As I reflect on last week’s Black Maternal & Parental Health Week, I am appreciative of the shared stories, especially those that gave ideas on the ways to make change versus just highlighting the statistics in terms of Black perinatal mental health.
Pause. The statistics are very important. In Canada, we do not collect race-based data (we should be!) so it’s difficult to make cases on health care racism and discrimination. As a midwifery student, I referenced UK race-based data as it’s the closest societal and health care model, but also looked at US statistics. Although the US does not have universal health care, Black American lived experiences echo here for Black Canadians too.
The Canadian website BIPOC Women’s Health (https://bipocwomenshealth.com/new-moms/postnatal-health/postpartum-depression-in-women-of-color/) shares the following information on the state of perinatal mental health in BIPOC communities:
- “Women of colour are at a disproportionately greater risk of experiencing [PMAD]s than their white counterparts. The Canadian Mental Health Association estimates that up 20% of new Indigenous mother’s experience PPD. Studies also suggest that Black and Hispanic mothers report earlier onset of [PMAD] symptoms than other groups.”
- “Recent evidence has shown that Black, Hispanic, and [Indigenous] mothers are more likely to be exposed to stressors including divorce, homelessness and IPV.”
- There is evidence that BIPOC people are less likely to find and use mental health services, highlighting barriers to access such as mistrust of the health care system, cultural/religious stigmas, fear of discrimination and lack of representation in mental health care providers.
- In the US, Black birthing people are 243% more likely than their white counterparts to die from pregnancy or childbirth related causes.
A post by @prepared_pregnancy on Instagram laid out some simple ways Black birthing people can make the change necessary to affect these statistics. I wanted to focus on what Black birthing people can do to affect change for their perinatal mental health care using my training and experiences in midwifery.
1) Learn to advocate for yourself
NB: Advocating for yourself in a discriminatory medical world is exhausting and defeating. In pop culture, we see some of the most powerful Black women advocating for themselves (https://www.washingtonpost.com/news/morning-mix/wp/2018/08/07/beyonce-serena-williams-open-up-about-potentially-fatal-childbirths-a-problem-especially-for-black-mothers/), yet almost dying because their own self-advocacy was not enough. I can empathize to how hard this can be.
I want to validate the very real fear about disclosing mental health challenges to health care providers. Due to the stigma around mental health challenges, especially as a Black person (including all the intersecting identities layered on), there is so much at risk – the risk of child apprehension and unnecessary involvement of CAS or social work, the risk of immigration status being revoked, being pathologized, being deemed ‘difficult’. We hear you and feel very compassionate to this challenge. As a midwifery student, I can attest to how real this stigma is and how much it can derail care in inappropriate, unfounded, and destructive ways.
- Put perinatal mental health in the forefront:
o Remind yourself that you are at the centre of perinatal care. When you start care with your desired provider, start each appointment with a mental health check in.
o Ask your health care provider what their protocol is for mental health disclosures and how you can work with them to create a plan that is tailored and safe for you. This is a good question to ask before you choose a provider.
- Put the plan on paper:
o Postpartum Support International has a handy advocacy checklist you can use to monitor symptoms and use as a way to start talking about your perinatal mental health (https://www.perinatalwellbeing.ca/pmadtool). We often think of birth plans (which can change so much), we should also think about perinatal mental health care plans because these can be very tangible ways to support. It can include a crisis plan and named care providers that you trust.
- Source a Black or allied birthworker (doula):
o Birthworkers’ role is to advocate for your interests, and when advocating for yourself is too hard, they can do it for you. They are often the first to notice when you are struggling with perinatal mental health, offer emotional support and resources and can even attend appointments with you and your healthcare provider.
o I understand that birthworkers can be costly, but there are some options in Ontario that are low cost or free if you qualify such as https://www.ocamacollective.com (big shout out to them! I have worked with this incredible group of predominantly Queer Black birthworkers and their dedication is unmatched), https://birthmarksupport.com, https://www.blackdoulas.ca.
2) Educate yourself
- Be a sponge:
o It is so important to absorb information on perinatal mental health. The more you know = the more you will be able to be a self-advocate. Try https://blackdoctor.org/expecting-make-sure-your-prepared-for-this-after-the-baby-arrives/2/, https://www.postpartum.net/resources/, https://www.perinatalwellbeing.ca/pmad-information
- Learn about the screening tools available:
o On your Ontario Perinatal Record (sidenote: it’s worthwhile to see what healthcare providers are recording during your pregnancy: https://www.pcmch.on.ca/wp-content/uploads/2022/02/OPR-2017.pdf) , there are screening tools that exist like the Generalized Anxiety Disorder GAD-2 scale, Depression Screening PHQ-2 and the Edinburgh Perinatal/Postnatal Depression Scale (EPDS). These are not perfect at all, but these are tools to start the conversation. Ask your healthcare provider to note that you initiated the screen. Be proactive about your mental health – it shows that you have a sense of agency, which is especially important if this document is referenced in legal proceedings.
3) Get an empowering birth team
o It is important to include perinatal mental health support in this birth team, which can range from perinatal psychotherapists (https://www.blacktherapistlist.com), birthworkers to peer support groups in the community you belong to (we at PWO also have peer support workers and low cost psychotherapists!). I have even seen friends and family take on this role successfully. Building trust is the hardest part of feeling supported in the perinatal period, so filtering in the right resources to support your mental wellbeing early on is crucial.
o I want to remind folks that in Ontario you can choose between a midwife, obstetrician and family doctor to provide your perinatal care. Do your research on what would best support your clinical care, as well as your perinatal mental wellbeing. I am biased – do consider a midwife, and check out Ancestral Hands Midwifery (https://ancestralhands.ca) for a list of all Ontario Black midwives.
o If you need guidance on navigating the healthcare system, we at PWO have an option to speak to someone on the Support Services team.
These above reflections from Black Maternal & Parental Health Week are small changes that folks can implement to ameliorate the provision of perinatal mental health care. I am aware this isn’t very exhaustive and doesn’t encompass fully the multitude of Black lived experiences and identities, but I am hoping to offer a jumping off point.
But, if you are a non-Black person, I hope this shows how much extra planning and thinking it requires to get proficient perinatal mental health care, and generally, perinatal health care for Black birthing communities.
I humbly say that I cannot embody and fully know the experiences of Black birthing people as a non-Black person. I am also humbled by how much I continue to learn. However, in my Filipinx culture, everyone is “kapwa”, which means we can and should empathize with everyone because of our shared human experiences. Anyone who has had perinatal mental health challenges can empathize, even just a little bit.
Thank you for reading!