. Do we use cloth diapers or disposables? Should we use a pacifier? How long should Caroline breastfeed? Why was the baby crying? As any parent will tell you, as soon as you answer one question, a new one arises—as do the judgments and criticisms (however well intended) of friends, loved ones, and, of course, all those “well-meaning” strangers.
A similar pattern occurred with our next two children, Maximo and Olivia. Caroline became more and more exhausted with each new baby, and we reached a crisis point soon after the birth of our third child, Olivia. Caroline’s memory and concentration were shot. She felt as if she were drowning in her own sense of overwhelm, she had constant brain fog (commonly called baby brain), she suffered from a loss of confidence and a feeling of isolation, and she was not able to take care of herself fully. She was extremely fatigued, suffered anxiety, felt her sleep was superficial at best, and had a deep fear that she was never going to recover.
As my worries about my wife deepened with each passing day, I remembered a patient I’d had when I first started working at the Nimbin Medical Centre—a gaunt mother named Susan. In her midtwenties, she already had five young children, and not surprisingly she was exhausted and finding it difficult to cope. She was extremely anxious during our appointment, and it was hard for her to describe exactly what was bothering her and how she was feeling, aside from general stress and utter fatigue. I was concerned and wanted to do everything that I could to help her. I ordered blood tests to make sure she wasn’t anemic and did a postpartum-depression screening test. I helped her arrange a social-worker appointment and a community-nurse home visit. When the blood work came back showing that she had low levels of iron, we discussed how this would have been contributing to her fatigue. We looked at ways of increasing iron in her diet while starting a simple iron supplement. Susan came in for her next appointment and I gently suggested that a referral to a counselor or psychologist might help her feel a lot better. I was just starting to pat myself on the back for a job well done and for going the extra mile for someone obviously in need—especially as my appointments with Susan always took closer to forty-five minutes than the usual twenty I was allotted—when she suddenly stood up and said, “God, I have to go.” She grabbed her handbag and ran out the door before I could say a word.
The next week I followed up with the community nurse who had visited Susan at home. The nurse told me that Susan was feeling a little bit better and did not require our services. I was very surprised. I couldn’t shake thinking about how Susan had seemed so distraught, running on empty, when I’d seen her.
Nearly eighteen months went by before I saw Susan again—this time in the ER of our local hospital with a bad case of pneumonia. She’d had another child by then and looked as exhausted and stressed-out as the first time I’d seen her. I admitted her to the hospital early in the morning to administer intravenous antibiotics, yet by late afternoon she stated that she was feeling better and was adamant that she had to go home. The meds had barely started to work, and she was discharged against medical advice. I haven’t been able to find out what happened to her and her family, and I still wonder about her and worry how she’s doing.
Desperate by this point to help Caroline on her road to recovery, I’d been keeping copious notes about my patients. I thought of other mothers I had seen—not all of them with symptoms as extreme as Susan’s, but with similar issues. They were mothers like my own partner, who was, I realized, far from unique in her suffering. These moms loved their children. But they were also miserable and completely drained. They were not themselves and seemed to have given up hope that they might ever recover their vitality. What if all my patients with similar, recurring symptoms had the same condition? What if the physical depletion caused by the demands of their pregnancies started a cascade effect of all these other things that left them exhausted, anxious, and miserable?
With the notion of postnatal depletion fueling me, I realized there was a pattern—something I could investigate. I started to trawl through the medical literature and textbooks, and I was speechless to find that almost nothing had been written about what seemed to be such an incredibly important topic. All I could uncover was information on postnatal depression and some small-scale studies looking at postnatal fatigue. Caring for the baby was the dominant topic. Completely overlooked were the moms needing care for themselves so that they could best care for their babies, and there was in fact nothing at all about postnatal depletion.
It was a lightbulb moment. I began to look outside of Western medicine for ideas on how to better support a mother’s needs after she gives birth. I read about the ancient wisdom of many indigenous cultures in which the time for mothers to fully recuperate was deeply respected and etched into the very social fabric of these cultures. These new mothers were supported by others in their community during this time of recovery: they were allowed to regain their strength, rest, and recuperate while bonding with their newborns. In our society, however, the typical dialogue tends to revolve around when the mother is going back to work and not much else.
I have no doubt that nearly all moms—no matter when they gave birth—can fully recover from postnatal depletion, regaining health and wellness far beyond what they have experienced in the past. I have seen the recovery process firsthand. With this book, I hope to give you the tools you need to restore your energy and sense of well-being.
