When Viviana Avila had her first baby, she knew she might experience what people call ‘baby blues.’ It’s a feeling of sadness that is common in the days and first weeks after giving birth, as hormones shift, sleep deteriorates, and you adapt to becoming a new mother.
“During pregnancy, you hear all the things to expect and how things could go and are going to go,” Avila said. “But I was not expecting postpartum depression to hit like a brick wall that it did.”
But it did hit like a brick wall, Avila said, and it was a shock.
“And it's a different kind of shock, because you're trying to bond with your baby, but you have all of these thoughts that you're like, these thoughts are not normal, they're not okay,” Avila said, “And you know you would never act on them, because you look at that baby and that's your world. You love that baby and looking for somewhere safe to express those feelings and find help is so scary.”
At first, Avila didn’t realize she had slipped into something beyond baby blues, and when she did, she didn’t know what to do.
“I had gone to the doctor, and you do all the tests,” Avila remembered. “You don't want to be honest in those tests, you know? You don't know what they're going to think about you. What if they tried to take my baby?”
Avila felt completely alone, but up to 19% of all women will grapple with depression after giving birth. Among Latina and Hispanic mothers, like Avila, that number spikes to 40%. Black women experience PPD at about the same rate. But while nearly half of all Latina and Black mothers are suffering from a devastating but treatable condition, they are 57% and 41%, respectively, less likely to start treatment for maternal depression than White women.
What’s going on?
UT Health San Antonio researcher Kelly McGlothen-Bell says there’s a disconnect between those who hope to provide care and those who need it. “We know there's bias in care, and specifically the lack of culturally responsive services,” McGlothen-Bell said, “So there's disproportionality in terms of cultural congruency amongst providers and patients.”
Cultural congruence occurs when a patient’s care respects and incorporates their cultural values, beliefs, and practices to improve outcomes.
“Where there is congruence, we tend to see lower rates of disparities,” McGlothen-Bell said.
Legislatures in a growing number of states are putting their Medicaid money on the idea that doulas — trained professionals who provide physical, emotional, and informational support to mothers during pregnancy, childbirth, and postpartum — might be able to provide that congruency by facilitating communication and serving as intermediaries between pregnant women and their health care providers.
In this episode of Petrie Dish, Bonnie Petrie talks with some San Antonio area experts on maternal mental health, social determinants of health, doula care, and the San Antonio Metro Health Healthy Start program about how culturally connected doula care can improve outcomes for Latina, Hispanic, and Black mothers.
Guests:
Viviana Avila
Kelly McGlothen-Bell, PhD, RN, IBCLC: Assistant Professor at UT Health San Antonio School of Nursing.
Quinisha McGruder: co-founder of the San Antonio Black Doula Collective. Board member, Texas Doula Association.
Angela Warren: San Antonio Metropolitan Health District community health worker with Unlocked.
Contributor:
Zita Powell: Healthy Families Network Coalition Coordinator, and co-chair of the African American Health Disparities Council.
