Rae gave birth during the COVID-19 pandemic. She developed postpartum depression while caring for her baby under lockdown, and tried to explain to her Chinese-Jamaican family what she was going through. And, psychiatrist Leena Mittal, who specializes in maternal mental health, speaks with Juleyka about normalizing this experience, which is the most common complication of pregnancy.
Featured Expert:
Leena Mittal is the Chief of the Division of Women’s Mental Health at Brigham and Women’s Hospital and an Instructor in Psychiatry at Harvard Medical School, and serves as the Program Director for the Women’s Mental Health Fellowship at the Brigham. Dr Mittal is the Associate Medical Director for the Massachusetts Child Psychiatry Access Program for Moms (MCPAP for Moms), an innovative statewide consultation service for providers seeing pregnant and postpartum women with mental health and substance use conditions. Dr. Mittal has numerous publications and speaks nationally on the treatment of mental health and substance use conditions throughout pregnancy and the postpartum period. She is board certified in psychiatry, psychosomatic medicine and addiction medicine. Learn more about Leena's work here.
If you loved this episode, be sure to listen to Telling Mamí She Needs Mental Help and When Mamí Makes You Doubt Becoming A Mom.
We’d love to hear your stories of triumph and frustration so send us a detailed voice memo to hello@talktomamipapi.com. You might be on a future episode! Let’s connect on Twitter and Instagram at @TalkToMamiPapi and email us at hello@talktomamipapi.com. And follow us on Apple Podcasts, Spotify and anywhere you listen to your favorite podcasts.
Juleyka Lantigua:
Hi everybody. Today, I'm speaking with Rae. Rae had her first child in March of 2020, right as the United States was declaring a state of emergency due to COVID-19. Her experience giving birth, then caring for a newborn was nothing like she anticipated. Neither was life as a new mom, especially isolated away from her support network and her Chinese Jamaican family. Let's get into it.
Rae: Hi, my name is Rae Hugh. I am a new mom to a adorable little 16 month old boy named Maddox. And in my family, we call my mom, mom, and my dad, dad. And my little boy, he's just been my grounding. So what's interesting about his birth is he was born in New York, March 15th of last year. So I went into labor, I remember like feeling cramps. I'm like, yeah, I think I'm going into labor probably in the next 24 hours. And then I just remember seeing on TV, the President declaring a state of emergency with COVID. It was just so many things compounded into one. Everyone prepares you for birth, they prepare you and tell you what to expect in the delivery and during pregnancy, but no one talks about what happens after, no one talks about the fourth trimester.
I guess the moment when I realized it was postpartum was when I looked at my son and I didn't have any emotions and that was really hard. And then I looked at him and I was just like, I felt guilty because I was breastfeeding. We were scared to even go get formula. And I was kind of struggling with my supply. And I just remember thinking, I'm going to just say it. I know this sounds terrible, I love my son. But there was a moment where I resented my son, and I was like, what is this? Why am I feeling this way? And I felt horrible. I'm like, who am I as a mother to resent my son? Who am I as a mother to look at him, and I just started feeling like he's ... And then it trickled into he's better off without me, because I can't provide for him, I can't give this milk. I brought him into this world where this pandemic is happening, I know it's not my fault, but maybe he's better off without me.
I was in a lot of pain. I couldn't even physically get up. It was a really hard labor that I had. I couldn't physically get up to change him. And there were moments where he would cry and I'd just let him cry. And I'll go in the bathroom and cry too. And suicidal thoughts came up and I am not a suicidal person at all. I love life. And I realized, okay, this is not normal. Connecting with other women helped a lot. I connected with other moms who became COVID moms and we all just bonded over everything. We had a weekly call. That was when I realized, okay, I'm not alone in this. There's clearly something here that's happening to moms. And that's when I started reaching out to my other girlfriends who have kids who are a little bit older.
