What Is Postnatal Depletion?
Exclusive excerpt from THE POSTNATAL DEPLETION CURE (a goop press book) by Dr. Oscar Serrallach
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 sub optimal 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.
This self-doubt can often manifest in what I call the phenomenon of choice overload. Most parents want the best for their children, making them an advertiser’s or a marketer’s dream. Which stroller is the best? Is it okay to buy something more affordable than the top-rated car seat? Is baby’s bottom going to chafe without those brand-name wipes and a wipes warmer? What about the crib? Welcome to our brave new world of mommy-and-daddy consumerism, where the pressure to find the “best” products and the “right” routine can be crippling.
Pregnancy is an exciting but stressful time for so many women, particularly for those who struggled to get pregnant in the first place. That struggle makes it all the more painful when motherhood is taxing. Many women worry that if it’s not all joy, if they don’t have an instant instinct for tending to their child’s every need, then they are failing somehow. Factor in the fears that they’re also letting down the woman they used to be and that they’re feeling unprepared for the tasks at hand, and their sense of inadequacy becomes palpable. Vulnerable new moms may also be subjected to judgment from their inner circle, a group that may consist of well-intentioned other mothers, mothers‑in‑law, sisters, aunts, other family members, neighbors, friends, and colleagues. The baby isn’t gaining weight or is having trouble eating? It’s probably because Mom’s doing something wrong. Who’s responsible if the baby isn’t sleeping well or has colic? Mommy, of course. These judgments aren’t always said aloud, but they’re implied by silence, subtle eye rolls, or offers of myriad suggestions that worked for someone else.
If this kind of undermining comes from your beloved partner, it can be even more devastating. A shell-shocked and exhausted partner can inadvertently make things much worse.
A change in a once-happy established dynamic can send even the best and sturdiest relationships into a downward spiral.
Shaming, whether subtle or overt, can have devastating consequences. This is even more reason why expectant and new parents need so much support and why we need to open up a healthy dialogue about realistic expectations and care.
Predisposing Physical Factors, Primarily Inflammation
Predisposing factors that impact your physical and mental health also make you more vulnerable to experiencing postnatal depletion. Being an older mother, for example, is a predisposing factor due solely to physiology, as older women take longer to recover from major events such as childbirth, are more sensitive to the negative effects of sleep deprivation, and have hormones that are harder to regulate.
Physiologically, inflammation is the key hallmark and consequence of postnatal depletion. It also exacerbates and sometimes causes depletion’s typical symptoms, as well as perpetuates the problem. In other words, inflammation begets inflammation.
There are many different types of inflammation, but at its core, inflammation occurs when there is either repairing or rebuilding going on in your body, or too many pro-oxidants being produced. Pro-oxidants are the harmful by‑product of metabolic processes like oxygen consumption, and the clearing of toxic substances such as pesticides or cosmetics from the body. Pro-oxidants do have a role where they help stimulate the immune system and the detoxification systems of the body — it is all about balance. I picture a pro- oxidant like a bill or debt, and antioxidants are like the cash or check that will help clear that bill. In the world of finance, economists know that for a healthy economy you need a good balance of buying and selling, and if this is out of balance it contributes to inflation. In the body this inflation contributes to inflammation.
Inflammation in and of itself is not bad, but too much certainly is; just as a society with too high a rate of inflation suffers, a body with too much inflammation also suffers.
A major cause of inflammation is found in your gut. Not for nothing is your gut called the second brain. It is one of the most important regulators of inflammation in your body, if not the most important one. Your microbiome— the healthy and unhealthy bacteria that process your food — can make you (and keep you healthy), but it can break you (make you sick), too.
One of the biggest predisposing factors for postnatal depletion is environmental toxins. Toxin is one of those buzzwords that is casually thrown around by people even though they might not know what it actually means. A toxin is essentially a substance that causes some part of the body to react in a negative way. Technically, toxins are produced only by living things, but the term is loosely used here to include other substances, such as heavy metals, air pollution from traffic, and some personal-care products. You may be surprised to know that we produce most toxins, within our bodies; these are called endogenous toxins. These toxins are created during digestion and when your body burns oxygen to provide energy. The by‑products of the oxygen burn are unstable molecules called free radicals. Your homemade toxins are totally normal, and your body is programmed to handle them so that they don’t have a toxic effect. In fact, these endogenous toxins are absolutely necessary for waking up and stimulating our antioxidant systems and the cleansing pathways within the body.
The issue lies with your personal load of exogenous toxins, those produced outside the body, and whether they are having a toxic effect on your body. Exogenous toxins enter your system when you eat or drink them (e.g., foods containing pesticide or herbicide residue), breathe them (e.g., exhaust fumes or other pollution), or absorb them (e.g., cosmic radiation and ultraviolet rays from the sun and cleansing or personal-care products with harsh chemicals).
