​By Claire Gagne and Claire Sibonney

By Christin Perry | February 25, 2020

​"Almost as soon as those two pink lines pop up on a pregnancy test, your hormones get the message that something's different at mission control. Progesterone and human chorionic gonadotropin (hCG) begin pumping to signal your body to halt production on your next menstrual period, and begin forming that cluster of cells into a mini-you instead. As you probably already know, as these hormones get to work, you'll experience an onslaught of early pregnancy symptoms like nausea, fatigue, and breast tenderness.

As pregnancy progresses, our bodies produce extraordinary amounts of estrogen and progesterone, says Aumatma Shah, fertility specialist and naturopathic doctor at the Bay Area's Holistic Fertility Center. "These two steroidal hormones are key to creating dopamine and serotonin, two neurotransmitters in the brain that are important in feeling calm and happy. This is why a lot of women feel amazing when pregnant: Pregnancy offers a surge of hormones and neurotransmitters that help us feel great."

But what happens to those feel-good pregnancy hormones once your baby is born? "Unfortunately, immediately postpartum and the week following delivery, estrogen and progesterone will both plummet. Simultaneously, there will be a surge in prolactin and oxytocin," says Shah.

These wildly swinging hormones are to blame for those crazy emotions you'll experience after giving birth. Here's a closer look at what happens to your hormones postpartum and when so you know what to expect—and so you know the loony emotions you're feeling are all completely normal.

​What Happens to Hormones Immediately After Giving Birth?
The birth of your sweet bundle of joy is undoubtedly one of the most exciting moments of your life. No matter how long you labor or what time you give birth—yes, even if it's at 3 a.m.—you'll likely feel an amazing, indescribable high when you meet your baby for the first time, or shortly thereafter. But those surging hormones will plummet over the next few days. Here's what's going on:

• Progesterone and estrogen decrease as soon as baby and the placenta are delivered.
• Oxytocin surges immediately following birth to compensate for the initial drops in progesterone and estrogen. This hormone is responsible for that strong mothering instinct you'll feel, but you'll probably still experience some "baby blues" in the first few days postpartum as the oxytocin works itself out of your system, says Shah.
• Prolactin increases to encourage breast milk production.

Postpartum Hormones at 3 to 6 Weeks
After those first few weeks pass, you may start to feel those rollercoaster-like emotions start to regulate a bit as you begin to get into the groove of caring for baby and get used to the lack of sleep. Ashley Margeson, a naturopathic doctor says, "the first three months are a bit of a whirlwind of sleep loss and emotions as your system runs mostly on adrenaline to move you through the day."
​
Around the six-week mark, she says, symptoms of postpartum depression may begin to show as those positive post-birth hormones continue to fade. "The changes you should look for closely are not wanting to shower or focus on hygiene, being afraid of leaving your baby with someone else, not being able to sleep fully due to continually checking on baby, and lack of desire for common tasks like eating, drinking, being around people, and leaving the house."

By: Jessica Grose | February 4th, 2021

"In early September, as the school year inched closer, a group of mothers in New Jersey decided they would gather in a park, at a safe social distance, and scream their lungs out. For months, as the pandemic disrupted work and home life, these moms, like so many parents, had been stretched thin — acting as caregivers, teachers and earners at once. They were breaking.

As are mothers all over the United States.

By now, you have read the headlines, repeating like a depressing drum beat:
“Working moms are not okay.” “Pandemic Triples Anxiety And Depression Symptoms In New Mothers.” “Working Moms Are Reaching The Breaking Point.”

You can also see the problem in numbers: Almost 1 million mothers have left the workforce — with Black mothers, Hispanic mothers and single mothers among the hardest hit. Almost one in four children experienced food insecurity in 2020, which is intimately related to the loss of maternal income. And more than three quarters of parents with children ages 8 to 12 say the uncertainty around the current school year is causing them stress.
​
Despite these alarm bells clanging, signaling a financial and emotional disaster among America’s mothers, who are doing most of the increased amount of child care and domestic work during this pandemic, the cultural and policy response enacted at this point has been nearly nonexistent.

The pandemic has touched every group of Americans, and millions are suffering, hungry and grieving. But many mothers in particular get no space or time to recover.

The impact is not just about mothers’ fate as workers, though the economic fallout of these pandemic years might have lifelong consequences. The pandemic is also a mental health crisis for mothers that fervently needs to be addressed, or at the very least acknowledged.

“Just before the pandemic hit, for the first time ever, for a couple months, we had more women employed than men,” said Michael Madowitz, an economist at the Center for American Progress. “And now we are back to late 1980s levels of women in the labor force.” The long-term ramifications for mothers leaving work entirely or cutting back on work during this time include: a broken pipeline for higher-level jobs and a loss of Social Security and other potential retirement income.

“Covid took a crowbar into gender gaps and pried them open,” said Betsey Stevenson, an economist at the University of Michigan. Her long-term concerns are even more fundamental: Will watching a generation of mothers go through this difficult time with little support turn the next generation of women off from parenthood altogether?

The economic disaster of the pandemic is directly related to maternal stress levels, and by extension, the stress levels of American children. Philip Fisher, a professor of psychology at the University of Oregon who runs an ongoing nationally representative survey on the impact of the pandemic on families with young children, points out that the stressors on mothers are magnified by a number of intersecting issues, including poverty, race, having special needs children and being a single parent.

“People are having a hard time making ends meet, that’s making parents stressed out, and that’s causing kids to be stressed out,” Dr. Fisher said. This buildup can lead to toxic stress, “And we know from all the science, that level of stress has a lasting impact on brain development, learning and physical health.” Almost 70 percent of mothers say that worry and stress from the pandemic have damaged their health.

The statistics on stress levels are shocking, but they are sterile; they don’t begin to expose the frayed lives of American mothers and their children during this pandemic. A young mother who self-identified as American Indian/Alaska Native summed up her situation in response to Dr. Fisher’s survey: “We are requesting government help for food. Relationship between partner and I are tense. I am personally struggling more now with depression and anxiety. My toddler has become more anxious as well and shown aggressive behavior. She seems overwhelmed most of the time.”
​
Times editor-at-large Jessica Bennett spent months communicating with three women, who kept detailed diaries of their days, for a look at just how much American mothers are doing every waking second."

"The amount of sleep you get while you’re pregnant not only affects you and your baby, but could impact your labor and delivery as well. Lack of sleep during pregnancy has been tied to a number of complications, including preeclampsia (a serious condition that affects your blood pressure and kidneys). This condition could result in pre-mature birth. Now is the time to take sleep seriously.When you become pregnant, one of the first symptoms you may notice is being overwhelmingly tired, even exhausted. Sleep will be irresistible to you. You can most likely blame your changing hormones for this, especially the extra progesterone that comes with being pregnant. In the beginning, pregnancy also lowers your blood pressure and blood sugar, which can make you feel tired.

Shortly after the first trimester, your energy should return. Sometime during the third trimester, you’ll begin to feel tired again. Some of this feeling can be blamed on the sheer physical exhaustion that comes from growing a baby and the stress that it puts on your body. However, your weariness during this time is in direct relation to your inability to get a good night’s sleep.

​Even if you’ve never had trouble sleeping before, you may find it much more difficult while you’re pregnant.

Path to improved health
Sleep should never be seen as a luxury. It’s a necessity — especially when you’re pregnant.
In fact, women who are pregnant need a few more hours of sleep each night or should supplement nighttime sleep with naps during the day, according to the National Institutes of Health.

For many pregnant women, getting 8 to 10 hours of sleep each night becomes more difficult the farther along they are in their pregnancy. There are many physical and emotional obstacles to sleep in this stage. Anxiety about being a mom or about adding to your family can keep you awake. Fear of the unknown or about the delivery can cause insomnia. Plus, there is the getting up every few hours to go to the bathroom. It also can be difficult to find a comfortable position in bed, especially if you are a former stomach sleeper.


If any of the following is keeping you awake at night, try these strategies for getting a good night’s sleep.

