Q&A With Dr. Oscar Serrallach, author of The Postnatal Depletion Cure (GOOP Press)
Q 1 : In reading your book, I was reminded of the great saying, “When a baby is born, so is a mother.” It seems we are experiencing a bit of a renaissance when it comes to new motherhood — and with it a nod to sacred, ancient traditions and an increased emphasis on the necessity to nurture new moms as well as their babies. As a doctor, what drew you to this work with new mothers?
First of all, I was a new Father, observing certain health struggles in my own partner, which had me concerned. And secondly, as a Family Doctor (GP) there was no denying the patterns I was seeing in the women presenting post-natally in my clinic.
How I actually came to my “Aha!” moment was quite by accident. I had a patient come to see me, she had a thick accent, she was a mother of young children and was not doing well. She asked me whether I thought she was suffering from postnatal depression, but I misunderstood her to say postnatal depletion, and it struck me as a very reasonable explanation for this woman’s symptoms.
This happened to coincide with the beginning of my studies in Functional Medicine, which was hugely exciting for me as a doctor. I was beginning to look at things through new eyes, and with new understanding of nutrition, inflammation, and the complex functioning of the body as a whole.
I began to research the idea of depletion occurring as a result of the unique and complex biological changes that occur in a woman’s body throughout pregnancy, birth and breastfeeding. It was difficult to find any information in the medical texts - apart from studies on Postnatal Depression. So, this led to me look beyond the orthodox literature and towards the practices of eastern philosophy and traditional cultures. I started reading about how for millennia, traditional cultures have had specific practices in place to support women in the 4th trimester and rituals to honour her transformation into becoming a mother, something we are lacking in our modern Western society.
Q 2 : With celebrities speaking out on their struggles and realities in new motherhood, women are feeling more empowered to come forward with their own struggles and difficulties. We hear a lot about postpartum depression, which is different from postnatal depletion. Can you explain the difference?
One of the problems I have seen, due to what is commonly referred to as the Mask of Motherhood, is how easy it is for Mothers to assume that everyone else is ok, and it is “just me” that is not coping. This has created a tense situation, where we feel ashamed if we are not coping, and certainly not encouraged to speak out, which becomes the perfect storm for exacerbating mental health problems. One positive aspect about the cult of celebrity means that people in the public eye yield a huge amount of influence, and those women speaking out on their experience do serve to inspire all women that it IS ok, and that they are NOT alone in their experience, which is amazingly healing.
The difference between postnatal depletion, and postnatal depression is that depletion is the much broader set of individualised circumstances which can occur in a woman from having had children, inside of which a number of complex health complications can more readily occur, including Depression.
There is a lot of overlap between the two conditions, but the two key defining features that may occur in Depression but not necessarily in Depletion are:
middle insomnia, or waking up in the night, which is not to do with the baby, and being awake for hours;and a 24/7 unrelenting sense of despair; ie, a loss of any feeling of joy.
Many mothers may experience intensely depressive thoughts, but are also able to still feel joy and happiness. In this case, afluctuating mental state is more likely to be a state of Depletion coupled with sleep deprivation in the longer term. Whereas, someone who is experiencing Depression stays locked in that depressed mindset, and is unable to feel any happiness whatsoever.
Q 3 : Here in the U.S., we are starting to talk about postpartum depression but statistics are climbing and it has been described as one of the greatest public health concerns of our time. Why do you think there is such a gap between treatment of women during pregnancy and during the postpartum period?
There is very little in the way of research, looking into the complex changes that occur with pregnancy, breast feeding and motherhood, and therefore doctors aren’t typically informed or even aware of the vast array of issues that may be present, let alone how to treat them.
Women who do present to their GPs sometimes have an experience that is either - at one extreme being told “its normal to be tired, you’re a Mother,’ and dismissed, or otherwise - put on anti-depressants. Many GPs are time poor and unfortunately do not have training in situations that do not fit the disease model of health care, so they are simply not able to correctly administer proper support and treatment.