HOW TO USE THIS BOOK
The book is divided into four easy-to-use parts:
In part 1, “Defining Postnatal Depletion,” I explain the causes of postnatal depletion and provide details about the physical, mental, and emotional conditions it creates, as well as why these conditions occur and can worsen during pregnancy and following birth. I also identify specific symptoms associated with postnatal depletion, giving you an understanding from a medical point of view about why you’re feeling so lethargic and unlike yourself, and I describe how non-Western cultures treat the postnatal period. There’s an awful lot of wonderful wisdom in how these societies regard and support new moms.
In part 2, “One Hundred Days of Repletion: Rebuilding Physical Wellness,” I describe how to replace vital micronutrients and macronutrients that will help your body recuperate. I also discuss how to rebuild your hormones and your energy and how to get the deep, sound sleep you really, really need!
In part 3, “The Second and Third Trimesters: Completing Physical Recovery,” I also tell you exactly what to eat and when for optimal nourishment. This will not only diminish your depletion, but, if you’re breastfeeding, give your baby the ample rewards of your nutritious and delicious eating. In addition to this food plan, I also offer you a structured exercise/movement plan that is gentle and simple and costs you nothing. Without your even realizing it, these plans will help you lose the baby weight in the healthiest way possible.
In part 4, “Recovering Your Life,” I show you how to focus on your emotional well-being, get your libido back, and improve all your important relationships. I also give you the information you need to set up your home and environment in a way that better supports your health in the long term.
The appendixes give you an accelerated recovery plan should you need to return to work, along with recipes, meal plans, and resources.
Through my own experiences as a father and husband, and in my professional work in integrative care, I have devoted my career to the treatment of postnatal depletion. Now, nearly a decade after I first started researching this phenomenon in earnest, I’ve written this book to give all moms (and their loved ones) the vital information they need to understand what will happen to their bodies, minds, and souls before, during, and after pregnancy. My goal is to give you the hope and support you deserve and to ease your worries—especially if you are feeling hopeless, as my partner once did. I’m going to give you all the tools you need to speed up your recovery and leave you feeling stronger, happier, and fully engaged with your baby and everyone else in your life. Your body has created a miracle, so let me show you how to find your way back to a full recovery.
Defining Postnatal Depletion
What Is Postnatal Depletion?
Having a baby is one of the greatest joys a woman can experience. Making a new life is miraculous, life changing, and monumental. Seeing your baby’s face for the first time is a wonderfully loving moment like no other.
Yet this magical life change can also create a perfect storm to destabilize a woman’s psyche. I’ve seen so many women go from highly functioning, world-traveling, happily ambitious, contented, emotionally centered, and utterly competent and organized professionals to zombie-like diaper-changing milking machines practically overnight. As you know, the physical act of nurturing a baby inside your body requires a huge amount of resources. Your body is designed to give that baby everything he or she needs to make it to term—often at your expense. This is due to the incredible ability of the placenta, through intriguingly complex mechanisms, to coerce and then extract what it needs from the mother.
And then, when it’s time for the baby to be born, the physical act of delivery also takes its toll—that’s why it’s called labor! You might not know that it’s very common to lose blood during an uncomplicated vaginal delivery; the average amount is about 17 ounces—more than 2 cups!—which is about what you would be allowed to donate at a blood bank. The average amount of blood loss for an uncomplicated cesarean birth is approximately twice that, at 34 ounces.
If you’re breastfeeding, the process might be satisfying, especially as you know your baby is getting proper nourishment, but it is also taxing due to the caloric and specific nutrient demands put on your body that making breast milk entails. Add into the mix ongoing sleep deprivation, the preset expectation of self-sufficiency that society has conditioned you to believe (think “I can do it all” and “My baby will never cry”), unending and repetitive chores, a body that feels forever changed, an often-hurried diet, and a total change of life direction.
Enter the well-meaning yet unhelpful comments, critiques, and endless comparisons to your friends’ and family members’ perfect little sleepers, who latched on to the breast without a peep (while your nipples are so sore you think they’re about to explode), and early motherhood can begin to feel much more like a gauntlet to survive than a rewarding experience to enjoy.
WHAT EXACTLY IS POSTNATAL DEPLETION?
Postnatal depletion is a constellation of symptoms affecting all spheres of a mother’s life after she gives birth. These symptoms arise from physiological issues, hormonal changes, and interruption of the circadian day/night rhythm of her sleep cycle, layered with psychological, mental, and emotional components.
Think of your body as a plastic bag full of water. The more water in the bag, the better you feel and the better you are able to cope. Each day of pregnancy, the birth, each sleepless night, each long day of breastfeeding, is like putting tiny pinpricks in the plastic bag. You can repair these holes, but it takes a little time. When there are only a few sticks of the pin, only a very small amount of water escapes the bag. The trouble, though, is when the holes start to come more quickly than you can repair them. Such is the body after childbirth; when there are too many stressors and not enough time to recover, your levels become depleted. Depending on the severity of depletion, the postnatal period can last for years after the baby is born—you can be left with a bag so filled with holes that it takes a long time to repair and refill. In the worst-case scenarios, I’ve even seen the depletion pattern occurring decades later. None of this suffering should continue for so long!