Heartburn
At some point in their pregnancy, most pregnant women suffer from heartburn, which is a form of indigestion that feels like burning in your chest and throat. Heartburn can wake you up in the middle of the night and ruin a good sleep. Minimize the chance for this by avoiding spicy foods. Also, cut down on rich foods for dinner.

Restless leg syndrome
Few things are more distracting than restless legs syndrome (RLS), especially when you are trying to go to sleep. While you can’t take traditional RLS medicines when you are pregnant, you can try to reduce the feelings of RLS with a good prenatal vitamin that includes folate and iron.

Morning sickness — at bedtime
Despite the name, morning sickness can occur any time and is often worse later in the day. Try eating a few crackers at bedtime and keep a stash in your nightstand in case a wave of nausea hits as you are trying to go to sleep.

​Insomnia
There are many ways insomnia can creep in and compromise your sleep time. Often, it’s just about being able to shut down your brain. Most medicines for insomnia should not be taken while you are pregnant. Instead, try journaling some of the things you are anxious about. Write down what is stressing you and try to let it go as you go to sleep. Also, stop drinking caffeine by early afternoon. Try not to take long naps during the day. Doing any — or all — of these things can help ease you back into sleep at a reasonable bedtime.

Leg cramps
Not many things can wake you as quickly and painfully as a leg cramp. Sometimes called a charley horse, these cramps are usually a contraction of your calf muscle. Less frequently, they can occur in your thigh or your foot. These can plague you in pregnancy because of a lack of minerals, especially calcium and magnesium. They also are more common if you are dehydrated. To guard against leg cramps, make sure that you continue to take your prenatal vitamin and drink plenty of water and other fluids during the day.

Finding a comfortable position
As your body grows, sleep becomes a little harder to come by, especially in the third trimester. It’s difficult to get comfortable. It’s harder to move around and shift positions in bed. If you’ve been a stomach or back sleeper, it can be hard to adjust to sleeping on your side. The best position to sleep in when you’re pregnant is on your left side. This improves blood flow and, therefore, nutrient flow to your baby. Try lying on your left side, knees bent with a pillow between your knees. It also helps to tuck a pillow under your stomach, as well, for extra support.

Frequent bathroom breaks
With the baby pushing down on your bladder, you likely can’t make it all night without waking at least once to go to the bathroom. You can help minimize nighttime bathroom trips by cutting down on how much you drink in the evenings. Just be sure to get adequate hydration during the day. Bright lights can make it harder for you to fall back asleep, so use nightlights so that you will not need to turn on the lights when you get up to go to the bathroom.
In addition to minimizing the common obstacles to getting a good night’s sleep, there are also ways to encourage good sleep habits. This is called good sleep hygiene.

• Be consistent with your sleep schedule. Go to bed and wake up at the same time every day.
• Prioritize sleep. It’s one of the healthiest things you can do for your body.
• Exercise, but do not exercise at bedtime.
• Keep daytime naps short.
• Stick to a bedtime routine that relaxes you, and don’t vary from it.
• Make your bedroom inviting. Do not keep a TV, computer, or other distracting tech gadgets in your bedroom.
• Do not eat at bedtime. Finish eating two to three hours before going to bed. 

​Things to consider
Sleep is essential to health. Lack of sleep is associated with many chronic diseases, including type 2 diabetes, obesity, depression, and even heart disease. If you’re pregnant, not getting an adequate amount of sleep can put you at risk for some serious conditions. Lack of sleep can also complicate your delivery.
In one research study, pregnant women who slept less than six hours at night late in pregnancy had longer labors and were more likely to have cesarean deliveries.

Another study reports that the sleep you get in your first trimester can affect your health in the third trimester. Women who don’t get enough sleep (less than five hours per night) in the first trimester are nearly 10 times more likely to develop preeclampsia late in pregnancy. Preeclampsia is a condition associated with pregnancy-related high blood pressure, swelling of hands and feet, and protein in urine.
​
If you’ve ever had a sleep disorder, it could be made worse by pregnancy. If you’ve had sleep apnea in the past, your snoring may get worse during pregnancy. This is especially true if you were already overweight when you became pregnant. Expect that RLS will worsen during this time. Heartburn will intensify, too."

"This is a question we often hear.  One of the challenges in answering this question is the interpretation of the word “best”.  On one hand, the best antidepressant is the one that is the most likely to be effective.  On the other hand, the best antidepressant is the one that carries the least risk when used during pregnancy. What this means is that there is no single answer.  Each situation is different, and our recommendations are based on a careful assessment of the patient’s course of illness, treatment history, past medication trials, and the most up-to-date information on reproductive safety. Added to this calculation is the understanding that untreated depression also carries some risk in terms of maternal well-being and has been associated with worse pregnancy outcomes.  

Stay with the Same Treatment or Switch?
We often meet with women who have switched to a different antidepressant medication in preparation for pregnancy.  Other women make a switch when they discover they are pregnant.  These switches are motivated by the belief that there is a “safer” medication to be used during pregnancy.  The reality is that most of the antidepressants taken by women today are relatively safe and carry a very low risk to the developing fetus.  What separates one antidepressant from another is that some medications have more data to support their reproductive safety than others.  But even this distinction is disappearing; we have data to support the use of most SSRIs (with less data on fluvoxamine or Luvox), the SNRIs duloxetine (Cymbalta) and venlafaxine (Effexor), and bupropion (Wellbutrin). Tricyclic antidepressants, although not commonly used today, also have data to support their reproductive safety.  

MAO Inhibitors: 
We have very little data on the reproductive safety of the MAO inhibitors. In addition, MAO inhibitors may have serious interactions with other medications frequency used during pregnancy and labor and delivery, specifically medications used to manage pain, such as nalbuphine (Nubain) and meperidine (Demerol).  In women taking these medications, we are likely to suggest switching to another antidepressant with a better reproductive safety profile.  

Mirtazapine (Remeron):  
At this point, we have less data on the use of the newer antidepressants. There is some data on mirtazapine, with the most recent study including 334 cases of neonates with prenatal exposure to mirtazapine.  While these data are reassuring and there is no indication that mirtazapine carries significant teratogenic risk, the number of mirtazapine exposures remains small.  Ideally we would like to have data from 600-700 exposures to get a better estimate of risk.  Making decisions regarding safety on studies with small sample sizes can lead to miscalculations of risk in either direction.

Other Antidepressants: 
The data is even more limited with regard to the use of vortioxetine (Trintellix), vilazodone (Viibryd), levomilnacipran (Fetzima). If there are effective alternatives, we typically recommend switching to another antidepressant.  
In settings where we have limited data regarding the reproductive safety of a particular antidepressant, we may consider switching to an antidepressant with a better characterized reproductive safety profile.  It is important, however, to carefully consider the benefits and risks of making this switch. With any switch, there is the risk of relapse when making a change in the maintenance treatment. Thus, there are situations where we recommend continuing an antidepressant with limited reproductive safety information because there are no effective alternatives and the risk of relapse is significant.  

What About Zoloft? Isn’t Zoloft the Safest?
At some point in the early 2000s, there emerged the belief that sertraline (Zoloft) was the safest antidepressant to use during pregnancy, and many women taking other antidepressants were encouraged to switch to sertraline during pregnancy.  It is somewhat unclear where this opinion came from — maybe one paper suggesting lower placental passage of sertraline compared to other antidepressants; however, there is and never was any solid data to support the assertion that sertraline is safer or the safest antidepressant.  Reflexively switching women to sertraline puts women at risk for recurrent illness.  

While sertraline is effective for the treatment of depression and anxiety and is a reasonable choice for many women, one problem with sertraline is that it tends to be under-dosed. The typical starting dose is 50 mg; however, many individuals will need 150 mg to 200 mg to effectively manage their symptoms.  Especially when sertraline treatment is initiated in the primary care setting, we often see women whose dose is too low to effectively manage their symptoms.   