Q 4 : You discuss in the book some examples of postnatal support in other cultures and write that, “Our Western culture has done our mothers a great disservice by not honoring them on their road to recovery.” How can we change the conversation and practice around postpartum care? And how can we do so within the constraints of the current healthcare and hospital systems? Are we shifting away from health insurance?
When you compare the postpartum practices of traditional cultures with how we do things in the west, it hardly seems surprising that we have the widespread health issues for women that we do. But crisis is a great catalyst for change and I do already see this happening.
Firstly, I am starting to see positive change in the paradigm of health care. The current system of orthodox medicine has been this disease-based, doctor-centred model, where the practice revolves around the clinician. It places a lot of pressure on that physician, and the information is limited to whatever insights he or she is able to provide.
The new paradigm which can broadly be called “Integrative” Medicine, is a client-centred paradigm, whereby the patient is in the middle of the picture, and multiple practitioners revolve around the patient. For example, in the clinic where I work in Australia, there are 20 or more practitioners from across many modalities and what we call Allied Health Services all under the one roof, and it is widely accepted that a patient could require a number of practitioners from different modalities, to put their minds together to find solutions for that patient. This is hugely inspiring.
In addition, I’m so happy to see more advocacy and awareness around the need for self-care. Our culture is starting to become more empowered with their health generally, with people no longer willing to be “fed” with outdated ideas, and more eager to take their power back in terms of making informed choices. From the ground up, and through women telling their stories - this is how we can drive the change that is needed.
Q 5 : We have heard the postpartum period referred to as the “fourth trimester” or the “first forty days.” In your opinion, how long does a mother need to recover after giving birth? And how should modern mothers handle the inevitable return to work, especially in the U.S. where maternity leave is not mandated and may/may not be covered by employers/insurance companies?
I would suggest deep rest for one month, deep support from extended networks for a hundred days and a real priority on sleep for one year. In Traditional Chinese Medicine, there is a saying, that the first forty-two days after birth will determine the next forty-two years. This can be a sobering thought for many woman and no, at present, our culture does not seem to support extended leave for women in the legislation although we can look to countries such as Denmark (known to be among the happiest cultures in the world) who have built more family values into their societal framework, with maternal and parental leave, and legislation that allows a far more family friendly balance in their work culture.
I love the idea of the Fourth Trimester, because it gives women a tangible framework to aim for. When you consider how much a woman’s body changes through pregnancy, and the incredible feat of birthing, and the massive hormonal changes that occur, it would seem that 40 days is the least amount of time a woman should take for her system to regulate again.
For starters, there is an enormous amount of hormone rebalancing that needs to take place, its not just about the “body getting back into shape”. Nature’s design is that this rebalancing should happen gradually, and in the right supported environment, as the Mother’s body heals and she gently finds her feet again, as well as her new rhythm.
And yet, for many western women, the idea of being confined for 40 days after having a baby, no household work, being fed a highly nutritious diet from extended family, seems extreme and even claustrophobic, because it is so unlike what we are accustomed to. In our culture of busyness, women are not used to relying on the support of others and perhaps feel like it clashes with their independence.
For a women returning to work, I would strongly encourage her tor read up on the Fourth Trimester, and see how she can incorporate practices that feel right for her own unique situation. It doesn’t need to be all or nothing. For example there may be some dietary wisdom she can incorporate, or it may be that once she returns home at the end of the day, she can be supported in fully being present with her baby, with her partner, friends, and community taking up some extra household duties.
I would encourage a woman to speak to her employer to discuss her needs and any certain considerations - not only from her boss, but also from her co-workers. This is empowering for everyone, because it also serves as modelling for younger people in the workplace who may learn and take encouragement from what they see.
Of course, what we are aiming for ultimately is change in the legislation with paid parental leave, because in any culture, this is a major metric in how a society measures its family values.
Even if you are unable to practice fourth trimester wisdom to the extent that you would like, talk openly about what you would like, what would be helpful, and what an ideal situation would be like. People around you won’t always know how to offer you support that is really actually helpful! Also, remember that nature is truly forgiving, and that we are healing and advocating for our culture in the longer term. I know it can feel hard, but it is worth it to examine your needs now in order to establish a precedent in your identity as a mother of identifying the areas where you need support and bringing others in to give it to you.
