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Postnatal DepletionEven 10 Years Later | Goop

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?
A
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 post-birth, 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.
Q
Youve identified a syndrome in mothers, which you call Postnatal Depletionwhat is it exactly?
A
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.
Q
How many women do you believe it affects? And for how long?
A
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.
Q
What are its symptoms?
A
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.
Q
What are its causes?
A
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. Multi-generational 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.
Q
Where should women start in terms of starting to feel like themselves again?
A
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 reevaluate 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.
Q
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?
A
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 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 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.