I was like, hey, did you ever feel this way? They're like, yeah, I did. I'm like, well, why didn't you say anything? And they'd be like, well no one really talks about it. And I thought I was just crazy. I didn't realize it was a thing, but I got over it. Again, it comes back to no one talks about it, and I had to go back and apologize to some of my friends, like I am so sorry if I ever came off as just insensitive or intolerant, I didn't realize how hard it was. And they're like, no, it's fine. It's just [inaudible 00:03:34] women, we deal with it.
I eventually found the courage to share with my mom, and I remember telling my mom, I think I'm depressed. And I come from a Christian family and my mom's like, well we'll pray for you, this and that. And I'm like, yeah, I do believe in prayer and reading James 1 did help me, but I need to understand why I feel this way. And I didn't know why I felt this way. I didn't ... All I wanted to do was just eat and sit on the couch and just stare at my child, and just really try and figure out what is happening.
So I was trying to talk to my mom about it. And I remember talking to my grandmother about it and I found myself getting really bitter with them, really angry. I was angry with my mom. Nobody met my son until he was six months. In our family, and any Chinese Jamaican can relate and I'm sure any Chinese Trinidadian or Chinese Haitian can relate to this, Chinese cultural roots are so embedded, that hierarchy and just that business comes first. It's community first. Work comes first before family. My family they're business owners, so they own a business as my dad and his brothers and my mom's involved. And my mom kept saying like, Rachel, you need to understand.
She says a lot of the people that work with them, they are the breadwinners for their family. So if somebody gets sick, it trickles in and affects everyone else. So she's like, it's bigger than me. I can't come and see you because I'm putting everyone at risk if I come see you. And I remember thinking I was so caught up in my feels, I couldn't think about anyone else. My mom eventually did come. She saw how much I struggled, and she saw my son and what meant the world to me was that she sat there on the sofa and she's like, Rae, you're a good mom. And that meant so much to me because I come from a family where I know my parents love me, but they don't say it.
I'm a first generation, Chinese Jamaican American. My family is very Chinese in that regard. There's no coddling. I remember my grandma telling me when I eventually moved home and I was like, grandma, how did you do it? You have four kids. How did you do it? She goes, you just manage. Like, what do you mean, you just manage? She goes, I'm too busy with children. I don't have time to be depressed. That's something in your head, you don't have time to be depressed. You're trying to finish, make money, like that's my grandma. And that's just how it is with Asians. Like you suppress, you suppress, you suppress.
Also just, I noticed across the board, like a lot of immigrant families, my parents came here and there were just trying to adjust and nobody has time for feelings. But you know what? As much as I got frustrated with my mom and my family, I appreciate them so much more. It's just so, again, it comes back to like sharing with my mom like, what did you go through? And I value so much more what they have to say because they went through all of this without having a platform to talk about it. So it's just like, man, my mom's a G, and I love her for it, and she did it with twins in a new country. God bless her.
Lantigua: On this show, we often talk about the difficulties, many first gens experience when talking about mental health with our families, but let's face it, postpartum depression and maternal mental health are topics that we talk about even less. To help us begin the conversation, I called in an expert.
Leena Mittal: I am Leena Mittal. I'm a psychiatrist based at the Brigham and Women's Hospital. I'm the director of the Division of Women's Mental Health and also the associate medical director for MCPAC for Moms, which is a statewide perinatal consultation service.
Lantigua: So you heard Rae's story.
Mittal: I did.
Lantigua: What did you hear as you listened?
Mittal: So what Rae described is so familiar. It is something that I hear day in and day out in so many ways. And her description of ... She really highlighted some of the challenges that were really exacerbated by the pandemic, but have existed even pre-pandemic in very similar ways. And the things that really struck me were her real clear description of disconnection and not feeling as the joy and the fantasy that she may have kind of expected around motherhood and early parenting, and having that not emerge in the way she had expected and that disappointment. And then she was so explicit in describing the emerging resentment around the baby, which I thought is something that so many women feel and are so afraid to talk about. But it's such a, such a common component of postpartum depression, frustration mixed with shame and guilt and sadness that really is kind of unique to that time period.
Lantigua: So let's pull back a little bit and talk about what are some of the core and root causes of postpartum depression?
