Women of Color and Maternal Mental Health: Why Are We So Underserved?

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women of color maternal mental healthOver the past year, I’ve made it a point in my advocacy efforts to focus more on women of color, talking with them about their mental health experiences during pregnancy and the postpartum period. Based on those conversations and my own personal experience, I’ve become especially interested in how perinatal mood disorders and their symptoms impact and manifest in our lives, what culturally specific barriers to support and treatment we encounter, and what mental health advocacy efforts are being made to remove those barriers for us. Here’s what I’ve learned from research, Postpartum Progress’ current survey on mothers of color and their experience with perinatal mental health, conversations I’ve had with fellow mothers of color, and from what I’ve seen in the mental health advocacy space.

 

  • We are woefully underserved by mental health professionals and social services that reside in our communities-for a variety of reasons. Many of the women I spoke to were dismissed, rebuffed, or had their mental health concerns during pregnancy and the postpartum period downplayed by their doctor, pediatrician, pastor, and/or social worker.
  • Women of color are either without health insurance, or have insurance plans that do not cover mental health services, especially during pregnancy. Medicaid, for example, often lapses in many states six weeks after pregnancy, leaving many without continued coverage and access to mental health care.
  • We are not informed or aware of what places us at a particular risk for developing one of these illnesses compared to Whites.
  • We simply aren’t aware of the symptoms of perinatal mood disorders.
  • Stigma around mental illness is prevalent in our cultures but this is especially true when it comes to motherhood. Our cultures place a significant emphasis on us being silent about our struggles, taking care of everyone else before ourselves, turning to religion in an effort to overcome, and on being strong in the face of adversity-particularly in the face of oppression, racism and other socioeconomic stressors. Seeking the help of a professional, and disclosing our symptoms is seen as a sign of weakness so much so that we ignore the need to make our mental health a priority. Health advocacy efforts focus solely on physical illnesses such as diabetes, heart disease, stroke, infant mortality, and cultural disparities in breastfeeding rates. The latest statistics show that women of color and those living at or below the poverty line have a higher rate of occurrence, yet none of the national organizations dedicated to empowering and serving minorities discuss maternal mental health and the disparities that exist in regards to diagnosis, support, and treatment. This is preposterous and negligent considering our rate of occurrence is 1 in 4.
  • Our reasons for not discussing it publicly are a significant barrier to raising awareness and seeking treatment. We face racial and gender discrimination in our places of employment so as you can imagine, disclosure of a postpartum mood disorder can increase the risk of losing our jobs significantly. Many of the women I’ve spoken with have expressed this fear, with several stating it was the sole reason they didn’t seek treatment either during pregnancy or when their symptoms peaked during their child’s first year. Support from family and friends is often minimal due to culture specific stigma and ignorance surrounding mental illness. Many of us living at the poverty line or who are in the lower-income bracket utilize the help of social services such as SNAP, WIC, and TANF; speaking from personal experience, I can say being under scrutiny from social workers and the state triggers fears of losing your children for being seen as unfit to care for them.
  • Lack of research. I’ve grown incredibly frustrated in my efforts to find consistent research on this issue because, quite frankly, it’s pretty scant. Most of the research that focuses solely on women of color and perinatal mental health is also out of date, with data from the late 90’s and early 2000’s.
  • Lack of targeted advocacy. We do not see women who look like us in literature doctor’s offices, or on websites that talk about perinatal mental health. There are very few if any advocacy campaigns or outreach targeted specifically towards us, like there are for other health issues and breastfeeding. Advocacy organizations often focus on minority mental health only during designated months once or twice a year, instead of on a consistent basis. Many organizations simply focus on all pregnant and new mothers, which is fine, but such a general scope ignores our unique experiences with mental health. Our disparities in support and treatment due to socioeconomic stressors, our particular needs, the risk factors we face, as well as the role culturally specific stigma plays as a barrier are not taken into consideration when calls to action are given. They are mentioned as an afterthought, a sentence or two in a post or article. The results of such inattentiveness are programs and initiatives that are not inclusive of our unique needs. Finally, we lack support groups in our own communities as well as safe spaces online to talk with other women like us who understand our unique struggles as mothers, which for many of us creates a very isolated existence.

This has to change. It’s unacceptable and as a woman of color and survivor of postpartum depression and anxiety, it hurts my heart to know our maternal mental health isn’t being actively prioritized, much less thought of.  While I fully understand that postpartum mood disorders don’t discriminate in terms of who they impact, and that the need to help pregnant and new moms is great all across the board, I also know that efforts are seriously lagging behind when it comes to the maternal mental health of women of color. We MUST do better. Later this week, I will talk about how we can but for now, I’m interested to hear your thoughts. Mothers of color, what has your experience been, and what kinds of supports and programs do you think would serve us better? What kind of improvements would YOU like to see?

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Quitando la Máscara: This Latina’s Fight Against Postpartum Anxiety

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latina mom jessica escobarToday I’m honored to share my lovely friend (and fellow Texan!) Jessica Escobar’s story with you. Jess is a proud Latina and Texas girl who grew up on the border in El Paso, but currently lives in Austin with her husband and two beautiful girls. She’s a lawyer, avid runner, and the woman loves her some Starbucks, y’all. She’s also a PPA survivor and one of the fiercest Warrior Moms I know. She’s one of my favorite people and I’m honored she decided to put on her brave and share her experience with you. 