Q 6 : In your chapter, “Recovering and Rebuilding Emotional Well-Being” you discuss the notion of being happy versus doing happy with regards to “finding the flow that leads to happiness.” Can you talk a little bit about this and how new mothers can apply it to their recovery?
A recent Cornell University study which looked at happiness over several decades came to the conclusion that we derive happiness from experiences, as opposed to material possessions. It explains why people who spend their lives working for a house, a car, and all the trappings of success can easily wake up one day to find that none of it has brought any happiness, but only a sense of emptiness.
“The Flow” that leads to happiness is something that the yogis have known for thousands of years, and many artists and athletes have realised too. It comes from simply being present, and riding the wave of focused attention that comes, culminating in a sense of connection to our source, our sacred self, regardless of what activity brings us to that state. What can bring us to this flow state? It is different for everyone, but a big clue might be to look for things which calm the mind, or in which you can “lose” your sense of time.
I think that periods of darkness, periods of struggle can be the greatest gift for many, because when we are in the struggle, we are really seeking answers and alternative ways. This is where we can stumble upon the gold of self-discovery. For Mothers, this is no exception. In my work helping women recover from Postnatal Depletion, I find that often a big factor underlying a health crisis is a lack of purpose, or a feeling that their true self has been lost in the role of Motherhood.
Often, what is underneath these feelings, is a deep desire to find one’s place in the world, to feel “ seen and heard,” or having a voice. This might be the same thing that brings happiness or a gateway to a flow state, and often it is interlinked with a creative outlet. It could be writing, surfing, or organising events. It could be working with your hands, or helping others.
My partner Caroline discovered a magical flow state which comes through music, specifically the mantra-based singing that is often a part of a yogic ritual. She found it after we had our children, once she returned to her yoga practice and now it is her passion to share this with others.
Once a woman has undergone her physical recovery from postnatal depletion, she is a bit clearer in her direction and feeling more able to look at bigger picture things. Remember, that it also requires patience and surrender and that everyone goes at their own gentle pace. It takes time, but gradual recovery is a gateway she needs to go through in order for the full transformation or true upgrade to occur, so that she is able to share her gifts with the world and enjoy the feeling of deep satisfaction and belonging which can occur from being in alignment with her calling.
Q 7 : One of the classic metaphors for the importance of taking care of oneself is the image of being in an airplane crash and remembering to put the oxygen mask on ourselves first— so we can then help others. Of course this is easier said than done, especially for new mothers. You write, “In our modern society, women have been socialized to put the needs of others before their own. They can even be harshly judged for identifying and revealing their own needs. To be a mother, she is told, requires total dedication and to be in a place of service and surrender. It is easier to be an unsupported martyr than it is to be a self-caring mother.” You hit on some major points here. What would you say to new moms struggling with this dichotomy? (And let’s be honest, most mothers do!)
Unfortunately, I have seen the countless casualties of this kind of thinking. I have seen women who are so unwell they are unable to take care of their families, and not only are they unwell, often they have waited until they are absolutely at crisis point before they have come to see me, and maybe by then we are dealing with a calamity. The longer things are left, the more time they will take to reverse, and the more complex they become.
Usually it comes down to what has been modelled to a woman in her own up-bringing, this is the socialization part. Sometimes it is helpful to discuss this and work out where the idea of self sacrifice or martyrdom has come from. .Acknowledgement is usually a good place to start, as well as the understanding that we are dealing with cultural influences that run deep and might not be serving us, or our families for that matter.
In my research, I have come across a fascinating theory called The Grandmother Hypothesis, looking at the evolutionary reason for menopause. This theory which has some weight in my view, is that women are designed to be around for many years after they stop having children of their own, not only to help raise the children, but importantly, to share their wisdom on things related to the survival of the species, such as bonding, communication and empathy.
