As Serrallach explains: 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 mom’s “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 mom’s brain shrinks 5 percent in the prenatal period, as it supports the growth of the baby (much of the brain is fat) and is re-engineered for parenthood. Serrallach has spent the majority of his career witnessing this syndrome, which he calls postnatal depletion, first-hand, watching as women fail—hormonally, nutritionally, and emotionally—to get back on their feet after the baby comes. Serrallach 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 didn’t 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 him—of a woman ripping out an IV to rush back to her family—and 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 child’s 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 have thought 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. There’s 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.
A Q&A with Dr. Oscar Serrallach
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. Nature’s 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 percent 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 percent).
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 baby’s brain), and the hormones produced by the placenta look very similar to the hypothalamic hormones—again 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 mother’s bloodstream, 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 post-birth, when the bond between mother and baby is established. Breastfeeding then keeps this bond strong. This is nature’s 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 of “compromises” in the postpartum period and beyond, for mother and baby.
Part of the job of the placenta is to reprogram the mother. It’s 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 child’s 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 mother’s detriment is the mother who “discharged” herself from hospital with pneumonia because she needed to get back to her children—without any external support, her upgraded program told her to take care of her children even if it means sacrificing her own health.
You’ve 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 one’s 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 percent of mothers will have some degree of postnatal depletion—possibly more, but because of the focus of our clinic I would have a slanted view. I don’t 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 seven 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 six 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 don’t experience depression and it is possible to have postnatal depression without the depletion.
What are the symptoms of postnatal depletion?
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 of postnatal depletion?
It is multifactorial:
We live in a society of continual ongoing stress and we literally don’t know how to relax or switch off. This has profound effects on hormones, immune function, brain structure, and gut health.
Woman are having babies later in life. In Australia the average age for a mother having her first baby is 30.9 years.
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.
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.
Sleep deprivation of having a newborn: Some research suggests that in the first year the average sleep debt is 700 hours! Reduced family and societal support is very common, as well.
Our food is becoming increasingly nutrient-poor. We are in many cases having “two mouthfuls of food for one mouthful of nutrition.”
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.
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. Multi-generational support groups for mothers have been part of indigenous cultures for millennium though they are sadly absent in our post-industrial culture.
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 three-step program as a guide to help mothers:
Step one: repletion and rebuilding of micronutrients and macronutrients.
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.
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.
Get a nutritional assessment to identify food sensitivities and food intolerances as these are often created or worsened in the pregnancy.
Nutritional advice often will begin by getting mothers off the “cardboard-hydrates,” i.e. hollow carbohydrates, and focusing on nutrient dense foods.
Get support, get support, get support. You can’t have too much support (and a babysitter is a lot cheaper than a divorce).
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.
Having assessments and therapies around hormonal health can be super useful.
Seeing a life coach, counselor, or psychologist around supporting emotional well-being is important.
We have specific recommendations around improving overall energy, sleep quality, and physical activity, which are all equally important parts of the road to recovery.
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 don’t 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!
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 quality—I’ve 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.
Step two: Recovery is the second step in our program and looks at the important areas below.
Optimizing activity and exercise
Education around the healthy home and the healthy kitchen
Recovering and optimizing relationships
In the recovery part of the program we look at 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.”
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 “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 it 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 magnesium 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.
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. [See more compiled tips from goop on clean living here and extra mom support here.]
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 mother’s 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 mother’s 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.”
Step three: Realization is the third step in the program and is about understanding motherhood as part of the heroine’s journey and discovering self-actualization through this process.
[Keep an eye out for Serrallach’s book, Mothermorphis, coming in 2018, for additional support. And in the meantime, see his goop piece on The Mother Wound.]
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 today’s age. These are called post-partum 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 thirty 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 healthy—in every sense of the word.
Oscar Serrallach graduated from Auckland School of Medicine in New Zealand in 1996. He specialized in general practice, family medicine, and did further training in functional medicine, working in a number of hospital and community-based jobs, as well as in an alternative community in Nimbin that exposed him to nutritional medicine, herbalism, and home birth. He has been working in the Byron Bay area of NSW, Australia since 2001, where he lives with his partner, Caroline, and their three children. Serrallach currently practices at the integrative medicine center, The Health Lodge, and his first book, Mothermorphosis, comes out in 2018 from goop Press. He also developed the goop vitamin/supplement protocol, The Mother Load, designed to support moms and moms-to-be.
Article by Goop and originally published here.