Are You Suffering From Postnatal Depletion?
Giving birth has lasting health effects—and poor postpartum care can make it worse
Words Jessica Elliott, Illustration Joy Gallagher
Published February 2019 DallasChild, CollinChild, FortWorthChild, NorthTexasChild
Updated February 20, 2019
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There’s the sharpness of sunlight when you step outdoors … the relentless battle against sleep while rocking your baby in the early morning hours when all is quiet and still … the jolt when your baby’s cries pierce the quiet … the bone-aching, desperate tiredness … the ever-present absentmindedness. There is nothing quite like the exhaustion of new motherhood. It is mind-numbing, life-changing.

One day while my newborn son was in the neonatal intensive care unit, I ordered tea with my hospital dinner. After a few sips I told my husband it was the best tea I’d ever had, and he sweetly pointed out that I’d never put the teabag in my cup. Yes, I had been drinking—and relishing—plain hot water.

The physical and mental tolls of giving birth are real, and they are life-altering. That’s the premise behind The Postnatal Depletion Cure: A Complete Guide to Rebuilding Your Health & Reclaiming Your Energy by Dr. Oscar Serrallach, an Australia-based doctor of functional medicine. Serrallach contends that all mothers—not just new mothers—suffer from a lack of bodily resources. Our “infant-centered focus” causes new mothers to suffer, he says. Citing research that a mother’s brain can shrink 5 percent throughout pregnancy and that the “placenta saps her of the essential nutrients she needs to be healthy and contented,” he believes women are fully stripped of resources when starting a family, and that the effects can last decades.

Serrallach uses the term postnatal depletion to describe the “constellation of symptoms affecting all issues of a mother’s life after she gives birth,” which arise from psychological issues, hormonal changes, and interruption of the circadian sleep cycle. These symptoms span loss of libido to lower energy and confidence, emotional shifts, anxiety, digestive issues, mothering guilt and more.

Comparing the human body to a plastic bag of water, Serrallach says that every pregnancy, every day of breastfeeding and every interrupted night is akin to putting a pinprick in the bag. When holes are being punched faster than they can be repaired, the result is long-term deprivation—or postnatal depletion syndrome.

“There’s not even a healthy dialogue around this concept, let alone healthy societal awareness and information,” Serrallach points out in his book. He’s right—in fact, his postnatal depletion syndrome is medically unrecognized; it’s a blend of findings and experience with the new mothers he has treated. (He now practices at The Health Lodge in Byron Bay in New South Wales.)

It comes as little surprise, then, that multiple local medical experts had never heard the term “postnatal depletion syndrome.” Few guides on the topic can be found, aside from a handful of blog posts that essentially outline Serrallach’s theories. This may be due in part to a troubling reality: that postpartum care in mothers is “one of the most underdiscussed and understudied issues in modern medicine,” according to a recent Vox article.

So, should we be concerned about crippling long-term effects of pregnancy and birth? Are “The Mother Load” vitamins Goop promotes ($90 for a month’s worth) in tandem with Serrallach’s book essential for new moms?

Describing postnatal depletion as a “syndrome” seems sensationalized, the experts I consulted agree across the board. But they also agree that having a baby is depleting—and that a lack of post-pregnancy care only makes things worse for American moms.

THE COST OF BECOMING MOM

“Building a human and delivering them into the world does take a toll on a person,” says Dr. Andrea Palmer, a mother and OBGYN who practices with Fenom Women’s Care at Baylor Scott and White in Fort Worth. “If you breastfeed, that is an extra toll on the body, so depleted is an appropriate term for how you feel after having a baby.”

Dr. Malathi Ellis of Nurture Women’s Healthcare in Frisco agrees, and similarly cites “hormonal shifts, lack of sleep, physical deconditioning and fluid shifts,” as the culprit for postpartum concerns. “The fluid dynamics are tremendous,” she says. “During pregnancy, your body manufactures 50 percent more blood volume, and 10 percent goes to the uterus. Then suddenly, you deliver the placenta, and the fluid shift is immense.”

Research is also clear that a woman’s first pregnancy rewires her brain for at least two years. A study led by neuroscientist Elseline Hoekzema and published in Nature Neuroscience proved that gray matter does shrink in certain areas—but that it’s essentially to reformat a new mom’s brain to enable a more compassionate, maternal response to her infants’ needs.

Ellis notes other lasting effects—for example, you can look at a 3,000-year-old female skeleton and tell whether she bore children due to scars left on her pelvic bonesand women do have varying pregnancy-related issues later in life. “So there are obviously long-lasting impacts of having children,” she says.

