The Fourth Trimester is an opportunity to heal from the physical and mental transformations you experienced during pregnancy and delivery. The latter is especially important for us: Black women* are at higher risk for postpartum mood and anxiety disorders (PMADs) yet less likely to seek treatment for postpartum depression symptoms.
While many of us have been socialized to put our needs on the back burner, pregnancy and postpartum is a perfect time to unlearn that.
In “Overdue,” our maternal health series made in partnership with Un-ruly and Gerber, doula and registered nurse Ebony Harvey talks about the physical and mental parts of postpartum recovery.
Postpartum depression and other mental health issues are much more common than we know. For one, some people may not understand that they’re actually in crisis. There can also be a lot of shame associated with these issues, as writer Michelle Lugalia explains in her essay “The Hardest Part Of Being Postpartum? Learning To Forgive Myself“:
“It took me a long time to realize that I wasn’t well. That while my C-section was a disappointment, the heaviness in my head and heart was not that disappointment. I was depressed; I had postpartum depression. My relatively laid-back demeanor and a life free of any mental illness did not prepare me to anticipate or recognize this moment.“
Knowing your mental health baseline can help you understand what’s happening before you reach crisis levels, says postpartum doula Ruth Gordon-Martin. (Ruth is also the founder of Coddle, a platform that provides education, products, and support for the Fourth Trimester and beyond.)
“[Ask yourself,] ‘What was my emotional state pre-baby or during pregnancy?’” she says. “That kind of gives you that sign… so the minute you are off from that, you know.”
Also knowing what symptoms to look out for and treatments that are available can help you feel more in control of your recovery if you’re diagnosed with a postpartum mood and anxiety disorder. Keep reading to learn more, or click on a link in the table of contents to jump to a specific section.
* There currently isn’t data tracking the postpartum mental health of Black nonbinary and trans folks.
Table of Contents
Understanding Inequities in Postpartum Mental Health
As we mentioned earlier, Black women are more likely to experience postpartum depression than white women. In a 2005 survey of 655 white, Black, and Hispanic women who had given birth two to six weeks prior, 44% of Black women “reported postpartum depressive symptoms compared to 31% of white women,” the Washington Post stated.
The disparity in postpartum depression rates comes as little surprise given the well-documented inequities Black women go through while giving birth. In a 2013 Listen to Mothers survey, Black women reported being treated poorly in the hospital because of their race “sometimes,” “usually,” and “always” 21% of the time compared to 8% for white mothers. We’re also twice as likely to experience severe maternal morbidity, or “instances where women almost die from a life-threatening complication during pregnancy or childbirth,” the Center for Reproductive Rights reports.
Yes, these mothers get to go home with their babies. But these “near misses” can lead to post traumatic stress disorder—something Postpartum Support International says 9% of women experience after giving birth.
Racism and interrelated socioeconomic factors may also play a role into why we’re at a higher risk, according to the Center for American Progress’ 2017 report “Suffering in Silence: Mood Disorders Among Pregnant and Postpartum Women of Color.” Workplace discrimination, the wage gap, lack of maternity benefits and support at work, and poverty—among other factors—can exacerbate mental health issues, the public policy research and advocacy organization reported.
…We as Black people need to make PMAD screenings a part of our postpartum care plans.
Lastly, and less studied, is the possible impact childhood trauma. “Increased exposure to violence and trauma—which can begin as early as childhood—can increase the likelihood of perinatal mood or anxiety disorders for Black women,” the Center for American Progress reported.
As for why Black women are less likely to seek professional help? Well, as we’re sure you can imagine, the answers are also societal. There’s the stigma around mental healthcare in their communities, the presence of the “strong Black woman” narrative, and the fear of child protective services deeming them unfit to be parents and taking their children away…
While these fears and stigmas are real, they shouldn’t get in the way of us getting the treatment we need.
The American College of Obstetricians and Gynecologists (ACOG) recommends that all OB/GYN providers screen patients for postpartum depression and anxiety as part of a full mood and emotional assessment. But given the varying rates of PMAD screening in general (and especially for people who look like us), we have to advocate for our mental health and address this head on to get the care we deserve.
That’s why we as Black people need to make PMAD screenings a part of our postpartum care plans. Talk to your provider about what that screening can look like for you during your pregnancy. (And if you’re reading this after you’ve given birth, you can still have that conversation / make that appointment with your healthcare provider.)
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Navigating Postpartum Mood and Anxiety Disorders (PMADs)
There is a spectrum of mental health issues. On one end is what’s known as having the “baby blues,” which is very common after delivery. Up to four in five new parents experience emotional highs and lows in the days immediately following childbirth, according to the March of Dimes.
