The Postnatal Depletion Cure A Complete Guide to

Rebuilding Your Health and Reclaiming Your Energy for

Mothers of Newborns, Toddlers, and Young Children

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The advice herein is not intended to replace the services of trained health
professionals or be a substitute for medical advice. You are advised to
consult with your health-care professional with regard to matters relating to
your health, and in particular regarding matters that may require diagnosis
or medical attention.

Copyright © 2018 by Oscar Serrallach, MD

Cover design by Claire Brown
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ISBN 978-1-478-97029-3

E3-20210728-JV-PC-COR
 Contents

Cover
Title Page
Copyright
Dedication
Epigraph
Introduction

PART I
DEFINING POSTNATAL DEPLETION
1. What Is Postnatal Depletion?
2. Physical Symptoms and Why They Worsen
3. Emotional Symptoms and Why They Worsen

PART II
ONE HUNDRED DAYS OF REPLETION:
REBUILDING PHYSICAL WELLNESS
4. Rebuilding Micronutrients
5. Rebuilding Macronutrients
6. Rebuilding Hormones
7. Rebuilding Energy
8. Rebuilding Sleep
 PART III
THE SECOND AND THIRD TRIMESTERS:
COMPLETING PHYSICAL RECOVERY
9. The Optimal Energy Food Plan
10. The Optimal Exercise Plan

PART IV
RECOVERING YOUR LIFE
11. Recovering and Rebuilding Emotional Well-Being
12. Recovering Your Self-Love
13. Recovering Your Relationship with Your Partner and with Your Libido

Conclusion
Thanks and Acknowledgments
About the Author
Appendix A—Jump-Start Your Recovery
Appendix B—Resources
Bibliography
Newsletters
This book is dedicated to all mothers who
have suffered and struggled in their
selfless roles as caregivers, often without
the unconditional support and wisdom
from their culture, societies, and families
that should have been their birthright. It is
your strength that has inspired and guided
me in writing this book.
The well-being of mothers is the fabric from which the
cloth of the future of our society is made.
—Dr. Oscar Serrallach
 Introduction

I have written this book to answer a question many women ask: “How do I
get my life and myself back after becoming a mother?” How do you find
the strength to deal with your needs when our society tells us to focus
entirely on the needs of the baby, causing you to disappear into the shadows
of your predestined role? This infant-centered focus is something I
witnessed in my practice as a doctor and as a father watching my
extraordinary partner, Caroline, struggle after the birth of our children. It
has been consistently mentioned by almost every mom I’ve spoken to, in
contexts that vary from energy to illness to time management to self-
confidence.
This is a huge hole in our thinking and treatment of new mothers. Worse,
it’s a hole that gets bigger and bigger because it’s not discussed from a
medical point of view. Postpartum depression, yes. Postnatal depletion? Say
what? There’s not even healthy dialogue around this concept, let alone
healthy societal awareness and information.
What’s just as, if not more, important to note is that postnatal depletion
doesn’t just affect new mothers—it affects all mothers. If a new mom isn’t
allowed to fully recover from the demanding requirements of pregnancy
and birth, the aftereffects can last for years. I’ve treated women who were
still depleted ten years after their babies were born. And if you then take
into account the stress and sleeplessness associated with raising tweens and
teenagers, coupled with the hormonal effects of perimenopause and
menopause, it can become a pretty grim journey if mothers aren’t truly
supported and allowed to recover.
I know that this condition is real, and I know there is no need for you to
suffer. There is almost a subconscious badge of honor associated with a
mom’s ability to juggle motherhood and child care with returning to work
as soon as possible. Our Western culture has done mothers a great
disservice by not honoring them on their road to recovery and giving them
the time they need to adjust to the monumental changes in their lives. This
needs to change! It is my hope that I can play a role in helping change the
narrative of how we think about postpartum care, and it is urgent that we
do. It was out of necessity that I went on a quest to help my darling partner,
Caroline, back to health. But she helped me discover the reasons why
mothers get so depleted, and what can be done to help them back to full
functioning.

