A special series on African-American, Asian-American and Latin-American women with postpartum depression.

Connecting Black Moms with Black Mental Health Providers

Connecting Black Moms with Black Mental Health Providers

The Problem

Postpartum mood and anxiety disorder symptoms don’t discriminate against some of the most vulnerable groups in our society. The social and environmental inequalities leave Black mothers struggling with access to care, support, and kindness while also facing rhorrific systemic racial hurtles.

We know that Black women and women of color are less likely to be believed when they report symptoms of Postpartum Depression and Anxiety. We also know that their symptoms are more likely to also be passed off as other illnesses. We find this unacceptable.

The Facts

The facts are that more women will suffer from postpartum depression and related illnesses this year than the combined number of new cases for men and women of tuberculosis, leukemia, multiple sclerosis, Parkinson’s disease, Alzheimer’s disease and epilepsy. Of those women, around 25% are in low income areas and report symptoms of postpartum depression or anxiety.

Black mothers tend to trend higher in the “low income” category because of the way systemic racism has impacted poverty. The racial and ethnic difference that peer-reviewed evidence shows us requires that we make changes to how Black women and women of color are receiving care.

Our Investment in a Solution

The evidence is troubling. The Postpartum Progress mission includes ALL women and for that reason we have established strategic goals around addressing the very vulnerable women who are not being served by a discriminating system.

Most recently we have created tools to empower women of color.

We created the Black/African New Mom Checklist.
We created the Hispanic New Mom Checklist.

In addition to these checklists, we have also compiled a list of 100 Black Providers as a resource for Black women. Being seen and heard without the roadblocks of judgement and bias are important in obtaining recovery for perinatal mood and anxiety disorders.

Often the racial differences between client and provider can make an already difficult process even more difficult. All of these providers are also women, because we believe in the unique power and ability for women to help one another. Our hope is that this list provides another layer of support for Black women on their journey to recover from postpartum depression and anxiety.

Announcing Our Black/African Diaspora Checklist

Black/AfricanDiaspora Checklist

Women of color, particularly Black women and women of African descent are less likely to be screened for PPD and less likely to get treatment and receive follow-up care. Results show that it is more likely for treatment teams to attribute symptoms of Black and Latin women to other ailments and not PPD.

To make it plain, while many women are never screened, women of color are bypassed in the screening process even more so, and when they do display symptoms of PPD, other factors are often blamed. Black women and women of African descent are consistently not getting the help they really need. This reality means it is vital for women who are at risk for perinatal mood disorders to be strong self-advocates while we work to change the systems that marginalize them.

People facing diagnosis of mental illness face significant difficulties around the stigmatization of having a mental health condition. When we factor in minority statuses, especially multiple overlapping minority identities, the stigma becomes heavier and far more damaging. This is what it means when activists and experts reference that African American and Black women are at the greatest risk in the maternal mental health discussion.

We believe that not a single mother should suffer in isolation with perinatal mood and anxiety disorders (PMADS). Perinatal mood and anxiety disorders do not discriminate, but systems do. Our response to systems that seek to disenfranchise women of color is to provide a tool to increase the quality of care Black women receive. Our African/Black Diaspora Checklist was designed with Black women in mind.

Our checklist was developed with feedback from clinical experts and patient input in order to empower Black women who are seeking support around their experiences with perinatal mood and anxiety disorders. The checklist is designed to:

  • Empower mothers to help themselves.
  • Facilitate conversations that can be difficult for mothers to start with their doctors and other care providers.
  • Reinforce the variety of recognized, evidence-based symptoms of perinatal mood and anxiety disorders to both mothers and clinicians.
  • Reinforce the variety of recognized, evidence-based risk factors of perinatal mood and anxiety disorders to both mothers and clinicians.
  • Help clinicians get a clearer picture of how to best assist their patients.

So what has changed?

We know that Black women and women of African descent experience a different range of symptoms and risk factors concerning PMADS. Additionally, Black women and women of African descent do not conceptualize their emotional experiences in the same way that other race and ethnic groups do. As a result, symptoms of depression may show up far more physical and less psychological.

Black and African women suffering with undiagnosed PMADS also have different environmental risk factors. Openly suffering from mental illness is something that is highly tabooed in the cultural relations of Black women (Schreiber et al). Among researchers of Black women’s experiences with depression, being strong repeatedly emerges as a key factor in their experiences (Beauboeuf-LaFontant, “You have to Show Strength” 35).