Mittal: It's almost a misnomer actually. When we're talking about depression that is related to the postpartum period, what we know about it is that actually the majority of cases emerge during pregnancy, or even before pregnancy, and that pregnancy and the postpartum period may exacerbate for some people, the mood disorder. And so what we see a lot with it is that it has this component that is biologically driven, but there's also a sort of a psychosocial component too. And what we see is that the abrupt changes in the hormonal state can be one precipitating factor, but also things like decreases or changes in sleep as well as role transitions and role changes and the sort of psychological adaptation to parenting, all of those things contribute and combine to create a context that can precipitate either a pre-existing tendency towards depression or a mood disorder, or a brand new episode that someone may never have experienced before.
Lantigua: So I imagine the pandemic was a huge factor in contributing to an increase in these kinds of feelings and situations. What does science tell us, in as much as we've gotten science out of the pandemic, about what the impact was on people like Rae?
Mittal: So one of the things that Ray described so beautifully was how much the disconnection and isolation she felt from others, from her family, from peers who have been through the transition to parenthood, how much that really impacted her and how her postpartum experience varied so much from what she had expected. And this is something that we hear time and time again, and something that research is starting to really show is that the transition to parenthood in the context of the pandemic was both fraught with trauma. So people's birthing experiences were quite traumatic. Some people were having to deliver in a hospital entirely alone. There was separation from the infant, just really, really challenging experiences like that.
Mittal: And then also a really profound sense of grief and loss around the expected experience that they might have hoped for. And so these are really prevailing features that have been kind of added to the unique components of the postpartum period and the perinatal period. And then in addition, the pandemic really made it very difficult to engage in the usual supports, social supports which are really, really important to the postpartum experience for parents. New parents and experienced parents need those things.
Lantigua: Yeah. Let me ask you a different question about women of color specifically, and whether there are identifiable barriers to diagnosis for women of color when it comes to postpartum effects?
Mittal: What we see and the research shows, that women of color are screened less often for postpartum depression in the OB office. When they are screened, they're referred less often and ultimately engage in treatment less often as compared to white women. And one of the things that I see in my practice daily is that there's also a real ... We see over and over again, that there are disparities in treatment and in outcomes, obstetrical outcomes and medical outcomes and pregnancy care, for women of color as compared to white women. And so I think there's this growing sense of, especially amongst my patients who are women of color are describing that, am I going to be well cared for in these settings? And that trust is so important when we're talking about trying to disclose issues around emotional wellness. One thing that we see and hear so much is how important it is to have mental health providers who are BIPAC providers all across the board, across the disciplines, providers of color. There aren't enough of us.
Lantigua: So let's talk about what a woman of color can do to be her best advocate. If the tendency on the institutional side is to diagnose less and to refer less, what can she do?
Mittal: So part of what I think is so important, and I think what I heard loud and clear from Rae, was really acknowledging what's happening internally. And one of the things that was so powerful in her story was the validation that she ultimately heard from her mother when she described that her mother talked about being proud of her as a mother herself. And this is a lot of what I hear from my patients, especially those who come from immigrant families where there's this real disconnect around the importance of emotional wellness and the role that emotional wellness can have and in the overall family. And so I think there's a component that we within communities of color really can do to amplify mental health. Right now, I see this in the current events, when we see Naomi Osaka and Simone Biles talking about mental health and wellness, and we're elevating the importance of that alongside all of health in general, and general health involves emotional health.
Mittal: And so I think that's something that we all can do. Additionally, I think that we as healthcare providers have to be thoughtful around being culturally responsive and engaged in talking about health and wellness and doing universal screening and not just waiting for somebody to bring it up, but really implementing standardized ways where we're talking to everybody about just how common perinatal emotional complications are. Perinatal depression is the most common complication of pregnancy and it's entirely treatable and preventable, but many people have no idea just how common it is because we're so quiet about it. Nobody talks about it. And so the more we normalize just how common it is and just how treatable it is, I think everybody will improve.
