First Person: Precious Reese
Parent Corner: Parenting, Racism, Mental Health, and Finding Support
Research: Preterm Delivery and Postpartum Depression in Women of Color
Interview: Cynthia Good Mojab, MS, LMHCA, IBCLC, RLC, CATSM
Resources for Parents of Color
This month we honor African American History Month with an issue devoted to the perinatal mental health experience of people of color. As you'll see, people of color may face additional challenges in dealing with their perinatal mental health--gaining access to providers, finding providers who have experience working with people of color, facing the stigma of having a mental illness, and struggling with personal and systemic racism that impacts their treatment and recovery.  

We'd love your feedback on this issue; please see our contact info at the bottom of the newsletter.
FirstPersonFIRST PERSON: Precious Reese
I wanted to write something truly profound and thought provoking. Really, I did. I wanted to talk to you about getting help when you need it and remind you that there are people who can support you in the first months after having a baby. I wanted to tell you to give yourself some grace, to do small things for yourself and to be patient with yourself and your baby. I wanted to be your cheerleader.
But I couldn't. I couldn't get a moment to jot these notes down and pretty them up for you. Even now, I am writing to you as I carpool to work. As I type, my weekend is replaying in my head. I'm trying to retrace my steps and find where in the world I could have found a moment to write. This is my norm: run, run, run like crazy, all day, all night. Chase little people (I have four, all 5 and under), be a wife, run a support group, take client calls at home, breastfeed around the clock, clean, brush teeth-- not mine... The kids. It is always about the kids. Are you tired yet? I'm tired too, believe me. Most of the time, I am stealing moments for myself. It isn't often that I just get a moment. There is always someone needing my attention.

I'm busier than ever, all the time. This is my motherhood. Not only am I busy caring for my tribe and working, but I am also busy trying to be my own cheerleader, hold myself when I feel lonely, and breastfeed without spilling coffee on my active almost 1-year-old's wiggly body. Breastfeeding Olympics is our favorite new activity. I try to do these things with grace, and sometimes I feel like I am just barely hanging on.

I find hope in being able to share with you that yes, this shit is hard. But you're here. You're still going. WE'RE still going. We are resilient. We take our deep breaths and turn them into the courage to do this again for another day. We take the love we have for our children and spin it into a protective cocoon to shroud them with. We care so deeply for our families that we just... keep... going. As difficult as it is to always be everything to everyone, somehow we are everything our families need. We are the light in our children's eyes when we tuck them in each night and greet them the next morning. We are the perfect remedy for owies. We are the wish boxes our children give their secrets to. We are a safe place to land when our spouses have a hard day and need a gentle reminder that they are appreciated. We are so damn good at this, even if by accident. I don't know if anyone else can identify with this but I certainly feel some days like I was thrown into this "family fire," rather than having chosen it.

But you're here. Even if all you can do today is nod and say, "I'm here." SAY IT. Keep saying it. Say it again. Listen to the courage it takes to tell yourself that you're showing up today. Whisper it one day, and hear that whisper become a roar the next. Say, "I can do this." If you don't believe it at first, keep saying it until you do.

Take a moment to make a toast to yourself. Raise a glass, a sippy cup, or a bottle even. Because sometimes that's all you got, and THAT'S OK. Fill it with wine, and toast to being your own cheerleader, toast to being the best person for your family, to making it through for one more day.

Precious is a wife, mother of four, and co-founder and facilitator of Black Power Circle, a support and empowerment group for Black women. She currently works as a Breastfeeding Peer Counselor and is passionate about access to birth and breastfeeding services for women, especially in communities of color.
Parenting, Racism, Mental Health, and Finding Support

Every new parent can use some reassurance at some point as they adapt to all the changes and challenges of parenthood. African American parents are up against some unique challenges--racism, stereotypes, and cultural attitudes about mental health. Sometimes it's easier to be surrounded by others who get it. That's why the Balance After Birth for Women of Color group exists--to give a safe space with other parents who understand what it's like to face the impact of racism and cultural differences in addition to the regular ups and downs of parenthood. We wanted to hear directly from the women who attend this group about what it's like to be an African American parent and what being part of a support group for women of color means to them. Below they share some thoughts.