What About Paxil? Doesn’t It Cause Heart Defects?
The most current data regarding the use of paroxetine (Paxil) during pregnancy does not indicate an association between the use of paroxetine during pregnancy and risk for cardiovascular malformations.  However, in 2006, GlaxoSmithKline (GSK) elected to change product label warnings for the antidepressant paroxetine (Paxil), advising against the use of this drug by women who are pregnant. This decision was based on two preliminary studies which suggested a small increase in the risk of cardiovascular malformations among infants exposed to paroxetine in utero. For many years, this concern regarding risk of heart defects resulted in recommendations that women taking paroxetine should either stop paroxetine or to switch to a different antidepressant during pregnancy.

However, in 2008, a study from the Motherisk Program in Toronto reported on the outcomes of over 3000 paroxetine-exposed infants and found no association between the use of paroxetine during pregnancy and increased risk of cardiovascular malformations.  Nonetheless, some women and their treaters continue to feel uncomfortable with the use of paroxetine during pregnancy. Furthermore, many websites (including reputable sites like the Mayo Clinic) continue to urge women to avoid paroxetine during pregnancy because of the risk of malformations. 

At this point, we typically do not recommend switching from paroxetine to another antidepressant for pregnancy. Although paroxetine is an SSRI, there are definitely situations where an individual may respond better to paroxetine than to other SSRIs. Thus, switching to a different antidepressant may increase risk for relapse. 

What About Lexapro? And Pristiq?
There are some newer antidepressants that are derived from older parent antidepressants.  For example, citalopram (Celexa) is a racemic mixture, composed of R- and S-enantiomers (or mirror images) of citalopram.  While the S-enantiomer is clinically active, the R-enantiomer is not.  Escitalopram or Lexapro contains only the active S-enantiomer.  Because the S-enantiomer is contained in the original citalopram formulation, we can infer that the reproductive safety of escitalopram (Lexapro) is the same as that of citalopram (Celexa).
Another example is desvenlafaxine or Pristiq.  For venlafaxine to be effective as an antidepressant, it must first be metabolized by the body to desvenlafaxine.  Pristiq contains only the active metabolite desvenlafaxine.   Because desvenlafaxine is a metabolic byproduct of the original venlafaxine formulation, we can infer that the reproductive safety of desvenlafaxine (Pristiq) is the same as that of venlafaxine (Effexor).

The Bottom Line
No two situations are identical; thus, we must carefully consider each woman’s clinical history and preferences in order to select a treatment plan that makes sense.  Ideally this discussion should occur long before a woman is pregnant, so that there is ample time to consider the various options and to make changes, if necessary.  

When we meet with women to discuss the use of antidepressant medications during pregnancy, we typically consider a number of issues:

1. Determine the risk of recurrent illness: Has she had one episode of depression or does she have recurrent depression? If she has attempted to discontinue antidepressants in the past, how long was she able to remain well without medication? If she has had prior pregnancies, what happened to her mood during pregnancy and the postpartum period?
2. Assess the severity of previous episodes of depression: Did the depression contribute to missed days of school or work? Psychiatric hospitalization? Suicidal ideation? Self-harm? Suicide attempt?
3. Review past medication trials: What antidepressants have been effective in the past? Which antidepressants have been ineffective? Assess dose and duration of treatment to determine if the trial was adequate.  
4. Identify factors that may mitigate risk: Has psychotherapy been helpful? Is this an option for decreasing risk for relapse? What about other non-pharmacologic interventions: mindfulness, meditation, yoga, acupuncture, exercise?
5. Discuss options for pharmacologic treatment during pregnancy: What are the antidepressants most likely to maintain stable mood during pregnancy? What is the medication with the best characterized reproductive safety profile? Does it make sense to maintain or to switch to a different antidepressant? Even if the woman ultimately decides that she would like to avoid medications during pregnancy, it is important to discuss options for treatment, in case she relapses during pregnancy and would like to resume treatment. 

We now have data to support the reproductive safety of a large number of antidepressants.  
The perinatal psychiatry consultation should be viewed as a collaborative venture, where provider and patient decide together what is the best option for treatment during pregnancy."

-​Ruta Nonacs, MD PhD

By: Love Amy Michelle | October 28, 2017

"Love Amy Michelle is a space for you to reconnect with yourself + to find some peace amidst the chaos."

By: Becky Vieira

"Dear Husband-I see you. Then and now. You might not think I did. 

I try to imagine what you endured. The pain, fear. While the primary focus was on me, my health and recovery, I know you were suffering also. Silently. Never saying a word of complaint.

I recognize all you did to get me where I am today. To get us here.

We thought we’d just be tired. That exhaustion would be the biggest of our problems once our son was born. Neither of us expected that I’d be gripped – no, controlled – by my postpartum depression. It was supposed to be the happiest time of our lives, not the living nightmare it soon became.

It started slowly, do you remember? We thought I was tired. That my hormones were adjusting yet again. But before we knew it I was underwater. The progression from healthy to dangerous transpired within days once that beast took hold of me.

How did you do it? We had a newborn. No idea what to do with him. You carried that aspirator in your back pocket at all times “just in case.” And while we watched him sleep for fear something would happen if one of us closed our eyes, I began losing my fight.

Yet you continued on.

I started to slip away. I wanted to leave, convinced you both would be better off without me. You held me when I needed it. Let me run into the street to scream, then greeted me at the door with a warm blanket and tea when I returned. Researched treatment. Medications. Called my doctor and hid my car keys when things got dark.

You also got up every morning and went to work. Held things together for us financially. All while receiving frantic calls from me. Coming home between meetings, at lunch. To check on us.

There was no guidebook for you. No one you could call to ask questions on how to handle the situation. I was wrapped in the support I found online from other mom’s with postpartum depression. But what did you have? No men on social media were presenting themselves as the husbands of women with PPD. You had nowhere to turn.

There are resources for PPD. Help. But no one can really tell you how to live through it. It felt as if we were thrust into a new universe, one that spoke an entirely different language. My mind started lying to me and my will to live was faltering. Our coping skills were stripped away and we had to find a way to survive. I needed to be healthy again.

You kept going, for all of us. Trusted your instincts and did the best you could. Yes, there were moments when I was angry over the things you said or did. But today I see that it was in my best interest. You always tried to help.
Even when I screamed at you and said horrible things. Threatened to walk out of your life because I was convinced you deserved better than a sick wife. You never gave up.

You should be proud of yourself and recognize all you did. I’m proud of you. And grateful you stayed by my side. I’ll never forget sitting on the kitchen floor, crying to you as I said, “I’m crazy.” You kissed me and said, “then I guess I’m crazy, too.” Our tears turned to laughter and I knew I’d never be alone.

We survived and our marriage is actually stronger today because of all we endured. You held it together so that I could fall apart safely. And then build myself back up again.

Yes, I spoke up. Got help. Worked on myself, started taking medication. But it would have been much harder without you by my side.

I know you suffered. Were scared. And probably angry, frustrated and hopeless at times. But I never saw that. I only felt loved and supported.
​
Thank you for everything. I see you and what you did for me and our family. And I’ll never forget."

​"If you think you may be suffering from postpartum depression, don’t wonder. Speak up. Talk to you doctor, partner, family and friends. If you are scared or worried about the stigma (I get it… we shouldn’t be concerned about that but of course we often are) and would rather talk to someone outside of your circle, you can call Postpartum Support International at 1.800.944.4773. If you just need a fellow mom to validate you and listen to your fears, find me on Instagram and reach out.
Anxious, overwhelmed, unhappy, or scared by how you feel? If you’re struggling emotionally, you could be depressed. Take this 10-question quiz to find out."