I’ve always been in charge of everything. I’m a typical Type A, first child. Growing up on the border, I’ve always served everyone around me before I think about myself.

I am literally incapable of relaxing or giving up control. It’s a coping mechanism, I think.

I didn’t know anything about postpartum depression when I had my first daughter in 2005. No one told me about it–not my doctor, not my family, no one.

In 2011, there was the internet. Blogs. That’s the only way I knew what PPD was and how women suffered. My doctor still didn’t warn me. I was my own advocate.

When I had my second daughter, I knew I could handle being a working mom of 2, a wife, and still be everything to everyone. I’m superwoman, and I’d get back into my normal life, no big.

When I told my doctor about a few incidents I’d had after she was born, he chocked them up to bad days. He literally called it the baby blues. For the record, “baby blues” is the stupidest name ever. Anyone who has ever been depressed knows that it is so much deeper than “feeling blue.”

But it wasn’t depression. I had felt depression before, and this wasn’t it. Looking back, the symptoms would soon add up.

I remember being desperate to find the perfect outfits for family pictures. I was literally obsessed and not finding them made me depressed. It was all I could think of. One lunch I went to Target for retail therapy to help me relax and I was standing in the food aisle thinking I would get my husband and daughter some goodies. I could make them happy. I froze, with no clue what to buy; I was freaked out and didn’t know why. I called my husband to have him talk me down. Why couldn’t I figure something out that should have been so easy?

I told my husband I wasn’t ok. I needed help but I didn’t know how.

Shortly after, I was reading this post by Katherine about postpartum anxiety and sat at my desk knowing I had an answer. I didn’t have PPD, I had postpartum anxiety. It was a thing.

  • I couldn’t stay still. I always had to be doing something. I’d clean into the night, even though I was exhausted after a long day.
  • I constantly had to be checking and rechecking things. I would turn back at least a couple times a week to be sure I’d turn off appliances and locked the door.
  • I panicked. I worried. If I was in a long line, I became like a trapped animal and wanted to escape.

I printed out the article and took it to my doctor so he would know PPA was a thing. He brushed it off and said I had PPD, which I’m not sure he fully believed, and only prescribed me some low dose pills because I told him I would see a counselor. Which I did.

That wasn’t the hard part about getting help. That was just a room with him, me and my husband. Thank God for my husband’s support.

No one knew. I didn’t have to announce to anyone that anything was wrong.

I was raised to work hard and do my best. Men have machismo, I had whatever is the Mexican woman’s opposite. I had to do everything for everyone and I wasn’t satisfied till it was. I would never abandon my work; I would never accept help. I’d just put on my face when I needed to deal with people and go into my hole when I didn’t.

Until I couldn’t anymore.

The face wasn’t working. I couldn’t hide it anymore. I knew it and so did my boss. Thank God for her, though. She knew, even before I did, I needed to a break.

I still remember the day I left my psychiatrist’s office and she told me it was time to take a break. From work. I cried because it meant I was officially broken since nothing else was working. I was that bad. I knew I was no longer in control and I couldn’t pretend I was.

I took the time off of work and was so embarrassed knowing that people would talk. But I was at the point where it was so bad, I couldn’t even care. I needed help. I needed the time for myself. I’m lucky I have insurance and a good job that enabled me to take the time off. The break was what I needed.

To this day, most of my family-and pretty much the world-doesn’t know what happened. Not my extended family anyway. I knew how some of them treated others with depression and infuriated me. A couple mocked them and wrote them off as pill poppers. How could I share such a deep battle as mine? They didn’t deserve to know.

I’m better. I’m not fixed and I never will be. It’s an ongoing battle. I don’t think I’ll ever be off meds. Which makes me sad to say. But I’ve mostly accepted it.

I am terrified and proud to write this.

I’m still scared to share my struggles with “my real world” because that would mean coming out from behind the mask, la máscara. Be judged by people who know me.

But I’m proud to share this if it might help someone in my shoes see herself and ask for help.

 

 

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Bye-Bye, SSRI

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I’m not on my SSRI anymore. It happened accidentally-I would get so scatterbrained with work and taking care of the twins plus the preschooler that I would totally forget for a day, then take it the next day and swear I wouldn’t do it again. That happened over and over for months. Then one day became three. Three became a week. Then one day I realized that it had been two weeks since I had taken one and it was an opportunity for a hard choice.

I had been considering getting off of it-this time around it was more of a precaution to ward off PPD/A since I was the poster child. I had talked at length with my husband and toyed around with the idea with my doctor. We decided to go for it, though I knew I had a hard road of withdrawals ahead and I would need to work extra hard to put what I had learned in therapy into practice.

After a few more days of feeling off but otherwise ok, I turned into a cranky grizzly bear. I cried constantly and my emotions were roller coaster to say the least. I had headaches and I was exhausted, but I pushed through.