In what I have seen in my work, I can’t help but agree this is the way that nature had intended for us. In terms of this, living as we do without this kind of support, a woman really needs to be proactive in ensuring she has support in the early years of raising children, and if it cannot come from the extended family, then it needs to come from within the community. Women need to acquire the skills to ask for help, and create networks of support for each other.
Finally, I would really encourage a Mother if she hasn’t already, to begin looking into practices of self-care and restoration. I believe that in a deep belly breath for example, or in the quiet place of a supported restorative yoga pose, a woman comes to know the truth for herself. She can sense it in her own deep cellular wisdom, she can hear and be guided by in her own intuition as far as what her needs are, and she needs to learn to trust and respond to this, above and beyond anything else.
Q 8 : What is the Mother vs. Martyr Challenge?
The Mother vs Matryr Challenge comes from the Motherwound. This is deep, deep work for women and for society at large. It is a wound that is inherited - not just directly from our own Mother, although that can be true, but from societal norms and from the Generations before - that communicates to a woman, “I made huge sacrifices in my own life to have children, therefore in order that you should honour me, you need to make the same sacrifices.” It is something that tends to come down through the Matrilineal, although there are many conditioned ways of thinking that apply to Mother / Son and Father / Son relationships too.
This wound contributes to a deep sense of guilt if a woman should dare to seek her own happiness or fulfilment, as it can translate to a sense of betrayal to their own Motherline. It can be a huge weight around a woman’s neck, which prevents her from being able to shine her light or reach self-actualisation.
Whenever we start to look at this particular area of healing for women, it is helpful to consider the motivation of helping to release their own daughters and the generations to come from inheriting the same wound. This was, a woman can start to understand that she is not acting out of selfishness, that we are all connected to each other, and that if one woman rises, then we all rise and benefit together.
Q 9 : Let’s talk about fathers and partners. We know about the affects of having a child on a woman’s mind and body. What affect does pregnancy, childbirth and ultimately becoming a parent have on a man? What is the physiological affect of childbirth on a father? Are there fluctuations in hormones?
This is not a well studied area but a very interesting one. It is known that a father’s testosterone can drop by 30% after the birth of a child and that prolactin levels increase - Nature’s way of giving a man more of a sense of being at ease, and creating an urge for him to stick around and be part of family life!
In the long term though, men need to be given sage advice as well, in terms of their new role and extra duties, as well as helpful ways of negotiating the confronting and life-changing waters of parenthood. A baby’s birth is a radical change for a father too, and many end up feeling on the outer, resulting in associated behaviours, such as spending more time at work, or addictive behaviours such as drinking or gambling or just feeling hard done by and disgruntled about life.
I am really happy to see more healthy dialogue out there nowadays for fathers as well, as they have also got their work cut out for them, in terms of over-coming the conditioning of society, that teaches them that it’s not masculine to show any vulnerability or to honour their emotions, and many other harmful and negative stereotypes. I would say, Fatherhood might possibly be one of the greatest (and most rewarding) challenges of Manhood that a man might experience, but like anything else it requires a dissolving of prior definitions and a willingness to think openly about a way forward.
Q 10 : What about relationships? If we are individually affected by baby’s arrival, what collective affect does it have on the parents and their relationship? Do you have any tips for couples as they navigate this new terrain?
The time of Matrescence for a women no doubt has huge ramifications for her partner, not to mention, the baby’s siblings as well. With the arrival of each baby, there is massive shifting taking place and it usually takes time for things to settle into the new dynamic.
Many couples are simply not prepared for the challenges and sadly, the early years of raising children can be a time of great pressure that causes many couples to go separate ways.
Firstly, many men are not prepared for the emotional bond that a Mother has with her baby, especially the uniquely intimate bond if she is breastfeeding. If a Father is unsure of his role in the equation, it can easily lead to a feeling of being displaced. A Mother can become impatient with her partner, since she feels like she is doing the lion’s share.
