Postnatal Depletion

Consider this: If youve had a child within the last decade, you might still be suffering some
consequenceslethargy, memory disturbances, and poor energy levels, among other symptoms.
And according to Dr. Oscar Serrallach, a family practitioner in rural Australia, its not just because
being a parent is hardphysically, the process of growing a baby exacts a significant toll. The
placenta passes nearly 7 grams of fat a day to the growing baby at the end of the pregnancy term,
while also tapping into the moms iron, zinc, Vitamin B12, Vitamin B9, iodine, and selenium stores
along with omega 3 fats like DHA and specific amino acids from proteins. On average, a moms
brain shrinks 5% in the prenatal period, as it supports the growth of the baby (much of the brain is
fat) and is re-engineered for parenthood. He has spent the majority of his career witnessing this
syndrome, which he calls Postnatal Depletion, first-hand, watching as women failhormonally,
nutritionally, and emotionallyto get back on their feet after the baby comes. Dr. Serrallach first
became tuned in to it when he encountered a patient named Susan, a mother of five children, who
was so emaciated and depleted that she was visibly running on empty. After an extensive visit
where he ran bloodwork, and proposed nutritional and emotional counseling, she looked at the
clock and bolted. And he didnt see her again: Until she turned up in the emergency room with
pneumonia so evolved that she needed intravenous antibiotics. She spent less than a day, before
checking herself out against his orders. That image stuck with himof a woman ripping out an IV
to rush back to her familyand its representation of a mother sublimating all of her own needs to
serve her children. Part of the brain shrinkage mentioned above, Dr. Serrallach explains, is
reprogramming: It supports the creation of baby radar, where mothers become intuitively aware
of their childs needs, if they are cold or hungry, or if they cry at night. This hyper-vigilance
becomes dangerous for the mother when she, in turn, is not supported. When his own wife had
their third child he observed that she too was totally destroyed, and unable to get back to feeling
like herself. Sound familiar? All the moms at goop think we have it. There is plenty of prenatal
support, he explains, but as soon as a baby is born, the whole focus goes to the baby. Theres
very little focus on the mother. The mother disappears into the shadows of her role. As in all
things, knowledge is power: Below, Dr. Serrallach outlines exactly what you need to do to shake
the brain fog, regain your energy, and get back on your feet.Q

Can you take us through what happens to a mom physiologically and

emotionally as the baby grows?
What is happening in our society is that many mothers-to-be are already depleted leading up to
the conception and pregnancy time. Natures design is that the developing fetus will take all that it
requires from its mother. The go between to ensure that this happens safely is the placenta. The
placenta is unique in humans in terms of how extensively the finger like projections of the
placenta reach into the womb lining, thus creating a massive surface area. The reason for this lies
in the fetal brain and its huge requirement for energy and fat (in the form of specific fatty acids
such as DHA). Toward the end of the pregnancy, up to 7 grams of fat pass across the placenta
each day to feed and build the baby (much higher than any other animal). Also, 60% of the total

energy that goes to the baby via the placenta is to feed the brain (other primates, including
gorillas, have a figure of around 20%).
The placenta serves two masters: the growing baby AND the mother. During the pregnancy, the
mother supplies everything that the growing baby needs, hence why so many mothers become
low in iron, zinc, Vitamin B12, Vitamin B9, iodine, and selenium. They also have much lower
reserves in important omega 3 fats like DHA and specific amino acids from proteins. The placenta
also tunes the mother to the baby, and the baby to the mother. This is no accident. The placenta
develops at the same time as the fetal hypothalamus (a hormone producing gland in the babys
brain) and the hormones produced by the placenta look very similar to the hypothalamic
hormonesagain no accident. A beautiful example of this occurs during birth. What causes labor
pains (contractions of the uterus) is oxytocin, which is also known as the love hormone. As the
baby is squeezed through the birth canal, its hypothalamus produces oxytocin which ends up in
the mothers blood stream, causing more contractions. It is as if the baby is assisting the mother in
its own birth. Once the baby is born, there are huge amounts of oxytocin in both the mother and
the baby, literally creating this love fest they call the baby bubble. This needs to be encouraged
and respected, and caregivers and fathers need to be aware of the importance of this time postbirth, when the bond between mother and baby is established. Breastfeeding then keeps this bond
strong. This is natures design, so the further we drift away from this in terms of interventions such
as caesarian surgery, and opting not to breastfeed, the more we can expect the cascade-like
flow on of compromises in the postpartum period and beyond, for mother and baby.
Part of the job of the placenta is to reprogram the mother. Its as though she gets a software
upgrade, with some parts of the brain being reinforced and other parts of the brain being
lessened. The average brain shrinkage during pregnancy is about 5%, but it is not so much the
brain getting smaller, but rather being modified to acquire the skills to become a mother. This is
not discussed or respected enough in our society, and I feel mothers need much support and
acknowledgement for this new phase of life. Part of this upgrade is the acquisition of the baby
radar, where mothers become intuitively aware of their childs needs, if they are cold or hungry,
or if they cry at night. This hyper vigilance is obviously vital for the survival of the child but if living
in an unsupportive society, it can lead to sleep problems, self doubt, insecurity, and feelings of
unworthiness. An extreme example of how this can work to the mothers detriment is the mother
who discharged herself from hospital with pneumonia because she needed to get back to her
childrenwithout any external support, her upgraded program told her to take care of her children
even if it means sacrificing her own health.