Clinicians and care providers must take into consideration the impact that race-based violence and oppression play in increasing the presentation of symptoms in Black women and women of African descent. Care providers who wish to provide quality care for Black women and women of African descent must be willing to change the lens to address the unique needs of this population.

As such, we’ve created the Black/African Diaspora New Mom Mental Health Checklist to help empower mothers of color speak directly to their clinicians. We hope it will help moms advocate for themselves and help clinicians recognize the signs and symptoms of postpartum depression and Black/African women.

Beauboeuf-LaFontant, Tamara. “You Have to Show Strength: An Exploration of Gender, Race, and Depression.” Gender & Society 21.1 (2007): 28-51. Web. 14 Jan. 2013.

Schreiber, Rita, Phyllis Noerager Stern, and Charmaine Wilson. “Being Strong: How Black West-Indian Canadian Women Manage Depression and Its Stigma.” Journal of Nursing Scholarship 32.1 (2000): 39-45. Web. 26 Feb. 2013

All Mothers Deserve Access to Affordable Postpartum Depression Treatment

[Editor’s Note: Today’s guest post comes from a Warrior Mom who struggled to find access to affordable postpartum depression treatment. This is not okay, and it needs to change. -Jenna]

All Mothers Deserve Access to Affordable Postpartum Depression Treatment

The doctor noticed I was depressed immediately.

After the initial intake, she looked in my eyes and declared, “You’re depressed.”
“Yes,” I responded.

This wasn’t news to me. My daughter was five months old and I knew what I was experiencing. The doctor began to list a number of suggestions for things that might help. I had a response for every one.

“Can someone help you with the baby?”
“No, everyone works and no one has time.”

“Could you take her to daycare?”
“No, I am breastfeeding her on demand, don’t like pumping/she won’t take a bottle, and we can’t afford it.”

Finally the doctor concluded the meeting with, “Well, there has to be something you can do,” without offering any more suggestions.

I guess that’s not fair. She did offer suggestions: a weekly massage and acupuncture routine that could be done in her office. The total cost of said treatment would be more than I could afford. I thanked her and left the office. A couple of months later I got a $400 bill for my visit.

Then there was the therapist I saw who was referred to me by another Warrior Mom. This therapist was supposed to be one of the best in the city for helping moms through postpartum depression. I saw her two or three times, but each visit cost around 275 dollars. She did not take insurance, which is something I kept coming up against when I identified the best therapists for women with postpartum depression.

“It’s worth the money,” someone told me.

Sure, I thought, but only if the money is actually there. I can’t fabricate money. I believe this therapist may have been able to help me, but I really needed to see her at least once a week and we simply did not have the resources for that.

By the time I saw the specialist who worked specifically with women who had postpartum depression, I had identified that that quality was one of the most important in my recovery. After seeing a therapist through my husband’s job who told me to “stop doing that” when I told her how my daughter’s crying triggered my anxiety and forced me to immediately drop what I was doing for her every whine and cry while simultaneously trembling, I knew that I needed to work with someone who understood and was sensitive to what I was experiencing.

My problem, which I suspect is a problem felt by many in my position, was getting access to the care that I needed. Every single specialist who worked with women who had postpartum depression did not take insurance except for one. I ended up seeing the one who accepted insurance and even then she didn’t accept my insurance. She told me that she had tried to work with my insurance company, but they claimed that there were already plenty of therapists in their network. Even though she did not take my insurance, she agreed to charge me what a normal copay would be. I was relieved to finally find an affordable option.

The whole process was extremely troubling to me. One of the things I was able to do during that time, which is not easy for someone suffering from depression, is advocate for myself. After almost a year of not feeling well, I realized that I had to take matters in to my own hands. That’s when I became more proactive. This was nearly impossible when my daughter was first born, and I wonder if I had had someone truly advocating for me who knew the proper information to help me find appropriate care, I might have suffered less.

The US Preventive Services Task Force recently recommended that all pregnant women and new mothers get screened for depression, but that is not where the work ends. It’s actually where it begins. How a doctor goes about laying out the resources available to a mother can make a world of difference in whether or not she follows through with seeking help.

