Last Updated on June 12, 2023 by BVN
Breanna Reeves
The National Maternal Mental Health Hotline received nearly 12,000 calls and texts from birthing and postpartum people within the first year of launching.
Of the 76% of people who called the hotline for themselves, 38% identified as being in their postpartum period.
The Department of Health and Human Services’ Health Resources and Services Administration launched the hotline last year on Mother’s Day to provide additional support and resources to those who are facing mental health challenges.
May also marked Maternal Mental Health Month, which emphasizes the importance of and raises awareness about mental health during and after pregnancy. With Minority Mental Health Awareness Month and Black Maternal Mental Health Week approaching in July, advocates continue highlighting the importance of addressing and treating maternal mental health conditions as the U.S. grapples with having the worst maternal health crisis, including poor maternal mental health outcomes, among western nations.
The Black Voice News sat down with Dr. Sayida Peprah-Wilson, a licensed clinical psychologist and doula who specializes in multicultural psychology, trauma, suicide prevention and maternal mental health, to discuss maternal mental health.
Dr. Peprah-Wilson has experience and expertise operating in community-based, in-home, psychiatric hospital, prison and private practice settings. She is also the founder and executive director of Diversity Uplifts, Inc., a nonprofit organization that offers direct services, consulting and training to support the improvement and wellbeing of women, birthing people, children and families.
This feature article has been edited and condensed for clarity.
Q: For those who don’t know, can you explain what maternal mental health is?
Dr. PW: Maternal mental health is really a catch-all phrase that is easier and more palatable for the general audience. It used to be that people would talk about postpartum depression. Now, people are using the term PMADS (perinatal mood and anxiety disorders) and that is really more appropriate because it gives you a sense that there are multiple things.
There are several types of mood and anxiety disorders that don’t present one specific way. According to Dr. Peprah-Wilson, the belief that maternal mental health conditions have specific markers is a flaw in the understanding. People with postpartum depression can exhibit symptoms beyond being sad and lethargic.
Q: Can you talk about some examples of maternal mental health conditions and how they may be brought on?
Dr. PW: There are two things that I always think about [with] perinatal mood anxiety disorders or maternal mental health. If you don’t think about people who’ve had previous mental health conditions, then you’re sort of missing that there are people who already have preexisting conditions that can get worse or can shift and alter during pregnancy.
There are people who’ve had mental health conditions, maybe even childhood [or] teenage depression, [and] everything’s been fine. [Now], they’re 30 years, [and] they have a really strong postpartum depression or some kind of postpartum anxiety, for example. They may not have realized that it could have put them in a position to be a little bit more at risk, or to be more aware that they might need more support and more strategy around making sure they maintain their mood.
There are several different maternal mental health conditions that can arise before, during and after pregnancy. In some instances, people who never had any previous mental health issues can develop mental health issues during or after pregnancy.
A birthing person can experience depression or anxiety during pregnancy, known as antenatal. Depression can occur after childbirth, known as the postnatal period. Dr. Peprah-Wilson explained that many people only consider maternal mental health as occurring after someone gives birth such as postpartum depression, but the same amount of people who develop maternal mental health issues after pregnancy also experience such issues during pregnancy. People who are currently pregnant are a population of people who are not considered as often when determining who is at risk of developing mental health issues.
Other maternal mental health conditions include postpartum anxiety or panic disorders that go beyond basic anxiety. Dr. Peprah-Wilson stressed that it is really valuable to know the difference between someone who is experiencing general anxiety and someone who is developing a panic disorder.
Screening carried out by clinicians and trained community health workers is an important way to properly diagnose people with the appropriate condition. Doulas, family members and other community people also play a vital role in noticing the difference between someone’s change in mood and behavior.
In the prenatal period (before birth), a birthing person can develop obsessive compulsive disorder or perinatal obsessive compulsive disorder which presents as obsessive thoughts and compulsive behaviors centered on themes around motherhood such as what’s happening with the baby. Postpartum post-traumatic stress disorder is a condition that can arise as a result of birth trauma and traumas related to the birthing experience as a whole, including during pregnancy. Maternal suicide or perinatal suicide occurs in about 5% of people who have some form of perinatal mood or anxiety disorder.
Q: What are some things that can impact maternal mental health?
Dr. PW: A first time mother in general tends to have a higher chance [of developing a maternal mental health condition] than a person that’s had children already just because of that factor of, “Oh, I know what I’m getting myself into.” The human psyche really likes homeostasis [balance], it likes to know that it knows what it knows, even though every day is a new day, and you often don’t know what you think you know. Every birth is different.
Younger mothers, particularly under 25, mothers of twins, mothers of multiples, are definitely considered to be at high risk given the fact that there is a lot more responsibility [and] often less support than they might have had even for their [first] child. It’s a lot on the body and it’s a lot to manage without support.
In particular, as we know, Black people and people of color have higher perinatal mood and anxiety disorders. It’s not because of genetics.
Other factors that can impact maternal mental health include family history of PMADS or general mental health concerns, inadequate postpartum planning and a lack of overall support during the pregnancy experience. Populations who often have a lack of support are people who have low incomes, who are in prison and single mothers; these populations are considered to be at high risk for developing such maternal mental health conditions.
Q: According to data from the California Health Care Foundation, between 2018 and 2020, “Prenatal and postpartum depressive symptoms were reported by about one in five Black birthing people,” higher than all other races/ethnicities. In your expert opinion, what factors contribute to why Black birthing people experience these symptoms at a higher rate?
