How Do I Know If I Have Postpartum Depression?: Black Perinatal Mental Health

Do you know your birth story? I know mine because when I was very young, I used to ask my mom to tell me about the night that I was born. I asked her to tell me this story over and over and over again, especially for bedtime. She told me this story so many times that whenever she would try to leave something out to make it shorter, I could and would verbally fill in the gaps. I loved learning about who my mom was and what commotion I caused on my way into the world.

Ignored in the Birth Canal

Here's the short version and a tiny bit of backstory. I am the youngest of three children born to my mom. So, this wasn't her first rodeo at labor and delivery. She went into labor in the wee hours of the morning while it was still dark outside, think around 2 or 3 am, during a very snowy night. She makes it to the hospital and they don't really listen to her. They ignore her when she tells them that something is wrong. She tells them that I'm coming too early because her obstetrician said that I would be due around the first week of April; the snowy night was in February.

They eventually admit her and then just kind of leave her in the hospital room all alone. A nurse comes in to "check on her," but only really glances at monitors. She doesn't physically check my mom or her cervix. Meanwhile, my mom keeps telling the nurse that I'm coming and that the labor is happening fast. Just so you know, my mom's second child was born prematurely and spent a long time in the neonatal intensive care unit (NICU). That was obviously very scary for my mom, and she was trying to avoid that from happening again. No one listened to her.

As my mom used to tell it, she was yelling for the nurse and physician because she could feel my head. As my mom laid in her hospital bed, attempting to sit up and fully preparing to catch me, it seems that in the nick of time that nurse came in, saw my head almost all the way out, and she went into emergency mode calling for help. My mom was right.

Generational Trauma: Why Didn't Anyone Listen?

As a child, I tried to picture it all. I did that so many times that I still feel like I can see it. Trying to picture tiny me almost hitting floor, head first, as the doctor barely catches me like a football. That's how it plays in my mind. It's sad. Why didn't they just listen to my mom from the beginning? Well, now I know why. She's Black. It's that simple.

It wasn't until I became an adult and started learning about racial bias, trauma, and birth health inequities, that I realized not only did my mom experience racist healthcare, but my life started with a near death experience due to race. Talk about generational trauma!

Sadly, these racist practices and system-wide policies still exist decades later. By now, you know the statistic about Black maternity deaths and Black infant mortality rates. What may be more of a surprise is the high number of Black parents who experience perinatal mental health complications and go without treatment because healthcare systems continue to misdiagnose, over-diagnose, and under-diagnose Black people for psychological concerns.

What Are The Symptoms?

Knowing that these issues persist is not enough to make them stop. While many people work to change the system, Black people are experiencing birth attempts everyday with parents and babies are suffering in the meantime. Therefore, it is important that you are equipped with some knowledge regarding advocacy and emotional regulation.

Dr. Google is not your friend in this situation. If you are experiencing concerns regarding mental health during the perinatal period (before conception, during pregnancy, or up to two years after your child comes home), it will be helpful to have a direct place to look and someone to contact.

Below are a list of common perinatal mental health complications and some of their symptoms. If you are feeling any of these things for longer than three weeks, please reach out to a licensed mental health provider who has experience with perinatal mental health. If you have a good relationship with your OB/GYN, they can often serve as a first line of defense for referrals and perhaps may prescribe medication, if you want to explore that option. Remember, all of these complications are treatable and in no way your fault.

Perinatal Anxiety (prenatal & postpartum anxiety) - between 6 and 10% of people in the perinatal period experience this, and it can occur alone or with perinatal depression. This category can also include perinatal panic disorders that cause panic attacks.

• Racing thoughts

• Constant worry

• Feeling that something bad will happen (may have vivid thoughts about the potential bad thing happening)

• Difficulties with sleep and appetite (sleeping too litte and changes in eating habits)

• Inability to sit still

• Physical symptoms like dizziness, hot flashes, and nausea

Perinatal Depression (prenatal & postpartum depression) - this is the most common birth complication and can be found in adoptive parents and parents of all genders. Teens are at a high risk for postpartum depression.