Youve identified a syndrome in mothers, which you call Postnatal Depletion

what is it exactly?
It is the common phenomenon of fatigue and exhaustion combined with a feeling of baby brain.
Baby Brain is a term that encompasses the symptoms of poor concentration, poor memory, and
emotional lability. Emotional lability is where ones emotions change up and down much more
easily than they would have in the past, e.g. crying for no reason. There is often a feeling of

isolation, vulnerability, and of not feeling good enough. It is experienced by many mothers, and
is an understandable and at times predictable outcome associated with the extremely demanding
task of being a mother from the perspective of both childbearing and child raising.
Along with these features, I have identified a typical associated biochemical fingerprint that is
partly the cause of and partly the result of postnatal depletion.

How many women do you believe it affects? And for how long?
I suspect up to 50% of mothers will have some degree of postnatal depletionpossibly more, but
because of the focus of our clinic I would have a slanted view. I dont tend to have mothers
seeking my helping who are feeling amazing.
Postnatal depletion, I feel, can affect mothers from birth until the time the child is 7 years of age
(possibly longer). There is a lot of overlap between postnatal depletion and depression in terms of
symptoms and biochemical findings. For some women postnatal depression occurs at the severe
end of the spectrum of postnatal depletion.
In Australia, the peak incidence of postnatal depression is four years after the child is born, not in
the first 6 months which was previously thought to be the time of highest incidence of depression.
This shows that postnatal depression is an accumulation of factors from the pregnancy, delivery,
and post childbirth. This is also the case for postnatal depletion though many mothers with
depletion dont experience depression and it is possible to have postnatal depression without the
depletion.

What are its symptoms?

Fatigue and exhaustion.

Tired on waking.

Falling asleep unintentionally.

Hyper-vigilance (a feeling that the radar is constantly on), which is often associated with
anxiety or a sense of unease. I often hear the words tired and wired describing how mothers feel.

Sense of guilt and shame around the role of being a mother and loss of self esteem. This is often
associated with a sense of isolation and apprehension and sometimes even fear about socializing or
leaving the house.

Frustration, overwhelm, and a sense of not coping. I often hear mothers say: There is no time
for me.

As mentioned, brain fog or baby brain.

Loss of libido.

What are its causes?

It is multifactorial.
1.

We live in a society of continual ongoing stress and we literally dont know how to relax or
switch off. This has profound effects on hormones, immune function, brain structure, and gut
health.

2.

Woman are having babies later in life. In Australia the average age for a mother having her
first baby is 30.9 years.

3.

Women tend to be in a depleted state going into motherhood with careers, demanding
social schedules, and the chronic sleep deprivation as the norm in our society.

4.

As a society we tend not to allow mothers to fully recover after childbirth before getting
pregnant again. It is not uncommon to see the phenomenon of a mother giving birth to two
children from separate pregnancies in the same calendar year. Also with assisted reproduction
we are seeing higher rates of twins which will obviously exacerbate any depletion.

5.

Sleep deprivation of having a newborn with some research suggesting that in the first year
the average sleep debt is 700 hours! Reduced family and societal support is very common.

6.

Our food is becoming increasingly nutrient poor. We are in many cases having 2 mouthfuls
of food for 1 mouthful of nutrition.

7.

Though poorly studied, there are specific aspects of the 21st-century lifestyle that are
contributory to postnatal depletion. This includes environmental pollutants such as air
pollution, heavy metals, chlorinated water, and electrosmog to name a few.

8.

There is a perceived notion that the mother has to be everything and as result many
mothers suffer in silence and are not receiving education, information, or support. Multigenerational support groups for mothers have been part of indigenous cultures for millennium
though they are sadly absent in our post-industrial culture.

9.