By: Melissa Willets

"If you're like me, your answer to the question: "Should I have another baby?" changes by the hour. I gaze at my sleeping, angelic children, snug in their beds at night, and think, YES! Definitely, the sooner the better, NOW. Then my kids are screaming, fighting over a single, blue crayon, and it's, NO! NO! NO! No more kids, ever.So how do you cut through those everyday moments of indecision, to get to the real answer of whether you should have another baby? Try asking yourself these six things:

1. How do you feel when you get your period?
Is it, relief or sadness? Last month my period was a welcome relief. I have a 10-month-old baby, a three-year-old, and an almost six-year-old. We've got enough going on! But this month it was different. I felt a little sad, and began to think, what if? What if our family is not quite complete yet? What if we had another baby?

2. How do you feel when you see a newborn?
Do you feel love sick, or just sick? I see an infant, and my heart swells. An involuntary, "aww," escapes my lips. I can't help it! I love how a newborn smells, I love her soft, delicious skin. Babies are heaven, pure and simple. And having another one is starting to feel like the greatest idea ever!

3. What do you picture your life to be like with another child?
Is life overwhelmingly hectic or charmingly challenging? I don't picture a scenario replete with loud crashes, screaming children, me trembling, gripping a too-full glass of wine, crying in frustration, as little people slowly take over my house, and my life. Instead, I see happiness. I picture smiles, hugs, cuddles, love and giggles. Oh, there's craziness too, believe you me. But mainly I hear The Beatles' song "All You Need Is Love," playing in my head when I imagine being a mom to four kids.

4. What would life be like if you didn't have another baby?
Arrow straight through the heart. Ouch. No, the truth is I've felt conflicted about having another baby for a while. Life is great the way it is. Life is full. We are parents to three, beautiful, funny, silly, smart, wonderful girls. Why mess with what is working pretty darn well for us? When I think this way, another baby seems like a bad idea...

5. What is your biggest reason for wanting another baby?
Is something still missing? Or, is it just hard to imagine closing that door yet? There are so many reasons I want another baby. I still long to feel a baby kick inside of me. I yearn to hold a newborn in my arms, knowing that I did that; I made that. I have also loved, loved seeing how my children love, and care about each other. Being witness to their sisterly bond has been the greatest privilege of my life. I know that adding to our family would just bring more love, and joy.
​
6. What is your biggest fear about having another baby?
I worry about tempting fate if we have another baby. Can I really be lucky enough to bring four healthy babies into the world? No one could be that lucky; it just isn't fair. Right? Sigh. I don't know."
​

By Uma Naidoo | December 07, 2018 | Updated March 27, 2019

"The human microbiome, or gut environment, is a community of different bacteria that has co-evolved with humans to be beneficial to both a person and the bacteria. Researchers agree that a person’s unique microbiome is created within the first 1,000 days of life, but there are things you can do to alter your gut environment throughout your life.

Ultra-processed foods and gut health

What we eat, especially foods that contain chemical additives and ultra-processed foods, affects our gut environment and increases our risk of diseases. Ultra-processed foods contain substances extracted from food (such as sugar and starch), added from food constituents (hydrogenated fats), or made in a laboratory (flavor enhancers, food colorings). It’s important to know that ultra-processed foods such as fast foods are manufactured to be extra tasty by the use of such ingredients or additives, and are cost effective to the consumer. These foods are very common in the typical Western diet. Some examples of processed foods are canned foods, sugar-coated dried fruits, and salted meat products. Some examples of ultra-processed foods are soda, sugary or savory packaged snack foods, packaged breads, buns and pastries, fish or chicken nuggets, and instant noodle soups.
Researchers recommend “fixing the food first” (in other words, what we eat) before trying gut modifying-therapies (probiotics, prebiotics) to improve how we feel. They suggest eating whole foods and avoiding processed and ultra-processed foods that we know cause inflammation and disease.


But what does my gut have to do with my mood?

When we consider the connection between the brain and the gut, it’s important to know that 90% of serotonin receptors are located in the gut. In the relatively new field of nutritional psychiatry we help patients understand how gut health and diet can positively or negatively affect their mood. When someone is prescribed an antidepressant such as a selective serotonin reuptake inhibitor (SSRI), the most common side effects are gut-related, and many people temporarily experience nausea, diarrhea, or gastrointestinal problems. There is anatomical and physiologic two-way communication between the gut and brain via the vagus nerve. The gut-brain axis offers us a greater understanding of the connection between diet and disease, including depression and anxiety.
When the balance between the good and bad bacteria is disrupted, diseases may occur. Examples of such diseases include: inflammatory bowel disease (IBD), asthma, obesity, metabolic syndrome, diabetes, and cognitive and mood problems. For example, IBD is caused by dysfunction in the interactions between microbes (bacteria), the gut lining, and the immune system.


Diet and depressionA recent study suggests that eating a healthy, balanced diet such as the Mediterranean diet and avoiding inflammation-producing foods may be protective against depression. Another study outlines an Antidepressant Food Scale, which lists 12 antidepressant nutrients related to the prevention and treatment of depression. Some of the foods containing these nutrients are oysters, mussels, salmon, watercress, spinach, romaine lettuce, cauliflower, and strawberries.

A better diet can help, but it’s only one part of treatment. It’s important to note that just like you cannot exercise out of a bad diet, you also cannot eat your way out of feeling depressed or anxious.
We should be careful about using food as the only treatment for mood, and when we talk about mood problems we are referring to mild and moderate forms of depression and anxiety. In other words, food is not going to impact serious forms of depression and thoughts of suicide, and it is important to seek treatment in an emergency room or contact your doctor if you are experiencing thoughts about harming yourself.
​

Suggestions for a healthier gut and improved mood
​

• Eat whole foods and avoid packaged or processed foods, which are high in unwanted food additives and preservatives that disrupt the healthy bacteria in the gut.
• Instead of vegetable or fruit juice, consider increasing your intake of fresh fruits and vegetables. Frozen fruits without added sugars/additives are a good choice too.
• Eat enough fiber and include whole grains and legumes in your diet.
• Include probiotic-rich foods such as plain yogurt without added sugars.
• To reduce sugar intake at breakfast, add cinnamon to plain yogurt with berries, or to oatmeal or chia pudding.
• Adding fermented foods such as kefir (unsweetened), sauerkraut, or kimchi can be helpful to maintain a healthy gut.
• Eat a balance of seafoods and lean poultry, and less red meat each week.
• Add a range of colorful fresh fruits and vegetables to your diet, and consider choosing certain organic produce."

By: ​Bethany Braun-Silva

"Expecting parents have multiple checklists of everything they need to get ready for their baby’s arrival. Cribs, bottles, car seats, and strollers are just a few of the essentials you need to consider before welcoming a new baby. But even before any of that, there’s the hospital bag checklist. A robe, a nightgown, slippers, and a few blankets are sure to make the list, but oftentimes, a postpartum recovery kit gets overlooked.

A postpartum recovery kit has what moms need to help with bleeding, soreness, and overall discomfort. You can create your own kit by buying things like disposable underwear, ice packs, and perineal spray separately, but there are also ready-made kits for moms that include all these things and more.

Many moms agree that postpartum recovery kits are a great choice. The Frida Mom Hospital Packing Kit for Labor, Delivery, Postpartum, for example, has over 1,000 five-star reviews on Amazon and a near-perfect 4.8-star rating. “I would 100% say that every postpartum experience needs this kit,” writes one customer. “I think it’s well worth the price for the comfort you’re getting.”

The Miloo Mom Hospital Labor and Delivery Gift Packing Kit for Delivery, Postpartum is also a great choice available on Amazon. One reviewer writes, “I was very impressed with my kit, and I used all of it when I was in the hospital.”

Convenience is so important when you have a new baby, especially when it comes to your healing. The first six weeks after giving birth are a critical time in the healing process, and having the right tools handy can make all the difference in your physical (and mental) health. If you’re pregnant or know someone who is, check out the postpartum recovery kits below."

By: ​Hilary Braaksma

"Pregnancy puts a lot of strain on your body, including at bedtime, which is why finding the best pregnancy pillow is so essential for many women.

