I remember hearing women say things like “maybe having a baby will change her and make her settle down and be more responsible.” Before a child is born, mothers-to-be are already made to feel inadequate. Parenting does not come with a handbook and even if it did, it is merely a map because each pregnancy and child brings something unique to the parenting puzzle. What works for one child may be a detriment to another. In communities of color, there is such an emphasis on being a good parent. I know it is meant with the best intentions, but as the saying goes “the road to hell is paved with good intentions.” Sometimes good intentions prevent people from seeking help. Studies show that “postpartum depression is a serious and debilitating illness that affects approximately 10%–20% of women who give birth.”
In 2001, I read about Melanie Stokes, a professional black woman, who committed suicide a few months after the birth of her only child that she tried years to conceive. My heart ached because I heard too often that black women do not have fertility problems and as soon as you give birth you are flooded with love that your maternal instincts kick in. Melanie Stokes was married to a doctor and her family was pro-active in noticing the warning signs of postpartum depression and sought medical attention. Unfortunately, she had a severe form of postpartum psychosis. Fifteen years later, her daughter Sommer Stokes and mother Carol Blocker are advocates for postpartum depression screening and treatment.
Studies noted “racial and ethnic disparities in the initiation and continuation of postpartum depression care were particularly troubling and warrant clinical and policy attention.” There are historical reasons why African-Americans in particular tend not to seek therapy. Science and medicine typically treated African-Americans as guinea pigs under the unfounded belief that we did not feel pain to justify operating without anesthesia. The stories of Anarcha, Tuskegee experiment and Henrietta Lacks warranted a healthy mistrust of the medical profession from the black community. Like their black counterparts, many Native American and Latina women were coerced into sterilization. Today, studies show black children and adults do not receive the same pain treatment as their white counterparts. Even when money is not an issue, there is unequal treatment of women of color in childbirth. Tennis legend Serena Williams told her story of complications during childbirth that went ignored. Complications and trauma during childbirth may affect postpartum depression.
A friend recently had a baby. During her pregnancy she was vibrant and exuberant. After the birth, I did not hear much. I figured she was busy adjusting to motherhood. A couple months later, she posted a picture of her adorable baby and mentioned dealing with postpartum depression. I wanted to share her story so that other women, especially women of color, would know that they are not alone and what to do when they expected joy from childbirth but instead experience depression and sadness. I spoke with new mom Emmanuelle Cuny-Diop about her experience with postpartum depression. I separately spoke with OB-GYN Dr. Dawne Collier about Emmanuelle’s experience. Dr. Collier offers information on how to advocate for yourself.*
Emmanuelle, what was your birth experience?
Emmanuelle Cuny-Diop (Emmanuelle): It was traumatic, but I would do it over again. I had no idea I could request a C-section until I was pushing for hours. I probably would have still tried to push my baby out, but just having the information would have been helpful. After hours of pushing, my daughter’s head was swollen and too big to fit past my pelvic bones. Her heart rate was dropping, and we had to make a quick decision. I remember feeling so defeated. Vaginal birth was supposedly the best way in my mind for the baby to be born. I felt like a loser until the doctor explained to me that it wasn’t my fault. I realized that no amount of pre-natal yoga or exercising would have changed this. Also, my daughter’s head was facing the wrong way. Although the doctor tried to turn her around with her hands, it didn’t work. They suggested a vacuum suction, but when finding about the possible side effects on the baby we didn’t feel comfortable with it and asked if there was another alternative. That is when they mentioned a C-Section and I said let’s please just do that now.
Even after the C-Section, my baby experienced trauma. Two days after my daughter’s birth, one of the doctors asked me if I had noticed my daughter shaking the night before or anything unusual. I said that she just had the hiccups after I breastfed her and shortly after we put her back into her incubator. The doctor then explained that my daughter experienced seizures later on that night and that they weren’t sure what it was. It could be epilepsy or meningitis, but they had to transfer her to another hospital. My dream was turning into a nightmare. My boyfriend rushed back to the hospital. He made it in time to get in the ambulance with her. I was hysterical and begged the hospital to please discharge me if they could not transfer me at the same time as my baby girl. I could not believe this was happening. The day before my hospital roommate’s baby had to be transferred to another hospital and it was hours before the mom was able to get moved to the same hospital. I remembered her tears because she too had just had a C-section and wasn’t even able to get up and be with her baby. I was not going to sit in this hospital for hours while my daughter was somewhere else. I was determined to be with her. Fortunately, they were able to transfer me and find me a bed shortly after she was moved. It was approximately another week or so of testing before we found out it was a stroke. I was a new mother and I did not know how to breastfeed. The mother instinct that everyone talked about did not kick in. Before being transferred, it seemed like they just grabbed my breast and stuffed it in the baby’s mouth. It was so impersonal. After being transferred, I noticed a difference in the quality of care, it was so much warmer. My lactation specialist at the new hospital was a black woman and I confided in her about being embarrassed because I didn’t know how to breastfeed. She said, “You’ve never breastfed and neither has the baby. You are learning together.” She was so patient and kind that it made me feel so much better about the whole learning to breastfeed experience.
