EXPLORING POSTPARTUM DEPRESSION (PPD) AMONG BLACK MOTHERS *

*Disclaimer:

This discussion uses gender-inclusive language such as "postpartum persons" or "postpartum individuals" but still acknowledges the history and trauma of Black women in pregnancy and motherhood and will continue to use the term "Black women" when appropriate.

The intention is to hold space for the unique experiences of Black women without diminishing their experiences. The discussion on motherhood includes all genders and identities and respects the diversity of experiences in caregiving and parenting.

AN OVERVIEW: WHAT IS POSTPARTUM DEPRESSION (PPD)?

  • Postpartum depression (PPD), or postnatal depression, is a major or minor depressive episode during the first 12 months after delivery. It is one of the most common complications in the postpartum period (Nelson et al., 2022). According to the National Health Service (NHS), postpartum depression affects more than 1 in 10 postpartum individuals; it can also affect partners (2022).

  • There are higher rates of postpartum depression observed in Black women due to structural inequities, which have led to Black women experiencing more trauma and socioeconomic inequality, less access to healthcare, and less social support during the perinatal period, which increases their risk for complications such as postpartum depression (Nelson et al., 2022). Black women have a higher likelihood of experiencing postpartum depression compared to their white counterparts, with estimates ranging between 7 and 28% (Nelson et al., 2022).

    The cultural expectation of being a "strong black woman" and the stigma surrounding mental health could be a reason for the low rates of diagnosis and treatment for postpartum depression (PPD) among Black women (Wenzel et al., 2021). It is essential to investigate this cultural gender schema and its impact on mental health.

  • Overall, the symptoms of postpartum depression can develop gradually and last for months, which is why many postpartum individuals do not realize they may have PPD (The National Health Service (NHS), 2022). The symptoms of postpartum depression are the same as those of general depression.

    There is a significant impact on the individual, family, and baby, such as cognitive and functional impairment in postpartum persons, increased risk of suicide and infanticide, lower quality of parent-infant interactions, shorter chestfeeding duration, and negative impacts on child development (Chan et al., 2020). Thus, early intervention is crucial to prevent the long-term effects of PPD.

  • Partners of birthing persons can also experience postpartum depression. They may feel anxious, sad, or overwhelmed by caring for a newborn and their partner's well-being. It's important for partners to seek help if needed.

    An OBDS resource that discusses the impact of postpartum depression on partners of birthing persons is coming soon…

WHAT CAUSES POSTPARTUM DEPRESSION: IS IT JUST HORMONES?

No! PPD is not solely attributed to hormonal changes after childbirth.

Depression and postpartum depression result from a combination of physical, hormonal, social, psychological, and emotional factors, known as the biopsychosocial model of depression (CAMH, 2018). Having a personal or family history of depression or experiencing depression during a previous pregnancy is a risk factor for developing postpartum depression (CAMH, 2018).

It is crucial to be aware of one's risk of PPD to enable one to take proactive steps such as seeking additional support or counselling during pregnancy and postpartum to manage their mental health. Identifying the risk early on and working with healthcare professionals to address it can improve outcomes for both the parent and the infant..

WHAT DOES PPD LOOK LIKE?

  • Depressed mood or depression with anxiety

    Anhedonia: loss of interest in things that would typically bring pleasure, such as the baby

    Physical feelings of being slowed down, restlessness, jumpiness and edginess

    Excessive feelings of guilt or worthlessness

    Changes in weight or appetite: gaining or losing weight

    Sleep disturbances and fatigue

    Diminished concentration and inability to think clearly, which can be worsened by sleep deprivation

    Finding it difficult to look after oneself and the baby

    Withdrawing from other people

    Recurrent thoughts of death or suicide; one may believe they and their baby would be better off dead

  • New postpartum individuals may overlook signs of depression as they experience changes in sleeping patterns and moods during new motherhood (CAMH, 2018). However, it is critical to recognize these symptoms as they could indicate postpartum depression. Fortunately, with adequate treatment and support, individuals can completely recover from the effects of postpartum depression.

  • Postpartum depression (PPD) is distinct from the "baby blues" that occur within the first few days of giving birth lasting up to two weeks. Baby blues are a common experience characterized by depression and anxiety caused by hormonal changes, tiredness, challenges with chestfeeding, and postpartum complications (UNICEF.org, n.d.). Unlike PPD, the baby blues do not require treatment and typically subside within two weeks with social support.

