When Imani Bates, 31, realized she had lost control over her pelvic and gluteal muscles shortly after giving birth, she felt profoundly disconnected from her body.

“I woke up and I couldn’t move them,” she says.“They were in complete paralysis. I panicked.”

Adjusting to dramatic physical changes so soon after birth triggered feelings of ineptitude for Bates, and catalyzed the onset of postpartum depression. “I began crying and blaming myself for having a natural, vaginal birth,” she recalls.“I thought my body failed me. I felt completely inadequate. I remember looking at my son and thinking he should have a better mother than me.”

Recent research on postpartum depression (PPD) suggests a link between the physical pain that new mothers experience and their risk for PPD. In a 2018 study, researchers concluded that the pain experienced by women following birth, rather than during labor and delivery, may be the primary culprit. But data on PPD risk often overlooks the ways that race and racism might increase the chances that Black women experience birth-related depression. That’s despite the fact that Black women are at an increased risk for childbirth complications, bias during medical care, and even maternal death.

Today, thankfully, PPD is more widely addressed in pregnancy-related discussions, but Black women like myself often struggle to find our place in the dialogue. The Black community has a history of emphasizing personal strength and self-sufficiency, which can decrease the chance that Black women seek assistance when their sadness becomes more than “the baby blues.”

Not only are Black women underserved, but they face an increased risk of mental health issues post-birth. While 20 percent of women display symptoms of perinatal mood or anxiety disorder (PMAD), like anxiety, depression, and obsessive-compulsive disorder, the figure climbs to 44 percent for Black women, compared to 31 percent for white women. Despite this prevalence, Black women face a myriad of social, economic, and cultural obstacles when seeking mental health care.

“When life was hard, there was no luxury to wallow.”

According to Dr. Amber A. Hewitt, a psychologist and specialist in gendered racial socialization, cultural expectations along with systemic circumstances act as obstacles to mental health treatment for Black women suffering from PPD.

“Cultural scripts utilized by Black women may be influenced by stereotypical roles such as the ‘Strong Black Woman’ or ‘Superwoman’,” says Hewitt. “The Superwoman stereotype reflects a woman who is constantly juggling multiple tasks and helping to provide for her family, albeit successfully, but at the expense of her own self-care and needs.”

The limited access Black Americans have to mental and behavioral health resources are well-documented. Financial barriers like paid time off work, insurance coverage, and access to quality child care all have the potential to limit Black women’s likelihood of seeking treatment, as well as the likelihood of successful outcomes from any treatment they do receive.

Tyrese Coleman, 38, experienced a complex and dissociative sadness after her twins were born premature and required extended time in the NICU. But she says the messages she overheard growing up made her reluctant to make her issues known.

As a child, Coleman says she was influenced by Black women who were too occupied with life’s responsibilities and hardships to experience sadness. “When life was hard, there was no luxury to wallow,” she says. “Don’t nobody have time to be depressed! There were children to feed, bodies to bathe, houses to clean.”

“I let myself be distracted by everything on purpose and that was not the way to deal with it,” Coleman says. “I think everything I did worked to suppress acknowledgment of what I felt in such a way that I was gaslighting myself.”

Hewitt says preoccupation with responsibility can harm Black women’s mental health. Black women often work long hours, and are more likely to be sandwiched between the responsibilities of caring for their parents as well as their children. Being overrepresented in low paying jobs due to hiring bias and wage discrimination can make seeking therapy an afterthought. “Some Black women may have been socialized, as a way to cope with oppression, that asking for help is a sign of weakness,” she says.

Coleman says that fear over how she could fit the demands of therapy into her busy schedule was likely what kept her from seeking help. “I didn’t want to start another thing when I already have 8 million other things going on,” she says.

So what can be done?

Identifying the signs of PPD early on is important, though it can be hard to find a mental health professional who understands the nuances of the Black experience. “It’s important for clinicians who treat Black women to screen for depression and be aware of the interaction between cultural and social determinants of health,” says Hewitt, who argues that some of the onus is on the health care community to make seeking help more attractive.

Culturally tailored initiatives like the National Alliance on Mental Illness and organizations like Black Women Birthing Justice aim to center the experiences of motherhood and depression through a Black lens. Other resources like Therapy For Black Girls, The Association of Black Psychologists, and The Black Therapist Network are also good starting points. For those uncertain if they are experiencing signs of PPD, The Postpartum Stress Center has a useful questionnaire. And local group therapy or community-based group therapy are ways to access low-cost or free services.

Bates says she never told her loved ones about her struggles with depression. “I gave birth [abroad] so I was away from family and then when we got back to the states, it was more stressful because my parents were facing eviction and no one really had any time to help me cope,” she explained.

Thankfully, her sister-in-law sensed something was wrong, and instilled in Bates the importance of finding support and making time for self-care. As part of that, she writes. “Writing has allowed me to really express feelings that I often suppress,” Bates says, “because I often feel people don’t understand.”