Postnatal Depletion—Even 10 Years Later

Postnatal Depletion—Even 10 Years Later

Dr. Serrallach

Consider this: If you’ve had a child within the last decade, you might still be suffering some consequences—lethargy, memory disturbances, and poor energy levels, among other symptoms. And according to Dr. Oscar Serrallach, goop-trusted family practitioner (all the way from rural Australia), it’s not just because being a parent is hard—physically, the process of growing a baby exacts a significant toll.



A Q&A with Dr. Oscar Serrallach




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 human placenta is interesting—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).

The placenta serves two masters: the growing baby AND the mother. During the pregnancy, the mother supplies most of the nutrients that the growing baby needs, hence why 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 feedback occurs during birth. What causes labor pains (contractions of the uterus) is oxytocin, which is also known as the “love hormone.” As the baby pushes against the birth canal, this signals to the mother’s hypothalamus to produce oxytocin, 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.



You’ve identified a syndrome in mothers, which you call postnatal depletion—what is it exactly?








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.



What are the symptoms of postnatal depletion?


  • Fatigue and exhaustion.

  • Tired on waking.

  • Falling asleep unintentionally.




  • As mentioned, brain fog or “baby brain.”

  • Loss of libido.


What are its causes of postnatal depletion?


It is multifactorial:




  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: 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.

  6. Processed, nutrient-poor foods make up a large percentage of the typical diet these days. We are in many cases having “two mouthfuls of food for one mouthful of nutrition.”

  7. 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.

  8. The phenomenon of inter-generational epigenetic changes in the expression of our genetics is very complex and I suspect it 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.




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 not always as long. 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: In our practice, we often find iron, vitamin B12, zinc, vitamin C, vitamin D, magnesium, and copper are deficient, insufficient, or out of balance.


  • 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).


  • 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 sleep

  • 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.



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.





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 is the author of The Postnatal Depletion Cure. He 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 practices at the integrative medicine center, The Health Lodge.


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