Expanding Outreach to Underserved Communities

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Divya KimarIn July, I had the privilege of speaking to over 100 survivors of PPD and other perinatal mood and anxiety disorders at the first Warrior Mom™ Conference about expanding outreach to underserved communities. When those of us who are survivors expand our advocacy efforts to support other struggling moms, we can benefit from reflecting on our own experience and understanding how the experience of perinatal emotional complications differs across different groups.

First, what do we mean by “underserved”? While women from ALL different places and backgrounds struggle with perinatal mood and anxiety disorders during pregnancy and postpartum, they face different challenges based on their identities, privilege, and life circumstances. A large body of research indicates that rates of maternal mental health disorders are higher among women who are disenfranchised. Women of color and low-income women experience PPD and related illnesses at nearly twice the rates of middle class white women; in fact, one study indicates that 40-60% of women living in poverty experience postpartum depression.[1] [2] [3] Moms who struggle with domestic violence, have a history of previous trauma, are recovering from substance abuse, and become a mother during the teenage years experience higher rates of depression and anxiety.[4] [5] Women of color are also more likely to experience poverty and pregnancy complications, which can lead to and exacerbate emotional complications. Lack of support, social isolation, and lack of access to physical and mental health services also contribute to and worsen depression and anxiety.[6] Plus, not only do women of color and economically disenfranchised women experience higher rates of mood and anxiety disorders, their rates of treatment are significantly lower.

Examining privilege, intersectionality, and the lens of diversity

As survivors, we may have ideas of how to help other moms who are struggling, based on our own experiences with PPD and related illnesses and what we found to be helpful. Before we can think about how we can support others, though, it is important to look at our own privilege. Privilege refers to any unearned benefit or advantage we receive in society because of an aspect of our identity, such as race, religion, gender identity, sexual orientation, class/wealth, ability, etc. When we say, “we warrior moms,” we may be making many assumptions about who “we” is, and, despite our best intentions, we may fail at being inclusive and/or representing folks outside our demographic. Reflecting on our privilege helps us think about how we can work with folks who share our privilege– as well as those who don’t– to create changes that benefit everyone.

Looking at perinatal mood and anxiety disorders through a “lens of diversity” can help us see how different aspects of our identities—and our privilege—affect our experiences with PPD, including whom we felt we could tell, the treatment we sought, our barriers to care, and the professionals who helped us. This process can illuminate why what was helpful for us may not necessarily be helpful to other moms. Here are some questions to consider:

What does postpartum depression mean for different communities? Here’s the thing: being able to SAY that you are experiencing postpartum depression, anxiety, or another perinatal emotional complication (let alone have the ability to seek treatment for it) is a privilege. For many moms, the challenges of unstable housing, poverty, homophobia, unsafe neighborhoods, and racism may exceed the need for treatment. Different moms have a different hierarchy of needs, and addressing their own mood and mental state may be seen as overly indulgent when there are bigger fish to fry.

Moreover, these same challenges may BE the actual source of stress for some moms. For example, one study found that 30% of low-income families can’t afford adequate diapers for their baby, and that this specific need was linked to depression and anxiety.[7] Research has clearly demonstrated the link between extenuating life circumstances (such as poverty, trauma, isolation, etc) and maternal mental illness, so, for some moms, it can be difficult—and not really relevant– to parse out the difference between a mental health issue and an expected reaction to incredible challenges.

Also, along these lines, some communities may view postpartum depression and related illnesses as unacceptable—or as something that happens to other people. A qualitative study of African American women provides some keen insight into the different conceptualizations and experiences of mental health issues.  According to one participant in the study, “There is no postpartum depression. Only white people go through it.” Another participant stated that a neighbor had told her that, “depression is something young mothers do to get out of needing to take care of their kids”.[8]

Who seeks and receives treatment and why? Treatment (such as talk therapy or medication) may be appealing and possible for some women and not others. One study found that Black and Latina women receive treatment at nearly half the rates of white women, and, considering that rates of depression and anxiety are higher among women of color, this statistic is particularly troubling.[9] In some communities, mental/behavioral health issues are heavily stigmatized; moreover, women may not have the ability to see a mental health provider who looks like her or represents her community. Just like many women may want to see a female Ob-Gyn, women of color may want to see a clinician of her racial/ethnic group—and may not be able to do so.