Dr. Dawne Collier (Dr. Dawne): It’s really unfortunate that Ms. Cuny had such a traumatic experience. But we must keep in mind that a Cesarean section is still surgery and should not be taken lightly. Cesarean section is associated with increased risks for the mother (such as intraoperative bleeding that could require a blood transfusion, infection, damage to nearby organs/need for hysterectomy, scar tissue formation, complications from blood clots, placenta abnormalities and risk of uterine rupture in future pregnancies/labor). So, we typically perform them for specific reasons. In this specific example, I agree that a trial of labor for a vaginal birth was appropriate, until it was unsafe to do so.
Did you have counseling before discharge about post-partum depression (PPD)?
Emmanuelle: Yes, they give you literature upon discharge and resources, but some of that is not covered by insurance, at least it was not covered by mine. But did you know that because of your hormones sometimes breastfeeding can increase chances of PPD? Plus, I was pro-active. While pregnant I was already seeing a therapist, I discussed PPD with her because I dealt with depression before. She didn’t think that I would be a candidate, but the trauma of the labor was like double labor. After the birth, I would randomly start crying. There was so much pressure to be a good mother. My therapist offered to have sessions via Skype, but I told her that I needed to come in person because things were different. I was also dealing with not working for the first time in my life and that took some adjusting to. Going to see my therapist in person offered some of my old normalcy. The description of motherhood and giving birth being a bed of roses and rainbows and sunshine was not my experience and I felt crazy. My therapist was supportive and made herself available at all hours for calls, Skype or Facetime in addition to my office visits. All of these things really helped.
Dr. Dawne: It is good that Ms. Cuny was proactive in her discussion about postpartum depression. Women with depression or anxiety occurring during or even prior to pregnancy are at an increased risk for developing PPD. Having a traumatic birth experience is also a risk factor to PPD. Since Ms. Cuny had both risk factors, close monitoring, evaluation, and assessment were warranted. And, there is evidence that breastfeeding may protect against postpartum depression or assist in a swifter recovery from symptoms.
You were very pro-active in trying to avoid PPD, but it still happened despite your vigilance. Fortunately, you recognized your symptoms.
Emmanuelle: My boyfriend is supportive and helpful. He is literally the best partner ever. When we got home from the hospital we decided to split the day into shifts. He would do the night shift with our baby from 6pm-6am and I would do the day from 6am-6pm so we would both be able to sleep. But even with that, I still felt off. I distinctly remember one time in NICU where I randomly burst into tears while breastfeeding or even sometimes when our baby was sleeping in her incubator. One night I literally felt like a spectator at a store window as my boyfriend changed her diaper for the first time with no issue at all. The first time I changed her diaper that same night, he had to help me, and she ended up spraying the entire wall and incubator door with her poop. Once again, I felt like the worst mother in the world. Where were these maternal instincts that were supposed to come naturally? Why didn’t I have them? What was wrong with me? I didn’t realize how much pressure I was putting on myself and that this was a learning process.
I had another complication from the pregnancy, tendinitis also known as mommy’s wrist or carpal tunnel. It was so bad that holding my baby was painful and I started physical therapy for both of my wrists. At my daughter’s two-month checkup the pediatrician had a survey. I asked the nurse, “Who’s going to read this, you or the doctor?” Because depending on who read it, determined how honest I would be. When she said the doctor, I was very frank about what I was experiencing.
Dr. Dawne: Excellent, we must partner with our patients to optimize their care. The more forthright our patients are about their symptoms, the better we are able to care for them. PPD can often go unrecognized because changes in appetite, sleep and libido can be attributed to normal pregnancy and postpartum changes. Therapy with a psychiatrist and/or therapy with medication may be needed in some cases. It’s also important to differentiate mania (inflated self-esteem or grandiosity, feeling rested after only 3 hours of sleep, or engaging in risky behaviors that worry friends and family) or bipolar disorder from depression, because antidepressants may trigger a psychotic episode.
I had not thought about little things like who’s reading my information effecting whether people get treatment.
Emmanuelle: I also think that if you suffered from depression, childhood trauma, or abuse that went untreated, you are more likely to experience PPD. For days after my daughter was born, I would not trust her with anyone but me and her father. I would look at her and think why anyone would want to hurt her. It was going back to why someone in my family hurt me as a child. I think childhood trauma may trigger traumatic memories if untreated. My therapist and I discussed a “corrective emotional experience” as helpful to move past hurtful memories. This is why I continued therapy immediately after my discharge. I also developed coping mechanisms such as listening to music, forcing myself outside and hanging out with people. I also kept up with my hair and nails and exercising with other moms and their babies in “stroller strides” classes. I had to learn to stop going into isolation and share with my close friends what I was feeling. They were all so supportive once I opened up.
Dr. Dawne: Again, I applaud Ms. Cuny on her proactive approach to her care. We can’t always choose our situations, but we can choose how we respond to them. With appropriate care, postpartum depression can be treated and overcome.
I am grateful for Emmanuelle sharing her experience and Dr. Dawne’s information. Every pregnancy is different. For more information about postpartum depression, the National Institute of Mental Health has information HERE.
Dr. Dawne Collier is merely offering information – not advice. This is for informational purposes only and not intended to serve as a substitute for the consultation, diagnosis, and/or medical treatment of your healthcare provider. You should consult with your physician and/or OB-GYN to discuss issues particular to your health. If you have a medical emergency, call your doctor or 911.