Yet feeling drained and weary is normal, experts say. “We know, for example, that pregnant women will get less sleep,” says Frisco psychiatrist Dr. Aparna Iyer, who specializes in perinatal mental health. “Does that mean they are depriving themselves? Not necessarily—women’s bodies are amazing; we’ve evolved to make up for that loss.” She adds that some women might feel more rested with six solid hours of sleep instead of the eight they used to get. “We know that sleep structure changes during pregnancy.”

So too do women’s nutritional stores, says Plano-based registered dietitian Keri Stoner-Davis of Lemond Nutrition. “But they are designed to increase in certain areas and decrease in others,” she explains. “The body is a lot more resilient than we think it is.”

She compares post-pregnancy effects to what one might feel after running an intense race. “Physiologically, it only makes sense that we would feel depleted and tired—as one might be after a 5K or marathon,” she says. “Just because you feel depleted doesn’t mean you are physiologically depleted, or malnourished for a lifetime.”

Young mothers (especially those who become pregnant within two years of starting their periods), women who have pregnancies less than 12 months apart, and women who don’t have adequate access to food could have “nutritional depletion,” which can be assessed by a physician or registered dietitian, Stoner-Davis says. “Some people are at risk for deficiencies post-birth, or even at any point in life, but that’s not the vast majority,” she says. “If you’re concerned about nutritional depletion as an individual or how your body is affected, that’s when you should seek out a professional.”

Then there are women who suffer from specific conditions that can be triggered by pregnancy or birth. Denton mother Lauren Penn, for instance, was fatigued and dizzy, had low blood pressure, heart-rate fluctuations, anxiety, chronic insomnia and other unusual symptoms after the birth of her now 5-year-old and 3-year-old daughters. She visited numerous doctors before learning she had an underlying genetic disorder called Ehlers-Danlos syndrome, which led to postural orthostatic tachycardia syndrome (POTS). It’s a circulatory problem that can begin during pregnancy and can cause the dizziness, low blood pressure, fatigue and other symptoms Penn experienced.

As a new mother, Penn struggled with sadness upon seeing fellow young mothers who had an abundance of energy for their children. “I just couldn’t physically or mentally handle the normal amount of activity that comes with having littles,” she says. “One of the most frustrating things about being a patient and a young mother is that a lot of doctors didn’t really listen to me, or passed me off as being ‘a tired mom.’ I was sidelined by the professionals who could have diagnosed me sooner.” She represents a cohort of women who feel less than cared for after giving birth—and that’s more than a medical problem; it’s a cultural one.

WHERE’S MY VILLAGE?

While postpartum exhaustion, anxiety and stress are normal, our cultural framework isn’t designed to ensure new mothers have rest, financial support (which has been cited in multiple surveys as a pre-dominant reason American women are having fewer children), and help when it comes to grocery shopping and cooking nutritious meals.

Our often sorely lacking maternity leave policies are just one example: Expecting mothers in Finland, for instance, can start their maternity leave as early as seven weeks before their planned due date, and 16 additional weeks of leave is paid through a governmental maternity grant, no matter the mother’s working situation.

But even Western culture as a whole is lacking in support, Serrallach argues. In China, for instance, new mothers traditionally don’t leave their homes for a month, and they receive help from a nanny of sorts (or a family member) who looks after baby’s and Mom’s needs. In South Korea, mothers spend 21 days sans guests to focus on nursing and restoring their health, while drinking hot teas and easy-to-digest, calcium- and iron-rich soups. Generally speaking, American moms don’t have those villages to rely on.

Not only do Americans often have limited support, we have culturally idealistic visions of motherhood that are not conducive to taking it easy after giving birth (or, one might argue, ever).

A study published in Frontiers in Psychology in November found that “women’s experiences of pressure toward perfect parenting are related to higher levels of guilt and stress”—which should come as no surprise to any parent. Parents increasingly try to balance work and child care—but mothers especially feel they are responsible for child care and expected to be “fully devoted to this task, putting the children’s needs before [their] own,” the story says. It goes on to say that “Mothers fear social penalties when they fail to meet the high motherhood standards.”

For years postpartum care has reinforced this idea of baby first. Typically women have only one postpartum appointment, and there’s still a stigma around seeking psychological help.

“It’s supposed to be the happiest time in a woman’s life, so there’s no room for being unhappy,” Iyer says. “When a woman seeks health care, it can appear as though she’s putting her needs before her baby. So women keep their struggles to themselves and put forth this image that they are doing fine.”