Many times these peaks and valleys are due to hormonal shifts or the growing pains of growing your family. These feelings typically subside on their own, going away within two weeks.
But if these feelings don’t go away, they might constitute a postpartum mood and anxiety disorder. PMADs include:
- Postpartum depression
- Postpartum anxiety
- Postpartum obsessive compulsive disorder
- Post-traumatic stress disorder
- Postpartum psychosis
If you’re diagnosed with any of these issues, please know that they are temporary and treatable with the help of medical and mental health professionals. This is not something you have to deal with alone. In fact, severe and untreated PMADs can be harmful and Trigger Warning: Click to reveal even fatal to you and your baby.
According to a 2013 article in JAMA Psychiatry, “suicide accounts for about 20% of postpartum deaths and is the second most common cause of mortality in postpartum women.” And while it’s incredibly rare, “untreated postpartum psychosis leads to an estimated 4% risk of infanticide,” The Atlantic reported in 2018.
Remember that if you are diagnosed with a PMAD, it’s not a reflection on your abilities as a parent. It’s simply a mental condition that needs to be treated, just like you treated any of the health issues you had in your pregnancy. Discuss your feelings with a mental health professional, as only they will be able to make the right recommendations for you.
Now, let’s talk about a few of the postpartum mood and anxiety disorders out there.
Postpartum depression
Postpartum depression is one of the most common PMADs out there. It may look like the baby blues on the outside, but it’s more serious. For starters, it lasts longer than the few weeks the baby blues lingers. Postpartum depression symptoms include:
- intense depression or mood swings,
- excessive crying,
- feeling disconnected from your baby,
- fatigue,
- loss of appetite,
- irritability,
- inability to concentrate, and
- insomnia.
It’s often easy to brush postpartum depression symptoms off as just the cost of being a new parent. But let go of the idea that being strong or being a good parent means struggling in silence and being in pain.
Postpartum depression can be treated with talk therapy and medication. If you’re breastfeeding, talk to your doctor or psychiatrist about medications that won’t harm your baby.
Postpartum anxiety
Postpartum anxiety sounds kind of vague: It’s characterized as “excessive worrying that occurs after having a baby.” But it is much more severe than the average anxiety that comes with becoming a parent.
Yes, it’s stressful to know that a person is 100% dependent on you for all of their needs. Yet it may be veering into PMAD territory if this dominates your every waking thought or keeps you awake all night.
An estimated 11-21% of people assigned female at birth experience postpartum anxiety, according to Cleveland Clinic.
One researcher found that Black women were more likely to describe their symptoms in physical terms rather than emotional ones.
Some of the thought and behavioral processes associated with postpartum anxiety include an obsessive checking on your baby’s health/wellbeing (such as checking that they’re breathing while asleep) or an unwillingness to leave your baby’s side, even when another trusted adult is present.
You may also experience physical symptoms of postpartum anxiety, like heart palpitations, loss of sleep, nausea, and muscle tension.
This is not something you have to bear alone. Tell your loved ones, your postpartum support team, and a mental health professional.
Postpartum psychosis
This is the rarest postpartum mood and anxiety disorder. (It’s believed to occur once or twice in every 1,000 births.) Postpartum psychosis symptoms include:
- hallucinations,
- hyperactivity,
- rapid mood swings,
- delusional beliefs, or
- paranoia and suspiciousness.
This PMAD is most prevalent in people with a family history of postpartum psychosis, schizoaffective disorder or schizophrenia, or bipolar disorder, or in people who have had a psychotic episode in their past.
While postpartum psychosis is serious, it’s also temporary and can be treated with the right help. This can include hospitalization, antipsychotic medications, and, in situations where those options aren’t effective, electroconvulsive shock therapy. (A mom shared her experience with postpartum psychosis and recovery here.)
Intrusive Thoughts
A common thread in many PMADs is intrusive thoughts. If you ever experience suicidal or intrusive thoughts of harming your child, please do not ignore it. Seek immediate help from your doctor, partner, loved ones, and/or a licensed mental health professional.
Just know that you’re not alone. Depending on the study, anywhere from 70% to 100% of “new mothers report unwanted, intrusive thoughts of infant-related harm with as many as half of all new mothers reporting unwanted, intrusive thoughts of harming their infant on purpose,” according to a 2019 report in BMC Psychiatry.
These thoughts don’t make you a bad mom or parent. In fact, according to registered nurse and doula Ebony Harvey, these thoughts are actually borne out of a desire to keep your baby safe.