On the availability of resources for African American families to address depression and anxiety
"No! There are few resources to add enough assistance to truly help you toward sustaining lifestyle changes. The services that exist are disjointed. If you are qualified and receive benefits for one service, most likely you will not be qualified for any other services that you need to rise out of your current circumstances. So when additional hardships happen, and they will, you go back down to survival mode, which throws you back into anxiety, panic, and depression. It is here where bad choices are most likely made. Once you are able to climb out, you are right back t o where you were, but worse because now you may have bad credit, broken relationships, poor health due to lack of being able to take proper care of yourself. It is a perpetual struggle."

Other challenges involving availability of resources are locations and lack of transportation. One of the group members stated when she was seeking assistance with DSHS, she was told to sell her car to make ends meet. So now she struggles with having to transport herself and her children on the bus, making several bus changes to get to her appointments. "It seems sometimes people working in social services programs are apathetic, just doing a job. It appears they are very judgmental towards folks enduring hardships. I'm often asked, 'Why are you not willing to work?', without inquiring about my circumstances. For instance, I am disabled and have  disabled children who have special needs. With so many challenges, it is very difficult to rise out of your circumstances."

One woman added, "In dysfunctional homes, life skills are not taught because your parent or guardian does not have these skills, skills such financial skills, establishing credit, etc. Thus the cycle of dysfunction continues because these resources are not available to you or are unknown."

Another woman commented, "There are not services that help with treating anxiety, panic attacks, or depression before crisis mode happens, such as suicide, violence, drugs. There is also a strong stigma about seeking mental health treatment."

On how race and culture have affected their feelings about  parenting
The feeling of being judged or labeled is strong. One woman shared that she feels that it was expected that an African American woman is just going to spank her children and not care to try to make their lives better.

One woman shared that because her children are the minority, she has to push them to be their best in school just to be able to compete. "My children have less benefits and privileges as others, so they have to work extra hard just to make it." She said she has to work hard to advocate for her children to not allow them to be labeled. These moms have to work extra hard to advocate for themselves which may come across as combative--they are often misunderstood. 

On race and culture and depression and anxiety
"It contributes to it!" one mom shared. She told about a time she was shopping at a grocery store and was asked by three different employees if she needed some help. It finally dawned on her that they must be afraid she was going to steal something. At the register she was immediately asked to show her ID. Prejudice and perceptions of being judged are strong, which make it difficult to reach out for help for fear of being looked down upon.

On what keeps them coming to the support group
"Ms. Linda [group facilitator]! She represents the group well. She is very passionate about our group. She is loving and warm. Linda is honest with you and helps you see alternatives. She listens and makes sure she understands what you are saying. She says, 'What I hear you saying is...' She is tactful. She is empowering. She connects naturally with people.
On recommendations for other moms who are struggling
The group unanimously stated, "reach out to a group." One woman stated that if she misses group she feels incomplete. This group of women is so strong and supportive of each other. When one shared a challenge she was having, other women encouraged and offer her suggestions.

If you've been thinking about attending a support group, PS-WA has a lot of options listed on our website: .

Balance After Birth for Women of Color meets every Thursday from 10-11:30am at St. Clare WIC Clinic Bridgeport Center, 11216 Bridgeport Way SW, Tacoma, WA 98499.

Preterm Delivery and Postpartum Depression in Women of Color

According to a study published in 2015, women of color and their newborns are at increased risk for experiencing postpartum depression (PPD). Researchers at Florida International University say that a higher incidence of preterm births is part of the problem.
There is previous research linking preterm birth and postpartum depression, but the FIU study is apparently the first to look at this relationship in Hispanic and African American women specifically.
One hundred two women with babies between three and 10 months old completed two validated self-report depression screenings. Researchers found that 30% of the mothers had had preterm births, and 17% exhibited postpartum depressive symptoms. Preterm delivery had a significant effect on both postpartum depression risk and negative affect in the infants. Additionally, researchers noted an indirect link between postpartum depressive symptoms and negative affect in the infants.
The findings confirm the necessity for early and frequent screening for postpartum depressive symptoms, particularly in women with infants born preterm. As well, it emphasizes the need to get at the root of the problem of higher preterm births in women of color. The CDC states that the rate of preterm birth for African American women is 1.5 times the rate for white women.