Find a little relief for those aches and pains by sleeping with a pillow that’s designed to cradle and comfort your pregnant shape. The latest pregnancy pillows come in a wide array of sizes and shapes to fit your particular needs, whether you’re looking to alleviate back pain or to find a positioning solution as a stomach sleeper

From full-body styles to wedges, the options are plentiful. Some favorite brands include Boppy and Leachco, but they’re not the only brands to shop for some of the best pregnancy pillows available in 2020. Below are seven pregnancy pillows we recommend for an amazing night of sleep."

Moonlight Slumber Comfort-U Total Body Support Pillow​

"​The Comfort-U Pillow by Moonlight Slumber cushions every curve of your aching body with Fusion Foss fiber. It feels soft and stays soft, but it also provides support where you need it most with its classic “U” shape. This is the perfect pregnancy pillow if you want to feel like you’re engulfed in a giant cloud. ($99.95; amazon.com)"

​Boppy Total Body Pillow in Ringtoss

By: Cedars-Sinai Staff| October 21, 2019​

"The biggest misconception women have about exercising while pregnant is that they can't do it at all, says Dr. Keren Lerner, OB-GYN at Cedars-Sinai. "It's not uncommon for women to wonder if working out during pregnancy will put the baby at risk," says Dr. Lerner. "I get asked that a lot."

Not only is it safe for pregnant women to exercise, but engaging in physical activity while pregnant can be beneficial for the health of a woman and her baby.
It can reduce the risk of preeclampsia, gestational diabetes, and hypertensive disorders during pregnancy. It can also minimize discomfort.
The American Pregnancy Association recommends at least 30 minutes of physical activity every day for women who have a normal, healthy pregnancy. 

The best types of workouts for pregnant women
It's important to know that not all pregnancy workouts are created equal. 
Dr. Lerner says workouts like Barre and Pilates are great because they focus on core strength, which can make the delivery and recovery process easier. 
"Prenatal yoga classes can be great for mind, body, soul, and core," Dr. Lerner says, as long as women are careful not to overextend their backs with deep bends or twists.
She also recommends swimming, especially in the third trimester.
"When there's more weight being carried, a lot of women end up with back pain," Dr. Lerner says.
"Because gravity is less of an issue in the water, women tend to be more comfortable in the pool."
No matter what workout they choose, pregnant women should drink plenty of water and take a rest if they start to feel dizzy or lightheaded while exercising.

​Workouts to avoid when pregnant
All pregnant women should avoid contact sports, as well as activities like skiing, snowboarding, rock climbing, horseback riding, and scuba diving.
If the pregnancy is high risk, women should talk to their doctor about their workout options.
Women should also seek medical advice if they get injured while exercising.
While 30 minutes of daily activity during pregnancy is recommended, women who enjoy working out aren't limited to this, Dr. Lerner says.
"Certainly those who are used to working out or have active jobs or lifestyles can endure more," Dr. Lerner says.
"They just need to be sure they're listening to their bodies." 

"Lifestyle changes to improve and prevent symptoms of depression and anxiety." 

By: Sarah Greenberg, MFT

• "Lifestyle changes can help people manage anxiety and depression, and take charge of their mental wellbeing.
• Some behaviors that are linked to improving or preventing anxiety and depression include addressing sleep issues, connecting with others, eating a nutritious diet and exercising.
• Change can be hard, especially for those with anxiety or depression, so it's important to be kind to yourself. 
• The best way to care for your mental health is the approach that works best for you. In some cases, professional help may also be needed."

"When Roy came to see me for longstanding symptoms of depression and anxiety (they often co-occur), he was hesitant at best. He wanted to feel better, but “getting treatment” didn’t fit with his narrative for what he was “supposed to be doing as a grown man” in his culture. He had a decent, consistent job, but felt his life lacked meaning and joy. He was so hard on himself and avoided others for fear of judgement.

I knew he’d run the other way if I jumped too quickly into a medical referral or diagnosis, so we started with the most human approaches — connecting about what was really going on for him, and exploring readily available lifestyle changes that aligned with his interest, motivation, and values. Within weeks, his spark started to come back, and within months he felt he had a new lease on life. He wasn’t suddenly happy all the time. But he felt a new sense of his capacity to take charge of his mental health.

Will everyone have an outcome like Roy from lifestyle changes? Definitely not — anxiety and depression are complex conditions with tremendous individual variation, varied underlying causes, and varied levels of severity. But can everyone benefit from learning the foundation for how to care for their mind either separately or as an adjunct to professional treatment? I believe so.

The following seven health behaviors are key ones linked to prevention or symptom improvement of anxiety and depression. 

While everything on this list is simple, it’s far from easy. Change is hard. And if you currently have depression or anxiety, it can be especially challenging. That’s why one of the key behaviors is being kind to yourself. 

If moved to do so, choose one area to work on at a time, perhaps an area you feel especially motivated or confident to address, or an area that feels aligned with your most important values. Then take it one step at a time. The funny thing about change is we often don’t know it’s happening, we just keep rowing in the right direction, and usually after a few, or a few thousand, twists and turns, we look back in awe at how far we’ve come. 

1. Sleep 

While 10-18% of adults in the U.S. experience chronic sleep issues, this number jumps to 65-90% of those with depression, and over 50% of those with generalized anxiety disorder. Of those with depression, 65% had sleep issues first. Addressing sleep issues can alleviate symptoms of mental health conditions, and given sleep problems are a risk factor for mental health conditions, can also help protect your mental health. 

There are many resources to help improve your sleep, such as this free app.

2. Self-Compassion

A disposition that tends towards self-critical, or perfectionistic, can be a risk factor for anxiety and depression. This can include feeling like you must be perfect to be accepted, an inability to accept flaws within yourself, intense self-scrutiny, or an unrealistic sense of others’ expectations and your capacity to meet them. 
​
Despite the fear of many who have this characteristic, the antidote to perfectionism isn’t letting it all go, or saying goodbye to standards – it’s self-compassion. According to researcher Kristen Neff, self-compassion has three components: self-kindness vs. self-judgment, common humanity vs. isolation, mindfulness vs. overidentification. How we treat ourselves through the ups and downs of life can have a tremendous impact on health and mental health.

3. Social Connection

From the time we are born, we need social connection in order to thrive. 
A recent study lead by researchers at Harvard sought to understand what could most protect us from depression that is within our control. After analyzing over 100 potential factors, they found that social connection was by far the most important protective factor. 
​
It’s been a lonely year for many. And many are anxious at the prospect of going back to normal. But connection doesn’t mean a big party or bustling office. It can be confiding in one trusted person about how you’re really doing, listening to how someone else is really doing, giving a meaningful thank you, or having a (safe) visit with any family member or friend. If this feels out of reach, try making a short list of people who at any point have given you a sense of belonging. Other studies have shown that just calling positive relationships to mind can have a positive impact on our capacity to tolerate stress."

"​In just 5 minutes you can reset your day in a positive way."

"Women who had Covid while expecting experienced guilt, shame and unhealthy levels of stress."

"Kate Glaser had chalked up her exhaustion to being 39 weeks pregnant and having twin toddlers in the house. She also wondered whether her flulike symptoms were a sign that she was about to go into labor. But when she woke up one morning with a 100.4-degree fever, she called her doctor and got a rapid Covid-19 test.

Two nurses came to deliver her results to her in the waiting room. They were dressed in full gowns, masks, face shields and gloves.

“I knew by the eerie silence and the way they were dressed that I was Covid positive,” she said. “It was an emotional moment; I felt really disappointed and shocked and, as a mom, I felt a lot of guilt. What did I do wrong?”

Glaser, who lives in the Buffalo, N.Y., area, returned home and isolated from her husband and the twins in her bedroom, where she spent hours mentally replaying all her activities leading up to the positive test result. She also made a public post on her Facebook page about her positive status, and what she was feeling — guilt, embarrassment and panic. The post went viral, and Glaser started hearing from women around the world who were pregnant and worried about Covid-19. The majority of the of the 2,300 comments she received were supportive; a few were harshly critical.