Dr. PW: What I know as a Black woman who’s given birth and who speaks to Black women and birthing people all the time, who works with doulas that are connecting to Black pregnant [and] postpartum people all the time, [is] the overall stress that is related to Blackness in America is a stress factor that other people don’t have. They have other factors, but that particular one is very pervasive in our system. Racism is very pervasive in the life of a person.
My mother’s family is from South Carolina. They moved to New Jersey some 100 years ago to make a better life, but it meant that the family got divided. My great great grandfather moved to New Jersey, left the family, and then the family joined him. Then, they have more kids in a different place without the aunties… without the [level of community they had in the south]. I just think about what it would have been like to have to raise nine [or] 10 children, while your husband is working in a new environment without the social support.
We’re in a tumultuous, psychological, physiological condition, where my grandmother is birthing and raising my mother, who then [births] me. If you just look one or two generations back, you start to see the difference between what their family condition was.
People who have better outcomes, generally speaking, in the United States, tend to be white women. They did a study and looked at individuals in graduate school who were Black, [who] had a graduate level degree and found they had higher risks of perinatal mood and anxiety disorders and higher risks of maternal death than white women who didn’t have a high school education.
Q: This past Mother’s Day, the U.S. Department of Health and Human Services celebrated the first anniversary of its National Maternal Mental Health Hotline. What are some other ways that institutions can implement supportive services for maternal mental health?
Dr. PW: The first thing that comes to mind is having providers that come from communities that you come from. People really underestimate [that] and it’s interesting because when it comes up, people [question whether] Black people have to only be served by Black people or Latinos only have to be served by Latinos. I’m like, well, no. But, the dominant population, the white population in America, has always been able to see itself in every condition. . . you see yourself as a president, as a teacher, as the banker, as the physician or the nurse, as everyone who could help you. There is an unconscious and conscious comfort around that.
There’s a positioning for all of those people who are creating systems, who are thinking of you because you’re their sister and their mother and their friend and their partner.
People of color and people of marginalization are not being centered in efforts around perinatal mental health and other things that are maternal related. If that’s the case, then it means that you’re less likely to have systems set up that consider your needs..
We know that people aren’t being screened the same either because the way that it shows up culturally can be different. If you’re expecting it to have dominant culture symptomology because that’s who the statistics were based off of, that’s who the research was always being done on, then you’re going to miss the nuances that are relevant for Black community, for the Latinx community, for Asian communities, for the indigenous population.
I think culturally competent care is the first thing that would be a really important intervention for systems to be thinking about. And that means that you’ve got to educate more people from communities, which means you also have to provide funds for people to get educated.
Q: For those experiencing maternal mental health issues, what would you like them to know?
Dr. PW: As a clinician and as a psychologist who assesses people for mental health conditions [and] also as a human that notices what people need, when you’re with someone that is experiencing acute or really clinically significant [symptoms], meaning they should see somebody, they can’t handle it on their own [and] you often leave them feeling uneasy…you need to go back.
I think most people can recognize when they feel like [this] and there’s like cultural phrases that represent this:
“I feel like I’m wildin’ out.”
“I’m just trippin’ girl.”
“I’m not sure how I’m going to get through this day.”
Hopelessness is a big part of depression, in particular, but I think with a lot of the mood and anxiety disorders, there’s an opportunity to get a sense of whether or not the person feels like there [is] hope.
There’s such a survival culture in Black culture that makes it so that by the time a Black mother feels overwhelmed, they’re completely unable to function and then what does that look like for their family? That’s not even an option because they may be the only one holding everyone up, and so then people endure. I see a lot of people who somehow survived postpartum depression and postpartum anxiety, postpartum OCD, possibly postpartum versions of psychosis.
Most Black women present way stronger “looking” and enduring and with resilience when they’re having a really hard time. It’s cultural to get it together and handle your business. Now another person, [who is] more culturally connected, would be like, “Tell me the difference between how you feel now like this versus when you’ve been overwhelmed before.” Compare their baseline life circumstances.
You really have to know people’s culture to understand how people show up when they’re overwhelmed. That’s not standard. That is not taught in school as much as it should be. There’s been a lot more efforts around this, to have all mental health people trained in perinatal mental health, but that is not standard. Most places aren’t even set up to serve the pregnant postpartum person.
Q: Is there anything else you’d like to add?
Dr. PW: I think it’s really great to know about some of the cultural movements that are happening around this so that people know where they can look to connect [for support]. Anybody, anywhere should be thinking, “Do I know a person that represents every person in the community that I serve, that is trained in perinatal mood anxiety disorders or is at least a therapist willing to work with people in this population, and really foster and nourish those relationships?”
If you’re a nurse, if you’re a doctor, if you’re a clinician, if you’re a public health person, know them by name, know where their clinics are so that you know the areas where people have access and where people don’t have access. Think about where funding needs to go because there’s a need for this.
Find your local culturally competent and congruent providers for the populations that you’re serving. If you’re serving a Black population, identify if there are other Black providers because we already know who the white providers are. We have access to the ones that are on the insurance panels and things like that, but there are some that may not be or there’s only one Black person in the whole network.
There are a number of individual organizations, Black women-led organizations around the U.S. that are really focused on Black maternal health. Many of them also focus on Black maternal mental health. They include Diversity Uplifts (organization), Black Lives Matter Alliance (organization), Shades of Blue Project (organization), Sisters in Loss (podcast) and Mom and Mind (podcast).
This article is published as part of the Commonwealth Fund Health Equity Reporting Fellowship.