MY STORY
Nimbin is a small, quaint town about an hour’s drive inland from Byron
Bay, which is Australia’s most eastern point in the state of New South
Wales. I moved there in 2003, feeling unfulfilled as a doctor and needing a
change to jolt me out of my career rut. I’d been a medical mercenary up
until then, chasing jobs from city to city, working on everything from drug
addiction to indigenous health to psychiatry to being part of the Emergency
Department team in the coastal town of Ballina.
Unlike most other areas of medicine, emergency medicine is
uncompromisingly simple: patients have specific needs that we can treat on
the spot. I really enjoyed the camaraderie, and my schedule left me time to
learn how to surf, practice my guitar, and be a player-coach for my local
soccer club. But a deep restlessness and frustration led me to Nimbin, a
town renowned for being a center of counterculture in my country; even
though I didn’t buy into the town’s somewhat notorious hippie ethos of
“free love and drugs,” I dove into the deep ecological consciousness that
was also an integral part of living in this area. I met many inspiring people
with thought-provoking ideas. This is where my evolution as a doctor
began.
At a music festival in 2003, I met Caroline Cowley, who soon became
my life partner. Although she was a high-flying professional, born and bred
in the metropolitan city of Melbourne, I was able to convince her to come
live in the sleepy countryside surrounding Nimbin. We fell deeply in love
and got very caught up in the romantic idealism of self-sufficiency. We
created a thriving garden and spent many hours working on the land. It
became quickly apparent to us that in this idyllic scenario we wanted to
start a family, which led us to become involved in the thriving local home-
birth community.
Having been trained in orthodox medicine, it was not an easy thing for
me to embrace the idea of our first child being born outside a hospital
setting. It took many meetings with home-birthing moms, experienced
midwives, and doctors who’d had home births with their own children to
finally warm me up to the idea. I tapped into an incredible amount of
support and information about prenatal and postpartum care, from books,
workshops, and mothers we met. One of the most wonderful experiences
was when Caroline had a “blessingway ceremony”—a tradition in the
Native American culture in which the mothers sit in a circle and share
stories in support of the mother-to-be. As the father-to-be, I was taken on a
ceremonial walk by an aboriginal friend of mine to a sacred area to
celebrate my up-and-coming role. It was a beautiful experience and made
me feel part of the long, ancient history of generations birthing generations.
Still, I couldn’t help myself: I wrote a very detailed birth plan in case we
did need to make the transfer to hospital!
Caroline and I were very fortunate to have a beautiful and totally routine
home birth with our first child, Felix, surrounded by family and loved ones.
Our local community even organized a meal-delivery roster for a full two
weeks, so we didn’t have to think about what to cook when we were sleep
deprived and adjusting to our amazing little baby. The instant quagmire of
parenting left us overwhelmed with decisions. Do we use cloth diapers or
disposables? Should we use a pacifier? How long should Caroline
breastfeed? Why was the baby crying? As any parent will tell you, as soon
as you answer one question, a new one arises—as do the judgments and
criticisms (however well intended) of friends, loved ones, and, of course, all
those “well-meaning” strangers.
A similar pattern occurred with our next two children, Maximo and
Olivia. Caroline became more and more exhausted with each new baby, and
we reached a crisis point soon after the birth of our third child, Olivia.
Caroline’s memory and concentration were shot. She felt as if she were
drowning in her own sense of overwhelm, she had constant brain fog
(commonly called baby brain), she suffered from a loss of confidence and a
feeling of isolation, and she was not able to take care of herself fully. She
was extremely fatigued, suffered anxiety, felt her sleep was superficial at
best, and had a deep fear that she was never going to recover.
As my worries about my wife deepened with each passing day, I
remembered a patient I’d had when I first started working at the Nimbin
Medical Centre—a gaunt mother named Susan. In her midtwenties, she
already had five young children, and not surprisingly she was exhausted
and finding it difficult to cope. She was extremely anxious during our
appointment, and it was hard for her to describe exactly what was bothering
her and how she was feeling, aside from general stress and utter fatigue. I
was concerned and wanted to do everything that I could to help her. I
ordered blood tests to make sure she wasn’t anemic and did a postpartum-
depression screening test. I helped her arrange a social-worker appointment
and a community-nurse home visit. When the blood work came back
showing that she had low levels of iron, we discussed how this would have
been contributing to her fatigue. We looked at ways of increasing iron in her
diet while starting a simple iron supplement. Susan came in for her next
appointment and I gently suggested that a referral to a counselor or
psychologist might help her feel a lot better. I was just starting to pat myself
on the back for a job well done and for going the extra mile for someone
obviously in need—especially as my appointments with Susan always took
closer to forty-five minutes than the usual twenty I was allotted—when she
suddenly stood up and said, “God, I have to go.” She grabbed her handbag
and ran out the door before I could say a word.
The next week I followed up with the community nurse who had visited
Susan at home. The nurse told me that Susan was feeling a little bit better
and did not require our services. I was very surprised. I couldn’t shake
thinking about how Susan had seemed so distraught, running on empty,
when I’d seen her.
Nearly eighteen months went by before I saw Susan again—this time in
the ER of our local hospital with a bad case of pneumonia. She’d had
another child by then and looked as exhausted and stressed-out as the first
time I’d seen her. I admitted her to the hospital early in the morning to
administer intravenous antibiotics, yet by late afternoon she stated that she
was feeling better and was adamant that she had to go home. The meds had
barely started to work, and she was discharged against medical advice. I
haven’t been able to find out what happened to her and her family, and I
still wonder about her and worry how she’s doing.
Desperate by this point to help Caroline on her road to recovery, I’d
been keeping copious notes about my patients. I thought of other mothers I
had seen—not all of them with symptoms as extreme as Susan’s, but with
similar issues. They were mothers like my own partner, who was, I realized,
far from unique in her suffering. These moms loved their children. But they
were also miserable and completely drained. They were not themselves and
seemed to have given up hope that they might ever recover their vitality.
What if all my patients with similar, recurring symptoms had the same
condition? What if the physical depletion caused by the demands of their
pregnancies started a cascade effect of all these other things that left them
exhausted, anxious, and miserable?
With the notion of postnatal depletion fueling me, I realized there was a
pattern—something I could investigate. I started to trawl through the
medical literature and textbooks, and I was speechless to find that almost
nothing had been written about what seemed to be such an incredibly
important topic. All I could uncover was information on postnatal
depression and some small-scale studies looking at postnatal fatigue. Caring
for the baby was the dominant topic. Completely overlooked were the
moms needing care for themselves so that they could best care for their
babies, and there was in fact nothing at all about postnatal depletion.
It was a lightbulb moment. I began to look outside of Western medicine
for ideas on how to better support a mother’s needs after she gives birth. I
read about the ancient wisdom of many indigenous cultures in which the
time for mothers to fully recuperate was deeply respected and etched into
the very social fabric of these cultures. These new mothers were supported
by others in their community during this time of recovery: they were
allowed to regain their strength, rest, and recuperate while bonding with
their newborns. In our society, however, the typical dialogue tends to
revolve around when the mother is going back to work and not much else.
I have no doubt that nearly all moms—no matter when they gave birth—
can fully recover from postnatal depletion, regaining health and wellness far
beyond what they have experienced in the past. I have seen the recovery
process firsthand. With this book, I hope to give you the tools you need to
restore your energy and sense of well-being.