Lantigua: Yeah. One of the recurring themes when I talk to women on the podcast is the power-through kind of advice that we give each other. "Just power through, there's light on the other side, you got this." So how can the rest of us be able, ready, aware enough, to support someone like Rae early, before she feels overwhelmed by the loneliness, overwhelmed by the circumstances? What are some of the things that we should be looking out for in the lives of the women we love as they're going through pregnancy?
Mittal: So I think that talking about self-care is so important. It's not a luxury, it's a necessity. And I think, especially when you come from a background where self-care is not elevated, but really seen as get your stuff done, just do what you need to do. That's what we can sort of internalize and then we can put our own needs to the side. And then already, I think socially we are as women often socialized to be caretakers and to attend to everybody's needs before ourselves. And so I think we can, if we can try to flip the script a little bit and acknowledge that you have to put your own oxygen mask on first as they say on the planes, self-care is so important to be able to fuel our ability to care for everybody else. So I think that's one of the most important things that we can do.
Lantigua: Is there anything that I failed to ask about that you think we absolutely should include in this discussion for our listeners?
Mittal: So one of the things that, or I guess maybe the set of things I always talk with people about when I meet them for the first time, is talking a little bit about people ask me, "Well, what can I do to prevent postpartum depression? Are there things that I can do to help avoid it from happening?" And so part of it is going into birth and delivery with some plans, but not a set of rigid expectations. Because the birthing process is unpredictable and can go a variety of different ways. And so just trying to have plans without being inflexible around what may happen, because that can lead to ultimately some challenging experiences. And then also really thinking about who's on your team. So who do you have in your support system? And is that a partner? Is that family? Is that some friends? Is that peers who are also parenting? Sort of trying to plan around who's your support system early on.
Mittal: It's the people who you can say, "Can you throw this load of laundry in? Can you set up the meal train?" Like not the people who want to come and hold the baby and admire the baby, which is lovely and wonderful, but that's not going to help you get a nap in or get the things done around the house. You need the kind of help that you can ask for the things that need to get done. And then also really trying to prioritize, sleep and sleep hygiene. There's nothing more disruptive to sleep than a newborn. And so it's really important to think about having ... How are you going to optimize sleep and how are you going to help support a feeding plan? Because newborn feeding can be so, it's unpredictable. And sleep when you can and then also get your body outside and going for walks as soon as you're medically cleared to do so. All of those things are really, really helpful and really based in evidence. There's a lot of research to support those things early in the postpartum period, as well as even towards the end of pregnancy,
Lantigua: Leena, you're a gift. Thank you so much.
Mittal: This is always such an important topic. I'm so glad that you guys are doing this topic.
Lantigua: All right, let's recap what we learned from Leena. Normalize self-care. Acknowledge your pain and understand that self-care is not a luxury but a need that has to be prioritized and met. Seek support. Find the people in your life willing to really help and ask them for specific, actionable support so you can rest, care for yourself and nurture your baby. And remember, stay flexible. As you make plans, avoid additional stress by staying open to change. Pandemic or not, the birthing process is unpredictable and things may not turn out exactly as you expected.
Lantigua: Thank you for listening and for sharing us. How to Talk to [Mami & Papi] About Anything is an original production of Lantigua Williams & Co. Virginia Lora is the show's producer. Kojin Tashiro is our mixer. Manuela Bedoya is our social media editor. Cedric Wilson is our lead producer. Jen Chien is our executive editor. Jimmy Gutierrez is our managing editor and the creator Juleyka Lantigua. On Twitter and Instagram we're @talktomamipapi. Please follow us and rate us on Apple Podcasts, Amazon Music, Pandora, Spotify, anywhere you listen to your favorite podcasts.
Lantigua: Bye everybody. Same place next week.
CITATION:
Lantigua-Williams, Juleyka, host. “Explaining She's Isolated, Depressed, and Caring for a Newborn.”
How to Talk to [Mamí & Papí] About Anything,
Lantigua Williams & Co., August 2, 2021. TalkToMamiPapi.com.