Moms fear postpartum depression that could lead to the loss of their children

"I was lying to you"

Smith had his first child at the age of 14. At the end of the hallway from her hospital room, another young black woman had twins.

"I saw these kids being driven down the hall," Smith recalls. "I saw her screaming."

Smith never confirmed what had happened, but she concluded that the children had been entrusted to another family. Memory has created a sense of dread that will prevail for years.

For many women of color, the fear of child protection services has just seen and heard incidents in their community.

"It's a lived experience," said Alfiee Breland-Noble, an associate professor of psychiatry at the Georgetown University Medical Center, specializing in depression among minority populations.

Studies in several states and at the national level have shown that welfare workers in childhood judge black mothers as being more able than white mothers, even taking into account factors such as maternal mortality. Education and poverty.

The result is a disproportionate number of Black youth in the foster care system – a major problem in Philadelphia, where black children make up 66% of this system, while they account for 49% of the children in the county.

At a recent Philadelphia City Council hearing, parents and child welfare advocates voiced their concerns regarding the reporting rules of child abuse cases and deportations. useless. The hearing was convened by City Councilor David Oh, who stated that he felt racially discriminated against by social workers at the Ministry of Social Services, who were investigating him for sexual assault following a medical injury. clavicle of his son. Oh said that he was teaching martial arts to his son and the investigation revealed no wrongdoing.

But for the women who experienced discrimination personally and collectively, Oh's experience did not reveal anything new.

Women sometimes try to hide their true feelings to protect their children, said Ayesha Uqdah, a community health worker who makes home visits for pregnant women and postpartum women through the Care Care Coalition maternity ward. .

During a home visit two months ago, Uqdah asked his client the 10 questions from the Edinburgh Postnatal Depression Scale survey, one of the most commonly used tools for identifying women at risk.

He asks women to note how often they have experienced certain situations over the last seven days, for example "I've been able to laugh" or "I've been so unhappy that I've been "The answers are counted for a score of 30, and anyone with a score greater than 10 is expected to undergo a formal clinical assessment.

The first time that Uqdah conducted the survey with a pregnant client, the woman got a 22. The woman refused to go for the mental health services that Uqdah had found for her.

A week after having her baby, the woman's answers earned her a score of zero: perfect mental health.

"I knew something was happening," Uqdah said. "But our job is not to push our customers to do something that they do not feel comfortable with."

So she waited. About a month later, the woman told Uqdah, "I lied to you. I really needed some services, but I did not want to confess to you, nor to yourself. "

The woman's first child had been placed under the care of the Human Services Department and had been reunited with her grandfather, Uqdah said. She did not want that to happen again.

Experts agree that postpartum depression is greatly underestimated. Aasta Mehta, a gynecologist and women's health advisor for the Philadelphia Office for Maternal, Child and Family Health, says many women do not receive screening.

Although the city does not monitor rates of postpartum depression, Mehta said the prevalence could be more prevalent in Philadelphia because of the high rate of poverty, a risk factor for postpartum mental illness.

Another barrier for women of color is that tools used by clinicians to screen for postpartum depression may be lacking.

Screening tools are not unique solutions

As a breastfeeding consultant, Jabina Coleman shares the most intimate moments of her clients as new moms. She shares a part of herself with her clients.

Like the fact that she suffered postpartum depression after her first child

"It was the darkest place," she said. "I've probably been crying every day for a year."

Perhaps this is why women often open up to Coleman about their own challenges, telling him things like "separating".

The term does not appear on any screening tool, but as soon as she hears it, Coleman knows that more is needed.

"Tell me what it's like for you," she said. "Are you sleeping, are you eating?"

Research shows that different cultures talk about mental illness in different ways. African Americans are less likely to use the term "depression," but may say they do not feel like themselves, said Georgetown's Breland-Noble.

It is also more common for members of minority communities to have mental illness as physical symptoms. Depression can result in headaches, for example, or anxiety through gastrointestinal problems.

Since many depression screening tools do not take these factors into account, they are not as relevant to women of color, said Breland-Noble.

Studies evaluating screening tools used with low-income African-American mothers have shown that they do not catch as many women as they should. Researchers recommend lower threshold scores for women of color, because those who need help may not get a score high enough to justify follow-up according to the guidelines in force.

Screening tools were developed on the basis of white participants in research, said Breland-Noble. "Providers must therefore create cultural nuances to make these screening tools more relevant."

For Saleemah McNeil, a reproductive psychotherapist and founder of the Oshun Family Center in Jenkintown, this may mean rephrasing survey questions that leave plenty of room for interpretation.

For example, question 6 on the filtering tool of Edinburgh reads as follows: "Things have become obvious to me."

"Many of my black clients will say," I have four kids, so does that mean everything does not bother me? McNeil said. "But managing does not mean working at full capacity."

Many screening tools also fail to ask questions about post-partum obsessive-compulsive disorder or post-traumatic stress disorder. Ms. McNeil pointed out that these may be particularly important for black women because they have higher rates of serious medical complications and even near-death experiences during pregnancy or childbirth.

"Postpartum mental illness can be different for everyone," McNeil said.

Auriel Dickey did not think she was harming herself or her child, but moving away from her daughter – when she returned to work after her maternity leave – caused painful memories.

That brought her back to 17 years old and watching her mother wither away from breast cancer.

"That grief was like my soul was trying to get out of my body," Dickey said.

Years later, when Dickey gave birth to his daughter, Oma, it was a meeting. The spark in Oma's eyes and her mischievous smile recalled the spirit of Dickey's mother.

But when she had to go back to work, Dickey felt that everything she had lost at age 17 was taken away again.

This is not what people traditionally view as postpartum depression, she said. "But that's it" for her.

Finally, the situation deteriorated so much that Dickey could not hide it. She told her company and the human resources helped her to follow a treatment.

"He did not take me seriously"

Six months after Nelly's birth, Portia Smith had the courage to see a doctor about her postpartum depression.

When she told him that she was crying every day and that she was feeling anxious about forgetting to lock the door or turn off a light, he said that it was normal. Many young mothers feel overwhelmed, he said.

"I look at it like it's been six months and it's not going better," Smith said. "But he did not take me seriously."

Research shows that health professionals are more likely to reject the concerns of women and non-white patients. Even Serena Williams, a world-renowned tennis star, has had to fight for doctors to take her seriously when she has postpartum complications.

Women who are reluctant to seek treatment in the first place conclude that it is not worth asking for help.

"You start thinking that everyone will treat you the same way," Smith said.

But she was determined.

Smith visited another behavioral health clinic where she received treatment and medication. Over the course of several months, she began to feel better. More importantly for Smith, she began to bond with her daughter.

Today, Smith and his three daughters go to the movie theater grill in Upper Darby for $ 5 a week and put on makeup together before each major release.

"I always have to be together," Smith said. "I'm sure we have this connection."