When I decided to become a physician I knew it was going to be the hardest, most challenging endeavor of my life up to that point. Once I set that lofty goal for myself, the roadmap to achieving this was mostly set out for me. I knew the following things had to occur: excel in my high school academics, get accepted to a collage, complete the medical school pre requisites, apply and get accepted to medical school, complete medical school, pass the licensing board exams and begin my practice as a physician. This is a very simplified roadmap and there were many other details that had to be executed to get where I am today BUT I had all the information and resources to be successful at reaching my goal.

Now let’s rewind to my third year out of medical school where I’m finally feeling confident in the medical practice that I’ve been building. This is when my partner and I found out we were pregnant with our first son. The pregnancy was unexpected but very welcomed and we set out to prepare to become parents. I decided that I would approach this end goal of having a family similarly to how I’ve approached achieving all goals in my life. Geez, was I in for a rude awakening. This new season of being pregnant was totally different because I no longer felt like I was in control of my body. I couldn’t just push through the nausea and fatigue to attend my regular pilates classes. I couldn’t ignore the food cravings and aversions and eat my typical diet of vegetables, fruit and lean proteins. I couldn’t push through the hormonal mood swings and be mostly positive and cheerful. I couldn’t help but feel isolated because my old social life didn’t quite mesh with this new pregnancy phase. I couldn’t embrace my changing body because I obsessively compared myself to the old me.

As I’m writing this, I realize that saying “I couldn’t” made me a victim to my own thoughts, emotions and actions. Only now that my second son is almost 11 months old, do I realize that this victim mentality was simply my coping mechanism. I want to reinforce that this is a revelation I have only just began to analyze…it’s been three years since I was pregnant with my first son! While in the trenches, however, I whole-heartedly felt like all of the above was impossible.

Today I can see that my coping mechanism during pregnancy and the postpartum season was deeming certain things impossible and giving into what felt easy. I am by no means saying this was a bad or wrong coping mechanism. I will not beat myself up for choosing this. I do not regret the decisions that I made. I am working on accepting these facts so I no longer give power to shame or guilt. I am also now choosing to put aside this old coping mechanism.

I do think that if I had the information I have now, I might have been able to set myself up for success better; I may have been able to utilize different coping mechanisms. I am still working on achieving the lofty goal of being an exceptional mom and creating a loving family. It’s just that now, I’m realizing this goal will never be achieved in the same way I was able to become a physician. Becoming a mother and creating a family is so much more complicated because there is no roadmap. There is also no endpoint because the journey is life long.  Since there are no universal instructions and achieving this goal means you constantly have to work on yourself, I’m realizing there is going to be a whole lot of trial and error. I am working on accepting that I will fail many times and that is okay because I think that’s the only way to do this whole mom thing.

My passion as a naturopathic physician has been reignited since becoming a mother because I want to integrate my experience in naturopathic medicine with my experience of being a mom to help women. A colleague recently introduced me to the book The Postnatal Depletion Cure by Dr. Oscar Serrallach, and I think this postpartum period needs much more attention that we give it. When a woman is asked to think about her postpartum health, I think the majority of women think about two things: postpartum depression and delivery recovery. Both of those topics are extremely important but they only skim the surface of a topic that is much deeper in the physical, mental, emotional and spiritual realms.

I have enjoyed reading the book by Dr. Serrallach because he connects a myriad of symptoms that many women report after giving birth and attributes them to the normal process of creating life, which is essentially a depletion of a woman’s resources. He defines postnatal depletion as “a constellation of symptoms affecting all sphere of a mother’s life after she gives birth. These symptoms arise from physiological issues, hormonal changes, and interruption of the circadian day/night rhythm of her sleep cycle, layered with psychological, mental, and emotional components (page 4).” That is an in-depth, complicated definition that so accurately reflects the complexity of the postpartum period. Why then are women left to fend for themselves during this time? Why aren’t there more resources for moms during this postpartum season where they can begin to address all these new and sudden changes to their health? As a new mom we’re trying to figure out how to keep a little human alive, we don’t have the time, energy or resources to figure out how to address our health too. This is why it’s so important to have postpartum resources, which removes the guesswork and allows someone else to take care of you during this critical time.

So what exactly are the symptoms of postnatal depletion syndrome? Here are some of the most common ones:

• Baby brain
• Sensitivity to light and sound
• Depression
• Anxiety
• Loss of self confidence and self esteem
• Any new medical condition that started during or after pregnancy
• Digestive issues that worsened or began since giving birth
• Severe fatigue
• Low sex drive and libido

I also want to point out that mothers can suffer with the above symptoms for many, many years after giving birth. I truly believe this is because women are not encouraged to make their own health the number 1 priority. Women in our society aren’t given the time, resources or support to address the health changes that occur due to pregnancy.

According to Dr. Serrallach, postnatal depletion occurs when there is a drain of a woman’s resources from multiple levels. He believes the primary causes of depletion are the following:

1. Enormous amounts of nutrients are taken from the mother during the process of creating a baby. The placenta is an organ that is created in a woman’s uterus when she is pregnant. The sole purpose of this organ is to nourish the growing fetus with mom’s nutrients through the umbilical cord. The intelligent design of a woman’s body prioritizes the baby’s nourishment over mom’s well being. This means that if a woman isn’t consuming all nutrients necessary for baby’s development, those resources will be pulled from mom’s reserves.  Let’s not forget that this depletion of nutrients can continue after birth if a mother decides to breastfeed.
2. Severe and chronic sleep deprivation that occurs because infants naturally wake many times a night to feed. The interrupted sleep and lack of restorative deep sleep impacts all aspects of life
3. The drastic and sudden change in a new mother’s life can lead to a completely new social lifestyle which can be isolating, overwhelming and stressful. The sudden shift to funneling most of your energy, time and resources to the baby is extremely draining on one’s psychological health. Talk about an identity crisis!
4. Substantial hormonal changes occur during pregnancy and the postpartum period. These shifts in hormones have significant impacts on our physiology. Ever wonder why you all of the sudden developed an autoimmune thyroid condition after pregnancy? Or dealt with gallbladder issues while pregnant? Or started reacting negatively to foods that never bothered you before? Hormones are the culprits because they work hand in hand with our immune system.
5. Stress…being a new mom is stressful no matter how you cut it. Chronic stress will negatively impact one’s health and worsen nutrient depletion.
6. Lack of societal support is a massive drain on a woman’s self-confidence and exacerbates overall stress.
7. Preexisting factors that were present even before getting pregnant can contribute to postnatal depletion syndrome. Dr. Serrallach talks about the huge role inflammation plays and as a naturopathic physician, I can attest to this. Inflammation is the underlying culprit of so many chronic diseases and syndromes.
8. Environmental toxin load has a massive impact on our body’s health. This is an enormously dense topic that I will unpack in a later blog post

Some refer to the postpartum period as the fourth trimester and I wish this concept were more mainstream. Women diligently go to all their OB appointments in the first 3 trimesters and then once the baby is born we are sent on our way with no real support for our own health. We need to do better because we are leaving women vulnerable to developing debilitating physical, mental and emotional symptoms.

Stay tuned for the next blog post where I will be discussing how postnatal depletion syndrome can be treated and what tests can be utilized to determine what needs to be treated in the first place.  

Dr. Shannon Estrada