What barriers do women face when speaking honestly about emotional complications and/or seeking treatment?   Women of color and/or women who are economically disenfranchised may face numerous barriers to seeking and receiving care, including cultural stigma, lack of mental health providers who accept Medicaid, lack of culturally or linguistically appropriate services, lack of childcare, lack of transportation, and fear of children being taken away. Also, although women of color are at a higher risk for perinatal mood and anxiety disorders, they are less likely to disclose symptoms to a healthcare provider. 

What are common images of women who suffer from perinatal emotional complications? What do they look like? Do they look like US? Like everyone? One participant from Sampson’s qualitative study “criticized current TV commercials for antidepressants, saying,

“Based on what you see on TV and their commercials and the ones holdin’ the dog by the window, that is so completely garbage. When asked how a commercial that accurately portrays PPD would look, one participant gave this vivid example: She movin’ around. She droppin’ the kids, you tired, you overworked. She doin’ the most, she cookin’, she cleanin’, she washin’ dishes. Doin’ everything at one time….Baby hollerin’, hand doin’ this here, I mean it’s just no time to stop, no time to stop.…Everything has to be done. Nobody else is gonna do it.”

Common media representations of mental health issues did not reflect the experiences of these women. What does that say about how we represent mental health issues?

What do we usually say to women who are struggling with perinatal emotional complications? We as survivors and advocates may be quick to say things like, “It’s OK, it’s not your fault, many women struggle like this, please don’t be ashamed, there is help, you can heal and be well”, etc. While many women will gain comfort from these statements, not all will. In some communities, postpartum depression is seen as something that affects weaker mothers and that “strong” mothers don’t “catch” depression. This blame, along with stigma, lack of diversity among mental health professionals, copious barriers to accessing care, and the stark reality that no amount of therapy will erase poverty and racism, illustrate how what we say will resonate differently with women in different life circumstances. In other words, the statement “there is help for you” doesn’t mean much if the logistical and cultural barriers to accessing help feel insurmountable.

So, when we look at maternal mental health disorders through this lens of diversity, we can see that we as advocates cannot talk about the importance of getting treatment without understanding the context of women’s lives: life circumstances; privilege, and lack thereof; and the barriers faced by so many women—transportation, childcare, lack of insurance, language, cultural stigma, lack of mental health providers of color.

So, how can we, as survivors, be better advocates for all moms who are struggling with PPD and related illnesses? We’ll discuss that, along with some tangible places to start making a difference, this Friday in Part Two!

[1] Chaudron LH et al. Accuracy of Depression Screening Tools for Identifying Postpartum Depression Among Urban Mothers. Pediatrics. 2010. doi: 10.1542/peds.2008-3261

[2] Satcher D. Mental Health: Culture, Race, and Ethnicity: A Supplement to Mental Health: A Report of the Surgeon General. U.S. Department of Health and Human Services, Washington, DC; 2001

[3] Isaacs MR (2006). Maternal depression: The silent epidemic in poor communities. Baltimore, MD, Annie E. Casey Foundation.

[4] Troutman BR & Cutrona CE Nonpsychotic postpartum depression among adolescent mothers. Journal of Abnormal Psychology. 1990; 99(1) :69-78.

[5] Ross L & Dennis CL (2009). The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: A systematic review. Journal of Women’s Health, 18 (4), 475-486.

[6] Templeton L. Velleman R, Persaud A., Milner P. The experiences of postnatal depression in women from black and minority ethnic communities in Wiltshire, UK. Ethn Health. 2003;8(3):207-221.

[7] http://www.motherjones.com/mojo/2013/07/inadequate-diaper-supply-linked-child-abuse-depression

[8] Sampson M et al. A disease you just caught: Low-income African-American mothers’ cultural beliefs about postpartum depression. Women’s Healthcare. 2014 Nov:44-50.

[9] Kozhimannil, K. B., Trinacty, C. M., Busch, A. B., Huskamp, H. A., & Adams, A. S. (2011). Racial and Ethnic Disparities in Postpartum Depression Care Among Low-Income Women. Psychiatric Services(Washington, D.C.), 62(6), 619–625. doi:10.1176/appi.ps.62.6.619.

 

Divya Kumar, Sc.M., CLC, PPD Divya Kumar has a Masters in public health and is certified as a postpartum doula and lactation counselor. In 2013, she helped create a state-funded perinatal support pilot program in four community health centers in Massachusetts. She currently provides perinatal support for women and families at Southern Jamaica Plain Health Center, one of the four pilot sites. In addition, she facilitates support groups for new parents and conducts workshops about the transition to parenthood. Divya tells it like it is and brings honesty, compassion, camaraderie, and humor to her work with new families. She is also the mother of two children and a survivor of perinatal emotional complications.

photo credit: ©Fotolia – Rawpixel

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Big News!!! Announcing the 2015 Postpartum Progress Warrior Mom™ Conference

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In 2004 came Postpartum Progress the blog.