I have heard other mothers in postpartum support groups say that the way their doctor dismissed them or just threw medication at them without listening to how they were feeling really turned them off from seeking help. It’s important that mothers who are suffering from a postpartum mood disorder work with understanding and sensitive practitioners. It’s crucial in those early months when a new mother may be feeling misunderstood, isolated, or like nobody cares or understands what she is going through.

The issue of insurance and cost of care were both a really huge barrier. I identified so many resources that could have helped me that I simply could not afford. My inability to access the best care made me feel that my recovery was not valued as much as the people who could afford the best resources.

There is room for much improvement. I hope that by talking about the barriers I encountered, it will encourage people to create programs that are accessible to all mothers, regardless of their ability to pay.

I hope that more resources like the free postpartum depression support groups I found will be made available. I hope that insurance companies will work with more specialists in postpartum depression who, in turn, want to work with the insurance companies. I hope that the specialists who do not accept insurance will find more ways to make their care accessible to more women. I hope doctors who screen their patients for postpartum depression will do more than hand the mother a prescription or piece of paper and send them on their way.

I hope more people will see the value in taking care of mothers so that we can take care of our families. We need to talk about how we can do better.

~Kristina Newman

PPD & Immigrant Life: When Your Village Is Far Away

[Editor’s Note: Today’s guest post comes from an immigrant Warrior Mom from Pakistan. A practicing Muslim, her family doesn’t discuss mental health, so she struggled to make sense of what was happening after her baby was born. -Jenna]

PPD & Immigrant Life: When Your Village Is Far Away

It does not give you a warning, it does not hold back any punches, and it definitely does not allow for clear thinking. For me postpartum depression was the most excruciating, humiliating, and traumatic experience of my life so far, thankfully. I have nothing else to compare it to, for which I am constantly grateful.

I had a worry free pregnancy. I worked until the day my water broke, albeit a little before my due date. I thought I was fairly prepared and could handle this baby birthing thing. Sure, I had a natural fear of the pain and anguish involved, but I was clear in my head that I would plow through it and all will be well.

I had done my share of extensive research on pregnancy, healthy eating, development milestones, and so on, and my bedside table was piled high with books with titles like working mother’s pregnancy guide and such. When I think back on those days, I realize that all those books didn’t have a lot of information on postpartum depression; they did not seem to red flag it. Even my OBGYN didn’t feel the need to fill me in.

Perhaps I was just unlucky.

I had a painfully long, induced labor, but my son was born after only four pushes, and then, it was done. He was healthy, and I was in a daze of happiness, elation, and perhaps relief. In the recovery room, a lot of information is thrown at you in a short span of time, and you are expected to absorb it, and leave in a day to start the most important journey of your life.

For me it meant I reached home and the panic hit me. I remember looking at my tiny tiny baby and wondering, what now? My husband on the other hand seemed to be happy and excited, not panicky at all.

From that moment on, I lost the ability to sleep and eat and as a result to think straight. I would meticulously feed him, note down the exact minutes and seconds he fed, how much he spit out and how much he slept. I would panic each time he would latch on and off, worrying if he was getting anything.

I would not sleep even when he would sleep because I had to keep an eye on him. I had to wake him up every other hour to feed him just in case he was hungry. I could not leave his side, and on top of it all, I could not eat. Not one bite.

I would keep asking my husband why the baby was sleeping too much and if I should wake him up. His pediatrician recognized on our first well visit that I was definitely not okay even though the baby was thriving perfectly. She told me I needed to relax and seek help.

Of course I did not do those things since in my culture. I am from Pakistan and a Muslim by faith. Women are taught sometimes consciously and mostly unconsciously that mental health issues are trivial pursuits and even taboo topics; you just bear your burden as best you can and carry on. We’re also taught that motherhood is the most natural thing in the world, so you are somehow hardwired to excel at it, with no setbacks.

I come from a fairly liberal background and studied law not only in Pakistan but also in the United Kingdom as well. I worked in a law firm for a few years, so I was not really subject to most of these cultural nuances, but I did grow up in that society and some things just latch on to you.

My husband finally did some research and diagnosed me with postpartum depression and tried to be understanding, most of the time. It was rough for him to see me melt into this puddle of confusion and incoherence. I always had my shit together, always. But now my thoughts and fears were paralyzing me.