At its core, postnatal depletion is the understandable outcome of a series of less-than-ideal events leading to depletion of a woman’s well-being at multiple levels. There are three primary factors at play here:
1. The nutrients given over to making, incubating, and birthing the baby are enormous, and this depletion continues after the birth for women who are breastfeeding.
2. Bone-gnawing exhaustion can occur from sleep deprivation—the result of never having a good, refreshing night’s sleep.
3. The drastic change of a new mother’s role is often accompanied by social isolation, which can have a deleterious effect on a woman’s psychological well-being.
Postnatal Depletion Is a Syndrome
In my many years of studying postnatal depletion, I’ve found incredibly few texts written about it. It’s important to understand why, because in order to get the best treatment, you’re going to have to think outside the box, as I have learned to do.
I view postnatal depletion as a spectrum on a scale from mild and moderate to severe. I view postpartum depression as a separate condition, but with a strong overlap of symptoms and issues with postnatal depletion. There are two important points that differentiate them. Postpartum depression is marked by true clinical depression that is pervasive, and it is also marked by “anhedonia,” which is a state in which a person takes no pleasure or joy from a situation or experience that in the past would have given them pleasure or joy. (Having a much-wanted baby is obviously that kind of situation.) Postpartum depression can be dangerous and must be treated by trained and competent mental-health professionals.
With postnatal depletion, I realized I needed to push past my medical school training and find a better system than the linear-thinking model, because my patients were suffering and my conventional treatments weren’t working. The linear-thinking model, on which conventional modern medicine is based, posits that cause A leads to effect B. In this model, effect B can be caused only by cause A. There is no other explanation. I’m sure you’ve dealt with this situation if you’ve ever gone to a doctor with certain symptoms, only to have them dismissed because they weren’t “typical.”
Try thinking of a room as a set of symptoms and signs that someone may typically experience with a disorder or a condition. When there is only one door into that room (such as cause A leading to effect B; for example, you have hypertension or high blood pressure, leading to damage in your arteries related to plaque buildup and a subsequent higher risk of strokes and heart attacks), that room is called a disease. Modern medicine does an excellent job of dealing with diseases. A syndrome, however, is a set of commonly experienced symptoms usually caused by many different factors—this would be as if the room had many doors into it, and it was not immediately clear which door led you into the room or set of symptoms.
Western medical doctors tend not to like syndromes because the linear-thinking model is too simplistic for effective treatment. But that’s what postnatal depletion is.
Postnatal depletion also involves many mineral, vitamin, and nutrient insufficiencies; a disease process typically deals with a deficiency. It’s important to understand the difference between these two words. Insufficiency is where the level of a mineral, vitamin, or nutrient is not in the disease-producing range, but in the suboptimal range. In other words, an insufficiency won’t give you a disease, but it means that your cells and organs are not able to run properly. This, in turn, can make you feel terrible.
POSTNATAL DEPLETION FACTORS
Before motherhood, the typical modern woman with her busy, high-paced life is usually already close to the maximum capacity of what she and her body can handle. Conception and pregnancy require huge amounts of physical resources, and then the baby’s delivery (whether by cesarean or vaginal delivery) places further strain on these physical resources—and this is just day one of being a mother! Breastfeeding or bottle-feeding a baby requires more precious resources; the average child needs 1 million calories of food before he or she is independent. Throw sleep deprivation into the mix, and it’s no surprise that moms can feel overwhelmed, overworked, overstimulated, and overneeded.
In our society, the time and resource demands of motherhood are higher than ever. And unfortunately, it’s becoming increasingly difficult for parents to easily access the nonhired help of family and community to assist in looking after children. This mismatch between expectation and support, stacked on top of nutrient depletion, leads directly to mothers feeling overwhelmed A new mother’s biology is not designed and shouldn’t be expected to have to deal with this level of ongoing and constant demands.
In my clinic, I do not see mothers who have failed or who are not trying hard enough. What I do see every day are mothers who are physically and emotionally depleted, exhausted, and stressed. They are at the end of their tether with no relief in sight.
Let’s take a deeper look at the four main factors causing postnatal depletion.