In 2011 came Postpartum Progress® the nonprofit.

In 2013 came Postpartum Progress’ Climb Out of the Darkness®, the world’s largest event raising awareness of perinatal mood and anxiety disorders.

And in 2015 …

Warrior Mom ConferenceANNOUNCING THE FIRST-EVER WARRIOR MOM™ CONFERENCE, a patient-centered, community-focused conference for survivors of perinatal mood and anxiety disorders, and those still working toward full recovery. There are several great conferences focused on perinatal mood and anxiety disorders mainly aimed at clinicians and organizations in the maternal mental health field, but this, my dear Warrior Moms, is for us!!! Get ready to get together in Boston next year!

The Postpartum Progress Warrior Mom Conference will be a time for us to do three things together: CELEBRATE recovery, BUILD community, and DEVELOP powerful skills for raising awareness and advocacy to help our fellow survivors around the world.  We will offer self-care workshops, Q&A sessions with top experts in reproductive psychiatry, keynotes and panel discussions, a live PPDchat with its creator Lauren Hale, and so much more we can’t wait to tell you about! The conference will allow us to gather together to share stories and information in a caring and supportive environment.

Here’s what you need to know now:

  • The conference is July 11-12, 2015 (SAVE THE DATE!!), in beautiful Boston, Massachusetts. We’ll be taking over Boston’s beautiful Back Bay at the St. Botolph’s Club – a historic brownstone on Commonwealth Avenue that is the perfect setting for our powerful yet intimate gathering.
  • Early Bird registration is $125 until June 1, 2014, wherein the registration fee will go up to $150. Registration will be capped at the first 125 tickets sold, so you’ll want to register as soon as possible to avoid missing out on all we have planned for that weekend!
  • We are working with area hotels to provide attendees with great rates on lodging — that information will be forthcoming.

This conference wouldn’t be possible without the work of three very special moms: Susan Petcher, A’Driane Nieves and Miranda Wicker. Together with the help of other volunteers they have worked their butts off to make this happen, and I am forever grateful to them for their dedication, leadership and hard work.  They are leading the charge on making this an amazing event, and I cannot WAIT!

Spots to attend this conference are limited, so if you want to be the first to know when registration opens up (soon!), sign up for our email alert by clicking the button below and filling out the super short form. Don’t miss it! We want to see you in Boston!

Be the first to know!

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You Are Not Your Feelings

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“Feelings come and go like clouds in a windy sky. Conscious breathing is my anchor.”
― Thích Nhất Hạnh, Stepping into Freedom: Rules of Monastic Practice for Novices

When I was in the midst of my battle with postpartum depression, postpartum anxiety, and postpartum OCD, I felt a lot of things. I felt turmoil, anger, sadness, rage, guilt, despair, hopelessness, frustration, numbness … I felt pretty much every negative emotion you can imagine and then some. Sometimes, I felt the lack of emotion, and that was just as bad if not worse. I felt like the world’s worst mother, a horrible wife, and an awful person in general. I felt like I was an utter and complete failure in every single way.

Unfortunately, I know that I am not alone in this. I wish that I were, but I’m not.  I’ve talked to many other women who say “I feel/felt…” and list off so many awful things. Usually, they say they, too, feel like a bad mother. A monster. A failure. A bad wife. Sometimes it’s “I don’t feel anything, what kind of mother doesn’t feel anything?” It is a sad reality that perinatal mood and anxiety disorders distort your perception, and not just of the world around you but of yourself.

The good news is that these feelings are exactly that. They are only a distorted perception. Much like looking in a warped mirror will give an inaccurate and untrue reflection of the physical appearance of whoever is standing in front of the mirror, our feelings while we battle maternal mental illness do not necessarily reflect the truth of who we are or how we are. Listen to me, and listen carefully: Your negative feelings do not define you. You do not have to be what and how you feel.

Let’s take an example from one of my cats. He seems to think he’s part lap dog, part teddy bear, part lion. He regularly sits at the back window and stares out at the wild turkeys that are MUCH larger than he is, plotting ways that he can go outside and try to take one on. The truth of the matter is that those turkeys would probably use him as a plaything. He thinks he’s a mighty hunter but he’s a dainty house-cat who has spent maybe 10 minutes outside in his entire life. He thinks he’s a puppy but he’s a cat.

