Black mothers face higher postpartum mental health risks. Here’s how to help in NYC

Janice Clarke still gets choked up recalling her distress as a new mom seven years ago. She struggled to breastfeed, barely slept and constantly worried her baby would fall out of even closed windows or that she was a bad mom. Her own mother was emotionally “terrorizing” her while she was trying to keep her baby alive, Clarke said.

She spoke Thursday at the Tremont Neighborhood Health Action Center in the Bronx during Black Maternal Health Week. Clarke, now a lactation consultant with Public Health Solutions, a nonprofit, eventually found mental health support. Now she wants the same for other new mothers. 

The top cause of pregnancy-related death isn’t hemorrhaging or heart problems but rather mental health conditions leading to suicide and overdose. Rapid hormonal shifts, sleep deprivation and stressors like the pressure to be a perfect parent can all destabilize mood-regulating brain circuits in vulnerable women. About 40% of Black birthing people experience mental health conditions while expecting and up to one year postpartum, nearly double the rate of the general population. 

Clarke and other health workers interviewed by Epicenter NYC say the best ways to support the mental health of expectant or new parents are to: show up, speak openly about what you’re seeing, be clear about help you’re offering, and bring in the experts when needed. 

This is especially true for Black pregnant people and new caregivers, who face compounding issues that increase the risk of mental health distress or substance misuse. These factors include “weathering,” a term coined for the toll of chronic stress and discrimination on Black people’s bodies. Weathering is linked to earlier menopause, onset of many chronic illnesses, and death. 

No easy signs or solutions

When Clarke was a new mother, it was a visiting nurse, not her husband or mother-in-law, who first recognized signs of postpartum anxiety and arranged for a social worker to follow up.

Clarke was experiencing both depression and anxiety, conditions that may present differently in Black women than in their peers, often as physical rather than psychological symptoms. That can make them harder for family members and providers without that lived experience to recognize. 

Her social worker was someone who listened and comforted a crying Clarke. Still, “talk therapy wasn’t enough for me,” Clarke said. “I was still suffering.”

So she and her social worker decided that medication would be her next step. It helped stabilize her symptoms after months of struggle.

However, Clarke’s sleeplessness persisted — her son was nursing around the clock. Her postpartum depression lasted two years and got worse before it improved. At one point, she was admitted to a psychiatric unit for five nights.

Stigma of mental health medications

“There is no shame in seeking psychiatric support when we are new mothers,” Clarke said. “If that includes medication, that is okay.”

It’s a point that Jhnelle White, a registered nurse with New Family Home Visits, a city initiative that provides support, services and referrals to new and expectant parents, repeats several times at the Tremont event. That’s because taking medication for mental health carries more of a stigma than taking, for instance, blood pressure medication, especially in Black and immigrant communities. 

Despite research showing that psychiatric medications pose a low risk to infants during breastfeeding, Black mothers are significantly less likely than white women to seek treatment for postpartum depression. One reason is fear that child welfare services may be quicker to take their child away, Shalonda Curtis-Hackett told Epicenter at a Black maternal health roundtable with the New York State Department of Health. 

Curtis-Hackett, who works as a doula and as a community outreach coordinator at the Neighborhood Defender Service, is advocating for action on the state Maternal Health, Dignity and Consent Act. The bill, currently in a state Assembly committee, would ease those concerns by prohibiting drug testing and screening of pregnant or postpartum people and newborns without consent unless medically necessary.

How to be their support person 

Meanwhile, the best way to support a pregnant person or new caregiver is to show up consistently and without judgment, White said. 

“Don’t care about being overbearing,” she said. “You could possibly save someone’s life.”

The trick, she says, is to offer your help with affirmations, hold the judgment and leave the offer on the table if they don’t initially accept. 

Affirmations can include, “I’m doing this for you because I love you. I want to be here to support you. To support you, you have to be here,” White said.

Identify and normalize mental health concerns. People close to patients may miss or avoid warning signs. White recalled one mother whose anxiety escalated toward psychosis as its signs went unaddressed. After White urged the woman’s partner, who was afraid to speak up, to say something, she received emergency care and recovered.

“I understand this fear — but we want to make sure our people are good,” White said. “Even if that means being a little overbearing or oversharing at times.”

White suggests checking in with statements like “It’s OK to not be OK” or “It’s not uncommon to feel anxiety or depression after giving birth.” You can also share what you’ve noticed and repeat your offer of support: “I feel like you might need a little more help.”

For Black women, especially mothers, the superwoman schema — suppressing emotions and helping others while refusing help, to the detriment of their own health — is common and linked to higher rates of anxiety and depression.

To make it easier for them to accept help, make it clear you’re the one that offered it, and that you want to. Be specific: “Can I take the baby on Tuesdays from this time to this time?” Offering set times can help them meet basic needs like rest or self-care while ensuring the baby is with someone trusted.

If they decline, keep the offer open. You can also help connect them with a trusted health care provider or other support. Trust and lived experience are key, says Patricia Loftman, a midwife with about 45 years of experience, and not just in terms of race or ethnicity but also class. Many Black and brown clinicians may not share certain patients’ experiences, she said, as some come from middle-class backgrounds with different values.

“They don’t have to say ‘I’m judging you,’ their care says ‘I’m judging you.’ How they speak to you says ‘I’m judging you.’ How they touch you says ‘I’m judging you,’ ” Loftman said. “When I put my hands on a Black or brown woman, it is with tenderness and love and they can feel it.”

Clarke said she often does a “warm handoff” for a mental health evaluation for patients showing red flags, offering to make the call together. 

Connecting them with a doula can also help, experts said. A new review in the medical journal JAMA Network Open found doula care was linked to lower anxiety, increased breastfeeding initiation and better postpartum follow-up.

Sometimes it’s as simple as asking yourself what care you would want for yourself or a loved one, said Loftman.

“Whatever you would want for yourself or for them, that’s what all women want, especially Black and brown women,” she said.