What I say to Fathers is that in the early period, a Mother’s primary job is to take care of the baby, and a Father’s job is to take care of the Mother. Men tend to be extremely single focused and task oriented, so this really speaks to them. This is not to say that Fathers shouldn’t get involved with caring for the baby—of course he should be looking to bond with his new child as well! But men need to be aware of how much their partners have been through after giving birth, and be sure to pay close attention when she expresses a need, a want, or a struggle. In the case of same sex couples, usually (but not always!) one partner will assume the role of primary care giver, the other needs to take the role as his or her supporter.
This also extends to keeping things running around the house, dealing with visitors. If the partner doesn’t necessarily understand everything that is going on for the Mother, that is ok, but they might need to be prepared to support their partner through a liminal space that can last months or even years. It might be necessary for the partner to seek some support as well.
Communication and a sense of relating and keeping the connection strong is also important, but what I often find is that verbal, face-to-face dialogue when partners are tired and stressed can sometimes be counter productive. So instead, arrange to spend time together, just being - watching a light hearted film, preparing food, doing activities as a family which are uncomplicated and enjoyable.
Many women derive a great sense of pleasure from seeing their partner take on their new role as the father, so it is lovely to allow space for this to happen. And anticipate that there will be things that Dad may do differently, in which case remember to keep your inner control-freak in check, if that is your tendency. It is important that the Father is supported in growing his own confidence in his new role.
Both partners need to remember to go gently and slowly. It is an intense time of huge change, made all the more challenging with the inevitable sleep deprivation that will occur, so don’t panic, even if there is a complete loss of bearings for a while. This is where self-care is vitally important for both partners, so that each has a chance to return to familiar activities that help create a sense of orientation, whether it be taking a walk outside the house, or some simple movement or activity. I highly recommend restorative yoga for women in the postnatal phase, and learning breath awareness techniques, for both partners to help stay centered and calm.
As for intimacy, once the baby comes along it is unlikely to be the spontaneous and exciting sex that it may have been before, so be ready for a more mature approach, that may even require it to be scheduled and enjoyed at a vastly different pace. Intimacy may not even always equate to sex, it may require some creative thinking to find sensual based activities that create that sense of connection for both partners. It can be an amazing healing and growth opportunity for both partners down the track to completely redefine what pleasure means to them, and learn how they can provide this for each other.
For both partners, this needs a huge amount of maturity and awareness. This is why I often think of this time as moving from Romantic Love, into a more sustainable “Mature” Love.
Parenting is a zone where we can all expect to feel like we fail from time to time. It is time, for our partners and for our children, to let go of any perfectionism and adopt a sense of realism and humanism. It is not a bad thing to make mistakes, to be flawed and to not cope all of the time, and it is a beautiful thing to say sorry and forgive and start over, with each new day.
Q 11 : One of the contributors to postnatal depletion is not having a support system in place. What can couples do, especially first-time parents, to best prepare themselves and each other for what is about to happen?
I often say in the postnatal time there are no be no visitors, only staff! If you are allowing visits from friends, communicate to them that the best gift would be for them to bring food, or help around the house. Many people do not feel comfortable making assumptions about what is useful, so it helps to prepare a list of jobs that you can stick on the front door.
Expecting parents can call their friends together in the time leading up to the birth, and ask for help. Often the task of organising a food roster can be taken on by someone in the inner circle. Check in with friends, to see if any of them would like to babysit down the track, some wont, but some may like to take on that role of trust. People generally love to help, it gives them a feeling of being part of a community which we all need so badly, they only need to be asked and told what to do.
Remember, that there is usually a huge excitement about the birth of a baby in the initial weeks after the baby’s arrival which can sustain the parents for a short while, but that the excitement wears off quickly, and often new parents are left feeling alone.
The other common experience for women is that they receive a lot of attention during their pregnancy, but then as soon as the baby comes, all the focus seems to shift to the baby. Mothers can feel invisible. Be prepared for this.
Do your research about what services are available in the community. For many women, a mothers support group is an invaluable resource, and I would encourage all women to seek this out. This can happen by accident, through attending prenatal yoga classes, or birth preparation classes, but otherwise she can check in local hospitals or by word of mouth find other women birthing in their neighbourhood.
