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Moms worry postpartum depression could mean losing their children

'I was lying to you'

Smith had her first child at age 14. Down the hall from her hospital room, another young black woman had twins.

, ”Smith recalled. “I saw her screaming.”

Smith never confirmed what happened, but she was born to another family. The memory created a sense of dread that would stick with here for years.

For many women of color, the fear of child-welfare services comes from seeing and hearing of incidents in their community. , ”Said Alfiee Breland-Noble, an associate professor of psychiatry at Georgetown University Medical Center, who specializes in depression in minority populations.

Studies in several states and at the national level a higher rate than white mothers, even when controlling factors like education and poverty.

The result is a disproportionate number of black youth in the foster-care system ̵

1; a pronounced issue in Philadelphia, where black children account for 66 percent or more. those in that system, even though they represent 49 percent of the county's children.

At a recent Philadelphia City Council hearing, parents and child-welfare advocates raised concerns abo child-abuse reporting rules and unnecessary removals. The hearing was called by Councilman David, who said he felt racially discriminated against by social workers within the Department of Human Services, who were investigating him for child abuse following a collateral injury to his son. Oh said he was teaching his son martial arts, and the inquiry found no wrongdoing.

But the experience revealed nothing new.

Women sometimes try to hide their real feelings to protect their kids, said Ayesha Uqdah, a community health worker who does home visits for pregnant and postpartum women through the nonprofit Maternity Care Coalition.

The Maternity Care Coalition's Ayesha Uqdah meets with a client. The women she works with often aren't about to postpartum depression out of fear they'll lose their kids. (Heather Khalifa / Philadelphia Inquirer)

During a home visit two months ago, Uqdah asked her 10 questions on the Edinburgh Postnatal Depression Scale survey, one of the most commonly used tools to identify women at risk.

It Ask women to rate how often they've experienced certain situations in the past seven days, like "I have been able to laugh" or "I have been so unhappy I have difficulty sleeping." , and anyone who scores above 10 is supposed to be referred to a formal clinical assessment.

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

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

"I knew there was something going on," Uqdah said. “But our job is not to push our clients to something they are not comfortable doing.”

So she waited. About Uqdah, "The woman was lying to you. I really did need services, but you didn't want to admit it to you or myself. ”

The woman's first child was taken to the Department of Human Services and ended up with her grandfather, Uqdah said. She didn 't want that happening again.

Experts agree postpartum depression is highly underreported. Many women are not given screening surveys, and even those who are – like Uqdah's client – may feel too fearful to answer truthfully, said Aasta Mehta, a gynecologist and women's health adviser for the Philadelphia Office of Maternal, Child and Family Health.

While the city does not track rates of postpartum depression, Mehta said it could be more prevalent in Philadelphia due to high levels of poverty, a risk factor for postpartum mental illness. Lactation consultant Jabina Coleman (left) introduces herself to new mom Christine Smith and her fourth month old, Henry, ” width=”2100″ height=”1400″/>

Lactation consultant Jabina Coleman (left) says hi to 4-month-old Henry and mom Christine Smith at the Lucien E. Blackwell West Philadelphia library. Coleman also helps run the Prenatal Mental Health Alliance for Women of Color. (Rachel Wisniewski / For the Philadelphia Inquirer)

Screening tools are not one-size-fits-all

As a lactation consultant, Jabina Coleman shares some or all clients' most intimate moments as new VAT. So she shares part of her clients, too.

"It was the darkest place," she said. "I probably cried every day for a year."

That might be why women often open up to Coleman about their own challenges, count her things like they're "snapping out."

The term doesn't appear on any screening tool, but as soon as she hears it, Coleman knows to ask more.

"Tell me what snapping out looks like for you," she'll say. “Are you sleeping? Are you eating? ”

Jabina Coleman and daughter Nyla Dwyer, 4, at home. Coleman, who often works with women of color on issues of postpartum depression, shares her own experiences with it. (Tom Gralish / Philadelphia Inquirer) Research shows that different cultures talk about mental illness in different ways. "Americans are likely to use the term" depression, "but may say they don't feel like themselves," said Georgetown's Breland-Noble.

It's also more common for people in minority communities to experience mental illness than physical symptoms. Depression can show up as headaches, for example, or anxiety as gastrointestinal issues.

Since many depression screening tools don't take those factors into consideration, they're not relevant to women of color, Breland-Noble said.

Studies evaluating screening tools used with low-income African American mothers found they do not catch as many women as they should. Researchers recommend lower cutoff scores for women of color, as those who need help may not score high enough to warrant a followup under current guidelines.

The screening tools were developed based on mostly white research participants, Breland-Noble said. "So providers have to do the work of creating the cultural nuances to make these screening tools more relevant." For Saleemah McNeil, a reproductive psychotherapist and founder of Oshun Family Center in Jenkintown, that can mean rewording survey questions that leave a

For example, Question 6 on the Edinburgh screening tool reads: "Things have been getting on top of me."

"A lot of my black clients will say," I'm managing with four kids, so does that mean things are not on top of me? "" McNeil said. "But managing does not mean full capacity."

Many of the screening tools also neglect to ask about postpartum obsessive-compulsive disorder or post-traumatic stress disorder. The laughter can be especially important for black women, because they have higher rates of serious medical complications and even near-death experiences during pregnancy or childbirth. "Postpartum mental illness can look different for everyone," McNeil said.

Auriel Dickey didn't have thoughts of harming her or her child, but being away from her daughter – when she returned to work after maternity leave – triggered painful memories.

Auriel Dickey and daughter Oma Smith, 2, prepare dinner at home. After Oma's birth, Dickey feared seeking help for postpartum depression would lead to her being judged unfit. (Tom Gralish / Philadelphia Inquirer)

"It's grief, it felt like my soul was trying to jump out of my body," Dickey

Years later, when Dickey gave birth to her daughter, Grandma, it was a reunion. The sparkle in Oma's eyes and her mischievous grin brought back the spirit of Dickey's mother.

But when she had to return to work, Dickey felt everything she lost at 17 was being taken from her again.

It's not what people traditionally think of as postpartum depression, she said. "But that's what it was" for here.

Eventually the situation got so bad Dickey couldn't hide it.

"He wasn't taking me seriously"

It took Portia Smith six months after Nelly's birth to work on the courage to see a doctor about her postpartum depression.

When she told him about crying every day and feeling wrapped with anxiety about forgetting to lock the door or turn off a light, he called it normal. Many young moms feel overwhelmed, he said.

"I'm looking at him, it's been six months and it's not getting any better," Smith said. “But he was not taking me seriously.”

Research shows medical professionals are more likely to dismiss the concerns of women and nonwhite patients. Even Serena Williams, a world-renowned tennis star, had to fight for doctors seriously when she experienced postpartum complications.

Women reluctant to seek treatment in the first place conclude it's not worth getting help. Start feeling like everybody's going to treat you the same way, ”Smith said.

But she was determined

Smith visited another behavioral-health clinic, where she was given therapy and medication. Over the course of several months, she started feeling better. Most importantly to Smith, she started bonding with her daughter

Portia Smith (right) and her daughters Nelly Smith (center), 19, and Najai Jones Smith (left), 15, pose for a selfie after Najai did their makeup . (Tom Gralish / Philadelphia Inquirer)

Today, Smith and her three daughters go to weekly $ 5 movies at Studio Movie Grill in Upper Darby and do their makeup together before each major outing.

"I always make us together, "Smith said. “I make sure we have that connection.”

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