Nearly 40% of Black mothers experience maternal mental health conditions, according to the Maternal Mental Health Leadership Alliance (MMHLA). Additionally, Black women, compared to white women, are twice as likely to experience postpartum depression and anxiety, but are only half as likely to receive treatment.
“At Atlantic Health, we’re committed to changing Black maternal mental health outcomes by recognizing risk factors and barriers to care, updating screening guidelines, cultivating a community that’s willing to have difficult conversations and continuing to find new ways to support,” says Atlantic Health’s System Medical Director of Women’s Health Melissa Lozano, MD, MA.
Black maternal health risk factors: Postpartum depression and anxiety
“We know that when individuals from marginalized communities aren’t supported the way they deserve — whether due to racial, social or cultural factors — the risk of mental health conditions increases,” Dr. Lozano says.
Mental health conditions during pregnancy can lead to mothers not being engaged in appropriate medical care, increased substance-use disorders, smoking or having a baby that is not growing as expected. Postpartum, you can have issues with bonding, challenges with feeding and experience higher levels of stress that can have negative implications on your newborn as well as the larger family unit.
Signs of postpartum depression and anxiety
“People often think signs of postpartum depression and anxiety culminate in a big, dramatic moment where someone is overwhelmed with tears and obvious sadness, and not able to function or cope,” Dr. Lozano says. “Sometimes that’s the case. Other times, it’s quite subtle.”
Signs may include:
- Bonding issues
- Changes in appetite
- Constant worrying
- Dizziness
- Extreme exhaustion
- Heart palpitations
- Insomnia
- Irritation fears
- Mood swings
- Obsessive thoughts
- Persistent sadness
- Racing thoughts
- Shortness of breath
- Thoughts of harm (for yourself or your baby)
“When I had my daughter about three years ago, I suffered with postpartum anxiety, and I myself didn’t even recognize the severity,” Dr. Lozano says. “I thought, I’m just a Type-A, first-time mom. Sometimes you don’t realize those pervasive thoughts — that inability to really let your body settle or rest — can be a sign of postpartum anxiety.”
Postpartum anxiety or depression can be common in the first few weeks after birth.
Some degree of stress or emotional change is expected, but if it persists, and impacts your ability to care for yourself or your baby, that’s when it’s critical to recognize that something isn’t right and additional support is needed,” Dr. Lozano says.
It’s also important to recognize that no one is immune to postpartum depression and anxiety.
“If someone has a family history of a mental health condition, that’s something we want to be mindful of,” Dr. Lozano says. “Often, mental health conditions can be present before pregnancy, but sometimes they present for the very first time during pregnancy or in the postpartum period. No one is really out of the woods. You never know how this experience is going to change you.”
Barriers to treatment and care
According to MMHLA, barriers to care for Black women include systemic racism, interpersonal racism, distrust, shame, stigma, fear of child protective services, logistical barriers and screening tools.
As the new system medical director of women’s health, one of Dr. Lozano’s primary goals is to address a common logistical barrier: access. Where OB/GYN practices are located (such as near bus or train lines) and when they’re open (including hours that support our working parents) are deeply important. Access is also layered. If a practice is located near a bus line, patients must also be able to afford the bus fare.
“Let’s make sure we have the fundamentals in place, and then we can continue to build a system that really works for patients,” Dr. Lozano says.
The importance of early screening
The state of New Jersey has been at the forefront of maternal mental health, most recently working to expand perinatal depression screening at various points during the pregnancy. This is especially important for Black women, who are often under-treated for depression.
“Because mental health conditions can present before, during or after pregnancy, organizations are updating the timing of when we screen patients,” Dr. Lozano says. “Some recommendations now include screening in the first trimester, again later in pregnancy and again postpartum. This helps us capture patients throughout their journey, maximize access and route patients appropriately, whether that’s to our in-office social workers or referring them for psychotherapy and/or pharmacotherapy.”
Embracing uncomfortable conversations, earlier and more often
OB/GYN organizations recommend checking in with your obstetric care provider within two to three weeks after you have a baby, Dr. Lozano says.
“We think of the traditional six-week appointment, but that is inadequate in and of itself,” she says. “At two to three weeks, you should be transitioning past those massive hormonal fluctuations and finding a new norm. But if none of that is happening, then an earlier appointment is an opportunity where we can check in with our birthing parents and make sure they’re headed in the right direction.”
Dr. Lozano strives to be frank with her patients, talking about her own experience and recognizing that postpartum depression and anxiety can be difficult to talk about.
Many Black women mistrust the health care system, and rightfully so, Dr. Lozano says. Obstetricians must unravel decades of systemic racism in health care with every interaction.
“We must be able to be uncomfortable in conversations and recognize that we’re not the people who came before us,” Dr. Lozano says. “Your obstetric care should be with a provider who is able to be open and meet you where you are. I tell my patients, ‘If there is ever a point that you don’t feel like I’m hearing you, please stop me so I can recognize that this is a moment where I need to be better.’”
Support for Black women with postpartum depression or anxiety
Treating postpartum depression and anxiety can have a three-prong approach, Dr. Lozano says. This includes:
- Adjunctive therapy: Meditation, physical activity, leaning into the support system around you — the fundamentals anyone could benefit from
- Psychotherapy: Talking to a therapist, social worker, psychologist or psychiatrist
- Pharmacotherapy: Medications to help with feelings of anxiety or sadness that are generally safe to take during pregnancy or while breastfeeding
Medications for depression and anxiety are usually safe and often very effective, including in the perinatal period. That said, like any medication, there can be side effects, so it’s important to have a thoughtful discussion with your provider about what’s right for you.
“Untreated mental health disorders can be much more dangerous, much scarier, than pharmacotherapy,” Dr. Lozano says. “When someone is not engaged in treatment or has an untreated mental health condition, we see associations with adverse pregnancy and infant outcomes. In extreme cases, they can harm themselves or their baby. We are trying to intervene earlier than that to optimize positive outcomes for the birthing parent and baby.”
Dr. Lozano is also seeking new ways to optimize areas of opportunity. This includes working with Atlantic Health’s behavioral health services to enhance the care we offer our patients.
“At Atlantic Health, we’re dedicated to improving Black maternal health care and cultivating change for better, more joyful outcomes,” Dr. Lozano says.
Related news articles