In your work, you talk about systems of oppression and how they impact access to resources, power, and opportunities. How do/would you see this issue relating to perinatal mental health in particular?
In the area of perinatal mental health, systemic racism, for example, results in 1) disproportionately more information and support being available that centers the experiences and needs of white families coping with perinatal mental health challenges, 2) disproportionately more white mental health care providers being accessible, and 3) disproportionately more perinatal mental health training centered on the experience and needs of white families being provided by white educators. While more information and support for perinatal mental health challenges are absolutely needed for white families, there is a comparative dearth of culturally appropriate information, support, and mental health care available to meet the needs of families of color. In addition to this dearth of resources, parents of color are parenting while their family and community are targeted by systemic racism. The measurably greater stress of this experience is chronic, significant, and inescapable. Parenting can be very hard. Parenting while coping with perinatal mental health challenges is even more difficult. And, parenting while coping with perinatal mental health challenges and while being targeted by systemic racism is exponentially more difficult still. These patterns are also true for families targeted by systemic heterosexism, cisgenderism, classism, ableism, and so on.
What misconceptions do you see non-POC perinatal providers having when it comes to relating to and working with families of color?
First, white perinatal care providers, like me, hold a great deal of unearned privilege. Not only do we tend not to recognize the privilege our white skin affords us, we also tend to fail to see how our unearned privilege negatively impacts the care we provide and the families we seek to serve. So, white perinatal providers must learn to see the elephant in the room: our unearned privilege and its negative repercussions in our work. If we do not do this, we will be unable to openly address power dynamics that can make therapy with us unsafe for our clients of color.
Second, we white perinatal care providers tend to think that our good character and/or good intentions will protect us from holding biases that negatively impact the care we provide families of color. Unfortunately, this is just not true. Anyone who lives in a society with systemic racism, such as the United States, will unavoidably soak up pervasive, false, and profoundly damaging messages about the supposed superiority of white people and the supposed inferiority of people of color. The situation is similar to breathing polluted air. No matter how much we do not want that pollution to enter our bodies, no amount of willpower can stop it. We are left with ingrained racial bias that we did not choose to develop and of which we may be largely or entirely unaware. Regardless of our intention or awareness, a wealth of research shows that automatic and unconscious cognitive processes routinely result in our biases affecting our judgments, decisions, assumptions, and behaviors. Being a good person with good intentions does not make us immune to bias and its negative impact on the families we seek to serve. Lessening the negative impact of racial bias in the provision of perinatal care requires the intentional and ongoing development of specialized knowledge and skill.
A third misconception white perinatal providers often have is that the perspectives, experiences, and life contexts of families of color are homogeneous. The truth is that there is incredibly diversity within communities of color. People who are only offered the racial or ethnic categories of "Black or African American," "Hispanic," "American Indian or Alaska Native," "Asian," and "Native Hawaiian or Other Pacific Islander" to describe themselves actually trace their roots to a vast number of countries, cultures, languages, and histories. Because of this immense diversity, there is no such thing as a "typical" person of color from any of these racial/ethnic categories. While it can be helpful to be aware of common patterns (e.g., how systemic racism affects a particular community), people of color need to be seen as individuals whose lived experiences will vary greatly even within a particular racial or ethnic group and whose lives are affected by many factors, only one of which is their racial/ethnic identity.
How would you explain the difference between a provider's cultural competence and their cultural humility?
There are many models of cultural competence. The brief definition I tend to use for cultural competence is the ability of providers and organizations to understand and respond effectively to the cultural needs of clients. In one model, Campinha-Bacote describes cultural competence as the ongoing, dynamic, and multidimensional process of developing, experiencing, and applying cultural awareness, knowledge, skills, encounters, and desire. While Campinha-Bacote's model mentions cultural humility briefly, it is not fully incorporated into the model.

