Selene Rivera Los Angeles Times
WWR Article Summary (tl;dr) Symptoms of postpartum depression can include severe mood swings and deep despondency as well as impulses that can impel a mother to harm herself or her child.
When Altagracia Mejía learned she was going to be a mother, happiness flooded her heart.
She picked out a crib. She took photos of her growing belly and redecorated her bedroom. She held a gender-reveal party on Zoom.
But her bliss didn't last long.
Perplexing feelings of anxiety and doubts that she ever could be a fit mother for her baby crept into her head during pregnancy while living in her small one-bedroom apartment. And while the Panorama City resident tried to brush away her uneasiness, those feelings seized her again after she gave birth to her daughter, Alexa, in the middle of the pandemic, on Sept. 8, 2020.
By the time Mejía's daughter was around 2 months old, the 26-year-old mother's episodes of anxiety and irritability had darkened into thoughts of suicide.
"In my most lucid moments, I ask myself over and over again what is happening to me," said Mejía, who immigrated to the United States from El Salvador four years ago in hopes of putting the poverty and violence of her homeland behind her. "I am supposed to be happy, resplendent and full of energy, but nothing is as they paint it on television or social networks.
"For society, especially for Latinos," she continued, "it is unforgivable for a woman to feel sad or have thoughts of death at this moment that is supposed to be the happiest of her life."
Mejía suffers from postpartum depression, a severe form of clinical depression related to pregnancy and childbirth. Symptoms include severe mood swings and deep despondency as well as impulses that can impel a mother to harm herself or her child.
Last week, Sandra Chico, the 28-year-old mother of three children found dead in an East Los Angeles home, was arrested on suspicion of murder and is being held on $2-million bail, L.A. County Sheriff's Department officials said Tuesday.
In an interview with The Times, Elizabeth Chico said her younger sister had exhibited symptoms of postpartum depression following the birth of her youngest child about a month ago. "All that stress, all that anxiety, it takes over you," she said.
Although the California Department of Public Health has not released figures on the number of women with postpartum depression since 2018, experts say that an increase in calls from women asking for help from local nonprofit organizations, along with lengthening hospital waiting lists, indicate that postpartum depression cases may have increased dramatically over the course of the COVID-19 pandemic.
Women of color continue to be among the most affected, in part because many do not have health insurance or their insurance covers little or no therapy, said Misty Richards, one of the directors of the Maternal Outpatient Mental Health Services program at UCLA. Evidence suggests that some Latina mothers may hesitate to seek help because of stigmas associated with mental illness, as well as cultural expectations surrounding motherhood and the traditional roles of women in Latin societies.
In addition, many of those afflicted are not being screened for postpartum depression, despite California's maternal mental health bill, AB 2193, which went into effect on July 1, 2019, and requires that obstetricians and gynecologists screen mothers for these conditions during and after pregnancy and ensure that they get any needed treatment.
The most recent available CDPH statistics, from 2018, indicated that 1 in 5 California women suffered from postpartum depression during or after giving birth, which translated to 100,000 cases a year. The report also states that: "Black and Latina women experience the highest percentage of depressive symptoms of all racial/ethnic groups during both the prenatal and postpartum periods."
According to the CDPH: "Disparities are particularly evident for prenatal symptoms of depression, which are twice as common for Black (19.9%) and Latina (17.1%) women compared to white (9.5%) and Asian/Pacific Islander (10.3%) women."
Richards, of the UCLA clinic, said that she has seen a 30% increase in postpartum depression cases since the pandemic started. She expressed particular concern for low-income women of color who are disappearing into the cracks of an inaccessible healthcare system.
She estimates that she sees 15 women a week, or about 700 cases a year. If the clinic is full, as has been the case since the beginning of the pandemic, she refers mothers to other affordable clinics and nonprofit organizations.
"A single 90-minute visit to the reproductive psychiatrist in California costs $500 to $800 if you don't have health insurance," said Richards, who currently has a 15-day waiting list for treating patients. "That money cannot be paid by a low-income person."
Responding to the pandemic, the California Department of Health Care Services implemented a Provisional Postpartum Care Extension programon Aug. 1, 2020, that allows Medi-Cal eligible mothers who are diagnosed with a maternal mental health condition to remain eligible for assistance for up to one year after giving birth — 10 months longer than the normal 60-day period of post-pregnancy care.
However, in order to get help, mothers must be diagnosed with postpartum depression, and many health experts are not even aware of the existence of the program, which will expire Dec. 31.
Medi-Cal, the service that pays for more than 50% of all births in California, would have covered mental aid assistance for Mejía, but her condition was never detected, she said.
"In my clinic, I filled out forms about how I felt, and even though they knew I had depression, they never gave me a positive diagnosis even after giving birth," she said.
While trying to navigate the labyrinthine U.S. medical system, Mejía felt isolated from friends and family. Fear of catching COVID-19, and shame over what she felt were her failures as a mother, kept her from seeking out others for comfort and support.
"Since I came to this country four years ago, I have worked as a babysitter," she said. "It was not possible to share that I could take care of other children, and not even be able to breastfeed my own daughter."
Because she couldn't afford a private specialist, Mejía, along with her husband of three years, Walberto Gochez, a maintenance worker, and her father, Marco Antonio Mejía, had to seek help on their own from Maternal Mental Health Now, a nonprofit that advocates for screening and treatment of prenatal and postpartum depression in Los Angeles County.
Eynav Accortt, a clinical psychologist at Cedars-Sinai Hospital, who treats women with anxiety and depression during pregnancy and postpartum (known as perinatal mood and anxiety disorders), said the pandemic has added a layer of complexity and isolation that could substantially increase rates of such cases.
"Women have been under more stress from the pandemic," she said. "They fear getting sick or their babies getting sick, they can't have home visits and this adds to the worries of the day, even if they aren't low-income."
According to Accortt, the Cedars-Sinai Reproductive Psychology Clinic received twice as many calls from women seeking help between January and April of this year, as it did during the entire previous year.
"About 11 patients who could have seen me for individual therapy, because I am in the network with their insurance company, were referred to other community providers, many of whom were already full," she said. "Right now, I have a three-week waiting list for a client to start individual therapy with me."
In 2020, about 6,500 women were screened for postpartum depression at Cedars-Sinai, and 300 to 500 who were at risk for perinatal mood and anxiety disorders were referred to local organizations for help. In addition, 150 other women obtained direct services such as individual therapy or support group aid from the Cedars-Sinai Reproductive Psychology Clinic.