The phenomenon of inter-generational epigenetic changes in the expression of our genetics

is very complex but explains in part the higher rate of allergic disease and autoimmune
disease that we are seeing in our society. In short we cannot do the same as what our parents
or grandparents did and expect the same level of health. We literally have to up our game
just to experience the same level of health as our parents, let alone experience better health.

Where should women start in terms of starting to feel like themselves

again?

In our clinic we talk about the four pillars of health: Sleep, Purpose, Activity, and Nutrition. I use
the acronym SPAN to illustrate this, alluding to the fact that while our lifespan is getting longer,
our health span (the years of independence and health) in society is getting shorter. We address
all four pillars with the repletion, recovery, and realization parts of our program. As a mother
graduates from each level we look at each pillar in more depth knowing we can gain traction with
the work that has been done at the previous levels. Giving too much information can be
overwhelming and unnecessary but to regain and maintain vitality it is important to continue the
journey of improvement. Trying to give a mother information about specific food additives, plastics
to avoid, pesticides to be aware of, cleaning products and cosmetics that may be contributing to
fatigue and hormonal issues may be total overwhelm for a mother in the repletion phase of her
program when she has fatigue and a foggy brain. But this same information is most necessary in
the recovery phase to enable continued ongoing health and wellness not only for herself but for
her family and community.
We use a 3-step program as a guide to help mothers.
REPLETION and REBUILDING of micronutrients and macronutrients
1. Go see a good functional health practitioner and get a comprehensive assessment of
micronutrients, -vitamins, and minerals: We often find iron, Vitamin B12, zinc, Vitamin C, Vitamin
D, Magnesium, and copper are deficient, insufficient, or out of balance.
2. I universally will start mothers on DHA (an omega 3 fatty acid), which is vital in repairing the
nervous system and brain. This can be found in a number of supplements and is typically sourced
from fish or algae.
3. A nutritional assessment to identify food sensitivities and food intolerances as these are often
created or worsened in the pregnancy.
4. Nutritional advice often will begin by getting mothers off the cardboard-hydrates, i.e. hollow
carbohydrates and focus on nutrient dense foods.
5. Get support, get support, get support. You cant have too much support and a babysitter is a lot
cheaper than a divorce.
6. Physical therapies that help engage the relaxation response can be very useful in this first part
of the repletion program. I particularly recommend restorative yoga and acupuncture.
7. Having assessments and therapies around hormonal health can be super useful.
8. Seeing a life coach, counselor, or psychologist around supporting emotional well being is
important.
9. We have specific recommendations around improving overall energy, sleep quality, and physical
activity which are all equally important parts of the road to recovery.

10. Hormonal health is obviously very important. What I find fascinating is that often after
addressing specific nutrient deficiencies and insufficiencies and giving support around sleep diet
and lifestyle hormonal health usually improves. In assessing hormones I find using questionnaires
and salivary hormone tests to be most useful. The most comprehensive test is a urinary steroid
hormone screen but it is costly, requires more time to interpret, and takes longer to get the
results. Blood tests for hormones are not that useful due to day/night variation in levels and due to
binding globulins in the blood which can give a misleading result. The free unbound hormone as
found in saliva is actually what the body utilizes. Given that, the blood tests for hormones that
may have some use are thyroid, DHEAs, and testosterone. In terms of therapies initially it is
important to look at lifestyle issues around physical activity, sleep, and stress management. In fact
the most important thing I believe is the relaxation response and to ensure that people can
indeed relax properly. It sounds strange to say but many of us dont know how to relax properly,
that when we are relaxing we are in fact stressed. Restorative yoga, acupuncture, sound healing,
and biofeedback such as HeartMath can all be useful activities to help teach us to relax properly!
11. After assessing and addressing lifestyle issues then the next aspect of hormonal health is
individualized

herbs

and

supplements

such

as

Rhodiola,

Hypericum,

Ashwaganda,

and

Phosphyltidyl Serine. A big issue around herbs is qualityIve found that only good quality herbs
work so I have become somewhat fussy about my brands! Occasionally direct hormonal
supplementation is required especially in the case of thyroid dysfunction.
RECOVERY is the 2nd step in our program and looks at the important areas of