“I was going down a rabbit hole of guilt and stress,” Glaser said, adding that for her, as much as the physical symptoms were bad, the mental stress of Covid was much worse.

Prolonged stress can have real consequences on pregnant people even outside of a pandemic and has been tied to low birthweight, changes in neurological development and other health impacts in children. And the pressure associated with a positive Covid-19 test increases these mental health risks.

The anxiety is not without reason. As of November 30, there have been more than 42,000 cases of coronavirus reported in pregnant women in the U.S., resulting in 57 maternal deaths. U.S. health officials have said pregnancy increases the risk of severe disease for mother and child, and being coronavirus-positive in late pregnancy may increase the rate of preterm birth.

Prenatal care and birth plans are also disrupted by a positive test result. “Women are expressing so much fear about being infected, but also about going to the hospital, delivering and being separated from their child,” said Laura Jelliffe-Pawlowski, an epidemiologist who is the primary investigator of HOPE COVID-19, a new study that focuses on the well-being of women who are pregnant during the pandemic.

The study launched in July and will follow more than 200 women around the world, from pregnancy to 18 months postpartum, to understand how Covid-19 and the pandemic response impacts pregnancy and infant health outcomes.

Dr. Jelliffe-Pawlowski and her team have analyzed the data from the first group of women, and they are finding “absolutely incredible” levels of stress and anxiety. “Sixty percent of women are experiencing nervousness and anxiety at levels that impede their everyday functioning,” she said, citing preliminary data. “There are a number of women, particularly lower-income women, expressing how hard it is to choose to stay in a job that puts them at risk versus quitting the job and not having enough food for their baby.”

Nearly 70 percent of the participants reported feeling worried about decreasing family income and more than 22 percent worried about food insecurity (though none had experienced it at the time of the survey). Dr. Jelliffe-Pawlowski worried that women were not necessarily getting the psychological care they needed: “If you can’t feed your family, seeking out mental health care is not your top priority.”

She also said more than 84 percent of women reported moderate to severe anxiety about giving birth during a pandemic. “Many women do not want to get tested because they will be stigmatized or separated from their baby or not allowed to have people in the room to support them,” she said. She added that similar visiting rules often hold true for babies in the NICU after being born preterm during the pandemic: Only one parent can be present in a 24-hour period. “It’s heart-wrenching to see families go through those choices.”

Dr. Jelliffe-Pawlowski is particularly interested in how stress impacts births and long-term outcomes for children as psychological stress is highly associated with preterm birth. After the attacks of September 11, 2001, the risk of preterm births almost doubled for people living near or working at the site of the fallen towers. She’s also concerned about long-term effects of stress and anxiety on maternal bonding during the pandemic.

Margaret Howard, a psychologist at Women & Infants Hospital in Providence and postpartum depression researcher at Brown University thinks it is absurd for pregnant women who test positive for an infectious virus to bear any guilt or stress associated with their diagnosis: “Are moms in a special category where they are expected to not get Covid? What about a sinus infection? Hay fever? Cancer? Why is Covid a moral failing for mothers?”

When Erica Evert, a pregnant mom in northern Virginia, received her postive Covid-19 test result, it didn’t make sense. She was near the end of her pregnancy, and hadn’t left the house in four and a half months, except for ob-gyn appointments to check on the baby.

“My first thought was, is this a false positive? I feel fine. And my second reaction was to start bawling,” said Evert. She was scheduled to have a cesarean section with her second baby and the test was merely a formality — until it was a life-changing event.
​
The hospital gave her a choice: She could deliver the next day and be treated as a Covid-19 patient — separated from her baby with no skin-to-skin contact, per the hospital’s policies. Or she could wait 10 days from the date she received the positive test result and deliver with her regular plan. She had four hours to make a choice she wasn’t expecting. “I kept thinking: am I going to make a decision that results in my child dying?” said Evert."

"Registered Dietitian Tracy Lockwood Beckerman gives tips on the most nutritious foods to eat to support your baby in each trimester of your pregnancy."

"The best way to feel empowered during your pregnancy and birthing experience is through education on the process and exercising your right to choose. This starts with making your first prenatal appointment. Making that appointment is imperative, but can feel scary if you do not know what to expect. 

Here are eight steps to help you feel empowered during pregnancy and as you enter into parenthood.

Contact your Insurance Provider

If you do not have insurance at the time of pregnancy, you have options. Please reach out to your local social service agency for assistance with State Assisted Medicaid in order for you to have access to prenatal care.

If you already have health insurance, it is time to do some research. Contact your insurance provider to understand your benefits during pregnancy, which may cover the cost of a birthing center or doula support. Also, speak with your insurance company to discuss preferences for your doctor such as sex of the doctor, ethnic preference, language preference, location preference, etc. You have a right to request what you would like; do not be afraid to ask!

Prepare to Meet Your Provider

Now that your insurance has provided you with options and you have your first appointment scheduled, it’s time for a visit. When getting ready for your first appointment prepare some questions for your provider to help you determine if it’s going to be a good fit. The best way to do this is by having them prewritten on good old fashioned paper or on your phone.

You might be wondering what to ask. Here are a few questions to start:

• Is there a nurse line that I can call if I have questions?
• If I experience bleeding or cramping, do I call you or the nurse?
• What do you consider an emergency?
• Will I need to change my habits regarding sex, exercise, nutrition?
• When will my next prenatal visit be scheduled?
• What type of testing do you recommend and when are they to be done? (In case you want to research the tests to decide if you want them or not.)

Know Your Rights

You made it to your first visit, and the receptionist gives you a clipboard to complete information and documents to sign. Be sure to read the informed consent and pay close attention to your rights as a patient. Learn what to do if you ever need to file a grievance, feel pressured by the doctor, midwife, or staff to participate in testing, or if someone refuses to explain procedures. You have a right to file a complaint with your insurance company and with your state’s medical board if the violation you experienced is egregious.

Ask for Clear Explanations of all Procedures

Now that you have read your informed consent and have your prepared questions for your provider, they will call you back to your appointment. Once you go behind that closed door, ask your provider to explain what will be done during this appointment. It is important for medical professionals to explain what procedures will be done during the visit.
If at any time you feel uncomfortable, please speak up! If you plan to bring a support person such as a partner, friend, or family member to this first visit, it might be helpful to think of a code word beforehand, so your support person can speak up for you if you become overwhelmed.

Don’t forget to ask the questions that you prepared. Feel free to take notes as they answer your questions. Notice how they respond to questions. Do you feel heard or is the provider rushing you? After the visit, take time to reflect on whether or not you felt comfortable with the provider during your appointment. This is a huge deal because if you are not comfortable, it is going to be hard to ask questions or feel as though you are receiving quality care. If you did not feel comfortable, it is okay to search for a different provider. You will be in the care of this individual for 9 months, so it is important to have the right team of people supporting you. You want to feel empowered during your pregnancy.

Bottom line: Tune in to how you feel. As a birthing person, you have choices and rights no matter what birthing environment you choose. If you don’t feel comfortable at any point during your pregnancy, it’s not too late to find a new environment or provider. 

Take Advantage of Opportunities for Education

What creates an empowered pregnancy? Education, education, education! Education allows you to make the best decisions for yourself and your family. Search online for different birth techniques and methodologies, and then find a class at your hospital, with a local organization, or even online!

Take time early in pregnancy to think about how you want your labor and delivery to go. Do research on classes that are in alignment with what you desire during the birthing process. There is something out there for whatever you want your birth to look like. Attending various classes can help you learn about different decisions you will have to make once the baby is born. Classes can help you think through decisions like knowing when you want to cut the cord, what newborn procedures you want your baby to have, when to do baby’s first bath, and infant feeding. Education allows space to have conversations and ask for help where needed so you can have an empowered pregnancy.

​Find a Community of Support for an Empowered Pregnancy

Nothing says empowerment like community. Join a group in your local community or online for additional support. Find a group of expecting pregnant people so you can add to your support team. Every new parent needs support, so do not be afraid; get involved. There is so much power in feeling understood by someone who has been through what you’re experiencing.