It is important that this group is a true support, and if you end up feeling drained and stressed in the longer term from any underlying competitive talk at gatherings, it could be that the group is not serving you, and perhaps you could find a friend to meet with, one on one.
There are many fantastic books, articles and online groups. Seek out those resources that come recommended, and remember that the internet can also be a dangerous place to be trawling for information, especially in a vulnerable state.
If you have the ability to pay for cleaning services, take away dinners, or babysitting, or all of the above, then I would highly recommend not giving it a second thought. Perhaps there are other expenses that can be suspended for the time being in order to allow for this? Make your wellbeing a priority, at least for the first year, longer if possible. Some people can tolerate more mess in the home, but simply cannot compromise on good food. Others feel it is important to keep putting energy into their career, in which case finding child care that allows you to feel relaxed in doing so is your top priority. Work out what your values are, and make a plan to stick to these but be prepared to let other areas go, just for the time being.
Q 12 : You introduce a beautiful concept called Mothermorphosis. Can you talk about this?
Mothermorphosis is a word play on metamorphosis, the process by which a caterpillar turns into a butterfly. It is a powerful metaphor for many reasons. Perhaps the most significant fact is that once a caterpillar is inside the cocoon, there is a period of time while the transformation is taking place. If you cut the cocoon open, you do not expect to find half caterpillar and half butterfly, you will find mush: there is not a direct evolution from one to the other. The caterpillar has to completely break down into mush, before it can it rebuild itself into a butterfly. For many women, they will find themselves in a state that feels a bit like mush for a while, before they truly transform into the Mother they will become.
I learned this from a good friend of mine Arne Rubinstein, who teaches about Rites of Passage. Arne is another doctor who gravitated towards traditional cultures and archetypal stories to find guidance in his work, and it is very powerful. He has been doing amazing work with young men for many years, but now teaches how to apply the wisdom of Rites of Passage rituals to many other areas of our modern culture as well.
In our culture, we are generally more aware about Adolescence, that it is a time of great change for young people as they turn into young adults, and we know to expect a bumpy ride for several years. However, with Matrescence (the transformation of a woman into a Mother) there is much less awareness about what I see as being a time of equal hormonal change to Adolescence.
I feel it is one of my areas of passion and drive to bring awareness to this process of Matrescence or Mothermorphosis, not only in terms of the spiritual expansion of the self into the new skin metaphorically, but also in terms of the real and measurable biological changes that occur during this time.
Q 13 : You passionately wrote in the conclusion of the book that “This is a new way of motherhood in which the wisdom of the ancients becomes the medicine of the future.” How hopeful are you that this way of thinking can change the current state of maternal health? What barriers or challenges do you see? How might these challenges be met?
I am immensely optimistic. People are ready for change. The rise of the sacred feminine which i see happening is a response to people no longer being prepared to accept the Patriarchal ways, of capitalistic governments, of profit driven medicine, of society that undervalues Mothers but places a high importance on outer appearance. When we go back thousands of years and catch a glimpse of ways that were much more in tune with nature, where they worshipped fertility and where family structures were vital for survival and people lived in villages - we feel instinctively that this is what we are craving. This epidemic of depression and mental health problems is stemmed from a deep lack of connection, and belonging. We are being pushed to breaking point, which is perhaps what was meant to happen all along.
We can meet these challenges day by day, by showing up for ourselves and each other, by acting more intuitively, by joining forces, by allowing our true, authentic self to be seen, by paying closer attention to those around us, and by asking each other if we are ok and in need of any help?
We have the undeniable advantage of technology and the internet at our disposal, and even though it is not perfect and we are still learning how to use it, i feel that overall for our ability to be educated and reach out to one another and make connections, it is ultimately empowering and positive. Consider people living in remote or disadvantaged communities, or people with disabilities - the Internet is life changing.
There are extraordinary people working in Maternal Care, who feel so passionate about the importance of our Mothers wellbeing, for the health of society at large. They are mostly people going quietly about their work, putting their energy into supporting Mothers, building circles, having difficult conversations, I am hugely inspired by the healing work that goes on every day, and more and more women are tapping into these veins of tremendous inspiration and hope.