  • It is important to note postpartum psychosis, another mental health condition that can occur within the first month after giving birth. Postpartum psychosis is a rare disorder that affects only 0.1 percent of new mothers (Kids Health Org, 2018). Symptoms include confusion, disorganized behaviour, and hallucinations. It is essential not to ignore these symptoms, as postpartum psychosis is a psychiatric emergency (Kids Health Org, 2018).

    An OBDS resource that discusses postpartum psychosis is coming soon…

RACIAL AND ETHNIC DISPARITIES IN PPD: WHO IS AFFECTED?

In the Black maternal health crisis, Black women face significantly higher maternal mortality and morbidity rates than their white counterparts, which persists regardless of age, income, and education (Liese et al., 2022). Perinatal Black women face discriminatory treatment from healthcare providers during childbirth, leading to low rates of mental health services in the postpartum period.

Black mothers face chronic stress due to sexism, racism, and classism, known as Sojourner Syndrome, which can lead to reproductive and perinatal health issues (Chan et al., 2020). Additionally, the life-course perspective theory suggests that repeated exposure to stressors related to physical, environmental, and socioeconomic factors can accumulate over time, affecting the long-term health of minority and disadvantaged groups and even impacting future generations (Mottl-Santiago et al., 2020).

THE ROLE OF DOULAS

Black doulas, as well as doulas in general, can assist with postpartum depression and maternity care by providing emotional and practical support, chestfeeding assistance, education on childbirth and infant care, and advocating for the parent's needs within the healthcare system.

Black women have requested other Black healthcare providers to improve their perinatal care and sense of safety. This underlines the importance of having Black doulas in Ontario, like the Ontario Black Doula Society.

Postpartum community doulas specialize in supporting pregnant, birthing, and postpartum individuals (Mottl-Santiago et al., 2020). They assist with care navigation, health education, and health literacy, providing culturally appropriate social support throughout the perinatal period. Doulas offer constant support during labour and birth and help with chestfeeding (Mottl-Santiago et al., 2020). Doula support has been found to improve health outcomes, including increased healthcare participation and infant immunization rates, decreased postpartum depression rates, and in some cases, lower incidence of low birth weight (Liese et al., 2022).

HOW TO MANAGE POSTPARTUM DEPRESSION?

  • Maintaining a healthy lifestyle

    Having strong social supports

    Going to antenatal classes and making friends with other pregnant individuals

    If you have a history or family history of depression or mental health issues, it is important to speak with your doctor if you are pregnant or planning to become pregnant.

    Screening more frequently for PPD and implementing culturally responsive interventions for Black women may be beneficial in lowering the likelihood of postpartum depression

  • Self-help strategies include making time for enjoyable activities, taking rest breaks as needed, getting sufficient sleep, exercising regularly, and maintaining a healthy diet.

    Support groups: Joining a support group can be helpful for postpartum individuals with PPD to connect with others who are going through similar experiences.

    Supportive counselling

    Maternal relaxation or massage

    If you require specialist mental health services, speak to a midwife or doctor who can refer you.

    Talk therapy, such as cognitive behavioural therapy (CBT) or psychotherapy. They can help treat postpartum depression by teaching patients how to recognize and combat negative beliefs, develop coping mechanisms, and enhance mood and functioning. These treatments offer a safe setting for discussing emotions and treating underlying mental health issues.

    Electroconvulsive Therapy (ECT): Consult with your healthcare provider if you are considering ECT as a treatment for postpartum depression. They can help weigh the potential benefits and risks and assess whether it is appropriate for you. ECT is typically reserved for severe cases of postpartum depression and is not a first-line treatment option.

    Antidepressants*: Medications are taken with supervision from a doctor if the individual is chestfeeding.

    *Disclaimer: Medications should not be the first option for treating PPD. Consulting a healthcare professional is crucial for determining the best treatment plan, which may include a combination of medication, therapy, and lifestyle changes. Every individual's experience is unique and requires a personalized approach.

    While antidepressants can be effective in managing the symptoms of postpartum depression, they do not address the underlying causes of the condition. A holistic approach that includes therapy, lifestyle changes, and social support can help in achieving long-term recovery from postpartum depression.

    Bright light therapy; while this therapy can be a promising option for treating PPD, it should be used as part of a comprehensive treatment plan and only under the guidance of a qualified healthcare professional.