As a modern mom, whether a wife, partner, or single, you know all about stress. You’ve likely spent years building a satisfying career, but even with help from your partner, you still need to shop and cook and clean and budget and get a new muffler for the car. You want to make time for your friends and loved ones, and you long to find a few minutes for yourself every day. You might have delayed motherhood due to the need to work or other financial considerations. This is a fairly recent trend; the average age in Australia of a mother having her first baby is 30.9 years. In the United States, according to the Centers for Disease Control and Prevention (CDC), the average age is 26.3. How can you not feel vulnerable? Maybe you don’t have a very family-friendly job and are allowed no more than a few weeks of parental leave, so you’re already worried about how to pay for child care. Yep, you’re stressed… and then along comes baby!
Motherhood is messy business; changing endless dirty diapers and washing baby puke out of your favorite shirt is humbling. How can you not be stressed when the baby is feeding what seems like 24/7 and you haven’t slept properly in a month? This is compounded by physical stressors: your body has been taxed by pregnancy and childbirth, by the demands of breastfeeding, by sleep deprivation, and by all the other demands associated with caring for another human being. Also, if you’ve had your baby later in life, the stress can be even more difficult to manage because you’ve had more time to establish your own routines, which are now being radically overhauled by your little one.
From a medical point of view, the focus on postpartum care is almost always on the needs of the baby, not the mother—unless the mother is showing signs of serious postpartum depression.
I see this happen all the time at the medical centers where I work, at parents’ groups, at child-care centers, with friends and families of friends, and in our general community. One of the strangest things that struck me was an unspoken competitiveness, which stemmed not so much from new parents but from society in general.
Take the birth itself. After the ordeal of childbirth, a message is sent out to the world stating the arrival of the baby and broadcasting the length of labor, the drugs used (or not), and the baby’s weight and gender. (If you’re really lucky, you’ll be told what the Apgar score is, too!) “Mother and baby are doing well” is the typical message. But that is the last time mother shows up in the same sentence as baby. This begins what is potentially an unhealthy dialogue in which intense focus on the baby is accompanied by a decided lack of pragmatic and emotional support for the baby’s mother.
The reality of modern parents is that the first time they are deeply involved in looking after a child is usually with their own baby. This is so common that we don’t even think about it, but that’s really a crazy fact! It’s like driving a car for the first time in rush-hour traffic without ever having taken lessons or receiving a license—and with no road map provided. For many people, parenting is an abstract concept—until it’s 3:00 a.m. and they’re holding an actual screaming baby who won’t settle down no matter what, leaving them delirious with exhaustion. From a social perspective, the only feedback that a new mother is likely to get is in the form of cultural values, competitiveness, and conflicting advice from other “parental drivers.” This is a guaranteed recipe for self-doubt and parental anxiety.
- "When Dr. Serrallach first wrote about postnatal depletion on goop, he hit a nerve-particularly with the revelation that some women in his practice experience the after effects of having a child for 7-10 years later. It shouldn't be this way, nor does it have to be: This is the comprehensive guide to women's health for every mother-new, or years out-who has ever felt tired, rundown, or just not like herself. With great empathy and wisdom, Dr. Serrallach explains how to restore your health and vitality using nutrition, gentle exercises, and simple strategies to get you to finally feel like yourself again."—Gwyneth Paltrow
"The best programs and solutions for health issues are born of doctors that want to help themselves or their loved ones. That is how Dr. Serrallach arrived at his understanding of postnatal depletion, and what makes this book so helpful to women with the same issue, which is a world epidemic. His book is aguide to reclaiming optimal health that any mother who has given birth in the last seven years should read."
—Alejandro Junger, M.D., New York Times bestselling author of Clean, Clean Eats, and Clean Gut and founder of the acclaimed Clean Program
- "Thank you Dr. Serrallach for writing this very eye opening and super important book! Postnatal depletion effects all moms, new or years out. It's so important to properly take the time and space to heal from your pregnancy and birth especially, in a culture where "getting back to normal quickly " is applauded. We all know it takes time for the new normal to work itself out, and you can't rush a process if you want it to have lasting, good and healthy results. I'm literally making all my clients and their partners read this as part of my pregnancy, doula and new mom coaching!"—Lori Bregman, celebrity doula, pregnancy and new mom coach; author of The Mindful Mom To Be
- "Moms, let's be real: having a baby is hard. It can wreak havoc on your energy, your body, and even your concentration. Post-baby, women need to practice self-care more than ever before, yet have less time than ever before. With great compassion and creativity, Dr. Serrallach proposes an answer-we can make little changes to our sleep habits, our eating habits, the way we talk to our loved ones, and to our expectations for ourselves to protect and fortify ourselves every day. Every woman deserves good health, and The Postnatal Depletion Cure will show you how to reclaim yours."—Dawn Dais, author of The Sh!t No One Tells You: A Guide to Surviving Your Baby's First Year
- On Sale
- Jun 5, 2018
- Page Count
- 304 pages
- Grand Central Life & Style