Prioritize your Physical Health

Proper nutrition before, during, and after pregnancy can improve birth outcomes and has significant implications for maternal health. Focusing on whole foods especially fruits and vegetables, eating enough protein and limiting processed food can play a role in reducing the risk of pregnancy-related complications, such as preeclampsia. Preeclampsia is a condition that disproportionately impacts Black pregnant people and can be a result of the long-term psychological toll of racism as well as current systemic barriers to proper treatment that delay the diagnosis or treatment of the condition. If this all sounds like a daunting task, you are encouraged to seek guidance from your doctor, midwife, doula, or support team.

Doulas can support your nutrition by offering suggestions for healthy meals and providing accountability and support. They can also make sure you’re being monitored for early warning signs of pregnancy-related complications.

Last but not least, physical exercise is another important aspect of prioritizing your physical health. Yes, it is safe to exercise while pregnant! Walking regularly, stretching, and yoga have been found to have significant benefits during pregnancy for both you and your baby. Being idle and sedentary during pregnancy presents its own risks, so do not be afraid to get your body moving. There are modified workouts that are readily available to pregnant persons. It is important for pregnant persons to speak with their provider about exercises that are safe for them.

If you need help finding easy, delicious recipes that focus on healthy fats, protein, and fruits/vegetables, check out our 5-ingredients or less recipe generator. Click to learn more about the benefits of doing a Whole30 while pregnant!

Prioritize your Mental Health

Focusing on your physical health during pregnancy is important; however, do not neglect your mental health. Venturing into parenthood is wonderful and stressful at the same time. If you are feeling overly anxious or depressed, ask for help.
Mental health professionals can equip you with tools for how to manage your stress, learn how to better communicate with your partner, heal emotional wounds, and help you replace toxic thoughts with more positive ones. Look for a trained perinatal mental health professional."

Opinion| Megan Markle: The Duchess of Sussex

"Perhaps the path to healing begins with three simple words: Are you OK?"

"It was a July morning that began as ordinarily as any other day: Make breakfast. Feed the dogs. Take vitamins. Find that missing sock. Pick up the rogue crayon that rolled under the table. Throw my hair in a ponytail before getting my son from his crib.

After changing his diaper, I felt a sharp cramp. I dropped to the floor with him in my arms, humming a lullaby to keep us both calm, the cheerful tune a stark contrast to my sense that something was not right.
I knew, as I clutched my firstborn child, that I was losing my second.

Hours later, I lay in a hospital bed, holding my husband’s hand. I felt the clamminess of his palm and kissed his knuckles, wet from both our tears. Staring at the cold white walls, my eyes glazed over. I tried to imagine how we’d heal.
I recalled a moment last year when Harry and I were finishing up a long tour in South Africa. I was exhausted. I was breastfeeding our infant son, and I was trying to keep a brave face in the very public eye.

​“Are you OK?” a journalist asked me. I answered him honestly, not knowing that what I said would resonate with so many — new moms and older ones, and anyone who had, in their own way, been silently suffering. My off-the-cuff reply seemed to give people permission to speak their truth. But it wasn’t responding honestly that helped me most, it was the question itself.

“Thank you for asking,” I said. “Not many people have asked if I’m OK.”

Sitting in a hospital bed, watching my husband’s heart break as he tried to hold the shattered pieces of mine, I realized that the only way to begin to heal is to first ask, “Are you OK?”

Are we? This year has brought so many of us to our breaking points. Loss and pain have plagued every one of us in 2020, in moments both fraught and debilitating. We’ve heard all the stories: A woman starts her day, as normal as any other, but then receives a call that she’s lost her elderly mother to Covid-19. A man wakes feeling fine, maybe a little sluggish, but nothing out of the ordinary. He tests positive for the coronavirus and within weeks, he — like hundreds of thousands of others — has died.

A young woman named Breonna Taylor goes to sleep, just as she’s done every night before, but she doesn’t live to see the morning because a police raid turns horribly wrong. George Floyd leaves a convenience store, not realizing he will take his last breath under the weight of someone’s knee, and in his final moments, calls out for his mom. Peaceful protests become violent. Health rapidly shifts to sickness. In places where there was once community, there is now division.

On top of all of this, it seems we no longer agree on what is true. We aren’t just fighting over our opinions of facts; we are polarized over whether the fact is, in fact, a fact. We are at odds over whether science is real. We are at odds over whether an election has been won or lost. We are at odds over the value of compromise.

That polarization, coupled with the social isolation required to fight this pandemic, has left us feeling more alone than ever.

When I was in my late teens, I sat in the back of a taxi zipping through the busyness and bustle of Manhattan. I looked out the window and saw a woman on her phone in a flood of tears. She was standing on the sidewalk, living out a private moment very publicly. At the time, the city was new to me, and I asked the driver if we should stop to see if the woman needed help.

He explained that New Yorkers live out their personal lives in public spaces. “We love in the city, we cry in the street, our emotions and stories there for anybody to see,” I remember him telling me. “Don’t worry, somebody on that corner will ask her if she’s OK.”
​
Now, all these years later, in isolation and lockdown, grieving the loss of a child, the loss of my country’s shared belief in what’s true, I think of that woman in New York. What if no one stopped? What if no one saw her suffering? What if no one helped?

I wish I could go back and ask my cabdriver to pull over. This, I realize, is the danger of siloed living — where moments sad, scary or sacrosanct are all lived out alone. There is no one stopping to ask, “Are you OK?”
​
Losing a child means carrying an almost unbearable grief, experienced by many but talked about by few. In the pain of our loss, my husband and I discovered that in a room of 100 women, 10 to 20 of them will have suffered from miscarriage. Yet despite the staggering commonality of this pain, the conversation remains taboo, riddled with (unwarranted) shame, and perpetuating a cycle of solitary mourning."

"​Moms of color have an increased risk of experiencing PPD and related disorders than women in other ethnic groups, but fear is keeping them from getting the treatment they need. Here’s why, and how Black families can get the right mental health support."

"During her first year as a mom, Karen Flores, then 31 years old, was afraid she was not emotionally stable enough to take care of her daughter. On the particularly hard days, Flores would take a walk with her daughter on the beach. “Out of nowhere, this bizarre thought came to my mind ‘push the stroller over the rocks and see what happens,’” she wrote on the site Maternal Mental Health Now. “I was paralyzed by the thought but forced myself to keep on walking while wondering where it had come from—'Oh, My God, am I crazy?' I wondered.”

Flores, now 50, was not crazy. She was suffering from postpartum depression, a condition that affects up to one in seven women, according to the American Psychological Association. Flores didn’t immediately seek out help. “I was extremely anxious and ashamed thinking that I was losing my mind and that my baby would be taken from me,” she says. “I tried praying and did a lot of cardio.” Before her daughter’s second birthday, she began working with a therapist to manage the symptoms of her depression.

​Black women like Flores are less likely to get help for postpartum mental health issues compared to both white women and Latinas, according to a study published in the journal Psychiatric Services. Part of this hesitation is caused by fear—these women fear they will be considered unfit and have their children taken away from them by Child Protective Services. These fears are not unwarranted since one in nine Black children will spend time in foster care by the time they're 18, according to data from the Adoption and Foster Care Analysis and Reporting System. This is the second-highest risk racial/ethnic group to end up in the foster care system behind Native American children.

“There’s a lack of trust of medical practitioners within the Black mom community nationwide,” explains Shivonne Odom, LCPC, LPC, founder of Akoma Counseling Concepts, LLC, in Silver Spring, Maryland, who specializes in maternal mental health counseling for mothers with perinatal disorders. “Many medical practitioners are not trained to refer or treat perinatal mood disorders so when they hear patients report typical symptoms of postpartum depression, practitioners mistake the severity of the symptoms for abuse.” Odom, who is Black herself, adds that many practitioners do not recognize a difference in how perinatal mood disorders present among ethnic groups. “This leads to improper treatment or poor rapport between practitioner and client,” she says.

