by Amy Harris
All people who give birth are at risk of postpartum depression (PPD), and rates of postpartum depression have increased in the U.S. since 2010, more than doubling among Hispanics, Blacks, and Asian/Pacific Islanders. However, despite being the most common psychological complication of childbirth, the condition is widely misunderstood and underdiagnosed by women, their families, and their healthcare providers.
Some of the symptoms of PPD are mood swings, frequent crying spells, trouble sleeping, problems concentrating, and a lack of appetite. Other symptoms are anxiety, feelings of guilt, increased or unexplained anger, feelings of hopelessness, or an empty or “flat” feeling.
Postpartum depression most commonly develops within 4-12 weeks of giving birth but can occur up to a year after the baby is born. As many as one out of every five women may experience the condition, and symptoms can make it hard for a mother to care for her baby. Postpartum depression can prevent bonding between a mother and baby and be harmful to social and cognitive health.
Immigrant women suffer from PPD
Many new Mainer mothers are in the U.S. alone, without the support of their partners and families, and the loss of culturally-specific support makes immigrant mothers vulnerable to postpartum depression. Back home in their country of origin, new mothers would have had a circle of women to cook, help with infant care, and provide postpartum support, but this is unlikely in the U.S.
Nuna Gleason, executive director of Wounded Healers International and the Maine Afro Yoga Project, and an immigrant from Kenya who is living in Maine, shared her experience with depression after having a young baby. She said that at first she didn’t understand what she was going through. “I wasn’t just sad,” she explained. “It felt like a fog, like I was constantly confused, overwhelmed, and exhausted in every way. I would cry on the phone with my sisters back in Kenya. I kept wondering why I didn’t feel more joy after such a long journey to bring my baby into the world.”
ADVERTISEMENT
Cait Vaughan is the program leader of In Her Presence’s Cultural Doula Program. She pointed out that many immigrant women are survivors of sexual violence and trauma that they experienced either prior to coming to the U.S. or after arrival in this country. Pregnancy and childbirth can retraumatize survivors and lead to worsening mental health, she said. According to national statistics, half of all immigrant women (almost three times the national average in the United States) are survivors of abuse.
Other risk factors for PPD are having a history of emotional sensitivity to hormonal shifts such as premenstrual syndrome, a personal or family history of depression or anxiety, a complicated pregnancy (such as having gestational diabetes) or childbirth (such as a cesarean section), a history of trauma, or financial or employment problems.
Help is possible
Postpartum depression is treatable, but language barriers and unfamiliar cultural norms can affect a woman’s support system, her understanding of mental health issues, and her willingness to seek help, both during pregnancy and after delivery.
Erin Kilduff, a nurse-midwife and psychiatric nurse practitioner at Women and Infant’s Hospital in Providence, RI also noted that mental health resources are in short supply – even scarcer for marginalized communities than for the general population. Yet vulnerable populations such as immigrants “experience profound isolation during a time that is inherently isolating,” according to Kilduff.
Even in cases where services are available, immigrants may be reluctant to seek them out. According to Marisa Rosenthal, a labor and delivery nurse at Maine Medical Center in Portland, some women avoid the doctor because they worry that if they are found to be depressed, child protective services could take their babies away. Fear of deportation may also make many women less likely to attend prenatal and postpartum care visits, where they could be screened for PPD.
To help address the reluctance to seek out care, in 2024 the founders of In Her Presence joined together with Vaughan and Gleason to create a cross-cultural collaborative program involving American-trained doulas and In Her Presence members. A doula is a trained professional who provides physical, emotional, and informational support to their client before, during, and after childbirth. In its first year, Vaughan and Gleason (both doulas) trained In Her Presence participants how to be cultural doulas, assisting medical professionals in providing culturally-competent and trauma-sensitive care. The program’s organizers hope to grow the program to meet the rising number of women with postpartum depression.
Very often a layered approach to treating postpartum depression works best. Seeing a professional counselor for talk therapy and taking medications such as antidepressants have been shown to be some of the most effective treatments for postpartum depression. Some women also begin to feel better when they are able to connect with other moms, ask for help watching their baby, and prioritize getting sleep. Postpartum Support International offers more than 50 free online support groups, including one for any member of the Black, Indigenous, or BIPOC communities who has experienced trauma (mental and/or physical) during childbirth.
Attitudes are changing
Stigma can prevent immigrant women from talking to others about their feelings, but as more women talk about postpartum depression and women’s mental health, the less stigmatized PPD will become. Further, as women of different cultures speak up about their emotional needs during pregnancy, childbirth, and postpartum, healthcare providers will learn how to provide more culturally competent care.
Cait Vaughan believes that all postpartum women should share their emotions with someone they trust, because “being alone with difficult feelings is so much harder than sharing them with another woman who may know exactly what you are feeling.”
And Nuna Gleason wants all mothers to know that “there is no shame in asking for support. You are not weak—your body, your mind, and your soul have just gone through something huge. Rest when you can. Let people help. Build a circle, even if it’s small. A doula, a friend, a sister on the phone—someone who reminds you that you’re still you underneath it all.”
Note: In rare cases, mothers can become so sad that they have thoughts of harming themselves or their baby. Immediate medical attention is needed if this happens because it can be a life-threatening emergency. If you or someone you know experiences these troubling thoughts, call 911 or your local emergency assistance number; the National Suicide Prevention Hotline (988) and website; or Postpartum Support International’s HelpLine at 1-800-944-4773 (4PPD), #1 En Español or #2 English.
