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Postpartum Depression On The Rise, Especially For Women Of Color, During COVID-19 Pandemic

Alondra Espinoza, 36, of East Los Angeles, is among those women whose postpartum depression was exacerbated by the pandemic. She was shocked after learning she was pregnant for the third time, in 2019, while raising her daughter, Jocelyn, now 15, and son, Isaiah, 11.

"During my pregnancy, I didn't want people to see me, I thought I was too old to start caring for a baby again," she said. "I started crying all the time and feeling irritated at the same time. As the months went by, I started to feel lonely, frustrated and desperate about what my future was going to be like. "

In January 2020, three months before giving birth, she had to stop working as a teacher's assistant because she suffers from sciatica. In April 2020, Espinoza gave birth to Lexi, and by June, postpartum depression hit her harder when she learned that her husband, Jezreel, a building demolition worker, would have to return to work out of state. "During the pandemic I couldn't go out, I was afraid that we would catch [the coronavirus] and I didn't know who to turn to," Espinoza said.

"My girl cried all the time, and I felt useless next to her," she continued. "I felt like she was freaking out. ... I wanted to get out of the house and run aimlessly, I wanted to disappear."

Like Mejía, Espinoza said, she was never diagnosed with postpartum depression despite filling out several forms at Garfield Medical Center in Monterey Park, where she gave birth.

"It took me about two months after giving birth to seek help on my own because I thought that asking for assistance was wrong," she said. "I believed that people would think that I am not a good mother and then social services would take away my children."

An employee of Garfield Medical Center, who did not want to be identified, said that since November 2019, the center has been screening all mothers before they return home with their newborns. "And if they screen high risk for postpartum depression, a social worker refers them to different resources," the employee said.

Regarding Espinoza's case, the employee said that there might have been a communication issue or "most likely she did not meet the criteria for high-risk postpartum."

"We only see the mothers for a short period of time, about four days, after the delivery," the employee said. "If they do not speak to us, we cannot catch them, we do not have a chance to help."

Emily C. Dossett, clinical assistant professor of psychiatry and behavioral sciences at USC's Keck School of Medicine, maintains that even though screening women for postpartum depression is now encoded in state law, "there is still a lack of resources available to do so, which puts doctors in a bad situation."

"If health experts are not aware of the postpartum screening laws or the [Provisional Postpartum Care Extension] law, and if there are not enough staff to refer women or therapists, there will always be mothers who will disappear into the cracks without any treatment," said Dossett, who since the pandemic began has seen a 25% increase in referrals from mothers in need of therapy.

"Postpartum depression can occur shortly after delivery or even up to a year later," Dossett continued. "That's why we need more affordable support services because in my experience I believe that 80% of women with postpartum depression can be treated with therapies."

Norwalk resident Adriana Rangel did not have postpartum depression until two months after giving birth to Ivana on Nov. 13, 2020.

"As if there was a switch in my brain, suddenly I began to feel sad, exhausted, I did not want to eat, I did not even want to take off my pajamas," said Rangel, 31. "I was no longer the talkative, cheerful and outgoing woman that people knew."

When her mother died of COVID-19 in February, Rangel plunged further into depression and feared getting sick or making her daughter sick. She subsequently was able to get help for her condition. She has private health insurance and pays $25 out of pocket for each weekly appointment to see a psychologist at Providence St. Joseph Hospital.

Mike Sherbun, executive director of the Providence Mental Health Clinical Institute, which is made up of 11 hospitals in Orange and Los Angeles counties, said that cases of postpartum depression have risen as much as 25% during the pandemic. He fears those figures are undercounted and may keep rising because they don't include women who don't seek help.

"These increases are just the tip of a mental health crisis in California," he said. "So our institute is in the process of opening more outpatient programs that can assist mothers with postpartum depression in Torrance and Tarzana."

Sherbun stressed that more laws are needed in California to cover all mothers, while current laws need to be enforced.

In the case of E.R., who asked not to disclose her full name, her OB/GYN did not tell her that she suffered from depression during pregnancy or after delivery until she, too, sought help on her own, she said. The Los Angeles resident, who gave birth in January, began to suffer from anxiety almost three months after her pregnancy began.

"I worked as a mental health case manager and even though I was scared of getting sick with COVID-19, I didn't want to stop working," E.R. said. "I heard from so many people who lost their jobs and couldn't pay their rent and didn't want to be in that situation. At the same time, I began to be scared by my future, the safety and stability of the baby, so I decided to work until the very moment I gave birth.

"I think working helped me a little bit not to think about depression and anxiety. However, once I had my baby, my mental health declined faster. I cried all the time. I fought with my husband.

"Part of my depression was also due to being isolated from my family and close friends. I come from a Latino family where we celebrate everything, and this time we couldn't because of the pandemic."

In the moments when she couldn't sleep, thoughts of ending her own life, or her child's, closed in on her.

"I thought that if she was dead, things would be better," she said. "What happens if I throw myself into a car or throw myself off a building?"

E.R. didn't confide in her family for fear that they would think she was crazy or that they would take her baby from her.

"In my family, with a mother from Mexico and a father from El Salvador, it is not normal for a mother to feel this way, or you just solve it yourself or you approach the priest to give you advice," she said.

E. R. asked her husband to accompany her to therapy groups, but he refused, wary of the stigma around mental health issues.

"Fortunately, he understands that I need help and has become more patient," E.R. said. "He also takes the baby with him when I have felt like I want a break. Having him on my side has helped me a lot."

Gabrielle Kaufman, clinical director of Maternal Mental Health Now, an organization that helps women with postpartum depression and advocates creating laws that benefit them, said there is still a lot to do at the state level.

"A couple of laws have been passed in the last three years to help this sector, but the pandemic has once again stalled us," she said. "If as health experts we do not follow current laws and do not advocate for more laws that protect mothers, we will have a mental health crisis that is going to leave a dent in the future."

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