Postpartum depression, anxiety, and other perinatal mood and anxiety disorders can affect any mother and can manifest up to one year after delivery. However, there are cultural nuances during pregnancy, labor, and delivery that can increase the risks of experiencing PPD for Black mothers. Statistics show that Black women are three to four times more likely to die during or after delivery than white women. From 2011 to 2015, there were 42.8 deaths per 100,000 live births for Black non-Hispanic women—a higher ratio than any other ethnic group. “These statistics along with birth trauma and untreated mental health issues prior to and during pregnancy may lead to postpartum depression,” Odom says.

Suffering in silence

Odom says she often sees the same themes preventing Black mothers from seeking mental health therapy. First, there’s the fear of losing control, independence, respect from others, or mental sanity. “Sometimes holding in this fear leads to a manifestation of irrational thoughts—'I’m not a good mom,’ ‘I feel empty,’ ‘I’m not emotionally connecting to my baby,’” she says. “The belief that something is wrong, which must mean I’m doing something wrong and I’m a bad mom is an extension of these irrational thoughts.”

Then she often hears that these women would prefer to seek help from their friends, family, and church rather than a mental health professional. “There’s definitely a cultural stigma discouraging mental health counseling in the Black community,” Odom explains. “Some believe that if you go to therapy you have to be admitted to a psychiatric hospital or will be required to take addictive prescription medications. Some people’s religious beliefs also shape their views on mental health and can impact their help-seeking behaviors.” There’s also concern passed down from generation to generation that mental health practitioners are suspicious of Black mothers."

By: Shanicia Boswell | August 26, 2020

"​Raising awareness about the history of Black breastfeeding and the factors that contribute to low rates of Black mothers breastfeeding is an important way to close the gap."

"I sat on the sofa crying silently between my mother and my fiancé. Tears spilled over my cheeks as we watched a movie and I held my newborn daughter. I was three days postpartum and my breasts were painfully engorged with milk. How was this happening? I had survived a med-free labor and delivery. This was supposed to be the easy part. Looking back nearly eight years ago at my breastfeeding journey, I always remember this day. I was a first-generation breastfeeder.

​That day and many other days, I sat between people I loved the most and felt completely alone and isolated. My partner could not help me with breastfeeding because he was a man who had no experience around breastfeeding. My mother could not help me because she had not breastfed me or my brother. My friends could not help me because I was the only one in my friendship circle who had a baby. Like many Black millennial women, I was embarking on this journey alone.

​Without the proper resources, my breastfeeding journey only lasted six months. I felt defeated. In fact, the statistics show that Black women are less likely to start breastfeeding than any other race of mother and even less likely to continue breastfeeding for six months. Only 69 percent of Black women initiate breastfeeding compared to 85 percent of white women. The question that is often asked after hearing statistics is why? There are many reasons. There are unfortunate events deeply connected to our race as a people: a history of wet nursing, oversexualization, lack of economic and familial support, are a few. For me, the question became how do we raise the numbers?

This is where Black Breastfeeding Week comes in. Black Breastfeeding Week is August 25 to 31, 2020, and is a campaign that has been part of National Breastfeeding Month for the past eight years. This year, through virtual events, Black mothers, lactation experts, and public health professionals have space to discuss their breastfeeding journeys, raise awareness, and explore public policies that address the disparities in statistics around Black maternal and infant care. Black Breastfeeding Week has become even more controversial this year because we are in a time where extreme emphasis has been placed upon race and it creates a space where white mothers feel isolated. White mothers are asking why Black women are choosing to segregate themselves, even down to the topic of breastfeeding. 

As the creator of Black Moms Blog, a collaborative blogging platform for mothers of color, I am no stranger to the "why aren't we included" questions from white mothers. The truth is, weeks like this should not have to exist. Platforms like mine should not be a necessity—but they are. The needs of Black mothers as well as the specific barriers we face are left out of the overall breastfeeding conversation. The historical and cultural context as to why is important.

​The History of Black Breastfeeding

Cultural reference should always be considered when discussing breastfeeding. During slavery, Black women were used as wet nurses. A wet nurse is someone who breastfeeds another woman's child. The true definition of a wet nurse states "employed," but replace that word with "forced," and the reality becomes clear. It is generational that Black women have developed a disdain for breastfeeding due to our historical relationship with wet nursing. Because of wet nursing, many Black women were unable to breastfeed their own children. Can you imagine the psychological effect that must have had on a moment that every mother should enjoy?"

"The coronavirus pandemic has brought on a slew of challenges for expecting women and new parents. With so much uncertainty, women must take care of their mental health. Because COVID-19 has disproportionally affected people of color, mothers in these communities need more support than ever, as people of color have less access to mental health services compared to white people. Moreover, when they do receive care, it is likely to be of poorer quality.

​In honor of National Pregnancy and Infant Loss Awareness Month, we spoke with Shonita Roach, executive director and spokesperson for the 2020 Multicultural Maternal Mental Health Conference, to learn why discussing issues that directly affect maternal mental health will positively impact women of color.

"This awareness month is very dear to my heart, as I also lost my son to an accidental death nearly 18 years ago, and I suffered postpartum depression and even contemplated suicide," Shonita told POPSUGAR. "Through extensive therapy, parenting classes, and spiritual healing, I have been able to thrive, create a loving family with my three boys, and serve as an advocate for women and mothers."

How a Lack of Diversity in the Medical Field Is Affecting Black Maternity Health

It's widely known that Black women experience higher chances of maternal health complications than white women in the US, and unfortunately, the lack of diversity in healthcare professions isn't making it any easier for women of color to get the help they need.

"When you talk about mental health or seeing a therapist or even taking medication for the condition, there is a lot of judgment and misnomers," Shonita told POPSUGAR. "So when you take into account the implicit (and explicit) bias against Black women and healthcare, it makes it especially challenging. The lack of multiculturalism in mental healthcare, from a discrepancy in diverse professionals to the lack of community-based services, creates a major barrier that is difficult to overcome."

Additionally, having more nonwhite doulas and medical professionals can have a positive, lasting impact on maternal health across the board. "Studies show that having doulas of diverse backgrounds contributes to reducing maternal and infant mortality rates," she explained. "What I love about doulas is that they are community-based and do a lot more intimate, one-on-one work with women. They fill the gap where the traditional healthcare system lacks."

How COVID-19 Has Negatively Impacted Black Maternal Health

COVID-19 has disproportionately affected communities of color, and in turn, has extended to Black maternal healthcare. While Shonita is encouraging families to do whatever they can to limit their exposure to the virus, she knows that can be difficult to do when you're pregnant or have just welcomed a child.

"It's important that communities everywhere practice the safety precautions to reduce the spread of this deadly virus," she explained. "However, those same precautions, such as reducing the use of public transportation unless absolutely necessary, isolating yourself, and staying home puts further strain and stress on expecting and postpartum women."
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"Not only that, the acceleration of the need for accessible technology and internet services proves to be paramount during the pandemic," she continued, noting how access to telehealth is a privilege and can be a challenge for marginalized communities. "The pandemic is also very isolating when it comes to prenatal visits: women are having to attend these alone without their partner or support system. Also, your friends and family are no longer allowed to visit the hospitals during and after delivery. The entire situation is so unfortunate and does not create a conducive environment for a healthy state of mind as you transition into motherhood, whether you're a first-time mom or a mother to multiple children."

Black Women's Struggle With Accessing Reproductive Healthcare

We would be remiss if we didn't mention some of the historical and cultural reasons that Black women have struggled to get adequate access to reproductive healthcare in the US.
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"Medical experimentation on the bodies of women of color and the oversexualization and degradation of Black breasts — which contributes to negative stigmas on Black breastfeeding — are just two examples of why it negatively impacts the sexual and reproductive health of Black women," she said. "This creates barriers of mistrust, misinformation about our bodies. All of this plays into the current disparities and stigmas surrounding reproductive health in marginalized communities."