Just as my delightful cat (and he really is, I absolutely adore him) is not what he feels like, we don’t have to be what we feel either. I’m a good mother. I’m a good wife. I’m certainly not a failure. I am not my feelings. You aren’t either. You do not have to let your feelings define you. I can tell you right now, you’re a WONDERFUL person. You have a beautiful spirit. You’re a fantastic parent. You have so much worth. You are strong and powerful.

Now I know first-hand that when you’re in the thick of things it’s a lot easier to say that than it is to believe it. In case you need help holding on to the truth and keeping track of the fact that you’re awesome and your negative feelings are just a bad mirror, this is a trick that might help. Please note that there’s no guarantee but it has helped some people, so feel free to give it a try and see if it can benefit you. :) (Also note, this is SO not my idea, I borrowed it from other people, like the therapist I used to see).

Put positive affirmations on your bathroom mirror. Every morning and every night, say them out loud, and go read them when you feel low. Things like “I am unique. I am wonderful. I am loved. I am strong. I am a good mother. I am a success.” Use the positive words to remind yourself that you rock. Please note that I am NOT saying “You should just change your thinking and everything will be all better!” Perinatal mood and anxiety disorders are not a matter of just having certain thinking patterns; all I’m saying is that sometimes hearing good things about ourselves, having a reminder that we have positive qualities, can help combat those nasty little bad feelings.

No matter what you feel, hold tight to the truth in the words of Thích Nhất Hạnh. Feelings come and go. They may be here now, but they will not always be. You do have to let them define you. You are not the nasty things that perinatal mood and anxiety disorders tell you you are. You are wonderful things. You are lovely, lovable and loved. You are you. And you are a better you than anyone else could come up with.

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Perinatal Mood and Anxiety Disorders News & Research Roundup

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postpartum depression newsThere are so many great posts and news stories about perinatal mood and anxiety disorders out there that it’s high time I did a news roundup.

Warrior Mom Stories

Prenatal Depression Nearly Drove Amanda Lee To Suicide — The Star   A great post on depression during pregnancy, also called antenatal depression or prenatal depression.

Mother’s Little Helper — What the Flicka Betsy Shaw writes about how she has fought against taking medication and tried to handle her depression on her own.

It’s Time to Speak Up: Postpartum Depression In African American Women — Black And Married With Kids Briana Myricks writes about the fact that women in the African American culture are resistant to speak up about PPD.

The $11 A Month That Changed My Life — Eat Pray Read Love Kelli writes about the fear of getting treated for PPD because of her Christian faith.

Not Always A Walk in the Park — Mikal & Josh This mom talks about the trauma of having a baby in the NICU and how it led to postpartum PTSD and anxiety.

Postpartum Depression — The Complete Guide to Imperfect Homemaking Kelly writes about not recognizing she had PPD.

Perinatal Mood & Anxiety Disorder Research

The Best Behavioral Therapy for OCD – NIMH  New research finds a specific type of cognitive behavioral therapy to be very effective for OCD.

Pregnancy Loss Increases the Risk of Postpartum Psychiatric Illness – MGH Center for Women’s Mental Health  Another study confirming the fact that women who experience miscarriage or stillbirth are more likely to have postpartum psychiatric illness after subsequent pregnancies.

Depressed Moms, Depressed Offspring – Los Angeles Times A British study finds that children who are born to moms with depression during pregnancy (antenatal depression) are more likely to experience depression in adolescence. “The findings, published in the journal JAMA Psychiatry, underscore the importance of treating depression in pregnant women, the authors wrote.”

Postpartum Diagnostic Switches Likely In Depressed Women – MedWire Research indicates that women with a history of major depression who show signs of hypomania after childbirth may actually have switched from depression to bipolar II in the postpartum period.

More

Why Maternal Mental Health Should Be A Priority — PLOS I found myself cheering as I read this piece. I’ve always found it shocking how little maternal mental health has been included, if at all, in conversations about global health and maternal health.

Is It The Baby Blues or Something More? — Psych Central 

Should Severe Premenstrual Symptoms be a Psychiatric Disorder? — NPR This story from NPR (you can scroll past the audio player to read the text version) takes a look at premenstrual dysphoric disorder and women who are affected by it.

 

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