BETTER FOR MOM, BETTER FOR BABY

The American mindset is slowly shifting, Palmer says. “There is an evolution that is happening, and we are starting to realize as a culture that birth is a big deal, and we are putting more importance on taking care of moms after babies,” she says, adding that there is a push from the American College of Obstetricians and Gynecologists for new mothers to receive more extensive treatment, beyond the usual single postpartum annual checkup. “It’s fairly inadequate for most moms to have one postpartum visit, and then see their doctor again in a year,” she says. “One visit is not necessarily enough to address all of the concerns and problems after having a baby.”

Palmer sees patients two weeks after giving birth for a “sanity check,” she says. “It’s making sure one foot is in front of the other, to ensure that she isn’t in trouble.”

She has additional follow-up visits six weeks post-birth and then again three to six months later for an annual exam. Ellis also pushes for more frequent postpartum appointments. “You generally feel not-so-awesome after pregnancy, so you don’t know whether you’re feeling how everyone feels, or if there’s actually something wrong,” she says. “That leads to a change I would like to see—we do too many visits during
pregnancy and not enough after.”

Ellis requires checkups at six weeks and two months postpartum, and also emphasizes a wellness visit with a general practitioner. If a mother is particularly struggling, she checks thyroid health and iron levels and for diabetes. “They are easy, inexpensive tests to do,” she says.

Still, while we wait for America to fully embrace this new direction, it’s up to moms to champion their own health post-baby. While Serrallach suggests a host of ways to restore general well-being—from yoga to aromatherapy, acupuncture to meditation, curbing social media exposure to “earthing,” or walking barefoot outdoors—for many women, getting as much rest as possible, easing back into an exercise routine and sticking to a nutritious diet are key to maintaining postpartum health, even long after baby arrives. (See sidebar below.)

Sidebar

WELLNESS AFTER BABY (EVEN WELL AFTER BABY)

EAT A SNACK OR MEAL EVERY THREE TO FOUR HOURS.
“If you aren’t eating well, you will feel the effects of being groggy even more,” says Keri Stoner-Davis, a Plano-based registered dietitian.

MAINTAIN A HEALTHFUL DIET.
If you’re breastfeeding, you’ll need at least 500 more calories a day, Stoner-Davis says. She recommends seeking high-quality grains, fruits, vegetables and lean proteins—or nutritious substitutes for vegans and vegetarians—to provide nutrition and balance. “As long as you’re aiming for a balanced diet, your nutritional stores should be replenished,” she says.

KEEP TAKING YOUR PRENATAL VITAMIN.
“It will help you keep up with your iron and calcium,” explains Dr. Andrea Palmer, an OBGYN who practices in Fort Worth, adding that vegetarians and vegans often should supplement with B12, and sometimes vitamin D. Your supplement doesn’t need to be a pricey one.

GET SUPPORT—AND THERAPY—WHEN YOU NEED IT.
Don’t be ashamed to seek mental health counseling, hormonal therapy, night nurses, familial or friend support—whatever will facilitate peace and rest. Before any supplementation (hormonal or nutritional) consult with a professional.

FIT IN SLEEP AND EXERCISE WHENEVER POSSIBLE.
“Sleep is huge—it’s when we repair,” says Dr. Malathi Ellis, an OBGYN who practices in Frisco. It’s a challenge for mothers to make time for sleep, and especially to return to exercise—but it’s worth the effort.

Then there are benefits from hormone therapy, which Serrallach also promotes. Dr. J. Mark Anderson of Southlake’s Executive Medicine of Texas recommends waiting at least three months postpartum prior to having hormone levels checked to allow the body to reset. (Palmer notes that estrogen levels are naturally low in lactating mothers to encourage milk supply, so women should wait until they are finished with nursing.)

“Get a good baseline when you’re feeling good, and then come back after you’ve had kids and see where you’re at,” Anderson says.

And women shouldn’t expect to return to their former selves after six weeks, Ellis says. “I tell them, it took nine months to get here, it’s going to take at least nine months to get out.”

Or longer, in some cases. “Sometimes, women come in at year two or three postpartum and say they aren’t back to themselves again,” Iyer says. “But here’s the thing: You have become a mother—you can’t become yourself again. Your baseline has shifted, your identity has shifted, so it’s up to us to explore who that person is.”

Psychologically, women may require help when they might have not needed it previously, Iyer adds. “With the birth of each new child, there’s a birth of a mother, a birth of a father, and we have to be open-minded about not knowing how it will deplete you,” she says.

Some mothers might need family members or friends to step in, while others might prefer hired help. Support might also come from a therapist or psychiatrist.

“Data shows when you put mental health first, it’s the best thing you can do for your baby,” Iyer says. “Our well-being and our child’s well-being don’t have to be mutually exclusive.”