However on my husband’s coaxing, I did try calling a helpline once or twice and was told of resources I could turn to (reading materials and maybe therapy if my insurance covered it) once they determined that I was not suicidal. I was not suicidal; I was just not myself.

The thought of navigating the internet for resources or finding a therapist covered by my insurance seemed like insurmountable tasks. I was just so tired, too tired to think. I could not remember how to make my go-to recipes. I could not watch TV. I just just did not know how to navigate through this fog.

I finally went to my OBGYN and asked her for anything to clear my head while in tears. She on the other hand told me I needed to hand the baby to my husband, sip a glass of wine, and just sleep for a few hours (forgetting that I was a practicing Muslim and could not have alcohol). That all made sense, but it felt like she was trivializing a disorder I so clearly had.

By this time my mother in law was with us looking after the baby, so my doctor suggested I should be grateful that I had help which she never had and I should snap out of it. That conversation made me feel even worse since now I was acutely aware of the fact that perhaps I was inviting God’s wrath by not being grateful and pulling myself together. But I had no idea how to get out of the haze that seemed to follow me everywhere.

My mind has always been my strength. I talk myself out of stressful situations. I enjoyed reading. I enjoyed cooking, but now I was incapable of seeing any silver lining, any sunshine, and it was killing me from the inside.

I come from a culture where depression or any sort of mental issues are not discussed or even acknowledged, at least for my mother’s generation. She would call (from Pakistan), and I would cry and she did not understand why, saying time and time again that as long as my baby was well, there was no reason to feel this way. But I had no choice in the matter. I tried to make her see that I was trying to find a way out, that I could not help how I was feeling, but to her it just seemed I was over reacting and just thinking too much and perhaps this state of mind was somehow a western phenomenon.

She even suggested that people had babies all the time and they all turn out okay and it should all come naturally to me. At some point the people around me, mostly family, started to blame breastfeeding for my state of being, thinking and suggesting out loud that formula feeding would solve the issue. I knew it would not.

In our culture, a woman is expected to receive 40 days of absolute rest and pampering after child birth. During this time, she is fed certain foods known to heal the body (and perhaps the mind, unknowingly) and is surrounded by family members who offer all kinds of advice and practical tips for taking care of the new baby.

I did have my mother-in-law living with us who tried to help in every way she could despite the fact that she had never heard of postpartum depression, so her help tended to constitute of constantly suggesting formula as opposed to nursing so I could get some rest and sleep. I know it must have been very hard for her seeing me in such a state and not having a clue as to how she could help.

It truly does take a village and being an immigrant in a foreign country meant my village was very very far.

I want to mention here that the constant portrayal of a “perfect” new mother with a sparkling house, a smiling baby and manicured nails in the media does not help an average new mother, not one bit. We end up feeling unnecessary pressures and focusing on all the imperfections around us and in us instead of using that time to bond with our precious babies.

I chugged along in a haze of anxiety trying to hide my fears, dismissing them as irrational and crying all the time praying to God to help me feel better. I so desperately wanted to be happy and not be plagued by dark thoughts. I resorted to simply not discussing myself every time my mother called. I would hide from my mother in law and cry my eyes out. In a way I felt sad that I had to hide this way from the women closest to me just so I would not have to explain what I had no idea how to explain.

Fast forward to about three months later, my fog cleared (somewhat) in the most bizarre way. I was struggling to get in touch with the state disability office while battling engorged painful breasts by heating up a pad to place over them. I was literally in tears of exhaustion standing by the ironing board.

I lifted the iron while holding the phone in my other hand and instead of placing the phone on my ear, I almost put the iron on my cheek. I stopped in time but just about. Somehow this jolted me in a way I did not expect. Coupled with the fact that my maternity leave was ending and I had to get back to work, my mind set shifted, perhaps the hormones balanced out, or I just got lucky.

I did struggle (still do) with balancing work, pumping, nursing and a baby (notice how I did not even count a house or my husband). Now I tell my story every chance I get. I am not ashamed or embarrassed one bit. Every woman needs to know about this crippling phase, just so she doesn’t feel punched in the stomach when a baby doesn’t come with rainbows and unicorns.

To all those who suffered and are suffering, please know that this foggy version of you is NOT you. Reach out to everyone and anyone, speak about it, discuss it and know that there is help and just take each day one day at a time.

~Jehanara Haider