"I know I need to exercise but I don't even have the energy to go for a walk," says Sarah, mum of an eight-month-old. "I feel so tired all the time and I'm anxious without any reason."
When I visited her, Sarah asked her husband to take notes because her brain was so foggy she could barely stay on track in conversation, let alone remember what we discussed.
According to Dr Oscar Serrallach, Sarah's symptoms are typical of a condition he has labelled postnatal depletion. Formerly an emergency medicine doctor, Dr Serrallach is now a GP in northern NSW, specialising in nutritional and integrative medicine.
"A lot of my clients were new mums, they seemed to be really tired and not coping well, and initially I thought this was quite normal. But just because something is common doesn't necessarily mean it's normal," he says.
"It wasn't until I had children with my partner Caroline that this really hit home. We had our children quite close together, and after our third child I saw a dramatic change in Caroline's energy levels. She got this baby brain that I heard so many mothers talking about, became very fatigued and was quite anxious.
"This was happening to a lot of women I saw and there seemed to be a biochemical pattern. I went to the textbooks and although there was a lot of information about postnatal depression there were few studies on postnatal fatigue – there seemed to be a huge gaping hole in the research. At this time I was starting to get into nutritional medicine so it was a natural evolution into learning about nutrition and micronutrients and helping with hormones and sleep."
How it happens
Dr Serrallach explains the physiology of growing a baby: "The placenta has to serve the needs of the mother and the baby. It will provide everything the baby needs in terms of nutrients, vitamins and fatty acids and whatever the child needs to be fully formed and healthy, and this is often at the expense of the mother.
"The average mother's brain shrinks around 5 per cent during pregnancy but parts of the brain are upgraded in preparation for the new role of nurturing a baby. I look at this in terms of a 'maternal upgrade' that the mother receives during pregnancy. Most mothers' brain volumes will rebuild, usually over about six months, but there will be women where that doesn't happen, and this would certainly lead to some of the symptoms we are seeing."
Postnatal depletion can happen whether this is your first baby or a subsequent child, and this depletion can be an accumulative process – you conceive a baby, grow a baby, birth a baby then breastfeed, then throw in some sleep deprivation and the emotional stress of adjusting to this new role, along with unrealistic expectations that you should be able to manage this all on your own.
If, like Sarah, your partner travels for work or you are a single parent, you can be isolated and lonely too. This naturally takes a toll on your own resources, especially when you have babies in close succession.
The possible postnatal depression overlap
There can be overlap between postnatal depression, which tends to be acute with more defined symptoms (mood swings, anxiety or panic; sleep disturbances unrelated to the baby's needs, changes in appetite, chronic exhaustion or hyperactivity; crying; irritability, negative, obsessive thoughts; fear of being alone or withdrawing from family and friends; loss of memory or concentration, unrealistic feelings of inadequacy or guilt, loss of confidence and self-esteem) and postnatal depletion which, according to Dr Serrallach, is more of a syndrome of accumulated issues, but includes symptoms of deep fatigue, hyper-vigilance and feeling overwhelmed.
This depletion can lead to poor immune function and subsequent issues such as mastitis and poor gut health, and it can be a vicious downward spiral towards postnatal depression.
And it's not just brand new mothers who are vulnerable: Dr Serrallach claims the accumulative effects of postnatal depletion can continue for up to 7 to 10 years for each pregnancy. And, in a study by Australian researchers published in BJOG, an international journal of obstetrics and gynaecology, postnatal depression can take up to four years to manifest. It's not just something that shows its ugly face in the six months or so after the birth of a baby.
Treating postnatal depletion
If you are suffering from the proverbial 'mummy brain', are feeling exhausted and hyper-vigilant, anxious or overwhelmed about life, whatever the age of your child, this could be due to the accumulative effects of postnatal depletion.
Dr Serrallach emphasises the importance of eating nutrient-dense food from preconception through the postnatal period, especially foods rich in protein, iron, and DHA, an omega-3 fatty acid – and also encourages mums to get enough vitamin D.
He stresses that a healthy breakfast can set you up for the day. "Typically when mothers are adrenally exhausted they will reach for more sugary, carbohydrate laden foods, because that's what the adrenals are asking for – immediate energy – but that may not serve the mother for the day. It will pick them up for a couple of hours but they will crash, so depending on the mother's individual needs, a healthy breakfast will have lots of protein and healthy fats t o help get that sustained energy. This could be anything from a cooked breakfast of bacon and eggs to a healthy smoothie with chia seeds and coconut oil and some super foods added."
Dr Serrallach's framework to treat postnatal depletion includes a three-pronged approach: repletion, recovery and realisation.
The 'repletion' program tests levels of nutrients as well as gut, liver and brain health and hormone levels; in severe cases, treatment may involve the use of intravenous vitamins. For instance, he says, some mothers may be so depleted they may actually need several intravenous iron infusions.
The 'recovery' period is more educational about a healthier lifestyle – how do we eat well, sleep well, exercise well? Dr Serrallach advises that a mother needs to be feeling at least 5/10 before we start introducing education – if you start talking about food additives or personal care products, for example, this is too much information too early.
The third part of the program, 'realisation', is about honouring the role of mothering, and can include counselling and referrals to appropriate support networks.
I asked Dr Serrallach what one key message about postnatal depletion would be.
"Support. Mothers supporting mothers, as well as education and preparation," he says. "There needs to be a much healthier dialogue about motherhood, and to really honour that it's something very special and sacred, and to get as much support as you can. Support is not a dirty word!"
Pinky McKay is an Internationally Certified Lactation Consultant (IBCLC) and best-selling baby-care author of Sleeping Like a Baby, 100 Ways to Calm the Crying and Parenting by Heart. See Pinky's books, blogs and baby massage DVD at her website, pinkymckay.com.