Your body is good at processing and eliminating endogenous toxins, but it is not efficient at clearing exogenous toxins, which usually require a lot of energy and resources to get out of your system.
If we overload that system, the toxic load can take hours to clear, which is why you might feel okay after a small amount of alcohol but experience the dreaded hangover after consuming more alcohol than your body can process. Your body is constantly processing toxins and may be having small hangover-like events all through the day or night . . . leading to brain fog, lethargy, muscle soreness, sugar cravings, and sleep problems.
The more toxins you are exposed to, the more inflammation they will create, which means the longer your recovery time will be because you’ll be far less resilient to stress. If you used to recover relatively quickly from a bad night’s sleep, you’ll find it much more difficult to do so if suffering from inflammation triggered by postnatal depletion.
A developing fetus tends to be very sensitive to toxins. This is why your obstetrician likely offered restrictions on what you should do or eat while pregnant. On the toxin list will be cigarettes, alcohol, raw cheeses, fish high in mercury (like sushi tuna or swordfish), and extreme heat (such as a sauna or hot tub). It’s often with much alarm and horror that pregnant moms learn just how these toxins may be affecting their baby. So many moms have told me about their deep guilt, shame, and worries that they may have unwittingly exposed their precious fetuses — as well as their own bodies — to the potentially damaging effects of pollutants and toxins. The problem is that these restrictions aren’t based on rigorous science but merely on common sense. We simply do not know the facts for certain, mainly because it is ethically impossible to do any testing on pregnant women; you can’t do a study in which some pregnant women are asked to eat a lot of tuna, for example, as it may cause harm.
In my practice, I often see women who start questioning their bodies, their own intuition, their food choices, their habits (good and bad), and even the quality of information that they get from all different sources — some excellent, some bogus and harmful. This, combined with the severe fatigue and baby brain that often accompany postnatal depletion, is a recipe for a downward spiral.
This downward spiral leads to the feelings of ongoing overwhelm and has undesirable effects on all aspects of a mother’s functioning and well-being.
WHY POSTNATAL DEPLETION IS SO COMMON IN WESTERN SOCIETIES
When I started researching postnatal depletion patterns, trying to understand how and why it was happening to so many of my patients, I knew I had to push past just reading medical textbooks.
Postnatal depletion isn’t just about physiology — it’s also about how and why mothers don’t get the emotional and social support they need when they need it the most.
So I started reading about other cultures to see if there were any sociological clues that could point me in the right direction. Was postnatal depletion really unique to our Western culture? The more I read, the more I realized that many other cultures had stunning commonalities about how they managed their postpartum care. A depth of conscious practices, rituals, and ceremony — plus the support and respect for the recovery of mothers — has been embedded in different cultural fabrics all over the world since at least the start of recorded history. There was a standard of care given to mothers postpartum that has been lost to modern Western culture.
I think it can be helpful to take a look at the wisdom of some of these cultural practices and try to embrace as many of them as will fit into your life. Many of these traditions have a postpartum diet, in which the mother is given foods that are high in fat, nutrient dense, and easy to digest. Even better, someone else does the shopping and cooking! She has an army of helpers on hand to allow her to sleep and rest. She has these helpers showing her how to best do the hands‑on baby care of feeding, changing, and bathing. She can relax in the knowledge that she is in a safe, nurturing place with those who only want the best for her and her new baby.
These cultures also share the notion of protected time — what is sometimes referred to as confinement but what really entails privacy, respect, and protection — with appropriate social support for the mother to fully recover after she gives birth. As a medical student I used to joke about one of the abbreviations found on the prenatal card that pregnant women would carry with them when attending visits with midwives or specialists. For the expected date of delivery (EDD) of the baby, there would usually be an EDC (estimated date of confinement). The medical students would tease one another that maybe pregnancy was like a prison sentence, and as ambitious students, we should remain childless lest we (horrors!) need to be confined ourselves.
This joke faded from my consciousness when a good friend of mine, who’d lived for thirty years in Ladakh, located in the Himalayan region of India, told me about the social support for newborns in traditional Ladakhi culture. There, when a baby was born, ten adults would be assigned to that baby to assist in various aspects of his or her initial and ongoing care through the child’s entire upbringing. Imagine having that kind of support ingrained into our society!
DO YOU HAVE POSTNATAL DEPLETION?
My life goal is to enable all mothers to have access to information that will help them not only prevent depletion but also recover from it. The bottom line is that if you want a healthy society, you need to have healthy communities. To have healthy communities, you have to start with a healthy family.
If you want a healthy family, you need to have the mother in the best possible health physically, emotionally, mentally, and spiritually.
I want to help you close the doors to postnatal depletion one at a time, and the first step is understanding how postnatal depletion is impacting your life.