Even so, if you experience suicidal thoughts or intrusive thoughts of harming your baby, don’t push them away. Get help immediately.
A note on Black women and PMAD symptoms and treatment
Being screened for PMADs is crucial to getting treatment. It’s important to note though that our symptoms may show up differently than in folks of other races. One researcher found that Black women were more likely to describe their symptoms in physical terms rather than emotional ones.
“African-American women will report more with symptoms such as fatigue, stomach pain, and headache compared to Caucasians,” Lucy Puryear, MD, medical director of The Women’s Place: Center for Reproductive Psychiatry, told the Seleni Institute.
And this is another reason why culturally competent care is so critical. Talk to your doctor to make sure they’re aware of these potential differences in symptom presentation so you can get the treatment you need. If you know something isn’t right and feel dismissed by your provider, this is definitely the time to find another provider.
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Recognizing Postpartum Mood and Anxiety Disorders in Partners
Did you know that you’re not the only parent who is at risk for postpartum mental illness. Your partner may also show postpartum depression symptoms that require professional intervention.
For straight couples, it’s estimated that one in six men experience high levels of anxiety in the postpartum period. And 10% of new fathers experience postpartum depression following childbirth. (This number jumps to 25% in the three- to six-month postpartum period.) Despite the lack of studies, we think it’s safe to say queer and trans partners can experience PMADs, too.
While non-birthing parents don’t experience the biological changes that come with pregnancy and childbirth, they’ll have just as many concerns about their child’s well-being after delivery. And they can still internalize an unhealthy level of stress and anxiety about their child’s health. Partners may also question themselves for not feeling the way they think they should.
Support your partner by asking them to talk to you, their community, and a trained professional about their feelings. This is something you can start before the baby is even here. It builds connection between the two of you, and can possibly stop a PMAD from forming.
After all, couples who reported higher levels of emotional support were less likely to experience postpartum depression.
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Finding Professional Support and Community
Let’s normalize PMADs within our community as being a part of the experience of giving birth—like sore nipples or fatigue. By understanding that our mental health is just as affected by pregnancy and delivery as our bodies are, we’re giving ourselves grace to get the treatment and support that we need.
When it comes to the postpartum period, help is a must—and if you’re experiencing a postpartum mental illness, professional help is a must. Your concerns and feelings are valid and you deserve to be heard. Don’t let fear or embarrassment (or an inattentive provider) prevent you from seeking out the help you need, and don’t let getting help make you feel like you’re a failure as a parent.
You’re anything but, boo.
You’re a human who has gone through something life-altering and need support. Talk to yourself like you would a friend: Would you let your bestie walk around depressed, lonely, and struggling?
Of course not. And neither should you.
Earlier in “Overdue,” we shared a list of resources and platforms that offer affordable and culturally competent therapy services. If you’ve already found your provider before you gave birth, amazing—make sure to keep up appointments with them even in these early days of pregnancy.
And if you’re in the fourth trimester and looking for support, that list is waiting for you. (We’d like to call special attention to Postpartum Support International and She Matters for their specific focus on postpartum mental health.)
Navigating all of this can be stressful. And we know that stress affects your mental and physical health. That means that any steps you can take to reduce your overall stress levels are worth it.
One way to reduce your stress is to rely on your community. Lean on those people who help you feel joyful, safe, and heard. In fact, studies have proven that women with social support not only reported better mental health, but healthier babies, too.
If you’re in a relationship, make a regular habit of talking to your partner about how you’re feeling. If you’re overwhelmed or they can do something to help you, let them know.
Something that people don’t talk enough about? How having community can also help you as you get familiar with and make peace with your postpartum body, postpartum doula Ruth Gordon-Martin says. The “snapbacks” you may see in your feed from influencers and celebrities are reflective of their realities, which often includes personal trainers, chefs, and nannies on one end of the spectrum and surgeons and filters on the other. And these unrealistic images can have a negative effect on your mental health.
“I encourage moms to look at other perspectives and see what other moms are going through,” Ruth says. “There’s a whole community of women embracing their body and telling everyone, ‘Listen. This is what postpartum bodies look like.”
Talk to your friends about how you’re feeling. And if you don’t have a lot of mom or parent friends in your community, we have a list of online and IRL support groups for you.
Preparing for the emotional rollercoaster ride that is postpartum and the Fourth Trimester is a commitment to having a fully empowered birth experience. And we’re so proud of you for taking this step to taking care of yourself. Because you deserve the same kind of care you give to everyone. And remember: Taking care of your mental health is a gift to yourself and your loved ones—especially your new baby.
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