The Postnatal Depletion Cure

Introduction

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.

MY STORY

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:

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.