    Hormone therapy; it is important to note that this therapy is not a one-size-fits-all solution for postpartum depression. It should only be used under the guidance of a qualified healthcare professional.

    Lastly, be kind to yourself! As a parent, it is normal to have high expectations. However, showing yourself empathy and compassion and seeking help when feeling overwhelmed is important. Remember that postpartum depression is an illness and is not your fault. It doesn't make you a bad parent (UNICEF.org, n.d.)

Individuals should seek support if their postpartum depression symptoms worsen after two weeks or last more than two weeks (UNICEF.org, n.d.).

Individuals should express their feelings to their partner, doctor, doula, or a friend for help.

WHEN TO REACH OUT FOR HELP?

RESOURCES

Talk to Your Healthcare Provider

Consult your healthcare professional to obtain a prescription for medication, receive a referral to a psychiatrist, psychologist or other mental health practitioners for treatment, or undergo blood tests to rule out any underlying medical conditions that may be causing your symptoms.

Access to Other Resources:

If You Do Not Have a Healthcare Provider

Get help online at Postpartum Support International

  • You also can call them at 1-800-944-4773

  • or text “Help” to 800-944-4773 (English)

  • or 971-203-7773 (Spanish)

CRISIS: If you are having thoughts of harming yourself or your baby, or are experiencing hallucinations, seek immediate assistance.

  • If it is an emergency, please call: 911

    • Or go to the nearest emergency room

  • Canada Suicide Prevention Service / Crisis Services Canada 

    • Text 45645 (4 p.m. - midnight ET)

    • Toll free 24/7: 1-833-456-4566

  • Call (free & confidential): 211 (Ontario) to be connected to various community, social services, government and health-related services.

CRTC to Implement a New 9-8-8 Number for Mental Health Crisis and Suicide Prevention by November 30th, 2023.

Canadian Radio-television and Telecommunications Commission (CRTC)

News release

Videos About PPD

  • CAMH. (2018). Postpartum Depression. CAMH. https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/postpartum-depression

    Chan, A. L., Guo, N., Popat, R., Robakis, T., Blumenfeld, Y. Y., Main, E., Scott, K. A., & Butwick, A. J. (2020). Racial and Ethnic Disparities in Hospital-Based Care Associated with Postpartum Depression. Journal of Racial and Ethnic Health Disparities. https://doi.org/10.1007/s40615-020-00774-y

    Kids Health Org. (2018). Postpartum Depression (for Parents) - KidsHealth. Kidshealth.org. https://kidshealth.org/en/parents/ppd.html

    Liese, K., Stewart, K., Pearson, P., Lofton, S., Mbande, T., Patil, C., Liu, L., & Geller, S. (2022). Melanated Group Midwifery Care: Centering the Voices of the Black Birthing Community. Journal of Midwifery & Women’s Health, 67(6), 696–700. https://doi.org/10.1111/jmwh.13438

    Mottl-Santiago, J., Herr, K., Rodrigues, D., Walker, C., Walker, C., & Feinberg, E. (2020). The Birth Sisters Program: A Model of Hospital-Based Doula Support to Promote Health Equity. Journal of Health Care for the Poor and Underserved, 31(1), 43–55. https://doi.org/10.1353/hpu.2020.0007

    Nelson, T., Ernst, S. C., & Watson-Singleton, N. N. (2022). Perinatal Complications, Poor Hospital Treatment, and Positive Screen for Postpartum Depressive Symptoms Among Black Women. Journal of Racial and Ethnic Health Disparities. https://doi.org/10.1007/s40615-022-01322-6

    The National Health Service (NHS). (2022, August 4). Overview - Postnatal depression. Nhs.uk; NHS. https://www.nhs.uk/mental-health/conditions/post-natal-depression/overview/

    UNICEF.org. (n.d.). What is postpartum depression? Www.unicef.org. https://www.unicef.org/parenting/mental-health/what-postpartum-depression

    Wenzel, E. S., Gibbons, R. D., O’Hara, M. W., Duffecy, J., & Maki, P. M. (2021). Depression and anxiety symptoms across pregnancy and the postpartum in low-income Black and Latina women. Archives of Women’s Mental Health. https://doi.org/10.1007/s00737-021-01139-y

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  • Monday, April 3, 2023

    By Sophie Xie, Third Year Nursing Student at Toronto Metropolitan University