• Appetite and sleep disruptions

• Crying and sadness

• Easily angered or increased irritability

• Little interest in the baby or feel "disconnect" from the child

• Feelings of guilt, shame or hopelessness

• Loss of interest, joy or pleasure in things you used to enjoy

• Possible thoughts of harming the baby or yourself

Perinatal Obsessive-Compulsive Disorder

• Obsessions, also called intrusive thoughts, that won't go away, are repetitive or mental images related to the baby. These thoughts are very upsetting and not something the parent has ever experienced before (unless they had perinatal OCD with another child)

• Compulsions, where the parent may do certain things repetitively in attempts to control fears and obsessions. This can look like cleaning constantly, checking safety things repeatedly, reordering and counting things at a high rate.

• Kind of feel scared about the obsessions

• Intense fear of being left alone with the child

• Hypervigilance in protecting the baby

• Parents with postpartum OCD know that their thoughts are bizarre and are very unlikely to ever act on them.

Postpartum Posttraumatic Stress Disorders (PTSD) - around 9% of people experience PTSD following a child birth

• Baby going to NICU

• Severe medical complications during pregnancy or birth (e.g., preeclampsia postpartum hemorrhage, hysterectomy, heart problems, perineal trauma, such as a 3rd degree tear)

• Prolapsed cord

• Unplanned C-section

• Use of vacuum extractor or forceps to deliver the baby

• Feelings of powerlessness, experiencing a lack of mediccal providers listening to you (Racialized and marginalized people are particularly at risk for this)

• Having history of, such as rape or sexual abuse, are also at a higher risk for experiencing postpartum PTSD.

Perinatal Bipolar Disorder I (aim for a specialist and may be best treated with medication or a combination of medication and psychotherapy)

• Delusions (often grandiose, but including paranoid)

• Continuous high energy

• Grandiose thoughts, inflated sense of self-importance

• Impulsiveness, poor judgment, distractability

• In the most severe cases, delusions and hallucinations

• Little need for sleep

• Mood much better than normal

• Overconfidence

• Periods of severely depressed mood and irritability

• Racing thoughts, trouble concentrating

• Rapid speech

Perinatal Bipolar Disorder II (aim for a specialist and may be best treated with medication or a combination of medication and psychotherapy)

• Anxiety

• Irritability

• Continuous high energy

• Little need for sleep

• Periods of severe depression

• Periods when mood much better than normal

• Overconfidence

• Racing thoughts, trouble concentrating

• Rapid speech

Perinatal Psychosis (aim for a specialist, especially) - This is extremely rare only occurring in 1 - 2 people in the 1,000 births. Psychosis presents early in postpartum, within the first two weeks. Get help immediately if you are suicidal or homicidal thoughts become intense. You can also call 1-800-273-8255 National Suicide Prevention Line or text HOME to 741741 the national crisis line about any type of crisis.

• Decreased need for or inability to sleep

• Delusions or strange beliefs

• Difficulty communicating at times

• Feeling very irritated

• Hallucinations (seeing or hearing things that aren’t there. Voice may encourage suicide or harm to the baby)

• Hyperactivity

• Paranoia and suspiciousness

• Rapid mood swings

What are some general risk factors besides racism and the intersection of race and gender?

• A personal or family history of depression, anxiety, or postpartum depression

• Relationship stress

• Complications in conception, pregnancy, birth, breastfeeding, or adoption

• Parents who’ve gone through fertility treatments,

• A recent major life event: loss, moved, changed jobs or recently unemployed

• Parents of multiples

• Parents with a baby in the Neonatal Intensive Care Unit (NICU)

• A thyroid imbalance

• Any form of diabetes (type 1, type 2 or gestational)

• Premenstrual dysphoric disorder (PMDD or PMS)

• Little, no, or insuffcient support in caring for the baby

• Financial stress (this is somewhat less of a factor for Black parents who are used to financial challenges)

Takeaways

Attempting to add a child to your life is already has many things to consider. Hopefully, this article helps equip you with the knowlege of what to look for and how to reach out for help if you need it.

• Black people in the perinatal period are at high risk for these concerns due to embedded racism and racist beliefs in the medical system.

• All PMADs are treatable with the support of a skilled mental health professional.

• If you have concerns about yourself or someone you know, seek support. Your safety and the safety of the baby is very important.

I hopeful this article is helpful on your perinatal and reproductive journey. If not for you, share it with someone who may need it.

For another, please take a moment to play a little today.

PlayfulLeigh,

Dr. Dowtin

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We see people across genders who are struggling in the perinatal period. If you or someone you know are need of support, reach out to schedule a free consult.