What is happening in our society is that many mothers-to-be are already depleted leading up to the conception and pregnancy time. Nature’s 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 baby’s brain) and the hormones produced by the placenta look very similar to the hypothalamic hormones—again 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 mother’s 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 nature’s 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. It’s 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 child’s 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 mother’s detriment is the mother who “discharged” herself from hospital with pneumonia because she needed to get back to her children—without any external support, her upgraded program told her to take care of her children even if it means sacrificing her own health.
Where should women start in terms of starting to feel like themselves again?
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 can’t 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 don’t 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 quality—I’ve 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 re-evaluate a mother’s 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 mother’s 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 heroine’s 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.