Optimizing sleep

Optimizing activity and exercise

Education around the healthy home and the healthy kitchen

Recovering and optimizing relationships

The recovery part of the program we take the same principles of Sleep, Purpose, Activity, and
Nutrition but take them to a more in-depth level especially as mothers are starting to feel better,
think more clearly, and take on more in terms of the house, kitchen, and self time.
Education around the healthy home and the healthy kitchen usually begins with resources
like Healthy Home, Healthy Family by Nicole Bijlsma and the Environmental Working Group.
The best type of exercise is activity, and if it is fun and social, mothers are much more likely to
make this a habit.
Follow-up with a psychologist, life coach, or mentor: I think this is essential during the recovery
phase to help re-evaluate a mothers direction and purpose in life and to look at how to get a
healthy balance between family life and personal self growth and support. This is very much
encouraged and we are bringing more and more of this level of therapy within the clinic. This can

also shed light and insight onto relationships with partners, families, and friends which may
already be strained and neglected or at times broken leading to even less support in a mothers
world. The primary relationship between mother and other parent (if present) whether it is the
father, stepfather or second mother often needs some special attention especially after the
battering of the storm of early childhood. There are psychologists and therapists that specialize in
this type of relationship rebuilding.
Fatigue is the most common symptom in postnatal depletion. Having vitality or boundless energy
is the end result of a series of body systems being in sync. Having deep chronic fatigue is the end
result of these systems being out of sync. I find a combination of addressing micronutrient
deficiencies along with macronutrient imbalances is a good start. The most important initial
micronutrients include iron and Vitamin B12, zinc, Vitamin C, and Vitamin D. With macronutrients
increasing healthy fats and focusing on quality protein such as organic eggs, fish, and meats and
also knowing which are the healthier carbohydrates. The best quality carbohydrates tend to come
from the above ground vegetables such as broccoli and cabbage.
Sleep is a conundrum for many mothers as they are too tired and too stressed and busy to sleep
well. Sleep hygiene is an important place to start where what you do in the hour before sleep can
make a huge difference. This involves exposing yourself only to soft yellow to orange lighting, a
soothing environment with calming music, and as much as children allow, to treat your bedroom
as a temple. In fact, if there is only one room that you keep tidy in your house if should be the
bedroom.
Once the lights are out, the room should be cool and as quiet and dark as possible. Computer use,
TV, and emotional stress tend to hijack sleep quality and should be avoided in the hour of wind
down to sleep.
Depending on your personal testing there can be a range of natural sleep enhancers that can be
very useful including GABA, 5-HTP, Melatonin, and Magneisum salt foot baths.
If switching off is the problem then techniques such as HeartMath HRV-based relaxation and
brain entrainment with binaural beats are a couple of the techniques that can be used to help
switch off the computer and allow sleep to happen faster.
3. REALIZATION is step 3 in the program and is about understanding motherhood as part of the
heroines journey and discovering self-actualization through this process
My intention is to publish a book this year that is partly a workbook to take women through the
three stages of our program. There will be a fourth part of the book that explains what postnatal
depletion is and how as a society we arrived at this point in history of having exhausted,
disconnected mothers. There will be an associated website that will have numerous questionnaires
with online scoring and protocol generation to supplement the book. The website will have all the
aspects of supports, blogs, and information that you would expect from an intentional online
community.

Why is this a new thing? Or is it not a new thing and just newly
acknowledged? Have women been experiencing this since the beginning of
time?
It is certainly much more common these days. Most of the so-called primitive cultures or first
people of the world had very specific practices to ensure that mothers made a full recovery from
childbirth. This is something that is not much talked about in todays age. These are called PostPartum Practices. From China to India, from Aboriginal Australia to the Americas, there have been
centuries of very deliberate practices in nutritional recovery, spiritual cleansing, and protection as
well as elaborate social supports.
In traditional Chinese culture they observe the sitting month Zuo Yue Zi where the mother would
not leave the house for 30 days, would not receive any visitors, and would have no duties apart
from breastfeeding the baby. Special rebuilding warm foods would be supplied and the mother
would

not

be

allowed

to

get

cold

or

even

shower

in

that

time.

Ancient cultures have made the realization that Western society unfortunately has not: For society
to be well and prosper, the mothers must be fully supported and healthyin every sense of the
word.
Oscar Serrallach graduated from Auckland School of Medicine in New Zealand in 1996 before
moving to Australia in 1998. After doing the standard medical rotations he did further work in a
number of hospital and community-based jobs including Emergency Medicine, Psychiatry,
Aboriginal Mens Health, and Addiction medicine. In 2003, he moved to Nimbin, NSW and began
working in an alternative community which exposed him to nutritional medicine, herbalism, and
home birth. He started a family and had three children in Nimbin before moving to Mullumbimby
in 2011 to start the Mullumbimby Integrative Medical Centre. There, he focuses on Nutritional and
Environmental Medicine with a special interest in helping women recovey from the postnatal
period. Until recently, he was a board member for ACNEM (Australasian College of Nutritional and
Environmental Medicine) and is currently the colleges journal editor.