HOW TO USE THIS BOOK

The book is divided into four easy-to-use parts:

In part 1, “Defining Postnatal Depletion,” I explain the causes of

postnatal depletion and provide details about the physical, mental,
and emotional conditions it creates, as well as why these conditions
occur and can worsen during pregnancy and following birth. I also
identify specific symptoms associated with postnatal depletion,
giving you an understanding from a medical point of view about why
you’re feeling so lethargic and unlike yourself, and I describe how
non-Western cultures treat the postnatal period. There’s an awful lot
of wonderful wisdom in how these societies regard and support new
moms.
In part 2, “One Hundred Days of Repletion: Rebuilding Physical
Wellness,” I describe how to replace vital micronutrients and
macronutrients that will help your body recuperate. I also discuss
how to rebuild your hormones and your energy and how to get the
deep, sound sleep you really, really need!
In part 3, “The Second and Third Trimesters: Completing Physical
Recovery,” I also tell you exactly what to eat and when for optimal
nourishment. This will not only diminish your depletion, but, if
you’re breastfeeding, give your baby the ample rewards of your
nutritious and delicious eating. In addition to this food plan, I also
offer you a structured exercise/movement plan that is gentle and
simple and costs you nothing. Without your even realizing it, these
plans will help you lose the baby weight in the healthiest way
possible.