Tervalon and Murray-Garcia conceptualize cultural humility as "a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues, and with themselves." Cultural humility goes beyond cultural competence by recognizing that we can never be fully culturally competent in any culture but our own. (And our own culture really is best understood as our particular subculture reflecting the intersection of our racial/ethnic/cultural heritage, immigration status, socioeconomic status, sexual orientation, gender identity/expression, and so on.) Cultural competence is not enough when a society is grounded in one or more systems of privilege/oppression. Cultural humility requires that we learn to recognize and counter bias and oppression as a fundamental part of individually and collectively providing effective care to families in our increasingly diverse world. This means that the ranks of perinatal care providers must not remain disproportionately white and that white perinatal care providers must actively help change that oppressive status quo.
How can a provider start on the road to cultural humility?
Because the development of cultural humility is a lifelong process, it cannot be "attained." It is better understood as a non-linear journey or a developmental process, rather than a destination. This means that one--or even many--readings, webinars, classes, or trainings will necessarily be insufficient to develop cultural humility. There will always be something more to learn and another step to take. A good place for white perinatal care providers, like me, to start is by looking within: learning about hidden cognitive processes within ourselves, understanding our own white racial identity development, exploring our unearned white privilege, and evaluating race-based power differences between ourselves and our clients and colleagues of color. Many cultural competence trainings ignore or only insufficiently touch on this kind of inward examination, focusing instead on facts and figures (cultural knowledge) related to communities of color that are viewed as "other" relative to the assumed norm of whiteness. But, there is nothing inherent in whiteness that justifies it being the reference against which communities of color are measured and described.
How important is it for a family of color to see a therapist of color for their perinatal mood or anxiety disorder? 
It is critical that families of color have equitable access to therapists of color for their perinatal mood or anxiety disorder. Some families of color may still choose to see a white therapist for any number of reasons. But the current state of affairs is that families of color are often unable to find a therapist of color while white families can easily see any number of white therapists if they desire. Families of color deserve an equal opportunity to receive perinatal mental health care from therapists who are truly culturally competent because they have lived experience with a similar cultural, historical, and social context. 

Cynthia Good Mojab, MS Clinical Psychology, is a Clinical Counselor, International Board Certified Lactation Consultant, author, and internationally recognized speaker. She is the Director of  LifeCircle Counseling and Consulting, LLC where she specializes in providing perinatal mental health care, including breastfeeding-compatible treatment for perinatal mental health challenges. Cynthia is Certified in Acute Traumatic Stress Management and is a member of the American Academy of Experts in Traumatic Stress and the National Center for Crisis Management. Her areas of focus include perinatal loss, grief, depression, anxiety, and trauma; lactational psychology; cultural humility; and social justice. She has authored, contributed to, and provided editorial review of numerous publications.
Blogs, Articles, and Online Resources
A writer, speaker, wife and mother who blogs.  
A'Driane Nieves
A writer,   artist, activist,   and speaker   with a heart for serving others   and social good. A mental health advocate living with bipolar disorder, and a   survivor of postpartum depression and anxiety.
Tyrese Coleman
A great resource that shows women of color at the intersection of motherhood and career.
Black Motherhood Empowered! The BOLD and COURAGEOUS - The Pride of Black Motherhood is  SUCCESS!
Women of Color and Mental Health Information
Seattle Area Resources
The Denise Louie Education Center
DLEC provides high-quality multicultural early education for kids, support and skills for new parents, as well as extra help for families in need, creating a supportive community for all.
The mission of the Equal Start Community Coalition is to promote healthy mothers, healthy families, and healthy communities. The main goal of the Coalition is to prevent infant mortality by promoting collaboration between communities and the health care sector, advocating for health equity, impacting political processes, and eliminating institutional racism.
Parent Groups, classes and events.  Building a strong community by supporting families of color through parenting programs, resource  sharing, and fostering meaningful connections.
Connecting communities of color/culture with counselors who understand and connecting counselors of color/culture with a network of support.
Open Arms provides services that support, educate, respect, honor, and empower women and their  families from pregnancy through birth to early parenting.
A counseling organization established to provide affordable counseling for women-identified folks on their journeys toward healing.  
We have a month's worth of posts related to the perinatal mental health of African Americans on our Facebook page. Visit this link to see all the articles and resources.
Go to Facebook
  • March 18, 19, 20: Interpersonal Psychotherapy 3-Day Conference. Swedish Medical Center--Cherry Hill Campus, James Tower. 
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Support, Education, Referral
Perinatal Support Washington (formerly Postpartum Support International of Washington)