A week later my coworker commented on how I looked like weight was off of my shoulders and I was much more level-headed than the week prior. She could actually tell that I had gotten over my withdrawal symptoms and I seemed happier. That was really nice to hear, because I’m always worried about how my emotions present themselves.

Two months off and I’m feeling pretty good. I still have my moments. I’ve always been a crier– after not being able to have a good cry when I needed the emotional release for nearly four years, the tears are welcome. No one has pulled me aside to tell me they think I need to get back on them, so for now I’ll take that as a positive sign too.

I’m relearning to operate in a stressful world without the thing that has helped me get through a lot of hard stuff. Sometimes I wonder if my emotions and reactions are a result of my history, or if they’re just normal feelings related to raising a strong-willed preschooler and infant twins. Or is it that I’ve changed so much as a person in the last four years that I don’t know quite what to expect of myself? It’s probably a little bit of everything. Raising kids is HARD. It’s emotionally and physically draining-I’ve had to grow up and make changes I never dreamed of. It’s confusing, and ugly and beautiful and the best thing I’ve ever done all rolled into one. 1972253_10101347043226636_9202139299031372242_n

When I’m having a rough go, chatting with other moms to find out that they’re all going through the same things helps me feel normal and gives me the boost I need to keep putting one foot in front of the other. Medicated or not, surrounding myself with real, honest moms was [is] a huge part of my recovery success and one of the best things I could’ve done.

I know that there’s a chance I may need to take medication again in the future. I needed it once before kids and I needed it for nearly four years after. I’m ok with what the future holds in that department-either way, I know that I’m always going to be trying to be the best me I can be for my three children and my husband. That won’t ever change.

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Adult Time-Outs: Lessons From Postpartum Rage

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As part of my recovery from PPD, I learned through lots of expensive therapy that I also experienced what’s called postpartum rage. What could be a simple annoyance to a regular person could send me flying off the handle. My rage manifested itself in yelling, lots and lots of yelling. Occasionally there were slammed doors and a desire to hit wIMG_1612alls-nearly all of it was directed toward my husband, but upon my return to work (pre-diagnosis) I reacted poorly to stressors and would find myself crying in my office, angry that I hadn’t been able to contain my frustrations or explain myself without becoming a blubbering idiot. My emotions during that time cost me a lot of professional respect that I’m still trying to gain back.

The birth of my twin girls brought a whole new set of stressors, but I didn’t experience the PPD/A to the extent I did with my son because I was prepared and so was my doctor.

Now that my son is older and he can read and understand my tone and body language, I have to work extra hard to contain my urges to express my gigantic frustrated feelings with loud words, slammed cabinet doors, or throwing a toy outside on the porch, aka “toy time out” when he accidentally-on-purpose tries to hit his sisters or nearly breaks the TV with said toy seven times. He’s my mini-me: a big-hearted fixer who wants to make and keep everyone happy, but he has just enough mischief behind those big blue eyes and smart-alec in his mouth to push every single one of my buttons. We butt heads a lot because we are so alike. Lately, I’m finding that he’s picking up on my yelling and it breaks my heart that he’s learned that from me. As a result, I’m trying to be extra aware of my triggers and follow through. Sometimes I walk away, but walking away isn’t always possible with the ten-month-old mobile twins in the mix. Sometimes I try to distract or deflect our attention from the stressor, even if that means TV, candy, or something I might find more annoying or would normally deny. Going outside always seems to help us both. Still, there are plenty of times when I lose my composure and I yell. When that happens, I try my best to walk away for just a minute to pull myself together, and then I explain my “big feelings” and talk about why I yelled. I also apologize and remind him that I always, always love him, even if I get mad or frustrated. We attempt special one-on-one time when we can, and I do my best to use positive reinforcement.

I need time-outs from more than just my son. The other night my husband tried to express his frustration with my addiction to screen time. I understood his underlying point, but his delivery frustrated me and I worked myself into anger (this happens a lot with us-he’s a man of few words and I expect lengthy discussions and explanations.) As I lay in bed trying to go to sleep, I felt the heat burning a hole in my tongue, and in order to resist saying things that were unnecessary and downright mean, I put myself in time out by exiting the room and laying on the couch in the dark. Twenty minutes later, he found me asleep and when I awoke, apologetic. He didn’t deserve my outburst.

I try to think of myself as s toddler when I’m frustrated. What are the roots of my rage? It’s usually the big three: fatigue, hunger, or feeling like I’m tapped out. If I can stop myself just before the yelling starts, or even in the midst of it, I address these things first. Snacks, snuggles with my three kiddos, sneaking off to take a rare Saturday afternoon nap, and trying to use my words to explain why I acted out and ask what we can do together to fix it all help. Communication is key with my husband. Venting to friends and patient coworkers helps me survive when I’m at the office.

I’m far from being the perfect parent, but I know that I still fall into the realm of normal. My son is not old enough to understand this, but I remember my mom saying “I love you, I will always love you, but I do not like you very much right now.” We all have those moments. All of us—and that’s okay.

Some of us just have to work a little bit harder to make sure they’re fewer and farther between.

 

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